,,ii #aag? ,,congress #b;d ,session ,s4 #ddhf ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,june #bc1 #bjbb ,mr4 ,book] 7= himself1 ,mr4 ,w>nock1 ,mr4 ,br[n1 ,mr4 ,m]kley1 ,mr4 ,c>d91 ,mr4 ,ka9e1 ,ms4 ,hirono1 ,ms4 ,w>r51 ,ms4 ,duckwor?1 ,mrs4 ,gillibr&1 & ,mr4 ,s&]s7 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 ( #bjbb4 #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 & report+ ,sec4 #ajja4 ,/r5g!n+ data collection1 improv+ data analysis1 & exp&+ data report+4 ,sec4 #ajjb4 ,elim9ation ( pr]equisite ( direct appropriations = data collection & analysis4 ,sec4 #ajjc4 ,collection ( data = ! ,m$ic>e program4 ,sec4 #ajjd4 ,revision ( ,,hipaa claims /&>ds4 ,sec4 #ajje4 ,national ,c5t] = ,heal? ,/ati/ics4 ,sec4 #ajjf4 ,disp>ities data collect$ by ! ,f$]al ,gov]nm5t4 ,sec4 #ajjg4 ,data collection & analysis grants to m9ority-s]v+ in/itutions4 ,sec4 #ajjh4 ,safety & effectiv5ess ( drugs ) respect to racial & e?nic backgr\nd4 ,sec4 #ajji4 ,improv+ heal? data reg>d+ ,native ,hawaiians & ,pacific ,isl&]s4 ,sec4 #ajaj4 ,cl>ification ( simplifi$ adm9i/rative report+ requirem5t4 ,sec4 #ajaa4 ,data collection reg>d+ p&emic prep>$ness1 te/+1 infections1 & dea?s4 ,sec4 #ajab4 ,commission on ,ensur+ ,data = ,heal? ,equity4 ,sec4 #ajac4 ,task ,=ce on ,prev5t+ ,bias 9 ,,ai & ,algori?ms4 ,,title ,,ii--,culturally & l+ui/ically appropriate heal? & heal? c>e ,sec4 #bjja4 ,def9itions2 f9d+s4 ,sec4 #bjjb4 ,improv+ access to s]vices = individuals ) limit$ ,engli% pr(ici5cy4 ,sec4 #bjjc4 ,ensur+ /&>ds = culturally & l+ui/ically appropriate s]vices 9 heal? c>e4 ,sec4 #bjjd4 ,culturally & l+ui/ically appropriate heal? c>e 9 ! ,public ,heal? ,s]vice ,act4 ,sec4 #bjje4 ,pilot program = improvem5t & developm5t ( ,/ate m$ical int]pret+ s]vices4 ,sec4 #bjjf4 ,tra9+ tomorr['s doctors = culturally & l+ui/ically appropriate c>e3 graduate m$ical education4 ,sec4 #bjjg4 ,f$]al reimbursem5t = culturally & l+ui/ically appropriate s]vices "u ! ,m$ic>e1 ,m$icaid1 & ,/ate ,*ildr5's ,heal? ,insurance ,programs4 ,sec4 #bjjh4 ,increas+ und]/&+ ( & improv+ heal? lit]acy4 ,sec4 #bjji4 ,requirem5ts = heal? programs or activities receiv+ ,f$]al funds4 ,sec4 #bjaj4 ,report on ,f$]al ef=ts to provide culturally & l+ui/ically appropriate heal? c>e s]vices4 ,sec4 #bjaa4 ,engli% in/ruction = individuals ) limit$ ,engli% pr(ici5cy4 ,sec4 #bjab4 ,implem5tation4 ,sec4 #bjac4 ,language access s]vices4 ,sec4 #bjad4 ,m$ically und]s]v$ populations4 ,,title ,,iii--,heal? work=ce div]sity ,sec4 #cjja4 ,am5dm5t to ! ,public ,heal? ,s]vice ,act4 ,sec4 #cjjb4 ,hispanic-s]v+ in/itutions1 hi/orically ,black colleges & univ]sities1 hi/orically ,black pr(essional or graduate in/itutions1 ,asian ,am]ican & ,native ,am]ican ,pacific ,isl&]-s]v+ in/itutions1 ,tribal ,colleges1 regional community-bas$ organizations1 & national m9ority m$ical associations4 ,sec4 #cjjc4 ,loan repaym5t program ( ,c5t]s = ,disease ,control & ,prev5tion4 ,sec4 #cjjd4 ,alli$ heal? work=ce div]sity4 ,sec4 #cjje4 ,coop]ative agreem5ts = onl9e degree programs at s*ools ( public heal? & s*ools ( alli$ heal?4 ,sec4 #cjjf4 ,national ,heal? ,c>e ,work=ce ,commission4 ,sec4 #cjjg4 ,s*ol>%ip & fell[%ip programs4 ,sec4 #cjjh4 ,mc,nair ,po/baccalaureate ,a*ievem5t ,program4 ,sec4 #cjji4 ,rules = det]m9ation ( full-"t equival5t resid5ts = co/-report+ p]iods4 ,sec4 #cjaj4 ,develop+ & implem5t+ /rategies = local heal? equity4 ,sec4 #cjaa4 ,heal? ,pr(essions ,work=ce ,fund4 ,sec4 #cjab4 ,future advancem5t ( academic nurs+4 ,sec4 #cjac4 ,f9d+s2 s5se ( ,congress relat+ to graduate m$ical education4 ,sec4 #cjad4 ,c>e] support = skill$1 int]nationally educat$ heal? pr(essionals4 ,sec4 #cjae4 ,/udy & report on /rategies = increas+ div]sity4 ,sec4 #cjaf4 ,conrad ,/ate #cj program2 physician ret5tion4 ,sec4 #cjag4 ,national ,hispanic ,nurses ,day4 ,sec4 #cjah4 ,exp&+ m$ical education4 ,,title ,,iv--,improv+ ,heal? ,c>e ,access & ,quality ,sec4 #djjj4 ,def9ition4 ,subtitle ,a--,r$uc+ ,b>ri]s to ,access+ ,c>e ,sec4 #djja4 ,protect+ protect$ areas4 ,sec4 #djjb4 ,repeal ( requirem5t = docum5tation evid5c+ citiz5%ip or nationality "u ! ,m$icaid program4 ,sec4 #djjc4 ,availability ( basic assi/ance to lawfully pres5t noncitiz5s4 ,sec4 #djjd4 ,improve af=dability & r$uce premium co/s ( heal? insurance = consum]s4 ,sec4 #djje4 ,remov+ citiz5%ip & immigration b>ri]s to access to af=dable heal? c>e "u ! ,,aca4 ,sec4 #djjf4 ,remov+ b>ri]s to access to af=dable heal? c>e = lawfully resid+ immigrants "u ,m$icaid & ,,*ip4 ,sec4 #djjg4 ,consi/5cy 9 heal? insurance cov]age = individuals ) f$]ally au?oriz$ pres5ce1 includ+ def]r$ action4 ,sec4 #djjh4 ,/udy on ! un9sur$4 ,sec4 #djji4 ,m$icaid fallback cov]age program = l[-income adults 9 non-expansion ,/ates4 ,sec4 #djaj4 ,increase & ext5sion ( tempor>y enhanc$ ,,fmap = ,/ates :i* beg9 to exp5d am\nts = c]ta9 m&atory individuals4 ,subtitle ,b--,improvem5t ( ,cov]age ,sec4 #daja4 ,m$icaid 9 ! t]ritories4 ,sec4 #dajb4 ,ext5sion ( ! ,supplem5tal ,security ,income ,program to ,pu]to ,rico1 ! ,unit$ ,/ates ,virg9 ,isl&s1 ,guam1 & ,am]ican ,samoa4 ,sec4 #dajc4 ,ext5sion ( ,m$ic>e second>y pay]4 ,sec4 #dajd4 ,indian def9$ 9 title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act4 ,sec4 #daje4 ,remov+ ,m$ic>e b>ri] to heal? c>e4 ,sec4 #dajf4 ,l[]+ ,m$ic>e premiums & prescription drug co/s4 ,sec4 #dajg4 ,r$uc+ co/-%>+1 align+ income & res\rce eligibility te/s1 simplify+ enrollm5t1 & o!r program improvem5ts = l[-income b5efici>ies4 ,sec4 #dajh4 #ajj p]c5t ,,fmap = m$ical assi/ance provid$ by urban ,indian organizations4 ,sec4 #daji4 #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$icaid program4 ,sec4 #daaj4 ,repeal ( requirem5t = e/ate recov]y "u ! ,m$icaid program4 ,sec4 #daaa4 ,all[ = susp5sion ( ,m$ic>e b5efits & premium liability = individuals :o are inc>c]at$ & provide a special enrollm5t p]iod ar\nd ! date ( release4 ,sec4 #daab4 ,f$]al ,employee ,heal? ,b5efit ,plans4 ,sec4 #daac4 ,cont9uation ( ,m$icaid income eligibility /&>d = pregnant individuals & infants4 ,subtitle ,c--,expansion ( ,access ,"p #a--;,g5]al ,provisions ,sec4 #dbja4 ,am5dm5t to ! ,public ,heal? ,s]vice ,act4 ,sec4 #dbjb4 ,bord] heal? grants4 ,sec4 #dbjc4 ,critical access hospital improvem5ts4 ,sec4 #dbjd4 ,m$ic>e remote monitor+ pilot projects4 ,sec4 #dbje4 ,community heal? c5t] collaborative access expansion4 ,sec4 #dbjf4 ,facilitat+ ! provision ( teleheal? s]vices across ,/ate l9es4 ,sec4 #dbjg4 ,scor+ ( prev5tive heal? sav+s4 ,sec4 #dbjh4 ,s5se ( ,congress on ma9t5ance ( ef=t provisions reg>d+ *ildr5's heal?4 ,sec4 #dbji4 ,protection ( ! ,,hhs ,(fices ( ,m9ority ,heal?4 ,sec4 #dbaj4 ,(fice ( ,m9ority ,heal? 9 ,vet]ans ,heal? ,adm9i/ration ( ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #dbaa4 ,/udy ( ,,d% paym5ts to ensure hospital access = l[-income pati5ts4 ,sec4 #dbab4 ,reau?orization ( programs "u ! ,native ,hawaiian ,heal? ,c>e ,improvem5t ,act4 ,"p #b--,rural ,sec4 #dbba4 ,e/abli%m5t ( ,rural ,community ,hospital 7,,r*7 ,program4 ,sec4 #dbbb4 ,rural ,heal? ,quality ,advisory ,commission & demon/ration projects4 ,sec4 #dbbc4 ,rural heal? c>e s]vices4 ,"p #c--;,indian ,communities ,sec4 #dbca4 ,assi/ant ,secret>y ( ! ,indian ,heal? ,s]vice4 ,sec4 #dbcb4 ,ext5sion ( full ,f$]al m$ical assi/ance p]c5tage to ,indian heal? c>e provid]s4 ,sec4 #dbcc4 ,conf]r+ ) urban ,indian organizations4 ,"p #d--,provid]s ,sec4 #dbda4 ,availability ( non-,engli% language speak+ provid]s4 ,sec4 #dbdb4 ,access to ess5tial community provid]s4 ,sec4 #dbdc4 ,provid] network adequacy 9 communities ( color4 ,"p #e--;,d5tal ,sec4 #dbea4 ,improv+ access to d5tal c>e4 ,sec4 #dbeb4 ,oral heal? lit]acy & aw>5ess campaign4 ,subtitle ,d--,advanc+ ,heal? ,equity ,?r\gh ,paym5t & ,deliv]y ,re=m ,sec4 #dcja4 ,s5se ( ,congress4 ,sec4 #dcjb4 ,c5t]s = ,m$ic>e ,m$icaid ,s]vices report+ & value-bas$ programs4 ,sec4 #dcjc4 ,developm5t & te/+ ( disp>ity r$uc+ deliv]y & paym5t models4 ,sec4 #dcjd4 ,div]sity 9 ,c5t]s = ,m$ic>e & ,m$icaid consultation4 ,sec4 #dcje4 ,support+ safety net & community-bas$ provid]s to compete 9 value-bas$ paym5t sy/ems4 ,subtitle ,e--,heal? ,emp[]m5t ,zones ,sec4 #ddja4 ,designation ( heal? emp[]m5t zones4 ,sec4 #ddjb4 ,assi/ance to ^? seek+ designation4 ,sec4 #ddjc4 ,b5efits ( designation4 ,sec4 #ddjd4 ,def9ition ( ,secret>y4 ,sec4 #ddje4 ,au?orization ( appropriations4 ,subtitle ,f--,equitable ,heal? ,c>e = ,all ,sec4 #deja4 ,f9d+s4 ,sec4 #dejb4 ,data collection & report+4 ,sec4 #dejc4 ,requir+ equitable heal? c>e 9 ! hospital value-bas$ pur*as+ program4 ,sec4 #dejd4 ,provision ( inequitable heal? c>e z a basis = p]missive exclusion f ,m$ic>e & ,/ate heal? c>e programs4 ,sec4 #deje4 ,(fice = ,civil ,rights & ,heal? ,equity ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 ,sec4 #dejf4 ,prohibit+ discrim9ation 9 heal? c>e4 ,sec4 #dejg4 ,f$]al ,heal? ,equity ,commission4 ,sec4 #dejh4 ,grants = hospitals to promote equitable heal? c>e & outcomes4 ,subtitle ,g--,inve/+ 9 ,equity ,sec4 #dfja4 ,def9itions4 ,sec4 #dfjb4 ,/rategy to inc5tivize heal? equity4 ,sec4 #dfjc4 ,pay = ,equity ,advisory ,c\ncil4 ,,title ,v--,improv+ heal? outcomes = wom51 *ildr51 & families ,subtitle ,a--,9 ,g5]al ,sec4 #ejja4 ,grants to promote heal? = und]s]v$ communities4 ,subtitle ,b--,pregnancy ,scre5+ ,sec4 #eaja4 ,pregnancy int5tion scre5+ initiative demon/ration program4 ,sec4 #eajb4 ,bir? defects prev5tion1 risk r$uction1 & aw>5ess4 ,subtitle ,c--,pregnancy-,relat$ ,c>e ,sec4 #ebja4 ,mo!rs & (fspr+ mortality & morbidity aw>5ess4 ,sec4 #ebjb4 ,,mommies4 ,sec4 #ebjc4 ,ju/ice = inc>c]at$ moms4 ,sec4 #ebjd4 ,,impact ,to ,save ,moms ,act4 ,sec4 #ebje4 ,protect+ moms & babies aga9/ climate *ange4 ,sec4 #ebjf4 ,te* to save moms4 ,sec4 #ebjg4 ,social det]m9ants = moms4 ,sec4 #ebjh4 ,data to save moms4 ,sec4 #ebji4 ,kira ,johnson ,act4 ,sec4 #ebaj4 ,moms matt]4 ,sec4 #ebaa4 ,task=ce ,recomm5d+ ,improvem5ts = ,unaddress$ ,m5tal ,p]9atal ,po/p>tum ,heal? 7,,triumph7 = ,new ,moms4 ,sec4 #ebab4 ,protect moms f dome/ic viol5ce4 ,sec4 #ebac4 ,p]9atal work=ce4 ,sec4 #ebad4 ,midwives s*ools & programs expansion4 ,sec4 #ebae4 ,ge/ational diabetes4 ,sec4 #ebaf4 ,consum] education campaign4 ,sec4 #ebag4 ,bibliographic database ( sy/ematic reviews = c>e ( *ildbe>+ individuals & newborns4 ,sec4 #ebah4 ,developm5t ( int]pr(essional mat]nity c>e educational models & tools4 ,sec4 #ebai4 ,dissem9ation ( ! quality family plann+ guidel9es4 ,subtitle ,d--,f$]al ,ag5cy ,coord9ation on ,mat]nal ,heal? ,sec4 #ecja4 ,int]ag5cy ,coord9at+ ,committee on ! ,promotion ( ,optimal ,mat]nity ,outcomes4 ,sec4 #ecjb4 ,expansion ( ,,cdc ,prev5tion ,rese>* ,c5t]s ,program to include ,c5t]s on ,optimal ,mat]nity ,outcomes4 ,sec4 #ecjc4 ,exp&+ models to be te/$ by ,c5t] = ,m$ic>e & ,m$icaid ,innovation to explicitly include mat]nity c>e & *ildr5's heal? models4 ,sec4 #ecjd4 ,int]ag5cy update to ! quality family plann+ guidel9es4 ,subtitle ,e--,reproductive & ,sexual ,heal? ,sec4 #edja4 ,f9d+s2 s5se ( ,congress on urg5t b>ri]s to abortion access & vital solutions4 ,sec4 #edjb4 ,em]g5cy contraception education & in=mation programs4 ,sec4 #edjc4 ,access to bir? control duties ( ph>macies to ensure provision ( ,,fda-approv$ contraception4 ,sec4 #edjd4 ,real education & access = heal?y y\?4 ,sec4 #edje4 ,compassionate assi/ance = rape em]g5cies4 ,sec4 #edjf4 ,m5/rual ,equity = ,all ,act ( #bjbb4 ,sec4 #edjg4 ,additional focus area = ! ,(fice on ,wom5's ,heal?4 ,sec4 #edjh4 ,includ+ s]vices furni%$ by c]ta9 /ud5ts1 int]ns1 & resid5ts sup]vis$ by c]tifi$ nurse midwives or c]tifi$ midwives )9 inpati5t hospital s]vices "u ,m$ic>e4 ,sec4 #edji4 ,grants to pr(essional organizations & m9ority-s]v+ in/itutions to increase div]sity 9 mat]nal1 reproductive1 & sexual heal? pr(essionals4 ,subtitle ,f--,*ildr5's ,heal? ,sec4 #eeja4 ,,c>+ = ,kids ,act4 ,sec4 #eejb4 ,end ,diap] ,ne$ ,act ( #bjbb4 ,sec4 #eejc4 ,decreas+ ! risk factors = sudd5 unexpect$ infant dea? & sudd5 unexpla9$ dea? 9 *ildhood4 ,subtitle ,g--,nutrition = ,wom51 ,*ildr51 ,families ,sec4 #efja4 ,clos+ ! meal gap4 ,sec4 #efjb4 ,repeal ( d5ial ( ,supplem5tal ,nutrition ,assi/ance ,program b5efits4 ,subtitle ,h--,univ]sal ,s*ool ,meals ,program ,sec4 #egja4 ,%ort title4 ,sec4 #egjb4 ,effective date4 ,sec4 #egjc4 ,free s*ool breakfa/ program4 ,sec4 #egjd4 ,apportionm5t to ,/ates4 ,sec4 #egje4 ,nutritional & o!r program requirem5ts4 ,sec4 #egjf4 ,special assi/ance program4 ,sec4 #egjg4 ,price = a paid lun*4 ,sec4 #egjh4 ,summ] food s]vice program = *ildr54 ,sec4 #egji4 ,summ] ,electronic ,b5efit ,transf] = ,*ildr5 ,program4 ,sec4 #egaj4 ,*ild & adult c>e food program4 ,sec4 #egaa4 ,meals & supplem5ts = *ildr5 9 aft]s*ool c>e4 ,sec4 #egab4 ,access to local foods3 f>m to s*ool program4 ,sec4 #egac4 ,fre% fruit & vegetable program4 ,sec4 #egad4 ,tra9+1 te*nical assi/ance1 & ,food ,s]vice ,managem5t ,in/itute4 ,sec4 #egae4 ,reimbursem5t ( s*ool meal del9qu5t debt program4 ,sec4 #egaf4 ,con=m+ am5dm5ts4 ,sec4 #egag4 ,measure ( pov]ty4 ,sec4 #egah4 ,supplem5tal nutrition assi/ance program4 ,sec4 #egai4 ,high] ,education ,act ( #aife4 ,sec4 #egbj4 ,elem5t>y & ,second>y ,education ,act ( #aife4 ,sec4 #egba4 ,am]ica ,,competes ,act4 ,sec4 #egbb4 ,work=ce ,innovation & ,opportunity ,act4 ,sec4 #egbc4 ,national ,sci5ce ,f\ndation ,au?orization ,act ( #bjjb4 ,sec4 #egbd4 ,*ild c>e & developm5t block grant4 ,sec4 #egbe4 ,*ildr5's ,heal? ,act ( #bjjj4 ,sec4 #egbf4 ,juv5ile ju/ice & del9qu5cy prev5tion4 ,subtitle ,i--,eld] ,c>e ,sec4 #ehja4 ,exp5ses = h\sehold & eld] c>e s]vices necess>y = ga9ful employm5t4 ,subtitle ,j--,miscellane\s provisions ,sec4 #eija4 ,cl>ification support+ p]missible use ( funds = /illbir? prev5tion activities4 ,,title ,,vi--,m5tal ,heal? & ,sub/ance ,use ,disord]s ,sec4 #fjja4 ,m5tal heal? f9d+s4 ,sec4 #fjjb4 ,s5se ( ,congress4 ,subtitle ,a--,access to ,c>e & ,fund+ ,/reams ,sec4 #fjaa4 ,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$ic>e program4 ,sec4 #fjab4 ,reau?orization ( ,m9ority ,fell[%ip ,program4 ,sec4 #fjac4 ,additional funds = ,national ,in/itutes ( ,heal?4 ,sec4 #fjad4 ,additional funds = ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities4 ,sec4 #fjae4 ,grants = increas+ racial & e?nic m9ority access to high-quality trauma support s]vices & m5tal heal? c>e4 ,sec4 #fjaf4 ,grants = un>m$ #i-a-a response programs4 ,subtitle ,b--,int]pr(essional ,c>e ,sec4 #fjba4 ,heal? pr(essions compet5cies to address racial & e?nic m5tal heal? inequities4 ,sec4 #fjbb4 ,int]pr(essional heal? c>e teams = behavioral heal? c>e4 ,sec4 #fjbc4 ,integrat$ ,heal? ,c>e ,demon/ration ,program4 ,subtitle ,c--,work=ce ,developm5t ,sec4 #fjca4 ,build+ an effective work=ce 9 m5tal heal?4 ,sec4 #fjcb4 ,pilot program to increase language access at ,f$]ally qualifi$ heal? c5t]s4 ,sec4 #fjcc4 ,heal? pr(essions compet5cies to address racial & e?nic m9ority m5tal heal? disp>ities4 ,subtitle ,d--,*ildr5's ,m5tal ,heal? ,sec4 #fjda4 ,p$iatric behavioral heal? c>e4 ,sec4 #fjdb4 ,m5tal heal? 9 s*ools4 ,sec4 #fjdc4 ,additional support = y\? & "y adult m5tal heal? s]vice provision4 ,sec4 #fjdd4 ,e>ly int]v5tion & prev5tion programs = transition-age y\?4 ,sec4 #fjde4 ,/rategies to increase access to teleheal? "u ,m$icaid & ,*ildr5's ,heal? ,insurance ,program4 ,sec4 #fjdf4 ,y\? & "y adult m5tal heal? promotion1 prev5tion1 int]v5tion1 & treatm5t4 ,sec4 #fjdg4 ,/udy on ! effects ( sm>tphone & social m$ia use on adolesc5ts4 ,subtitle ,e--,community-,bas$ ,c>e ,sec4 #fjea4 ,m5tal heal? at ! bord]4 ,sec4 #fjeb4 ,asian ,am]ican1 ,african ,am]ican1 ,native ,hawaiian1 ,pacific ,isl&]1 ,indig5\s1 ,middle ,ea/]n & ,nor? ,african1 & ,hispanic & ,lat9o behavioral & m5tal heal? outrea* & education /rategy4 ,subtitle ,f--,reports ,sec4 #fjfa4 ,address+ racial & e?nic m5tal heal? inequities rese>* gaps4 ,sec4 #fjfb4 ,rese>* on adv]se heal? effects associat$ ) int]actions ) law en=cem5t4 ,sec4 #fjfc4 ,geo,access /udy4 ,sec4 #fjfd4 ,co-occurr+ conditions4 ,sec4 #fjfe4 ,te*nical correction4 ,subtitle ,g--,miscellane\s ,provisions ,sec4 #fjga4 ,*ildr5's ,m5tal ,heal? ,infra/ructure ,act4 ,sec4 #fjgb4 ,m5tal heal? = ,lat9os4 ,sec4 #fjgc4 ,/r5g!n+ m5tal heal? supports = ,,bipoc communities4 ,sec4 #fjgd4 ,,/rong support = *ildr54 ,sec4 #fjge4 ,improv+ access to m5tal heal?4 ,sec4 #fjgf4 ,m5tal ,heal? 9 ,s*ools ,excell5ce ,program4 ,sec4 #fjgg4 ,s*ool social work]s improv+ /ud5t success4 ,sec4 #fjgh4 ,opioid grants to support c>egiv]s1 k9%ip c>e families1 & k9%ip c>egiv]s4 ,,title ,,vii--,address+ high-impact m9ority diseases ,subtitle ,a--,canc] ,sec4 #gjja4 ,lung canc] mortality r$uction4 ,sec4 #gjjb4 ,expansion ( pro/ate canc] rese>*1 outrea*1 scre5+1 te/+1 access1 & treatm5t effectiv5ess4 ,sec4 #gjjc4 ,pro/ate rese>*1 imag+1 & m5's education4 ,sec4 #gjjd4 ,pro/ate canc] detection rese>* & education4 ,sec4 #gjje4 ,national ,pro/ate ,canc] ,c\ncil4 ,sec4 #gjjf4 ,improv$ ,m$icaid cov]age = c]ta9 brea/ & c]vical canc] pati5ts 9 ! t]ritories4 ,sec4 #gjjg4 ,canc] prev5tion & treatm5t demon/ration = e?nic & racial m9orities4 ,sec4 #gjjh4 ,r$uc+ canc] disp>ities )9 ,m$ic>e4 ,subtitle ,b--,viral ,hepatitis & ,liv] ,canc] ,control & ,prev5tion ,sec4 #gjea4 ,viral hepatitis & liv] canc] control & prev5tion4 ,sec4 #gjeb4 ,liv] canc] & disease prev5tion1 aw>5ess1 & pati5t track+ grants4 ,subtitle ,c--,acquir$ ,bone ,m>r[ ,failure ,diseases ,sec4 #gaja4 ,acquir$ bone m>r[ failure diseases4 ,subtitle ,d--,c>diovascul> ,disease1 ,*ronic ,disease1 ,obesity1 & ,o!r ,disease ,issues ,sec4 #gaea4 ,guidel9es = disease scre5+ = m9ority pati5ts4 ,sec4 #gaeb4 ,,cdc ,wisewoman ,scre5+ ,program4 ,sec4 #gaec4 ,report on c>diovascul> c>e = wom5 & m9orities4 ,sec4 #gaed4 ,cov]age ( compreh5sive tobacco cessation s]vices 9 ,m$icaid1 ,,*ip1 & private heal? insurance4 ,sec4 #gaee4 ,cl9ical rese>* fund+ = oral heal?4 ,sec4 #gaef4 ,guide on evid5ce-bas$ /rategies = public heal? dep>tm5t obesity prev5tion programs4 ,sec4 #gaeg4 ,/ephanie ,tubbs ,jones ,ut]9e ,fibroid ,rese>* & ,education ,act4 ,subtitle ,e--,,hiv_/,,aids ,sec4 #gbja4 ,/atem5t ( policy4 ,sec4 #gbjb4 ,f9d+s4 ,sec4 #gbjc4 ,additional fund+ = ,,aids drug assi/ance program treatm5ts4 ,sec4 #gbjd4 ,enhanc+ ! national ,,hiv surveillance sy/em4 ,sec4 #gbje4 ,evid5ce-bas$ /rategies = improv+ l9kage to1 & ret5tion 91 appropriate c>e4 ,sec4 #gbjf4 ,improv+ entry into1 & ret5tion 91 c>e & antiretroviral adh]5ce = p]sons ) ,,hiv4 ,sec4 #gbjg4 ,s]vices to r$uce ,,hiv_/,,aids 9 racial & e?nic m9ority communities4 ,sec4 #gbjh4 ,m9ority ,,aids initiative4 ,sec4 #gbji4 ,heal? c>e pr(essionals treat+ individuals ) ,,hiv4 ,sec4 #gbaj4 ,,hiv_/,,aids provid] loan repaym5t program4 ,sec4 #gbaa4 ,d5tal education loan repaym5t program4 ,sec4 #gbab4 ,r$uc+ new ,,hiv infections among inject+ drug us]s4 ,sec4 #gbac4 ,report on impact ( ,,hiv_/,,aids 9 vuln]able populations4 ,sec4 #gbad4 ,national ,,hiv_/,,aids obs]vance days4 ,sec4 #gbae4 ,review ( all ,f$]al & ,/ate laws1 policies1 & regulations reg>d+ ! crim9al prosecution ( individuals = ,,hiv-relat$ (f5ses4 ,sec4 #gbaf4 ,exp&+ support = condoms 9 prisons4 ,sec4 #gbag4 ,automatic re9/atem5t or enrollm5t 9 ,m$icaid = p :o te/ positive = ,,hiv be=e re5t]+ communities4 ,sec4 #gbah4 ,/op ,,hiv 9 prison4 ,sec4 #gbai4 ,transf] ( funds = implem5tation ( ,end+ ! ,,hiv ,epidemic3 ,a ,plan = ,am]ica4 ,sec4 #gbbj4 ,pr,e,p access & cov]age4 ,subtitle ,f--,diabetes ,sec4 #gbea4 ,rese>*1 treatm5t1 & education4 ,sec4 #gbeb4 ,rese>*1 education1 & o!r activities4 ,sec4 #gbec4 ,programs to educate heal? provid]s on ! causes & effects ( diabetes 9 m9ority populations4 ,sec4 #gbed4 ,rese>*1 education1 & o!r activities reg>d+ diabetes 9 ,am]ican ,indian populations4 ,sec4 #gbee4 ,updat$ report on heal? disp>ities4 ,subtitle ,g--,lung ,disease ,sec4 #gcja4 ,national a/hma burd54 ,sec4 #gcjb4 ,a/hma-relat$ activities ( ! ,c5t]s = ,disease ,control & ,prev5tion4 ,sec4 #gcjc4 ,influ5za & pneumonia vacc9ation campaign4 ,sec4 #gcjd4 ,*ronic ob/ructive pulmon>y disease4 ,subtitle ,h--,tub]culosis ,sec4 #gcea4 ,elim9ation ( all =ms ( tub]culosis4 ,sec4 #gceb4 ,additional fund+ = ,/ates 9 combat+ & elim9at+ tub]culosis4 ,sec4 #gcec4 ,/r5g!n+ cl9ical rese>* fund+ = tub]culosis4 ,subtitle ,i--,o/eo>?ritis & ,musculoskeletal ,diseases ,sec4 #gdja4 ,f9d+s4 ,sec4 #gdjb4 ,o/eo>?ritis & o!r musculoskeletal heal?-relat$ activities ( ! ,c5t]s = ,disease ,control & ,prev5tion4 ,sec4 #gdjc4 ,grants = compreh5sive o/eo>?ritis & musculoskeletal disease heal? education )9 heal? pr(essions s*ools4 ,subtitle ,j--,sleep & ,circadian ,rhy?m ,disord]s ,sec4 #gdea4 ,%ort title2 f9d+s4 ,sec4 #gdeb4 ,sleep & circadian rhy?m disord]s rese>* activities ( ! ,national ,in/itutes ( ,heal?4 ,sec4 #gdec4 ,sleep & circadian rhy?m heal? disp>ities-relat$ activities ( ! ,c5t]s = ,disease ,control & ,prev5tion4 ,sec4 #gded4 ,grants = compreh5sive sleep & circadian heal? education )9 heal? pr(essions s*ools4 ,sec4 #gdee4 ,report on impact ( sleep & circadian heal? disord]s 9 vuln]able & racial_/e?nic populations4 ,subtitle ,k--,kidney ,disease ,rese>*1 ,surveillance1 ,prev5tion1 & ,treatm5t ,sec4 #geja4 ,kidney disease1 rese>*1 surveillance1 prev5tion1 & treatm5t4 ,sec4 #gejb4 ,kidney disease rese>* 9 m9ority populations4 ,sec4 #gejc4 ,kidney disease action plan4 ,sec4 #gejd4 ,home dialysis & increas+ end-/age r5al disease treatm5t modalities 9 m9ority communities action plan4 ,sec4 #geje4 ,increas+ kidney transplants 9 m9ority populations4 ,sec4 #gejf4 ,environm5tal & occupational heal? programs4 ,sec4 #gejg4 ,und]/&+ ! treatm5t patt]ns associat$ ) provid+ c>e & treatm5t ( kidney failure 9 m9ority populations4 ,sec4 #gejh4 ,improv+ access 9 und]s]v$ areas4 ,sec4 #geji4 ,! ,jack ,reynolds ,memorial ,m$igap ,expansion ,act2 ,m$igap cov]age = b5efici>ies ) end-/age r5al disease4 ,subtitle ,l--,div]sity 9 ,cl9ical ,trials ,sec4 #geea4 ,,fda review ( cl9ical trial be/ practices4 ,sec4 #geeb4 ,div]sify+ ,inve/igations ,via ,equitable ,rese>* ,/udies = ,ev]yone ,trials ,act4 ,sec4 #geec4 ,cl9ical trial div]sity4 ,sec4 #geed4 ,pati5t exp]i5ce data4 ,subtitle ,m--,additional ,provisions ,address+ ,high-,impact ,m9ority ,diseases ,sec4 #gfja4 ,m$ic>e cov]age ( multi-canc] e>ly detection scre5+ te/s4 ,sec4 #gfjb4 ,amputation ,r$uction & ,compassion ,act4 ,sec4 #gfjc4 ,elim9at+ ! co9surance requirem5t = c]ta9 colorectal canc] scre5+ te/s furni%$ "u ! ,m$ic>e program4 ,sec4 #gfjd4 ,exp&+ ! availability ( m$ical nutrition !rapy s]vices "u ! ,m$ic>e program4 ,sec4 #gfje4 ,enc\rag+ ! developm5t & use ( ,,dis>m antimicrobial drugs4 ,sec4 #gfjf4 ,treat & ,r$uce ,obesity ,act4 ,sec4 #gfjg4 ,inc5tives1 improvem5ts1 & outrea* to increase div]sity 9 ,alzheim]'s disease rese>*4 ,,title ,,viii--,heal? ,in=mation ,te*nology ,sec4 #hjja4 ,def9itions4 ,subtitle ,a--,r$uc+ ,heal? ,disp>ities ,?r\gh ,heal? ,,x ,sec4 #haja4 ,,hrsa assi/ance to heal? c5t]s = promotion ( ,heal? ,,x4 ,sec4 #hajb4 ,assessm5t ( impact ( ,heal? ,,x on racial & e?nic m9ority communities2 outrea* & adoption ( ,heal? ,,x 9 su* communities4 ,sec4 #hajc4 ,nondiscrim9ation & heal? equity 9 heal? in=mation te*nology4 ,sec4 #hajd4 ,language access 9 heal? in=mation te*nology4 ,subtitle ,b--,modifications ,to ,a*ieve ,p>ity 9 ,exi/+ ,programs ,sec4 #hbja4 ,ext5d+ fund+ to /r5g!n ! ,heal? ,,x infra/ructure 9 racial & e?nic m9ority communities4 ,sec4 #hbjb4 ,ext5d+ competitive grants = ! developm5t ( loan programs to facilitate adoption ( c]tifi$ ,,ehr te*nology by provid]s s]v+ racial & e?nic m9ority gr\ps4 ,sec4 #hbjc4 ,au?orization ( appropriations4 ,subtitle ,c--,additional ,rese>* & ,/udies ,sec4 #hcja4 ,data collection & assessm5ts conduct$ 9 coord9ation ) m9ority-s]v+ in/itutions4 ,sec4 #hcjb4 ,/udy ( heal? in=mation te*nology 9 m$ically und]s]v$ communities4 ,sec4 #hcjc4 ,assessm5t ( use & misuse ( de-id5tifi$ heal? data4 ,subtitle ,d--,clos+ ,gaps 9 ,fund+ ,to ,adopt ,c]tifi$ ,e,h,rs ,sec4 #hdja4 ,ext5d+ ,m$icaid ,,ehr inc5tive paym5ts to rehabilitation facilities1 long-t]m c>e facilities1 & home heal? ag5cies4 ,sec4 #hdjb4 ,ext5d+ physician assi/ant eligibility = ,m$icaid electronic heal? record inc5tive paym5ts4 ,subtitle ,e--,exp&+ ,access to ,teleheal? ,s]vices ,sec4 #heja4 ,remov+ geographic requirem5ts = teleheal? s]vices4 ,sec4 #hejb4 ,exp&+ orig9at+ sites4 ,,title ,,ix--,acc\ntability & ,evaluation ,sec4 #ijja4 ,prohibition on discrim9ation 9 ,f$]al assi/$ heal? c>e s]vices & rese>* on ! basis ( sex 7includ+ sexual ori5tation1 g5d] id5tity1 & pregnancy1 includ+ t]m9ation ( pregnancy71 race1 color1 national orig91 m>ital /atus1 familial /atus1 or disability /atus4 ,sec4 #ijjb4 ,treatm5t ( ,m$ic>e paym5ts "u title ,,vi ( ! ,civil ,rights ,act ( #aifd4 ,sec4 #ijjc4 ,acc\ntability & transp>5cy )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 ,sec4 #ijjd4 ,unit$ ,/ates ,commission on ,civil ,rights4 ,sec4 #ijje4 ,s5se ( ,congress conc]n+ full fund+ ( activities to elim9ate racial & e?nic heal? disp>ities4 ,sec4 #ijjf4 ,,gao & ,,nih reports4 ,sec4 #ijjg4 ,inve/igative & en=cem5t actions4 ,sec4 #ijjh4 ,f$]al ,heal? ,equity ,commission4 ,,title ,x--,address+ ,social ,det]m9ants & ,improv+ ,environm5tal ,ju/ice ,subtitle ,a--,9 ,g5]al ,sec4 #ajjja4 ,def9itions4 ,sec4 #ajjjb4 ,f9d+s4 ,sec4 #ajjjc4 ,heal? impact assessm5ts4 ,sec4 #ajjjd4 ,grant program to conduct environm5tal heal? improvem5t activities & to improve social det]m9ants ( heal?4 ,sec4 #ajjje4 ,additional rese>* on ! relation%ip betwe5 ! built environm5t & ! heal? ( community resid5ts4 ,sec4 #ajjjf4 ,environm5t & public heal? re/oration4 ,sec4 #ajjjg4 ,,gao report on heal? effects ( ,deepwat] ,horizon oil rig explosion 9 ! ,gulf ,coa/4 ,sec4 #ajjjh4 ,e/abli% an int]ag5cy c\nsel & grant programs on social det]m9ants ( heal?4 ,sec4 #ajjji4 ,correct+ ,hurtful & ,ali5at+ ,names 9 ,gov]nm5t ,expression 7,,*ange74 ,sec4 #ajjaj4 ,&rew ,ke>se ,acc\ntability = ,d5ial ( ,m$ical ,c>e4 ,sec4 #ajjaa4 ,inve/+ 9 community heal+4 ,sec4 #ajjab4 ,environm5tal ju/ice mapp+ & data collection4 ,sec4 #ajjac4 ,antiracism 9 public heal?4 ,sec4 #ajjad4 ,,lgbtq ess5tial data4 ,sec4 #ajjae4 ,social det]m9ants accel]ator4 ,sec4 #ajjaf4 ,improv+ social det]m9ants ( heal?4 ,subtitle ,b--,gun ,viol5ce ,sec4 #ajaja4 ,reaffirm+ rese>* au?ority ( ! ,c5t]s = ,disease ,control & ,prev5tion4 ,sec4 #ajajb4 ,national ,viol5t ,dea? ,report+ ,sy/em4 ,sec4 #ajajc4 ,report on effects ( gun viol5ce on public heal?4 ,sec4 #ajajd4 ,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+ high-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$uce heal? disp>ities & b>ri]s to high-quality heal? s]vices require bett] & m consi/5t data1 & bett] & m consi/5t collection ( & access to data4 7#e7 ,a full range ( culturally & l+ui/ically appropriate heal? c>e & public heal? s]vices mu/ be available & accessible 9 e community4 7#f7 ,racial & e?nic m9orities & und]s]v$ 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 ( #bjaj 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? ,act1 "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$uce heal? disp>ities1 among o!r purposes4 ,i ,data collection & report+ #ajja4 ,/r5g!n+ data collection1 improv+ data analysis1 & exp&+ data report+ 7a7 ,am5dm5ts to ! ,public ,heal? ,s]vice ,act 7#a7 ,purpose ,! purpose ( ! am5dm5ts made by ?is subsection is to promote culturally & l+ui/ically appropriate data collection1 analysis1 & report+ by race1 e?nicity1 sex1 prim>y language1 sexual ori5tation1 disability /atus1 g5d] id5tity1 age1 & socioeconomic /atus 9 f$]ally support$ heal? programs4 7#b7 ,,ahrq g5]al au?orities ,section #ijb7;a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bii;a7a77 is am5d$-- 7,a7 9 p>agraph 7#h71 by /rik+ & at ! end2 7,b7 9 p>agraph 7#i71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+3 7#aj7 cultural & l+ui/ic compet5ce ( heal? c>e s]vices & ( data collection activities describ$ "u section #caja4 4 7#c7 ,(fice ( ,m9ority ,heal? ,section #agjg7;g77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a77 is am5d$ by ins]t+ ,middle ,ea/]n]s & ,nor? ,africans2 aft] ,blacks24 7#d7 ,(fice ( ! ,national ,coord9ator = ,heal? ,in=mation ,te*nology ,section #cjja ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj-#aa7 is am5d$-- 7,a7 9 subsection 7b7-- 7i7 9 p>agraph 7#aj71 by /rik+ & at ! end2 7ii7 9 p>agraph 7#aa71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7iii7 by add+ at ! end ! foll[+3 7#ab7 ensures ! int]op]ability ( heal? in=mation sy/ems among f$]ally conduct$ or support$ heal? c>e or public heal? programs1 ,/ate heal? ag5cies1 & social s]vice ag5cies4 2 & 7,b7 by am5d+ clause 7vii7 9 subsection 7c77#c77;,a7 to read z foll[s3 7vii7 ,/rategies to enhance ! use ( heal? in=mation te*nology 9 improv+ ! quality ( heal? c>e2 r$uc+ m$ical errors2 r$uc+ heal? disp>ities & ensur+ ! provision ( equitable heal? s]vices2 improv+ public heal?2 increas+ prev5tion & coord9ation ) community res\rces2 ensur+ int]op]ability among f$]ally conduct$ or support$ heal? c>e or public heal? programs1 ,/ate heal? ag5cies1 & social s]vice ag5cies2 & improv+ ! cont9uity ( c>e among heal? c>e sett+s4 4 7#e7 ,data collection1 analysis1 & quality ,section #caja ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjjkk7 is am5d$-- 7,a7 9 subsections 7a77#a77;,a71 7a77#a77;,c71 7a77#b77;,b71 & 7a77#b77;,e71 by /rik+ & disability /atus & ins]t+ sexual ori5tation1 g5d] id5tity1 age1 disability /atus1 & socioeconomic /atus2 7,b7 9 subsection 7a77#a71 by am5d+ subp>agraph 7,d7 to read z foll[s3 7,d7 data = additional population gr\ps if su* gr\ps c be aggregat$ into ! data collection /&>ds describ$ "u p>agraph 7#b74 2 7,c7 9 subsection 7a77#b7-- 7i7 9 subp>agraph 7,c7-- 7,i7 9 clause 7i71 by /rik+ & at ! end2 7,,ii7 9 clause 7ii7-- 7aa7 by /rik+ is a m9or or legally incapacitat$ & ins]t+ is a m9or1 requires assi/ance ) communication 9 spee* or writ+1 or is legally incapacitat$2 & 7bb7 by /rik+ ! semicolon at ! end & ins]t+ 2 &2 & 7,,iii7 by add+ at ! end ! foll[+3 7iii7 collects data 9 a mann] t is culturally & l+ui/ically appropriate2 2 7ii7 9 subp>agraph 7,d77iii71 by /rik+ & at ! end2 7iii7 9 subp>agraph 7,e71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7iv7 by add+ at ! end ! foll[+3 7,f7 use1 :]e practicable1 ! /&>ds develop$ by ! ,heal? & ,m$ic9e ,division ( ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e 7=m]ly kn[n z ! ,in/itute ( ,m$ic9e7 9 ! #bjji publication titl$ ,race1 ,e?nicity1 & ,language ,data3 ,/&>dization = ,heal? ,c>e ,quality ,improvem5t4 2 & 7#f7 9 subsection 7a77#c71 by am5d+ subp>agraph 7,b7 to read z foll[s3 7,b7 develop int]op]ability & security sy/ems = data managem5t among f$]ally conduct$ or support$ heal? c>e or public heal? programs1 ,/ate heal? ag5cies1 & social s]vice ag5cies4 4 7b7 ,coroll>y provisions 7#a7 ,recomm5dations by ! ,data ,c\ncil ,! ,data ,c\ncil ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 9 consultation ) ! ,director ( ! ,national ,c5t] = ,heal? ,/ati/ics1 ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 ! ,deputy ,assi/ant ,secret>y = ,wom5's ,heal?1 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid1 ! ,national ,coord9ator = ,heal? ,in=mation ,te*nology1 & o!r appropriate public & private entities & (ficials1 %all make recomm5dations to ! ,secret>y ( ,heal? & ,human ,s]vices conc]n+ h[ to-- 7,a7 implem5t ! am5dm5ts made by ?is section1 :ile m9imiz+ ! co/ & adm9i/rative burd5s ( data collection & report+ on all p>ties1 includ+ pati5ts & provid]s2 7,b7 exp& aw>5ess among ,f$]al ag5cies1 ,/ates1 t]ritories1 ,indian ,tribes1 c\nties1 municipalities1 heal? provid]s1 heal? plans1 & ! g5]al public t data collection1 analysis1 & report+ by race1 e?nicity1 sex1 prim>y language1 sexual ori5tation1 g5d] id5tity1 age1 socioeconomic /atus1 & disability /atus is legal & necess>y to ensure equity & nondiscrim9ation 9 ! quality ( heal? c>e s]vices2 7,c7 ensure t future pati5t record sy/ems foll[ ,f$]al /&>ds promulgat$ "u ! ,,hite* ,act 7#db ,u4,s4,c4 #bja note7 = ! 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 /atus1 & disability /atus data1 subject to all applicable privacy & confid5tiality requirem5ts1 includ+ ,,hipaa privacy & security law z def9$ 9 section #cjji7;a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj-#ai7;a772 7,f7 ensure ! cultural & l+ui/ic compet5ce ( entities t receive ,f$]al support to collect & report data pursuant to ! am5dm5ts made by subsection 7a72 & 7,g7 safegu>d & prev5t ! misuse ( data collect$ "u section #caja ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjjkk71 z am5d$ by subsection 7a77#e74 7#b7 ,rules ( con/ruction ,no?+ 9 ?is section %all be con/ru$ to-- 7,a7 p]mit ! use ( in=mation collect$ "u ?is section or any provision am5d$ by ?is section 9 a mann] t w\ld adv]sely affect any individual provid+ any su* in=mation2 or 7,b7 dim9i% any requirem5ts on heal? c>e provid]s to collect data1 includ+ su* requirem5ts 9 effect on or aft] ! date ( enactm5t ( ?is ,act4 7#c7 ,te*nical assi/ance = ! analysis ( heal? disp>ity data ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 & 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 & ! ,national ,coord9ator = ,heal? ,in=mation ,te*nology1 %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$2 7,e7 %>+ data ) ext]nal organizations = rese>* & quality improvem5t purposes2 & 7,f7 id5tify+ & address+ issues relat+ to ! int]op]ability ( ,f$]al- & ,/ate-level heal? in=mation sy/ems :i* und]m9e ! ability ( heal?-relat$ programs collect+ data "u ?is section to a*ieve ! purpose describ$ 9 subsection 7a77#a74 7#d7 ,ref]5ces ,except z o!rwise specifi$1 any ref]5ce to ! t]m racial & e?nic m9ority gr\p 9 any ,f$]al regulation1 guidance1 ord]1 or docum5t = e/abli%m5t or implem5tation ( any f$]ally conduct$ or support$ heal? c>e or public heal? program1 activity1 or survey %all be treat$ z hav+ ! def9ition giv5 to su* t]m 9 section #agjg7;g7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f7;g774 7#e7 ,au?orization ( appropriations ,to c>ry out ?is subsection1 subsection 7a71 & ! am5dm5ts made by subsection 7a71 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 7c7 ,additions to ! ,public ,heal? ,s]vice ,act ,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 ,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 ! ,national ,coord9ator = ,heal? ,in=mation ,te*nology1 & ! ,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 #caja4 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>ities2 & 7#e7 develop educational programs to tra9 heal? provid]s1 heal? c>e organizations1 heal? plans1 heal?-relat$ ag5cies1 & frontl9e heal? c>e work]s on h[ to collect & report disaggregat$ data 9 a culturally & l+ui/ically appropriate mann]4 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 #caja4 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 #bjbc ?r\gh #bjbg4 #cdcb4 ,ov]sampl+ ( und]repres5t$ gr\ps 9 ,f$]al heal? surveys 7a7 ,national /rategy 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,national ,c5t] = ,heal? ,/ati/ics1 & o!r (ficials )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices z ! ,secret>y det]m9es appropriate1 %all develop & implem5t a su/a9able national /rategy = ov]sampl+ und]repres5t$ 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$]al heal? surveys & program data collections4 ,su* national /rategy %all include a /rategy = ov]sampl+ ( ,middle ,ea/]n]s & ,nor? ,africans1 ,asian ,am]icans1 ,native ,hawaiians1 & ,pacific ,isl&]s4 7#b7 ,consultation ,9 develop+ & implem5t+ a national /rategy1 z describ$ 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$]al dep>tm5ts & ag5cies1 includ+ subag5cies ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices2 & 7,c7 consult on1 & use z models1 ! #bjad ,national ,heal? ,int]view ,survey ov]sample ( ,native ,hawaiian & ,pacific ,isl&] populations1 ! #bjaf ,behavioral ,risk ,factor ,survey ( ,heal? ,risk ,behaviors ,among ,arab ,adults ,)9 ! ,/ate ( ,mi*igan1 & ! #bjag ,behavioral ,risk ,factor ,surveillance ,sy/em ov]sample ( ,am]ican ,indian & ,alaska ,native communities4 7b7 ,progress report ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is section1 ! ,secret>y %all submit to ! ,congress a progress report1 :i* %all include ! national /rategy requir$ by 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 #bjbc ?r\gh #bjbg4 4 #ajjb4 ,elim9ation ( pr]equisite ( direct appropriations = data collection & analysis ,section #caja ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjjkk71 z am5d$ by section #ajja7;a71 is fur!r am5d$-- 7#a7 by /rik+ subsection 7h72 & 7#b7 by r$esignat+ subsection 7i7 z subsection 7h74 #ajjc4 ,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;,d4 ,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 enrollm5t 9 ,m$ic>e b5efits "u title ,,xviii1 ! ,commission] ( ,social ,security %all transmit an individual's demographic data z collect$ "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#e71 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 9 consultation ) ! ,commission] ( ,social ,security1 %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 & ! provision ( inequitable heal? c>e s]vices by a heal? c>e provid]1 z appropriate2 7,c7 make su* data available to rese>*]s1 "u ! protections outl9$ 9 p>agraph 7#g72 7,d7 provide opportunities to individuals enroll$ 9 ,m$ic>e to submit updat$ 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 subsection 7a7 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 ( ,heal? & ,human ,s]vices 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 #ejj million = #bjbb & #ajj million = ea* fiscal ye> !reaft]4 4 #ajjd4 ,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 seq47 7relat+ to ! collection ( data on demographics 9 a heal?-relat$ transaction7 to require-- 7#a7 ! use1 at a m9imum1 ( /&>ds = data collection on race1 e?nicity1 sex1 prim>y language1 sexual ori5tation1 g5d] id5tity1 age1 disability /atus1 & socioeconomic /atus develop$ "u section #caja ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjjkk71 z am5d$ by section #ajja7;a77#e72 & 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 #ajje4 ,national ,c5t] = ,heal? ,/ati/ics ,section #cjf7n7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdbk7n77 is am5d$-- 7#a7 9 p>agraph 7#a71 by /rik+ #bjjc & ins]t+ #bjbd2 7#b7 9 p>agraph 7#b71 9 ! fir/ s5t5ce1 by /rik+ #bjjc & ins]t+ #bjbd2 & 7#c7 9 p>agraph 7#c71 by /rik+ #bjjb & ins]t+ #bjbd4 #ajjf4 ,disp>ities data collect$ by ! ,f$]al ,gov]nm5t 7a7 ,repository ( ,gov]nm5t data ,! ,secret>y ( ,heal? & ,human ,s]vices1 9 coord9ation ) ! (ficials ref]5c$ 9 subsection 7b71 %all e/abli% a c5traliz$ electronic repository ( ,f$]al ,gov]nm5t data on factors relat$ 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 g5d] id5tity1 age1 disability /atus1 or socioeconomic /atus dur+ ! prec$+ cal5d> ye> %all submit su* data to ! repository ( ,f$]al ,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 ! provision ( equitable heal? s]vices1 & o!r areas ( heal? & well-be+ by factors t include race1 e?nicity1 sex1 prim>y language1 sexual ori5tation1 g5d] id5tity1 disability /atus1 & 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 #ajjg4 ,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 #bjbc ?r\gh #bjbg4 #ajjh4 ,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 ins]t+ aft] section #eje;,g 7#ba ,u4,s4,c4 #cee;h7 ! foll[+3 #eje;,h4 ,safety & effectiv5ess ( drugs ) respect to racial & e?nic backgr\nd 7a7 ,preapproval /udies ,if !re is evid5ce ( a racial or e?nic disp>ity 9 safety or effectiv5ess ) respect to 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 ( a racial or e?nic disp>ity 9 safety or effectiv5ess ) respect to 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 ,9 ?is section1 ! t]m evid5ce ( a racial or e?nic disp>ity 9 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 /udies requir$ "u section #eje;,h1 or comply ) any o!r requirem5t ( su* 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;,h14 #ajji4 ,improv+ heal? data reg>d+ ,native ,hawaiians & ,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 & ,pacific ,isl&] heal? data 7a7 ,def9itions ,9 ?is section3 7#a7 ,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 7#b7 ,native ,hawaiians & ,pacific ,isl&]s 7,,nhpi7 ,! t]m ,native ,hawaiians & ,pacific ,isl&]s or ,,nhpi 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#c7 ,,nhpi /akehold] gr\ps ,! t]m ,,nhpi /akehold] gr\p includes ea* ( ! foll[+3 7,a7 ,community gr\p ,a gr\p ( ,,nhpi :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 ,a gr\p ( ,,nhpi ) a demon/rat$ hi/ory ( address+ ,,nhpi issues1 includ+ a ,,nhpi coalition4 7,c7 ,designat$ organization ,an entity e/abli%$ to repres5t ,,nhpi populations & :i* has /atutory responsibilities to provide1 or has community support = provid+1 heal? c>e4 7,d7 ,gov]nm5t repres5tatives ( ,,nhpi populations ,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 7b7 ,prelim9>y heal? survey 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,national ,c5t] = ,heal? ,/ati/ics ( ! ,c5t]s = ,disease ,control & ,prev5tion 7ref]r$ to 9 ?is section z ,,n*s71 %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* ,,nhpi 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$s ( ,,nhpi populations2 or 7,b7 requir$ = develop+ or implem5t+ ! national /rategy "u subsection 7c74 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 ) ,,nhpi /akehold] gr\ps4 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 ( #bjbb4 7c7 ,national /rategy 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,,n*s & o!r ag5cies )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices z ! ,secret>y det]m9es appropriate1 %all develop & implem5t a su/a9able national /rategy = id5tify+ & evaluat+ ! heal? /atus & heal? c>e ne$s ( ,,nhpi populations liv+ 9 ! cont95tal ,unit$ ,/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 ( #bjbb1 ! ,secret>y-- 7,a7 %all consult ) repres5tatives ( ,,nhpi /akehold] gr\ps2 & 7,b7 may solicit ! p>ticipation ( repres5tatives f o!r ,f$]al ag5cies4 7d7 ,progress report ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb1 ! ,secret>y %all submit to ,congress a progress report1 :i* %all include ! national /rategy describ$ 9 subsection 7c77#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$ic9e ,division to submit to ! ,secret>y & to ,congress1 n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb1 a report conta9+ a description ( ! results ( ! /udy conduct$ "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 #bjbc ?r\gh #bjbg4 4 #ajaj4 ,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 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 #ajaa4 ,data collection reg>d+ p&emic prep>$ness1 te/+1 infections1 & dea?s 7a7 ,skill$ nurs+ ,facilities ,quality ,report+ ,section #ahai ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#c7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7l7 ,requirem5ts relat+ to report+ dur+ public heal? em]g5cies ,dur+ a public heal? em]g5cy decl>$ by ! ,secret>y pursuant to section #cai ( ! ,public ,heal? ,s]vice ,act1 a skill$ nurs+ facility %all1 n lat] ?an "o ye> aft] ! fir/ day ( su* decl>ation1 & mon?ly !reaft] dur+ ! application ( su* decl>ation1 submit to ! ,secret>y ! foll[+ in=mation1 ) respect to su* facility & ! resid5ts ( su* facility3 7#a7 ,in=mation describ$ 9 section #dhc4hj7;g77#a7 ( title #db1 ,code ( ,f$]al ,regulations4 7#b7 ,! age1 race1 e?nicity1 sex1 sexual ori5tation1 g5d] id5tity1 socioeconomic /atus1 disability /atus1 & pref]r$ language ( ! resid5ts ( su* skill$ nurs+ facility4 4 7b7 ,transp>5cy ( demographic in=mation 9 c]ta9 sett+s 7#a7 ,demographic in=mation ,! ,secret>y ( ,heal? & ,human ,s]vices %all po/ ! foll[+ in=mation ) respect to skill$ nurs+ facilities 7z def9$ 9 section #ahai7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#c7;a7771 congregate c>e sett+s 7includ+ skill$ nurs+ facilities1 assi/$ liv+ facilities1 prisons & jails1 resid5tial behavioral heal? c>e & psy*iatric facilities1 & facilities provid+ s]vices = ag+ adults & p ) disabilities71 & nurs+ facilities 7z def9$ 9 section #aiai7;a7 ( su* ,act 7#db ,u4,s4,c4 #acifr7a777 on ! ,nurs+ ,home ,comp>e website 7z describ$ 9 section #ahai7;i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#c7;i7771 or a successor website1 aggregat$ by ,/ate3 7,a7 ,! age1 race1 e?nicity1 sex1 sexual ori5tation1 g5d] id5tity1 socioeconomic /atus1 disability /atus1 & pref]r$ language ( ! resid5ts ( su* skill$ nurs+ facilities1 congregate c>e sett+s 7includ+ skill$ nurs+ facilities1 assi/$ liv+ facilities1 prisons & jails1 resid5tial behavioral heal? c>e & psy*iatric facilities1 & facilities provid+ s]vices = ag+ adults & p ) disabilities71 & nurs+ facilities ) suspect$ or confirm$ infections1 includ+ resid5ts previ\sly treat$ = ,,covid-#ai4 7,b7 ,! age1 race1 e?nicity1 sex1 sexual ori5tation1 g5d] id5tity1 socioeconomic /atus1 disability /atus1 & pref]r$ language relat+ to total dea?s & public heal? em]g5cy-relat$ dea?s among resid5ts ( su* skill$ nurs+ facilities1 congregate sett+s 7includ+ skill$ nurs+ facilities1 assi/$ liv+ facilities1 prisons & jails1 resid5tial behavioral heal? c>e & psy*iatric facilities1 & facilities provid+ s]vices = ag+ adults & p ) disabilities71 & nurs+ facilities4 7#b7 ,confid5tiality ,any in=mation report$ "u ?is subsection t is made available to ! public %all be made s available 9 a mann] t protects ! id5tity ( resid5ts ( skill$ nurs+ facilities1 congregate c>e sett+s 7includ+ skill$ nurs+ facilities1 assi/$ liv+ facilities1 prisons & jails1 resid5tial behavioral heal? c>e & psy*iatric facilities1 & facilities provid+ s]vices = ag+ adults & p ) disabilities71 & nurs+ facilities4 7#c7 ,implem5tation ,not)/&+ any o!r provision ( law1 ! ,secret>y ( ,heal? & ,human ,s]vices may implem5t ! provisions ( ?is subsection by program in/ruction or o!rwise4 7c7 ,equitable data collection & disclosure reg>d+ p&emics ,"p ,a ( title ,,xi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq47 z am5d$ by section #ajjc1 is fur!r am5d$ by add+ at ! end ! foll[+ new section3 #aaej;,e4 ,equitable data collection & disclosure reg>d+ p&emics 7a7 ,9 g5]al ,n lat] ?an #fj days aft] ! ,secret>y submits to ,congress writt5 notification ( ! det]m9ation t a disease or disord] pres5ts a public heal? em]g5cy or t a public heal? em]g5cy o!rwise exi/s1 subject to ! succe$+ subsections1 ! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion & ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices & 9 consultation ) ! ,director ( ! ,indian ,heal? ,s]vice1 %all collect & make publicly available on ! website ( ! ,c5t]s = ,disease ,control & ,prev5tion & ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 & update e day dur+ a p&emic1 data collect$ across all surveillance sy/ems relat+ to a public heal? em]g5cy decl>$ "u section #cai ( ! ,public ,heal? ,s]vice ,act t is caus$ by a disease 7z det]m9$ by ! ,secret>y71 disaggregat$ by race1 e?nicity1 sex1 sexual ori5tation1 g5d] id5tity1 age1 pref]r$ language1 socioeconomic /atus1 disability /atus1 & c\nty1 includ+ ! foll[+3 7#a7 ,data relat+ to all te/+ = ! pa?og5 or pa?og5s caus+ ! p&emic1 includ+ ! numb] ( individuals te/$ & ! numb] ( te/s t 7 positive4 7#b7 ,data relat+ to treatm5t = ! pa?og5 caus+ ! p&emic1 includ+ hospitalizations & int5sive c>e unit admissions4 7#c7 ,data relat+ to p&emic outcomes1 includ+ total fatalities & case fatality rates 7express$ z ! proportion ( individuals :o 7 infect$ ) ! pa?og5 caus+ ! p&emic & di$ f ! pa?og574 7#d7 ,9 ! case a vacc9e is develop$ 9 response to a p&emic1 data relat+ to su* vacc9ation1 includ+-- 7,a7 ! numb] ( vacc9es adm9i/]$2 7,b7 ! numb] ( vacc9ations (f]$1 accept$1 & refus$2 7,c7 ! mo/ common reasons = refusal2 & 7,d7 ! p]c5tage ( vacc9e doses allocat$ & adm9i/]$ to ea* priority gr\p4 7b7 ,application ( c]ta9 /&>ds ) respect to data collection ,to ! ext5t practicable1 data collect$ "u subsection 7a7 %all foll[ /&>ds develop$ by ! ,dep>tm5t ( ,heal? & ,human ,s]vices ,(fice ( ,m9ority ,heal? & be collect$1 analyz$1 & report$ 9 accordance ) ! /&>ds promulgat$ by ! ,assi/ant ,secret>y = ,plann+ & ,evaluation "u title ,,xxxi ( ! ,public ,heal? ,s]vice ,act4 7c7 ,privacy ,9 publi%+ data pursuant to subsection 7a71 ! ,secret>y %all take all necess>y /eps to protect ! privacy ( individuals ^: in=mation is includ$ 9 su* data1 includ+-- 7#a7 comply+ ) privacy protections provid$ "u ! regulations promulgat$ "u section #bfd7;c7 ( ! ,heal? ,insurance & ,acc\ntability ,act ( #aiif2 & 7#b7 protections f all inappropriate int]nal use by an entity t collects1 /ores1 or receives ! data1 includ+ use ( su* data 9 det]m9ations ( eligibility 7or cont9u$ eligibility7 9 heal? plans1 & f inappropriate uses4 4 7d7 ,report requirem5ts foll[+ public heal? em]g5cies 7#a7 ,publicly available summ>y ,n lat] ?an #fj days aft] ! date on :i* ! ,secret>y ( ,heal? & ,human ,s]vices c]tifies t a public heal? em]g5cy decl>$ "u section #cai ( ! ,public ,heal? ,s]vice ,act has end$1 ! ,secret>y %all make publicly available on ! website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices a summ>y ( ! f9al /ati/ics relat$ to su* em]g5cy4 7#b7 ,report to ,congress ,n lat] ?an #fj days aft] ! date on :i* ! ,secret>y ( ,heal? & ,human ,s]vices c]tifies t a public heal? em]g5cy decl>$ "u section #cai ( ! ,public ,heal? ,s]vice ,act has end$1 ! ,secret>y %all submit to ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions & ! ,committee on ,f9ance ( ! ,s5ate & ! ,committee on ,en]gy & ,comm]ce & ! ,committee on ,ways & ,means ( ! ,h\se ( ,repres5tatives a report-- 7,a7 describ+ ! te/+1 hospitalization1 mortality rates1 vacc9ation rates1 & pref]r$ language ( pati5ts associat$ ) ! p&emic by race & e?nicity1 rural & urban areas 7z def9$ 9 section #ahhf7;d77#b77;,d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#b77;,d771 & congregate c>e sett+s 7includ+ skill$ nurs+ facilities1 assi/$ liv+ facilities1 prisons & jails1 resid5tial behavioral heal? c>e & psy*iatric facilities1 & facilities provid+ s]vices = ag+ adults & p ) disabilities7 & noncongregate c>e sett+s 7z su* t]ms are def9$ by ! ,secret>y72 & 7,b7 propos+ evid5c$-bas$ response /rategies to safegu>d ! heal? ( ^! communities 9 future p&emics4 #ajab4 ,commission on ,ensur+ ,data = ,heal? ,equity 7a7 ,9 g5]al ,n lat] ?an #cj days aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is section z ! ,secret>y7 %all e/abli% a commission1 to be kn[n z ! ,commission on ,ensur+ ,data = ,heal? ,equity 7ref]r$ to 9 ?is section z ! ,commission7 to provide cle> & robu/ guidance to improve ! collection1 analysis1 & use ( demographic data 9 respond+ to future public heal? em]g5cies4 7b7 ,memb]%ip & ,*airp]son 7#a7 ,memb]%ip ,! ,commission %all be compos$ (-- 7,a7 ! ,assi/ant ,secret>y = ,prep>$ness & ,response2 7,b7 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion2 7,c7 ! ,director ( ! ,national ,in/itutes ( ,heal?2 7,d7 ! ,commission] ( ,food & ,drugs2 7,e7 ! ,adm9i/rator ( ! ,f$]al ,em]g5cy ,managem5t ,ag5cy2 7,f7 ! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities2 7,g7 ! ,director ( ! ,indian ,heal? ,s]vice2 7,h7 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices2 7,i7 ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality2 7,j7 ! ,surgeon ,g5]al2 7,k7 ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration2 7,l7 ! ,director ( ! ,(fice ( ,m9ority ,heal?2 7,m7 ! ,director ( ! ,(fice ( ,wom5's ,heal?2 7,n7 ! ,*airp]son ( ! ,national ,c\ncil on ,disability2 7,o7 at lea/ #d ,/ate1 local1 t]ritorial1 & ,tribal public heal? (ficials repres5t+ dep>tm5ts ( public heal?1 or an ,urban ,indian heal? repres5tative1 :o %all repres5t jurisdictions f diff]5t regions ( ! ,unit$ ,/ates ) relatively high conc5trations ( hi/orically m>g9aliz$ populations & rural populations1 to be appo9t$ by ! ,secret>y2 7,p7 ! ,national ,coord9ator = ,heal? ,in=mation ,te*nology2 7,q7 at lea/ #c indep5d5t individuals ) exp]tise on racially & e?nically div]se repres5tation ) k or field exp]i5ce ) community-bas$ p>ticipatory rese>* on racial & e?nic disp>ities 9 public heal?1 to be appo9t$ by ! ,secret>y2 & 7,r7 at lea/ #d individuals ) exp]tise on heal? equity & demographic data disp>ities ) k (1 or field exp]i5ce 91 language1 disability /atus1 sex1 sexual ori5tation1 g5d] id5tity1 or socioeconomic /atus4 7#b7 ,*airp]son ,! ,assi/ant ,secret>y = ,prep>$ness & ,response %all s]ve z ! ,*airp]son ( ! ,commission4 7c7 ,duties ,! ,commission %all-- 7#a7 exam9e b>ri]s to collect+1 analyz+1 & us+ demographic data 9 public heal?2 7#b7 det]m9e h[ to be/ use su* data to promote heal? equity across ! ,unit$ ,/ates & r$uce racial1 ,tribal1 & o!r demographic disp>ities 9 heal? outcomes2 7#c7 7,a7 ga!r available data relat$ to treatm5t ( individuals ) disabilities dur+ ! ,,covid-#ai p&emic & o!r public heal? em]g5cies1 includ+ access to vacc9ations1 d5ial ( treatm5t = preexi/+ conditions1 removal or d5ial ( disability relat$ equipm5t 7includ+ v5tilators & cont9u\s positive airway pressure 7commonly ref]r$ to z ,,cpap7 ma*9es71 & data on completion ( d-n-resuscitate ord]s2 & 7,b7 id5tify b>ri]s to obta9+ accurate & timely data relat$ to treatm5t ( su* individuals2 7#d7 solicit input f public heal? (ficials1 community-connect$ organizations1 heal? c>e provid]s1 ,/ate & local ag5cy (ficials1 ,tribal (ficials1 & o!r exp]ts on b>ri]s to1 & be/ practices =1 collect+ demographic data2 & 7#e7 recomm5d policy *anges t ! data indicates are necess>y to r$uce demographic disp>ities 9 heal? outcomes4 7d7 ,report ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,commission %all submit to ,congress1 & publi% on ! website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 a report conta9+-- 7#a7 ! f9d+s ( ! ,commission pursuant to subsection 7c72 7#b7 to ! ext5t possible1 an analysis (-- 7,a7 racial & o!r demographic disp>ities 9 ,,covid-#ai mortality1 includ+ an analysis ( comorbidities & case fatality rates2 7,b7 sex1 sexual ori5tation1 & g5d] id5tity disp>ities 9 ,,covid-#ai treatm5t & mortality2 & 7,c7 ,f$]al ,gov]nm5t policies t disp>ately exac]bate ! ,,covid-#ai impact1 & recomm5dations to improve racial & o!r demographic disp>ities 9 heal? outcomes2 7#c7 an analysis ( ,,covid-#ai treatm5t ( individuals ) disabilities1 includ+ equity ( access to treatm5t & equipm5t & int]sections ( disability /atus ) o!r demographic factors1 includ+ race2 7#d7 an analysis ( :at demographic data is curr5tly be+ collect$1 ! accuracy ( t data & any gaps1 h[ ?is data is curr5tly be+ us$ to in=m ef=ts to combat ,,covid-#ai1 & :at res\rces are ne$$ to supplem5t exi/+ public heal? data collection2 & 7#e7 ! ,commission's recomm5dations ) respect to-- 7,a7 h[ to enhance ,/ate1 local1 t]ritorial1 & ,tribal capacity to conduct public heal? rese>* on ,,covid-#ai & 9 future public heal? em]g5cies1 ) a focus on exp&$ capacity to analyze data on disp>ities correlat$ ) race1 e?nicity1 income1 sex1 sexual ori5tation1 g5d] id5tity1 age1 disability /atus1 specific geographic areas1 & o!r relevant demographic *>act]i/ics2 7,b7 h[ to collect1 process1 & disclose to ! public ! data describ$ 9 subp>agraph 7,a7 9 a way t ma9ta9s individual privacy :ile help+ direct ! ,/ate1 local1 & ,tribal response to public heal? em]g5cies2 7,c7 h[ to improve demographic data collection relat$ to ,,covid-#ai & o!r public heal? em]g5cies 9 ! %ort-t]m & long-t]m1 includ+ h[ to cont9ue to gr[ & value ! ,tribal sov]eignty ( data & in=mation conc]n+ urban & rural ,tribal communities2 7,d7 h[ to improve transp>5cy & equity ( treatm5t = individuals ) disabilities dur+ ! ,,covid-#ai public heal? em]g5cy & future public heal? em]g5cies2 & 7,e7 h[ to support ,/ate1 local1 & ,tribal capacity to elim9ate b>ri]s to vacc9ations1 te/+1 & treatm5t dur+ ! ,,covid-#ai public heal? em]g5cy & future public heal? em]g5cies4 7e7 ,/aff ( commission 7#a7 ,additional /aff ,! ,*airp]son ( ! ,commission may appo9t & fix ! pay ( additional /aff to ! ,commission z ! ,*airp]son consid]s appropriate4 7#b7 ,applicability ( c]ta9 civil s]vice laws ,! /aff ( ! ,commission may be appo9t$ )\t reg>d to ! provisions ( title #e1 ,unit$ ,/ates ,code1 gov]n+ appo9tm5ts 9 ! competitive s]vice1 & may be paid )\t reg>d to ! provisions ( *apt] #ea & sub*apt] ,,iii ( *apt] #ec ( t title relat+ to classification & ,g5]al ,s*$ule pay rates4 7#c7 ,detailees ,any ,f$]al ,gov]nm5t employee may be detail$ to ! ,commission )\t reimbursem5t f ! ,commission1 & ! detailee %all reta9 ! rights1 /atus1 & privileges ( 8 or h] regul> employm5t )\t int]ruption4 7f7 ,coord9ation ) o!r ef=ts ,! ,secret>y %all1 9 e/abli%+ ! ,commission "u ?is section1 take su* /eps z may be necess>y to ensure t ! "w ( ! ,commission does n ov]lap )1 or o!rwise duplicate1 o!r ,f$]al ,gov]nm5t ef=ts ) respect to ensur+ heal? equity 9 data collection 9 public heal? em]g5cies4 7g7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ su* sums z may be necess>y to c>ry out ?is section4 #ajac4 ,task ,=ce on ,prev5t+ ,bias 9 ,,ai & ,algori?ms 7a7 ,9 g5]al ,n lat] ?an #cj days aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is section z ! ,secret>y7 %all e/abli% a ,task ,=ce to be kn[n z ! ,task ,=ce on ,prev5t+ ,,ai & ,algori?mic ,bias 9 ,heal?c>e 7ref]r$ to 9 ?is section z ! ,task ,=ce7 to provide cle> & robu/ guidance on h[ to ensure t ! developm5t & integration ( artificial intellig5ce & algori?mic te*nologies )9 ! heal? c>e s]vice deliv]y process does n exac]bate heal? disp>ities & exp&s access to heal? c>e s]vices4 7b7 ,memb]%ip & ,*airp]son 7#a7 ,memb]%ip ,! ,task ,=ce %all be compos$ (-- 7,a7 ! ,*ief ,in=mation ,(fic] ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices2 7,b7 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion2 7,c7 ! ,director ( ! ,national ,in/itutes ( ,heal?2 7,d7 ! ,commission] ( ,food & ,drugs2 7,e7 ! ,adm9i/rator ( ! ,f$]al ,em]g5cy ,managem5t ,ag5cy2 7,f7 ! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities2 7,g7 ! ,director ( ! ,indian ,heal? ,s]vice2 7,h7 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices2 7,i7 ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality2 7,j7 ! ,surgeon ,g5]al2 7,k7 ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration2 7,l7 ! ,director ( ! ,(fice ( ,m9ority ,heal?2 7,m7 ! ,director ( ! ,(fice ( ,wom5's ,heal?2 7,n7 ! ,*airp]son ( ! ,national ,c\ncil on ,disability2 7,o7 ! ,national ,coord9ator = ,heal? ,in=mation ,te*nology2 7,p7 at lea/ #d ,/ate1 local1 t]ritorial1 & ,tribal public heal? (ficials repres5t+ dep>tm5ts ( public heal?1 or an ,urban ,indian heal? repres5tative1 :o %all repres5t jurisdictions f diff]5t regions ( ! ,unit$ ,/ates ) relatively high conc5trations ( hi/orically m>g9aliz$ populations1 to be appo9t$ by ! ,secret>y2 7,q7 at lea/ #c indep5d5t individuals ) exp]tise on racially & e?nically div]se repres5tation ) k or field exp]i5ce ) community-bas$ p>ticipatory rese>* on racial & e?nic disp>ities 9 public heal?1 to be appo9t$ by ! ,secret>y2 & 7,r7 at lea/ #d individuals ) exp]tise on heal? equity & demographic data disp>ities ) k (1 or field exp]i5ce 91 language1 disability /atus1 sex1 sexual ori5tation1 g5d] id5tity1 or socioeconomic /atus4 7#b7 ,*airp]son ,! ,*ief ,in=mation ,(fic] ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices 7or ! ,*ief ,in=mation ,(fic]'s designee7 %all s]ve z ! ,*airp]son ( ! ,task ,=ce4 7c7 ,duties ,! ,task ,=ce %all-- 7#a7 exam9e :]e to place artificial intellig5ce & algori?ms 9 ! heal? c>e s]vice deliv]y process relative to ! use ( autonom\s human decision mak]s2 7#b7 id5tify ! risks ( heal? c>e sy/em utilization ( artificial intellig5ce & algori?ms 9 t]ms ( civil rights1 civil lib]ties1 & discrim9atory bias 9 heal? c>e access1 quality1 & outcomes2 & 7#c7 prep>e & submit ! report "u subsection 7d74 7d7 ,report ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,task ,=ce %all-- 7#a7 submit a writt5 report ( ! f9d+s ( ! exam9ation "u p>agraph 7#a7 & recomm5dations to ,congress ) respect to implem5tation ( artificial intellig5ce & algori?ms 9 heal? c>e deliv]y & mitigation ( ! risks associat$ ) t implem5tation2 & 7#b7 publi% su* report on ! website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7e7 ,public comm5t ,n lat] ?an #fj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,task ,=ce %all publi% 9 ! ,f$]al ,regi/] a notice provid+ = a public comm5t p]iod on ! duties & activities ( ! ,task ,=ce ( n less ?an #ij days1 beg9n+ on ! date ( t publication4 7f7 ,/aff ( commission 7#a7 ,additional /aff ,! ,*airp]son ( ! ,task ,=ce may appo9t & fix ! pay ( additional /aff to ! ,task ,=ce z ! ,*airp]son consid]s appropriate4 7#b7 ,applicability ( c]ta9 civil s]vice laws ,! /aff ( ! ,task ,=ce may be appo9t$ )\t reg>d to ! provisions ( title #e1 ,unit$ ,/ates ,code1 gov]n+ appo9tm5ts 9 ! competitive s]vice1 & may be paid )\t reg>d to ! provisions ( *apt] #ea & sub*apt] ,,iii ( *apt] #ec ( t title relat+ to classification & ,g5]al ,s*$ule pay rates4 7#c7 ,detailees ,any ,f$]al ,gov]nm5t employee may be detail$ to ! ,task ,=ce )\t reimbursem5t f ! ,task ,=ce1 & ! detailee %all reta9 ! rights1 /atus1 & privileges ( 8 or h] regul> employm5t )\t int]ruption4 ,,ii ,culturally & l+ui/ically appropriate heal? & heal? c>e #bjja4 ,def9itions2 f9d+s 7a7 ,def9itions ,9 ?is title1 ! def9itions 9 section #cdjj ( ! ,public ,heal? ,s]vice ,act1 z add$ by section #bjjd1 %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 cognitive1 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 ! individual1 ! nature1 l5g?1 & complexity ( ! communication involv$1 & ! 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$e access to heal? c>e4 7#aa7 ,culturally compet5t language s]vices 9 heal? c>e sett+s %\ld be available z a matt] ( c\rse4 #bjjb4 ,improv+ access to s]vices = individuals ) limit$ ,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 compet5t 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$]al ag5cy to translate any ,engli% language writt5 mat]ial prep>$ = ! g5]al public relat+ to a public heal? em]g5cy1 includ+ vacc9e di/ribution & education1 into ! top #ae non-,engli% languages 9 ! ,unit$ ,/ates 7accord+ to ! mo/ rec5t data f ! ,am]ican ,community ,survey or its replacem5t7 n lat] ?an #g days aft] any su* mat]ial is made available 9 ,engli%2 7#d7 to require ea* ,f$]al ag5cy to ensure t recipi5ts ( ,f$]al f9ancial assi/ance provide culturally compet5t s]vices & mean+ful access to applicants & b5efici>ies :o are individuals ) limit$ ,engli% pr(ici5cy2 7#e7 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#f7 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 7prohibit+ heal? c>e provid]s & organizations f discrim9at+ 9 ! provision ( s]vices74 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 #bjjc7;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 title1 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-- 7i7 provid+ a range ( language assi/ance options2 7ii7 giv+ notice to individuals ) limit$ ,engli% pr(ici5cy ( ! "r to compet5t language s]vices2 7iii7 tra9+ /aff 7at lea/ annually72 & 7iv7 monitor+ & assess+ ! quality ( ! language s]vices 7at lea/ annually72 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 significant 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 section #aeeg ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahaaf72 & 7,i7 ! /eps ! ag5cy w take & res\rces ! ag5cy w provide to ensure t individuals "k _! rights1 includ+ ! ability to file a compla9t4 7#c7 ,submission ( plan to ,,doj ,ea* ag5cy t is requir$ to prep>e a plan "u p>agraph 7#a7 %all-- 7,a7 consult ) populations :o are directly impact$ by policies 9 ! plan & _! repres5tatives 9 ! developm5t ( ! plan2 & 7,b7 :5 ! plan is f9aliz$1 s5d a copy ( su* plan to ! ,attorney ,g5]al1 to s]ve z ! c5tral repository ( all su* plans4 #bjjc4 ,ensur+ /&>ds = culturally & l+ui/ically appropriate s]vices 9 heal? c>e 7a7 ,applicability ,?is section %all apply to any heal? program or activity-- 7#a7 ( :i* any "p is receiv+ ,f$]al f9ancial assi/ance1 includ+ cr$its1 subsidies1 or contracts ( insurance2 or 7#b7 t is c>ri$ out 7includ+ indirectly ?r\gh contracts1 subcontracts1 or o!r support7 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/ ye>ly2 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 ( #aiif1 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 report$ 9 su* a way z to be int]op]able ) heal? in=mation sy/ems at ! ,f$]al & ,/ate levels2 & 7,d7 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 ) community-bas$ organizations & 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 annually make available to ! public in=mation ab\t _! progress & successful innovations 9 implem5t+ ! /&>ds "u ?is section1 translat$ mat]ials ( su* in=mation t is culturally & l+ui/ically appropriate to ! communities s]v$ "u ?is section1 & provide public notice 9 su* 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 or activity describ$ 9 subsection 7a7-- 7#a7 %all ensure t comm5ts ) respect to su* program or activity 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 #bjjd4 ,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 a 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 age1 & 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 cognitive disability1 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* ,act1 includ+ a provid] ( s]vices "u "p ,b ( su* title ,,xviii1 & may include a hospital1 a hospice provid]1 a palliative c>e provid]1 & 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 ,! t]m heal? c>e includes all heal? c>e ne$$ ?r\gh\t ! life cycle & ! end ( life4 7#h7 ,heal? c>e s]vices ,! t]m heal? c>e s]vices means s]vices t address physical & m5tal heal? conditions1 z well z conditions impact$ by social det]m9ants ( heal?1 9 all c>e sett+s ?r\gh\t ! life cycle & ! end ( life4 7#i7 ,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>e s]vices4 7#aj7 ,heal? educator ,! t]m heal? educator includes a pr(essional ) a baccalaureate degree :o is responsible = design+1 implem5t+1 & evaluat+ individual & population heal? promotion1 heal? education 7includ+ education on end-(-life c>e options71 end-(-life c>e1 or *ronic disease prev5tion programs4 7#aa7 ,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#ab7 ,individual ) a disability ,! t]m individual ) a disability means any individual :o has a disability z def9$ = ! purpose ( section #ejd ( ! ,rehabilitation ,act ( #aigc4 7#ac7 ,individual ) limit$ ,engli% pr(ici5cy ,! t]m individual ) limit$ ,engli% pr(ici5cy means an individual :o self-id5tifies on ! ,c5sus z speak+ ,engli% less ?an v well4 7#ad7 ,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 hospice & palliative c>e1 & relat$ discipl9es to improve ! heal? outcomes ( an individual & ! community4 ,su* provid]s may include hospitals1 heal?1 m5tal heal?1 or sub/ance use prev5tion & treatm5t cl9ics & provid]s1 home heal? ag5cies1 home- & community-bas$ s]vices provid]s1 congregate c>e sett+s 7includ+ any skill$ nurs+ facilities1 assi/$ liv+ facilities1 prisons & jails1 resid5tial behavioral heal? c>e & psy*iatric facilities1 & facilities provid+ s]vices = ag+ adults & p ) disabilities71 ambulatory surg]y c5t]s1 rehabilitation c5t]s1 & employ$1 indep5d5t1 or contract$ physicians4 7#ae7 ,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#af7 ,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#ag7 ,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#ah7 ,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#ai7 ,m9ority gr\p ,! t]m m9ority gr\p means a racial & e?nic m9ority gr\p z def9$ 9 ?is section4 7#bj7 ,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#ba7 ,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#bb7 ,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>ance-- 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#bc7 ,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#bd7 ,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#be7 ,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 ,middle ,ea/]n]s & ,nor? ,africans1 & ,native ,hawaiians & o!r ,pacific ,isl&]s4 7#bf7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality4 7#bg7 ,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#bh7 ,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#bi7 ,/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#cj7 ,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#ca7 ,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#cb7 ,und]s]v$ communities ,! t]m und]s]v$ communities means populations %>+ a p>ticul> *>act]i/ic1 z well z geographic communities1 :o h be5 sy/ematically d5i$ a full opportunity to p>ticipate 9 aspects ( economic1 social1 & civic life1 su* z-- 7,a7 ,black1 ,lat9o1 & ,indig5\s & ,native ,am]ican p]sons1 ,asian ,am]icans & ,pacific ,isl&]s1 ,middle ,ea/]n]s & ,nor? ,africans1 & o!r p]sons ( color2 7,b7 memb]s ( religi\s m9orities2 7,c7 lesbian1 gay1 bisexual1 transg5d]1 & que] p]sons2 7,d7 p]sons ) disabilities2 7,e7 p]sons :o live 9 rural areas2 & 7,f7 p]sons o!rwise adv]sely affect$ by p]si/5t pov]ty or inequality z def9$ 9 ,executive ,ord] #acihe4 7#cc7 ,und]s]v$ populations ,! t]m und]s]v$ populations means populations %>+ a p>ticul> *>act]i/ic1 z well z geographic communities1 :o h be5 sy/ematically d5i$ a full opportunity to p>ticipate 9 aspects ( economic1 social1 & civic life1 z def9$ 9 ,executive ,ord] #acihe4 7#cd7 ,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#ce7 ,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>y %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 7,a7 ,9 g5]al ,! ,c5t] %all provide res\rces via ! int]net to id5tify & l9k heal? c>e provid]s to compet5t & qualifi$ int]pret] & translation s]vices4 7,b7 ,tra9+ ,= purposes ( provid+ ! s]vices describ$ 9 subp>agraph 7,a71 ! ,c5t] %all adopt a language access plan t includes tra9+ requirem5ts = ,c5t] /aff to provide su* s]vices4 7#b7 ,translation ( writt5 mat]ial 7,a7 ,vital docum5ts ,! ,c5t] %all provide1 directly or ?r\gh contract1 to provid]s ( heal? c>e s]vices & heal? c>e-relat$ s]vices1 at no co/ to su* provid]s & 9 a timely & reasonable mann]1 vital docum5ts-- 7i7 :i* may be submitt$ by cov]$ entities 7z def9$ 9 section #ib4d ( title #de1 ,code ( ,f$]al ,regulations1 z 9 effect on ,may #ah1 #bjaf7 = translation into non-,engli% languages or alt]native =mats at a fif?-grade read+ level2 & 7ii7 f compet5t translation s]vices1 ! quality ( :i* %all be monitor$ & 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] %all1 n lat] ?an #de cal5d> days ( ! ,secret>y receiv+ f9al approval ( ! =m f ! ,(fice ( ,managem5t & ,budget-- 7i7 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 replacem5t2 & 7ii7 po/ all translat$ =ms on ! ,c5t]'s website4 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 t is l9k$ to ! toll-free telephone numb] #a-hjj-,,m$ic>e & a toll-free telephone hotl9e provid$ = pursuant to section #acaa7;d77#d77;,b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act by an ,ex*ange e/abli%$ "u title ,i ( su* ,act-- 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+ 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$]al notices writt5 9 ,engli%2 & 7,c7 to le>n h[ to access language s]vices4 7#d7 ,heal? in=mation cle>+h\se 7,a7 ,9 g5]al ,! ,c5t] %all develop & ma9ta91 & make available on ! int]net & 9 pr9t1 an in=mation cle>+h\se t includes ! in=mation describ$ 9 subp>agraphs 7,b7 ?r\gh 7,f7-- 7i7 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 errors2 7ii7 to improve m$ical outcomes1 improve cultural compet5ce1 r$uce heal? c>e co/s caus$ by miscommunication ) individuals ) limit$ ,engli% pr(ici5cy2 & 7iii7 to r$uce or elim9ate ! duplication ( ef=ts to translate mat]ials4 7,b7 ,docum5t templates ,! ,c5t] %all collect & evaluate = accuracy1 develop1 & make available templates = /&>d docum5ts t are necess>y = pati5ts & consum]s to access & make educat$ 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 su* 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 provide1 at no co/1 to all heal? c>e provid]s & all provid]s ( heal? c>e-relat$ s]vices1 in=mation relat+ to culturally & l+ui/ically appropriate heal? c>e = m9ority populations resid+ 9 ! ,unit$ ,/ates1 includ+-- 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 organizations = heal? c>e s]vices & heal? c>e-relat$ s]vices2 & 7v7 culturally & l+ui/ically appropriate in=mation = educators1 practition]s1 /ud5ts1 & 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 su* 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 seq472 & 7,,iv7 9 pap] =mat ^u reque/4 7,g7 ,in=mation ab\t progress ,! ,c5t] %all-- 7i7 regul>ly collect & make publicly available in=mation ab\t ! progress ( entities receiv+ grants "u section #cdjb reg>d+ successful innovations 9 implem5t+ ! requirem5ts ( ?is subsection2 & 7ii7 provide public notice 9 ! entities' communities ab\t ! availability ( su* 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 ( ! ,c5t] %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]s1 social s]vice provid]s1 & community-bas$ organizations 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 #bjbc ?r\gh #bjbg4 #cdjb4 ,innovations 9 culturally & l+ui/ically appropriate heal? c>e grants 7a7 ,9 g5]al 7#a7 ,grants ,! ,secret>y %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(ici5cy & communication disabilities4 7#b7 ,coord9ation ,9 mak+ grants "u ?is section1 & 9 ! design & implem5tation ( ! program e/abli%$ "u ?is section1 ! ,secret>y %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?4 7b7 ,eligibility ,to be eligible to receive a grant "u subsection 7a71 an entity %all 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>y4 7c7 ,application ,an eligible entity seek+ a grant "u ?is section %all 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 7d7 ,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 data2 & 7#ad7 ensure t culturally compet5t c>e & language assi/ance are available to individuals ) limit$ ,engli% pr(ici5cy4 7e7 ,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 7f7 ,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 7g7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #e1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 #cdjc4 ,rese>* on cultural & language compet5ce 7a7 ,9 g5]al ,! ,secret>y %all exp& rese>* conc]n+ language access 9 ! provision ( heal? c>e s]vices4 7b7 ,eligibility ,! ,secret>y 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' k & aw>5ess ( ! b>ri]s to quality heal? c>e s]vices t are fac$ by individuals ) limit$ ,engli% pr(ici5cy & communication disabilities4 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+ :e!r ! enc\nt] occurs dur+ 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 #bjbc ?r\gh #bjbg4 4 #bjje4 ,pilot program = improvem5t & developm5t ( ,/ate m$ical int]pret+ s]vices 7a7 ,grants au?oriz$ ,! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is section z ! ,secret>y7 %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 #bjbc1 & end+ on ,septemb] #cj1 #bjbf4 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+ ,,lep 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 #bjje ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb1 #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 #bjjf4 ,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$ical resid5cy tra9+ program = education & tra9+ 9 culturally & l+ui/ically appropriate s]vice deliv]y1 :i* %all include all m$ically und]s]v$ populations 7z def9$ 9 section #ccj7;b77#c7 ( ! ,public ,heal? ,s]vice ,act71 %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 mov+ ! left m>g9 ( clause 7xii7 #d ems to ! left2 & 7#b7 by add+ at ! end ! foll[+ new clause3 7xiii7 ,! 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 #bjjg4 ,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]vices 79 ?is subsection ref]r$ to z ! ,secret>y71 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$ic>e s]vice provid]s to provide culturally & l+ui/ically appropriate s]vices to ,m$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$ 9 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 individuals ) limit$ ,engli% pr(ici5cy1 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 ! requirem5ts ( 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/ #aj grants to provid]s ( s]vices describ$ 9 p>agraph 7#b77;,a77i72 7,b7 at lea/ #aj grants to s]vice provid]s describ$ 9 p>agraph 7#b77;,a77ii72 7,c7 at lea/ #aj grants to organizations describ$ 9 p>agraph 7#b77;,a77iii72 & 7,d7 at lea/ #aj grants to sponsors describ$ 9 p>agraph 7#b77;,a77iv74 7#d7 ,consid]ations 9 aw>d+ grants 7,a7 ,v>iation among 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$ic>e b5efici>ies 9 bo? urban & rural sett+s4 7iv7 ,! grantees repres5t ea* ,c5t]s = ,m$ic>e ,m$icaid ,s]vices region1 z def9$ by ! ,secret>y4 7v7 ,! grantees s]ve ,m$ic>e b5efici>ies 9 at lea/ two l>ge metropolitan /ati/ical areas ) racial1 e?nic1 sexual1 g5d]1 disability1 & economically div]se populations4 7,b7 ,priority = p>tn]%ips ) community organizations & ag5cies ,9 aw>d+ grants "u ?is subsection1 ! ,secret>y %all give priority to eligible entities t h a p>tn]%ip )-- 7i7 a community organization2 or 7ii7 a consortium ( community organizations1 ,/ate ag5cies1 & local ag5cies2 t has exp]i5ce 9 provid+ language s]vices4 7#e7 ,use ( funds = compet5t language s]vices 7,a7 ,9 g5]al ,subject to subp>agraph 7,e71 a grantee may only use grant funds receiv$ "u ?is subsection to pay = ! provision ( compet5t language s]vices to ,m$ic>e b5efici>ies :o are individuals ) limit$ ,engli% pr(ici5cy4 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 utilize 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$]al ,regi/] on ,may #ah1 #bjaf2 & 7,,ii7 9 ! case ( int]pret] s]vices1 are provid$ ?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$ic>e b5efici>y :o is limit$ ,engli% pr(ici5t1 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$ical em]g5cies to pati5ts :o are individuals ) limit$ ,engli% pr(ici5cy f any applicable legal or regulatory requirem5ts relat$ to provid+ compet5t int]pret] & translation s]vices )\t undue delay4 7,d7 ,m$ic>e ,advantage organizations & ,,pdp sponsors ,a grantee t is a ,m$ic>e ,advantage organization or a prescription drug plan sponsor mu/ provide at lea/ #ej p]c5t ( ! grant funds t ! grantee 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$ic>e b5efici>ies :o are individuals ) limit$ ,engli% pr(ici5cy4 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$ic>e b5efici>ies :o are limit$ ,engli% pr(ici5cy 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 is 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$ic>e b5efici>ies t ! grantee s]ves & ! ,secret>y det]m9es t ! data is accurate & %[s a great] numb] ( individuals ) limit$ ,engli% pr(ici5cy ?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 limit$ ,engli% pr(ici5t = all po9ts ( contact betwe5 ! pati5t & ! grantee1 9 a timely mann] dur+ all h\rs ( op]ation2 7,d7 notify ,m$ic>e b5efici>ies ( _! "r to receive language s]vices 9 _! prim>y language at lea/ annually2 7,e7 po/ signage 9 ! prim>y languages commonly us$ 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 #bjjb ( ?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$1 prim>y language data mu/ also be collect$ on ! p>5t or legal gu>dian ( su* recipi5t4 7#h7 ,no ,co/ ,%>+ ,m$ic>e b5efici>ies :o are limit$ ,engli% pr(ici5t %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$1 disaggregat$ by age & entitlem5t basis 7on ! basis ( age1 disability1 or det]m9ation ( end /age r5al disease74 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$ic>e b5efici>ies :o are individuals ) limit$ ,engli% pr(ici5cy 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$ic>e b5efici>y access to c>e & utilization ( s]vices2 7ii7 ! effici5cy & co/-effectiv5ess ( heal? c>e deliv]y2 7iii7 pati5t satisfaction ) respect to bo? heal? s]vice deliv]y & language assi/ance2 7iv7 heal? outcomes2 & 7v7 ! provision ( culturally appropriate s]vices provid$ 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 ,limit$ ,engli% pr(ici5t def9$ ,9 ?is subsection1 ! t]m limit$ ,engli% pr(ici5t ref]s to individuals :o self-id5tify on ! ,c5sus z speak+ ,engli% less ?an v well4 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 9 subp>agraph 7,c71 by add+ & at ! end2 & 7iii7 by ins]t+ aft] subp>agraph 7,c7 ! foll[+ new subp>agraph3 7,d7 language assi/ance s]vices z def9$ 9 subsection 7lll71 2 & 7,b7 by add+ at ! end ! foll[+ new subsection3 7lll7 ,language assi/ance s]vices & relat$ t]ms ,! 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 #cdjj74 4 7#b7 ,cov]age ,section #ahcb7;a77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciek7a77#b77 is am5d$-- 7,a7 9 subp>agraph 7,i71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,j71 by /rik+ ! p]iod at ! end & 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 #ahfa7lll774 4 7#c7 ,paym5t ,section #ahcc7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77 is am5d$-- 7,a7 9 p>agraph 7#i71 by /rik+ & at ! end2 7,b7 9 p>agraph 7#aj71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by ins]t+ aft] p>agraph 7#aj7 ! foll[+ new p>agraph3 7#aa7 9 ! case ( language assi/ance s]vices 7z def9$ 9 section #ahfa7lll771 #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 #ahfa7lll7 ( 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 ( #bjbb1 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 #bjje7;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#cj7 & ins]t+ 7#cj71 & 7#ca74 7#c7 ,def9ition ( m$ical assi/ance 7,a7 ,9 g5]al ,section #aije7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is am5d$-- 7i7 9 p>agraph 7#cj71 by /rik+ & at ! end2 7ii7 by r$esignat+ p>agraph 7#ca7 z p>agraph 7#cb72 & 7iii7 by ins]t+ aft] p>agraph 7#cj7 ! foll[+ new p>agraph3 7#ca7 language assi/ance s]vices1 z su* t]m is def9$ 9 section #ahfa7lll71 provid$ 9 a timely mann] to individuals ) limit$ ,engli% pr(ici5cy z def9$ 9 section #cdjj ( ! ,public ,heal? ,s]vice ,act2 & 4 7,b7 ,con=m+ am5dm5ts 7i7 ,section #aijb7nn77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7nn77#c77 is am5d$ by /rik+ p>agraph 7#cj7 & ins]t+ ! la/ p>agraph4 7ii7 ,section #aije7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is am5d$1 9 ! #e? s5t5ce1 by /rik+ p>agraph 7#cj7 & ins]t+ ! la/ p>agraph4 7#d7 ,use ( d$uctions & co/ %>+ ,subsections 7a77#b7 & 7b77#b7 ( section #aiaf7;a77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifo7a77#b77 are ea* am5d$-- 7,a7 9 subp>agraph 7,g71 by ins]t+ a comma aft] plan2 7,b7 9 subp>agraph 7,h71 by /rik+ 2 or & ins]t+ a comma2 7,c7 9 subp>agraph 7,i71 by /rik+ 2 & & ins]t+ 1 or2 & 7,d7 by add+ at ! end ! foll[+ new subp>agraph3 7,j7 language assi/ance s]vices describ$ 9 section #aije7;a77#ca72 & 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#h71 7#i71 7#aj71 7#aa71 & 7#ab72 7,b7 9 subsection 7c71 by add+ at ! end ! foll[+ new p>agraph3 7#ab7 ,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 #ahfa7lll71 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#ab71 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#ab74 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 individuals ) limit$ ,engli% pr(ici5cy 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 su* sums z may be necess>y = ea* ( fiscal ye>s #bjbb ?r\gh #bjbf4 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 subsection4 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 is 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 limit$ ,engli% pr(ici5t individuals1 ! 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] ( individuals ) limit$ ,engli% pr(ici5cy :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 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 7,,iv7 a hospice provid]2 or 7,v7 a palliative c>e provid]2 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 ,language assi/ance s]vices ,! t]m language assi/ance s]vices has ! mean+ giv5 su* t]m 9 section #ahfa7lll7 ( ! ,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 #bjbc4 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 #bjjh4 ,increas+ und]/&+ ( & improv+ heal? lit]acy 7a7 ,9 g5]al ,! ,secret>y1 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[ 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 "u subsection 7a7 t is aw>d$ ?r\gh ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality %all be us$-- 7,a7 to def9e & increase ! und]/&+ ( heal? lit]acy across all areas ( heal? c>e1 includ+ end ( life c>e2 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 "u subsection 7a7 t is aw>d$ ?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 & end ( life c>e programs = pati5ts ) l[ heal? lit]acy2 7,b7 ! tailor+ ( disease managem5t programs & end ( life c>e 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 section3 7#a7 ,l[ heal? lit]acy ,! 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 7#b7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices-- 7,a7 act+ ?r\gh ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 ) respect to grants "u subsection 7c77#a72 & 7,b7 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration ) respect to grants "u subsection 7c77#b74 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 #bjbc ?r\gh #bjbg4 #bjji4 ,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$4 ,reg4 #cadff72 & 7#b7 ! t]m heal? program or activity has ! mean+ giv5 su* t]m 9 section #ib4d ( title #de1 ,code ( ,f$]al ,regulations1 z 9 effect on ,may #ah1 #bjaf 7#ha ,f$4 ,reg4 #cadff74 7b7 ,requirem5ts ,a cov]$ 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]y at lea/ annually2 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 #bjaj4 ,report on ,f$]al ef=ts to provide culturally & l+ui/ically appropriate heal? c>e s]vices 7a7 ,report ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 & annually !reaft]1 ! ,secret>y ( ,heal? & ,human ,s]vices %all ent] into a contract ) ! ,national ,academy ( ,m$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 #bjbc ?r\gh #bjbg4 #bjaa4 ,engli% in/ruction = individuals ) limit$ ,engli% pr(ici5cy 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 z ,,esl7 in/ruction to individuals ) limit$ ,engli% pr(ici5cy1 includ+ heal? c>e-relat$ ,engli% in/ruction1 & %all det]m9e1 aft] consultation ) appropriate /akehold]s1 ! me*anism = adm9i/]+ & di/ribut+ su* grants4 7b7 ,eligible entity ,9 ?is section1 ! t]m eligible entity means-- 7#a7 a ,/ate2 or 7#b7 a community-bas$ organization t pr$om9antly employs & s]ves racial & e?nic m9ority gr\ps 7z def9$ 9 section #agjg7;g7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f7;g774 7c7 ,application ,an eligible entity t desires to receive a grant "u ?is section %all apply by submitt+ to ! ,secret>y ( ,education an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7d7 ,use ( grant ,an eligible entity %all use grant funds provid$ "u ?is section to-- 7#a7 develop & implem5t a plan = assur+ ! availability ( ,,esl in/ruction1 free ( *>ge1 to ! community s]v$ by ! eligible entity1 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 ) limit$ ,engli% pr(ici5cy to access & regul>ly negotiate ! heal? c>e sy/em effectively2 7#b7 develop a plan = mak+ ,,esl in/ruction available free to *>ge to individuals ) limit$ ,engli% pr(ici5cy 9 ! community s]v$ by ! eligible entity :o are seek+ in/ruction1 includ+1 :]e appropriate1 ?r\gh ! use ( public-private p>tn]%ips2 & 7#c7 provide ,,esl in/ruction to individuals ) limit$ ,engli% pr(ici5cy 9 ! community s]v$ by ! eligible entity4 7e7 ,supplem5t1 n supplant ,an eligible entity aw>d$ a grant "u ?is section %all use funds made available "u ?is section to supplem5t1 & n supplant1 o!r ,f$]al1 ,/ate1 & local funds t w\ld o!rwise be exp5d$ to c>ry out activities "u ?is section4 7f7 ,duties ( ! ,secret>y ,! ,secret>y ( ,education %all-- 7#a7 collect & make publicly available annual data on h[ mu* ,f$]al1 ,/ate1 & local gov]nm5ts sp5d annually on ,,esl in/ruction2 7#b7 collect data f eligible entities aw>d$ a grant "u ?is section to id5tify ! unmet ne$s ( individuals ) limit$ ,engli% pr(ici5cy = appropriate ,,esl in/ruction1 includ+-- 7,a7 ! pref]r$ writt5 & spok5 language ( su* individuals2 7,b7 ! availability ( enrollm5t 9 ,,esl in/ruction programs 9 ! communities s]v$ by ea* eligible entity aw>d$ a grant "u ?is section1 includ+ ! ext5t ( wait+ li/s = ,,esl in/ruction1 h[ _m programs ma9ta9 wait+ li/s1 &1 = programs t d n h wait+ li/s1 ! reasons :y su* a li/ is unnecess>y or o!rwise n ma9ta9$2 7,c7 ! availability ( programs to geographically isolat$ communities2 7,d7 ! impact ( c\rse enrollm5t policies1 includ+ op5 enrollm5t1 on ! availability ( ,,esl in/ruction2 7,e7 ! numb] ( individuals ) limit$ ,engli% pr(ici5cy & ! numb] ( individuals enroll$ 9 ,,esl in/ruction programs 9 ! communities s]v$ by ea* eligible entity aw>d$ a grant "u ?is section2 7,f7 ! effectiv5ess ( ! ,,esl in/ruction provid$ ?r\gh grants aw>d$ "u ?is section 9 meet+ ! ne$s ( individuals receiv+ su* in/ruction2 & 7,g7 an assessm5t ( ! ne$ = programs t integrate job tra9+ & ,,esl in/ruction1 to assi/ individuals ) limit$ ,engli% pr(ici5cy 9 obta9+ bett] jobs2 7#c7 det]m9e ! co/ & mo/ appropriate me?ods ( mak+ ,,esl in/ruction available to all individuals ) limit$ ,engli% pr(ici5cy 9 ! ,unit$ ,/ates :o are seek+ in/ruction2 & 7#d7 n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 issue a report to ,congress t-- 7,a7 assesses ! in=mation collect$ 9 p>agraphs 7#a71 7#b71 & 7#c7 & makes recomm5dations on /eps t %\ld be tak5 to realize ! goal ( mak+ ,,esl in/ruction available to all individuals ) limit$ ,engli% pr(ici5cy 9 ! ,unit$ ,/ates :o are seek+ in/ruction2 & 7,b7 evaluates ! impact ( ! grant program au?oriz$ "u ?is section on ! accessibility (1 & ability to effectively negotiate1 ! heal? c>e sy/em = individuals ) limit$ ,engli% pr(ici5cy :o h receiv$ ,,esl in/ruction fund$ by a grant "u ?is section4 7g7 ,au?orization ( ,appropriations ,!re are au?oriz$ to be appropriat$ to ! ,secret>y ( ,education #bej1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg to c>ry out ?is section4 #bjab4 ,implem5tation 7a7 ,g5]al provisions 7#a7 ,immunity ,a p]son injur$ by a violation ( ?is title 7includ+ an am5dm5t made by ?is title7 by a ,/ate may br+ a civil action 9 ! appropriate ,f$]al c\rt = su* injury 9 accordance ) ?is section4 7#b7 ,rem$ies ,9 a civil action "u ?is section = a violation ( ?is title1 su* rem$ies %all be available z w\ld be available 9 a civil action = su* violation aga9/ any p>ty o!r ?an a ,/ate4 7b7 ,rule ( con/ruction ,no?+ 9 ?is title may be con/ru$ 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 #bjac4 ,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/$1 ! range & av]age wait "t = a consum] to speak ) an int]pret]1 ! numb] ( compla9ts & any /eps ! hotl9e1 & any entity contract+ ) ! ,secret>y to provide language s]vices1 h tak5 to actively address "s ( ! consum] compla9ts4 7f7 ,effective date ,! am5dm5ts made by ?is section %all n apply to plans beg9n+ prior to ! date ( ! enactm5t ( ?is ,act4 #bjad4 ,m$ically und]s]v$ populations ,section #ccj7;b77#c7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;b7b77#c77 is am5d$ to read z foll[s3 7#c7 ,m$ically und]s]v$ ,! t]m m$ically und]s]v$1 ) respect to a population1 ref]s to-- 7,a7 ! population ( an urban or rural area designat$ by ! ,secret>y z-- 7i7 an area ) a %ortage ( p]sonal heal? s]vices2 or 7ii7 a population gr\p hav+ a %ortage ( su* s]vices2 or 7,b7 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 #cjja4 ,am5dm5t to ! ,public ,heal? ,s]vice ,act ,title ,,xxxiv ( ! ,public ,heal? ,s]vice ,act1 z add$ by section #bjjd1 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+ ( /&>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 ,coord9ation ) o!r ef=ts ,9 provid+ = ! e/abli%m5t ( ! work+ gr\p "u subsection 7a71 ! ,secret>y %all take su* /eps z may be necess>y to ensure t ! "w ( ! work+ gr\p does n ov]lap )1 or o!rwise duplicate1 o!r ,f$]al ,gov]nm5t ef=ts ) respect to ensur+ heal? equity 9 data collection 9 public heal? em]g5cies4 7f7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 #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$]al entities :i* may include m9ority heal? pr(essional associations & m9ority sections ( major heal? pr(essional associations to ensure ! adequacy & accuracy ( in=mation4 7d7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 #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 hi/orically ,black pr(essional or graduate in/itutions eligible = grants "u section #cbf ( ! ,high] ,education ,act ( #aife2 7,c7 ,hispanic-s]v+ heal? pr(essions s*ools2 7,d7 ,hispanic-s]v+ in/itutions1 z def9$ 9 section #ejb ( su* ,act2 7,e7 ,tribal ,colleges or ,univ]sities1 z def9$ 9 section #caf ( su* ,act2 7,f7 ,asian ,am]ican & ,native ,am]ican ,pacific ,isl&]-s]v+ in/itutions1 z def9$ 9 section #cga7;c7 ( su* ,act2 7,g7 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,h7 heal? pr(essional associations1 :i* may include und]repres5t$ m9ority heal? pr(essional associations2 & 7,i7 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 are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 #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(essions s*ool4 ,! ,secret>y %all promulgate additional regulations to def9e ! scope & proc$ures = ! program "u ?is subsection4 7f7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 #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 univ]sities & o!r in/itutions to ent] into agreem5ts ) eligible individuals "u :i*-- 7#a7 ! univ]sity or in/itution supports ! eligible individual's c>e] 9 a nonrese>*-relat$ heal? & wellness pr(ession2 & 7#b7 ! eligible individual commits to p]=m+ a p]iod ( obligat$ s]vice 9 su* a c>e] to s]ve1 or to "w on heal? issues affect+1 und]s]v$ communities1 su* z racial & e?nic m9ority communities4 7b7 ,eligible individuals ,to be an eligible individual = purposes ( subsection 7a71 an individual %all 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*ool4 7c7 ,application ,to seek a grant "u ?is section1 a univ]sity or o!r in/itution %all submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7d7 ,use ( funds ,a univ]sity or o!r in/itution receiv+ a grant "u ?is section %all use ! grant = agreem5ts describ$ 9 subsection 7a74 ,su* agreem5ts may-- 7#a7 support an eligible individual's heal? activities or projects t involve und]s]v$ communities1 includ+ racial & e?nic m9ority communities2 7#b7 support an eligible individual's heal?-relat$ c>e] advancem5t activities2 7#c7 pay1 or reimburse = paym5t (1 /ud5t loans or tra9+ or cr$5tial+ co/s = eligible individuals :o are heal? pr(essionals & are focus$ on heal? issues affect+ und]s]v$ communities1 includ+ racial & e?nic m9ority communities2 & 7#d7 e/abli% & promote lead]%ip tra9+ programs = eligible individuals to decrease heal? disp>ities & to increase cultural compet5ce ) ! goal ( increas+ div]sity 9 lead]%ip positions4 7e7 ,def9ition ,9 ?is section1 ! t]m c>e] 9 a nonrese>*-relat$ heal? & wellness pr(ession 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 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 #bjbc ?r\gh #bjbg4 #cdaf4 ,rese>* on ! effect ( work=ce div]sity on quality 7a7 ,9 g5]al ,! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality 79 ?is section ref]r$ to z ! ,director71 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 are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 #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 report ( ! ,national ,academy ( ,m$ic9e 7=m]ly ! ,in/itute ( ,m$ic9e7 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 are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 4 #cjjb4 ,hispanic-s]v+ in/itutions1 hi/orically ,black colleges & univ]sities1 hi/orically ,black pr(essional or graduate in/itutions1 ,asian ,am]ican & ,native ,am]ican ,pacific ,isl&]-s]v+ in/itutions1 ,tribal ,colleges1 regional community-bas$ organizations1 & national m9ority m$ical associations ,"p ,b ( title ,,vii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bic et seq47 is am5d$ by add+ at ! end ! foll[+3 #gdb4 ,hispanic-s]v+ in/itutions1 hi/orically ,black colleges & univ]sities1 hi/orically ,black pr(essional or graduate in/itutions1 ,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 hi/orically ,black pr(essional or graduate in/itutions eligible = grants "u section #cbf ( ! ,high] ,education ,act ( #aife1 ,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*ools2 & 7#c7 reta9+ exi/+ enroll$ und]repres5t$ m9ority /ud5ts 9 a heal? pr(essions s*ool4 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 college & 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 are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 4 #cjjc4 ,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$ by /rik+ #ejj1jjj = fiscal ye> #aiid1 & su* sums z may be necess>y = ea* ( ! fiscal ye>s #aiie ?r\gh #bjjb & ins]t+ su* sums z may be necess>y = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 #cjjd4 ,alli$ heal? work=ce div]sity 7a7 ,increas+ work=ce div]sity 9 ! pr(essions ( physical !rapy1 occupational !rapy1 respiratory !rapy1 audiology1 & spee*-,language pa?ology ,title ,,vii ( ! ,public ,heal? ,s]vice ,act is am5d$-- 7#a7 by r$esignat+ "p ,g 7#db ,u4,s4,c4 #bie;j et seq47 z "p ,h2 & 7#b7 by ins]t+ aft] "p ,f 7#db ,u4,s4,c4 #bie;h7 ! foll[+ new "p3 ,g ,increas+ work=ce div]sity 9 ! pr(essions ( physical !rapy1 occupational !rapy1 respiratory !rapy1 audiology1 & spee*-language pa?ology #ghc4 ,s*ol>%ips & /ip5ds 7a7 ,9 g5]al ,! ,secret>y may aw>d grants & contracts to eligible entities to increase educational opportunities 9 ! pr(essions ( physical !rapy1 occupational !rapy1 respiratory !rapy1 audiology1 & spee*-language pa?ology = eligible individuals by-- 7#a7 provid+ /ud5t s*ol>%ips or /ip5ds1 includ+ =-- 7,a7 completion ( an accel]at$ degree program2 7,b7 completion ( an associate's1 ba*elor's1 ma/]'s1 or doctoral degree program2 & 7,c7 entry by a diploma or associate's degree practition] into a bridge or degree completion program2 7#b7 provid+ assi/ance = completion ( pr]equisite c\rses or o!r prep>ation necess>y = acceptance = enrollm5t 9 ! eligible entity2 & 7#c7 c>ry+ out activities to increase ! ret5tion ( /ud5ts 9 "o or m programs 9 ! pr(essions ( physical !rapy1 occupational !rapy1 respiratory !rapy1 audiology1 & spee*-language pa?ology4 7b7 ,consid]ation ( recomm5dations ,9 c>ry+ out subsection 7a71 ! ,secret>y %all take into consid]ation ! recomm5dations ( national organizations repres5t+ ! pr(essions ( physical !rapy1 occupational !rapy1 respiratory !rapy1 audiology1 & spee*-language pa?ology1 includ+ ! ,am]ican ,physical ,!rapy ,association1 ! ,am]ican ,occupational ,!rapy ,association1 ! ,am]ican ,spee*-,language-,he>+ ,association1 ! ,am]ican ,association = ,respiratory ,c>e1 ! ,am]ican ,academy ( ,audiology1 & ! ,academy ( ,doctors ( ,audiology4 7c7 ,requir$ in=mation & conditions = aw>d recipi5ts 7#a7 ,9 g5]al ,! ,secret>y may require recipi5ts ( aw>ds "u ?is section to report to ! ,secret>y conc]n+ ! annual admission1 ret5tion1 & graduation rates = eligible individuals 9 programs ( ! recipi5t lead+ to a degree 9 any ( ! pr(essions ( physical !rapy1 occupational !rapy1 respiratory !rapy1 audiology1 & spee*-language pa?ology4 7#b7 ,fall+ rates ,if any ( ! rates report$ by a recipi5t "u p>agraph 7#a7 fall bel[ ! av]age = su* recipi5t ov] ! #b ye>s prec$+ ! ye> cov]$ by ! report1 ! recipi5t %all provide ! ,secret>y ) plans = imm$iately improv+ su* rates4 7#c7 ,ineligibility ,a recipi5t describ$ 9 p>agraph 7#b7 %all be ineligible = cont9u$ fund+ "u ?is section if ! plan ( ! recipi5t fails to improve ! rates )9 ! #a-ye> p]iod beg9n+ on ! date su* plan is implem5t$4 7d7 ,def9itions ,9 ?is section3 7#a7 ,eligible entities ,! t]m eligible entity means an accr$it$ education program t is c>ry+ out a program = recruit+ & reta9+ /ud5ts und]repres5t$ 9 ! pr(essions ( physical !rapy1 occupational !rapy1 respiratory !rapy1 audiology1 & spee*-language pa?ology 7includ+ racial or e?nic m9orities1 or /ud5ts f disadvantag$ backgr\nds74 7#b7 ,eligible individual ,! t]m eligible individual means an individual :o-- 7,a7 is a memb] ( a class ( p]sons :o are und]repres5t$ 9 ! pr(essions ( physical !rapy1 occupational !rapy1 respiratory !rapy1 audiology1 & spee*-language pa?ology1 includ+ individuals :o are-- 7i7 racial or e?nic m9orities2 7ii7 f disadvantag$ backgr\nds2 or 7iii7 individuals ) a disability 7z def9$ 9 section #c7a7 ( ! ,am]icans ) ,disabilities ,act ( #aiij71 or :o h an individualiz$ education program 7z def9$ 9 section #fjb ( ! ,individuals ) ,disabilities ,education ,act71 are cov]$ "u section #ejd ( ! ,rehabilitation ,act ( #aigc1 or h o!r docum5tation e/abli%+ ! /ud5t's disability 7z su* t]m is def9$ 9 section #c7a7 ( ! ,am]icans ) ,disabilities ,act ( #aiij72 7,b7 has a f9ancial ne$ = a s*ol>%ip or /ip5d2 & 7,c7 is enroll$ 7or accept$ = enrollm5t7 at an audiology1 spee*-language pa?ology1 respiratory !rapy1 physical !rapy1 or occupational !rapy program z a full-"t /ud5t at an eligible entity4 7e7 ,au?orization ( ,appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #h1jjj1jjj = ! fir/ fiscal ye> comm5c+ aft] ! date ( enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb & ea* ( ! #d succe$+ fiscal ye>s4 4 7b7 ,eligibility cl>ification reg>d+ /ud5ts support$ ?r\gh m5tal & behavioral heal? education & tra9+ grants ,section #gef7;a77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bid;e-#a7;a77#a77 is am5d$ by ins]t+ aft] occupational !rapy ! foll[+3 7:i* may include ma/]'s & doctoral level programs74 #cjje4 ,coop]ative agreem5ts = onl9e degree programs at s*ools ( public heal? & s*ools ( alli$ heal? ,"p ,d ( title ,,vii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bid et seq47 is am5d$ by ins]t+ aft] section #gee ( su* ,act 7#db ,u4,s4,c4 #bid;e7 ! foll[+3 #gee;,a4 ,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 #bjbc ?r\gh #bjbg4 4 #cjjf4 ,national ,heal? ,c>e ,work=ce ,commission 7a7 ,s5se ( ,congress ,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$s ( racial & e?nic m9orities1 individuals ) l[] socioeconomic /atus1 individuals ) m5tal1 developm5tal1 & physical disabilities1 lesbian1 gay1 bisexual1 transg5d]1 que]1 & que/ion+ populations1 & individuals :o are memb]s ( multiple m9ority or special population gr\ps4 7b7 ,reau?orization ,section #eaja7;h77#b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #bidq7h77#b77 is am5d$ by /rik+ su* sums z may be necess>y & ins]t+ #c1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbe4 #cjjg4 ,s*ol>%ip & fell[%ip programs ,subtitle ,b ( title ,,xxxiv ( ! ,public ,heal? ,s]vice ,act1 z add$ by section #cjja1 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 are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 #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 are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 #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]vice1 %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 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 sexual & reproductive heal?1 includ+ family plann+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 "u subsection 7b7 %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 are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 #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 9 ! f\r? ye> ( a #d-ye> in/itution ( high] education or a 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 "u subsection 7b7 %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 ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality %all give priority to eligible individuals "u subsection 7b7 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 or 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 are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 #cdbb4 ,edw>d ,r4 ,roybal ,heal? ,s*ol> ,program 7a7 ,9 g5]al ,! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 ! ,adm9i/rator ( ! ,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 "u subsection 7b7 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 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 ! ,adm9i/rator ( ! ,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 ! ,adm9i/rator ( ! ,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 #bjbc ?r\gh #bjbg4 #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 are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 4 #cjjh4 ,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 #bjbc ?r\gh #bjbg4 4 #cjji4 ,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 #bjjf7;a71 is am5d$-- 7#a7 9 subp>agraph 7,e71 by /rik+ ,subject to subp>agraphs 7,j7 & 7,k71 su* rules & ins]t+ ,subject to subp>agraphs 7,j71 7,k71 & 7,m71 su* rules2 7#b7 9 subp>agraph 7,j71 by /rik+ ,su* rules & ins]t+ ,subject to subp>agraph 7,m71 su* rules2 7#c7 9 subp>agraph 7,k71 by /rik+ ,9 det]m9+ & ins]t+ ,subject to subp>agraph 7,m71 9 det]m9+2 & 7#d7 by add+ at ! end ! foll[+ new subp>agraph3 7,m7 ,treatm5t ( c]ta9 resid5ts & int]ns ,= purposes ( co/-report+ p]iods beg9n+ on or aft] ,octob] #a1 #bjbb1 9 det]m9+ ! hospital's numb] ( full-"t equival5t resid5ts = purposes ( ?is p>agraph1 all "t sp5t by an int]n or resid5t 9 an approv$ 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;,b77xi77 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 #bjbb1 ! provisions ( subp>agraph 7,m7 ( subsection 7h77#d7 %all apply "u ?is subp>agraph 9 ! same mann] z !y apply "u su* subsection4 4 #cjaj4 ,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 an eligible in/itution ( 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$4 7b7 ,develop+ capacity = increas+ local heal? equity ,z a condition on receipt ( a grant "u subsection 7a71 an in/itution ( high] education %all agree to use su* grant to build an evid5ce base = successful /rategies = increas+ local heal? equity1 & to s]ve z a national model ( driv+ local heal? equity1 by support+-- 7#a7 res\rces to /r5g!n in/itutional metrics & capacity to execute in/itution-wide heal? work=ce goals t c s]ve z models = increas+ heal? equity 9 communities across ! ,unit$ ,/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* su* in/itution is locat$ = ! purposes (-- 7#a7 /r5g!n+ connections betwe5 su* in/itution & ! community-- 7,a7 to improve evaluation (1 & address1 ! heal? & heal? work=ce ne$s ( su* community2 & 7,b7 to engage su* community 9 heal? work=ce developm5t2 7#b7 develop+1 enhanc+1 or accel]at+ innovative und]graduate & graduate programs 9 ! biom$ical sci5ces & heal? pr(essions2 & 7#c7 /r5g!n+ pipel9e programs 9 ! biom$ical sci5ces & heal? pr(essions1 includ+ by develop+ p>tn]%ips betwe5 in/itutions ( high] education & elem5t>y s*ools & second>y s*ools to recruit ! next g5]ation ( heal? pr(essionals e>li] 9 ! pipel9e to a heal? c>e c>e]4 7d7 ,eligible in/itution ( high] education def9$ ,= purposes ( ?is section1 an eligible in/itution ( high] education includes-- 7#a7 a program au?oriz$ "u section #cag7;a7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajei;d7a772 or 7#b7 a pr(essional or graduate in/itution describ$ 9 section #cbf ( su* ,act 7#bj ,u4,s4,c4 #ajfc;b74 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 #bjbc ?r\gh #bjbg4 #cjaa4 ,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$1 to ! ,heal? ,pr(essions ,work=ce ,fund-- 7,a7 #cib1jjj1jjj = fiscal ye> #bjbc2 7,b7 #dab1jjj1jjj = fiscal ye> #bjbd2 7,c7 #dcb1jjj1jjj = fiscal ye> #bjbe2 7,d7 #ded1jjj1jjj = fiscal ye> #bjbf2 7,e7 #dgf1jjj1jjj = fiscal ye> #bjbg2 7,f7 #ejj1jjj1jjj = fiscal ye> #bjbh2 7,g7 #ebe1jjj1jjj = fiscal ye> #bjbi2 & 7,h7 #eeb1jjj1jjj = fiscal ye> #bjcj4 7#b7 ,heal? pr(essions education programs ,= ! purpose ( c>ry+ out heal? pr(essions education programs au?oriz$ "u title ,,vii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bib et seq471 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 #bfe1jjj1jjj = fiscal ye> #bjbc4 7,b7 #bgh1jjj1jjj = fiscal ye> #bjbd4 7,c7 #bib1jjj1jjj = fiscal ye> #bjbe4 7,d7 #cjg1jjj1jjj = fiscal ye> #bjbf4 7,e7 #cbb1jjj1jjj = fiscal ye> #bjbg4 7,f7 #cch1jjj1jjj = fiscal ye> #bjbh4 7,g7 #cee1jjj1jjj = fiscal ye> #bjbi4 7,h7 #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 ,act 7#db ,u4,s4,c4 #bif et seq471 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 #abg1jjj1jjj = fiscal ye> #bjbc4 7,b7 #acd1jjj1jjj = fiscal ye> #bjbd4 7,c7 #adj1jjj1jjj = fiscal ye> #bjbe4 7,d7 #adg1jjj1jjj = fiscal ye> #bjbf4 7,e7 #aed1jjj1jjj = fiscal ye> #bjbg4 7,f7 #afb1jjj1jjj = fiscal ye> #bjbh4 7,g7 #agj1jjj1jjj = fiscal ye> #bjbi4 7,h7 #agi1jjj1jjj = fiscal ye> #bjcj4 #cjab4 ,future advancem5t ( academic nurs+ 7a7 ,support = nurs+ education & ! future nurs+ work=ce ,"p ,d ( title ,,viii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bifp et seq47 is am5d$ by add+ at ! end ! foll[+3 #hcb4 ,nurs+ education enhancem5t & mod]nization grants 9 und]s]v$ areas 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 may aw>d grants to s*ools ( nurs+ =-- 7#a7 increas+ ! numb] ( faculty & /ud5ts at su* s*ools 9 ord] to enhance ! prep>$ness ( ! ,unit$ ,/ates =1 & ! ability ( ! ,unit$ ,/ates to address & quickly respond to1 public heal? em]g5cies decl>$ "u section #cai & p&emics2 or 7#b7 ! enhancem5t & mod]nization ( nurs+ education programs4 7b7 ,priority ,9 select+ grant recipi5ts "u ?is section1 ! ,secret>y %all give priority to s*ools ( nurs+ t-- 7#a7 are locat$ 9 a m$ically und]s]v$ community2 7#b7 are locat$ 9 a heal? pr(essional %ortage area z def9$ "u section #ccb7;a72 or 7#c7 are in/itutions ( high] education li/$ "u section #cga7;a7 ( ! ,high] ,education ,act ( #aife4 7c7 ,consid]ation ,9 aw>d+ grants "u ?is section1 ! ,secret>y1 to ! ext5t practicable1 may ensure equitable di/ribution ( aw>ds among ! geographic regions ( ! ,unit$ ,/ates4 7d7 ,use ( funds ,a s*ool ( nurs+ t receives a grant "u ?is section may use ! funds aw>d$ ?r\gh su* grant = activities t include-- 7#a7 enhanc+ enrollm5t & ret5tion ( /ud5ts at su* s*ool1 ) a priority = /ud5ts f disadvantag$ backgr\nds 7includ+ racial or e?nic gr\ps und]repres5t$ 9 ! nurs+ work=ce71 individuals f rural & und]s]v$ areas1 l[-income individuals1 & fir/ g5]ation college /ud5ts 7z def9$ 9 section #djb;,a7h77#c7 ( ! ,high] ,education ,act ( #aife72 7#b7 creat+1 support+1 or mod]niz+ educational programs & curriculum at su* s*ool2 7#c7 reta9+ curr5t faculty1 & hir+ new faculty1 ) an emphasis on faculty f racial or e?nic gr\ps :o are und]repres5t$ 9 ! nurs+ work=ce2 7#d7 mod]niz+ infra/ructure at su* s*ool1 includ+ audiovisual or o!r equipm5t1 p]sonal protective equipm5t1 simulation & augm5t$ reality res\rces1 teleheal? te*nologies1 & virtual & physical laboratories2 7#e7 p>tn]+ ) a heal? c>e facility1 nurse-manag$ heal? cl9ic1 community heal? c5t]1 or o!r facility t provides heal? c>e 9 ord] to provide educational opportunities = ! purpose ( e/abli%+ or exp&+ cl9ical education2 7#f7 enhanc+ & exp&+ nurs+ programs t prep>e nurse rese>*]s & sci5ti/s2 7#g7 e/abli%+ nurse-l$ intradiscipl9>y & int]pr(essional educational p>tn]%ips2 & 7#h7 o!r activities t ! ,secret>y det]m9es fur!r ! developm5t1 improvem5t1 & expansion ( s*ools ( nurs+4 7e7 ,reports f entities ,ea* s*ool ( nurs+ aw>d$ a grant "u ?is section %all submit an annual report to ! ,secret>y on ! activities conduct$ "u su* grant1 & o!r in=mation z ! ,secret>y may require4 7f7 ,report to ,congress ,n lat] ?an #e ye>s aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y %all submit to ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate & ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives a report t provides a summ>y ( ! activities & outcomes associat$ ) grants made "u ?is section4 ,su* report %all include-- 7#a7 a li/ ( s*ools ( nurs+ receiv+ grants "u ?is section1 includ+ ! prim>y geographic location ( any s*ool ( nurs+ t 0 improv$ or exp&$ ?r\gh su* a grant2 7#b7 ! total numb] ( /ud5ts :o are enroll$ at or :o h graduat$ f any s*ool ( nurs+ t 0 improv$ or exp&$ ?r\gh a grant "u ?is section1 :i* su* /ati/ic %all-- 7,a7 to ! ext5t su* in=mation is available1 be deid5tifi$ & disaggregat$ by race1 e?nicity1 age1 sex1 geographic region1 disability /atus1 & o!r relevant factors2 & 7,b7 include an indication ( ! numb] ( su* /ud5ts :o are f racial or e?nic gr\ps und]repres5t$ 9 ! nurs+ work=ce1 su* /ud5ts :o are f rural or und]s]v$ areas1 su* /ud5ts :o are l[-income /ud5ts1 & su* /ud5ts :o are fir/ g5]ation college /ud5ts 7z def9$ 9 section #djb;,a7h77#c7 ( ! ,high] ,education ,act ( #aife72 7#c7 to ! ext5t su* in=mation is available1 ! effects ( ! grants aw>d$ "u ?is section on reta9+ & hir+ ( faculty1 includ+ any increase 9 div]se faculty1 ! numb] ( cl9ical education p>tn]%ips1 ! mod]nization ( nurs+ education infra/ructure1 & o!r ways ?is section helps address & quickly respond to public heal? em]g5cies & p&emics2 7#d7 recomm5dations = improv+ ! grants aw>d$ "u ?is section2 & 7#e7 any o!r consid]ations z ! ,secret>y det]m9es appropriate4 7g7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re is au?oriz$ to be appropriat$ #a1jjj1jjj1jjj1 to rema9 available until exp5d$4 4 7b7 ,/r5g!n+ nurse education ,! head+ ( "p ,d ( title ,,viii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bifp et seq47 is am5d$ by /rik+ ,basic4 #cjac4 ,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 individuals 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$s ( su* individuals become m s]i\s1 complex1 & co/ly4 7#f7 ,*ang+ demographics 7su* z an ag+ population71 new heal? c>e deliv]y models 7su* z m$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$ical education4 ,immigration pa?ways l /ud5t1 ex*ange-visitor1 & employm5t visas1 & programs l ! ,national ,int]e/ ,waiv] & ,conrad ,/ate #cj ,j-#a ,visa ,waiv]1 help improve heal? access across ! ,unit$ ,/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 program71 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 increas+ ! racial & e?nic div]sity ( physicians 9 ! ,unit$ ,/ates2 & 7#d7 mitigat+ disp>ities 9 heal? & heal? c>e4 #cjad4 ,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 ,recession1 & 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? 7#bcf1hhj by #bjbe71 & prim>y c>e 7#df1jjj by #bjbe74 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]vices 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>y7 may aw>d grants to eligible entities "u p>agraph 7#b7 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 #cjae4 ,/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 #cjaf4 ,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 #bjbb4 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 ( #bjbb2 & 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#h72 & 2 & 7,e7 9 subp>agraph 7,d71 9 ! matt] prec$+ clause 7i71 by ins]t+ 1 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 "w 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 ! ali5 demon/rates1 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 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 subp>agraph 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 ,/ate #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> ! 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 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 #cjag4 ,national ,hispanic ,nurses ,day 7a7 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,a special gr\p ( nurses 9 ! ,nation are ! ,hispanic nurses4 7#b7 ,hispanic nurses provide culturally & e?nically compet5t c>e & are educat$ to be s5sitive to regional & community cu/oms ( p]sons ne$+ c>e4 7#c7 ,hispanic nurses are well-position$ to provide lead]%ip to elim9ate heal? c>e disp>ities t exi/ 9 ! ,nation4 7#d7 ,s9ce #aige1 ! ,national ,association ( ,hispanic ,nurses 7,,nahn7 has repres5t$ ,hispanic nurses 7,r,ns_/,l,p,ns7 9 ! ,unit$ ,/ates & is ! only nurs+ organization = ,hispanic nurses ^: mission is to advance ! heal? 9 ,hispanic communities & to lead1 promote1 & advocate = educational1 pr(essional1 & lead]%ip opportunities = ,hispanic nurses4 7#e7 ,s9ce ,septemb] is ! mon? t has be5 set aside to honor ! contributions ( ,hispanics1 x is only fitt+ t ,hispanic nurses be recogniz$ & honor$ dur+ ?is "t = _! out/&+ contributions to _! community & c\ntry4 7#f7 ,! designation ( an obs]vation day w help to raise aw>5ess ( ! accompli%m5ts ( ,hispanic nurses & pave ! way = ! important "w t !y mu/ cont9ue to c>ry out4 7#g7 ,ea* ,febru>y1 ! ,national ,association ( ,hispanic ,nurses conv5es ne>ly #ajj nurs+ lead]s f academia1 rese>*1 education1 & practice 9 ! ,di/rict ( ,columbia = a day on ,capitol ,hill promot+ legislation t improves ! heal? ( ,hispanic communities4 7#h7 ,hispanic nurses are /rong allies to ,congress z !y help in=m1 educate1 & "w closely ) legislators to improve ! education1 ret5tion1 recruitm5t1 & practice ( all nurses &1 m importantly1 ! heal? & safety ( ! pati5ts = :om !y provide c>e4 7#i7 ,hispanic nurses add ne$$ div]sity to ! nurs+ pr(ession1 & ^! nurses h engag$ 9 num]\s ways to support communities & ! ne$s ( an ov]look$1 "u res\rc$1 & und]s]v$ population be+ sev]ely impact$ by ,,covid-#ai4 7b7 ,s5se ( ,congress ,! ,congress-- 7#a7 supports ! goals & ideals1 & ! designation1 ( ,national ,hispanic ,nurses ,day1 z propos$ by ! ,national ,association ( ,hispanic ,nurses2 7#b7 recognizes ! significant contributions ( ,hispanic nurses to ! heal? c>e sy/em ( ! ,unit$ ,/ates2 & 7#c7 enc\rages ! p ( ! ,unit$ ,/ates to obs]ve ,national ,hispanic ,nurses ,day ) appropriate recognition1 c]emonies1 activities1 & programs to demon/rate ! importance ( ,hispanic nurses to ! ev]yday lives ( pati5ts & ! communities !y s]ve4 #cjah4 ,exp&+ m$ical education ,subp>t ,,ii ( "p ,c ( title ,,vii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bicm et seq47 is am5d$ by add+ at ! end ! foll[+3 #gdi;,c4 ,grants = s*ools ( m$ic9e & s*ools ( o/eopa?ic m$ic9e 9 und]s]v$ areas 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 may aw>d grants to in/itutions ( high] education 7includ+ consortiums ( su* in/itutions7 = ! e/abli%m5t1 improvem5t1 or expansion ( a s*ool ( m$ic9e or o/eopa?ic m$ic9e1 or a bran* campus ( a s*ool ( m$ic9e or o/eopa?ic m$ic9e4 7b7 ,priority ,9 select+ grant recipi5ts "u ?is section1 ! ,secret>y %all give priority to any in/itution ( high] education 7or consortium ( su* in/itutions7 t-- 7#a7 proposes to use ! grant = ! e/abli%m5t ( a s*ool ( m$ic9e or o/eopa?ic m$ic9e1 or a bran* campus ( a s*ool ( m$ic9e or o/eopa?ic m$ic9e1 9 an area-- 7,a7 9 :i* no o!r su* s*ool is bas$2 & 7,b7 t is a m$ically und]s]v$ community or a heal? pr(essional %ortage area2 or 7#b7 is an in/itution describ$ 9 section #cga7;a7 ( ! ,high] ,education ,act ( #aife4 7c7 ,consid]ations ,9 aw>d+ grants "u ?is section1 ! ,secret>y1 to ! ext5t practicable1 may ensure equitable di/ribution ( aw>ds among ! geographical regions ( ! ,unit$ ,/ates4 7d7 ,use ( funds ,an in/itution ( high] education 7or a consortium ( su* in/itutions7-- 7#a7 %all use grant am\nts receiv$ "u ?is section to-- 7,a7 recruit1 enroll1 & reta9 /ud5ts1 includ+ individuals :o are f disadvantag$ backgr\nds 7includ+ racial & e?nic gr\ps und]repres5t$ among m$ical /ud5ts & heal? pr(essions71 individuals f rural & und]s]v$ areas1 l[-income individuals1 & fir/ g5]ation college /ud5ts1 at a s*ool ( m$ic9e or o/eopa?ic m$ic9e or bran* campus ( a s*ool ( m$ic9e or o/eopa?ic m$ic9e2 & 7,b7 develop1 implem5t1 & exp& curriculum t emphasizes c>e = rural & und]s]v$ populations1 includ+ accessible & culturally & l+ui/ically appropriate c>e & s]vices1 at su* s*ool or bran* campus2 & 7#b7 may use grant am\nts receiv$ "u ?is section to-- 7,a7 plan & con/ruct-- 7i7 a s*ool ( m$ic9e or o/eopa?ic m$ic9e 9 an area 9 :i* no o!r su* s*ool is bas$2 or 7ii7 a bran* campus ( a s*ool ( m$ic9e or o/eopa?ic m$ic9e 9 an area 9 :i* no o!r su* s*ool is bas$2 7,b7 plan1 develop1 & meet crit]ia = accr$itation = a s*ool ( m$ic9e or o/eopa?ic m$ic9e or bran* campus ( a s*ool ( m$ic9e or o/eopa?ic m$ic9e2 7,c7 hire faculty1 includ+ faculty f racial & e?nic gr\ps :o are und]repres5t$ among ! m$ical & o!r heal? pr(essions1 & o!r /aff to s]ve at su* a s*ool or bran* campus2 7,d7 support educational programs at su* a s*ool or bran* campus2 7,e7 mod]nize & exp& infra/ructure at su* a s*ool or bran* campus2 & 7,f7 support o!r activities t ! ,secret>y det]m9es fur!r ! e/abli%m5t1 improvem5t1 or expansion ( a s*ool ( m$ic9e or o/eopa?ic m$ic9e or bran* campus ( a s*ool ( m$ic9e or o/eopa?ic m$ic9e4 7e7 ,application ,to be eligible to receive a grant "u subsection 7a71 an in/itution ( high] education 7or a consortium ( su* in/itutions71 %all submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require1 includ+ a description ( ! in/itution's or consortium's plann$ activities describ$ 9 subsection 7d74 7f7 ,report+ 7#a7 ,reports f entities ,ea* in/itution ( high] education1 or consortium ( su* in/itutions1 aw>d$ a grant "u ?is section %all submit an annual report to ! ,secret>y on ! activities conduct$ "u su* grant1 & o!r in=mation z ! ,secret>y may require4 7#b7 ,report to ,congress ,n lat] ?an #e ye>s aft] ! date ( enactm5t ( ?is section & e #e ye>s !reaft]1 ! ,secret>y %all submit to ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate & ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives a report t provides a summ>y ( ! activities & outcomes associat$ ) grants made "u ?is section4 ,su* reports %all include-- 7,a7 a li/ ( aw>dees1 includ+ _! prim>y geographic location1 & location ( any s*ool ( m$ic9e or o/eopa?ic m$ic9e1 or a bran* campus ( a s*ool ( m$ic9e or o/eopa?ic m$ic9e t 0 e/abli%$1 improv$1 or exp&$ "u a grant aw>d$ "u ?is section2 7,b7 ! total numb] ( /ud5ts 7includ+ ! numb] ( /ud5ts f racial & e?nic gr\ps und]repres5t$ among m$ical /ud5ts & heal? pr(essions1 l[-income /ud5ts1 & fir/ g5]ation college /ud5ts7 :o-- 7i7 are enroll$ at or :o h graduat$ f any s*ool ( m$ic9e or o/eopa?ic m$ic9e1 or a bran* campus ( a s*ool ( m$ic9e or o/eopa?ic m$ic9e1 t 0 e/abli%$1 improv$1 or exp&$ "u a grant aw>d$ "u ?is section1 deid5tifi$ & disaggregat$ by race1 e?nicity1 age1 sex1 geographic region1 disability /atus1 & o!r relevant factors1 to ! ext5t su* in=mation is available2 & 7ii7 subsequ5tly p>ticipate 9 an accr$it$ int]n%ip or m$ical resid5cy program ^u graduation f any s*ool ( m$ic9e or o/eopa?ic m$ic9e1 or a bran* campus ( a s*ool ( m$ic9e or o/eopa?ic m$ic9e1 t 0 e/abli%$1 improv$1 or exp&$ "u a grant aw>d$ "u ?is section1 deid5tifi$ & disaggregat$ by race1 e?nicity1 age1 sex1 geographic region1 disability /atus1 m$ical specialty pursu$1 & o!r relevant factors1 to ! ext5t su* in=mation is available2 7,c7 ! effects ( ! grants aw>d$ "u ?is section on ! heal? c>e provid] work=ce1 includ+ any impact on demographic repres5tation disaggregat$ by race1 e?nicity1 & sex1 & ! fields or specialties pursu$ by /ud5ts :o h graduat$ f any s*ool ( m$ic9e or o/eopa?ic m$ic9e1 or a bran* campus ( a s*ool ( m$ic9e or o/eopa?ic m$ic9e1 t 0 e/abli%$1 improv$1 or exp&$ "u a grant aw>d$ "u ?is section2 7,d7 ! effects ( ! grants aw>d$ "u ?is section on heal? c>e access 9 und]s]v$ areas1 includ+ m$ically und]s]v$ communities & heal? pr(essional %ortage areas2 & 7,e7 recomm5dations = improv+ ! grants aw>d$ "u ?is section1 & any o!r consid]ations z ! ,secret>y det]m9es appropriate4 7#c7 ,public availability ,! ,secret>y %all make reports submitt$ "u p>agraph 7#b7 publicly available on ! int]net website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7g7 ,def9itions ,9 ?is section3 7#a7 ,bran* campus 7,a7 ,9 g5]al ,! t]m bran* campus1 ) respect to a s*ool ( m$ic9e or o/eopa?ic m$ic9e1 means an additional location ( su* s*ool t is geographically ap>t & indep5d5t ( ! ma9 campus1 at :i* ! s*ool (f]s at lea/ #ej p]c5t ( ! program lead+ to a degree ( doctor ( m$ic9e or doctor ( o/eopa?y t is (f]$ at ! ma9 campus4 7,b7 ,indep5d5ce f ma9 campus ,= purposes ( subp>agraph 7,a71 ! location ( a s*ool describ$ 9 su* subp>agraph %all be consid]$ to be indep5d5t ( ! ma9 campus describ$ 9 su* subp>agraph if ! location-- 7i7 is p]man5t 9 nature2 7ii7 (f]s c\rses 9 educational programs lead+ to a degree1 c]tificate1 or o!r recogniz$ educational cr$5tial2 7iii7 has its own faculty & adm9i/rative or sup]visory organization2 & 7iv7 has its own budget>y & hir+ au?ority4 7#b7 ,fir/ g5]ation college /ud5t ,! t]m fir/ g5]ation college /ud5t has ! mean+ giv5 su* t]m 9 section #djb;,a7h77#c7 ( ! ,high] ,education ,act ( #aife4 7#c7 ,heal? pr(essional %ortage area ,! t]m heal? pr(essional %ortage area has ! mean+ giv5 su* t]m 9 section #ccb7;a74 7#d7 ,in/itution ( high] education ,! t]m in/itution ( high] education has ! mean+ giv5 su* t]m 9 section #aja ( ! ,high] ,education ,act ( #aife4 7h7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re is au?oriz$ to be appropriat$ #a1jjj1jjj1jjj1 to rema9 available until exp5d$4 4 ,,iv ,improv+ ,heal? ,c>e ,access & ,quality #djjj4 ,def9ition ,9 ?is title & ! am5dm5ts made by ?is title1 ! t]m heal? c>e includes all heal? c>e ne$$ ?r\gh\t ! life cycle & ! end ( life4 ,a ,r$uc+ ,b>ri]s to ,access+ ,c>e #djja4 ,protect+ protect$ areas ,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 inspection int]view1 reque/ = id5tification1 se>*1 seizure1 s]vice ( *>g+ docum5ts or subpo5as1 or surveillance = ! purposes ( immigration en=cem5t2 & 7ii7 includes an en=cem5t action at1 or focus$ on1 a protect$ area 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 protect$ area includes all ( ! physical space locat$ )9 #a1jjj feet (-- 7i7 any m$ical treatm5t or m5tal heal? c>e facility1 includ+ any hospital1 doctor's (fice1 heal? cl9ic1 alcohol or drug prev5tion1 c\nsel+1 or treatm5t facilities1 syr+e ex*ange s]vices1 vacc9ation1 treatm5t1 or te/+ sites1 em]g5t or urg5t c>e facility1 sites t s]ve pregnant individuals1 or community heal? c5t]s2 7ii7 any public or private s*ool1 includ+ any kn[n & lic5s$ day c>e facility1 pres*ool1 sites ( e>ly *ildhood programs1 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 ev5t or be=e or aft] s*ool program1 includ+ field trips & int]s*ola/ic ev5ts2 7iv7 any s*ool bus or s*ool bus /op2 7v7 places :]e *ildr5 ga!r su* z a playgr\nd1 recreation c5t]1 libr>y1 fo/] c>e facility1 or gr\p home = *ildr52 7vi7 any physical /ructure ( an organization or subdivision ( gov]nm5t t-- 7,i7 assi/s *ildr51 pregnant wom51 victims ( crime or abuse1 or individuals ) significant m5tal or physical disabilities2 7,,ii7 provides social s]vices & assi/ance1 includ+ homeless %elt]s1 community-bas$ organizations1 facilities t s]ve disabl$ p]sons1 drug or alcohol c\nsel+ & treatm5t facilities1 food banks or food pantries1 & o!r places provid+ 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 ,social ,security1 or ! ,unit$ ,/ates ,h\s+ ,act2 or 7,,iii7 provides hospice1 palliative1 or o!r available end-(-life c>e s]vices to t]m9ally ill p]sons2 7vii7 any *ur*1 synagogue1 mosque1 or o!r place ( wor%ip or religi\s /udy1 includ+ build+s r5t$ = ! purpose ( religi\s s]vices1 retreats1 c\nsel+1 work%ops1 in/ruction1 & education2 7viii7 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 7ix7 ! site ( a fun]al1 grave-side c]emony1 ros>y1 w$d+1 or o!r religi\s c]emony or obs]vance2 7x7 any public demon/ration1 su* z a m>*1 rally1 or p>ade2 7xi7 any dome/ic viol5ce %elt]1 rape crisis c5t]1 *ild advocacy c5t]1 sup]vis$ visitation c5t]1 family ju/ice c5t]1 or victim s]vices provid]2 7xii7 congressional di/rict (fices2 7xiii7 indoor & outdoor premises ( dep>tm5ts ( motor vehicles2 7xiv7 a place :]e disa/] or em]g5cy response & relief is provid$1 includ+ evacuation r\tes1 places :]e %elt] or em]g5cy supplies1 food1 or wat] are di/ribut$1 or places :]e regi/ration = disa/]-relief assi/ance or family reunification is und]way2 or 7xv7 any o!r location specifi$ by ! ,secret>y ( ,homel& ,security = purposes ( ?is subsection4 7,e7 ,! 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#b7 7,a7 ,an en=cem5t action may n take place at1 or be focus$ on1 a protect$ area unless-- 7i7 ! action involves exig5t circum/ances2 & 7ii7 prior approval = ! en=cem5t action 0 obta9$4 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 ! noncitiz5 :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 protect$ area1 (fic]s & ag5ts ref]r$ to 9 subp>agraph 7,a7 %all make e ef=t-- 7i7 to limit ! "t sp5t at ! protect$ area2 7ii7 to limit ! en=cem5t action at ! protect$ area 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 protect$ area1 (fic]s or ag5ts are l$ to a protect$ area1 & no exig5t circum/ance & prior approval ) respect to ! protect$ area1 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 surveillance on an individual2 & 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 ) respect to en=cem5t actions at or focus$ on protect$ areas & en=cem5t actions t lead (fic]s or ag5ts to a protect$ area2 & 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 ( ea* ,field ,(fice ( ,u4,s4 ,immigration & ,cu/oms ,en=cem5t2 7ii7 ea* ,field ,(fice ,director ( ,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 ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb1 ! ,secret>y ( ,homel& ,security %all modify ! ,notice to ,appe> =m 7,i-#hfb7-- 7,a7 to provide ! subject ( an en=cem5t action ) in=mation1 writt5 9 pla9 language1 summ>iz+ ! re/rictions aga9/ en=cem5t actions at protect$ areas set =? 9 ?is subsection & ! rem$ies available to ! individual if su* action violates su* re/rictions2 7,b7 to ensure t ! in=mation describ$ 9 subp>agraph 7,a7 is accessible to an individual ) limit$ ,engli% pr(ici5cy2 & 7,c7 to ensure t a subject ( an en=cem5t action is 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 protect$ area2 7ii7 ! numb] ( en=cem5t actions 9 :i* (fic]s or ag5ts 7 subsequ5tly l$ to a protect$ area2 & 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 :e!r ! site 0 a protect$ area &1 if s-- 7aa7 id5tification ( ! protect$ area2 7bb7 ea* reason :y ! en=cem5t action 0 tak5 !re2 7cc7 :]e ! en=cem5t action 0 tak5 )\t prior approval1 c]tification t notification to headqu>t]s ( a submitt+ ag5cy 0 provid$ aft] ! en=cem5t action took place2 & 7dd7 a report ( :at occurr$ dur+ & imm$iately aft] ! en=cem5t action2 7,,iv7 ! compon5ts ( ! ag5cy involv$ 9 ! en=cem5t action2 7,v7 a description ( ! en=cem5t action1 includ+ ! nature ( ! crim9al activity ( its int5d$ t>get2 7,,vi7 ! numb] ( individuals1 if any1 arre/$ or tak5 into cu/ody2 7,,vii7 ! numb] ( collat]al arre/s1 if any1 & ! reasons = ea* su* arre/2 7,,viii7 a c]tification :e!r ! location adm9i/rator ( a protect$ area 0 contact$ be=e1 dur+1 or aft] ! en=cem5t action2 & 7,,ix7 ! 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 #djjb4 ,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 ,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 #djjc4 ,availability ( basic assi/ance to lawfully pres5t noncitiz5s 7a7 ,elim9ation ( arbitr>y eligibility re/rictions 7#a7 ,9 g5]al ,sections #djb1 #djc1 #daa1 #dab1 #dba1 & #dbb ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#h ,u4,s4,c4 #afab1 #afac1 #afba1 #afbb1 #afca1 & #afcb7 are repeal$4 7#b7 ,con=m+ am5dm5ts ,title ,,iv ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#h ,u4,s4,c4 #afja et seq47 is am5d$-- 7,a7 9 section #dja7;b77#e7 ( 7#h ,u4,s4,c4 #afaa7;b77#e771 by /rik+ ! program def9$ 9 section #djb7;a77#c77;,a7 7relat+ to ! supplem5tal security income program7 & ins]t+ ! ,supplem5tal ,security ,income ,program "u title ,,xvi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acha et seq472 7,b7 9 section #djd7;a7 7#h ,u4,s4,c4 #afad7;a771 by /rik+ 1 #djb1 or #djc2 7,c7 9 section #dac 7#h ,u4,s4,c4 #afbe7-- 7i7 by /rik+ ,a ,/ate & ins]t+ ! foll[+3 7a7 ,/ate or local public b5efit def9$ ,9 ?is section1 except z provid$ 9 p>agraphs 7#b7 & 7#c71 ! t]m ,/ate or local public b5efit-- 7#a7 means-- 7,a7 any grant1 contract1 loan1 pr(essional lic5se1 or comm]cial lic5se provid$ by an ag5cy ( a ,/ate or local gov]nm5t or by appropriat$ funds ( a ,/ate or local gov]nm5t2 & 7,b7 any retirem5t1 welf>e1 heal?1 disability1 public or assi/$ h\s+1 po/second>y education1 food assi/ance1 unemploym5t b5efit1 or any o!r simil> b5efit = :i* paym5ts or assi/ance are provid$ to an individual1 h\sehold1 or family eligibility unit by an ag5cy ( a ,/ate or local gov]nm5t or by appropriat$ funds ( a ,/ate or local gov]nm5t2 7#b7 %all n apply-- 7,a7 to any contract1 pr(essional lic5se1 or comm]cial lic5se = a nonimmigrant ^: visa = entry is relat$ to su* employm5t 9 ! ,unit$ ,/ates1 or to a citiz5 ( a freely associat$ /ate1 if section #ada ( ! applicable compact ( free association approv$ 9 ,public ,law #ii-bci or #ii-feh 7or a successor provision7 is 9 effect2 7,b7 ) respect to b5efits = an ali5 :o z a "w au?oriz$ nonimmigrant or z an ali5 lawfully admitt$ = p]man5t resid5ce "u ! ,immigration & ,nationality ,act qualifi$ = su* b5efits & = :om ! ,unit$ ,/ates "u reciprocal treaty agreem5ts is requir$ to pay b5efits1 z det]m9$ by ! ,secret>y ( ,/ate1 aft] consultation ) ! ,attorney ,g5]al2 or 7,c7 to ! issuance ( a pr(essional lic5se to1 or ! r5ewal ( a pr(essional lic5se by1 a =eign national n physically pres5t 9 ! ,unit$ ,/ates2 & 7#c7 does n include any ,f$]al public b5efit4 7b7 ,pro( ( eligibility requirem5t ,a ,/ate 2 & 7ii7 9 subsection 7b71 z s designat$1 by /rik+ 7z def9$ 9 section #daa7;c772 7,d7 9 section #dcb7;d7 7#h ,u4,s4,c4 #afdb7;d771 by /rik+ 7z def9$ 9 section #daa7;c77 & ins]t+ 7z def9$ 9 section #dac7;a772 7,e7 9 section #dce 7#h ,u4,s4,c4 #afde71 by /rik+ 7z provid$ "u section #djc72 & 7,f7 9 section #dcf 7#h ,u4,s4,c4 #afdf7-- 7i7 by /rik+ ! food /amp program 7z def9$ 9 section #djb7;a77#c77;,b77 & ins]t+ ! supplem5tal nutrition assi/ance program e/abli%$ "u ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjaa et seq472 & 7ii7 by /rik+ ! supplem5tal security income program 7z def9$ 9 section #djb7;a77#c77;,a77 & ins]t+ ! ,supplem5tal ,security ,income ,program "u title ,,xvi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acha et seq474 7b7 ,qualifi$ noncitiz5s ,title ,,iv ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#h ,u4,s4,c4 #afja et seq47 is am5d$-- 7#a7 9 ! title head+1 by /rik+ ,ali5s & ins]t+ ,noncitiz5s2 7#b7 9 section #dja1 9 ! section head+-- 7,a7 by /rik+ qualifi$ ali5s & ins]t+ qualifi$ noncitiz5s2 & 7,b7 by /rik+ ,ali5s & ins]t+ ,noncitiz5s2 7#c7 by /rik+ qualifi$ ali5 ea* place x appe>s & ins]t+ qualifi$ noncitiz52 7#d7 by /rik+ qualifi$ ali5s ea* place x appe>s & ins]t+ qualifi$ noncitiz5s2 7#e7 by /rik+ qualifi$ ali5's ea* place x appe>s & ins]t+ qualifi$ noncitiz5's2 7#f7 by /rik+ an ali5 ea* place t x appe>s & ins]t+ a noncitiz52 7#g7 by /rik+ ali5 ea* place x appe>s & ins]t+ noncitiz52 7#h7 by /rik+ ali5s ea* place x appe>s & ins]t+ noncitiz5s2 & 7#i7 by /rik+ ali5's ea* place x appe>s & ins]t+ noncitiz5's4 7c7 ,access to basic s]vices = lawfully resid+ noncitiz5s ,section #dca ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#h ,u4,s4,c4 #afda7 is am5d$-- 7#a7 9 subsection 7b7-- 7,a7 9 ! subsection head+1 by /rik+ ,qualifi$ ali5 & ins]t+ ,qualifi$ noncitiz52 & 7,b7 9 ! matt] prec$+ p>agraph 7#a71 by /rik+ b5efit & all t foll[s ?r\gh ! p]iod at ! end ( ! subsection & ins]t+ b5efit1 is lawfully pres5t 9 ! ,unit$ ,/ates42 7#b7 9 subsection 7c7-- 7,a7 9 ! subsection head+1 by /rik+ ali5s z qualifi$ ali5s & ins]t+ noncitiz5s z qualifi$ noncitiz5s2 7,b7 9 p>agraph 7#c77;,b71 by /rik+ 2 or & ins]t+ a semicolon2 7,c7 9 p>agraph 7#d71 by /rik+ ! p]iod at ! end & ins]t+ 2 or2 & 7,d7 by ins]t+ aft] p>agraph 7#d7 ! foll[+3 7#e7 a noncitiz5-- 7,a7 9 a category t 0 treat$ z lawfully pres5t = purposes ( section #aaja ( ! ,pati5t ,protection & ,af=dable ,c>e ,act ( #bjaj 7#db ,u4,s4,c4 #ahjja72 7,b7 :o met ! requirem5ts ( section #djb7;a77#b77;,d7 ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#h ,u4,s4,c4 #afab7;a77#b77;,d77 on or be=e ,janu>y #a1 #bjbc2 7,c7 :o is grant$ special immigrant juv5ile /atus z describ$ by section #aja7;a77#bg77;,j7 ( ! ,immigration & ,nationality ,act 7#h ,u4,s4,c4 #aaja7;a77#bg77;,j772 7,d7 :o has a p5d+1 bona fide application = nonimmigrant /atus "u section #aja7;a77#ae77,u7 ( ! ,immigration & ,nationality ,act 7#h ,u4,s4,c4 #aaja7;a77#ae77,u772 7,e7 :o 0 grant$ relief "u ! ,def]r$ ,action = ,*ildhood ,arrivals program2 or 7,f7 any o!r p]son :o is n a citiz5 ( ! ,unit$ ,/ates b :o resides 9 a ,/ate or t]ritory ( ! ,unit$ ,/ates & is f$]ally au?oriz$ to be pres5t 9 ! ,unit$ ,/ates4 2 & 7#c7 by add+ at ! end ! foll[+3 7d7 ,noncitiz5 ,9 ?is title1 ! t]m noncitiz5 means any individual :o is n a citiz5 ( ! ,unit$ ,/ates4 4 7d7 ,*ild nutrition programs ,section #gdb ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#h ,u4,s4,c4 #afae7 is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 9 ! subsection head+1 by /rik+ ,s*ool lun* & breakfa/ programs & ins]t+ ,*ild nutrition programs2 7,b7 by /rik+ ! s*ool lun* program & ins]t+ any program2 & 7,c7 by /rik+ ! s*ool breakfa/ program "u section #d ( ! & ins]t+ any program "u !2 & 7#b7 9 subsection 7b77#a7-- 7,a7 by /rik+ ,no?+ 9 ?is ,act %all prohibit or require a ,/ate to provide to an individual :o is n a citiz5 or a qualifi$ ali51 z def9$ 9 section #dca7;b71 & ins]t+ ,a ,/ate %all n d5y2 & 7,b7 by /rik+ p>agraph 7#b7 & ins]t+ p>agraph 7#b7 on ! basis ( an individual's citiz5%ip or citiz5%ip1 ali5age1 or immigration /atus4 7e7 ,exclusion ( m$ical assi/ance exp5ditures = citiz5s ( freely associat$ ,/ates ,section #aajh7;h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acjh7;h77 is am5d$-- 7#a7 by /rik+ ,exp5ditures & ins]t+3 7#a7 ,9 g5]al ,exp5ditures 2 & 7#b7 by add+ at ! end ! foll[+3 7#b7 ,m$icaid programs ,) respect to eligibility = b5efits = a ,/ate plan approv$ "u title ,,xix1 o!r ?an m$ical assi/ance describ$ 9 section #dja7;b77#a77;,a71 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]nor ( ,pu]to ,rico1 ! ,virg9 ,isl&s1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 or ,am]ican ,samoa 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 7f7 ,*ild heal? insurance program ,section #bajg7;e77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77 is am5d$ by /rik+ subp>agraph 7,o74 7g7 ,con=m+ am5dm5ts 7#a7 ,supplem5tal food assi/ance program ,! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjaa et seq47 is am5d$-- 7,a7 9 section #e 7#g ,u4,s4,c4 #bjad7-- 7i7 9 subsection 7d7-- 7,i7 9 p>agraph 7#a71 by /rik+ law7 & all t foll[s ?r\gh ! semicolon at ! end & ins]t+ law722 & 7,,ii7 9 p>agraph 7#aj71 by /rik+ subsection 7k7 & ins]t+ subsection 7j72 7ii7 by /rik+ subsection 7i72 7iii7 9 subsection 7j71 by /rik+ subsections 7a7 ?r\gh 7i7 & ins]t+ subsections 7a7 ?r\gh 7h72 & 7iv7 by r$esignat+ subsections 7j7 ?r\gh 7n7 z subsection 7i7 ?r\gh 7m71 respectively2 7,b7 9 section #f 7#g ,u4,s4,c4 #bjae7-- 7i7 9 subsection 7f77#b77;,b71 by /rik+ an ali5 lawfully admitt$ = p]man5t & all t foll[s ?r\gh ! end ( ! subsection & ins]t+ a noncitiz5 lawfully pres5t 9 ! ,unit$ ,/ates42 & 7ii7 9 subsection 7s77#b71 by /rik+ 7i71 7k71 7l71 7m71 & 7n7 & ins]t+ 7j71 7k71 7l71 & 7m72 & 7,c7 9 section #aa7;e77#b77;,b77v77,,ii7 7#g ,u4,s4,c4 #bjbj7;e77#b77;,b77v77,,ii771 by /rik+ ali5s & ins]t+ noncitiz5s4 7#b7 ,m$icaid ,section #aijc7v7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7v77 is am5d$-- 7,a7 9 p>agraph 7#a7-- 7i7 by /rik+ p>agraphs 7#b7 & 7#d7 & ins]t+ p>agraph 7#b72 & 7ii7 by /rik+ admitt$ = & all t foll[s ?r\gh ! end ( ! p>agraph & ins]t+ pres5t 9 ! ,unit$ ,/ates42 & 7,b7 by /rik+ p>agraph 7#d74 7#c7 ,h\s+ assi/ance ,section #bad7;a7 ( ! ,h\s+ & ,community ,developm5t ,act ( #aihj 7#db ,u4,s4,c4 #adcf;a7a77 is am5d$-- 7,a7 9 p>agraph 7#f71 by /rik+ 2 or & ins]t+ a semicolon2 7,b7 9 p>agraph 7#g71 by /rik+ ! p]iod at ! end & ins]t+ 2 or2 & 7,c7 by add+ at ! end ! foll[+3 7#h7 a qualifi$ noncitiz5 7z def9$ 9 section #dca ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#h ,u4,s4,c4 #afda772 4 7#d7 ,assi/ance n treat$ z debt abs5t fraud ,section #bac;,a ( ! ,immigration & ,nationality ,act 7#h ,u4,s4,c4 #aahc;a7 is am5d$-- 7,a7 9 subsection 7a77#c7-- 7i7 9 subp>agraph 7,a71 by /rik+ 7z provid$ "u section #djc ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif72 & 7ii7 9 subp>agraph 7,b71 9 ! undesignat$ matt] foll[+ clause 7ii71 by /rik+ 7z provid$ "u section #djc ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif72 & 7,b7 9 subsection 7b77#a77;,a71 by /rik+ b5efit1 & ins]t+ b5efit by fraud12 & 7,c7 9 subsection 7d77#b77;,b71 by /rik+ 1 #djc7;c77#b71 or #daa7;b74 7#e7 ,report ,section #efe ( ! ,illegal ,immigration ,re=m & ,immigrant ,responsibility ,act ( #aiif 7#h ,u4,s4,c4 #acga7 is am5d$-- 7,a7 by /rik+ p>agraph 7#b72 & 7,b7 by r$esignat+ p>agraph 7#c7 z p>agraph 7#b74 7h7 ,pres]v+ access to heal? c>e ,section #cf;,b7c77#a77;,b7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ to read z foll[s3 7,b7 ,special rule = c]ta9 individuals lawfully pres5t 9 ! ,unit$ ,/ates ,if-- 7i7 a taxpay] has a h\sehold income :i* is n great] ?an #ajj p]c5t ( an am\nt equal to ! pov]ty l9e = a family ( ! size involv$1 7ii7 ! taxpay] is a non-citiz5 lawfully pres5t 9 ! ,unit$ ,/ates1 7iii7 ! taxpay] is ineligible = m9imum ess5tial cov]age "u section #ejjj;,a7f77#a77;,a77ii71 & 7iv7 "u ! ,m$icaid eligibility crit]ia = non-citiz5s 9 effect on ,decemb] #bf1 #bjbj1 ! taxpay] w\ld be ineligible = su* m9imum ess5tial cov]age by reason ( ! taxpay]'s immigration /atus1 ! taxpay] %all1 = purposes ( ! cr$it "u ?is section1 be treat$ z an applicable taxpay] ) a h\sehold income :i* is equal to #ajj p]c5t ( ! pov]ty l9e = a family ( ! size involv$4 4 7i7 ,f$]al ag5cy guidance ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ea* ,f$]al ag5cy1 z applicable1 %all issue guidance ) respect to implem5t+ ! am5dm5ts made by ?is section4 7j7 ,effective date ,! am5dm5ts made by ?is section %all take effect on ! date ( enactm5t ( ?is ,act4 #djjd4 ,improve af=dability & r$uce premium co/s ( heal? insurance = consum]s 7a7 ,9 g5]al ,section #cf;,b7b77#c77;,a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ to read z foll[s3 7,a7 ,applicable p]c5tage ,! applicable p]c5tage = any taxable ye> %all be ! p]c5tage su* t ! applicable p]c5tage = any taxpay] ^: h\sehold income is )9 an income ti] specifi$ 9 ! foll[+ table %all increase1 on a slid+ scale 9 a l9e> mann]1 f ! initial premium p]c5tage to ! f9al premium p]c5tage specifi$ 9 su* table = su* income ti]3 ,9 ! case ( h\sehold income 7express$ z a p]c5t ( pov]ty l9e7 )9 ! foll[+ income ti]3,! initial premium p]c5tage is--,! f9al premium p]c5tage is-- ,up to #aej p]c5t#j4jj4j #aej p]c5t up to #bjj p]c5t#j4jc4j #bjj p]c5t up to #bej p]c5t#c4jd4j #bej p]c5t up to #cjj p]c5t#d4jf4j #cjj p]c5t up to #djj p]c5t#f4jh4e #djj p]c5t & high]#h4eh4e4 4 7b7 ,con=m+ am5dm5t ,section #cf;,b7c77#a77;,a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ b does n exce$ #djj p]c5t4 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjba4 #djje4 ,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;,b71 z am5d$ by section #djjc7;h7-- 7i7 by am5d+ ! head+ to read z foll[s3 ,special rule = c]ta9 individuals ineligible = ,m$icaid due to /atus2 & 7ii7 by am5d+ clause 7ii7 to read z foll[s3 7ii7 ! taxpay] is a noncitiz5 :o is n eligible = ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act by reason ( ! individual's immigration /atus1 2 & 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$-- 7,a7 by /rik+ subsection 7e72 & 7,b7 by r$esignat+ subsections 7f7 & 7g7 z subsections 7e7 & 7f71 respectively4 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$ ,/ates14 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$-- 7,a7 by /rik+ subsection 7d72 & 7,b7 by r$esignat+ subsection 7e7 z subsection 7d74 7#e7 ,requirem5t to ma9ta9 m9imum ess5tial cov]age ,section #ejjj;,a7d7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7,a7 by /rik+ p>agraph 7#c72 & 7,b7 by r$esignat+ p>agraph 7#d7 z p>agraph 7#c74 7b7 ,con=m+ am5dm5ts 7#a7 ,e/abli%m5t ( program ,section #adaa7;a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjha7;a77 is am5d$-- 7,a7 by /rik+ p>agraph 7#a72 & 7,b7 by r$esignat+ p>agraphs 7#b71 7#c71 & 7#d7 z p>agraphs 7#a71 7#b71 & 7#c71 respectively4 7#b7 ,qualifi$ individuals ,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 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply to ye>s1 plan ye>s1 & taxable ye>s1 z applicable1 beg9n+ aft] ,decemb] #ca1 #bjbb4 #djjf4 ,remov+ b>ri]s to access to af=dable heal? c>e = lawfully resid+ immigrants "u ,m$icaid & ,,*ip 7a7 ,m$icaid ,section #aijc7v7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7v77#d771 z am5d$ by section #djjc7;g77#b71 is am5d$ by add+ at ! end ! foll[+3 7#d7 ,cov]age ( lawfully resid+ immigrants 7,a7 ,9 g5]al ,not)/&+ title ,,iv ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif1 a ,/ate %all provide m$ical assi/ance "u ?is title to individuals :o are lawfully resid+ 9 ! ,unit$ ,/ates 7includ+ individuals describ$ 9 p>agraph 7#a71 batt]$ individuals describ$ 9 section #dca7;c7 ( su* ,act1 & individuals ) an approv$ or p5d+ application = def]r$ action or o!r f$]ally au?oriz$ pres5ce71 if !y o!rwise meet ! eligibility requirem5ts = m$ical 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 paym5t74 7,b7 ,treatm5t ( m$ical assi/ance provid$ to lawfully resid+ immigrants ,no debt %all accrue "u an affidavit ( support aga9/ any sponsor ( an individual provid$ m$ical assi/ance "u subp>agraph 7,a7 on ! basis ( provision ( assi/ance to su* individual & ! co/ ( su* assi/ance %all n be consid]$ z an unreimburs$ co/4 7,c7 ,v]ification requirem5t ,z "p ( ! ,/ate's ongo+ eligibility r$et]m9ation requirem5ts & proc$ures = an individual provid$ m$ical assi/ance z a result ( ! application ( subp>agraph 7,a71 a ,/ate %all v]ify t ! individual cont9ues to lawfully reside or be lawfully pres5t 9 ! ,unit$ ,/ates us+ ! docum5tation pres5t$ to ! ,/ate by ! individual on initial enrollm5t4 ,if ! ,/ate _c successfully v]ify t ! individual is lawfully resid+ or pres5t 9 ! ,unit$ ,/ates 9 ?is mann]1 x %all require t ! individual provide ! ,/ate ) fur!r docum5tation or o!r evid5ce to v]ify t ! individual is lawfully resid+ or pres5t 9 ! ,unit$ ,/ates4 4 7b7 ,,*ip ,section #bajg7;e77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a771 z am5d$ by section #djjc7;f71 is am5d$ by ins]t+ aft] subp>agraph 7,n7 ! foll[+ new subp>agraph3 7,o7 ,p>agraph 7#d7 ( section #aijc7v7 7relat+ to lawfully resid+ individuals74 4 7c7 ,effective date 7#a7 ,9 g5]al ,except z provid$ 9 p>agraph 7#b71 ! am5dm5ts made by ?is section %all take effect on ! date ( enactm5t ( ?is ,act & %all apply to s]vices furni%$ on or aft] ! date t is #ij days aft] su* date ( enactm5t4 7#b7 ,exception if /ate legislation requir$ ,9 ! case ( a ,/ate plan = m$ical assi/ance "u title ,,xix1 or a ,/ate *ild heal? plan "u title ,,xxi1 ( ! ,social ,security ,act :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 ! respective ,/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 7d7 ,pres]v+ cov]age 7#a7 ,9 g5]al ,no?+ 9 ?is section1 includ+ ! am5dm5ts made by ?is section1 %all prev5t lawfully pres5t noncitiz5s :o are ineligible = full b5efits "u ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act f secur+ a cr$it = :i* su* lawfully pres5t noncitiz5s w\ld be eligible "u section #cf;,b7c77#a77;,b7 ( ! ,int]nal ,rev5ue ,code ( #aihf & "u ! ,m$icaid provisions = lawfully pres5t noncitiz5s1 z 9 effect on ! date prior to ! date ( enactm5t ( ?is ,act4 7#b7 ,def9ition ,= purposes ( p>agraph 7#a71 ! t]m full b5efits means1 ) respect to an individual & ,/ate1 m$ical assi/ance = all s]vices cov]$ "u ! ,/ate plan "u title ,,xix ( ! ,social ,security ,act t is n less 9 am\nt1 duration1 or scope1 or is det]m9$ by ! ,secret>y ( ,heal? & ,human ,s]vices to be sub/antially equival5t to ! m$ical assi/ance available = an individual describ$ 9 section #aijb7;a77#aj77;,a77i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77i774 #djjg4 ,consi/5cy 9 heal? insurance cov]age = individuals ) f$]ally au?oriz$ pres5ce1 includ+ def]r$ action 7a7 ,9 g5]al ,= purposes ( eligibility "u any ( ! provisions describ$ 9 subsection 7b71 all individuals grant$ lawful pres5ce 9 ! ,unit$ ,/ates %all be consid]$ to be lawfully pres5t 9 ! ,unit$ ,/ates4 7b7 ,provisions describ$ ,! provisions describ$ 9 ?is subsection are ! foll[+3 7#a7 ,ex*ange eligibility ,section #acaa ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca74 7#b7 ,r$uc$ co/-%>+ eligibility ,section #adjb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjga74 7#c7 ,premium subsidy eligibility ,section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf4 7#d7 ,m$icaid & *ip eligibility ,titles ,,xix & ,,xxi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq42 #acig;aa et seq471 includ+ "u section #aijc7v7 ( su* ,act 7#db ,u4,s4,c4 #acif;b7v774 7c7 ,effective date 7#a7 ,9 g5]al ,subsection 7a7 %all take effect on ! date ( enactm5t ( ?is ,act4 7#b7 ,transition ?r\gh special enrollm5t p]iod ,9 ! case ( an individual describ$ 9 subsection 7a7 :o1 be=e ! fir/ day ( ! fir/ annual op5 enrollm5t p]iod "u subp>agraph 7,b7 ( section #acaa7;c77#f7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;c77#f77 beg9n+ aft] ! date ( enactm5t ( ?is ,act1 is grant$ lawful pres5ce 9 ! ,unit$ ,/ates & :o1 z a result ( su* subsection1 qualifies = a subsidy "u a provision describ$ 9 p>agraph 7#b7 or 7#c7 ( subsection 7b71 ! ,secret>y ( ,heal? & ,human ,s]vices %all e/abli% a special enrollm5t p]iod "u subp>agraph 7,c7 ( su* section #acaa7;c77#f7 dur+ :i* su* individual may enroll 9 qualifi$ heal? plans ?r\gh ,ex*anges "u title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjja note et seq47 & qualify = su* a subsidy4 ,= su* an individual :o has be5 grant$ f$]ally au?oriz$ pres5ce 9 ! ,unit$ ,/ates z ( ! date ( enactm5t ( ?is ,act1 su* special enrollm5t p]iod %all beg9 n lat] ?an #ij days aft] su* date ( enactm5t4 ,no?+ 9 ?is p>agraph %all be con/ru$ z affect+ ! au?ority ( ! ,secret>y to e/abli% additional special enrollm5t p]iods "u su* subp>agraph 7,c74 #djjh4 ,/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\p 7z def9$ 9 section #agjg7;g77#a7 ( ! ,public ,heal? ,s]vice ,act71 & /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%ip1 & immigration /atus1 9 a mann] consi/5t ) title ,i ( ?is ,act1 includ+ ! am5dm5ts made by su* title2 & 7,b7 n use su* report1 or any in=mation ga!r$ 9 prep>+ su* report-- 7i7 to engage 9 or anticipate any deportation or immigration relat$ en=cem5t action by any entity1 includ+ ! ,dep>tm5t ( ,homel& ,security2 or 7ii7 = ! exploitation (1 or discrim9ation aga9/1 communities ( color or ! ,,lgbtq population4 #djji4 ,m$icaid fallback cov]age program = l[-income adults 9 non-expansion ,/ates 7a7 ,9 g5]al ,z soon z possible aft] ! date ( enactm5t ( ?is ,act ! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y7 %all-- 7#a7 directly or by contract1 e/abli% a program t (f]s eligible individuals ! opportunity to enroll 9 heal? b5efits cov]age t meets ! requirem5ts describ$ 9 subsection 7c7 & any requirem5ts applicable to su* cov]age pursuant to subsection 7d72 & 7#b7 ensure t su* program is adm9i/]$ consi/5t ) ! requirem5ts ( section #dca4aj7;c77#b7 ( title #db1 ,code ( ,f$]al ,regulations4 7b7 ,def9ition ( eligible individual ,9 ?is section1 ! t]m eligible individual means an individual :o-- 7#a7 is describ$ 9 section #aijb7;a77#aj77;,a77i77,,viii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77i77,,viii772 7#b7 resides 9 a ,/ate t-- 7,a7 does n exp5d am\nts = m$ical assi/ance "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 = all individuals describ$ 9 su* section2 & 7,b7 did n exp5d am\nts = m$ical assi/ance "u su* title = all su* individuals z ( ! date ( enactm5t ( ?is ,act2 & 7#c7 w\ld n be eligible = m$ical assi/ance "u su* ,/ate's plan = m$ical assi/ance "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 or a waiv] ( su* plan1 z su* plan or waiv] 0 9 effect on su* date4 7c7 ,heal? b5efits cov]age requirem5ts ,! requirem5ts describ$ 9 ?is subsection ) respect to heal? b5efits cov]age are ! foll[+3 7#a7 ,ess5tial heal? b5efits ,at a m9imum1 ! cov]age meets ! m9imum /&>ds requir$ "u p>agraph 7#e7 ( section #aicg7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#g7;b77 = b5*m>k cov]age describ$ 9 p>agraph 7#a7 ( su* section or b5*m>k equival5t cov]age describ$ 9 p>agraph 7#b7 ( su* section4 7#b7 ,premiums & co/-%>+ ,no premiums are impos$ = ! cov]age1 & deductibles1 co/-%>+1 or simil> *>ges may only be impos$ 9 accordance ) ! requirem5ts impos$ on ,/ate ,m$icaid plans "u section #aiaf ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifo74 7d7 ,application ( requirem5ts & provisions ( title ,,xix ( ! ,social ,security ,act ,! ,secret>y %all specify t-- 7#a7 any requirem5t applicable to ! furni%+ ( m$ical assi/ance "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 by ,/ates t h elect$ to make m$ical assi/ance available to individuals describ$ 9 section #aijb7;a77#aj77;,a77i77,,viii7 ( su* title 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77i77,,viii77 t does n conflict ) ! requirem5ts specifi$ 9 subsection 7c7 applies to ! program e/abli%$ "u ?is section2 & 7#b7 o!r provisions ( su* title apply to su* program4 7e7 ,no ,/ate m&ate ,no?+ 9 ?is section %all be con/ru$ z requir+ a ,/ate to make exp5ditures relat$ to ! program e/abli%$ "u ?is section & ! ,secret>y %all n impose any su* requirem5t4 7f7 ,fund+ ,!re are appropriat$ to ! ,secret>y = ea* fiscal ye> beg9n+ ) fiscal ye> #bjbb f any funds 9 ! ,treasury n o!rwise appropriat$1 su* sums z are necess>y to c>ry out ?is section4 #djaj4 ,increase & ext5sion ( tempor>y enhanc$ ,,fmap = ,/ates :i* beg9 to exp5d am\nts = c]ta9 m&atory individuals 7a7 ,9 g5]al ,section #aije7;ii77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7ii77#a77 is am5d$-- 7#a7 by /rik+ #h-qu>t] p]iod & ins]t+ #dj-qu>t] p]iod2 & 7#b7 by /rik+ #e p]c5tage po9ts & ins]t+ #aj p]c5tage po9ts4 7b7 ,effective date ,! am5dm5ts made by ?is section %all take effect z if includ$ 9 ! enactm5t ( section #ihad ( ! ,am]ican ,rescue ,plan ,act ( #bjba 7,public ,law #aag-b74 ,b ,improvem5t ( ,cov]age #daja4 ,m$icaid 9 ! t]ritories 7a7 ,elim9ation ( g5]al m$icaid fund+ limitations 7,cap7 = t]ritories 7#a7 ,9 g5]al ,section #aajh ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acjh7 is am5d$-- 7,a7 9 subsection 7f71 9 ! matt] prec$+ p>agraph 7#a71 by /rik+ subsections 7g7 & 7h7 & ins]t+ subsections 7g71 7h71 & 7i72 7,b7 9 subsection 7g77#b71 9 ! matt] prec$+ subp>agraph 7,a71 by ins]t+ subsection 7i7 & aft] subject to2 & 7,c7 by add+ at ! end ! foll[+ new subsection3 7i7 ,sunset ( m$icaid fund+ limitations = ,pu]to ,rico1 ! ,virg9 ,isl&s1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa ,subsections 7f7 & 7g7 %all n apply to ,pu]to ,rico1 ! ,virg9 ,isl&s1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa beg9n+ ) fiscal ye> #bjbd4 4 7#b7 ,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;f7114 7,b7 ,section #aijc7u7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7u77 is am5d$ by /rik+ p>agraph 7#d74 7#c7 ,effective date ,! am5dm5ts made by ?is section %all apply beg9n+ ) fiscal ye> #bjbd4 7b7 ,elim9ation ( specific ,f$]al m$ical assi/ance p]c5tage 7,,fmap7 limitation = t]ritories ,section #aije7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b77 is am5d$1 9 clause 7#b71 by ins]t+ = fiscal ye>s be=e fiscal ye> #bjbd aft] ,am]ican ,samoa4 7c7 ,p]mitt+ ,m$icaid ,,d% allotm5ts = t]ritories ,section #aibc7;f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;f77 is am5d$-- 7#a7 9 p>agraph 7#f71 by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,t]ritories 7i7 ,fiscal ye> #bjbc ,= fiscal ye> #bjbc1 ! ,,d% allotm5t = ,pu]to ,rico1 ! ,virg9 ,isl&s1 ,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#c74 2 & 7#b7 9 p>agraph 7#i71 by ins]t+ be=e ! p]iod at ! end ! foll[+3 1 & includes1 beg9n+ ) fiscal ye> #bjbc1 ,pu]to ,rico1 ! ,virg9 ,isl&s1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa4 #dajb4 ,ext5sion ( ! ,supplem5tal ,security ,income ,program to ,pu]to ,rico1 ! ,unit$ ,/ates ,virg9 ,isl&s1 ,guam1 & ,am]ican ,samoa 7a7 ,9 g5]al ,section #cjc ( ! ,social ,security ,am5dm5ts ( #aigb 7#hf ,/at4 #adhd7 is am5d$ by /rik+ subsection 7b74 7b7 ,con=m+ am5dm5ts 7#a7 ,def9ition ( /ate ,section #aaja7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acja7;a77#a77 is am5d$ by /rik+ ! #e? s5t5ce & ins]t+ ! foll[+3 ,su* t]m :5 us$ 9 title ,,xvi includes ,pu]to ,rico1 ! ,unit$ ,/ates ,virg9 ,isl&s1 ,guam1 & ,am]ican ,samoa44 7#b7 ,elim9ation ( limit on total paym5ts to ! t]ritories ,section #aajh ( su* ,act 7#db ,u4,s4,c4 #acjh7 is am5d$-- 7,a7 9 ! section head+1 by /rik+ 2 limitation on total paym5ts2 7,b7 by /rik+ subsection 7a72 & 7,c7 9 subsection 7c71 by /rik+ p>agraphs 7#b7 & 7#d7 & r$esignat+ p>agraphs 7#c7 & 7#e7 z p>agraphs 7#b7 & 7#d71 respectively4 7#c7 ,unit$ ,/ates nationals treat$ ! same z citiz5s ,section #afad7;a77#a77;,b7 ( su* ,act 7#db ,u4,s4,c4 #achb;c7a77#a77;,b77 is am5d$-- 7,a7 9 clause 7i77,i71 by ins]t+ or national1 aft] citiz52 7,b7 9 clause 7i77,,ii71 by add+ 2 or at ! end2 & 7,c7 9 clause 7ii71 by ins]t+ or national aft] citiz54 7#d7 ,t]ritories includ$ 9 geographic mean+ ( ,unit$ ,/ates ,section #afad7;e7 ( su* ,act 7#db ,u4,s4,c4 #achb;c7e77 is am5d$ by /rik+ & ! ,di/rict ( ,columbia & ins]t+ 1 ! ,di/rict ( ,columbia1 ,pu]to ,rico1 ! ,unit$ ,/ates ,virg9 ,isl&s1 ,guam1 & ,am]ican ,samoa4 7c7 ,waiv] au?ority ,! ,commission] ( ,social ,security may waive or modify any /atutory requirem5t relat+ to ! provision ( b5efits "u ! ,supplem5tal ,security ,income ,program "u title ,,xvi ( ! ,social ,security ,act 9 ,pu]to ,rico1 ! ,unit$ ,/ates ,virg9 ,isl&s1 ,guam1 or ,am]ican ,samoa1 to ! ext5t t ! ,commission] deems x necess>y 9 ord] to adapt ! program to ! ne$s ( ! t]ritory involv$4 7d7 ,effective date ,?is section & ! am5dm5ts made by ?is section %all take effect on ! #a/ day ( ! #a/ ,f$]al fiscal ye> t beg9s #a ye> or m aft] ! date ( ! enactm5t ( ?is ,act4 #dajc4 ,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 #bjbc 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 #bjbc 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 #dajd4 ,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 ,9 ?is title3 7#a7 ,9 g5]al ,! t]m ,indian means-- 7,a7 an ,indian1 a ,cali=nia ,indian1 or an ,urban ,indian 7z ^? t]ms are def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc772 or 7,b7 an individual :o is ( ,indian desc5t & a memb] ( an ,indian community s]v$ by a local facility or program ( ! ,indian ,heal? ,s]vice4 7#b7 ,inclusions ,! t]m ,indian includes ! foll[+ individuals3 7,a7 ,a memb] ( a f$]ally recogniz$ ,indian ,tribe4 7,b7 ,a resid5t ( an urban c5t] :o meets #a or m ( ! foll[+ crit]ia3 7i7 ,a memb] ( 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 ( #bjbb or lat] by ! ,/ate 9 :i* !y reside1 or be+ a desc5dant1 9 ! fir/ or second degree1 ( any su* memb]4 7ii7 ,an ,eskimo or ,aleut or o!r ,alaska ,native4 7iii7 ,an individual :o 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 = s]vices provid$ by ! ,indian ,heal? ,s]vice1 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;b7d7772 & 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 7c7 ,effective date ( ,,irc am5dm5t ,! am5dm5t made by subsection 7b77#c7 %all apply to taxable ye>s beg9n+ aft] ! date ( ! enactm5t ( ?is ,act4 #daje4 ,remov+ ,m$ic>e b>ri] to heal? c>e 7a7 ,"p ,a ,section #ahah7;a77#c77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#b7;a77#c77;,b77 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 #ahcf7;a77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieo7a77#b77;,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 #dajf4 ,l[]+ ,m$ic>e premiums & prescription drug co/s 7a7 ,m$ic>e ,co/ ,assi/ance ,program 7#a7 ,9 g5]al ,title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #ahii;,c4 ,m$ic>e ,co/ ,assi/ance ,program 7a7 ,9 g5]al ,effective beg9n+ ,janu>y #a1 #bjbc1 9 ! case ( a ,m$ic>e ,co/ ,assi/ance ,program eligible individual 7z def9$ 9 subsection 7b77#a771 ! ,secret>y %all provide ,m$ic>e co/ assi/ance = ! foll[+ co/s incurr$ ) respect to ! individual3 7#a7 ,premiums "u section #ahah4 7#b7 ,premiums "u section #ahci4 7#c7 ,co9surance "u ?is title 7includ+ co9surance describ$ 9 section #ahac74 7#d7 ,d$uctibles e/abli%$ "u ?is title 7includ+ ^? describ$ 9 section #ahac & section #ahcc7;b774 7#e7 ,! diff]5ce betwe5 ! am\nt t is paid "u section #ahcc7;a7 & ! am\nt t w\ld be paid "u su* section if any ref]5ce to a p]c5t less ?an #ajj p]c5t !re9 7 deem$ a ref]5ce to #ajj p]c5t4 7b7 ,det]m9ation ( eligibility 7#a7 ,m$ic>e ,co/ ,assi/ance ,program eligible individual def9$ ,! t]m ,m$ic>e ,co/ ,assi/ance ,program eligible individual means an individual :o-- 7,a7 is eligible =1 & is receiv+1 m$ical assi/ance = ! paym5t ( m$ic>e co/-%>+ "u a ,/ate ,m$icaid program pursuant to clause 7i71 7iii71 or 7iv7 ( section #aijb7;a77#aj77;,e7 z ( ,decemb] #ca1 #bjbb2 or 7,b7 7i7 is entitl$ to hospital insurance b5efits "u "p ,a 7includ+ an individual entitl$ to su* b5efits pursuant to an enrollm5t "u section #ahah72 & 7ii7 has income at or bel[ #bjj p]c5t ( ! pov]ty l9e applicable to a family ( ! size involv$4 7#b7 ,jo9t det]m9ation by ,commission] ( ,social ,security = ,,lis & ,m$ic>e co/ assi/ance 7,a7 ,9 g5]al ,! det]m9ation ( :e!r an individual is a ,m$ic>e ,co/ ,assi/ance ,program eligible individual %all be det]m9$ by ! ,commission] ( ,social ,security jo9tly ) ! det]m9ation ( :e!r an individual is a subsidy eligible individual describ$ 9 section #ahfj;,d-#ad7;a77#c74 ,su* det]m9ation %all be made ) respect to eligibility = ,m$ic>e co/ assi/ance "u ?is section & premium & co/-%>+ subsidies "u section #ahfj;,d-#ad ^u application ( an individual = a det]m9ation ) respect to eligibility = ei!r su* assi/ance or su* subsidies4 ,!re are au?oriz$ to be appropriat$ to ! ,social ,security ,adm9i/ration su* sums z may be necess>y = ! det]m9ation ( eligibility "u ?is p>agraph4 7,b7 ,effective p]iod ,det]m9ations "u ?is p>agraph ) respect to eligibility = ea* ( su* assi/ance or su* subsidies %all be effective beg9n+ ) ! mon? 9 :i* ! individual applies = a det]m9ation describ$ 9 subp>agraph 7,a7 & %all rema9 9 effect until su* "t z ! ,secret>y det]m9es ! individual is no long] eligible z det]m9$ "u subp>agraph 7,c77ii74 7,c7 ,r$et]m9ations ,) respect to eligibility det]m9ations "u ?is p>agraph-- 7i7 r$et]m9ations %all be made at ! same "t ) respect to eligibility = ,m$ic>e co/ assi/ance "u ?is section & co/-%>+ subsidies "u section #ahfj;,d-#ad1 b n m frequ5tly ?an once e #ab mon?s2 7ii7 a r$et]m9ation %all automatically det]m9e t an individual rema9s eligible = su* assi/ance or subsidies unless-- 7,i7 ! ,commission] has in=mation indicat+ t ! individual's circum/ances h *ang$ su* t ! individual is no long] eligible = su* assi/ance or subsidies2 7,,ii7 ! ,commission] s5ds notice to ! individual reg>d+ su* in=mation t reque/s a response ei!r confirm+ or correct+ su* in=mation2 & 7,,iii7 ! individual ei!r confirms su* in=mation or fails to provide docum5tation indicat+ t su* circum/ances h n *ang$ )9 #fj days ( receiv+ ! notice describ$ 9 subclause 7,,ii72 7iii7 ! ,commission] %all e/abli% proc$ures = appeals ( su* det]m9ations t are simil> to ! proc$ures describ$ 9 ! ?ird s5t5ce ( section #afca7;c77#a77;,a72 & 7iv7 judicial review ( ! f9al decision ( ! ,commission] made aft] a he>+ %all be available to ! same ext5t1 & ) ! same limitations1 z provid$ 9 subsections 7g7 & 7h7 ( section #bje4 7,d7 ,treatm5t ( m$icaid b5efici>ies ,! ,secret>y %all provide t individuals :o are full-b5efit dual eligible individuals 7z def9$ 9 section #aice7;c77#f77 or :o are recipi5ts ( supplem5tal security income b5efits "u title ,,xvi %all be treat$ z a ,m$ic>e ,co/ ,assi/ance ,program eligible individual &1 9 ! case ( su* individual :o is a "p ,d eligible individual1 a subsidy eligible individual describ$ 9 section #ahfj;,d-#ad7;a77#c74 7,e7 ,simplifi$ application =m 7i7 ,9 g5]al ,! ,secret>y %all develop & di/ribute a simplifi$ application =m = use by individuals 9 apply+ = ,m$ic>e co/ assi/ance "u ?is section & premium & co/-%>+ subsidies "u section #ahfj;,d-#ad4 ,su* =m %all be easily readable bas$ on culturally fluid language = all demographics beyond j ! v>i\s languages (f]$4 ,an audio v]sion1 digital v]sion1 & photo-voice option %\ld also be provid$ = all le>n]s4 ,! ,secret>y %all provide = ! translation ( su* application =m into at lea/ ! #aj languages 7o!r ?an ,engli%7 t are mo/ (t5 us$ by individuals apply+ = hospital insurance b5efits "u section #bbf or #bbf;,a & %all make ! translat$ =ms available to ! ,commission] ( ,social ,security4 7ii7 ,consultation ,9 develop+ ! =m "u clause 7i71 ! ,secret>y %all consult ) b5efici>y gr\ps4 7#c7 ,income det]m9ations ,= purposes ( apply+ ?is section-- 7,a7 9 ! case ( an individual :o is n treat$ z a ,m$ic>e ,co/ ,assi/ance ,program eligible individual or a subsidy eligible individual "u p>agraph 7#b77;,d71 income %all be det]m9$ 9 ! mann] describ$ "u section #afab = purposes ( ! supplem5tal security income program1 except t support & ma9t5ance furni%$ 9 k9d %all n be c\nt$ z income2 & 7,b7 ! t]m pov]ty l9e has ! mean+ giv5 su* t]m 9 section #fgc7b7 ( ! ,community ,s]vices ,block ,grant ,act 7#db ,u4,s4,c4 #iijb7b771 includ+ any revision requir$ by su* section4 7c7 ,b5efici>y protections 7#a7 ,9 g5]al ,9 ! case 9 :i* ! paym5t = ,m$ic>e co/ assi/ance = a ,m$ic>e ,co/ ,assi/ance ,program eligible individual ) respect to an item or s]vice is r$uc$ or elim9at$1 ! individual %all n h any legal liability to make paym5t to a provid] ( s]vices 7z def9$ 9 section #ahfa7u77 or suppli] 7z def9$ 9 section #ahfa7;d77 or to an organization describ$ 9 section #aijc7m77#a77;,a7 = ! s]vice1 & any lawful sanction t may be impos$ ^u a provid] ( s]vices or suppli] or su* an organization = excess *>ges "u ?is title or title ,,xix %all apply to ! imposition ( any *>ge impos$ ^u ! individual 9 su* case4 7#b7 ,cl>ification ,?is p>agraph %all n be con/ru$ z prev5t+ paym5t ( any m$ic>e co/ assi/ance by a m$ic>e supplem5tal policy or an employ] retiree heal? plan on behalf ( an individual4 7d7 ,adm9i/ration 7#a7 ,9 g5]al ,! ,secret>y %all e/abli% proc$ures = ! adm9i/ration ( ! program "u ?is section4 7#b7 ,fund+ ,= purposes ( c>ry+ out ?is section1 ! ,secret>y %all make paym5ts f ! ,f$]al ,hospital ,insurance ,tru/ ,fund "u section #ahag & ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda1 9 su* proportion z ! ,secret>y det]m9es appropriate1 ( su* am\nts z ! ,secret>y det]m9es necess>y to provide ,m$ic>e co/ assi/ance "u ?is section4 7e7 ,ref]5ces to m$ic>e co/-,%>+ ,effective beg9n+ ,janu>y #a1 #bjbc1 any ref]5ce to m$ic>e co/-%>+ describ$ 9 section #aije7p7 %all be deem$ a ref]5ce to ,m$ic>e co/ assi/ance "u ?is section4 7f7 ,outrea* ef=ts ,= provisions relat+ to outrea* ef=ts to increase aw>5ess ( ! availability ( ,m$ic>e co/ assi/ance1 see section #aadd4 4 7#b7 ,special enrollm5t p]iod 7,a7 ,no premium p5alty ,section #ahci7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7b77 is am5d$1 9 ! la/ s5t5ce1 by ins]t+ ! foll[+ be=e ! p]iod3 or1 effective beg9n+ ,janu>y #a1 #bjbc1 = individuals :o are ,m$ic>e ,co/ ,assi/ance ,program eligible individuals 7z def9$ 9 section #ahii;,b7b77#a7744 7,b7 ,special enrollm5t p]iod ,section #ahcg ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciep7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7p7 ,special enrollm5t p]iod = ,m$ic>e ,co/ ,assi/ance ,program eligible individual 7#a7 ,9 g5]al ,effective beg9n+ ,janu>y #a1 #bjbc1 ! ,secret>y %all e/abli% special enrollm5t p]iods = ,m$ic>e ,co/ ,assi/ance ,program eligible individuals 7z def9$ 9 section #ahii;,c7b77#a774 7#b7 ,cov]age p]iod ,9 ! case ( an individual :o enrolls dur+ ! special enrollm5t p]iod provid$ "u p>agraph 7#a71 ! cov]age p]iod "u ?is "p %all-- 7,a7 beg9 on ! fir/ day ( ! fir/ mon? 9 :i* ! individual applies = a det]m9ation "u section #ahii;,c7b77#b77;,a72 & 7,b7 rema9 9 effect until su* "t z ! ,secret>y det]m9es ! individual is no long] eligible z det]m9$ "u section #ahii;,c7b77#b77;,c77ii74 4 7,c7 ,con=m+ sunset ( ,/ate agreem5ts relat+ to enrollm5t ( qualifi$ m$ic>e b5efici>ies 7i7 ,"p ,a ,section #ahah7;g7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#b7;g77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#c7 ,sunset ,?is subsection %all n apply on or aft] ,janu>y #a1 #bjbc4 4 7ii7 ,"p ,b ,section #ahdc7;h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciev7h77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#c7 ,sunset ) respect to qualifi$ m$ic>e b5efici>ies ,?is subsection %all n apply ) respect to qualifi$ m$ic>e b5efici>ies on or aft] ,janu>y #a1 #bjbc4 4 7#c7 ,public aw>5ess campaign ,section #aadd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#ad7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7d7 ,public aw>5ess campaign 7#a7 ,9 g5]al ,! ,commission] %all conduct a public aw>5ess campaign to educate ,m$ic>e b5efici>ies on ! availability ( ,m$ic>e co/ assi/ance = l[-income individuals "u section #ahii;,b4 7#b7 ,coord9ation ,9 c>ry+ out ! public aw>5ess campaign "u p>agraph 7#a71 ! ,commission] %all coord9ate ) ,/ate heal? insurance assi/ance programs describ$ 9 subsection 7a77#a77;,a7 ( section #aai ( ! ,m$ic>e ,improvem5ts = ,pati5ts & ,provid]s ,act ( #bjjh 7#db ,u4,s4,c4 #acie;b-#c note71 ! ,adm9i/rator ( ! ,adm9i/ration = ,community ,liv+1 & ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 7#c7 ,fund+ ,!re is appropriat$ to ! ,commission]1 out ( any funds 9 ! ,treasury n o!rwise appropriat$1 #aj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbe1 to provide grants to ,/ate heal? insurance assi/ance programs to c>ry out outrea* & education activities "u ! public aw>5ess campaign pursuant to ?is subsection4 4 7b7 ,mov+ ,m$ic>e co/-,%>+ b5efits f ,m$icaid to ,m$ic>e 7#a7 ,end+ mo/ ,m$ic>e co/-,%>+ b5efits "u ,m$icaid ,section #aijb7;a77#aj7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77 is am5d$-- 7,a7 by ins]t+ = cal5d> qu>t]s beg9n+ be=e ,janu>y #a1 #bjbc1 be=e = mak+ ea* place x appe>s 9 clauses 7i71 7iii71 & 7iv7 ( subp>agraph 7,e72 & 7,b7 9 ! matt] foll[+ subp>agraph 7,g7-- 7i7 by ins]t+ furni%$ dur+ cal5d> qu>t]s beg9n+ be=e ,janu>y #a1 #bjbc aft] 7describ$ 9 section #aije7p77#c772 7ii7 by /rik+ 7,,xv7 & ins]t+ 1 7,,xv72 7iii7 by /rik+ & 7,,xviii7 & ins]t+ 1 7,,xviii72 7iv7 by /rik+ & 7,,xix7 & ins]t+ 7,,xix72 & 7v7 by ins]t+ 1 & 7,,xx7 no m$ical assi/ance = m$ic>e co/-%>+1 o!r ?an m$ical assi/ance = m$ic>e co/-%>+ = qualifi$ disabl$ & work+ individuals describ$ 9 section #aije7s71 %all be made available aft] ,janu>y #a1 #bjbc be=e ! semicolon at ! end4 7#b7 ,con=m+ am5dm5ts 7,a7 ,title ,,xix 7i7 ,section #aijc7;i7 ( su* ,act 7#db ,u4,s4,c4 #acif;b7i771 z am5d$ by section #djjb1 is am5d$-- 7,i7 9 p>agraph 7#bf71 by /rik+ or at ! end2 7,,ii7 9 p>agraph 7#bg71 by /rik+ ! p]iod at ! end & ins]t+ 2 or2 & 7,,iii7 by ins]t+ aft] p>agraph 7#bg7 ! foll[+ new p>agraph3 7#bh7 ) respect to any am\nt exp5d$ = m$ical assi/ance = m$ic>e co/-%>+ 7o!r ?an m$ical assi/ance = m$ic>e co/-%>+ = qualifi$ disabl$ & work+ individuals describ$ 9 section #aije7s77 furni%$ dur+ cal5d> qu>t]s beg9n+ on or aft] ,janu>y #a1 #bjbc4 4 7ii7 ,section #aije7;a7 ( su* ,act 7#db ,u4,s4,c4 #acif;d7a77 is am5d$1 9 ! fir/ s5t5ce1 by ins]t+ furni%$ dur+ cal5d> qu>t]s beg9n+ be=e ,janu>y #a1 #bjbc aft] m$ic>e co/-%>+4 7iii7 ,section #aicc7;g7 ( su* ,act 7#db ,u4,s4,c4 #acifu-#c7;g77 is am5d$-- 7,i7 9 p>agraph 7#b77,q71 by /rik+ p>agraph 7#d71 = ea* subsequ5t ye> & ins]t+ p>agraphs 7#d7 & 7#e71 = ea* subsequ5t ye> be=e #bjbc2 & 7,,ii7 by add+ at ! end ! foll[+3 7#e7 ,sunset ,no individual %all be select$ to be a qualify+ individual = any cal5d> ye> or p]iod "u ?is section beg9n+ on or aft] ,janu>y #a1 #bjbc1 & no ,/ate allocation %all be made = any fiscal ye> or p]iod "u ?is section beg9n+ on or aft] ,janu>y #a1 #bjbc4 4 7iv7 ,section #aice7;a7 ( su* ,act 7#db ,u4,s4,c4 #acifu-#e7;a77 is am5d$-- 7,i7 9 p>agraph 7#b77;,a71 by /rik+ make det]m9ations & ins]t+ prior to ,janu>y #a1 #bjbc1 make det]m9ations2 & 7,,ii7 9 p>agraph 7#c71 by ins]t+ prior to ,janu>y #a1 #bjbc1 be=e ! ,/ate %all4 7c7 ,enhanc+ prescription drug af=dability by exp&+ access to assi/ance ) out-(-,pocket co/s "u ,m$ic>e "p ,d = l[-,income s5iors & individuals ) disabilities 7#a7 ,exp&+ access ,section #ahfj;,d-#ad ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7 is am5d$-- 7,a7 9 subsection 7a7-- 7i7 9 ! subsection head+1 by /rik+ #aej p]c5t & ins]t+ #bjj p]c5t2 7ii7 9 p>agraph 7#a7-- 7,i7 9 ! p>agraph head+1 by /rik+ #ace p]c5t & ins]t+ #bjj p]c5t2 & 7,,ii7 9 ! matt] prec$+ subp>agraph 7,a7-- 7aa7 by /rik+ #ace p]c5t & ins]t+ #bjj p]c5t2 & 7bb7 by /rik+ & :o meets ! res\rces requirem5t describ$ 9 p>agraph 7#c77;,d7 or :o is cov]$ "u ?is p>agraph "u p>agraph 7#c77;,b77i7 & ins]t+ or :o is cov]$ "u ?is p>agraph "u p>agraph 7#c77;,b77v72 7iii7 by /rik+ p>agraph 7#b72 7iv7 9 p>agraph 7#c7-- 7,i7 9 subp>agraph 7,a7-- 7aa7 9 clause 7i71 by add+ & at ! end2 7bb7 9 clause 7ii7-- 7,,aa7 by /rik+ #aej p]c5t & ins]t+ #bjj p]c5t2 & 7,,bb7 by /rik+ 2 & at ! end & ins]t+ a p]iod2 & 7cc7 by /rik+ clause 7iii72 7,,ii7 by /rik+ subp>agraphs 7,b7 & 7,c7 & ins]t+ ! foll[+3 7,b7 ,det]m9ations ,= provisions relat+ to jo9t det]m9ations ) respect to eligibility = ,m$ic>e co/ assi/ance "u section #ahii;,c & premium & co/-%>+ subsidies "u ?is section1 see section #ahii;,c7b77#b74 7,c7 ,income det]m9ations ,= purposes ( apply+ ?is section-- 7i7 9 ! case ( an individual :o is n treat$ z a ,m$ic>e co/-%>+ assi/ance eligible individual & a subsidy eligible individual "u section #ahii;,c7b77#b77;,d71 income %all be det]m9$ 9 ! mann] describ$ "u section #afab = purposes ( ! supplem5tal security income program1 except t support & ma9t5ance furni%$ 9 k9d %all n be c\nt$ z income2 & 7ii7 ! t]m pov]ty l9e has ! mean+ giv5 su* t]m 9 section #fgc7b7 ( ! ,community ,s]vices ,block ,grant ,act 7#db ,u4,s4,c4 #iijb7b771 includ+ any revision requir$ by su* section4 2 & 7,,iii7 by /rik+ subp>agraphs 7,d71 7,e71 & 7,g72 & 7v7 9 p>agraph 7#d71 by /rik+ subp>agraph 7,b72 & 7,b7 9 subsection 7c77#a71 9 ! second s5t5ce1 by /rik+ subsections 7a77#a77;,d7 & 7a77#b77;,e7 & ins]t+ subsection 7a77#a77;,d74 7#b7 ,treatm5t ( r$uction ( co/-,%>+ = individuals receiv+ home & community-bas$ s]vices ,section #ahfj;,d-#ad7;a77#a77;,d77i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#a77;,d77i77 is am5d$-- 7,a7 by /rik+ :o w\ld be su* an in/itutionaliz$ individual or c\ple1 if ! full-b5efit dual eligible individual 7 n2 & 7,b7 by /rik+ or subsection 7c7 or 7d7 ( section #aiae or "u a ,/ate plan am5dm5t "u subsection 7i7 ( su* section & ins]t+ 1 section #aaae;,a1 section #aiae1 or "u a ,/ate plan am5dm5t4 7#c7 ,effective date ,! am5dm5ts made by ?is subsection %all apply to plan ye> #bjbc & subsequ5t plan ye>s4 #dajg4 ,r$uc+ co/-%>+1 align+ income & res\rce eligibility te/s1 simplify+ enrollm5t1 & o!r program improvem5ts = l[-income b5efici>ies 7a7 ,increase 9 income eligibility to #ace p]c5t ( ,,fpl = qualifi$ ,m$ic>e b5efici>ies 7#a7 ,9 g5]al ,section #aije7p77#b77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77#b77;,a77 is am5d$ by /rik+ %all be at lea/ ! p]c5t provid$ "u subp>agraph 7,b7 7b n m ?an #ajj p]c5t7 ( ! (ficial pov]ty l9e & all t foll[s ?r\gh ! p]iod at ! end & ins]t+ ! foll[+3 %all be-- 7i7 be=e ,janu>y #a1 #bjbc1 at lea/ ! p]c5t provid$ "u subp>agraph 7,b7 7b n m ?an #ajj p]c5t7 ( ! (ficial pov]ty l9e 7z def9$ by ! ,(fice ( ,managem5t & ,budget1 & revis$ annually 9 accordance ) section #fgc7b7 ( ! ,omnibus ,budget ,reconciliation ,act ( #aiha7 applicable to a family ( ! size involv$2 & 7ii7 on or aft] ,janu>y #a1 #bjbc1 equal to #ace p]c5t ( ! (ficial pov]ty l9e 7z s def9$ & revis$7 applicable to a family ( ! size involv$4 4 7#b7 ,n c\nt+ 9-k9d support & ma9t5ance z income ,section #aije7p77#b77;,d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77#b77;,d77 is am5d$ by add+ at ! end ! foll[+ new clause3 7iii7 ,9 det]m9+ income "u ?is subsection1 support & ma9t5ance furni%$ 9 k9d %all n be c\nt$ z income4 4 7b7 ,increase 9 income eligibility to #bjj p]c5t ( ,,fpl = specifi$ l[-,income ,m$ic>e b5efici>ies 7#a7 ,eligibility ( individuals ) incomes bel[ #aej p]c5t ( ,,fpl ,section #aijb7;a77#aj77;,e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,e77 is am5d$-- 7,a7 by add+ & at ! end ( clause 7ii72 7,b7 9 clause 7iii7-- 7i7 by /rik+ & #abj p]c5t 9 #aiie & ye>s !reaft] & ins]t+ #abj p]c5t 9 #aiie & ye>s !reaft] be=e #bjbc1 & #bjj p]c5t 9 #bjbc & ye>s !reaft]2 & 7ii7 by /rik+ & at ! end2 & 7,c7 by /rik+ clause 7iv74 7#b7 ,ref]5ces ,section #aije7p77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77#a77 is am5d$ by add+ at & bel[ subp>agraph 7,c7 ! foll[+ flu% s5t5ce3 ,! t]m specifi$ l[-income m$ic>e b5efici>y means an individual describ$ 9 section #aijb7;a77#aj77;,e77iii74 4 7#c7 ,con=m+ am5dm5ts 7,a7 ,! fir/ s5t5ce ( section #aije7;b7 ( su* ,act 7#db ,u4,s4,c4 #acif;d7b77 is am5d$ by /rik+ 8& section #aicc7;d704 7,b7 ,section #aicc ( su* ,act 7#db ,u4,s4,c4 #acifu-#c7 is repeal$4 7c7 #ajj p]c5t ,,fmap ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7jj7 ,increas$ ,,fmap = exp&$ m$ic>e co/-,%>+ populations 7#a7 ,9 g5]al ,not)/&+ subsection 7b71 ) respect to exp5ditures describ$ 9 p>agraph 7#b7 ! ,f$]al m$ical assi/ance p]c5tage %all be equal to #ajj p]c5t4 7#b7 ,exp5ditures describ$ ,! exp5ditures describ$ 9 ?is p>agraph are exp5ditures made on or aft] ,janu>y #a1 #bjbc1 = m$ical assi/ance = m$ic>e co/-%>+ provid$ to any individual "u clause 7i71 7ii71 or 7iii7 ( section #aijb7;a77#aj77;,e7 :o w\ld n h be5 eligible = m$ic>e co/-%>+ "u any su* clause "u ! income or res\rce eligibility /&>ds 9 effect on ,octob] #a1 #bjah4 4 7d7 ,consolidation ( l[-,income subsidy res\rce eligibility te/s 7#a7 ,9 g5]al ,section #ahfj;,d-#ad7;a77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#c77 is am5d$-- 7,a7 by /rik+ subp>agraph 7,d72 7,b7 by r$esignat+ subp>agraphs 7,e7 ?r\gh 7,g7 z subp>agraphs 7,d7 ?r\gh 7,f71 respectively2 & 7,c7 9 ! head+ ( subp>agraph 7,d71 z s r$esignat$1 by /rik+ ,alt]native4 7#b7 ,cl>ification ( c]ta9 rules relat+ to income & res\rce det]m9ations ,section #ahfj;,d-#ad7;a77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#c771 z am5d$ by p>agraph 7#a71 is am5d$ by /rik+ subp>agraph 7,f7 & ins]t+ ! foll[+ new subp>agraphs3 7,f7 ,res\rce exclusions ,9 det]m9+ ! res\rces ( an individual 7& ! eligible sp\se ( ! individual1 if any7 "u section #afac = purposes ( subp>agraph 7,d7-- 7i7 no "p ( ! value ( any life insurance policy %all be tak5 into acc\nt2 7ii7 no "p ( ! value ( any vehicle %all be tak5 into acc\nt2 7iii7 !re %all be exclud$ an am\nt equal to #a1ejj ea* ) respect to any individual or eligible sp\se ( an individual :o atte/s t "s ( ! res\rces ( su* individual or sp\se w be us$ to meet ! burial & relat$ exp5ses ( su* individual or sp\se2 & 7iv7 no balance 91 or b5efits receiv$ "u1 an employee p5sion b5efit plan 7z def9$ 9 section #c ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd7 %all be tak5 into acc\nt4 7,g7 ,family size ,9 det]m9+ ! size ( ! family ( an individual = purposes ( det]m9+ ! income eligibility ( su* individual "u ?is section1 an individual's family %all consi/ (-- 7i7 ! individual2 7ii7 ! individual's sp\se :o lives 9 ! same h\sehold z ! individual 7if any72 & 7iii7 any o!r individuals :o-- 7,i7 are relat$ to ! individual ^: income eligibility is 9 "q or su* individual's sp\se :o lives 9 ! same h\sehold2 7,,ii7 are liv+ 9 ! same h\sehold z su* individual2 & 7,,iii7 are dep5d5t on su* individual or su* individual's sp\se :o is liv+ 9 ! same h\sehold = at lea/ "o-half ( _! f9ancial support4 4 7#c7 ,con=m+ am5dm5ts ,section #ahfj;,d-#ad7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77 is am5d$-- 7,a7 9 p>agraph 7#a71 9 ! matt] prec$+ subp>agraph 7,a71 by ins]t+ 7z det]m9$ "u p>agraph 7#c77;,g77 aft] family ( ! size involv$2 & 7,b7 9 p>agraph 7#c71 z am5d$ by p>agraphs 7#a7 & 7#b7-- 7i7 9 subp>agraph 7,a71 9 ! matt] prec$+ clause 7i71 by /rik+ subp>agraph 7,f7 & ins]t+ subp>agraph 7,e72 7ii7 9 subp>agraph 7,a77ii71 by ins]t+ 7z det]m9$ "u subp>agraph 7,g77 aft] family ( ! size involv$2 7iii7 9 subp>agraph 7,a77iii71 by /rik+ or 7,e72 7iv7 9 subp>agraph 7,b77v71 9 ! matt] prec$+ subclause 7,i71 by /rik+ subp>agraph 7,f7 & ins]t+ subp>agraph 7,e72 & 7v7 9 subp>agraph 7,d77i71 9 ! matt] prec$+ subclause 7,i71 by /rik+ subject to ! life insurance policy exclusion provid$ "u subp>agraph 7,g7 & ins]t+ subject to ! res\rce exclusions provid$ "u subp>agraph 7,f74 7e7 ,alignm5t ( l[-,income subsidy & m$ic>e sav+s program income & res\rce eligibility te/s 7#a7 ,application ( ,m$icaid sp\sal impov]i%m5t res\rce all[ance to ,,msp & ,,lis res\rce eligibility ,section #aije7p77#a77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77#a77;,c77 is am5d$ to read z foll[s3 7,c7 ^: res\rces 7z det]m9$ "u section #afac = purposes ( ! supplem5tal security income program subject to ! res\rce exclusions "u subp>agraph 7,g7 ( section #ahfj;,d-#ad7;a77#c77 d n exce$-- 7i7 9 ! case ( an individual ) a sp\se1 an am\nt equal to ! sum ( ! fir/ am\nt specifi$ 9 subsection 7f77#b77;,a77i7 ( section #aibd 7z adju/$ "u subsection 7g7 ( su* section7 & ! am\nt specifi$ 9 subsection 7f77#b77;,a77ii77,,ii7 ( su* section 7z s adju/$72 or 7ii7 9 ! case ( an individual :o does n h a sp\se1 an am\nt equal to ( ! am\nt describ$ 9 clause 7i74 4 7#b7 ,application to ,q,d,w,is ,section #aije7s77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7s77#c77 is am5d$ to read z foll[s3 7#c7 ^: res\rces 7z det]m9$ "u section #afac = purposes ( ! supplem5tal security income program subject to ! res\rce exclusions "u subp>agraph 7,g7 ( section #ahfj;,d-#ad7;a77#c77 d n exce$-- 7,a7 9 ! case ( an individual ) a sp\se1 ! am\nt 9 effect = ! ye> "u clause 7i7 ( subsection 7p77#a77;,c72 & 7,b7 9 ! case ( an individual :o does n h a sp\se1 ! am\nt 9 effect = ! ye> "u clause 7ii7 ( subsection 7p77#a77;,c72 & 4 7#c7 ,application to ,,lis ,clause 7i7 ( section #ahfj;,d-#ad7;a77#c77;,d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#c77;,d771 z r$esignat$ & am5d$ by subsection 7d77#a71 is am5d$ to read z foll[s3 7i7 ,9 g5]al ,! res\rces requirem5t ( ?is subp>agraph is t an individual's res\rces 7z det]m9$ "u section #afac = purposes ( ! supplem5tal security income program subject to ! res\rce exclusions provid$ "u subp>agraph 7,g77 d n exce$ ! am\nt 9 effect = ! ye> "u section #aije7p77#a77;,c77ii74 4 7f7 ,enrollm5t simplifications 7#a7 ,application ( #c-mon? retroactive eligibility to ,q,m,bs 7,a7 ,9 g5]al ,section #aijb7;e77#h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#h77 is am5d$ by /rik+ aft] ! end ( ! mon? 9 :i* ! det]m9ation fir/ occurs & ins]t+ 9 or aft] ! ?ird mon? be=e ! mon? 9 :i* ! individual makes application = assi/ance4 7,b7 ,process = submitt+ claims dur+ retroactive eligibility p]iod ,section #aijb7;e77#h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#h77 is fur!r am5d$ by add+ at ! end ! foll[+3 ,! ,secret>y %all provide = a process "u :i* claims = m$ical assi/ance "u ! ,/ate plan may be submitt$ = s]vices furni%$ to su* an individual dur+ su* #c-mon? p]iod be=e ! mon? 9 :i* ! individual made application = assi/ance44 7,c7 ,con=m+ am5dm5t ,section #aije7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is am5d$1 9 ! matt] prec$+ p>agraph 7#a71 by /rik+ or1 9 ! case ( m$ic>e co/-%>+ ) respect to a qualifi$ m$ic>e b5efici>y describ$ 9 subsection 7p77#a71 if provid$ aft] ! mon? 9 :i* ! individual becomes su* a b5efici>y4 7#b7 ,/ate option = #ab-mon? cont9u\s eligibility = ,s,l,m,bs & ,q,w,d,is ,section #aijb7;e77#ab7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#ab77 is am5d$-- 7,a7 by r$esignat+ subp>agraphs 7,a7 & 7,b7 z clauses 7i7 & 7ii71 respectively2 7,b7 by ins]t+ 7,a7 aft] 7#ab72 & 7,c7 by add+ at ! end ! foll[+3 7,b7 ,at ! option ( ! ,/ate1 ! plan may provide t an individual :o is det]m9$ to be eligible = b5efits "u a ,/ate plan approv$ "u ?is title "u any ( ! foll[+ eligibility categories1 or :o is r$et]m9$ to be eligible = su* b5efits "u any ( su* categories1 %all be consid]$ to meet ! eligibility requirem5ts met on ! date ( application & %all rema9 eligible = ^? b5efits until ! end ( ! #ab-mon? p]iod foll[+ ! date ( ! det]m9ation or r$et]m9ation ( eligibility1 except t a ,/ate may provide = su* det]m9ations m frequ5tly1 b n m frequ5tly ?an once e #f mon?s = an individual3 7i7 ,a specifi$ l[-income m$ic>e b5efici>y describ$ 9 subsection 7a77#aj77;,e77iii7 ( ?is section :o is det]m9$ eligible = m$ic>e co/-%>+ describ$ 9 section #aije7p77#c77;,a77ii74 7ii7 ,a qualifi$ disabl$ & work+ individual describ$ 9 section #aije7s7 :o is det]m9$ eligible = m$ic>e co/-%>+ describ$ 9 section #aije7p77#c77;,a77i74 4 7#c7 ,/ate option to use ,express ,lane eligibility = ! ,m$ic>e ,sav+s ,program ,section #aijb7;e77#ac77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#ac77;,a77 is am5d$ by add+ at ! end ! foll[+ new clause3 7iii7 ,/ate option to ext5d express lane eligibility to o!r populations 7,i7 ,9 g5]al ,at ! option ( ! ,/ate1 ! ,/ate may apply ! provisions ( ?is p>agraph ) respect to det]m9+ eligibility "u ?is title = an eligible individual 7z def9$ 9 subclause 7,,ii774 ,9 apply+ ?is p>agraph 9 ! case ( a ,/ate mak+ su* an option1 any ref]5ce 9 ?is p>agraph to a *ild ) respect to ?is title 7o!r ?an a ref]5ce to *ild heal? assi/ance7 %all be deem$ to be a ref]5ce to an eligible individual4 7,,ii7 ,eligible individual def9$ ,9 ?is clause1 ! t]m eligible individual means any ( ! foll[+3 7aa7 ,a qualifi$ m$ic>e b5efici>y describ$ 9 section #aije7p77#a7 = purposes ( det]m9+ eligibility = m$ic>e co/-%>+ 7z def9$ 9 section #aije7p77#c774 7bb7 ,a specifi$ l[-income m$ic>e b5efici>y describ$ 9 subsection 7a77#aj77;,e77iii7 ( ?is section = purposes ( det]m9+ eligibility = m$ic>e co/-%>+ describ$ 9 section #aije7p77#c77;,a77ii74 7cc7 ,a qualifi$ disabl$ & work+ individual describ$ 9 section #aije7s7 = purposes ( det]m9+ eligibility = m$ic>e co/-%>+ describ$ 9 section #aije7p77#c77;,a77i74 4 7g7 ,m$icaid treatm5t ( c]ta9 ,m$ic>e provid]s ,section #aijb7n7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7n77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#d7 ,a ,/ate plan %all n d5y a claim f a provid] or suppli] ) respect to m$ic>e co/-%>+ describ$ 9 subp>agraph 7,b71 7,c71 or 7,d7 ( section #aije7p77#c7 = an item or s]vice :i* is eligible = paym5t "u title ,,xviii on ! basis t ! provid] or suppli] does n h a provid] agreem5t 9 effect "u ?is title or does n o!rwise s]ve all individuals entitl$ to m$ical assi/ance "u ?is title4 ,! ,/ate %all create a me*anism ?r\gh :i* provid]s or suppli]s t d n o!rwise h provid] agreem5ts ) ! ,/ate c bill ! ,/ate = m$ic>e co/-%>+ = qualifi$ m$ic>e b5efici>ies4 4 7h7 ,eligibility = o!r programs ,section #aije7p7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#g7 ,not)/&+ any o!r provision ( law1 any m$ical assi/ance = "s or all m$ic>e co/-%>+ "u ?is title %all n be consid]$ income or res\rces 9 det]m9+ eligibility =1 or ! am\nt ( assi/ance or b5efits provid$ "u1 any o!r public b5efit provid$ "u ,f$]al law or ! law ( any ,/ate or political subdivision !re(4 4 7i7 ,treatm5t ( qualifi$ ,m$ic>e b5efici>ies1 specifi$ l[-,income ,m$ic>e b5efici>ies1 & o!r dual eligibles z m$ic>e b5efici>ies ,section #ahfb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7p7 ,treatm5t ( ,qualifi$ ,m$ic>e ,b5efici>ies 7,q,m,bs71 ,specifi$ ,l[-,income ,m$ic>e ,b5efici>ies 7,s,l,m,bs71 & ,o!r ,dual ,eligibles ,no?+ 9 ?is title %all be con/ru$ z au?oriz+ a provid] ( s]vices or suppli] to discrim9ate 7?r\gh a private contractual arrangem5t or o!rwise7 aga9/ an individual :o is o!rwise entitl$ to s]vices "u ?is title on ! basis t ! individual is a qualifi$ m$ic>e b5efici>y 7z def9$ 9 section #aije7p77#a771 a specifi$ l[-income m$ic>e b5efici>y1 or is o!rwise eligible = m$ical assi/ance = m$ic>e co/-%>+ or o!r b5efits "u title ,,xix4 4 7j7 ,additional ,fund+ = ,/ate ,heal? ,insurance ,assi/ance ,programs 7#a7 ,grants 7,a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is subsection ref]r$ to z ! ,secret>y7 %all use am\nts made available "u subp>agraph 7,b7 to make grants to ,/ates = ,/ate heal? insurance assi/ance programs receiv+ assi/ance "u section #dcfj ( ! ,omnibus ,budget ,reconciliation ,act ( #aiij4 7,b7 ,fund+ ,= purposes ( mak+ grants "u ?is subsection1 ! ,secret>y %all provide = ! transf]1 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 9 ! same proportion z ! ,secret>y det]m9es "u section #ahec7;f7 ( su* ,act 7#db ,u4,s4,c4 #aciew-#bc7;f771 ( #ej1jjj1jjj to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,program ,managem5t ,acc\nt = ea* ( ! fiscal ye>s #bjbd ?r\gh #bjbh1 to rema9 available until exp5d$4 7#b7 ,am\nt ( grants ,! am\nt ( a grant to a ,/ate "u ?is subsection f ! total am\nt made available "u p>agraph 7#a7 %all be equal to ! sum ( ! am\nt allocat$ to ! ,/ate "u p>agraph 7#c77;,a7 & ! am\nt allocat$ to ! ,/ate "u subp>agraph 7#c77;,b74 7#c7 ,allocation to ,/ates 7,a7 ,allocation bas$ on p]c5tage ( l[-income b5efici>ies ,! am\nt allocat$ to a ,/ate "u ?is subp>agraph f #b_/c ( ! total am\nt made available "u p>agraph 7#a7 %all be bas$ on ! numb] ( individuals :o meet ! requirem5t "u subsection 7a77#c77;,a77ii7 ( section #ahfj;,d-#ad ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7 b :o h n enroll$ to receive a subsidy "u su* section #ahfj;,d-#ad relative to ! total numb] ( individuals :o meet ! requirem5t "u su* subsection 7a77#c77;,a77ii7 9 ea* ,/ate1 z e/imat$ by ! ,secret>y4 7,b7 ,allocation bas$ on p]c5tage ( rural b5efici>ies ,! am\nt allocat$ to a ,/ate "u ?is subp>agraph f #a_/c ( ! total am\nt made available "u p>agraph 7#a7 %all be bas$ on ! numb] ( "p ,d eligible individuals 7z def9$ 9 section #ahfj;,d-#a7;a77#c77;,a7 ( su* ,act 7#db ,u4,s4,c4 #aciew-#aja7;a77#c77;,a777 resid+ 9 a rural area relative to ! total numb] ( su* individuals 9 ea* ,/ate1 z e/imat$ by ! ,secret>y4 7#d7 ,portion ( grant bas$ on p]c5tage ( l[-income b5efici>ies to be us$ to provide outrea* to individuals :o may be subsidy eligible individuals or eligible = ! ,m$ic>e ,sav+s ,program ,ea* grant aw>d$ "u ?is subsection ) respect to am\nts allocat$ "u p>agraph 7#c77;,a7 %all be us$ to provide outrea* to individuals :o may be subsidy eligible individuals 7z def9$ 9 section #ahfj;,d-#ad7;a77#c77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#c77;,a777 or eligible = ! program ( m$ical assi/ance = paym5t ( ! co/ ( m$ic>e co/-%>+ "u ! ,m$icaid program pursuant to sections #aijb7;a77#aj77;,e7 & #aicc ( su* ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,e71 #acifu-#c74 7k7 ,effective date 7#a7 ,9 g5]al ,except z provid$ 9 p>agraph 7#b71 ! am5dm5ts & repeal made by ?is section take effect on ,janu>y #a1 #bjbc1 &1 ) respect to title ,,xix ( ! ,social ,security ,act1 apply to cal5d> qu>t]s beg9n+ on or aft] ,janu>y #a1 #bjbc4 7#b7 ,exception = ,/ate legislation ,9 ! case ( a ,/ate plan = m$ical assi/ance "u title ,,xix ( ! ,social ,security ,act :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 & repeal 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 #dajh4 #ajj p]c5t ,,fmap = m$ical assi/ance provid$ by urban ,indian organizations 7a7 ,9 g5]al ,! ?ird s5t5ce ( section #aije7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b77 is am5d$ by /rik+ = ! #h fiscal ye> qu>t]s beg9n+ ) ! fir/ fiscal ye> qu>t] beg9n+ aft] ! date ( ! enactm5t ( ! ,am]ican ,rescue ,plan ,act ( #bjba1 & ins]t+ &4 7b7 ,effective date ,! am5dm5t made by ?is section %all apply to m$ical assi/ance provid$ on or aft] ! date ( enactm5t ( ?is ,act4 #daji4 #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;d7b77 is am5d$ by /rik+ 1 = su* #h fiscal ye> qu>t]s4 7b7 ,effective date ,! am5dm5t made by ?is section %all apply to m$ical assi/ance provid$ on or aft] ! date ( enactm5t ( ?is ,act4 #daaj4 ,repeal ( requirem5t = e/ate recov]y "u ! ,m$icaid program ,section #aiag ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifp7 is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 by am5d+ p>agraph 7#a7 to read z foll[s3 7#a7 ,no li5 may be impos$ aga9/ ! prop]ty ( any individual prior to 8 dea? on acc\nt ( m$ical assi/ance paid or to be paid on 8 behalf "u ! ,/ate plan1 except pursuant to ! judgm5t ( a c\rt on acc\nt ( b5efits incorrectly paid on behalf ( su* individual4 2 7,b7 by /rik+ p>agraph 7#b72 7,c7 9 p>agraph 7#c71 by /rik+ 7#a77;,b7 & ins]t+ 7#a72 & 7,d7 by r$esignat+ p>agraph 7#c7 z p>agraph 7#b72 & 7#b7 by am5d+ subsection 7b7 to read z foll[s3 7b7 ,adju/m5t or recov]y ( m$ical assi/ance correctly paid "u a ,/ate plan ,no adju/m5t or recov]y ( any m$ical assi/ance correctly paid on behalf ( an individual "u ! ,/ate plan may be made4 4 #daaa4 ,all[ = susp5sion ( ,m$ic>e b5efits & premium liability = individuals :o are inc>c]at$ & provide a special enrollm5t p]iod ar\nd ! date ( release 7a7 ,special enrollm5t p]iod = individuals inc>c]at$ at "t ( ,m$ic>e eligibility ,section #ahcg7;i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciep7i77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#e7 7,a7 ,9 ! case ( an individual :o-- 7i7 at ! "t ! individual fir/ satisfies p>agraph 7#a7 or 7#b7 ( section #ahcf7;a71 is inc>c]at$2 or 7ii7 has elect$ n to enroll 7or to be deem$ enroll$7 "u ?is section dur+ ! individual's initial enrollm5t p]iod2 !re %all be a special enrollm5t p]iod describ$ 9 subp>agraph 7,b74 7,b7 ,! special enrollm5t p]iod ref]r$ to 9 subp>agraph 7,a7 is ! #f-mon? p]iod beg9n+ on ! fir/ day aft] :i* ! individual is no long] inc>c]at$4 4 7b7 ,premium am\nt ,section #ahci7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7a77 is am5d$-- 7#a7 9 p>agraph 7#a71 9 ! second s5t5ce1 by /rik+ or 7#g7 & ins]t+ 7#g7 or 7#h72 & 7#b7 by add+ at ! end ! foll[+ new p>agraph3 7#h7 ,9 ! case ( an individual ^: cov]age p]iod includes mon?s 9 :i* by reason ( cu/ody "u p5al au?ority cov]age is exclud$ pursuant to section #ahfb7;a77#c71 ! premium am\nt = su* mon?s su* individual is 9 cu/ody "u p5al au?ority %all be z]o4 4 7c7 ,con=m+ am5dm5t ,section #ahah7;d77#e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#b7;d77#e77 is am5d$ by add+ at ! end ! foll[+3 7,d7 ,9 ! case ( an individual :o is a p]son :o is exclud$ f cov]age pursuant to section #ahfb7;a77#c7 by reason ( cu/ody "u p5al au?ority1 ! am\nt ( ! mon?ly premium = su* individual %all be z]o = any mon? 9 :i* su* individual is 9 cu/ody "u p5al au?ority4 4 #daab4 ,f$]al ,employee ,heal? ,b5efit ,plans 7a7 ,cov]age ( pregnancy ,! ,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? b5efits plan "u *apt] #hi ( title #e1 ,unit$ ,/ates ,code4 7b7 ,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 #daac4 ,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 #bjbc1 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 #bjbc1 ) 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 ,expansion ( ,access #a ,g5]al ,provisions #dbja4 ,am5dm5t to ! ,public ,heal? ,s]vice ,act ,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 ,b ! foll[+3 ,d ,recon/ruction & ,improvem5t ,grants = ,public ,heal? ,c>e ,facilities ,s]v+ ,pacific ,isl&]s & ! ,insul> ,areas #cdda4 ,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 hospice or palliative c>e provid]1 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\ps 7z def9$ 9 section #agjg7;g77#a772 or 7ii7 t-- 7,i7 s]ves a disproportionate p]c5tage ( local pati5ts :o are f a racial & e?nic m9ority gr\p1 or has a pati5t population 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 eligible entities 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 7,g7 compreh5sive & pati5t-c5tric heal? c>e2 7,h7 creation & di/ribution ( education mat]ials on available heal? c>e options2 or 7,i7 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,g7 accessibility & availability ( in=mation on heal? c>e2 7,h7 compreh5siv5ess ( heal? c>e2 & 7,i7 pati5t involvem5t & *oice 9 heal? c>e2 & 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 prep>+ = end ( life & ensur+ t end-(-life c>e is accessible & available1 z well z 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 #bjbc ?r\gh #bjcj4 #cddb4 ,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 #cdda7;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 ( high-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 #bjbc ?r\gh #bjcj4 #cddc4 ,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 are receiv+ assi/ance "u title ,,xviii ( ! ,social ,security ,act or "u a ,/ate plan "u title ,,xix ( su* ,act 7or "u a waiv] ( su* plan71 or 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 #dbjb4 ,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 7,f7 ,a nonpr(it organization s]v+ immigrants4 7b7 ,au?orization ,f funds appropriat$ pursuant to 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 require & demon/rat+ ! entity's capacity to provide culturally & l+ui/ically appropriate s]vices to bord] area resid5ts4 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,q7 end-(-life c>e2 & 7,r7 address+ social det]m9ants ( heal?2 & 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> #bjbd1 & su* sums z may be necess>y = ea* succe$+ fiscal ye>4 #dbjc4 ,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 #bjbc4 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 #dbjd4 ,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? & heal? c>e 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$ic>e paym5ts to ag5cies ,an inc5tive paym5t "u ?is section-- 7#a7 %all be 9 addition to ! paym5ts t a home heal? ag5cy w\ld o!rwise receive "u title ,,xviii ( ! ,social ,security ,act = ! provision ( home heal? s]vices2 & 7#b7 %all h no effect on ! am\nt ( su* paym5ts4 #dbje4 ,community heal? c5t] collaborative access expansion ,section #ccj7r77#d7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;b7r77#d77 is am5d$-- 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 #dbjf4 ,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 ( section #ahcd7m77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d774 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 #dbjg4 ,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-;fiscal-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$ible & publicly available epidemiological projection models1 incorporat+ cl9ical trials or obs]vational /udies 9 humans1 to avoid future heal? c>e co/s4 4 #dbjh4 ,s5se ( ,congress on ma9t5ance ( ef=t provisions reg>d+ *ildr5's heal? ,x is ! s5se ( ! ,congress t-- 7#a7 ! ma9t5ance ( ef=t provisions add$ 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$icaid program "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 & ,*ildr5's ,heal? ,insurance ,program "u title ,,xxi ( su* ,act 7#db ,u4,s4,c4 #acig;aa et seq47 to protect vuln]able & disabl$ adults1 *ildr51 & s5ior citiz5s1 _m ( :om are also memb]s ( communities ( color2 7#b7 ! ma9t5ance ( ef=t provisions = *ildr5's cov]age h be5 ext5d$ by ! ,congress ?r\gh ,septemb] #cj1 #bjbg2 7#c7 ! ma9t5ance ( ef=t provisions ensure ! cont9u$ success ( ! ,m$icaid program & ,*ildr5's ,heal? ,insurance ,program & 7 int5d$ to specifically protect vuln]able & disabl$ *ildr51 _m ( :om are also memb]s ( communities ( color2 & 7#d7 ! ma9t5ance ( ef=t provisions mu/ be /rictly en=c$ & proposals to weak5 or waive ! ma9t5ance ( ef=t provisions mu/ n be consid]$4 #dbji4 ,protection ( ! ,,hhs ,(fices ( ,m9ority ,heal? 7a7 ,9 g5]al ,pursuant to section #agjg;,a ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f;a71 ! ,(fices ( ,m9ority ,heal? e/abli%$ )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 ! ,(fices ( ,m9ority ,heal? ref]r$ to 9 subsection 7a7 play a critical role 9 address+ heal? disp>ities & %\ld be adequately fund$ & giv5 a prom95t role 9 evaluat+ & e/abli%+ heal? policies & programs4 #dbaj4 ,(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? & heal? c>e education1 heal? c>e quality1 & 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 & ,pacific ,isl&]s4 7,d7 ,blacks4 7,e7 ,hispanics4 7#b7 ,! t]m ,hispanic means individuals ^: orig9 is f ,mexico1 ,pu]to ,rico1 ,cuba1 ,c5tral or ,s\? ,am]ica1 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 #dbaa4 ,/udy ( ,,d% paym5ts to ensure hospital access = l[-income pati5ts 7a7 ,9 g5]al ,n lat] ?an ,janu>y #a1 #bjbc1 ! ,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? c>e 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 includ+ end-(-life 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 #dbab4 ,reau?orization ( programs "u ! ,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 #b ,rural #dbba4 ,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 #bjjg7;b77#a71 is am5d$ by add+ at ! end ( ! foll[+ new subsection3 7mmm7 ,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 #ahfa7mmm77#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 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7z7 ,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 #ahfa7mmm77#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 ( ! ,social ,security ,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 #ahcd7z7 ( ! ,social ,security ,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] 7z72 & 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 ( ! ,social ,security ,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 ( ! ,social ,security ,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 #ahcd7z74 4 7#c7 ,te*nical am5dm5ts 7,a7 ,consultation ) ,/ate ag5cies ,section #ahfc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciez7 is am5d$ by /rik+ & 7dd77#b7 & ins]t+ 7dd77#b71 & 7mmm77#a74 7,b7 ,provid] agreem5ts ,section #ahff7;a77#b77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#b77;,a77 is am5d$ by ins]t+ section #ahcd7z77#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 #bjbb4 #dbbb4 ,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 end-(-life c>e1 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? c>e s]vices to a*ieve rural heal? quality & accessibility goals = pati5ts2 & 7,c7 developm5t ( quality improvem5t support /ructures to assi/ rural heal? sy/ems & pr(essionals 9 ! provision ( heal? c>e 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 #bjbc ?r\gh #bjbg4 7#b7 ,availability 7,a7 ,9 g5]al ,funds appropriat$ "u p>agraph 7#a7 %all rema9 available = exp5diture ?r\gh fiscal ye> #bjbg4 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> #bjbh4 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 #dbbc4 ,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? & heal? c>e /atus improvem5t = projects focus+ on heal? promotion2 or 7ii7 b5*m>ks ( increas$ access to prim>y & end-(-life c>e1 includ+ track+ factors su* z ! numb] & type ( prim>y & end-(-life 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 & t]m9al illness2 & 7v7 /r5g!n ! rural heal? c>e sy/em z a :ole & across all facets ( ! heal? c>e deliv]y sy/em1 includ+ end-(-life c>e1 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 #bjbd1 ! ,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 su* sums z may be necess>y = ea* ( fiscal ye>s #bjbd ?r\gh #bjbg4 4 #c ,indian ,communities #dbca4 ,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$1 9 ! matt] relat+ to ! ,assi/ant ,secret>ies ( ,heal? & ,human ,s]vices1 by /rik+ 7#f7 & ins]t+ 7#g71 #a ( :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 #dbcb4 ,ext5sion ( full ,f$]al m$ical assi/ance p]c5tage to ,indian heal? c>e provid]s ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is am5d$-- 7#a7 9 subsection 7a71 by am5d+ p>agraph 7#i7 to read z foll[s3 7#i7 cl9ic s]vices furni%$ by or "u ! direction ( a physician1 )\t reg>d to :e!r ! cl9ic itself is adm9i/]$ by a physician1 includ+-- 7,a7 su* s]vices furni%$ outside ! cl9ic by cl9ic p]sonnel to an eligible individual :o does n reside 9 a p]man5t dwell+ or does n h a fix$ home or mail+ address2 & 7,b7 su* s]vices furni%$ outside ! cl9ic by any ,indian ,heal? ,s]vice facility1 a heal? program or facility op]at$ by a tribe or tribal organization "u ! ,indian ,self-,det]m9ation ,act 7,public ,law #ic-fch71 or an urban ,indian organization receiv+ funds "u title ,v ( ! ,indian ,heal? ,c>e ,improvem5t ,act2 2 & 7#b7 9 subsection 7b71 by ins]t+ aft] ,papa ,ola ,lokahi "u section #h ( su* ,act ! foll[+3 2 ! ,f$]al m$ical assi/ance p]c5tage %all also be #ajj p] c5tum ) respect to am\nts exp5d$ z m$ical assi/ance = s]vices :i* are receiv$ by an ,indian ,heal? ,s]vice facility1 a heal? program or facility op]at$ by a tribe or tribal organization "u ! ,indian ,self-,det]m9ation ,act 7,public ,law #ic-fch71 or an urban ,indian organization receiv+ funds "u title ,v ( ! ,indian ,heal? ,c>e ,improvem5t ,act4 #dbcc4 ,conf]r+ ) urban ,indian organizations ,section #ead ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #affj;d7 is am5d$ by /rik+ subsection 7b7 & ins]t+ ! foll[+3 7b7 ,requirem5t ,! ,secret>y %all ensure t ! ,s]vice & o!r ag5cies & (fices ( ! ,dep>tm5t & ! ,dep>tm5t ( ,vet]ans ,affairs conf]1 to ! maximum ext5t practicable1 ) urban ,indian organizations 9 c>ry+ out-- 7#a7 ?is ,act2 & 7#b7 o!r provisions ( law relat+ to ,indian heal? c>e4 4 #d ,provid]s #dbda4 ,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 #dbdb4 ,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 #bjbc1 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 ( #bjbb71 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 #dbdc4 ,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 #dbda7;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 availability ( heal? c>e options = pati5ts2 & 7,v7 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* /&>ds2 4 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 ( #bjbb4 #e ,d5tal #dbea4 ,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 7#db ,u4,s4,c4 #acie et seq47 & ! ,m$icaid program "u title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq47 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 & urban ,indian communities ,section #aai ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afafl7 is am5d$-- 7#a7 9 subsection 7d7-- 7,a7 by /rik+ p>agraph 7#b7 & ins]t+ ! foll[+3 7#b7 ,requirem5t2 exclusion ,subject to p>agraphs 7#c7 & 7#d71 9 e/abli%+ a national program "u p>agraph 7#a71 ! ,secret>y-- 7,a7 %all n r$uce ! am\nts provid$ = ! ,community ,heal? ,aide ,program describ$ 9 subsections 7a7 & 7b72 7,b7 %all exclude d5tal heal? aide !rapi/ s]vices f s]vices cov]$ "u su* ,program2 & 7,c7 %all include urban ,indian organizations4 2 & 7,b7 9 p>agraph 7#c71 by /rik+ or tribal organization ea* place x appe>s & ins]t+ 1 tribal organization1 or urban ,indian organization2 & 7#b7 9 subsection 7e71 by /rik+ or a tribal organization & ins]t+ a tribal organization1 or an urban ,indian organization4 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 at ! end & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,,ii7 d5tal & oral heal? s]vices 7z def9$ 9 subsection 7nnn772 4 7#b7 ,d5tal & oral heal? s]vices def9$ ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 z am5d$ by sections #bjjg7;b7 & #dbba7;a71 is am5d$ by add+ at ! end ! foll[+ new subsection3 7nnn7 ,d5tal & oral heal? s]vices 7#a7 ,! t]m d5tal & 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 conditions1 includ+-- 7,a7 r\t9e diagno/ic & prev5tive c>e su* z d5tal clean+s1 exams1 & x-rays2 7,b7 basic d5tal s]vices su* z fill+s & extractions2 7,c7 major d5tal s]vices su* z root canals1 cr[ns1 & d5tures2 7,d7 em]g5cy d5tal c>e2 & 7,e7 o!r necess>y s]vices relat$ to d5tal & oral heal? 7z def9$ by ! ,secret>y74 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 & 7,,ee7 ) respect to d5tal & oral heal? s]vices 7z def9$ 9 section #ahfa7nnn771 ! 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+ 1 7#b77;,,ii71 aft] 7includ+ adm9i/ration ( ! heal? risk assessm5t74 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 #bjbc4 7d7 ,requir+ cov]age ( d5tal s]vices = adults "u ! ,m$icaid program 7#a7 ,m&atory cov]age 7,a7 ,9 g5]al 7i7 ,requirem5t ,section #aijb7;a77#aj77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 is am5d$ by ins]t+ 1 7#aj7 aft] 7#e74 7ii7 ,effective date ,! am5dm5t made by clause 7i7 %all apply ) respect to m$ical assi/ance furni%$ 9 cal5d> qu>t]s beg9n+ on or aft] ! date t is #a ye> aft] ! date ( ! enactm5t ( ?is ,act4 7,b7 ,b5*m>k cov]age ,section #aicg7;b77#e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#g7;b77#e77 is am5d$ by /rik+ ! p]iod & ins]t+ 1 &1 beg9n+ ) ! fir/ qu>t] beg9n+ on or aft] ! date ( ! enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb1 cov]age ( d5tal & oral heal? s]vices 7z def9$ 9 section #aije7kk7744 7#b7 ,def9ition ( s]vices ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 z am5d$ by section #dajg1 is fur!r am5d$-- 7,a7 9 subsection 7a77#aj71 by /rik+ d5tal s]vices & ins]t+ d5tal & oral heal? s]vices 7z def9$ 9 subsection 7kk77#a772 & 7,b7 by add+ at ! end ! foll[+ new subsection3 7kk7 ,d5tal & oral heal? s]vices 7#a7 ,= purposes ( ?is title1 ! t]m d5tal & oral heal? s]vices means s]vices necess>y to prev5t disease & promote oral heal?1 re/ore oral /ructures to heal? & function1 r$uce oral pa91 & treat em]g5cy oral conditions4 ,su* t]m includes ! s]vices specifi$ 9 p>agraph 7#b74 7#b7 ,= purposes ( p>agraph 7#a71 ! s]vices specifi$ 9 ?is p>agraph are ! foll[+3 7,a7 ,r\t9e diagno/ic & prev5tive c>e 7su* z d5tal clean+s1 exams1 & x-rays74 7,b7 ,basic d5tal s]vices 7su* z fill+s & extractions7 & major d5tal s]vices 7su* z root canals1 cr[ns1 & d5tures74 7,c7 ,em]g5cy d5tal c>e4 7,d7 ,temporom&ibul> 7,,tmd7 & or(acial pa9 disord] treatm5t4 7,e7 ,o!r necess>y s]vices relat$ to d5tal & oral heal? 7z specifi$ by ! ,secret>y7404 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#c7 ,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#hf71 by /rik+ & at ! end2 7iii7 9 p>agraph 7#hg71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7iv7 by ins]t+ aft] p>agraph 7#hg7 ! foll[+3 7#hh7 provide =-- 7,a7 in=m+1 9 writ+1 all individuals :o h be5 det]m9$ to be eligible = m$ical assi/ance ( ! availability ( d5tal & oral heal? s]vices 7z def9$ 9 section #aije7kk772 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 section #aije7r77#c77;,c774 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#d7 ,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#hh77;,c7 = ! ,/ate 9 :i* ! s]vices are provid$4 4 7#e7 ,enhanc$ ,,fmap2 ma9t5ance ( ef=t 7,a7 ,m$icaid ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 z am5d$ by p>agraph 7#b71 is fur!r am5d$-- 7i7 9 subsection 7b71 by /rik+ & 7ii7 & ins]t+ 7ii71 & 7ll72 & 7ii7 by add+ at ! end ( ! foll[+ new subsection3 7ll7 ,increas$ ,,fmap = exp5ditures = d5tal & oral heal? s]vices 7#a7 ,9 g5]al ,! ,f$]al m$ical assi/ance p]c5tage ) respect to am\nts exp5d$ by su* ,/ate = m$ical assi/ance consi/+ ( d5tal & oral heal? s]vices 7z def9$ 9 subsection 7kk77 furni%$ dur+ ! fir/ cal5d> qu>t] beg9n+ on or aft] ! date t is #a ye> aft] ! date ( ! enactm5t ( ?is subsection or dur+ any subsequ5t qu>t]7 to individuals #ba ye>s ( age or old] %all be equal to1 9 ! case ( su* s]vices furni%$-- 7,a7 dur+ ! #c-ye> p]iod beg9n+ on ! fir/ day ( su* fir/ cal5d> ye>1 #ajj p]c5t2 7,b7 dur+ ! #a-ye> p]iod imm$iately foll[+ ! p]iod describ$ 9 subp>agraph 7,a71 #ie p]c5t2 7,c7 dur+ ea* subsequ5t #a-ye> p]iod 7?r\gh ! ?ird su* subsequ5t p]iod71 ! p]c5tage specifi$ "u ?is p>agraph = ! prec$+ #a-ye> p]iod1 r$uc$ by #e p]c5tage po9ts2 & 7,d7 dur+ any qu>t] beg9n+ aft] ! #g-ye> p]iod beg9n+ on ! fir/ day describ$ 9 subp>agraph 7,a71 #hj p]c5t4 7#b7 ,no r$uction 9 ,,fmap ,p>agraph 7#a7 %all n apply ) respect to am\nts exp5d$ by a ,/ate if ! ,f$]al m$ical assi/ance p]c5tage o!rwise applicable to su* am\nts )\t application ( su* p>agraph w\ld be high] ?an su* p]c5tage available to su* am\nts ) application ( su* p>agraph4 4 7#f7 ,exclusion ( am\nts attributable to increas$ ,,fmap f t]ritorial caps ,section #aajh ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acjh71 z am5d$ by section #daja7;a71 is am5d$-- 7,a7 9 subsection 7f71 9 ! matt] prec$+ p>agraph 7#a71 by /rik+ subsections 7g71 7h71 & 7i72 & 7,b7 by add+ at ! end ! foll[+3 7j7 ,exclusion f caps ( am\nts attributable to increas$ ,,fmap = cov]age ( d5tal & oral s]vices ,any paym5t made to a t]ritory = exp5ditures = m$ical assi/ance t are subject to an increase 9 ! ,f$]al m$ical assi/ance p]c5tage applicable to su* exp5ditures "u section #aije7ll7 %all n be tak5 into acc\nt = purposes ( apply+ paym5t limits "u subsections 7f7 & 7g7 to ! ext5t t su* paym5t exce$s ! am\nt ( ! paym5t t w\ld h be5 made to ! t]ritory = su* exp5ditures )\t reg>d to su* section4 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;b771 z am5d$ by section #bjac7;a71 is fur!r 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 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 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 organizations4 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 ,alt]native d5tal heal? c>e provid]s def9$ ,! 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,b7 ,indian ,heal? ,c>e ,improvem5t ,act ,! t]ms ,indian tribe1 tribal organization1 & ,urban ,indian organization h ! mean+ giv5 ! t]ms 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc74 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 #dbeb4 ,oral heal? lit]acy & aw>5ess campaign ,! ,public ,heal? ,s]vice ,act is am5d$ by ins]t+ aft] section #cdj;,g-#a ( su* ,act 7#db ,u4,s4,c4 #bef;g-#a7 ! foll[+3 #cdj;,g-#b4 ,oral heal? lit]acy & aw>5ess 7a7 ,campaign ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all e/abli% a public education campaign 7ref]r$ to 9 ?is subsection z ! campaign7 across all relevant programs ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration 7includ+ ! heal? c5t] program1 oral heal? work=ce programs1 mat]nal & *ild heal? programs1 ! ,ryan ,:ite ,,hiv_/,,aids ,program1 & rural heal? programs7 to increase oral heal? lit]acy & aw>5ess4 7b7 ,/rategies ,9 c>ry+ out ! campaign1 ! ,secret>y %all id5tify oral heal? lit]acy & aw>5ess /rategies t are evid5ce bas$ & focus$ on oral heal? c>e education1 includ+ education on prev5tion ( oral disease su* z e>ly *ildhood & o!r c>ies1 p]iodontal disease1 & oral canc]4 7c7 ,focus ,! ,secret>y %all design ! campaign to communicate directly ) specific populations1 includ+ *ildr51 pregnant wom51 p>5ts1 ! eld]ly1 individuals ) disabilities1 & e?nic & racial m9ority populations1 includ+ ,indians1 ,alaska ,natives1 & ,native ,hawaiians1 9 a culturally & l+ui/ically appropriate mann]4 7d7 ,outcomes ,9 c>ry+ out ! campaign1 ! ,secret>y %all include a process = measur+ outcomes & effectiv5ess4 7e7 ,report to ,congress ,n lat] ?an #c ye>s aft] ! date ( enactm5t ( ?is section1 ! ,secret>y %all submit to ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives & ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate a report on ! outcomes & effectiv5ess ( ! campaign4 7f7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re is au?oriz$ to be appropriat$ #gej1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 4 ,d ,advanc+ ,heal? ,equity ,?r\gh ,paym5t & ,deliv]y ,re=m #dcja4 ,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? & heal? c>e disp>ities & a*iev+ heal? equity mu/ be c5tral to & requir$ 9 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 prioritize prim>y c>e & consid] ! holi/ic ne$s ( & o!r factors ) respect to ! pati5t population1 includ+ ) respect to behavioral heal?1 oral heal?1 end-(-life c>e1 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 #dcjb4 ,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 #dcjc4 ,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 nonm$ical s]vices t address socially det]m9$ b>ri]s to heal? 9 all /ages ( ! life cycle ?r\gh end-(-life1 includ+ ,engli% pr(ici5cy /atus1 l[ heal? & heal? c>e lit]acy1 lack ( access to heal? c>e plann+1 includ+ end-(-life c>e plann+1 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 #dcjd4 ,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 #dcje4 ,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 ,e ,heal? ,emp[]m5t ,zones #ddja4 ,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 #ddjb4 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? c>e 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? & heal? c>e 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 #ddjb4 ,assi/ance to ^? seek+ designation ,at ! reque/ ( any organization or entity seek+ to submit a reque/ "u section #ddja7;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 #ddja7;b77#a72 7#b7 to complete a heal? assessm5t1 includ+ an assessm5t ( heal? disp>ities "u section #ddja7;c77#a77;,d72 or 7#c7 to prep>e & submit a reque/1 includ+ a /rategic plan1 9 accordance ) section #ddja4 #ddjc4 ,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 #ddja4 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 #ddja4 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 #ddjd4 ,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 #ddje4 ,au?orization ( appropriations ,to c>ry out ?is subtitle1 !re is au?oriz$ to be appropriat$ #ajj1jjj1jjj = fiscal ye> #bjbc4 ,f ,equitable ,heal? ,c>e = ,all #deja4 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,9 #aiff1 ,dr4 ,m>t9 ,lu!r ,k+1 ,jr41 said ,( all ! =ms ( inequality1 inju/ice 9 heal? c>e is ! mo/ %ock+ & inhuman because x (t5 results 9 physical dea?44 7#b7 ,inequity 9 heal? c>e rema9s a p]si/5t & deva/at+ reality = _m communities1 &1 9 p>ticul>1 communities ( color4 7#c7 ,! provision ( inequitable heal? c>e has complex causes1 _m /emm+ f sy/emic inequality 9 access to heal? c>e1 h\s+1 nutrition1 economic opportunity1 education1 & o!r factors4 7#d7 ,heal? c>e outcomes = ,black communities 9 p>ticul> lag f> beh9d ^? ( ! population z a :ole4 7#e7 ,dr4 ,an?ony ,fauci1 ,director ( ! ,national ,in/itute ( ,all]gy & ,infecti\s ,diseases1 said on ,april #g1 #bjbj1 ! coronavirus outbreak is %9+ a bright light on unacceptable heal? disp>ities 9 ! ,black community4 7#f7 ,a contribut+ factor 9 heal? disp>ities is explicit & implicit bias 9 ! deliv]y ( heal? c>e1 result+ 9 inf]ior c>e & poor] outcomes = "s pati5ts on ! basis ( factors t include race1 national orig91 sex 7includ+ sexual ori5tation or g5d] id5tity71 disability1 age1 & religion4 7#g7 ,! ,national ,academy ( ,m$ic9e 7=m]ly kn[n z ! ,in/itute ( ,m$ic9e7 issu$ a report 9 #bjjb titl$ ,unequal ,treatm5t1 f9d+ t racial & e?nic m9orities receive l[]-quality heal? c>e ?an ,:ites d1 ev5 :5 insurance /atus1 income1 age1 & sev]ity ( condition is comp>able4 7#h7 ,j z ,congress has s\ght to elim9ate bias1 bo? explicit & implicit1 9 employm5t1 h\s+1 & o!r p>ts ( our society1 ! elim9ation ( bias & ! legacy ( /ructural racism 9 heal? c>e is ( p>am\nt importance4 #dejb4 ,data collection & report+ 7a7 ,requir$ report+ 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices1 9 consultation ) ! ,director = ,civil ,rights & ,heal? ,equity1 ! ,director ( ! ,national ,in/itutes ( ,heal?1 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 & ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all by regulation require all heal? c>e provid]s & facilities t are requir$ "u o!r provisions ( law to report data on specific heal? outcomes to ! ,dep>tm5t ( ,heal? & ,human ,s]vices 9 aggregate =m1 to disaggregate su* data by demographic *>act]i/ics1 includ+ by race1 national orig91 sex 7includ+ sexual ori5tation & g5d] id5tity71 disability1 & age1 z well z any o!r factor t ! ,secret>y ( ,heal? & ,human ,s]vices det]m9es w\ld be useful = det]m9+ a patt]n ( provision ( inequitable heal? c>e4 7#b7 ,propos$ regulations ,n lat] ?an #ij days aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all issue propos$ regulations to c>ry out p>agraph 7#a74 7b7 ,repository ,! ,secret>y ( ,heal? & ,human ,s]vices %all-- 7#a7 n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 e/abli% a repository ( ! disaggregat$ data report$ pursuant to subsection 7a72 7#b7 subject to p>agraph 7#c71 make ! data 9 su* repository publicly available2 & 7#c7 ensure t su* repository does n conta9 any data t is individually id5tifiable4 #dejc4 ,requir+ equitable heal? c>e 9 ! hospital value-bas$ pur*as+ program 7a7 ,equitable heal? c>e z value measurem5t ,section #ahhf7;b77#c77;,b77viii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77;,b77viii77 is am5d$ by add+ at ! end ! foll[+ new subclause3 7,,xiii7 7aa7 ,effective = paym5ts beg9n+ ) fiscal ye> #bjbd1 9 exp&+ ! numb] ( measures "u subclause 7,,iii71 ! ,secret>y %all adopt measures t relate to equitable heal? c>e furni%$ by hospitals 9 inpati5t sett+s4 7bb7 ,9 c>ry+ out ?is subclause1 ! ,secret>y %all solicit input & recomm5dations f individuals & gr\ps repres5t+ communities ( color & o!r protect$ classes & ensure measures adopt$ pursuant to ?is subclause acc\nt = social det]m9ants ( heal?1 z def9$ 9 section #dejf7;e77#aj7 ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb4 7cc7 ,= purposes ( ?is subclause1 ! t]m equitable heal? c>e ref]s to ! pr9ciple t high-quality c>e %\ld be provid$ to all individuals & heal? c>e treatm5t & s]vices %\ld n v>y on acc\nt ( ! real or p]ceiv$ race1 national orig91 sex 7includ+ sexual ori5tation & g5d] id5tity71 disability1 or age ( an individual1 z well z any o!r factor t ! ,secret>y det]m9es w\ld be useful = det]m9+ a patt]n ( provision ( inequitable heal? c>e4 4 7b7 ,inclusion ( equitable heal? c>e measures ,section #ahhf7o77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7o77#b77;,b77 is am5d$ by add+ at ! end ! foll[+ new clause3 7iv7 ,inclusion ( equitable heal? c>e measures ,beg9n+ 9 fiscal ye> #bjbd1 measures select$ "u subp>agraph 7,a7 %all include ! equitable heal? c>e measures describ$ 9 subsection 7b77#c77;,b77viii77,,xiii74 4 #dejd4 ,provision ( inequitable heal? c>e z a basis = p]missive exclusion f ,m$ic>e & ,/ate heal? c>e programs ,section #aabh7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g7;b77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#ah7 ,provision ( inequitable heal? c>e 7,a7 ,9 g5]al ,subject to subp>agraph 7,b71 any heal? c>e provid] t ! ,secret>y det]m9es has engag$ 9 a patt]n ( provid+ inequitable heal? c>e 7z def9$ 9 section #dejf7;e77#g7 ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb7 on ! basis ( race1 national orig91 sex 7includ+ sexual ori5tation & g5d] id5tity71 disability1 or age ( an individual4 7,b7 ,exception ,= purposes ( c>ry+ out subp>agraph 7,a71 ! ,secret>y %all n exclude any heal? c>e provid] f p>ticipation 9 ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act or ! ,m$icaid program "u title ,,xix ( su* ,act if ! exclusion ( su* heal? c>e provid] w\ld result 9 increas$ difficulty 9 access to heal? c>e s]vices = und]s]v$ or l[-income communities4 4 #deje4 ,(fice = ,civil ,rights & ,heal? ,equity ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices 7a7 ,"n ( (fice ,beg9n+ on ! date ( enactm5t ( ?is ,act1 ! ,(fice = ,civil ,rights ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices %all be kn[n z ! ,(fice = ,civil ,rights & ,heal? ,equity ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 ,any ref]5ce to ! ,(fice = ,civil ,rights ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices 9 any law1 regulation1 map1 docum5t1 record1 or o!r pap] ( ! ,unit$ ,/ates %all be deem$ to be a ref]5ce to ! ,(fice = ,civil ,rights & ,heal? ,equity4 7b7 ,head ( (fice ,! head ( ! ,(fice = ,civil ,rights & ,heal? ,equity %all be ! ,director = ,civil ,rights & ,heal? ,equity1 to be appo9t$ by ! ,presid5t4 ,any ref]5ce to ! ,director ( ! ,(fice = ,civil ,rights ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices 9 any law1 regulation1 map1 docum5t1 record1 or o!r pap] ( ! ,unit$ ,/ates %all be deem$ to be a ref]5ce to ! ,director = ,civil ,rights & ,heal? ,equity4 #dejf4 ,prohibit+ discrim9ation 9 heal? c>e 7a7 ,prohibit+ discrim9ation 7#a7 ,9 g5]al ,no heal? c>e provid] may1 on ! basis1 9 :ole or 9 "p1 ( race1 sex 7includ+ sexual ori5tation & g5d] id5tity71 disability1 age1 or religion1 subject an individual to ! provision ( inequitable heal? c>e4 7#b7 ,notice ( pati5t rights ,! ,secret>y %all provide to ea* pati5t a notice ( a pati5t's rights "u ?is section4 7b7 ,adm9i/rative compla9t & conciliation process 7#a7 ,compla9ts & answ]s 7,a7 ,9 g5]al ,an aggriev$ p]son may1 n lat] ?an #a ye> aft] an alleg$ violation ( subsection 7a7 has occurr$ or conclud$1 file a compla9t ) ! ,director alleg+ provision ( inequitable heal? c>e by a provid] describ$ 9 subsection 7a74 7,b7 ,compla9t ,a compla9t submitt$ pursuant to subp>agraph 7,a7 %all be 9 writ+ & %all conta9 su* in=mation & be 9 su* =m z ! ,director requires4 7,c7 ,oa? or affirmation ,! compla9t & any answ] made "u ?is subsection %all be made "u oa? or affirmation1 & may be reasonably & fairly modifi$ at any "t4 7#b7 ,response to compla9ts 7,a7 ,9 g5]al ,^u ! fil+ ( a compla9t "u ?is subsection1 ! foll[+ proc$ures %all apply3 7i7 ,compla9ant notice ,! ,director %all s]ve notice ^u ! compla9ant ackn[l$g+ receipt ( su* fil+ & advis+ ! compla9ant ( ! "t limits & proc$ures provid$ "u ?is section4 7ii7 ,respond5t notice ,! ,director %all1 n lat] ?an #cj days aft] receipt ( su* fil+-- 7,i7 s]ve on ! respond5t a notice ( ! compla9t1 toge!r ) a copy ( ! orig9al compla9t2 & 7,,ii7 advise ! respond5t ( ! proc$ural rights & obligations ( respond5ts "u ?is section4 7iii7 ,answ] ,! respond5t may file1 n lat] ?an #fj days aft] receipt ( ! notice f ! ,director1 an answ] to su* compla9t4 7iv7 ,inve/igative duties ,! ,director %all-- 7,i7 make an inve/igation ( ! alleg$ provision ( inequitable heal? c>e2 & 7,,ii7 complete su* inve/igation )9 #ahj days 7unless x is impracticable to complete su* inve/igation )9 #ahj days7 aft] ! fil+ ( ! compla9t4 7,b7 ,inve/igations 7i7 ,patt]n or practice ,9 ! c\rse ( inve/igat+ ! compla9t1 ! ,director may seek records ( c>e provid$ to pati5ts o!r ?an ! compla9ant if necess>y to demon/rate or disprove an allegation ( provision ( inequitable heal? c>e or to det]m9e :e!r !re is a patt]n or practice ( su* c>e4 7ii7 ,acc\nt+ = social det]m9ants ( heal? ,9 inve/igat+ ! compla9t & rea*+ a det]m9ation on ! validity ( ! compla9t1 ! ,director %all acc\nt = social det]m9ants ( heal? & ! effect ( su* social det]m9ants on heal? c>e outcomes4 7iii7 ,inability to complete inve/igation ,if ! ,director is unable to complete 7or f9ds x is impracticable to complete7 ! inve/igation )9 #ahj days aft] ! fil+ ( ! compla9t 7or1 if ! ,secret>y takes fur!r action "u p>agraph 7#f77;,b7 ) respect to a compla9t1 )9 #ahj days aft] ! comm5cem5t ( su* fur!r action71 ! ,director %all notify ! compla9ant & respond5t 9 writ+ ( ! reasons involv$4 7iv7 ,report to ,/ate lic5s+ au?orities ,on conclud+ ea* inve/igation "u ?is subp>agraph1 ! ,director %all provide to ! appropriate ,/ate lic5s+ au?orities in=mation specify+ ! results ( ! inve/igation4 7,c7 ,report 7i7 ,f9al report ,on complet+ ea* inve/igation "u ?is p>agraph1 ! ,director %all prep>e a f9al inve/igative report4 7ii7 ,modification ( report ,a f9al report "u ?is subp>agraph may be modifi$ if additional evid5ce is lat] discov]$4 7#c7 ,conciliation 7,a7 ,9 g5]al ,dur+ ! p]iod beg9n+ on ! date on :i* a compla9t is fil$ "u ?is subsection & end+ on ! date ( f9al disposition ( su* compla9t 7includ+ dur+ an inve/igation "u p>agraph 7#b77;,b771 ! ,director %all1 to ! ext5t feasible1 engage 9 conciliation ) respect to su* compla9t4 7,b7 ,conciliation agreem5t ,a conciliation agreem5t aris+ out ( su* conciliation %all be an agreem5t betwe5 ! respond5t & ! compla9ant1 & %all be subject to approval by ! ,director4 7,c7 ,rights protect$ ,! ,director %all approve a conciliation agreem5t only if ! agreem5t protects ! rights ( ! compla9ant & o!r p]sons simil>ly situat$4 7,d7 ,publicly available agreem5t 7i7 ,9 g5]al ,subject to clause 7ii71 ! ,secret>y %all make available to ! public a copy ( a conciliation agreem5t ent]$ into pursuant to ?is subsection unless ! compla9ant & respond5t o!rwise agree1 & ! ,secret>y det]m9es1 t disclosure is n requir$ to fur!r ! purposes ( ?is subsection4 7ii7 ,limitation ,a conciliation agreem5t t is made available to ! public pursuant to clause 7i7 may n disclose individually id5tifiable heal? in=mation4 7#d7 ,failure to comply ) conciliation agreem5t ,:5ev] ! ,director has reasonable cause to believe t a respond5t has brea*$ a conciliation agreem5t1 ! ,director %all ref] ! matt] to ! ,attorney ,g5]al to consid] fil+ a civil action to en=ce su* agreem5t4 7#e7 ,writt5 cons5t = disclosure ( in=mation ,no?+ said or done 9 ! c\rse ( conciliation "u ?is subsection may be made public1 or us$ z evid5ce 9 a subsequ5t proce$+ "u ?is subsection1 )\t ! writt5 cons5t ( ! p>ties to ! conciliation4 7#f7 ,prompt judicial action 7,a7 ,9 g5]al ,if ! ,director det]m9es at any "t foll[+ ! fil+ ( a compla9t "u ?is subsection t prompt judicial action is necess>y to c>ry out ! purposes ( ?is subsection1 ! ,director may recomm5d t ! ,attorney ,g5]al promptly comm5ce a civil action "u subsection 7d74 7,b7 ,imm$iate suit ,if ! ,director det]m9es at any "t foll[+ ! fil+ ( a compla9t "u ?is subsection t ! public int]e/ w\ld be s]v$ by all[+ ! compla9ant to br+ a civil action "u subsection 7c7 9 a ,/ate or ,f$]al c\rt imm$iately1 ! ,director %all c]tify t ! adm9i/rative process has conclud$ & t ! compla9ant may file su* a suit imm$iately4 7#g7 ,annual report ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 & annually !reaft]1 ! ,director %all make publicly available a report detail+ ! activities ( ! ,(fice = ,civil ,rights & ,heal? ,equity "u ?is subsection1 includ+-- 7,a7 ! numb] ( compla9ts fil$ & ! basis on :i* ! compla9ts 7 fil$2 7,b7 ! numb] ( inve/igations und]tak5 z a result ( su* compla9ts2 & 7,c7 ! disposition ( all su* inve/igations4 7c7 ,en=cem5t by private p]sons 7#a7 ,9 g5]al 7,a7 ,civil action 7i7 ,9 suit ,a compla9ant "u subsection 7b7 may comm5ce a civil action to obta9 appropriate relief ) respect to an alleg$ violation ( subsection 7a71 or = brea* ( a conciliation agreem5t "u subsection 7b71 9 an appropriate di/rict c\rt ( ! ,unit$ ,/ates or ,/ate c\rt-- 7,i7 n soon] ?an ! e>lie/ (-- 7aa7 ! date a conciliation agreem5t is rea*$ "u subsection 7b72 7bb7 ! date ( a f9al disposition ( a compla9t "u subsection 7b72 or 7cc7 #ahj days aft] ! fir/ day ( ! alleg$ violation2 & 7,,ii7 n lat] ?an #b ye>s aft] ! f9al day ( ! alleg$ violation4 7ii7 ,/atute ( limitations ,! computation ( su* #b-ye> p]iod %all n include any "t dur+ :i* an adm9i/rative proce$+ 7includ+ inve/igation or conciliation7 "u subsection 7b7 0 p5d+ ) respect to a compla9t "u su* subsection4 7,b7 ,b>r+ suit ,if ! ,director has obta9$ a conciliation agreem5t "u subsection 7b7 reg>d+ an alleg$ violation ( subsection 7a71 no action may be fil$ "u ?is p>agraph by ! compla9ant involv$ ) respect to ! alleg$ violation except = ! purpose ( en=c+ ! t]ms ( su* an agreem5t4 7#b7 ,relief :i* may be grant$ 7,a7 ,9 g5]al ,9 a civil action "u p>agraph 7#a71 if ! c\rt f9ds t a violation ( subsection 7a7 or brea* ( a conciliation agreem5t has occurr$1 ! c\rt may aw>d to ! pla9tiff actual & punitive damages1 & may grant z relief1 z ! c\rt det]m9es to be appropriate1 any p]man5t or tempor>y injunction1 tempor>y re/ra9+ ord]1 or o!r ord] 7includ+ an ord] enjo9+ ! def5dant f engag+ 9 a practice violat+ subsection 7a7 or ord]+ su* affirmative action z may be appropriate74 7,b7 ,fees & co/s ,9 a civil action "u p>agraph 7#a71 ! c\rt1 9 its discretion1 may all[ ! prevail+ p>ty1 o!r ?an ! ,unit$ ,/ates1 a reasonable attorney's fee & co/s4 ,! ,unit$ ,/ates %all be liable = su* fees & co/s to ! same ext5t z a private p]son4 7#c7 ,int]v5tion by ,attorney ,g5]al ,^u timely application1 ! ,attorney ,g5]al may int]v5e 9 a civil action "u p>agraph 7#a71 if ! ,attorney ,g5]al c]tifies t ! case is ( g5]al public importance4 7d7 ,en=cem5t by ! ,attorney ,g5]al 7#a7 ,comm5cem5t ( actions 7,a7 ,patt]n or practice cases ,! ,attorney ,g5]al may comm5ce a civil action 9 any appropriate di/rict c\rt ( ! ,unit$ ,/ates if ! ,attorney ,g5]al has reasonable cause to believe t any heal? c>e provid] cov]$ by subsection 7a7-- 7i7 is engag$ 9 a patt]n or practice t violates su* subsection2 or 7ii7 is engag$ 9 a violation ( su* subsection t raises an issue ( significant public importance4 7,b7 ,cases by ref]ral ,! ,director may det]m9e1 bas$ on a patt]n ( compla9ts1 a patt]n ( violations1 a review ( data report$ by a heal? c>e provid] cov]$ by subsection 7a71 or any o!r means1 t !re is reasonable cause to believe a heal? c>e provid] is engag$ 9 a patt]n or practice t violates subsection 7a74 ,if ! ,director makes su* a det]m9ation1 ! ,director %all ref] ! relat$ f9d+s to ! ,attorney ,g5]al4 ,if ! ,attorney ,g5]al f9ds t su* reasonable cause exi/s1 ! ,attorney ,g5]al may comm5ce a civil action 9 any appropriate di/rict c\rt ( ! ,unit$ ,/ates4 7#b7 ,en=cem5t ( subpo5as ,! ,attorney ,g5]al1 on behalf ( ! ,director1 or ano!r p>ty at ^: reque/ a subpo5a is issu$ "u ?is subsection1 may en=ce su* subpo5a 9 appropriate proce$+s 9 ! di/rict c\rt ( ! ,unit$ ,/ates = ! di/rict 9 :i* ! p]son to :om ! subpo5a 0 address$ resides1 0 s]v$1 or transacts bus9ess4 7#c7 ,relief :i* may be grant$ 9 civil actions 7,a7 ,9 g5]al ,9 a civil action "u p>agraph 7#a71 ! c\rt-- 7i7 may aw>d su* prev5tive relief1 includ+ a p]man5t or tempor>y injunction1 tempor>y re/ra9+ ord]1 or o!r ord] aga9/ ! p]son responsible = a violation ( subsection 7a7 z is necess>y to assure ! full enjoym5t ( ! rights grant$ by ?is subsection2 7ii7 may aw>d su* o!r relief z ! c\rt det]m9es to be appropriate1 includ+ monet>y damages1 to aggriev$ p]sons2 & 7iii7 may1 to v9dicate ! public int]e/1 assess punitive damages aga9/ ! respond5t-- 7,i7 9 an am\nt n exce$+ #ejj1jjj1 = a fir/ violation2 & 7,,ii7 9 an am\nt n exce$+ #a1jjj1jjj1 = any subsequ5t violation4 7,b7 ,fees & co/s ,9 a civil action "u ?is subsection1 ! c\rt1 9 its discretion1 may all[ ! prevail+ p>ty1 o!r ?an ! ,unit$ ,/ates1 a reasonable attorney's fee & co/s4 ,! ,unit$ ,/ates %all be liable = su* fees & co/s to ! ext5t provid$ by section #bdab ( title #bh1 ,unit$ ,/ates ,code4 7#d7 ,int]v5tion 9 civil actions ,^u timely application1 any p]son may int]v5e 9 a civil action comm5c$ by ! ,attorney ,g5]al "u p>agraphs 7#a7 & 7#b7 if ! action involves an alleg$ violation ( subsection 7a7 ) respect to :i* su* p]son is an aggriev$ p]son 7includ+ a p]son :o is a compla9ant "u subsection 7b77 or a conciliation agreem5t to :i* su* p]son is a p>ty4 7e7 ,def9itions ,9 ?is section3 7#a7 ,aggriev$ p]son ,! t]m aggriev$ p]son means-- 7,a7 a p]son :o believes t ! p]son 0 or w be injur$ 9 violation ( subsection 7a72 or 7,b7 ! p]sonal repres5tative or e/ate ( a deceas$ p]son :o 0 injur$ 9 violation ( subsection 7a74 7#b7 ,director ,! t]m ,director means ! ,director = ,civil ,rights & ,heal? ,equity ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7#c7 ,disability ,! t]m disability has ! mean+ giv5 su* t]m 9 section #c ( ! ,am]icans ) ,disabilities ,act ( #aiij 7#db ,u4,s4,c4 #abajb74 7#d7 ,conciliation ,! t]m conciliation means ! attempt$ resolution ( issues rais$ by a compla9t1 or by ! inve/igation ( su* compla9t1 ?r\gh in=mal negotiations involv+ ! compla9ant1 ! respond5t1 & ! ,secret>y4 7#e7 ,conciliation agreem5t ,! t]m conciliation agreem5t means a writt5 agreem5t sett+ =? ! resolution ( ! issues 9 conciliation4 7#f7 ,individually id5tifiable heal? in=mation ,! t]m individually id5tifiable heal? in=mation means any in=mation1 includ+ demographic in=mation collect$ f an individual-- 7,a7 t is creat$ or receiv$ by a heal? c>e provid] cov]$ by subsection 7a71 heal? plan1 employ]1 or heal? c>e cle>+h\se2 7,b7 t relates to ! pa/1 pres5t1 or future physical or m5tal heal? or condition (1 ! provision ( heal? c>e to1 or ! pa/1 pres5t1 or future paym5t = ! provision ( heal? c>e to1 ! individual2 & 7,c7 7i7 t id5tifies ! individual2 or 7ii7 ) respect to :i* !re is a reasonable basis to believe t ! in=mation c be us$ to id5tify ! individual4 7#g7 ,provision ( inequitable heal? c>e ,! t]m provision ( inequitable heal? c>e means ! provision ( any heal? c>e s]vice1 by a heal? c>e provid] 9 a mann] t-- 7,a7 fails to meet a high-quality c>e /&>d1 mean+ ! heal? c>e provid] fails to-- 7i7 avoid h>m to pati5ts z a result ( ! heal? s]vices t are int5d$ to help ! pati5t2 7ii7 provide heal? s]vices bas$ on sci5tific k to all & to all pati5ts :o b5efit2 7iii7 refra9 f provid+ s]vices to pati5ts n likely to b5efit2 7iv7 provide c>e t is responsive to pati5t pref]5ces1 ne$s1 & values2 & 7v7 avoids waits or delays 9 c>e2 & 7,b7 is discrim9atory 9 int5t or effect bas$ at lea/ 9 "p on a basis specifi$ 9 subsection 7a74 7#h7 ,respond5t ,! t]m respond5t means ! p]son or o!r entity accus$ 9 a compla9t ( a violation ( subsection 7a74 7#i7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#aj7 ,social det]m9ants ( heal? ,! t]m social det]m9ants ( heal? means conditions 9 ! environm5ts 9 :i* individuals live1 "w1 att5d s*ool1 & wor%ip1 t affect a wide range ( heal?1 function+1 & quality-(-life outcomes & risks4 7f7 ,rule ( con/ruction ,no?+ 9 ?is section %all be con/ru$ z repeal+ or limit+ ! effect ( title ,,vi ( ! ,civil ,rights ,act ( #aifd 7#db ,u4,s4,c4 #bjjj;d et seq471 section #aeeg ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahaaf71 section #ejd ( ! ,rehabilitation ,act ( #aigc 7#bi ,u4,s4,c4 #gid71 or ! ,age ,discrim9ation ,act ( #aige 7#db ,u4,s4,c4 #faja et seq474 #dejg4 ,f$]al ,heal? ,equity ,commission 7a7 ,e/abli%m5t ( ,commission 7#a7 ,9 g5]al ,!re is e/abli%$ ! ,f$]al ,heal? ,equity ,commission 79 ?is section ref]r$ to z ! ,commission74 7#b7 ,memb]%ip 7,a7 ,9 g5]al ,! ,commission %all be compos$ (-- 7i7 #h vot+ memb]s appo9t$ "u subp>agraph 7,b72 & 7ii7 ! nonvot+1 ex (ficio memb]s li/$ 9 subp>agraph 7,c74 7,b7 ,vot+ memb]s ,n m ?an #d ( ! memb]s describ$ 9 subp>agraph 7,a77i7 %all at any "o "t be ( ! same political p>ty4 ,su* memb]s %all h recogniz$ exp]tise 9 & p]sonal exp]i5ce ) racial & e?nic heal? inequities1 heal? c>e ne$s ( vuln]able & m>g9aliz$ populations1 & heal? equity z a vehicle = improv+ heal? /atus & heal? outcomes4 ,su* memb]s %all be appo9t$ to ! ,commission z foll[s3 7i7 #d memb]s ( ! ,commission %all be appo9t$ by ! ,presid5t4 7ii7 #b memb]s ( ! ,commission %all be appo9t$ by ! ,presid5t pro tempore ( ! ,s5ate1 ^u ! recomm5dations ( ! majority lead] & ! m9ority lead] ( ! ,s5ate4 ,ea* memb] appo9t$ to ! ,commission "u ?is clause %all be appo9t$ f a diff]5t political p>ty4 7iii7 #b memb]s ( ! ,commission %all be appo9t$ by ! ,speak] ( ! ,h\se ( ,repres5tatives ^u ! recomm5dations ( ! majority lead] & ! m9ority lead] ( ! ,h\se ( ,repres5tatives4 ,ea* memb] appo9t$ to ! ,commission "u ?is clause %all be appo9t$ f a diff]5t political p>ty4 7,c7 ,ex (ficio memb] ,! ,commission %all h ! foll[+ nonvot+1 ex (ficio memb]s3 7i7 ,! ,director = ,civil ,rights & ,heal? ,equity ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7ii7 ,! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal? ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7iii7 ,! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities4 7iv7 ,! ,*airp]son ( ! ,advisory ,committee on ,m9ority ,heal? e/abli%$ "u section #agjg7;c7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f7;c774 7#c7 ,t]ms ,! t]m ( (fice ( ea* memb] appo9t$ "u p>agraph 7#b77;,b7 ( ! ,commission %all be #f ye>s4 7#d7 ,*airp]son2 ,vice ,*airp]son 7,a7 ,*airp]son ,! ,presid5t %all1 ) ! concurr5ce ( a majority ( ! memb]s ( ! ,commission appo9t$ "u p>agraph 7#b77;,b71 designate a ,*airp]son f among ! memb]s ( ! ,commission appo9t$ "u su* p>agraph4 7,b7 ,vice ,*airp]son 7i7 ,designation ,! ,speak] ( ! ,h\se ( ,repres5tatives %all1 9 consultation ) ! majority lead]s & ! m9ority lead]s ( ! ,s5ate & ! ,h\se ( ,repres5tatives & ) ! concurr5ce ( a majority ( ! memb]s ( ! ,commission appo9t$ "u p>agraph 7#b77;,b71 designate a ,vice ,*airp]son f among ! memb]s ( ! ,commission appo9t$ "u su* p>agraph4 ,! ,vice ,*airp]son may n be a memb] ( ! same political p>ty z ! ,*airp]son4 7ii7 ,duty ,! ,vice ,*airp]son %all act 9 place ( ! ,*airp]son 9 ! abs5ce ( ! ,*airp]son4 7#e7 ,removal ( memb]s ,! ,presid5t may remove a memb] ( ! ,commission only = neglect ( duty or malfeasance 9 (fice4 7#f7 ,quorum ,a majority ( memb]s ( ! ,commission appo9t$ "u p>agraph 7#b77;,b7 %all con/itute a quorum ( ! ,commission1 b a less] numb] ( memb]s may hold he>+s4 7b7 ,duties ( ! ,commission 7#a7 ,9 g5]al ,! ,commission %all-- 7,a7 monitor & report on ! implem5tation ( ?is ,act2 & 7,b7 inve/igate1 monitor1 & report on progress t[>ds heal? equity & ! elim9ation ( heal? disp>ities4 7#b7 ,annual report ,! ,commission %all-- 7,a7 submit to ! ,presid5t & ,congress at lea/ "o report annually on heal? equity & heal? disp>ities2 & 7,b7 include 9 su* report-- 7i7 a description ( actions tak5 by ! ,dep>tm5t ( ,heal? & ,human ,s]vices & any o!r ,f$]al ag5cy relat$ to heal? equity or heal? disp>ities2 & 7ii7 recomm5dations on ensur+ equitable heal? c>e & elim9at+ heal? disp>ities4 7c7 ,p[]s 7#a7 ,he>+s 7,a7 ,9 g5]al ,! ,commission or1 at ! direction ( ! ,commission1 any subcommittee or memb] ( ! ,commission1 may1 = ! purpose ( c>ry+ out ?is section1 z ! ,commission or ! subcommittee or memb] consid]s advisable-- 7i7 hold su* he>+s1 meet & act at su* times & places1 take su* te/imony1 receive su* evid5ce1 & adm9i/] su* oa?s2 & 7ii7 require1 by subpo5a or o!rwise1 ! att5dance & te/imony ( su* witnesses & ! production ( su* books1 records1 correspond5ce1 memor&a1 pap]s1 docum5ts1 tapes1 & mat]ials4 7,b7 ,limitation on he>+s ,! ,commission may hold a he>+ "u subp>agraph 7,a77i7 only if ! he>+ is approv$-- 7i7 by a majority ( ! memb]s ( ! ,commission appo9t$ "u subsection 7a77#b77;,b72 or 7ii7 by a majority ( su* memb]s pres5t at a meet+ :5 a quorum is pres5t4 7#b7 ,issuance & en=cem5t ( subpo5as 7,a7 ,issuance ,a subpo5a issu$ "u p>agraph 7#a7 %all-- 7i7 be> ! signature ( ! ,*airp]son ( ! ,commission2 & 7ii7 be s]v$ by any p]son or class ( p]sons designat$ by ! ,*airp]son = t purpose4 7,b7 ,en=cem5t ,9 ! case ( contumacy or failure to obey a subpo5a issu$ "u p>agraph 7#a71 ! ,unit$ ,/ates di/rict c\rt = ! di/rict 9 :i* ! subpo5a$ p]son resides1 is s]v$1 or may be f\nd may issue an ord] requir+ ! p]son to appe> at any designat$ place to te/ify or to produce docum5t>y or o!r evid5ce4 7,c7 ,noncompliance ,any failure to obey ! ord] ( ! c\rt may be puni%$ by ! c\rt z a contempt ( c\rt4 7#c7 ,witness all[ances & fees 7,a7 ,9 g5]al ,section #ahba ( title #bh1 ,unit$ ,/ates ,code1 %all apply to a witness reque/$ or subpo5a$ to appe> at a he>+ ( ! ,commission4 7,b7 ,exp5ses ,! p] diem & mileage all[ances = a witness %all be paid f funds available to pay ! exp5ses ( ! ,commission4 7#d7 ,po/al s]vices ,! ,commission may use ! ,unit$ ,/ates mails 9 ! same mann] & "u ! same conditions z o!r ag5cies ( ! ,f$]al ,gov]nm5t4 7#e7 ,gifts ,! ,commission may accept1 use1 & dispose ( gifts or donations ( s]vices or prop]ty4 7d7 ,adm9i/rative ,provisions 7#a7 ,/aff 7,a7 ,director ,!re %all be a full-"t /aff director = ! ,commission :o %all-- 7i7 s]ve z ! adm9i/rative head ( ! ,commission2 & 7ii7 be appo9t$ by ! ,*airp]son ) ! concurr5ce ( ! ,vice ,*airp]son4 7,b7 ,o!r p]sonnel ,! ,commission may-- 7i7 appo9t su* o!r p]sonnel z x consid]s advisable1 subject to ! provisions ( title #e1 ,unit$ ,/ates ,code1 gov]n+ appo9tm5ts 9 ! competitive s]vice1 & ! provisions ( *apt] #ea & sub*apt] ,,iii ( *apt] #ec ( t title relat+ to classification & ,g5]al ,s*$ule pay rates2 & 7ii7 may procure tempor>y & int]mitt5t s]vices "u section #caji7;b7 ( title #e1 ,unit$ ,/ates ,code1 at rates = individuals n 9 excess ( ! daily equival5t paid = positions at ! maximum rate = ,,gs-#ae ( ! ,g5]al ,s*$ule "u section #eccb ( title #e1 ,unit$ ,/ates ,code4 7#b7 ,comp5sation ( memb]s 7,a7 ,non-,f$]al employees ,ea* memb] ( ! ,commission :o is n an (fic] or employee ( ! ,f$]al ,gov]nm5t %all be comp5sat$ at a rate equal to ! daily equival5t ( ! annual rate ( basic pay prescrib$ = level ,,iv ( ! ,executive ,s*$ule "u section #ecae ( title #e1 ,unit$ ,/ates ,code1 = ea* day 7includ+ travel "t7 dur+ :i* ! memb] is engag$ 9 ! p]=mance ( ! duties ( ! ,commission4 7,b7 ,f$]al employees ,ea* memb] ( ! ,commission :o is an (fic] or employee ( ! ,f$]al ,gov]nm5t %all s]ve )\t comp5sation 9 addition to ! comp5sation receiv$ = ! s]vices ( ! memb] z an (fice or employee ( ! ,f$]al ,gov]nm5t4 7,c7 ,travel exp5ses ,a memb] ( ! ,commission %all be all[$ travel exp5ses1 includ+ p] diem 9 lieu ( subsi/5ce1 at rates au?oriz$ = an employee ( an ag5cy "u sub*apt] ,i ( *apt] #eg ( title #e1 ,unit$ ,/ates ,code1 :ile away f ! home or regul> place ( bus9ess ( ! memb] 9 ! p]=mance ( ! duties ( ! ,commission4 7#c7 ,coop]ation ,! ,commission may secure directly f any ,f$]al dep>tm5t or ag5cy su* in=mation z ! ,commission consid]s necess>y to c>ry out ?is ,act4 ,^u reque/ ( ! ,*airman ( ! ,commission1 ! head ( su* dep>tm5t or ag5cy %all furni% su* in=mation to ! ,commission4 7e7 ,p]man5t ,commission ,section #ad ( ! ,f$]al ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 %all n apply to ! ,commission4 7f7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ = fiscal ye> #bjbb & ea* fiscal ye> !reaft] su* sums z may be necess>y to c>ry out ! duties ( ! ,commission4 #dejh4 ,grants = hospitals to promote equitable heal? c>e & outcomes 7a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y7 %all aw>d grants to hospitals to promote equitable heal? c>e treatm5t & s]vices1 & r$uce disp>ities 9 c>e & outcomes4 7b7 ,consultation ,9 e/abli%+ ! crit]ia = grants "u ?is section & evaluat+ applications = su* grants1 ! ,secret>y %all consult ) ! ,director = ,civil ,rights & ,heal? ,equity ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7c7 ,use ( funds ,a hospital %all use funds receiv$ f a grant "u ?is section to e/abli% or exp& programs to provide equitable heal? c>e to all pati5ts & to ensure equitable heal? c>e outcomes4 ,su* uses may include-- 7#a7 provid+ explicit & implicit bias tra9+ to m$ical provid]s & /aff2 7#b7 provid+ translation or int]pretation s]vices = pati5ts2 7#c7 recruit+ & tra9+ a div]se work=ce2 7#d7 track+ data relat$ to c>e & outcomes2 & 7#e7 tra9+ on cultural s5sitivity4 7d7 ,priority ,9 aw>d+ grants "u ?is section1 ! ,secret>y %all give priority to hospitals t h receiv$ disproportionate %>e hospital paym5ts "u section #ahhf7r7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7r77 or section #aibc ( su* ,act 7#db ,u4,s4,c4 #acifr-#d7 ) respect to fiscal ye> #bjba4 7e7 ,supplem5t1 n supplant ,grants aw>d$ "u ?is section %all be us$ to supplem5t1 n supplant1 any nongov]nm5t ef=ts1 or o!r ,f$]al1 ,/ate1 or local funds provid$ to a recipi5t4 7f7 ,equitable heal? c>e def9$ ,! t]m equitable heal? c>e has ! mean+ giv5 su* t]m 9 section #ahhf7;b77#c77;,b77viii77,,xiii77cc7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77;,b77viii77,,xiii77cc771 z add$ by section #dejc7;a74 7g7 ,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 #bjbb ?r\gh #bjbg4 ,g ,inve/+ 9 ,equity #dfja4 ,def9itions ,9 ?is subtitle3 7#a7 ,advisory ,c\ncil ,! t]m ,advisory ,c\ncil means ! ,pay = ,equity ,c\ncil conv5$ "u section #dfjc4 7#b7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#c7 ,/rategy ,! t]m ,/rategy means ! ,pay = ,equity ,/rategy set =? "u section #dfjb4 #dfjb4 ,/rategy to inc5tivize heal? equity 7a7 ,9 g5]al ,! ,secret>y1 9 consultation ) ! heads ( o!r appropriate ,f$]al ag5cies1 %all develop jo9tly ) ! ,advisory ,c\ncil & submit to ! ,committee on ,f9ance ( ! ,s5ate & ! ,committee on ,en]gy & ,comm]ce & ! ,committee on ,ways & ,means ( ! ,h\se ( ,repres5tatives1 & make publicly available on ! int]net website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 a ,pay = ,equity ,/rategy4 7b7 ,cont5ts ,! ,/rategy %all e/abli% goals = ,f$]al programs1 includ+ ^? au?oriz$ "u titles ,,xviii & ,,xix ( ! ,social ,security ,act1 to inc5tivize heal? equity1 :i* may include at lea/-- 7#a7 incorporat+ measures ( equity into all paym5t models by #bjbe2 7#b7 ty+ a p]c5tage ( reimbursem5t 9 value-bas$ paym5t models to equity measure p]=mance by #bjbh2 & 7#c7 increas+ ! numb] ( safety net provid]s p>ticipat+ 9 value-bas$ paym5t by a set p]c5tage by #bjcj4 7c7 ,duties ( ! ,secret>y ,! ,secret>y1 9 c>ry+ out subsection 7a71 %all ov]see ! foll[+3 7#a7 ,collect+ & mak+ publicly available in=mation submitt$ by ! ,advisory ,c\ncil4 7#b7 ,coord9at+ & assess+ exi/+ ,f$]al ,gov]nm5t programs & activities to assess capacity to meet equity goals4 7#c7 ,provid+ te*nical assi/ance1 z appropriate1 su* z dissem9at+ id5tifi$ be/ practices & in=mation %>+ bas$ on reports develop$ z a result ( ?is subtitle4 7d7 ,initial /rategy2 updates ,! ,secret>y %all-- 7#a7 n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ?is ,act1 develop1 publi%1 & submit to ! ,committee on ,f9ance ( ! ,s5ate & ! ,committee on ,en]gy & ,comm]ce & ! ,committee on ,ways & ,means ( ! ,h\se ( ,repres5tatives ! /rategy outl9$ 9 subsection 7a72 & 7#b7 bi5nially update1 publi%1 & submit to ,congress an updat$ /rategy to-- 7,a7 reflect new developm5ts1 *all5ges1 opportunities1 & solutions2 & 7,b7 review progress &1 bas$ on ! results ( su* review1 recomm5d priority actions = improv+ ! implem5tation ( su* recomm5dations1 z appropriate4 7e7 ,process = public input ,! ,secret>y %all e/abli% a process = public input to in=m ! developm5t (1 & updates to1 ! ,/rategy1 includ+ a process = ! public to submit recomm5dations to ! ,advisory ,c\ncil & an opportunity = public comm5t on ! propos$ ,/rategy4 #dfjc4 ,pay = ,equity ,advisory ,c\ncil 7a7 ,conv5+ ,! ,secret>y %all conv5e a ,pay = ,equity ,advisory ,c\ncil to advise & provide recomm5dations1 includ+ id5tifi$ be/ practices1 to ! ,secret>y on ! ,pay = ,equity ,/rategy4 7b7 ,memb]%ip 7#a7 ,9 g5]al ,! memb]s ( ! ,advisory ,c\ncil %all consi/ (-- 7,a7 ! appo9t$ memb]s "u p>agraph 7#b72 & 7,b7 ! ,f$]al memb]s "u p>agraph 7#c74 7#b7 ,appo9t$ memb]s ,9 addition to ! ,f$]al memb]s "u p>agraph 7#c71 ! ,secret>y %all appo9t n m ?an #ae vot+ memb]s ( ! ,advisory ,c\ncil :o are n repres5tatives ( ,f$]al dep>tm5ts or ag5cies & :o %all include at lea/ #a repres5tative ( ea* ( ! foll[+3 7,a7 ,b5efici>ies ( ,m$ic>e & ,m$icaid4 7,b7 ,safety net heal? c>e provid]s4 7,c7 ,value-bas$ paym5t exp]ts4 7,d7 ,o!r memb]s ) exp]tise & liv$ exp]i5ce ! ,secret>y deems appropriate4 7#c7 ,f$]al memb]s ,! ,f$]al memb]s ( ! ,advisory ,c\ncil1 :o %all be nonvot+ memb]s1 %all consi/ ( ! foll[+3 7,a7 ,! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 7or ! ,adm9i/rator's designee74 7,b7 ,! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration4 7#d7 ,div]se repres5tation ,! ,secret>y %all ensure t ! memb]%ip ( ! ,advisory ,c\ncil reflects ! div]sity ( individuals impact$ by ,f$]al heal? paym5t programs4 7c7 ,meet+s ,! ,advisory ,c\ncil %all meet qu>t]ly dur+ ! #a-ye> p]iod beg9n+ on ! date ( enactm5t ( ?is ,act & at lea/ #c times dur+ ea* ye> !reaft]4 ,meet+s ( ! ,advisory ,c\ncil %all be op5 to ! public4 ,v ,improv+ heal? outcomes = wom51 *ildr51 & families ,a ,9 ,g5]al #ejja4 ,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? = m$ically 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 nonb9>y1 g5d]-noncon=m+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 m$ically und]s]v$ communities1 & especially among racial & e?nic m9ority wom51 racial & e?nic m9ority *ildr51 adolesc5ts1 & lesbian1 gay1 bisexual1 transg5d]1 que]1 nonb9>y1 g5d]-noncon=m+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 pregnant1 bir?+1 & po/p>tum p & *ildr51 especially among racial & e?nic m9ority pregnant1 bir?+1 & po/p>tum p & *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 #bjbc ?r\gh #bjbg4 4 ,b ,pregnancy ,scre5+ #eaja4 ,pregnancy int5tion scre5+ initiative demon/ration program ,"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[+3 #cii,v-#g4 ,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 ,to be eligible to seek a grant "u ?is section1 an entity %all-- 7#a7 provide non-directive1 compreh5sive1 m$ically accurate in=mation2 & 7#b7 be a community-bas$ 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 p ) 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$s & goals ( su* p4 7e7 ,evaluation 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all1 by grant or contract1 & aft] consultation z describ$ 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 ( p ) bo? contraceptive & pre-pregnancy c>e4 7,c7 ,consid]ation ( heal? inequities 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-- 7,a7 submit to ,congress a report on ! results ( ! evaluation conduct$ "u p>agraph 7#a72 & 7,b7 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 #bjbc ?r\gh #bjbg4 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 #eajb4 ,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 :o are pregnant or brea/fe$+4 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 or brea/fe$+ t may be associat$ ) bir? defects1 heal? risks to a brea/f$ infant1 or o!r heal? risks1 su* z exposures to m$ications1 *emicals1 infections1 foodborne pa?og5s1 illnesses1 nutrition1 life/yle1 or climate- & wea!r-relat$ factors2 7,b7 ! provision ( accurate1 evid5ce-bas$ in=mation weigh+ risks ( exposures dur+ brea/fe$+ aga9/ ! b5efits ( brea/fe$+2 & 7,c7 ! provision ( in=mation describ$ 9 subp>agraph 7,a7 or 7,b7 ?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 pregnancy & brea/fe$+ in=mation s]vices 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 ,! ,secret>y %all provide = an evaluation ( pregnancy & brea/fe$+ in=mation s]vices c>ri$ out by ,/ates 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$-- 7#a7 #e1jjj1jjj = fiscal ye> #bjbc2 7#b7 #f1jjj1jjj = fiscal ye> #bjbd2 7#c7 #g1jjj1jjj = fiscal ye> #bjbe2 7#d7 #h1jjj1jjj = fiscal ye> #bjbf2 & 7#e7 #i1jjj1jjj = fiscal ye> #bjbg4 ,c ,pregnancy-,relat$ ,c>e #ebja4 ,mo!rs & (fspr+ mortality & morbidity aw>5ess 7a7 ,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 section 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 mortality & factors relat+ to su* mortality 7includ+ oral & m5tal heal?71 intimate p>tn] viol5ce1 & 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 #bjbc ?r\gh #bjbg4 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]vices1 act+ ?r\gh ! ,associate ,adm9i/rator ( ! ,mat]nal & ,*ild ,heal? ,bureau ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration 7ref]r$ to 9 ?is p>agraph z ! ,secret>y71 %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/ ,/ates1 p]9atal quality collaboratives1 & 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 ,/ate1 p]9atal quality collaborative1 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 :i* may include-- 7aa7 in=mation on evid5ce-bas$ practices to improve ! quality & safety ( mat]nal heal? c>e 9 hospitals & o!r heal? c>e sett+s ( a ,/ate or heal? c>e sy/em1 includ+ by address+ topics commonly associat$ ) heal? complications or risks relat$ to pr5atal c>e1 labor c>e1 bir?+1 & po/p>tum c>e2 7bb7 be/ practices = improv+ mat]nal heal? c>e bas$ on data f9d+s & reviews conduct$ by a ,/ate mat]nal mortality review committee t address topics ( relevance to common complications or heal? risks relat$ to pr5atal c>e1 labor c>e1 bir?+1 & po/p>tum c>e2 7cc7 in=mation on address+ det]m9ants ( heal? t impact mat]nal heal? outcomes = p be=e1 dur+1 & aft] pregnancy2 7dd7 ob/etric hemorrhage2 7ee7 ob/etric & po/p>tum c>e = p ) sub/ance use disord]s1 includ+ opioid use disord]2 7ff7 mat]nal c>diovascul> sy/em2 7gg7 mat]nal m5tal heal?2 7hh7 po/p>tum c>e basics = mat]nal safety2 7ii7 r$uction ( p]ip>tum racial & e?nic inequities2 7jj7 r$uction ( prim>y ces>ean bir?2 7kk7 sev]e hyp]t5sion 9 pregnancy2 7ll7 sev]e mat]nal morbidity reviews2 7mm7 support aft] a sev]e mat]nal morbidity ev5t2 7nn7 ?romboembolism2 7oo7 optimization ( support = brea/fe$+2 7pp7 mat]nal oral heal?2 & 7qq7 intimate p>tn] viol5ce2 & 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 #bjbc ?r\gh #bjbg4 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 p & _! 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 ( teams t-- 7i7 is multidiscipl9>y 9 nature & includes ! full range ( p]9atal & mat]nity c>e provid]s2 7ii7 works to improve measurable outcomes = mat]nal & infant heal? by advanc+ evid5ce-in=m$ cl9ical practices us+ quality improvem5t pr9ciples2 7iii7 works ) 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 7iv7 employs /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 7v7 has ! goal ( improv+ population-level outcomes 9 mat]nal & infant heal?2 & 7vi7 has ! goal ( improv+ outcomes ( all bir?+ p1 ?r\gh ! coord9ation1 integration1 & collaboration across bir? sett+s4 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 #bjbc ?r\gh #bjbg4 7#e7 ,expansion ( ,m$icaid & ,,*ip cov]age = pregnant & po/p>tum p 7,a7 ,requir+ cov]age ( oral heal? s]vices = pregnant & po/p>tum p 7i7 ,m$icaid ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 z previ\sly am5d$ by ?is ,act1 is am5d$-- 7,i7 9 subsection 7a77#d71 by ins]t+ 2 & 7,g7 oral heal? s]vices = pregnant & po/p>tum p 7z def9$ 9 subsection 7mm77 be=e ! semicolon at ! end2 & 7,,ii7 by add+ at ! end ! foll[+ new subsection3 7mm7 ,oral heal? s]vices = pregnant & po/p>tum p 7#a7 ,9 g5]al ,= purposes ( ?is title1 ! t]m oral heal? s]vices = pregnant & po/p>tum p means d5tal s]vices necess>y to prev5t disease & promote oral heal?1 re/ore oral /ructures to heal? & function1 & treat em]g5cy conditions t are furni%$ to a p]son dur+ pregnancy 7or dur+ ! #a-ye> p]iod beg9n+ on ! la/ day ( ! pregnancy74 7#b7 ,cov]age requirem5ts ,to satisfy ! requirem5t to provide oral heal? s]vices = pregnant & po/p>tum p1 a ,/ate %all provide cov]age = prev5tive1 diagno/ic1 p]iodontal1 & re/orative c>e consi/5t ) recomm5dations = p]9atal oral heal? c>e & d5tal c>e dur+ pregnancy f ! ,am]ican ,academy ( ,p$iatric ,d5ti/ry & ! ,am]ican ,college ( ,ob/etricians & ,gynecologi/s4 4 7ii7 ,,*ip ,section #bajc7;c77#f77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7c77#f77;,a77 is am5d$ by ins]t+ or a t>get$ l[-income pregnant p]son aft] t>get$ l[-income *ild4 7,b7 ,ext5d+ ,m$icaid cov]age = pregnant & po/p>tum p ,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 = pregnant & po/p>tum p 7z def9$ 9 section #aije7mm777 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+ ,,*ip cov]age = pregnant & po/p>tum p ,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,d7 ,con=m+ am5dm5ts 7i7 ,section #aijb7;e77#af7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#af77 is am5d$-- 7,i7 9 subp>agraph 7,a71 by /rik+ may provide & all t foll[s ?r\gh ! p]iod & ins]t+ ! foll[+3 may provide t ! ,/ate w provide ! m$ical assi/ance describ$ 9 subp>agraph 7,b7 to an individual :o1 :ile pregnant1 is eligible = & has receiv$ m$ical assi/ance "u ! ,/ate plan approv$ "u ?is title 7or a waiv] ( su* plan71 includ+ dur+ a p]iod ( retroactive eligibility "u subsection 7a77#cd7 & ?r\gh ! end ( ! mon? 9 :i* ! #a-ye> p]iod beg9n+ on ! la/ day ( ! individual's pregnancy ends42 & 7,,ii7 9 subp>agraph 7,b71 by /rik+ #ab-mon? ea* place x appe>s & ins]t+ #a-ye>4 7ii7 ,section #aije7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is am5d$1 9 ! fif? s5t5ce1 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 p :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 ,eligibility /&>ds = t>get$ l[-income pregnant p ,dur+ ! p]iod t beg9s on ! date ( enactm5t ( ?is p>agraph & ends on ! date t is five 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 p on ! basis ( be+ pregnant 7includ+ pregnancy-relat$ assi/ance provid$ to t>get$ l[-income pregnant p 7z def9$ 9 section #baab7;d771 pregnancy-relat$ assi/ance provid$ to p :o are eligible = su* assi/ance ?r\gh application ( section #aijb7v77#d77;,a7 "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 p on ! basis ( be+ pregnant7 %all n h 9 effect1 ) respect to su* p1 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 p & "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 p "u su* programs2 7ii7 optional b5efits t ,/ates may provide to pregnant & po/p>tum p "u su* programs2 & 7iii7 ! availability ( diff]5t k9ds ( b5efits = pregnant & po/p>tum p1 includ+ oral heal? & m5tal heal? b5efits1 "u su* programs4 7,g7 ,f$]al fund+ = co/ ( ext5d$ ,m$icaid & ,,*ip cov]age = po/p>tum p 7i7 ,m$icaid ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 z previ\sly am5d$ by ?is ,act1 is fur!r am5d$-- 7,i7 9 subsection 7b71 by /rik+ & 7ll7 & ins]t+ 7ll71 & 7nn72 & 7,,ii7 by add+ at ! end ! foll[+3 7nn7 ,increas$ ,,fmap = ext5d$ m$ical assi/ance = po/p>tum p ,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 p]son :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 ( _! 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#ac7 ,enhanc$ paym5t = ext5d$ assi/ance provid$ to pregnant p ,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 p]son :o is eligible = su* assi/ance on ! basis ( be+ pregnant 7includ+ pregnancy-relat$ assi/ance provid$ to a t>get$ l[-income pregnant p]son 7z def9$ 9 section #baab7;d771 pregnancy-relat$ assi/ance provid$ to a p]son :o is eligible = su* assi/ance ?r\gh application ( section #aijb7v77#d77;,a7 "u section #bajg7;e77#a71 or any o!r assi/ance "u ! plan 7or waiv]7 provid$ to a p]son :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 ,guidance on ,/ate options = ,m$icaid cov]age ( d\la s]vices ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 %all issue guidance = ! ,/ates conc]n+ options = ,m$icaid cov]age & paym5t = support s]vices provid$ by d\las4 7,i7 ,effective date 7i7 ,9 g5]al ,subject to clause 7ii71 ! am5dm5ts made by ?is p>agraph %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 p>agraph1 ! 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 seq471 z am5d$ by section #eaja1 is fur!r am5d$ by add+ at ! end ! foll[+ new section3 #cii,v-#h4 ,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 bias1 cultural compet5cy1 & respectful c>e practices 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 s*ool ( nurs+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 demon/rate engagem5t ) gr\ps engag$ 9 ! implem5tation ( heal? c>e pr(essional tra9+ 9 implicit bias & deliv]+ culturally compet5t c>e1 su* z dep>tm5ts ( public heal?1 p]9atal quality collaboratives1 hospital sy/ems1 & heal? c>e pr(essional gr\ps1 9 ord] to obta9 input on res\rces ne$$ = effective implem5tation /rategies2 & 7#d7 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#d74 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 p]son 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 #bjbc ?r\gh #bjbg4 4 7#g7 ,special supplem5tal nutrition program = p1 infants1 & *ildr5 ,section #ag7;d77#c77;,a77ii7 ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aghf7;d77#c77;,a77ii77 is am5d$-- 7,a7 by /rik+ ! clause designation & head+ & all t foll[s ?r\gh ,a ,/ate & ins]t+ ! foll[+3 7ii7 ,pregnant & po/p>tum p 7,i7 ,brea/fe$+ p ,a ,/ate 2 7,b7 9 subclause 7,i7 7z s designat$71 by /rik+ #a ye> & all t foll[s ?r\gh e>li] & ins]t+ #b ye>s po/p>tum2 & 7,c7 by add+ at ! end ! foll[+3 7,,ii7 ,po/p>tum p ,a ,/ate may elect to c]tify a po/p>tum p]son = a p]iod ( #b ye>s4 4 7#h7 ,def9itions ,9 ?is subsection3 7,a7 ,mat]nal mortality ,! t]m mat]nal mortality means dea? ( a p]son t occurs dur+ pregnancy or )9 ! "o-ye> p]iod foll[+ ! end ( su* pregnancy4 7,b7 ,pregnancy relat$ dea? ,! t]m pregnancy relat$ dea? includes ! dea? ( a p]son dur+ pregnancy or )9 "o ye> ( ! end ( pregnancy f a pregnancy complication1 a *a9 ( ev5ts initiat$ by pregnancy1 or ! aggravation ( an unrelat$ condition by ! physiologic effects ( pregnancy4 7,c7 ,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 p]son's heal?4 7b7 ,increase 9 tax on c]ta9 tobacco products & imposition ( tax on nicot9e 7#a7 ,increas+ tax on cig>ettes 7,a7 ,small cig>ettes ,section #egja7;b77#a7 ( ! ,int]nal ,rev5ue ,code ( #aihf 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+ #baa4ci4 7#b7 ,tax p>ity = small cig>s ,section #egja7;a77#a7 ( su* ,code is am5d$ by /rik+ #ej4cc & ins]t+ #ajj4ff4 7#c7 ,tax p>ity = l>ge cig>s ,section #egja7;a77#b7 ( su* ,code is am5d$ by /rik+ #eb4ge p]c5t & all t foll[s ?r\gh ! p]iod & ins]t+ #di4ef p] p\nd & a proportionate tax at ! l rate on all fractional p>ts ( a p\nd b n less ?an #aj4jf c5ts p] cig>44 7#d7 ,tax p>ity = smokeless tobacco 7,a7 ,section #egja7;e7 ( su* ,code is am5d$-- 7i7 9 p>agraph 7#a71 by /rik+ #a4ea & ins]t+ #bf4hd1 7ii7 9 p>agraph 7#b71 by /rik+ #ej4cc c5ts & ins]t+ #aj4gj1 & 7iii7 by add+ at ! end ! foll[+ new p>agraph3 7#c7 ,smokeless tobacco sold 9 discrete s+le-use units ,on discrete s+le-use units1 #ajj p] ?\s&4 4 7,b7 ,section #egjb7m7 ( su* ,code is am5d$-- 7i7 9 p>agraph 7#a71 by /rik+ or *ew+ tobacco & ins]t+ 1 *ew+ tobacco1 or discrete s+le-use unit1 7ii7 9 p>agraphs 7#b7 & 7#c71 by ins]t+ & t is n a discrete s+le-use unit be=e ! p]iod at ! end ( ea* su* p>agraph1 & 7iii7 by add+ at ! end ! foll[+ new p>agraph3 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$1 & 7,b7 is 9 ! =m ( a loz5ge1 tablet1 pill1 p\*1 dissolvable /rip1 or o!r discrete s+le-use or s+le-dose unit4 4 7#e7 ,tax p>ity = pipe tobacco ,section #egja7;f7 ( su* ,code is am5d$ by /rik+ #b4hcaa c5ts & ins]t+ #di4ef4 7#f7 ,tax p>ity = ,roll-,y\r-,own tobacco ,section #egja7;g7 ( su* ,code is am5d$ by /rik+ #bd4gh & ins]t+ #di4ef4 7#g7 ,tax p>ity = ,roll-,y\r-,own tobacco & c]ta9 process$ tobacco ,section #egjb7o7 ( su* ,code 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#h7 ,imposition ( tax on nicot9e = use 9 vap+1 etc 7,a7 ,9 g5]al ,section #egja ( su* ,code is am5d$ by r$esignat+ subsection 7h7 z subsection 7i7 & by ins]t+ aft] subsection 7g7 ! foll[+ new subsection3 7h7 ,nicot9e ,on taxable nicot9e1 manufactur$ 9 or import$ into ! ,unit$ ,/ates1 !re %all be impos$ a tax equal to ! doll> am\nt specifi$ 9 section #egja7;b77#a7 p] #a1haj milligrams ( nicot9e 7& a proportionate tax at ! l rate on any fractional "p !re(74 4 7,b7 ,taxable nicot9e ,section #egjb ( su* ,code is am5d$ by add+ at ! end ! foll[+ new subsection3 7q7 ,taxable nicot9e 7#a7 ,9 g5]al ,except z o!rwise provid$ 9 ?is subsection1 ! t]m taxable nicot9e means any nicot9e :i* has be5 extract$1 conc5trat$1 or syn!siz$4 7#b7 ,exception = products approv$ by ,food & ,drug ,adm9i/ration ,su* t]m %all n include any nicot9e if ! manufactur] or import] !re( demon/rates to ! satisfaction ( ! ,secret>y ( ,heal? & ,human ,s]vices t su* nicot9e w be us$ 9-- 7,a7 a drug-- 7i7 t is approv$ "u section #eje ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act or lic5s$ "u section #cea ( ! ,public ,heal? ,s]vice ,act1 or 7ii7 = :i* an inve/igational use exemption has be5 au?oriz$ "u section #eje7;i7 ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act or "u section #cea7;a7 ( ! ,public ,heal? ,s]vice ,act1 or 7,b7 a comb9ation product 7z describ$ 9 section #ejc7;g7 ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act71 ! con/itu5t p>ts ( :i* 7 approv$ or cle>$ "u section #eje1 #eaj7k71 or #eae ( su* ,act4 7#c7 ,coord9ation ) taxation ( o!r tobacco products ,tobacco products meet+ ! def9ition ( cig>s1 cig>ettes1 smokeless tobacco1 pipe tobacco1 & roll-y\r-own tobacco 9 ?is section %all be classifi$ & tax$ z su* despite any conc5tration ( ! nicot9e inh]5t 9 ^? products or any addition ( nicot9e to ^? products dur+ ! manufactur+ process4 7#d7 ,regulations ,! ,secret>y %all prescribe su* regulations or o!r guidance z is necess>y or appropriate to c>ry out ! purposes ( ?is subsection1 includ+ regulations or o!r guidance = coord9at+ ! taxation ( tobacco products & taxable nicot9e to protect rev5ue & prev5t d\ble taxation4 4 7,c7 ,taxable nicot9e treat$ z a tobacco product ,section #egjb7;c7 ( su* ,code is am5d$ by /rik+ & roll-y\r-own tobacco & ins]t+ roll-y\r-own tobacco1 & taxable nicot9e4 7,d7 ,manufactur] ( taxable nicot9e ,section #egjb ( su* ,code1 z am5d$ by subp>agraph 7,b71 is am5d$ by add+ at ! end ! foll[+ new subsection3 7r7 ,manufactur] ( taxable nicot9e 7#a7 ,9 g5]al ,any p]son :o extracts1 conc5trates1 or syn!sizes nicot9e %all be treat$ z a manufactur] ( taxable nicot9e 7& z manufactur+ su* taxable nicot9e74 7#b7 ,application ( rules relat$ to manufactur]s ( tobacco products ,any ref]5ce to a manufactur] ( tobacco products1 or to manufactur+ tobacco products1 %all be treat$ z includ+ a ref]5ce to a manufactur] ( taxable nicot9e1 or to manufactur+ taxable nicot9e1 respectively4 4 7#i7 ,repeal ( special rules = det]m9+ price ( cig>s ,section #egjb ( su* ,code is am5d$ by /rik+ subsection 7l74 7#aj7 ,floor /ocks taxes 7,a7 ,imposition ( tax ,on cov]$ tobacco products1 & cig>ette pap]s & tubes1 manufactur$ 9 or import$ into ! ,unit$ ,/ates :i* are remov$ be=e ! 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 ,cov]$ tobacco products ,= purposes ( ?is p>agraph1 ! t]m cov]$ tobacco products means any tobacco product o!r ?an-- 7i7 cig>s describ$ 9 section #egja7;a77#b7 ( ! ,int]nal ,rev5ue ,code ( #aihf1 7ii7 discrete s+le-use units 7z def9$ 9 section #egjb7m77#d7 ( su* ,code1 z am5d$ by ?is subsection71 & 7iii7 taxable nicot9e 7z def9$ 9 section #egjb7q7 ( su* ,code1 z am5d$ by ?is subsection74 7,c7 ,cr$it aga9/ tax ,ea* p]son %all be all[$ z a cr$it aga9/ ! taxes impos$ by subp>agraph 7,a7 an am\nt equal to ! less] ( #a1jjj or ! am\nt ( su* taxes4 ,= purposes ( ! prec$+ s5t5ce1 all p]sons treat$ z a s+le employ] "u subsection 7b71 7c71 7m71 or 7o7 ( section #dad ( ! ,int]nal ,rev5ue ,code ( #aihf %all be treat$ z #a p]son = purposes ( ?is subp>agraph4 7,d7 ,liability = tax & me?od ( paym5t 7i7 ,liability = tax ,! p]son ref]r$ to 9 subp>agraph 7,a7 %all be liable = ! tax impos$ by su* subp>agraph4 7ii7 ,me?od ( paym5t ,! tax impos$ by subp>agraph 7,a7 %all be paid 9 su* mann] z ! ,secret>y may provide4 7,e7 ,articles 9 =eign trade zones 7i7 ,9 g5]al ,not)/&+ ! ,act ( ,june #ah1 #aicd 7commonly kn[n z ! ,=eign ,trade ,zone ,act1 #dh ,/at4 #iih1 #ai ,u4,s4,c4 #ha;a et seq47 or any o!r provision ( law1 any cov]$ tobacco products1 or cig>ette pap]s & tubes1 :i* are locat$ 9 a =eign trade zone on ! tax increase date1 %all be subject to ! tax impos$ by subp>agraph 7,a7 if-- 7,i7 int]nal rev5ue taxes h be5 det]m9$1 or cu/oms duties liquidat$1 ) respect to su* article be=e su* date pursuant to a reque/ made "u ! #a/ proviso ( section #c7;a7 ( su* ,act1 or 7,,ii7 su* article is held on su* date "u ! sup]vision ( an (fic] ( ! ,unit$ ,/ates ,cu/oms & ,bord] ,protection ( ! ,dep>tm5t ( ,homel& ,security pursuant to ! #b;d proviso ( su* section #c7;a74 7,f7 ,tax increase date ,= purposes ( ?is p>agraph1 ! t]m tax increase date means ! fir/ day ( ! fir/ cal5d> qu>t] describ$ 9 p>agraph 7#aa77;,a74 7,g7 ,c]ta9 o!r def9itions ,t]ms us$ 9 ?is p>agraph :i* are also us$ 9 section #egjb ( ! ,int]nal ,rev5ue ,code ( #aihf %all h ! same mean+ z :5 us$ 9 su* section4 7#aa7 ,effective date 7,a7 ,9 g5]al ,except z o!rwise provid$ 9 ?is p>agraph1 ! am5dm5ts made by ?is subsection %all apply to articles remov$ 9 cal5d> qu>t]s beg9n+ aft] ! date ( ! enactm5t ( ?is ,act4 7,b7 ,delay$ effective date = c]ta9 products ,! am5dm5ts made by p>agraphs 7#c71 7#d77;,a77iii71 7#d77;,b71 & 7#h7 %all apply to articles remov$ 9 cal5d> qu>t]s beg9n+ aft] ! date :i* is #ahj days aft] ! date ( ! enactm5t ( ?is ,act4 7#ab7 ,transition rule = p]mit & bond requirem5ts ,a p]son :i* is lawfully engag$ 9 bus9ess z a manufactur] or import] ( taxable nicot9e 7)9 ! mean+ ( sub*apt] ,a ( *apt] #eb ( ! ,int]nal ,rev5ue ,code ( #aihf1 z am5d$ by ?is subsection7 on ! date ( ! enactm5t ( ?is ,act1 fir/ becomes subject to ! requirem5ts ( sub*apt] ,b ( *apt] #eb ( su* ,code by reason ( ! am5dm5ts made by ?is subsection1 & submits an application "u su* sub*apt] ,b to engage 9 su* bus9ess n lat] ?an #ij days aft] ! date ( ! enactm5t ( ?is ,act1 %all n be d5i$ ! "r to c>ry on su* bus9ess by reason ( su* requirem5ts be=e f9al action on su* application4 #ebjb4 ,,mommies 7a7 ,,gao /udy & report 7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report on ! gaps 9 cov]age ) respect to-- 7,a7 pregnant individuals enroll$ "u a ,/ate plan 7or waiv] ( su* plan7 "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 & ! ,*ildr5's ,heal? ,insurance ,program "u title ,,xxi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq472 & 7,b7 po/p>tum individuals enroll$ "u a ,/ate plan 7or waiv] ( su* plan7 "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 & ! ,*ildr5's ,heal? ,insurance ,program "u title ,,xxi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq47 :o receiv$ assi/ance "u ei!r su* program dur+ _! pregnancy4 7#b7 ,cont5t ( report ,! report requir$ "u ?is p>agraph %all include ! foll[+3 7,a7 ,in=mation ab\t ! abilities & successes ( ,/ate ,m$icaid ag5cies 9 det]m9+ :e!r pregnant & po/p>tum individuals are eligible "u ano!r insurance af=dability program1 & 9 transition+ any su* individuals :o are s eligible to cov]age "u su* a program at ! end ( _! p]iod ( eligibility = m$ical assi/ance1 pursuant to section #dce4abjj ( ! title #db1 ,code ( ,f$]al ,regulations 7z 9 effect on ,septemb] #a1 #bjah74 7,b7 ,in=mation on factors contribut+ to gaps 9 cov]age t disproportionately impact und]s]v$ populations1 includ+ l[-income individuals1 ,black1 ,indig5\s1 & o!r individuals ( color1 individuals :o reside 9 a heal? pr(essional %ortage area 7z def9$ 9 section #ccb7;a77#a77;,a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;e7a77#a77;,a777 or individuals :o are memb]s ( a m$ically und]s]v$ population 7z def9$ by section #ccj7;b77#c7 ( su* ,act 7#db ,u4,s4,c4 #bed;b7b77#c77;,a7774 7,c7 ,recomm5dations = address+ & r$uc+ su* gaps 9 cov]age4 7,d7 ,su* o!r in=mation z ! ,comptroll] ,g5]al deems necess>y4 7#c7 ,data disaggregation ,to ! greate/ ext5t possible1 ! ,comptroll] ,g5]al %all disaggregate data pres5t$ 9 ! report1 includ+ by age1 g5d] id5tity1 race1 e?nicity1 income level1 & o!r demographic factors4 7b7 ,mat]nity c>e home demon/ration project ,title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is am5d$ by ins]t+ ! foll[+ new section aft] section #aidg3 #aidh4 ,mat]nity ,c>e ,home ,demon/ration ,project 7a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y %all e/abli% a demon/ration project 79 ?is section ref]r$ to z ! demon/ration project7 "u :i* ! ,secret>y %all provide grants to ,/ates to ent] into arrangem5ts ) eligible entities to implem5t or exp& a mat]nity c>e home model = eligible individuals4 7b7 ,goals ( demon/ration project ,! goals ( ! demon/ration project are ! foll[+3 7#a7 ,to improve-- 7,a7 mat]nity & infant c>e outcomes2 7,b7 bir? equity2 7,c7 heal? equity =-- 7i7 ,black1 ,indig5\s1 & o!r p ( color2 7ii7 lesbian1 gay1 bisexual1 transg5d]1 que]1 non-b9>y1 & g5d] nonconfirm+ individuals2 7iii7 p ) disabilities2 & 7iv7 o!r und]s]v$ populations2 7,d7 communication by mat]nity1 infant c>e1 & social s]vices provid]s2 7,e7 integration ( p]9atal support s]vices1 includ+ community heal? work]s1 d\las1 social work]s1 public heal? nurses1 pe] lactation c\nselors1 lactation consultants1 *ildbir? educators1 pe] m5tal heal? work]s1 & o!rs1 into heal? c>e entities & organizations2 7,f7 c>e coord9ation betwe5 mat]nity1 infant c>e1 oral heal? s]vices1 & social s]vices provid]s )9 ! community2 7,g7 ! quality & safety ( mat]nity & infant c>e2 7,h7 ! exp]i5ce ( individuals receiv+ mat]nity c>e1 includ+ by increas+ ! ability ( an individual to develop & foll[ _! own bir?+ plans2 & 7,i7 access to adequate pr5atal & po/p>tum c>e1 includ+-- 7i7 pr5atal c>e t is initiat$ 9 a timely mann]2 7ii7 n few] ?an #e po/-pregnancy visits to a mat]nity c>e provid]2 & 7iii7 int]pregnancy c>e4 7#b7 ,to provide coord9at$1 evid5ce-bas$1 respectful1 culturally & l+ui/ically appropriate1 & p]son-c5t]$ mat]nity c>e managem5t4 7#c7 ,to decrease-- 7,a7 sev]e & prev5table mat]nal morbidity & mat]nal mortality2 7,b7 ov]all heal? c>e sp5d+2 7,c7 unnecess>y em]g5cy dep>tm5t visits2 7,d7 inequities 9 mat]nal & infant c>e outcomes1 includ+ racial1 economic1 disability1 g5d]-bas$1 & geographical inequities2 7,e7 racial1 g5d]1 economic1 & o!r discrim9ation among heal? c>e pr(essionals2 7,f7 racism1 discrim9ation1 disrespect1 & abuse 9 mat]nity c>e sett+s2 7,g7 ! rate ( ces>ean deliv]ies = l[-risk pregnancies2 7,h7 ! rate ( pre-t]m bir?s & infants born ) l[ bir? weight2 & 7,i7 ! rate ( avoidable mat]nal & newborn hospitalizations & admissions to int5sive c>e units4 7c7 ,consultation ,9 design+ & implem5t+ ! demon/ration project ! ,secret>y %all consult ) /akehold]s1 includ+-- 7#a7 ,/ates2 7#b7 organizations repres5t+ relevant heal? c>e pr(essionals1 includ+ oral heal? s]vices pr(essionals2 7#c7 organizations1 p>ticul>ly reproductive ju/ice & bir? ju/ice organizations l$ by p ( color1 t repres5t consum]s ( mat]nal heal? c>e1 includ+ consum]s ( mat]nal heal? c>e :o are disproportionately impact$ by poor mat]nal heal? outcomes2 7#d7 repres5tatives ) exp]i5ce implem5t+ o!r mat]nity c>e home models1 includ+ repres5tatives f ! ,c5t] = ,m$ic>e & ,m$icaid ,innovation2 7#e7 community-bas$ heal? c>e pr(essionals1 includ+ d\las1 lactation consultants1 & o!r /akehold]s2 7#f7 exp]ts 9 promot+ heal? equity & combat+ racial bias 9 heal? c>e sett+s2 & 7#g7 ,black1 ,indig5\s1 & o!r mat]nal heal? c>e consum]s ( color :o h exp]i5c$ sev]e mat]nal morbidity4 7d7 ,application & selection ( ,/ates 7#a7 ,9 g5]al ,a ,/ate seek+ to p>ticipate 9 ! demon/ration project %all submit an application to ! ,secret>y at su* "t & 9 su* mann] z ! ,secret>y %all require4 7#b7 ,selection ( ,/ates 7,a7 ,9 g5]al ,! ,secret>y %all select at lea/ #aj ,/ates to p>ticipate 9 ! demon/ration project4 7,b7 ,selection requirem5ts ,9 select+ ,/ates to p>ticipate 9 ! demon/ration project1 ! ,secret>y %all-- 7i7 ensure t !re is geographic & regional div]sity 9 ! areas 9 :i* activities w be c>ri$ out "u ! project2 7ii7 ensure t ,/ates ) significant inequities 9 mat]nal & infant heal? outcomes1 includ+ sev]e mat]nal morbidity1 & o!r inequities bas$ on race1 income1 or access to mat]nity c>e1 are includ$2 & 7iii7 ensure t at lea/ #a t]ritory is includ$4 7e7 ,grants 7#a7 ,9 g5]al ,f am\nts appropriat$ "u subsection 7l71 ! ,secret>y %all aw>d #a grant = ea* ye> ( ! demon/ration project to ea* ,/ate t is select$ to p>ticipate 9 ! demon/ration project4 7#b7 ,use ( grant funds ,a ,/ate may use funds receiv$ "u ?is section to-- 7,a7 aw>d grants or make paym5ts to eligible entities z "p ( an arrangem5t describ$ 9 subsection 7f77#b72 7,b7 provide f9ancial inc5tives to heal? c>e pr(essionals1 includ+ community-bas$ heal? c>e work]s & community-bas$ d\las1 :o p>ticipate 9 ! ,/ate's mat]nity c>e home model2 7,c7 provide adequate tra9+ = heal? c>e pr(essionals1 includ+ community-bas$ heal? c>e work]s1 d\las1 & c>e coord9ators1 :o p>ticipate 9 ! ,/ate's mat]nity c>e home model1 :i* may include tra9+ = cultural humility & antiracism1 racial bias1 heal? equity1 reproductive & bir? ju/ice1 trauma-in=m$ c>e1 home visit+ skills1 & respectful communication & li/5+ skills1 p>ticul>ly 9 reg>ds to mat]nal heal?2 7,d7 pay = p]sonnel & adm9i/rative exp5ses associat$ ) design+1 implem5t+1 & op]at+ ! ,/ate's mat]nity c>e home model2 7,e7 pay = items & s]vices t are furni%$ "u ! ,/ate's mat]nity c>e home model & = :i* paym5t is o!rwise unavailable "u ?is title2 7,f7 pay = s]vices & mat]ials to ensure culturally & l+ui/ically appropriate communication1 includ+-- 7i7 language s]vices su* z int]pret]s & translation ( writt5 mat]ials2 & 7ii7 developm5t ( culturally & l+ui/ically appropriate mat]ials2 & auxili>y aids & s]vices2 & 7,g7 pay = o!r co/s relat$ to ! ,/ate's mat]nity c>e home model1 z det]m9$ by ! ,secret>y4 7#c7 ,grant = national indep5d5t evaluator 7,a7 ,9 g5]al ,f ! am\nts appropriat$ "u subsection 7l71 prior to aw>d+ any grants "u p>agraph 7#a71 ! ,secret>y %all ent] into a contract ) a national ext]nal entity to create a s+le1 uni=m process to-- 7i7 ensure t ,/ates t receive grants "u p>agraph 7#a7 comply ) ! requirem5ts ( ?is section2 & 7ii7 evaluate ! outcomes ( ! demon/ration project 9 ea* p>ticipat+ ,/ate4 7,b7 ,annual report ,! contract describ$ 9 subp>agraph 7,a7 %all require ! national ext]nal entity to submit to ! ,secret>y-- 7i7 a ye>ly evaluation report = ea* ye> ( ! demon/ration project2 & 7ii7 a f9al impact report aft] ! demon/ration project has conclud$4 7,c7 ,secret>y's au?ority ,no?+ 9 ?is p>agraph %all prev5t ! ,secret>y f mak+ a det]m9ation t a ,/ate is n 9 compliance ) ! requirem5ts ( ?is section )\t ! national ext]nal entity mak+ su* a det]m9ation4 7f7 ,p>tn]%ip ) eligible entities 7#a7 ,9 g5]al ,z a condition ( receiv+ a grant "u ?is section1 a ,/ate %all ent] into an arrangem5t ) "o or m eligible entities t meets ! requirem5ts ( p>agraph 7#b74 7#b7 ,arrangem5ts ) eligible entities ,"u an arrangem5t betwe5 a ,/ate & an eligible entity "u ?is subsection1 ! eligible entity %all p]=m ! foll[+ functions1 ) respect to eligible individuals enroll$ ) ! entity "u ! ,/ate's mat]nity c>e home model-- 7,a7 provide culturally & l+ui/ically appropriate congru5t c>e1 :i* may include pr5atal c>e1 family plann+ s]vices1 m$ical c>e1 m5tal & behavioral c>e1 po/p>tum c>e1 & oral heal? s]vices to su* eligible individuals ?r\gh a team ( heal? c>e pr(essionals1 :i* may include ob/etrician-gynecologi/s1 mat]nal-fetal m$ic9e speciali/s1 family physicians1 prim>y c>e provid]s1 oral heal? provid]s1 physician assi/ants1 advanc$ practice regi/]$ nurses su* z nurse practition]s & c]tifi$ nurse midwives1 c]tifi$ midwives1 c]tifi$ pr(essional midwives1 physical !rapi/s1 social work]s1 traditional & community-bas$ d\las1 lactation consultants1 *ildbir? educators1 community heal? work]s1 pe] m5tal heal? support]s1 & o!r heal? c>e pr(essionals2 7,b7 conduct a risk assessm5t ( ea* su* eligible individual to det]m9e if _! pregnancy is high or l[ risk1 & e/abli% a tailor$ pregnancy c>e plan1 :i* takes into consid]ation ! individual's own pref]5ces & pregnancy c>e & bir?+ plans & det]m9es ! appropriate support s]vices to r$uce ! individual's m$ical1 social1 & environm5tal risk factors1 = ea* su* eligible individual bas$ on ! results ( su* risk assessm5t2 7,c7 assign ea* su* eligible individual to a culturally & l+ui/ically appropriate c>e coord9ator1 :i* may be a nurse1 social work]1 traditional or community-bas$ d\la1 community heal? work]1 midwife1 or o!r heal? c>e provid]1 :o is responsible = ensur+ t su* eligible individual receives ! necess>y m$ical c>e & connections to ess5tial support s]vices2 7,d7 provide1 or arrange = ! provision (1 ess5tial support s]vices1 su* z s]vices t address-- 7i7 food access1 nutrition1 & ex]cise2 7ii7 smok+ cessation2 7iii7 sub/ance use disord] & addiction treatm5t2 7iv7 anxiety1 depression1 trauma1 & o!r m5tal & behavioral heal? issues2 7v7 brea/fe$+1 *e/fe$+1 or o!r infant fe$+ options supports1 initiation1 cont9uation1 & duration2 7vi7 /able1 af=dable1 safe1 & heal?y h\s+2 7vii7 transportation2 7viii7 intimate p>tn] viol5ce2 7ix7 community & police viol5ce2 7x7 home visit+ s]vices2 7xi7 *ildbir? & newborn c>e education2 7xii7 oral heal? education2 7xiii7 cont9u\s labor support2 7xiv7 gr\p pr5atal c>e2 7xv7 family plann+ & contraceptive c>e & supplies2 & 7xvi7 af=dable *ild c>e2 7,e7 z appropriate1 facilitate connections to a usual prim>y c>e provid]1 :i* may be a reproductive heal? c>e provid]2 7,f7 ref] to guidel9es & op9ions ( m$ical associations :5 det]m9+ :e!r an elective deliv]y %\ld be p]=m$ on an eligible individual be=e #ci weeks ( ge/ation2 7,g7 provide su* eligible individual ) evid5ce-bas$ & culturally & l+ui/ically appropriate education & res\rces to id5tify pot5tial w>n+ signs ( pregnancy & po/p>tum complications & :5 & h[ to obta9 m$ical att5tion2 7,h7 provide1 or arrange = ! provision (1 culturally & l+ui/ically appropriate pregnancy & po/p>tum heal? s]vices1 includ+ family plann+ c\nsel+ & s]vices1 to eligible individuals2 7,i7 track & report po/p>tum heal? & bir? outcomes ( su* eligible individuals & _! *ildr52 7,j7 ensure t c>e is p]son-c5t]$1 culturally & l+ui/ically appropriate1 & pati5t-l$1 includ+ by engag+ eligible individuals 9 _! own c>e1 includ+ ?r\gh communication & education2 & 7,k7 ensure adequate tra9+ = appropriately s]v+ ! population ( individuals eligible = m$ical assi/ance "u ! ,/ate plan 7or waiv] ( su* plan71 includ+ ?r\gh reproductive ju/ice1 bir? ju/ice1 bir? equity1 & anti-raci/ frameworks1 home visit+ skills1 & k ( social s]vices4 7g7 ,t]m ( demon/ration project ,! ,secret>y %all conduct ! demon/ration project = a p]iod ( #e ye>s4 7h7 ,report ,n lat] ?an #ah mon?s aft] ! date ( ! enactm5t ( ?is section & annually !reaft] = ea* ye> ( ! demon/ration project t]m1 ! ,secret>y %all submit a report to ,congress on ! results ( ! demon/ration project1 includ+-- 7#a7 ! results ( ! f9al report ( ! national ext]nal entity requir$ "u subsection 7e77#c77;,b77ii72 & 7#b7 recomm5dations on :e!r ! model /udi$ 9 ! demon/ration project %\ld be cont9u$ or m widely adopt$1 includ+ by private heal? plans4 7i7 ,waiv] au?ority ,to ! ext5t t ! ,secret>y det]m9es necess>y 9 ord] to c>ry out ! demon/ration project1 ! ,secret>y may waive section #aijb7;a77#a7 7relat+ to /atewid5ess7 & section #aijb7;a77#aj77;,b7 7relat+ to comp>ability74 7j7 ,te*nical assi/ance ,! ,secret>y %all e/abli% a process to provide te*nical assi/ance to ,/ates t are aw>d$ grants "u ?is section & to eligible entities & o!r provid]s p>ticipat+ 9 a ,/ate mat]nity c>e home model fund$ by su* a grant4 7k7 ,def9itions ,9 ?is section3 7#a7 ,eligible entity ,! t]m eligible entity means an entity or organization t provides m$ically accurate1 compreh5sive mat]nity s]vices to individuals :o are eligible = m$ical assi/ance "u a ,/ate plan "u ?is title or a waiv] ( su* a plan1 & may include3 7,a7 ,a free/&+ bir? c5t]4 7,b7 ,an entity or organization receiv+ assi/ance "u section #ccj ( ! ,public ,heal? ,s]vice ,act4 7,c7 ,a f$]ally qualifi$ heal? c5t]4 7,d7 ,a rural heal? cl9ic4 7,e7 ,a heal? facility op]at$ by an ,indian tribe or tribal organization 7z ^? t]ms are def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act74 7#b7 ,eligible individual ,! t]m eligible individual means a pregnant individual or a =m]ly pregnant individual dur+ ! #a-ye> p]iod beg9n+ on ! la/ day ( ! pregnancy1 or su* long] p]iod beg9n+ on su* day z a ,/ate may elect1 :o is-- 7,a7 enroll$ 9 a ,/ate plan "u ?is title1 a waiv] ( su* a plan1 or a ,/ate *ild heal? plan "u title ,,xxi2 & 7,b7 a pati5t ( an eligible entity :i* has ent]$ into an arrangem5t ) a ,/ate "u subsection 7g74 7l7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to ! ,secret>y1 = ea* ( fiscal ye>s #bjbc ?r\gh #bjcj1 su* sums z may be necess>y to c>ry out ?is section4 4 7c7 ,reapplication ( ,m$ic>e paym5t rate floor to prim>y c>e s]vices furni%$ "u ,m$icaid & inclusion ( additional provid]s 7#a7 ,reapplication ( paym5t floor2 additional provid]s 7,a7 ,9 g5]al ,section #aijb7;a77#ac7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#ac77 is am5d$-- 7i7 9 subp>agraph 7,b71 by /rik+ 2 & & ins]t+ a semicolon2 7ii7 9 subp>agraph 7,c71 by /rik+ ! semicolon & ins]t+ 2 &2 & 7iii7 by add+ at ! end ! foll[+ new subp>agraph3 7,d7 paym5t = prim>y c>e s]vices 7z def9$ 9 subsection 7jj77#a77 furni%$ 9 ! p]iod t beg9s on ! fir/ day ( ! fir/ mon? t beg9s aft] ! date ( enactm5t ( ?is subp>agraph by a provid] describ$ 9 subsection 7jj77#b7-- 7i7 at a rate t is n less ?an #ajj p]c5t ( ! paym5t rate t applies to su* s]vices & ! provid] ( su* s]vices "u "p ,b ( title ,,xviii 7or1 if great]1 ! paym5t rate t w\ld be applicable "u su* "p if ! conv]sion factor "u section #ahdh7;d7 = ! ye> 7 ! conv]sion factor "u su* section = #bjji72 7ii7 9 ! case ( items & s]vices t are n items & s]vices provid$ "u su* "p1 at a rate to be e/abli%$ by ! ,secret>y2 & 7iii7 9 ! case ( items & s]vices t are furni%$ 9 rural areas 7z def9$ 9 section #ahhf7;d77#b77;,d771 heal? pr(essional %ortage areas 7z def9$ 9 section #ccb7;a77#a77;,a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;e7a77#a77;,a7771 or m$ically und]s]v$ areas 7accord+ to a designation "u section #ccj7;b77#c77;,a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;b7b77#c77;,a7771 at ! rate o!rwise applicable to su* items or s]vices "u clause 7i7 or 7ii7 increas$1 at ! ,secret>y's discretion1 by n m ?an #be p]c5t2 4 7,b7 ,con=m+ am5dm5ts 7i7 ,section #aijb7;a77#ac77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#ac77;,c77 is am5d$ by /rik+ subsection 7jj7 & ins]t+ subsection 7jj77#a74 7ii7 ,section #aije7;dd7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7dd77 is am5d$-- 7,i7 by /rik+ ,not)/&+ & ins]t+ ! foll[+3 7#a7 ,9 g5]al ,not)/&+ 2 7,,ii7 by /rik+ section #aijb7;a77#ac77;,c7 & ins]t+ subp>agraph 7,c7 ( section #aijb7;a77#ac72 7,,iii7 by ins]t+ or = s]vices describ$ 9 subp>agraph 7,d7 ( section #aijb7;a77#ac7 furni%$ dur+ an additional p]iod specifi$ 9 p>agraph 7#b71 aft] #bjae12 7,,iv7 by /rik+ "u su* section & ins]t+ "u subp>agraph 7,c7 or 7,d7 ( section #aijb7;a77#ac71 z applicable2 & 7,v7 by add+ at ! end ! foll[+3 7#b7 ,additional p]iods ,= purposes ( p>agraph 7#a71 ! foll[+ are additional p]iods3 7,a7 ,! p]iod t beg9s on ! fir/ day ( ! fir/ mon? t beg9s aft] ! date ( enactm5t ( ?is p>agraph4 4 7#b7 ,improv$ t>get+ ( prim>y c>e ,section #aijb7;jj7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7jj77 is am5d$-- 7,a7 by r$esignat+ p>agraphs 7#a7 & 7#b7 z clauses 7i7 & 7ii71 respectively1 & realign+ ! left m>g9s accord+ly2 7,b7 by /rik+ ,= purposes ( subsection 7a77#ac77;,c7 & ins]t+ ! foll[+3 7#a7 ,9 g5]al 7,a7 ,def9ition ,= purposes ( subp>agraphs 7,c7 & 7,d7 ( subsection 7a77#ac7 2 & 7,c7 by ins]t+ aft] clause 7ii7 7z s r$esignat$7 ! foll[+3 7,b7 ,exclusions ,su* t]m does n include any s]vices describ$ 9 subp>agraph 7,a7 or 7,b7 ( p>agraph 7#a7 if su* s]vices are provid$ 9 an em]g5cy dep>tm5t ( a hospital4 7#b7 ,additional provid]s ,= purposes ( subp>agraph 7,d7 ( subsection 7a77#ac71 a provid] describ$ 9 ?is p>agraph is any ( ! foll[+3 7,a7 ,a physician ) a prim>y specialty designation ( family m$ic9e1 g5]al int]nal m$ic9e1 or p$iatric m$ic9e1 or ob/etrics & gynecology4 7,b7 ,an advanc$ practice cl9ician1 z def9$ by ! ,secret>y1 t works "u ! sup]vision (-- 7i7 a physician t satisfies ! crit]ia specifi$ 9 subp>agraph 7,a72 7ii7 a nurse practition] or a physician assi/ant 7z su* t]ms are def9$ 9 section #ahfa7;aa77#e77;,a77 :o is work+ 9 accordance ) ,/ate law2 or 7iii7 or a c]tifi$ nurse-midwife 7z def9$ 9 section #ahfa7;gg77 or a c]tifi$ pr(essional midwife :o is work+ 9 accordance ) ,/ate law4 7,c7 ,a rural heal? cl9ic1 f$]ally qualifi$ heal? c5t]1 heal? c5t] t receives fund+ "u title ,x ( ! ,public ,heal? ,s]vice ,act1 or o!r heal? cl9ic t receives reimbursem5t on a fee s*$ule applicable to a physician4 7,d7 ,an advanc$ practice cl9ician sup]vis$ by a physician describ$ 9 subp>agraph 7,a71 ano!r advanc$ practice cl9ician1 or a c]tifi$ nurse-midwife4 7,e7 ,a midwife :o is work+ 9 accordance ) ,/ate law4 4 7#c7 ,ensur+ paym5t by manag$ c>e entities 7,a7 ,9 g5]al ,section #aijc7m77#b77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7m77#b77;,a77 is am5d$-- 7i7 9 clause 7xii71 by /rik+ & aft] ! semicolon2 7ii7 by realign+ ! left m>g9 ( clause 7xiii7 s z to align ) ! left m>g9 ( clause 7xii7 & by /rik+ ! p]iod at ! end ( clause 7xiii7 & ins]t+ 2 &2 & 7iii7 by ins]t+ aft] clause 7xiii7 ! foll[+3 7xiv7 su* contract provides t 7,i7 paym5ts to provid]s specifi$ 9 section #aijb7;a77#ac77;,d7 = prim>y c>e s]vices 7z def9$ 9 section #aijb7;jj77 t are furni%$ dur+ a ye> or p]iod 7z specifi$ 9 section #aijb7;a77#ac77;,d7 & section #aije7;dd77 are at lea/ equal to ! am\nts set =? & requir$ by ! ,secret>y by regulation2 7,,ii7 ! entity %all1 ^u reque/1 provide docum5tation to ! ,/ate1 suffici5t to enable ! ,/ate & ! ,secret>y to ensure compliance ) subclause 7,i72 & 7,,iii7 ! ,secret>y %all approve paym5ts describ$ 9 subclause 7,i7 t are furni%$ ?r\gh an agre$ ^u capitation1 p>tial capitation1 or o!r value-bas$ paym5t arrangem5t if ! capitation1 p>tial capitation1 or o!r value-bas$ paym5t arrangem5t is bas$ on a reasonable me?odology & ! entity provides docum5tation to ! ,/ate suffici5t to enable ! ,/ate & ! ,secret>y to ensure compliance ) subclause 7,i74 4 7,b7 ,con=m+ am5dm5t ,section #aicb7;f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;f77 is am5d$-- 7i7 by /rik+ section #aijb7;a77#ac77;,c7 & ins]t+ subsections 7,c7 & 7,d7 ( section #aijb7;a77#ac72 & 7ii7 by ins]t+ 1 & clause 7xiv7 ( section #aijc7m77#b77;,a7 be=e ! p]iod4 7d7 ,,macpac report & ,,cms guidance on increas+ access to d\la s]vices = ,m$icaid b5efici>ies 7#a7 ,,macpac ,report 7,a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,m$icaid & ,,*ip ,paym5t & ,access ,commission 7ref]r$ to 9 ?is subsection z ,,macpac7 %all publi% a report on ! cov]age ( d\la s]vices "u ,/ate ,m$icaid programs1 :i* %all at a m9imum include ! foll[+3 7i7 ,in=mation ab\t cov]age = d\la s]vices "u ,/ate ,m$icaid programs t curr5tly provide cov]age = su* c>e1 includ+ ! type ( d\la s]vices (f]$ 7su* z pr5atal1 labor & deliv]y1 po/p>tum support1 & also community-bas$ & traditional d\la s]vices74 7ii7 ,an analysis ( b>ri]s to cov]+ d\la s]vices "u ,/ate ,m$icaid programs4 7iii7 ,an id5tification ( effective /rategies to increase ! use ( d\la s]vices 9 ord] to provide bett] c>e & a*ieve bett] mat]nal & infant heal? outcomes1 includ+ /rategies t ,/ates may use to recruit1 tra91 & c]tify a div]se d\la work=ce1 p>ticul>ly f und]s]v$ communities1 communities ( color1 & communities fac+ l+ui/ic or cultural b>ri]s4 7iv7 ,recomm5dations = legislative & adm9i/rative actions to increase access to d\la s]vices 9 ,/ate ,m$icaid programs1 includ+ actions t ensure d\las may e>n a liv+ wage t acc\nts = _! "t & co/s associat$ ) provid+ c>e & community-bas$ d\la program adm9i/ration & op]ation4 7,b7 ,/akehold] consultation ,9 develop+ ! report requir$ "u subp>agraph 7,a71 ,,macpac %all consult ) relevant /akehold]s1 includ+-- 7i7 ,/ates2 7ii7 organizations1 especially reproductive ju/ice & bir? ju/ice organizations l$ by p ( color1 repres5t+ consum]s ( mat]nal heal? c>e1 includ+ ^? t are disproportionately impact$ by poor mat]nal heal? outcomes2 7iii7 organizations & individuals repres5t+ d\las1 includ+ community-bas$ d\la programs & ^? :o s]ve und]s]v$ communities1 includ+ communities ( color1 & communities fac+ l+ui/ic or cultural b>ri]s2 7iv7 organizations repres5t+ heal? c>e provid]s2 & 7v7 ,black1 ,indig5\s1 & o!r mat]nal heal? c>e consum]s ( color :o h exp]i5c$ sev]e mat]nal morbidity4 7#b7 ,,cms guidance 7,a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date t ,,macpac publi%es ! report requir$ "u p>agraph 7#a77;,a71 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices %all issue guidance to ,/ates on increas+ access to d\la s]vices "u ,m$icaid4 ,su* guidance %all at a m9imum include-- 7i7 options = ,/ates to provide m$ical assi/ance = d\la s]vices "u ,/ate ,m$icaid programs2 7ii7 be/ practices = ensur+ t d\las1 includ+ community-bas$ d\las1 receive reimbursem5t = d\la s]vices provid$ "u a ,/ate ,m$icaid program1 at a level t all[s d\las to e>n a liv+ wage t acc\nts = _! "t & co/s associat$ ) provid+ c>e & community-bas$ d\la program adm9i/ration2 & 7iii7 be/ practices = increas+ access to d\la s]vices1 includ+ s]vices provid$ by community-bas$ d\las1 "u ,/ate ,m$icaid programs4 7,b7 ,/akehold] consultation ,9 develop+ ! guidance requir$ "u subp>agraph 7,a71 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices %all consult ) ,,macpac & o!r relevant /akehold]s1 includ+-- 7i7 ,/ate ,m$icaid (ficials2 7ii7 organizations repres5t+ consum]s ( mat]nal heal? c>e1 includ+ ^? t are disproportionately impact$ by poor mat]nal heal? outcomes2 7iii7 organizations repres5t+ d\las1 includ+ community-bas$ d\las & ^? :o s]ve und]s]v$ communities1 su* z communities ( color & communities fac+ l+ui/ic or cultural b>ri]s2 & 7iv7 organizations repres5t+ m$ical pr(essionals4 7e7 ,,gao report on ,/ate ,m$icaid programs' use ( teleheal? ,to increase access to mat]nity c>e ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit a report to ,congress on ,/ate ,m$icaid programs' use ( teleheal? to increase access to mat]nity c>e4 ,su* report %all include ! foll[+3 7#a7 ,! numb] ( ,/ate ,m$icaid programs t utilize teleheal? t increases access to mat]nity c>e4 7#b7 ,) respect to ,/ate ,m$icaid programs t utilize teleheal? t increases access to mat]nity c>e1 in=mation ab\t-- 7,a7 common *>act]i/ics ( su* programs' approa*es to utiliz+ teleheal? t increases access to mat]nity c>e2 7,b7 diff]5ces 9 ,/ates' approa*es to utiliz+ teleheal? to improve access to mat]nity c>e1 & ! result+ diff]5ces 9 ,/ate mat]nal heal? outcomes1 z det]m9$ by factors describ$ 9 subsection 7,c72 & 7,c7 :5 comp>$ to pati5ts :o receive mat]nity c>e 9 p]son1 :at is kn[n ab\t-- 7i7 ! demographic *>act]i/ics1 su* z race1 e?nicity1 sex1 sexual ori5tation1 g5d] id5tity1 disability /atus1 age1 & pref]r$ language ( ! individuals enroll$ 9 su* programs :o use teleheal? to access mat]nity c>e2 7ii7 heal? outcomes = su* individuals1 includ+ frequ5cy ( mortality & sev]e morbidity1 z comp>$ to individuals ) simil> *>act]i/ics :o did n use teleheal? to access mat]nity c>e2 7iii7 ! s]vices provid$ to individuals ?r\gh teleheal?1 includ+ family plann+ s]vices1 m5tal heal? c>e s]vices1 & oral heal? s]vices2 7iv7 ! devices & equipm5t provid$ to individuals = remote pati5t monitor+ & teleheal?1 includ+ blood pressure monitors & blood glucose monitors2 7v7 ! quality ( mat]nity c>e provid$ ?r\gh teleheal?1 includ+ :e!r mat]nity c>e provid$ ?r\gh teleheal? is culturally & l+ui/ically appropriate2 7vi7 ! level ( pati5t satisfaction ) mat]nity c>e provid$ ?r\gh teleheal? to individuals enroll$ 9 ,/ate ,m$icaid programs2 7vii7 ! impact ( utiliz+ teleheal? to increase access to mat]nity c>e on sp5d+1 co/ sav+s1 access to c>e1 & utilization ( c>e "u ,/ate ,m$icaid programs2 & 7viii7 ! accessibility & effectiv5ess ( teleheal? = mat]nity c>e dur+ ! ,,covid-#ai p&emic4 7#c7 ,an id5tification & analysis ( ! b>ri]s to us+ teleheal? to increase access to mat]nity c>e "u ,/ate ,m$icaid programs4 7#d7 ,recomm5dations = su* legislative & adm9i/rative actions relat$ to increas+ access to teleheal? mat]nity s]vices "u ,m$icaid z ! ,comptroll] ,g5]al deems appropriate4 #ebjc4 ,ju/ice = inc>c]at$ moms 7a7 ,s5se ( ,congress ,x is ! s5se ( ,congress t-- 7#a7 ! respect & prop] c>e t bir?+ p des]ve is inclusive2 & 7#b7 reg>dless ( race1 e?nicity1 g5d] id5tity1 sexual ori5tation1 religion1 m>ital /atus1 familial /atus1 socioeconomic /atus1 immigration /atus1 inc>c]ation /atus1 or disability1 all des]ve dignity4 7b7 ,end+ ! %ackl+ ( pregnant individuals 7#a7 ,9 g5]al ,= ea* fiscal ye> t beg9s on or aft] ! date t is #ahj days aft] ! date ( enactm5t ( ?is ,act1 = ea* ,/ate t receives a grant "u subp>t #a ( "p ,e ( title ,i ( ! ,omnibus ,crime ,control & ,safe ,/reets ,act ( #aifh 7#cd ,u4,s4,c4 #ajaea et seq47 7commonly ref]r$ to z ! ,edw>d ,byrne ,memorial ,ju/ice ,assi/ance ,grant ,program7 & t does n h 9 effect ?r\gh\t ! ,/ate = su* fiscal ye> laws re/rict+ ! use ( re/ra9ts on pregnant individuals 9 correctional facilities t provide rights1 proc$ures1 requirem5ts1 effects1 & p5alties t are sub/antially simil> to ^? set =? 9 section #dcbb ( title #ah1 ,unit$ ,/ates ,code1 ! am\nt ( su* grant t w\ld o!rwise be allocat$ to su* ,/ate "u su* subp>t = ! fiscal ye> %all be decreas$ by #be p]c5t4 7#b7 ,reallocation ,am\nts n allocat$ to a ,/ate = failure to comply ) p>agraph 7#a7 %all be reallocat$ 9 accordance ) subp>t #a ( "p ,e ( title ,i ( ! ,omnibus ,crime ,control & ,safe ,/reets ,act ( #aifh 7#cd ,u4,s4,c4 #ajaea et seq47 to ,/ates t h compli$ ) su* p>agraph4 7c7 ,creat+ model programs = ! c>e ( inc>c]at$ individuals 9 ! pr5atal & po/p>tum p]iods 7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,attorney ,g5]al1 act+ ?r\gh ! ,director ( ! ,bureau ( ,prisons 79 ?is subsection ref]r$ to z ! ,director71 %all e/abli%1 9 n few] ?an #f ,bureau ( ,prisons facilities1 programs to optimize mat]nal heal? outcomes = pregnant & po/p>tum individuals inc>c]at$ 9 su* facilities4 ,! ,attorney ,g5]al %all e/abli% su* programs 9 consultation ) /akehold]s su* z-- 7,a7 ,f$]al ,public ,def5d]s & ,executive ,directors ( ,community ,def5d] ,organizations2 7,b7 relevant community-bas$ organizations1 p>ticul>ly organizations t repres5t inc>c]at$ & =m]ly inc>c]at$ individuals & organizations t seek to improve mat]nal heal? outcomes = pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps2 7,c7 relevant organizations repres5t+ pati5ts1 ) a p>ticul> focus on pati5ts f racial & e?nic m9ority gr\ps2 7,d7 organizations repres5t+ mat]nity c>e provid]s & mat]nal heal? c>e education programs2 7,e7 p]9atal heal? work]s2 & 7,f7 rese>*]s & policy exp]ts 9 fields relat$ to mat]nal heal? c>e = inc>c]at$ individuals4 7#b7 ,/>t date ,ea* facility select$ "u p>agraph 7#a7 %all beg9 ! programs to optimize mat]nal heal? outcomes = pregnant & po/p>tum individuals inc>c]at$ 9 su* facilities n lat] ?an #ah mon?s aft] ! date ( enactm5t ( ?is ,act4 7#c7 ,facility priority ,9 c>ry+ out p>agraph 7#a71 ! ,director1 9 consultation ) ! /akehold]s describ$ 9 p>agraph 7#a71 %all give priority to a facility bas$ on-- 7,a7 ! numb] ( pregnant & po/p>tum individuals inc>c]at$ 9 su* facility &1 among su* individuals1 ! numb] ( pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps2 & 7,b7 ! ext5t to :i* ! lead]s ( su* facility h demon/rat$ a commitm5t to develop+ exempl>y programs = pregnant & po/p>tum individuals inc>c]at$ 9 su* facility4 7#d7 ,program duration ,! programs e/abli%$ "u ?is subsection %all be c>ri$ out = a #e-ye> p]iod4 7#e7 ,programs ,bureau ( ,prisons facilities select$ by ! ,director %all e/abli% programs = pregnant & po/p>tum inc>c]at$ individuals1 & su* programs may-- 7,a7 provide access to p]9atal heal? work]s f pregnancy ?r\gh ! po/p>tum p]iod2 7,b7 provide access to heal?y foods & c\nsel+ on nutrition1 recomm5d$ activity levels1 & safety measures ?r\gh\t pregnancy2 7,c7 tra9 correctional (fic]s to ensure t pregnant inc>c]at$ individuals receive safe & respectful treatm5t2 7,d7 tra9 m$ical p]sonnel to ensure t pregnant inc>c]at$ individuals receive trauma-in=m$1 culturally congru5t c>e t promotes ! heal? & safety ( ! pregnant individuals2 7,e7 provide c\nsel+ & treatm5t = individuals :o h suff]$ f-- 7i7 diagnos$ m5tal or behavioral heal? conditions1 includ+ trauma & sub/ance use disord]s2 7ii7 trauma or viol5ce1 includ+ dome/ic viol5ce2 7iii7 human immunodefici5cy virus2 7iv7 sexual abuse2 7v7 pregnancy or infant loss2 or 7vi7 *ronic conditions2 7,f7 provide evid5ce-bas$ pregnancy & *ildbir? education1 p>5t+ support1 & o!r relevant =ms ( heal? lit]acy2 7,g7 provide cl9ical education opportunities to mat]nity c>e provid]s 9 tra9+ to exp& pa?ways into mat]nal heal? c>e c>e]s s]v+ inc>c]at$ individuals2 7,h7 (f] opportunities = po/p>tum individuals to ma9ta9 contact ) ! individual's newborn *ild to promote bond+1 includ+ enhanc$ visitation policies1 access to prison nurs]y programs1 or brea/fe$+ support2 7,i7 provide re5try assi/ance1 p>ticul>ly to-- 7i7 ensure access to heal? insurance cov]age & transf] ( heal? records to community provid]s if an inc>c]at$ individual exits ! crim9al ju/ice sy/em dur+ su* individual's pregnancy or 9 ! po/p>tum p]iod2 & 7ii7 connect individuals exit+ ! crim9al ju/ice sy/em dur+ pregnancy or 9 ! po/p>tum p]iod to community-bas$ res\rces1 su* z ref]rals to heal? c>e provid]s1 sub/ance use disord] treatm5ts1 & social s]vices t address social det]m9ants ( mat]nal heal?2 or 7,j7 e/abli% p>tn]%ips ) local public entities1 private community entities1 community-bas$ organizations1 ,indian ,tribes & 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 & urban ,indian organizations 7z su* t]m is def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc77 to e/abli% or exp& pretrial div]sion programs z an alt]native to inc>c]ation = pregnant & po/p>tum individuals1 includ+-- 7i7 evid5ce-bas$ *ildbir? education or p>5t+ classes2 7ii7 pr5atal heal? coord9ation2 7iii7 family & individual c\nsel+2 7iv7 evid5ce-bas$ scre5+s1 education1 &1 z ne$$1 treatm5t = m5tal & behavioral heal? conditions1 includ+ drug & alcohol treatm5ts2 7v7 family case managem5t s]vices2 7vi7 dome/ic viol5ce education & prev5tion2 7vii7 physical & sexual abuse c\nsel+2 & 7viii7 programs to address social det]m9ants ( heal? su* z employm5t1 h\s+1 education1 transportation1 & nutrition4 7#f7 ,implem5tation & report+ ,a facility select$ "u p>agraph 7#a7 %all be responsible =-- 7,a7 implem5t+ programs1 :i* may include ! programs describ$ 9 p>agraph 7#e72 & 7,b7 n lat] ?an #c ye>s aft] ! date ( enactm5t ( ?is ,act1 & n lat] ?an #f ye>s aft] ! date ( enactm5t ( ?is ,act1 report+ results ( ! programs to ! ,director1 includ+ in=mation describ+-- 7i7 relevant quantitative indicators ( success 9 improv+ ! /&>d ( c>e & heal? outcomes = pregnant & po/p>tum inc>c]at$ individuals 9 ! facility1 includ+ data /ratifi$ by race1 e?nicity1 sex1 g5d]1 age1 geography1 disability /atus1 ! category ( ! crim9al *>ge aga9/ su* individual1 rates ( pregnancy-relat$ dea?s1 pregnancy-associat$ dea?s1 cases ( infant mortality & morbidity1 rates ( pre-t]m bir?s & l[-bir?weight bir?s1 cases ( sev]e mat]nal morbidity1 cases ( viol5ce aga9/ pregnant or po/p>tum individuals1 diagnoses ( mat]nal m5tal or behavioral heal? conditions1 & o!r su* in=mation z appropriate2 7ii7 relevant qualitative & quantitative evaluations f pregnant & po/p>tum inc>c]at$ individuals :o p>ticipat$ 9 su* programs1 includ+ measures ( pati5t-report$ exp]i5ce ( c>e2 & 7iii7 /rategies to su/a9 su* programs aft] fiscal ye> #bjbh & exp& su* programs to o!r facilities4 7#g7 ,report ,n lat] ?an #f ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,director %all submit to ! ,attorney ,g5]al & ,congress a report describ+ ! results ( ! programs c>ri$ out "u ?is subsection4 7#h7 ,ov]sight ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,attorney ,g5]al %all aw>d a contract to an indep5d5t organization or indep5d5t organizations to conduct ov]sight ( ! programs describ$ 9 p>agraph 7#e74 7#i7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is subsection #aj1jjj1jjj = ea* ( fiscal ye>s #bjbd ?r\gh #bjbh4 7d7 ,grant program ,to improve mat]nal heal? outcomes = individuals 9 ,/ate & local correctional facilities 7#a7 ,e/abli%m5t ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,attorney ,g5]al1 act+ ?r\gh ! ,director ( ! ,bureau ( ,ju/ice ,assi/ance 79 ?is subsection ref]r$ to z ! ,director71 %all aw>d ,ju/ice = ,inc>c]at$ ,moms grants to ,/ates to e/abli% or exp& programs 9 ,/ate & local correctional facilities = pregnant & po/p>tum inc>c]at$ individuals4 ,! ,attorney ,g5]al %all aw>d su* grants 9 consultation ) /akehold]s su* z-- 7,a7 ,f$]al ,public ,def5d]s & ,executive ,directors ( ,community ,def5d] ,organizations2 7,b7 relevant community-bas$ organizations1 p>ticul>ly organizations t repres5t inc>c]at$ & =m]ly inc>c]at$ individuals & organizations t seek to improve mat]nal heal? outcomes = pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps2 7,c7 relevant organizations repres5t+ pati5ts1 ) a p>ticul> focus on pati5ts f racial & e?nic m9ority gr\ps2 7,d7 organizations repres5t+ mat]nity c>e provid]s & mat]nal heal? c>e education programs2 7,e7 p]9atal heal? work]s2 & 7,f7 rese>*]s & policy exp]ts 9 fields relat$ to mat]nal heal? c>e = inc>c]at$ individuals4 7#b7 ,applications ,ea* ,/ate desir+ a grant "u ?is subsection %all submit to ! ,director an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,director may require4 7#c7 ,use ( funds ,a ,/ate t is aw>d$ a grant "u ?is subsection %all use su* grant to e/abli% or exp& programs = pregnant & po/p>tum inc>c]at$ individuals1 & su* programs may-- 7,a7 provide access to p]9atal heal? work]s f pregnancy ?r\gh ! po/p>tum p]iod2 7,b7 provide access to heal?y foods & c\nsel+ on nutrition1 recomm5d$ activity levels1 & safety measures ?r\gh\t pregnancy2 7,c7 tra9 correctional (fic]s to ensure t pregnant inc>c]at$ individuals receive safe & respectful treatm5t2 7,d7 tra9 m$ical p]sonnel to ensure t pregnant inc>c]at$ individuals receive trauma-in=m$1 culturally congru5t c>e t promotes ! heal? & safety ( ! pregnant individuals2 7,e7 provide c\nsel+ & treatm5t = individuals :o h suff]$ f-- 7i7 diagnos$ m5tal or behavioral heal? conditions1 includ+ trauma & sub/ance use disord]s2 7ii7 trauma or viol5ce1 includ+ dome/ic viol5ce2 7iii7 human immunodefici5cy virus2 7iv7 sexual abuse2 7v7 pregnancy or infant loss2 or 7vi7 *ronic conditions2 7,f7 provide evid5ce-bas$ pregnancy & *ildbir? education1 p>5t+ support1 & o!r relevant =ms ( heal? lit]acy2 7,g7 provide cl9ical education opportunities to mat]nity c>e provid]s 9 tra9+ to exp& pa?ways into mat]nal heal? c>e c>e]s s]v+ inc>c]at$ individuals2 7,h7 (f] opportunities = po/p>tum individuals to ma9ta9 contact ) ! individual's newborn *ild to promote bond+1 includ+ enhanc$ visitation policies1 access to prison nurs]y programs1 or brea/fe$+ support2 7,i7 provide re5try assi/ance1 p>ticul>ly to-- 7i7 ensure access to heal? insurance cov]age & transf] ( heal? records to community provid]s if an inc>c]at$ individual exits ! crim9al ju/ice sy/em dur+ su* individual's pregnancy or 9 ! po/p>tum p]iod2 & 7ii7 connect individuals exit+ ! crim9al ju/ice sy/em dur+ pregnancy or 9 ! po/p>tum p]iod to community-bas$ res\rces1 su* z ref]rals to heal? c>e provid]s1 sub/ance use disord] treatm5ts1 & social s]vices t address social det]m9ants ( mat]nal heal?2 or 7,j7 e/abli% p>tn]%ips ) local public entities1 private community entities1 community-bas$ organizations1 ,indian ,tribes & 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 & urban ,indian organizations 7z su* t]m is def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc77 to e/abli% or exp& pretrial div]sion programs z an alt]native to inc>c]ation = pregnant & po/p>tum individuals1 includ+-- 7i7 evid5ce-bas$ *ildbir? education or p>5t+ classes2 7ii7 pr5atal heal? coord9ation2 7iii7 family & individual c\nsel+2 7iv7 evid5ce-bas$ scre5+s1 education1 &1 z ne$$1 treatm5t = m5tal & behavioral heal? conditions1 includ+ drug & alcohol treatm5ts2 7v7 family case managem5t s]vices2 7vi7 dome/ic viol5ce education & prev5tion2 7vii7 physical & sexual abuse c\nsel+2 & 7viii7 programs to address social det]m9ants ( heal? su* z employm5t1 h\s+1 education1 transportation1 & nutrition4 7#d7 ,priority ,9 aw>d+ grants "u ?is subsection1 ! ,director %all give priority to applicants bas$ on-- 7,a7 ! numb] ( pregnant & po/p>tum individuals inc>c]at$ 9 ! ,/ate &1 among su* individuals1 ! numb] ( pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps2 & 7,b7 ! ext5t to :i* ! ,/ate has demon/rat$ a commitm5t to develop+ exempl>y programs = pregnant & po/p>tum individuals inc>c]at$ 9 ! correctional facilities 9 su* ,/ate4 7#e7 ,grant duration ,a grant aw>d$ "u ?is subsection %all be = a #e-ye> p]iod4 7#f7 ,implem5t+ & report+ ,a ,/ate t receives a grant "u ?is subsection %all be responsible =-- 7,a7 implem5t+ ! program fund$ by ! grant2 & 7,b7 n lat] ?an #c ye>s aft] ! date ( enactm5t ( ?is ,act1 & n lat] ?an #f ye>s aft] ! date ( enactm5t ( ?is ,act1 report+ results ( su* program to ! ,attorney ,g5]al1 includ+ in=mation describ+-- 7i7 relevant quantitative indicators ( ! program's success 9 improv+ ! /&>d ( c>e & heal? outcomes = pregnant & po/p>tum inc>c]at$ individuals 9 ! facility1 includ+ data /ratifi$ by race1 e?nicity1 sex1 g5d]1 age1 geography1 disability /atus1 category ( ! crim9al *>ge aga9/ su* individual1 incid5ce rates ( pregnancy-relat$ dea?s1 pregnancy-associat$ dea?s1 cases ( infant mortality & morbidity1 rates ( pre-t]m bir?s & l[-bir?weight bir?s1 cases ( sev]e mat]nal morbidity1 cases ( viol5ce aga9/ pregnant or po/p>tum individuals1 diagnoses ( mat]nal m5tal or behavioral heal? conditions1 & o!r su* in=mation z appropriate2 7ii7 relevant qualitative & quantitative evaluations f pregnant & po/p>tum inc>c]at$ individuals :o p>ticipat$ 9 su* programs1 includ+ measures ( pati5t-report$ exp]i5ce ( c>e2 & 7iii7 /rategies to su/a9 su* programs beyond ! duration ( ! grant & exp& su* programs to o!r facilities4 7#g7 ,report ,n lat] ?an #f ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,attorney ,g5]al %all submit to ,congress a report describ+ ! results ( programs c>ri$ out us+ grants "u ?is subsection4 7#h7 ,ov]sight ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,attorney ,g5]al %all aw>d a contract to an indep5d5t organization or indep5d5t organizations to conduct ov]sight ( ! programs describ$ 9 p>agraph 7#c74 7#i7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is subsection #aj1jjj1jjj = ea* ( fiscal ye>s #bjbd ?r\gh #bjbh4 7e7 ,,gao report 7#a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report on adv]se mat]nal & infant heal? outcomes among inc>c]at$ individuals & infants born to su* individuals1 ) a p>ticul> focus on racial & e?nic inequities 9 mat]nal & infant heal? outcomes = inc>c]at$ individuals4 7#b7 ,cont5ts ( report ,! report describ$ 9 ?is subsection %all include-- 7,a7 to ! ext5t practicable-- 7i7 ! numb] ( pregnant individuals :o are inc>c]at$ 9 ,bureau ( ,prisons facilities2 7ii7 ! numb] ( inc>c]at$ individuals1 includ+ ^? inc>c]at$ 9 ,f$]al1 ,/ate1 & local correctional facilities1 :o h exp]i5c$ a pregnancy-relat$ dea?1 pregnancy-associat$ dea?1 or ! dea? ( an infant 9 ! mo/ rec5t #aj ye>s ( available data2 7iii7 ! numb] ( cases ( sev]e mat]nal morbidity among inc>c]at$ individuals1 includ+ ^? inc>c]at$ 9 ,f$]al1 ,/ate1 & local correctional facilities1 9 ! mo/ rec5t #aj ye>s ( available data2 7iv7 ! numb] ( pre-t]m & l[-bir?weight bir?s ( infants born to inc>c]at$ individuals1 includ+ ^? inc>c]at$ 9 ,f$]al1 ,/ate1 & local correctional facilities1 9 ! mo/ rec5t #aj ye>s ( available data2 & 7v7 /ati/ics on ! racial & e?nic inequities 9 mat]nal & infant heal? outcomes & sev]e mat]nal morbidity rates among inc>c]at$ individuals1 includ+ ^? inc>c]at$ 9 ,f$]al1 ,/ate1 & local correctional facilities2 7,b7 9 ! case t ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates is unable to det]m9e ! in=mation requir$ 9 clauses 7i7 ?r\gh 7v7 ( subp>agraph 7,a71 an assessm5t ( ! b>ri]s to det]m9+ su* in=mation & recomm5dations = improvem5ts 9 track+ mat]nal heal? outcomes among inc>c]at$ individuals1 includ+ ^? inc>c]at$ 9 ,f$]al1 ,/ate1 & local correctional facilities2 7,c7 a discussion ( causes ( adv]se mat]nal heal? outcomes t are unique to inc>c]at$ individuals1 includ+ ^? inc>c]at$ 9 ,f$]al1 ,/ate1 & local correctional facilities2 7,d7 a discussion ( causes ( adv]se mat]nal heal? outcomes & sev]e mat]nal morbidity t are unique to inc>c]at$ individuals f racial & e?nic m9ority gr\ps2 7,e7 recomm5dations to r$uce mat]nal mortality & sev]e mat]nal morbidity among inc>c]at$ individuals & to address racial & e?nic inequities 9 mat]nal heal? outcomes = inc>c]at$ individuals 9 ,bureau ( ,prisons facilities & ,/ate & local correctional facilities2 & 7,f7 su* o!r in=mation z may be appropriate to r$uce ! occurr5ce ( adv]se mat]nal heal? outcomes among inc>c]at$ individuals & to address racial & e?nic inequities 9 mat]nal heal? outcomes = su* individuals4 7f7 ,,macpac report 7#a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is section1 ! ,m$icaid & ,,*ip ,paym5t & ,access ,commission 7ref]r$ to 9 ?is subsection z ,,macpac7 %all publi% a report on ! implications ( pregnant & po/p>tum inc>c]at$ individuals be+ ineligible = m$ical assi/ance "u a ,/ate plan "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 t conta9s ! in=mation describ$ 9 p>agraph 7#b74 7#b7 ,in=mation describ$ ,= purposes ( p>agraph 7#a71 ! in=mation describ$ 9 ?is p>agraph includes-- 7,a7 in=mation on ! effect ( ineligibility = m$ical assi/ance "u a ,/ate plan "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 on mat]nal heal? outcomes = pregnant & po/p>tum inc>c]at$ individuals1 conc5trat+ on ! effects ( su* ineligibility = pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps2 & 7,b7 ! pot5tial implications on mat]nal heal? outcomes result+ f susp5d+ eligibility = m$ical assi/ance "u a ,/ate plan "u su* title ( su* ,act :5 a pregnant or po/p>tum individual is inc>c]at$4 7g7 ,def9itions ,9 ?is section3 7#a7 ,culturally congru5t ,! t]m culturally congru5t means t ! c>e1 mat]nity c>e1 heal? c>e s]vices1 provid]1 or non-cl9ical support made available is 9 agreem5t ) ! pref]r$ cultural values1 beliefs1 worldview1 language1 & practices ( ! heal? c>e consum] & o!r /akehold]s4 7#b7 ,mat]nity c>e provid] ,! t]m mat]nity c>e provid] means a heal? c>e provid] :o-- 7,a7 is a physician1 physician assi/ant1 midwife :o meets at a m9imum ! int]national def9ition ( ! midwife & global /&>ds = midwif]y education z e/abli%$ by ! ,int]national ,conf$]ation ( ,midwives1 nurse practition]1 or cl9ical nurse speciali/2 & 7,b7 has a focus on mat]nal or p]9atal heal?4 7#c7 ,mat]nal mortality ,! t]m mat]nal mortality means a dea? occurr+ dur+ or )9 a "o-ye> p]iod aft] pregnancy t is caus$ by pregnancy-relat$ or *ildbir? complications1 includ+ a suicide1 ov]dose1 or o!r dea? result+ f a m5tal heal? or sub/ance use disord] attribut$ to or aggravat$ by pregnancy-relat$ or *ildbir? complications4 7#d7 ,p]9atal heal? work] ,! t]m p]9atal heal? work] means a d\la1 community heal? work]1 pe] support]1 brea/fe$+ & lactation educator or c\nselor1 nutritioni/ or dietitian1 *ildbir? educator1 social work]1 home visitor1 language int]pret]1 or navigator4 7#e7 ,po/p>tum & po/p>tum p]iod ,! t]ms po/p>tum & po/p>tum p]iod ref] to ! #a-ye> p]iod beg9n+ on ! la/ day ( ! pregnancy ( an individual4 7#f7 ,pregnancy-associat$ dea? ,! t]m pregnancy-associat$ dea? means a dea? ( a pregnant or po/p>tum individual1 by any cause1 t occurs dur+1 or )9 #a ye> foll[+1 ! individual's pregnancy1 reg>dless ( ! outcome1 duration1 or site ( ! pregnancy4 7#g7 ,pregnancy-relat$ dea? ,! t]m pregnancy-relat$ dea? means a dea? ( a pregnant or po/p>tum individual t occurs dur+1 or )9 #a ye> foll[+1 ! individual's pregnancy1 f a pregnancy complication1 a *a9 ( ev5ts initiat$ by pregnancy1 or ! aggravation ( an unrelat$ condition by ! physiologic effects ( pregnancy4 7#h7 ,racial & e?nic m9ority gr\p ,! t]m racial & e?nic m9ority gr\p has ! mean+ giv5 su* t]m 9 section #agjg7;g77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a774 7#i7 ,sev]e mat]nal morbidity ,! t]m sev]e mat]nal morbidity means a heal? condition1 includ+ m5tal heal? conditions & sub/ance use disord]s1 attribut$ to or aggravat$ by pregnancy or *ildbir? t results 9 significant %ort-t]m or long-t]m consequ5ces to ! heal? ( ! individual :o 0 pregnant4 7#aj7 ,social det]m9ants ( mat]nal heal? ,! t]m social det]m9ants ( mat]nal heal? means non-cl9ical factors t impact mat]nal heal? outcomes1 includ+-- 7,a7 economic factors1 :i* may include pov]ty1 employm5t1 food security1 support = & access to lactation & o!r infant fe$+ options1 h\s+ /ability1 & relat$ factors2 7,b7 neighborhood factors1 :i* may include quality ( h\s+1 access to transportation1 access to *ild c>e1 availability ( heal?y foods & nutrition c\nsel+1 availability ( clean wat]1 air & wat] quality1 ambi5t temp]atures1 neighborhood crime & viol5ce1 access to broadb&1 & relat$ factors2 7,c7 social & community factors1 :i* may include sy/emic racism1 g5d] discrim9ation or discrim9ation bas$ on o!r protect$ classes1 workplace conditions1 inc>c]ation1 & relat$ factors2 7,d7 h\sehold factors1 :i* may include ability to conduct lead te/+ & abatem5t1 c> seat in/allation1 indoor air temp]atures1 & relat$ factors2 7,e7 education access & quality factors1 :i* may include educational atta9m5t1 language & lit]acy1 & relat$ factors2 & 7,f7 heal? c>e access factors1 includ+ heal? insurance cov]age1 access to culturally congru5t heal? c>e s]vices1 provid]s1 & non-cl9ical support1 access to home visit+ s]vices1 access to wellness & /ress managem5t programs1 heal? lit]acy1 access to teleheal? & items requir$ to receive teleheal? s]vices1 & relat$ factors4 7#aa7 ,/ate ,! t]m ,/ate means any ,/ate ( ! ,unit$ ,/ates1 ! ,di/rict ( ,columbia1 or any t]ritory or possession ( ! ,unit$ ,/ates4 #ebjd4 ,,impact ,to ,save ,moms ,act 7a7 ,p]9atal ,c>e ,alt]native ,paym5t ,model ,demon/ration ,project 7#a7 ,9 g5]al ,= ! p]iod ( fiscal ye>s #bjbc ?r\gh #bjbg1 ! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is subsection z ! ,secret>y71 act+ ?r\gh ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 %all e/abli% & implem5t1 9 accordance ) ! requirem5ts ( ?is subsection1 a demon/ration project1 to be kn[n z ! ,p]9atal ,c>e ,alt]native ,paym5t ,model ,demon/ration ,project 7ref]r$ to 9 ?is subsection z ! ,demon/ration ,project71 = purposes ( all[+ ,/ates to te/ paym5t models "u _! ,/ate plans "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 & ,/ate *ild heal? plans "u title ,,xxi ( su* ,act 7#db ,u4,s4,c4 #acig;aa et seq47 ) respect to mat]nity c>e provid$ to pregnant & po/p>tum individuals enroll$ 9 su* ,/ate plans & ,/ate *ild heal? plans4 7#b7 ,coord9ation ,9 e/abli%+ ! ,demon/ration ,project1 ! ,secret>y %all coord9ate ) /akehold]s su* z-- 7,a7 ,/ate ,m$icaid programs2 7,b7 relevant organizations repres5t+ mat]nal heal? c>e provid]s2 7,c7 relevant organizations repres5t+ pati5ts1 ) a p>ticul> focus on individuals f demographic gr\ps ) disproportionate rates ( adv]se mat]nal heal? outcomes2 7,d7 relevant community-bas$ organizations1 p>ticul>ly organizations t seek to improve mat]nal heal? outcomes = individuals f demographic gr\ps ) disproportionate rates ( adv]se mat]nal heal? outcomes2 7,e7 non-cl9ical p]9atal heal? work]s su* z d\las1 community heal? work]s1 pe] support]s1 c]tifi$ lactation consultants1 nutritioni/s & dieticians1 social work]s1 home visitors1 & navigators2 7,f7 relevant heal? insurance issu]s2 7,g7 hospitals1 heal? sy/ems1 free/&+ bir? c5t]s 7z su* t]m is def9$ 9 p>agraph 7#c77;,b7 ( section #aije7l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l7771 ,f$]ally-qualifi$ heal? c5t]s 7z su* t]m is def9$ 9 p>agraph 7#b77;,b7 ( su* section71 & rural heal? cl9ics 7z su* t]m is def9$ 9 section #ahfa7;aa7 ( su* ,act 7#db ,u4,s4,c4 #aciex7aa7772 7,h7 rese>*]s & policy exp]ts 9 fields relat$ to mat]nity c>e paym5t models2 & 7,i7 any o!r /akehold]s z ! ,secret>y det]m9es appropriate1 ) a p>ticul> focus on /akehold]s f demographic gr\ps ) disproportionate rates ( adv]se mat]nal heal? outcomes4 7#c7 ,consid]ations ,9 e/abli%+ ! ,demon/ration ,project1 ! ,secret>y %all consid] ea* ( ! foll[+3 7,a7 ,f9d+s f any evaluations ( ! ,/rong ,/>t = ,mo!rs & ,newborns initiative c>ri$ out by ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 & ! ,adm9i/ration on ,*ildr5 & ,families4 7,b7 ,any alt]native paym5t model t-- 7i7 is design$ to improve mat]nal heal? outcomes = racial & e?nic gr\ps ) disproportionate rates ( adv]se mat]nal heal? outcomes2 7ii7 includes me?ods = /ratify+ pati5ts by pregnancy risk level &1 z appropriate1 adju/+ paym5ts "u su* model to take into acc\nt pregnancy risk level2 7iii7 e/abli%es evid5ce-bas$ quality metrics = su* paym5ts2 7iv7 includes consid]ation ( non-hospital bir? sett+s su* z free/&+ bir? c5t]s 7z s def9$72 7v7 includes consid]ation ( social det]m9ants ( heal? t are relevant to mat]nal heal? outcomes su* z h\s+1 transportation1 nutrition1 & o!r non-cl9ical factors t influ5ce mat]nal heal? outcomes2 or 7vi7 includes div]se mat]nity c>e teams t include-- 7,i7 mat]nity c>e provid]s1 includ+ ob/etrician-gynecologi/s1 family physicians1 physician assi/ants1 midwives :o meet1 at a m9imum1 ! int]national def9ition ( ! t]m midwife & global /&>ds = midwif]y education 7z e/abli%$ by ! ,int]national ,conf$]ation ( ,midwives71 & nurse practition]s-- 7aa7 f racially1 e?nically1 & pr(essionally div]se backgr\nds2 7bb7 ) exp]i5ce practic+ 9 racially & e?nically div]se communities2 or 7cc7 :o h und]gone tra9+s on racism1 implicit bias1 & explicit bias2 & 7,,ii7 non-cl9ical p]9atal heal? work]s su* z d\las1 community heal? work]s1 pe] support]s1 c]tifi$ lactation consultants1 nutritioni/s & dieticians1 social work]s1 home visitors1 & navigators4 7#d7 ,eligibility ,to be eligible to p>ticipate 9 ! ,demon/ration ,project1 a ,/ate %all submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7#e7 ,evaluation ,! ,secret>y %all conduct an evaluation ( ! ,demon/ration ,project to det]m9e ! impact ( ! ,demon/ration ,project on-- 7,a7 mat]nal heal? outcomes1 ) data /ratifi$ by race1 e?nicity1 socioeconomic indicators1 & any o!r factors z ! ,secret>y det]m9es appropriate2 7,b7 sp5d+ on mat]nity c>e by ,/ates p>ticipat+ 9 ! ,demon/ration ,project2 7,c7 to ! ext5t practicable1 subjective measures ( pati5t exp]i5ce2 & 7,d7 any o!r areas ( assessm5t t ! ,secret>y det]m9es relevant4 7#f7 ,report ,n lat] ?an "o ye> aft] ! completion or t]m9ation date ( ! ,demon/ration ,project1 ! ,secret>y %all submit to ! ,committee on ,en]gy & ,comm]ce1 ! ,committee on ,ways & ,means1 & ! ,committee on ,education & ,labor ( ! ,h\se ( ,repres5tatives & ! ,committee on ,f9ance & ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate1 & make publicly available1 a report conta9+-- 7,a7 ! results ( any evaluation conduct$ "u p>agraph 7#e72 & 7,b7 a recomm5dation reg>d+ :e!r ! ,demon/ration ,project %\ld be cont9u$ aft] fiscal ye> #bjbf & exp&$ on a national basis4 7#g7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ su* sums z are necess>y to c>ry out ?is subsection4 7#h7 ,def9itions ,9 ?is subsection3 7,a7 ,alt]native paym5t model ,! t]m alt]native paym5t model has ! mean+ giv5 su* t]m 9 section #ahcc7z77#c77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7z77#c77;,c774 7,b7 ,p]9atal ,! t]m p]9atal means ! p]iod beg9n+ on ! day a p]son becomes pregnant & end+ on ! la/ day ( ! #a-ye> p]iod beg9n+ on ! la/ day ( su* p]son's pregnancy4 7b7 ,,macpac report 7#a7 ,9 g5]al ,n lat] ?an two ye>s aft] ! date ( ! enactm5t ( ?is section1 ! ,m$icaid & ,,*ip ,paym5t & ,access ,commission %all publi% a report on issues relat+ to ! cont9uity ( cov]age "u ,/ate plans "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 & ,/ate *ild heal? plans "u title ,,xxi ( su* ,act 7#db ,u4,s4,c4 #acig;aa et seq47 = pregnant & po/p>tum individuals4 ,su* report %all1 at a m9imum1 include ! foll[+3 7,a7 ,an assessm5t ( any exi/+ policies "u su* ,/ate plans & su* ,/ate *ild heal? plans reg>d+ presumptive eligibility = pregnant individuals :ile _! application = enrollm5t 9 su* a ,/ate plan or su* a ,/ate *ild heal? plan is be+ process$4 7,b7 ,an assessm5t ( any exi/+ policies "u su* ,/ate plans & su* ,/ate *ild heal? plans reg>d+ measures to ensure cont9uity ( cov]age "u su* a ,/ate plan or su* a ,/ate *ild heal? plan = pregnant & po/p>tum individuals1 includ+ su* individuals :o ne$ to *ange _! heal? insurance cov]age dur+ _! pregnancy or ! po/p>tum p]iod foll[+ _! pregnancy4 7,c7 ,an assessm5t ( any exi/+ policies "u su* ,/ate plans & su* ,/ate *ild heal? plans reg>d+ measures to automatically re5roll individuals :o are eligible to enroll "u su* a ,/ate plan or su* a ,/ate *ild heal? plan z a p>5t4 7,d7 ,if det]m9$ appropriate by ! ,commission1 any recomm5dations = ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 or su* ,/ate plans & su* ,/ate *ild heal? plans1 to ensure cont9uity ( cov]age "u su* a ,/ate plan or su* a ,/ate *ild heal? plan = pregnant & po/p>tum p4 7#b7 ,po/p>tum def9$ ,9 ?is subsection1 ! t]m po/p>tum means ! #a-ye> p]iod beg9n+ on ! la/ day ( a p]son's pregnancy4 #ebje4 ,protect+ moms & babies aga9/ climate *ange 7a7 ,grant program ,to protect vuln]able mo!rs & babies f climate *ange risks 7#a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y7 %all e/abli% a grant program 79 ?is subsection ref]r$ to z ! ,program7 to protect vuln]able individuals f risks associat$ ) climate *ange4 7#b7 ,grant au?ority ,9 c>ry+ out ! ,program1 ! ,secret>y may aw>d1 on a competitive basis1 grants to #aj cov]$ entities4 7#c7 ,applications ,to be eligible = a grant "u ! ,program1 a cov]$ entity %all submit to ! ,secret>y an application at su* "t1 9 su* =m1 & conta9+ su* in=mation z ! ,secret>y may require1 :i* %all include1 at a m9imum1 a description ( ! foll[+3 7,a7 ,plans = ! use ( grant funds aw>d$ "u ! ,program & h[ pati5ts & /akehold] organizations 7 involv$ 9 ! developm5t ( su* plans4 7,b7 ,h[ su* grant funds w be t>get$ to geographic areas t h disproportionately high levels ( risks associat$ ) climate *ange = vuln]able individuals4 7,c7 ,h[ su* grant funds w be us$ to address racial & e?nic inequities 9-- 7i7 adv]se mat]nal & infant heal? outcomes2 & 7ii7 exposure to risks associat$ ) climate *ange = vuln]able individuals4 7,d7 ,/rategies to prev5t an initiative assi/$ ) su* grant funds f caus+-- 7i7 adv]se environm5tal impacts2 7ii7 displacem5t ( resid5ts & bus9esses2 7iii7 r5t & h\s+ price increases2 or 7iv7 disproportionate adv]se impacts on racial & e?nic m9ority gr\ps & o!r und]s]v$ populations4 7#d7 ,selection ( grant recipi5ts 7,a7 ,tim+ ,n lat] ?an #bgj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all select ! recipi5ts ( grants "u ! ,program4 7,b7 ,consultation ,9 select+ cov]$ entities = grants "u ! ,program1 ! ,secret>y %all consult )-- 7i7 repres5tatives ( /akehold] organizations2 7ii7 ! ,adm9i/rator ( ! ,environm5tal ,protection ,ag5cy2 7iii7 ! ,adm9i/rator ( ! ,national ,oceanic & ,atmosph]ic ,adm9i/ration2 & 7iv7 f ! ,dep>tm5t ( ,heal? & ,human ,s]vices-- 7,i7 ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?2 7,,ii7 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices2 7,,iii7 ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration2 7,,iv7 ! ,director ( ! ,national ,in/itutes ( ,heal?2 & 7,v7 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion4 7,c7 ,priority ,9 select+ a cov]$ entity to be aw>d$ a grant "u ! ,program1 ! ,secret>y %all give priority to cov]$ entities t s]ve a c\nty-- 7i7 designat$1 or locat$ 9 an area designat$1 z a nonatta9m5t area pursuant to section #ajg ( ! ,clean ,air ,act 7#db ,u4,s4,c4 #gdjg7 = any air pollutant = :i* air quality crit]ia h be5 issu$ "u section #ajh7;a7 ( su* ,act 7#db ,u4,s4,c4 #gdjh7;a772 7ii7 ) a level ( vuln]ability ( mod]ate-to-high or high]1 accord+ to ! ,social ,vuln]ability ,index ( ! ,c5t]s = ,disease ,control & ,prev5tion2 or 7iii7 ) temp]atures t pose a risk to human heal?1 z det]m9$ by ! ,secret>y1 9 consultation ) ! ,adm9i/rator ( ! ,national ,oceanic & ,atmosph]ic ,adm9i/ration & ! ,*air ( ! ,unit$ ,/ates ,global ,*ange ,rese>* ,program1 bas$ on ! be/ available sci5ce4 7,d7 ,limitation ,a recipi5t ( grant funds "u ! ,program may n use su* grant funds to s]ve a c\nty t is s]v$ by any o!r recipi5t ( a grant "u ! ,program4 7#e7 ,use ( funds ,a cov]$ entity aw>d$ grant funds "u ! ,program may only use su* grant funds = ! foll[+3 7,a7 ,initiatives to id5tify risks associat$ ) climate *ange = vuln]able individuals & to provide s]vices & support to su* individuals t address su* risks1 :i* may include-- 7i7 tra9+ = heal? c>e provid]s1 d\las1 & o!r employees 9 hospitals1 bir? c5t]s1 midwif]y practices1 & o!r heal? c>e practices t provide pr5atal or labor & deliv]y s]vices to vuln]able individuals on ! id5tification (1 & pati5t c\nsel+ relat+ to1 risks associat$ ) climate *ange = vuln]able individuals2 7ii7 hir+1 tra9+1 or provid+ res\rces to community heal? work]s & p]9atal heal? work]s :o c help id5tify risks associat$ ) climate *ange = vuln]able individuals1 provide pati5t c\nsel+ ab\t su* risks1 & c>ry out ! di/ribution ( relevant s]vices & support2 7iii7 enhanc+ ! monitor+ ( risks associat$ ) climate *ange = vuln]able individuals1 includ+ by-- 7,i7 collect+ data on su* risks 9 specific c5sus tracts1 neighborhoods1 or o!r geographic areas2 & 7,,ii7 %>+ su* data ) local heal? c>e provid]s1 d\las1 & o!r employees 9 hospitals1 bir? c5t]s1 midwif]y practices1 & o!r heal? c>e practices t provide pr5atal or labor & deliv]y s]vices to local vuln]able individuals2 & 7iv7 provid+ vuln]able individuals-- 7,i7 air condition+ units1 resid5tial wea!rization support1 filtration sy/ems1 h\sehold appliances1 or relat$ items2 7,,ii7 direct f9ancial assi/ance2 & 7,,iii7 s]vices & support1 includ+ h\s+ & transportation assi/ance1 to prep>e = or recov] f extreme wea!r ev5ts1 :i* may include floods1 hurricanes1 wildfires1 dr\ghts1 & relat$ ev5ts4 7,b7 ,initiatives to mitigate levels ( & exposure to risks associat$ ) climate *ange = vuln]able individuals1 :i* %all be bas$ on ! be/ available sci5ce & :i* may include initiatives to-- 7i7 develop1 ma9ta91 or exp& urban or community =e/ry initiatives & tree canopy cov]age initiatives2 7ii7 improve infra/ructure1 includ+ build+s & pav$ surfaces2 7iii7 develop or improve community outrea* networks to provide culturally & l+ui/ically appropriate in=mation & notifications ab\t risks associat$ ) climate *ange = vuln]able individuals2 & 7iv7 provide enhanc$ s]vices to racial & e?nic m9ority gr\ps & o!r und]s]v$ populations4 7#f7 ,l5g? ( aw>d ,a grant "u ?is subsection %all be disburs$ ov] #d fiscal ye>s4 7#g7 ,te*nical assi/ance ,! ,secret>y %all provide te*nical assi/ance to a cov]$ entity aw>d$ a grant "u ! ,program to support ! developm5t1 implem5tation1 & evaluation ( activities fund$ ) su* grant4 7#h7 ,reports to ,secret>y 7,a7 ,annual report ,= ea* fiscal ye> dur+ :i* a cov]$ entity is disburs$ grant funds "u ! ,program1 su* cov]$ entity %all submit to ! ,secret>y a report t summ>izes ! activities c>ri$ out by su* cov]$ entity ) su* grant funds dur+ su* fiscal ye>1 :i* %all include a description ( ! foll[+3 7i7 ,! involvem5t ( /akehold] organizations 9 ! implem5tation ( initiatives assi/$ ) su* grant funds4 7ii7 ,relevant heal? & environm5tal data1 disaggregat$1 to ! ext5t practicable1 by race1 e?nicity1 g5d]1 & pregnancy /atus4 7iii7 ,qualitative fe$back receiv$ f vuln]able individuals ) respect to initiatives assi/$ ) su* grant funds4 7iv7 ,crit]ia us$ 9 select+ ! geographic areas assi/$ ) su* grant funds4 7v7 ,ef=ts to address racial & e?nic inequities 9 adv]se mat]nal & infant heal? outcomes & 9 exposure to risks associat$ ) climate *ange = vuln]able individuals4 7vi7 ,any negative & un9t5d$ impacts ( initiatives assi/$ ) su* grant funds1 includ+-- 7,i7 adv]se environm5tal impacts2 7,,ii7 displacem5t ( resid5ts & bus9esses2 7,,iii7 r5t & h\s+ price increases2 & 7,,iv7 disproportionate adv]se impacts on racial & e?nic m9ority gr\ps & o!r und]s]v$ populations4 7vii7 ,h[ ! cov]$ entity w address & prev5t any impacts describ$ 9 clause 7vi74 7,b7 ,publication ,n lat] ?an #cj days aft] ! date on :i* a report is submitt$ "u subp>agraph 7,a71 ! ,secret>y %all publi% su* report on a public website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7#i7 ,report to ,congress ,n lat] ?an ! date t is #e ye>s aft] ! date on :i* ! ,program is e/abli%$1 ! ,secret>y %all submit to ,congress & publi% on a public website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices a report on ! results ( ! ,program1 includ+ ! foll[+3 7,a7 ,summ>ies ( ! annual reports submitt$ "u p>agraph 7#h74 7,b7 ,evaluations ( ! initiatives assi/$ ) grant funds "u ! ,program4 7,c7 ,an assessm5t ( ! effectiv5ess ( ! ,program 9-- 7i7 id5tify+ risks associat$ ) climate *ange = vuln]able individuals2 7ii7 provid+ s]vices & support to su* individuals2 7iii7 mitigat+ levels ( & exposure to su* risks2 & 7iv7 address+ racial & e?nic inequities 9 adv]se mat]nal & infant heal? outcomes & 9 exposure to su* risks4 7,d7 ,a description ( h[ ! ,program c\ld be exp&$1 includ+-- 7i7 monitor+ ef=ts or data collection t w\ld be requir$ to id5tify areas ) high levels ( risks associat$ ) climate *ange = vuln]able individuals2 7ii7 h[ su* areas c\ld be id5tifi$ us+ ! /rategy develop$ "u subsection 7d72 & 7iii7 recomm5dations = additional fund+4 7#aj7 ,cov]$ entity def9$ ,9 ?is subsection1 ! t]m cov]$ entity means a consortium ( organizations s]v+ a c\nty t-- 7,a7 %all include a community-bas$ organization2 & 7,b7 may include-- 7i7 ano!r /akehold] organization2 7ii7 ! gov]nm5t ( su* c\nty2 7iii7 ! gov]nm5ts ( "o or m municipalities )9 su* c\nty2 7iv7 a ,/ate or local public heal? dep>tm5t or em]g5cy managem5t ag5cy2 7v7 a local heal? c>e practice1 :i* may include a lic5s$ & accr$it$ hospital1 bir? c5t]1 midwif]y practice1 or o!r heal? c>e practice t provides pr5atal or labor & deliv]y s]vices to vuln]able individuals2 7vi7 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 #ecjd772 7vii7 an ,urban ,indian organization 7z def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc772 & 7viii7 an in/itution ( high] education4 7#aa7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is subsection #ajj1jjj1jjj = fiscal ye>s #bjbc ?r\gh #bjbf4 7b7 ,grant program = education & tra9+ at heal? pr(ession s*ools 7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all e/abli% a grant program 79 ?is subsection ref]r$ to z ! ,program7 to provide funds to heal? pr(ession s*ools to support ! developm5t & integration ( education & tra9+ programs = id5tify+ & address+ risks associat$ ) climate *ange = vuln]able individuals4 7#b7 ,grant au?ority ,9 c>ry+ out ! ,program1 ! ,secret>y may aw>d1 on a competitive basis1 grants to heal? pr(ession s*ools4 7#c7 ,application ,to be eligible = a grant "u ! ,program1 a heal? pr(ession s*ool %all submit to ! ,secret>y an application at su* "t1 9 su* =m1 & conta9+ su* in=mation z ! ,secret>y may require1 :i* %all include1 at a m9imum1 a description ( ! foll[+3 7,a7 ,h[ su* heal? pr(ession s*ool w engage ) vuln]able individuals1 & /akehold] organizations repres5t+ su* individuals1 9 develop+ & implem5t+ ! education & tra9+ programs support$ by grant funds aw>d$ "u ! ,program4 7,b7 ,h[ su* heal? pr(ession s*ool w ensure t su* education & tra9+ programs w address racial & e?nic inequities 9 exposure to1 & ! effects (1 risks associat$ ) climate *ange = vuln]able individuals4 7#d7 ,use ( funds ,a heal? pr(ession s*ool aw>d$ a grant "u ! ,program %all use ! grant funds to develop1 & integrate into ! curriculum & cont9u+ education ( su* heal? pr(ession s*ool1 education & tra9+ on ea* ( ! foll[+3 7,a7 ,id5tify+ risks associat$ ) climate *ange = vuln]able individuals & individuals ) ! int5t to become pregnant4 7,b7 ,h[ risks associat$ ) climate *ange affect vuln]able individuals & individuals ) ! int5t to become pregnant4 7,c7 ,racial & e?nic inequities 9 exposure to1 & ! effects (1 risks associat$ ) climate *ange = vuln]able individuals & individuals ) ! int5t to become pregnant4 7,d7 ,pati5t c\nsel+ & mitigation /rategies relat+ to risks associat$ ) climate *ange = vuln]able individuals4 7,e7 ,relevant s]vices & support = vuln]able individuals relat+ to risks associat$ ) climate *ange & /rategies = ensur+ vuln]able individuals h access to su* s]vices & support4 7,f7 ,implicit & explicit bias1 racism1 & discrim9ation4 7,g7 ,relat$ topics id5tifi$ by su* heal? pr(ession s*ool bas$ on ! engagem5t ( su* heal? pr(ession s*ool ) vuln]able individuals & /akehold] organizations repres5t+ su* individuals4 7#e7 ,p>tn]%ips ,9 c>ry+ out activities ) grant funds1 a heal? pr(ession s*ool aw>d$ a grant "u ! ,program may p>tn] ) "o or m ( ! foll[+3 7,a7 ,a ,/ate or local public heal? dep>tm5t4 7,b7 ,a heal? c>e pr(essional memb]%ip organization4 7,c7 ,a /akehold] organization4 7,d7 ,a heal? pr(ession s*ool4 7,e7 ,an in/itution ( high] education4 7#f7 ,reports to ,secret>y 7,a7 ,annual report ,= ea* fiscal ye> dur+ :i* a heal? pr(ession s*ool is disburs$ grant funds "u ! ,program1 su* heal? pr(ession s*ool %all submit to ! ,secret>y a report t describes ! activities c>ri$ out ) su* grant funds dur+ su* fiscal ye>4 7,b7 ,f9al report ,n lat] ?an ! date t is #a ye> aft] ! end ( ! la/ fiscal ye> dur+ :i* a heal? pr(ession s*ool is disburs$ grant funds "u ! ,program1 ! heal? pr(ession s*ool %all submit to ! ,secret>y a f9al report t summ>izes ! activities c>ri$ out ) su* grant funds4 7#g7 ,report to ,congress ,n lat] ?an ! date t is #f ye>s aft] ! date on :i* ! ,program is e/abli%$1 ! ,secret>y %all submit to ,congress & publi% on a public website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices a report t includes ! foll[+3 7,a7 ,a summ>y ( ! reports submitt$ "u p>agraph 7#f74 7,b7 ,recomm5dations to improve education & tra9+ programs at heal? pr(ession s*ools ) respect to id5tify+ & address+ risks associat$ ) climate *ange = vuln]able individuals4 7#h7 ,heal? pr(ession s*ool def9$ ,9 ?is subsection1 ! t]m heal? pr(ession s*ool means an accr$it$-- 7,a7 m$ical s*ool2 7,b7 s*ool ( nurs+2 7,c7 midwif]y program2 7,d7 physician assi/ant education program2 7,e7 tea*+ hospital2 7,f7 resid5cy or fell[%ip program2 or 7,g7 o!r s*ool or program det]m9$ appropriate by ! ,secret>y4 7#i7 ,au?orization ( ,appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is subsection #e1jjj1jjj = fiscal ye>s #bjbc ?r\gh #bjbf4 7c7 ,,nih ,consortium on ,bir? & ,climate ,*ange ,rese>* 7#a7 ,e/abli%m5t ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,director ( ! ,national ,in/itutes ( ,heal? 79 ?is subsection ref]r$ to z ! ,director ( ,,nih7 %all e/abli% ! ,consortium on ,bir? & ,climate ,*ange ,rese>* 79 ?is subsection ref]r$ to z ! ,consortium74 7#b7 ,duties 7,a7 ,9 g5]al ,! ,consortium %all coord9ate1 across ! in/itutes1 c5t]s1 & (fices ( ! ,national ,in/itutes ( ,heal?1 rese>* on ! risks associat$ ) climate *ange = vuln]able individuals4 7,b7 ,requir$ activities ,9 c>ry+ out subp>agraph 7,a71 ! ,consortium %all-- 7i7 e/abli% rese>* priorities1 includ+ by prioritiz+ rese>* t-- 7,i7 id5tifies ! risks associat$ ) climate *ange = vuln]able individuals ) a p>ticul> focus on inequities 9 su* risks among racial & e?nic m9ority gr\ps & o!r und]s]v$ populations2 & 7,,ii7 id5tifies /rategies to r$uce levels (1 & exposure to1 su* risks1 ) a p>ticul> focus on risks among racial & e?nic m9ority gr\ps & o!r und]s]v$ populations2 7ii7 id5tify gaps 9 available data relat$ to su* risks2 7iii7 id5tify gaps 91 & opportunities =1 rese>* collaborations2 7iv7 id5tify fund+ opportunities = community-bas$ organizations & rese>*]s f racially1 e?nically1 & geographically div]se backgr\nds2 & 7v7 publi% annual reports on ! "w & f9d+s ( ! ,consortium on a public website ( ! ,national ,in/itutes ( ,heal?4 7#c7 ,memb]%ip ,! ,director ( ,,nih %all appo9t to ! ,consortium repres5tatives ( su* in/itutes1 c5t]s1 & (fices ( ! ,national ,in/itutes ( ,heal? z ! ,director ( ,,nih consid]s appropriate1 includ+1 at a m9imum1 repres5tatives (-- 7,a7 ! ,national ,in/itute ( ,environm5tal ,heal? ,sci5ces2 7,b7 ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities2 7,c7 ! ,eunice ,k5n$y ,%riv] ,national ,in/itute ( ,*ild ,heal? & ,human ,developm5t2 7,d7 ! ,national ,in/itute ( ,nurs+ ,rese>*2 & 7,e7 ! ,(fice ( ,rese>* on ,wom5's ,heal?4 7#d7 ,*airp]son ,! ,*airp]son ( ! ,consortium %all be designat$ by ! ,director ( ,,nih & select$ f among ! repres5tatives appo9t$ "u p>agraph 7#c74 7#e7 ,consultation ,9 c>ry+ out ! duties describ$ 9 p>agraph 7#b71 ! ,consortium %all consult )-- 7,a7 ! heads ( relevant ,f$]al ag5cies1 includ+-- 7i7 ! ,environm5tal ,protection ,ag5cy2 7ii7 ! ,national ,oceanic & ,atmosph]ic ,adm9i/ration2 7iii7 ! ,occupational ,safety & ,heal? ,adm9i/ration2 & 7iv7 f ! ,dep>tm5t ( ,heal? & ,human ,s]vices-- 7,i7 ! ,(fice ( ,m9ority ,heal? 9 ! ,(fice ( ! ,secret>y2 7,,ii7 ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices2 7,,iii7 ! ,heal? ,res\rces & ,s]vices ,adm9i/ration2 7,,iv7 ! ,c5t]s = ,disease ,control & ,prev5tion2 7,v7 ! ,indian ,heal? ,s]vice2 & 7,,vi7 ! ,adm9i/ration = ,*ildr5 & ,families2 & 7,b7 repres5tatives (-- 7i7 /akehold] organizations2 7ii7 heal? c>e provid]s & pr(essional memb]%ip organizations ) exp]tise 9 mat]nal heal? or environm5tal ju/ice2 7iii7 ,/ate & local public heal? dep>tm5ts2 7iv7 lic5s$ & accr$it$ hospitals1 bir? c5t]s1 midwif]y practices1 or o!r heal? c>e practices t provide pr5atal or labor & deliv]y s]vices to vuln]able individuals2 & 7v7 in/itutions ( high] education1 includ+ su* in/itutions t are m9ority-s]v+ in/itutions or h exp]tise 9 mat]nal heal? or environm5tal ju/ice4 7d7 ,/rategy = id5tify+ climate *ange risk zones = vuln]able mo!rs & babies 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all develop a /rategy 79 ?is subsection ref]r$ to z ! ,/rategy7 = designat+ areas t ! ,secret>y det]m9es to h a high risk ( adv]se mat]nal & infant heal? outcomes among vuln]able individuals z a result ( risks associat$ ) climate *ange4 7#b7 ,/rategy requirem5ts 7,a7 ,9 g5]al ,9 develop+ ! ,/rategy1 ! ,secret>y %all e/abli% a process to id5tify areas :]e vuln]able individuals are expos$ to a high risk ( adv]se mat]nal & infant heal? outcomes z a result ( risks associat$ ) climate *ange 9 conjunction ) o!r factors t c impact su* heal? outcomes1 includ+-- 7i7 ! incid5ce ( diseases associat$ ) air pollution1 extreme heat1 & o!r environm5tal factors2 7ii7 ! availability & accessibility ( mat]nal & infant heal? c>e provid]s2 7iii7 ,engli%-language pr(ici5cy among p ( reproductive age2 7iv7 ! heal? insurance /atus ( p ( reproductive age2 7v7 ! numb] ( p ( reproductive age :o are memb]s ( racial or e?nic gr\ps ) disproportionately high rates ( adv]se mat]nal & infant heal? outcomes2 7vi7 ! socioeconomic /atus ( p ( reproductive age1 includ+ ) respect to-- 7,i7 pov]ty2 7,,ii7 unemploym5t2 7,,iii7 h\sehold income2 & 7,,iv7 educational atta9m5t2 & 7vii7 access to quality h\s+1 transportation1 & nutrition4 7,b7 ,res\rces ,9 develop+ ! ,/rategy1 ! ,secret>y %all id5tify1 & incorporate a description (1 ! foll[+3 7i7 ,exi/+ mapp+ tools or ,f$]al programs t id5tify-- 7,i7 risks associat$ ) climate *ange = vuln]able individuals2 & 7,,ii7 o!r factors t c influ5ce mat]nal & infant heal? outcomes1 includ+ ! factors describ$ 9 subp>agraph 7,a74 7ii7 ,environm5tal1 heal?1 socioeconomic1 & demographic data relevant to id5tify+ risks associat$ ) climate *ange = vuln]able individuals4 7iii7 ,exi/+ monitor+ networks t collect data describ$ 9 clause 7ii71 & any gaps 9 su* networks4 7iv7 ,f$]al1 ,/ate1 & local /akehold]s involv$ 9 ma9ta9+ monitor+ networks id5tifi$ "u clause 7iii71 & h[ su* /akehold]s are coord9at+ _! monitor+ ef=ts4 7v7 ,additional monitor+ networks1 & enhancem5ts to exi/+ monitor+ networks1 t w\ld be requir$ to address gaps id5tifi$ "u clause 7iii71 includ+ at ! subc\nty & c5sus tract level4 7vi7 ,fund+ am\nts requir$ to e/abli% ! monitor+ networks id5tifi$ "u clause 7v7 & recomm5dations = ,f$]al1 ,/ate1 & local coord9ation ) respect to su* networks4 7vii7 ,pot5tial uses = data collect$ & g5]at$ z a result ( ! ,/rategy1 includ+ h[ su* data may be us$ 9 det]m9+ recipi5ts ( grants "u ! program e/abli%$ by subsection 7a7 or o!r simil> programs4 7viii7 ,o!r in=mation ! ,secret>y consid]s relevant = ! developm5t ( ! ,/rategy4 7#c7 ,coord9ation & consultation ,9 develop+ ! ,/rategy1 ! ,secret>y %all-- 7,a7 coord9ate ) ! ,adm9i/rator ( ! ,environm5tal ,protection ,ag5cy & ! ,adm9i/rator ( ! ,national ,oceanic & ,atmosph]ic ,adm9i/ration2 & 7,b7 consult )-- 7i7 /akehold] organizations2 7ii7 heal? c>e provid]s & pr(essional memb]%ip organizations ) exp]tise 9 mat]nal heal? or environm5tal ju/ice2 7iii7 ,/ate & local public heal? dep>tm5ts2 7iv7 lic5s$ & accr$it$ hospitals1 bir? c5t]s1 midwif]y practices1 or o!r heal? c>e provid]s t provide pr5atal or labor & deliv]y s]vices to vuln]able individuals2 & 7v7 in/itutions ( high] education1 includ+ su* in/itutions t are m9ority-s]v+ in/itutions or h exp]tise 9 mat]nal heal? or environm5tal ju/ice4 7#d7 ,notice & comm5t ,at lea/ #bdj days be=e ! date on :i* ! ,/rategy is publi%$ 9 accordance ) p>agraph 7#e71 ! ,secret>y %all provide-- 7,a7 notice ( ! ,/rategy on a public website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices2 & 7,b7 an opportunity = public comm5t ( at lea/ #ij days4 7#e7 ,publication ,n lat] ?an #ah mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all publi% on a public website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices-- 7,a7 ! ,/rategy2 7,b7 ! public comm5ts receiv$ "u p>agraph 7#d72 & 7,c7 ! responses ( ! ,secret>y to su* public comm5ts4 7e7 ,def9itions ,9 ?is section1 ! foll[+ def9itions apply3 7#a7 ,adv]se mat]nal & infant heal? outcomes ,! t]m adv]se mat]nal & infant heal? outcomes includes ! outcomes ( pre-t]m bir?1 l[ bir? weight1 /illbir?1 infant or mat]nal mortality1 & sev]e mat]nal morbidity4 7#b7 ,in/itution ( high] education ,! t]m in/itution ( high] education has ! mean+ giv5 su* t]m 9 section #aja ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajja74 7#c7 ,m9ority-s]v+ in/itution ,! t]m m9ority-s]v+ in/itution means an entity specifi$ 9 any ( p>agraphs 7#a7 ?r\gh 7#g7 ( section #cga7;a7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajfgq7a774 7#d7 ,racial & e?nic m9ority gr\p ,! t]m racial & e?nic m9ority gr\p has ! mean+ giv5 su* t]m 9 section #agjg7;g7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f7;g774 7#e7 ,risks associat$ ) climate *ange ,! t]m risks associat$ ) climate *ange includes risks associat$ ) extreme heat1 air pollution1 extreme wea!r ev5ts1 & o!r environm5tal issues associat$ ) climate *ange t c result 9 adv]se mat]nal & infant heal? outcomes4 7#f7 ,/akehold] organization ,! t]m /akehold] organization means-- 7,a7 a community-bas$ organization ) exp]tise 9 provid+ assi/ance to vuln]able individuals2 7,b7 a nonpr(it organization ) exp]tise 9 mat]nal or infant heal? or environm5tal ju/ice2 & 7,c7 a pati5t advocacy organization repres5t+ vuln]able individuals4 7#g7 ,vuln]able individual ,! t]m vuln]able individual means-- 7,a7 an individual :o is pregnant2 7,b7 an individual :o 0 pregnant dur+ any portion ( ! prec$+ #a-ye> p]iod2 & 7,c7 an individual "u #c ye>s ( age4 #ebjf4 ,te* to save moms 7a7 ,def9itions ,9 ?is section3 7#a7 ,po/p>tum & po/p>tum p]iod ,! t]ms po/p>tum & po/p>tum p]iod ref] to ! #a-ye> p]iod beg9n+ on ! la/ day ( ! pregnancy ( an individual4 7#b7 ,racial & e?nic m9ority gr\p ,! t]m racial & e?nic m9ority gr\p has ! mean+ giv5 su* t]m 9 section #agjg7;g77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a774 7#c7 ,sev]e mat]nal morbidity ,! t]m sev]e mat]nal morbidity means a heal? condition1 includ+ m5tal heal? conditions & sub/ance use disord]s1 attribut$ to or aggravat$ by pregnancy or *ildbir? t results 9 significant %ort-t]m or long-t]m consequ5ces to ! heal? ( ! individual :o 0 pregnant4 7#d7 ,social det]m9ants ( mat]nal heal? ,! t]m social det]m9ants ( mat]nal heal? means non-cl9ical factors t impact mat]nal heal? outcomes1 includ+-- 7,a7 economic factors1 :i* may include pov]ty1 employm5t1 food security1 support = & access to lactation & o!r infant fe$+ options1 h\s+ /ability1 & relat$ factors2 7,b7 neighborhood factors1 :i* may include quality ( h\s+1 access to transportation1 access to *ild c>e1 availability ( heal?y foods & nutrition c\nsel+1 availability ( clean wat]1 air & wat] quality1 ambi5t temp]atures1 neighborhood crime & viol5ce1 access to broadb&1 & relat$ factors2 7,c7 social & community factors1 :i* may include sy/emic racism1 g5d] discrim9ation or discrim9ation bas$ on o!r protect$ classes1 workplace conditions1 inc>c]ation1 & relat$ factors2 7,d7 h\sehold factors1 :i* may include ability to conduct lead te/+ & abatem5t1 c> seat in/allation1 indoor air temp]atures1 & relat$ factors2 7,e7 education access & quality factors1 :i* may include educational atta9m5t1 language & lit]acy1 & relat$ factors2 & 7,f7 heal? c>e access factors1 includ+ heal? insurance cov]age1 access to culturally congru5t heal? c>e s]vices1 provid]s1 & non-cl9ical support1 access to home visit+ s]vices1 access to wellness & /ress managem5t programs1 heal? lit]acy1 access to teleheal? & items requir$ to receive teleheal? s]vices1 & relat$ factors4 7b7 ,integrat$ teleheal? models 9 mat]nity c>e s]vices 7#a7 ,9 g5]al ,section #aaae;,a7b77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b77 is am5d$ by add+ at ! end ! foll[+3 7xxviii7 ,focus+ on title ,,xix1 provid+ = ! adoption ( & use ( teleheal? tools t all[ = scre5+1 monitor+1 & managem5t ( common heal? complications ) respect to an individual receiv+ m$ical assi/ance dur+ su* individual's pregnancy & = n m ?an a #a-ye> p]iod beg9n+ on ! la/ day ( ! pregnancy4 4 7#b7 ,effective date ,! am5dm5t made by p>agraph 7#a7 %all take effect #a ye> aft] ! date ( ! enactm5t ( ?is section4 7c7 ,grants ,to exp& ! use ( te*nology-,enabl$ collaborative le>n+ & capacity models = pregnant & po/p>tum individuals ,title ,,iii ( ! ,public ,heal? ,s]vice ,act is am5d$ by ins]t+ aft] section #ccj,n 7#db ,u4,s4,c4 #bed;c-#bj7 ! foll[+ new section3 #ccj,n-#a4 ,exp&+ capacity = mat]nal heal? outcomes 7a7 ,e/abli%m5t ,beg9n+ n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is section1 ! ,secret>y %all aw>d grants to eligible entities to evaluate1 develop1 & exp& ! use ( te*nology-enabl$ collaborative le>n+ & capacity build+ models & improve mat]nal heal? outcomes-- 7#a7 9 heal? pr(essional %ortage areas2 7#b7 9 areas ) high rates ( mat]nal mortality & sev]e mat]nal morbidity2 7#c7 9 areas ) significant racial & e?nic inequities 9 mat]nal heal? outcomes2 & 7#d7 = m$ically und]s]v$ populations & ,am]ican ,indians & ,alaska ,natives1 includ+ ,indian ,tribes1 ,tribal organizations1 & ,urban ,indian organizations4 7b7 ,use ( ,funds 7#a7 ,requir$ uses ,recipi5ts ( grants "u ?is section %all use ! grants to-- 7,a7 tra9 mat]nal heal? c>e provid]s1 /ud5ts1 & o!r simil> pr(essionals ?r\gh models t include-- 7i7 me?ods to increase safety & heal? c>e quality2 7ii7 tra9+ to increase aw>5ess (1 & elim9ate implicit bias1 racism1 & discrim9ation 91 ! provision ( heal? c>e2 7iii7 be/ practices 9 scre5+ = &1 z ne$$1 evaluat+ & treat+ mat]nal m5tal heal? conditions & sub/ance use disord]s2 7iv7 tra9+ on be/ practices 9 mat]nity c>e = pregnant & po/p>tum individuals dur+ ! ,,covid-#ai public heal? em]g5cy or future public heal? em]g5cies2 7v7 me?ods to scre5 = social det]m9ants ( mat]nal heal? risks 9 ! pr5atal & po/p>tum p]iods2 & 7vi7 ! use ( remote pati5t monitor+ tools = pregnancy-relat$ complications describ$ 9 section #aaae;,a7b77#b77;,b77xxviii7 ( ! ,social ,security ,act2 7,b7 evaluate & collect in=mation on ! effect ( su* models on-- 7i7 access to1 & quality (1 c>e2 7ii7 outcomes ) respect to ! heal? ( an individual2 & 7iii7 ! exp]i5ce ( individuals :o receive pregnancy-relat$ heal? c>e2 7,c7 develop qualitative & quantitative measures to id5tify be/ practices = ! expansion & use ( su* models2 7,d7 /udy ! effect ( su* models on pati5t outcomes & mat]nity c>e provid]s2 & 7,e7 conduct any o!r activity1 z det]m9$ by ! ,secret>y4 7#b7 ,p]missible uses ,recipi5ts ( grants "u ?is section may use grants to support-- 7,a7 ! use & expansion ( te*nology-enabl$ collaborative le>n+ & capacity build+ models1 includ+ h>dw>e & s(tw>e t-- 7i7 enable di/ance le>n+ & te*nical support2 & 7ii7 support ! secure ex*ange ( electronic heal? in=mation2 & 7,b7 mat]nity c>e provid]s1 /ud5ts1 & o!r simil> pr(essionals 9 ! provision ( mat]nity c>e ?r\gh su* models4 7c7 ,application 7#a7 ,9 g5]al ,an eligible entity seek+ a grant "u subsection 7a7 %all submit to ! ,secret>y an application1 at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7#b7 ,assurance ,an application "u p>agraph 7#a7 %all include an assurance t su* entity %all collect in=mation on1 & assess ! effect (1 ! use ( te*nology-enabl$ collaborative le>n+ & capacity build+ models1 includ+ ) respect to-- 7,a7 mat]nal heal? outcomes2 7,b7 access to mat]nal heal? c>e s]vices2 7,c7 quality ( mat]nal heal? c>e2 & 7,d7 ret5tion ( mat]nity c>e provid]s s]v+ areas & populations describ$ 9 subsection 7a74 7d7 ,limitations 7#a7 ,numb] ,! ,secret>y may n aw>d m ?an #a grant "u ?is section to an eligible entity4 7#b7 ,duration ,a grant aw>d$ "u ?is section %all be = a #e-ye> p]iod4 7e7 ,access to broadb& ,9 adm9i/]+ grants "u ?is section1 ! ,secret>y may coord9ate ) o!r ag5cies to ensure t fund+ opportunities are available to support access to reliable1 high-spe$ int]net = grantees4 7f7 ,te*nical assi/ance ,! ,secret>y %all provide 7ei!r directly or by contract7 te*nical assi/ance to eligible entities1 includ+ recipi5ts ( grants "u subsection 7a71 on ! developm5t1 use1 & su/a9ability ( te*nology-enabl$ collaborative le>n+ & capacity build+ models to exp& access to mat]nal heal? c>e s]vices provid$ by su* entities1 includ+-- 7#a7 9 heal? pr(essional %ortage areas2 7#b7 9 areas ) high rates ( mat]nal mortality & sev]e mat]nal morbidity or significant racial & e?nic inequities 9 mat]nal heal? outcomes2 & 7#c7 = m$ically und]s]v$ populations or ,am]ican ,indians & ,alaska ,natives4 7g7 ,rese>* & evaluation ,! ,secret>y1 9 consultation ) exp]ts1 %all develop a /rategic plan to rese>* & evaluate ! evid5ce = su* models4 7h7 ,report+ 7#a7 ,eligible entities ,an eligible entity t receives a grant "u subsection 7a7 %all submit to ! ,secret>y a report1 at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7#b7 ,secret>y ,n lat] ?an #d ye>s aft] ! date ( enactm5t ( ?is section1 ! ,secret>y %all submit to ! ,congress1 & make available on ! website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 a report t includes-- 7,a7 a description ( grants aw>d$ "u subsection 7a7 & ! purpose & am\nts ( su* grants2 7,b7 a summ>y (-- 7i7 ! evaluations conduct$ "u subsection 7b77#a77;,b72 7ii7 any te*nical assi/ance provid$ "u subsection 7f72 & 7iii7 ! activities conduct$ "u subsection 7a72 & 7,c7 a description ( any significant f9d+s ) respect to-- 7i7 pati5t outcomes2 & 7ii7 be/ practices = exp&+1 us+1 or evaluat+ te*nology-enabl$ collaborative le>n+ & capacity build+ models4 7i7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section1 #f1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 7j7 ,def9itions ,9 ?is section3 7#a7 ,eligible entity 7,a7 ,9 g5]al ,! t]m eligible entity means an entity t provides1 or supports ! provision (1 mat]nal heal? c>e s]vices or o!r evid5ce-bas$ s]vices = pregnant & po/p>tum individuals-- 7i7 9 heal? pr(essional %ortage areas2 7ii7 9 areas ) high rates ( adv]se mat]nal heal? outcomes or significant racial & e?nic inequities 9 mat]nal heal? outcomes2 or 7iii7 :o are-- 7,i7 memb]s ( m$ically und]s]v$ populations2 or 7,,ii7 ,am]ican ,indians & ,alaska ,natives1 includ+ ,indian ,tribes1 ,tribal organizations1 & ,urban ,indian organizations4 7,b7 ,inclusions ,an eligible entity may include entities t lead1 or are capable ( lead+1 a te*nology-enabl$ collaborative le>n+ & capacity build+ model4 7#b7 ,heal? pr(essional %ortage area ,! t]m heal? pr(essional %ortage area means a heal? pr(essional %ortage area designat$ "u section #ccb4 7#c7 ,indian ,tribe ,! t]m ,indian ,tribe has ! mean+ giv5 su* t]m 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act4 7#d7 ,mat]nal mortality ,! t]m mat]nal mortality means a dea? occurr+ dur+ or )9 ! #a-ye> p]iod aft] pregnancy caus$ by pregnancy-relat$ or *ildbir? complications1 includ+ a suicide1 ov]dose1 or o!r dea? result+ f a m5tal heal? or sub/ance use disord] attribut$ to or aggravat$ by pregnancy or *ildbir? complications4 7#e7 ,m$ically und]s]v$ population ,! t]m m$ically und]s]v$ population has ! mean+ giv5 su* t]m 9 section #ccj7;b77#c74 7#f7 ,po/p>tum ,! t]m po/p>tum means ! #a-ye> p]iod beg9n+ on ! la/ date ( an individual's pregnancy4 7#g7 ,sev]e mat]nal morbidity ,! t]m sev]e mat]nal morbidity means a heal? condition1 includ+ a m5tal heal? or sub/ance use disord]1 attribut$ to or aggravat$ by pregnancy or *ildbir? t results 9 significant %ort-t]m or long-t]m consequ5ces to ! heal? ( ! individual :o 0 pregnant4 7#h7 ,te*nology-enabl$ collaborative le>n+ & capacity build+ model ,! t]m te*nology-enabl$ collaborative le>n+ & capacity build+ model means a di/ance heal? education model t connects heal? c>e pr(essionals1 & o!r speciali/s1 ?r\gh simultane\s int]active videoconf]5c+ = ! purpose ( facilitat+ case-bas$ le>n+1 dissem9at+ be/ practices1 & evaluat+ outcomes 9 ! context ( mat]nal heal? c>e4 7#i7 ,tribal organization ,! t]m ,tribal organization has ! mean+ giv5 su* t]m 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act4 7#aj7 ,urban ,indian organization ,! t]m ,urban ,indian organization has ! mean+ giv5 su* t]m 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act4 4 7d7 ,grants ,to promote equity 9 mat]nal heal? outcomes ?r\gh digital tools 7#a7 ,9 g5]al ,beg9n+ n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all make grants to eligible entities to r$uce racial & e?nic inequities 9 mat]nal heal? outcomes by increas+ access to digital tools relat$ to mat]nal heal? c>e4 7#b7 ,applications ,to be eligible to receive a grant "u ?is subsection1 an eligible entity %all submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7#c7 ,prioritization ,9 aw>d+ grants "u ?is subsection1 ! ,secret>y %all prioritize an eligible entity-- 7,a7 9 an area ) high rates ( adv]se mat]nal heal? outcomes or significant racial & e?nic inequities 9 mat]nal heal? outcomes2 7,b7 9 a heal? pr(essional %ortage area designat$ "u section #ccb ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;e72 & 7,c7 t promotes te*nology t addresses racial & e?nic inequities 9 mat]nal heal? outcomes4 7#d7 ,limitations 7,a7 ,numb] ,! ,secret>y may aw>d n m ?an #a grant "u ?is subsection to an eligible entity4 7,b7 ,duration ,a grant aw>d$ "u ?is subsection %all be = a #e-ye> p]iod4 7#e7 ,te*nical assi/ance ,! ,secret>y %all provide te*nical assi/ance to an eligible entity on ! developm5t1 use1 evaluation1 & po/-grant su/a9ability ( digital tools = purposes ( promot+ equity 9 mat]nal heal? outcomes4 7#f7 ,report+ 7,a7 ,eligible entities ,an eligible entity t receives a grant "u p>agraph 7#a7 %all submit to ! ,secret>y a report1 at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7,b7 ,secret>y ,n lat] ?an #d ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ,congress a report t includes-- 7i7 an evaluation on ! effectiv5ess ( grants aw>d$ "u ?is subsection to improve heal? outcomes = pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps2 7ii7 recomm5dations on new grant programs t promote ! use ( te*nology to improve su* mat]nal heal? outcomes2 & 7iii7 recomm5dations ) respect to-- 7,i7 te*nology-bas$ privacy & security safegu>ds 9 mat]nal heal? c>e2 7,,ii7 reimbursem5t rates = mat]nal teleheal? s]vices2 7,,iii7 ! use ( digital tools to analyze l>ge data sets to id5tify pot5tial pregnancy-relat$ complications2 7,,iv7 b>ri]s t prev5t mat]nity c>e provid]s f provid+ teleheal? s]vices across ,/ates2 7,v7 ! use ( consum] digital tools su* z mobile phone applications1 pati5t portals1 & we>able te*nologies to improve mat]nal heal? outcomes2 7,,vi7 b>ri]s t prev5t access to teleheal? s]vices1 includ+ a lack ( access to reliable1 high-spe$ int]net or electronic devices2 7,,vii7 b>ri]s to data %>+ betwe5 ! ,special ,supplem5tal ,nutrition ,program = ,wom51 ,infants1 & ,*ildr5 program & mat]nity c>e provid]s1 & recomm5dations = address+ su* b>ri]s2 & 7,,viii7 lessons le>n$ f exp&$ access to teleheal? relat$ to mat]nity c>e dur+ ! ,,covid-#ai public heal? em]g5cy4 7#g7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is subsection #f1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 7e7 ,report on ! use ( te*nology 9 mat]nity c>e 7#a7 ,9 g5]al ,n lat] ?an #fj days aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all ent] into an agreem5t ) ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e 7ref]r$ to 9 ?is section z ! ,national ,academies7 "u :i* ! ,national ,academies %all conduct a /udy on ! use ( te*nology & pati5t monitor+ devices 9 mat]nity c>e4 7#b7 ,cont5t ,! agreem5t ent]$ into pursuant to p>agraph 7#a7 %all provide = ! /udy ( ! foll[+3 7,a7 ,! use ( innovative te*nology 7includ+ artificial intellig5ce7 9 mat]nal heal? c>e1 includ+ ! ext5t to :i* su* te*nology has affect$ racial or e?nic biases 9 mat]nal heal? c>e4 7,b7 ,! use ( pati5t monitor+ devices 7includ+ pulse oximet] devices7 9 mat]nal heal? c>e1 includ+ ! ext5t to :i* su* devices h affect$ racial or e?nic biases 9 mat]nal heal? c>e4 7,c7 ,be/ practices = r$uc+ & prev5t+ racial or e?nic biases 9 ! use ( innovative te*nology & pati5t monitor+ devices 9 mat]nity c>e4 7,d7 ,be/ practices 9 ! use ( innovative te*nology & pati5t monitor+ devices = pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps4 7,e7 ,be/ practices ) respect to privacy & security safegu>ds 9 su* use4 7#c7 ,report ,n lat] ?an #bd mon?s aft] ! date ( enactm5t ( ?is ,act1 ! ,national ,academies %all complete ! /udy "u ?is subsection1 & transmit a report ( ! results ( su* /udy to ,congress4 #ebjg4 ,social det]m9ants = moms 7a7 ,task =ce ,to develop a /rategy ,to address social det]m9ants ( mat]nal heal? 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices %all conv5e a task =ce 79 ?is subsection ref]r$ to z ! ,task ,=ce7 to develop a /rategy to coord9ate ef=ts betwe5 ,f$]al ag5cies to address social det]m9ants ( mat]nal heal? ) respect to pregnant & po/p>tum individuals4 7#b7 ,ex (ficio memb]s ,! ex (ficio memb]s ( ! ,task ,=ce %all consi/ ( ! foll[+3 7,a7 ,! ,secret>y ( ,heal? & ,human ,s]vices 7or a designee !re(74 7,b7 ,! ,secret>y ( ,h\s+ & ,urban ,developm5t 7or a designee !re(74 7,c7 ,! ,secret>y ( ,transportation 7or a designee !re(74 7,d7 ,! ,secret>y ( ,agriculture 7or a designee !re(74 7,e7 ,! ,secret>y ( ,labor 7or a designee !re(74 7,f7 ,! ,adm9i/rator ( ! ,environm5tal ,protection ,ag5cy 7or a designee !re(74 7,g7 ,! ,assi/ant ,secret>y = ! ,adm9i/ration = ,*ildr5 & ,families 7or a designee !re(74 7,h7 ,! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 7or a designee !re(74 7,i7 ,! ,director ( ! ,indian ,heal? ,s]vice 7or a designee !re(74 7,j7 ,! ,director ( ! ,national ,in/itutes ( ,heal? 7or a designee !re(74 7,k7 ,! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration 7or a designee !re(74 7,l7 ,! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal? ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices 7or a designee !re(74 7,m7 ,! ,deputy ,assi/ant ,secret>y = ,wom5's ,heal? ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices 7or a designee !re(74 7,n7 ,! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion 7or a designee !re(74 7,o7 ,! ,director ( ! ,(fice on ,viol5ce ,aga9/ ,wom5 ( ! ,dep>tm5t ( ,ju/ice 7or a designee !re(74 7#c7 ,appo9t$ memb]s ,9 addition to ! ex (ficio memb]s ( ! ,task ,=ce1 ! ,secret>y ( ,heal? & ,human ,s]vices %all appo9t ! foll[+ memb]s ( ! ,task ,=ce3 7,a7 ,at lea/ two repres5tatives ( pati5ts1 to include-- 7i7 a repres5tative ( pati5ts :o h suff]$ f sev]e mat]nal morbidity2 or 7ii7 a repres5tative ( pati5ts :o is a family memb] ( an individual :o suff]$ a pregnancy-relat$ dea?4 7,b7 ,at lea/ two lead]s ( community-bas$ organizations t address mat]nal mortality & sev]e mat]nal morbidity ) a specific focus on racial & e?nic inequities4 ,9 appo9t+ su* lead]s "u ?is subp>agraph1 ! ,secret>y ( ,heal? & ,human ,s]vices %all give priority to individuals :o are lead]s ( organizations l$ by individuals f racial & e?nic m9ority gr\ps4 7,c7 ,at lea/ two p]9atal heal? work]s4 7,d7 ,a pr(essionally div]se panel ( mat]nity c>e provid]s4 7#d7 ,*air ,! ,secret>y ( ,heal? & ,human ,s]vices %all select ! *air ( ! ,task ,=ce f among ! memb]s ( ! ,task ,=ce4 7#e7 ,report ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,task ,=ce %all submit to ,congress a report on-- 7,a7 ! /rategy develop$ "u p>agraph 7#a72 7,b7 recomm5dations on fund+ am\nts ) respect to implem5t+ su* /rategy2 & 7,c7 recomm5dations = h[ to exp& cov]age ( social s]vices to address social det]m9ants ( mat]nal heal? "u ,m$icaid manag$ c>e organizations & ,/ate ,m$icaid programs4 7#f7 ,t]m9ation ,section #ad ( ! ,f$]al ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 %all n apply to ! ,task ,=ce ) respect to t]m9ation4 7b7 ,h\s+ = ,moms grant program 7#a7 ,def9itions ,9 ?is subsection3 7,a7 ,eligible entity ,! t]m eligible entity means-- 7i7 a community-bas$ organization2 7ii7 a ,/ate or local gov]nm5tal entity1 includ+ a ,/ate or local public heal? dep>tm5t2 7iii7 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 #ecjd772 or 7iv7 an ,urban ,indian organization 7z su* t]m is def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc774 7,b7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,h\s+ & ,urban ,developm5t4 7#b7 ,e/abli%m5t ,! ,secret>y %all e/abli% a ,h\s+ = ,moms grant program to make grants to eligible entities to increase access to safe1 /able1 af=dable1 & adequate h\s+ = pregnant & po/p>tum individuals & _! families4 7#c7 ,application ,to be eligible to receive a grant "u ?is subsection1 an eligible entity %all submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may provide4 7#d7 ,priority ,9 aw>d+ grants "u ?is subsection1 ! ,secret>y %all give priority to an eligible entity t-- 7,a7 is a community-bas$ organization or w p>tn] ) a community-bas$ organization to implem5t initiatives to increase access to safe1 /able1 af=dable1 & adequate h\s+ = pregnant & po/p>tum individuals & _! families2 7,b7 is op]at+ 9 an area ) high rates ( adv]se mat]nal heal? outcomes or significant racial or e?nic inequities 9 mat]nal heal? outcomes1 to ! ext5t su* data are available2 & 7,c7 is op]at+ 9 an area ) a high pov]ty rate or a significant numb] ( individuals :o lack consi/5t access to safe1 /able1 af=dable1 & adequate h\s+4 7#e7 ,use ( funds ,an eligible entity t receives a grant "u ?is subsection %all use funds f ! grant = ! purposes (-- 7,a7 id5tify+ & conduct+ outrea* to pregnant & po/p>tum individuals :o are l[-income & lack consi/5t access to safe1 /able1 af=dable1 & adequate h\s+2 7,b7 provid+ safe1 /able1 af=dable1 & adequate h\s+ options to su* individuals2 7,c7 connect+ su* individuals ) local organizations (f]+ safe1 /able1 af=dable1 & adequate h\s+ options2 7,d7 provid+ application assi/ance to su* individuals seek+ to enroll 9 programs (f]+ safe1 /able1 af=dable1 & adequate h\s+ options2 7,e7 provid+ direct f9ancial assi/ance to su* individuals = ! purposes ( ma9ta9+ safe1 /able1 & adequate h\s+ = ! duration ( ! individual's pregnancy & po/p>tum p]iods2 & 7,f7 work+ ) relevant /akehold]s to ensure t local h\s+ & homeless %elt] infra/ructure is supportive to pregnant & po/p>tum individuals1 includ+ ?r\gh-- 7i7 heal?-promot+ h\s+ codes2 7ii7 en=cem5t ( h\s+ codes2 7iii7 proactive r5tal inspection programs2 7iv7 code en=cem5t (fic] tra9+2 & 7v7 p>tn]%ips betwe5 regional (fices ( ! ,dep>tm5t ( ,h\s+ & ,urban ,developm5t & community-bas$ organizations to ensure h\s+ laws are und]/ood & violations are discov]$4 7#f7 ,report+ 7,a7 ,eligible entities ,! ,secret>y %all require ea* eligible entity receiv+ a grant "u ?is subsection to annually submit to ! ,secret>y & make publicly available a report on ! /atus ( activities conduct$ us+ ! grant4 7,b7 ,secret>y ,n lat] ?an ! end ( ea* fiscal ye> 9 :i* grants are made "u ?is subsection1 ! ,secret>y %all submit to ,congress & make publicly available a report t-- 7i7 summ>izes ! reports receiv$ "u subp>agraph 7,a72 7ii7 evaluates ! effectiv5ess ( grants aw>d$ "u ?is subsection 9 increas+ access to safe1 /able1 af=dable1 & adequate h\s+ = pregnant & po/p>tum individuals & _! families2 & 7iii7 makes recomm5dations ) respect to ensur+ activities describ$ 9 p>agraph 7#e7 cont9ue aft] grant am\nts made available "u ?is subsection are exp5d$4 7#g7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is subsection #aj1jjj1jjj = fiscal ye> #bjbc1 :i* %all rema9 available until exp5d$4 7c7 ,dep>tm5t ( ,transportation 7#a7 ,report ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,transportation %all submit to ,congress & make publicly available a report conta9+-- 7,a7 an assessm5t ( transportation b>ri]s prev5t+ individuals f att5d+ pr5atal & po/p>tum appo9tm5ts1 access+ mat]nal heal? c>e s]vices1 or access+ s]vices & res\rces relat$ to social det]m9ants ( mat]nal heal?2 7,b7 recomm5dations on h[ to ov]come ! b>ri]s assess$ "u subp>agraph 7,a72 & 7,c7 an assessm5t ( transportation safety risks = pregnant individuals & recomm5dations on h[ to mitigate ^? risks4 7#b7 ,consid]ations ,9 c>ry+ out p>agraph 7#a71 ! ,secret>y ( ,transportation %all give special consid]ation to solutions =-- 7,a7 pregnant & po/p>tum individuals liv+ 9 a heal? pr(essional %ortage area designat$ "u section #ccb ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;e72 7,b7 pregnant & po/p>tum individuals liv+ 9 areas ) high mat]nal mortality or sev]e morbidity rates or significant racial or e?nic inequities 9 mat]nal heal? outcomes2 & 7,c7 pregnant & po/p>tum individuals ) a disability t impacts mobility4 7d7 ,dep>tm5t ( ,agriculture 7#a7 ,special supplem5tal nutrition program = wom51 infants1 & *ildr5 7,a7 ,ext5sion ( po/p>tum p]iod ,section #ag7;b77#aj7 ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aghf7;b77#aj77 is am5d$ by /rik+ six & ins]t+ #bd4 7,b7 ,report ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all submit to ,congress a report t evaluates ! effect ( ! am5dm5t made by subp>agraph 7,a7 on-- 7i7 mat]nal & infant heal? outcomes1 includ+ racial & e?nic inequities ) respect to ^? outcomes2 7ii7 brea/fe$+ rates among po/p>tum individuals2 7iii7 qualitative evaluations ( family exp]i5ces "u ! special supplem5tal nutrition program = wom51 infants1 & *ildr5 e/abli%$ "u section #ag ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aghf72 & 7iv7 o!r relevant in=mation z det]m9$ by ! ,secret>y4 7#b7 ,grant program = heal?y food & clean wat] = pregnant & po/p>tum individuals 7,a7 ,9 g5]al ,! ,secret>y %all e/abli% a program 7ref]r$ to 9 ?is p>agraph z ! program7 to aw>d grants1 on a competitive basis1 to eligible entities to c>ry out ! activities describ$ 9 subp>agraph 7,d74 7,b7 ,application ,to be eligible = a grant "u ! program1 an eligible entity %all submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y det]m9es appropriate4 7,c7 ,priority ,9 aw>d+ grants "u ! program1 ! ,secret>y %all give priority to an eligible entity t-- 7i7 is1 or w p>tn] )1 an eligible entity describ$ 9 p>agraph 7#c77;,a77i72 & 7ii7 is op]at+ 9 an area ) a high rate (-- 7,i7 adv]se mat]nal heal? outcomes2 or 7,,ii7 significant racial or e?nic inequities 9 mat]nal heal? outcomes4 7,d7 ,use ( funds ,an eligible entity %all use a grant aw>d$ "u ! program to deliv] heal?y food1 infant =mula1 clean wat]1 or diap]s to pregnant & po/p>tum individuals locat$ 9 areas t are food des]ts1 z det]m9$ by ! ,secret>y us+ data f ! ,food ,access ,rese>* ,atlas ( ! ,dep>tm5t ( ,agriculture4 7,e7 ,reports 7i7 ,eligible entities ,n lat] ?an #a ye> aft] ! date on :i* an eligible entity receives a grant "u ! program1 & annually !reaft]1 ! eligible entity %all submit to ! ,secret>y a report on ! /atus ( activities conduct$ us+ ! grant1 :i* %all conta9 su* in=mation z ! ,secret>y may require4 7ii7 ,secret>y 7,i7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date on :i* ! fir/ grant is aw>d$ "u ! program1 ! ,secret>y %all submit to ,congress a report t includes-- 7aa7 a summ>y ( ! reports submitt$ by eligible entities "u clause 7i72 7bb7 an assessm5t ( ! ext5t to :i* food di/ribut$ us+ grants aw>d$ "u ! program 0 pur*as$ f local & regional food sy/ems2 7cc7 an evaluation ( ! effect ( ! program on mat]nal & infant heal? outcomes1 includ+ racial & e?nic inequities ) respect to ^? outcomes2 & 7dd7 recomm5dations ) respect to ensur+ ! activities describ$ 9 subp>agraph 7,d7 cont9ue aft] ! grant p]iod fund+ ^? activities expires4 7,,ii7 ,publication ,! ,secret>y %all make ! report submitt$ "u subclause 7,i7 publicly available on ! website ( ! ,dep>tm5t ( ,agriculture4 7,f7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ! program #e1jjj1jjj = ! p]iod ( fiscal ye>s #bjbb ?r\gh #bjbd4 7#c7 ,def9itions ,9 ?is subsection3 7,a7 ,eligible entity ,! t]m eligible entity means-- 7i7 a community-bas$ organization2 7ii7 a ,/ate or local gov]nm5tal entity1 includ+ a ,/ate or local public heal? dep>tm5t2 7iii7 an ,indian ,tribe or ,tribal organization 7z ^? t]ms are def9$ 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #ecjd772 & 7iv7 an ,urban ,indian organization 7z def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc774 7,b7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,agriculture4 7e7 ,environm5tal /udy ?r\gh ,national ,academies 7#a7 ,9 g5]al ,n lat] ?an #fj days aft] ! date ( enactm5t ( ?is ,act1 ! ,adm9i/rator ( ! ,environm5tal ,protection ,ag5cy %all seek to ent] into an agreem5t ) ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e 7ref]r$ to 9 ?is subsection z ! ,national ,academies7 "u :i* ! ,national ,academies agree to conduct a /udy on ! impacts (1 ) respect to mat]nal & infant heal? incomes1 wat] & air quality1 exposure to extreme temp]atures1 environm5tal *emicals1 environm5tal risks 9 ! workplace & ! home1 & pollution levels4 7#b7 ,/udy requirem5ts ,! agreem5t "u p>agraph 7#a7 %all direct ! ,national ,academies to make recomm5dations =-- 7,a7 improv+ environm5tal conditions to improve mat]nal & infant heal? outcomes2 & 7,b7 r$uc+ or elim9at+ racial & e?nic inequities 9 ^? outcomes4 7#c7 ,report ,! agreem5t "u p>agraph 7#a7 %all direct ! ,national ,academies to complete ! /udy "u ?is subsection1 & submit to ,congress & make publicly available a report on ! results ( ! /udy1 n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act4 7f7 ,*ild c>e access 7#a7 ,grant program ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is subsection ref]r$ to z ! ,secret>y7 %all aw>d grants to eligible organizations to c>ry out programs to provide pregnant & po/p>tum individuals ) free & accessible drop-9 *ild c>e s]vices dur+ pr5atal & po/p>tum appo9tm5ts4 7#b7 ,application ,to be eligible to receive a grant "u ?is subsection1 an eligible entity %all submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7#c7 ,eligible organizations 7,a7 ,eligibility ,to be eligible to receive a grant "u ?is subsection1 an organization %all be an organization t-- 7i7 provides *ild c>e s]vices2 & 7ii7 c c>ry out a program provid+ pregnant & po/p>tum individuals ) free & accessible drop-9 *ild c>e s]vices dur+ pr5atal & po/p>tum appo9tm5ts4 7,b7 ,prioritization ,9 select+ grant recipi5ts "u ?is subsection1 ! ,secret>y %all give priority to eligible organizations t op]ate 9 an area t has1 to ! ext5t data ) respect to su* an area are available-- 7i7 high rates ( adv]se mat]nal heal? outcomes2 or 7ii7 significant racial or e?nic inequities 9 mat]nal heal? outcomes4 7#d7 ,tim+ ,! ,secret>y %all comm5ce ! grant program "u p>agraph 7#a7 n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act4 7#e7 ,report+ 7,a7 ,grantees ,ea* recipi5t ( a grant "u ?is subsection %all annually submit to ! ,secret>y & make publicly available a report on ! /atus ( activities conduct$ us+ ! grant4 ,ea* su* report %all include-- 7i7 an analysis ( ! effect ( ! fund$ program on pr5atal & po/p>tum appo9tm5t att5dance rates2 7ii7 summ>ies ( qualitative assessm5ts ( ! fund$ program f-- 7,i7 pregnant & po/p>tum individuals p>ticipat+ 9 ! program2 & 7,,ii7 ! families ( su* individuals2 & 7iii7 su* additional in=mation z ! ,secret>y may require4 7,b7 ,secret>y ,n lat] ?an ! end ( fiscal ye> #bjbd1 ! ,secret>y %all submit to ! ,congress1 & make publicly available1 a report conta9+ ea* ( ! foll[+3 7i7 ,a summ>y ( ! reports receiv$ "u subp>agraph 7,a74 7ii7 ,an assessm5t ( ! effects1 if any1 ( ! fund$ programs on mat]nal heal? outcomes1 ) a specific focus on racial & e?nic inequities 9 su* outcomes4 7iii7 ,a description ( actions ! ,secret>y c take to ensure t pregnant & po/p>tum individuals eligible = m$ical assi/ance "u a ,/ate plan "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aicf et seq47 h access to free & accessible drop-9 *ild c>e s]vices dur+ pr5atal & po/p>tum appo9tm5ts1 includ+ id5tification ( ! fund+ necess>y to c>ry out su* actions4 7#f7 ,drop-,9 *ild c>e s]vices def9$ ,9 ?is subsection1 ! t]m drop-9 *ild c>e s]vices means *ild c>e 7includ+ e>ly *ildhood education7 s]vices t are-- 7,a7 deliv]$ at a facility t meets ! requirem5ts ( all applicable laws & regulations ( ! ,/ate or local gov]nm5t 9 :i* x is locat$1 includ+ ! requirem5ts = lic5s+ ( ! facility z a *ild c>e facility2 & 7,b7 provid$ 9 s+le enc\nt]s )\t requir+ full-"t enrollm5t ( a p]son 9 a *ild c>e program4 7#g7 ,au?orization ( appropriations ,to c>ry out ?is subsection1 !re is au?oriz$ to be appropriat$ #e1jjj1jjj = ! p]iod ( fiscal ye>s #bjbc ?r\gh #bjbe4 7g7 ,grants to local entities address+ social det]m9ants ( mat]nal heal? 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is subsection ref]r$ to z ! ,secret>y7 %all aw>d grants to eligible entities to-- 7,a7 address social det]m9ants ( mat]nal heal? = pregnant & po/p>tum individuals2 & 7,b7 elim9ate racial & e?nic inequities 9 mat]nal heal? outcomes4 7#b7 ,application ,to be eligible to receive a grant "u ?is subsection an eligible entity %all submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may provide4 7#c7 ,prioritization ,9 aw>d+ grants "u p>agraph 7#a71 ! ,secret>y %all give priority to an eligible entity t-- 7,a7 is a community-bas$ organization1 or w p>tn] ) a community-bas$ organization to c>ry out ! activities "u p>agraph 7#d72 7,b7 is op]at+ 9 an area ) high rates ( adv]se mat]nal heal? outcomes or significant racial or e?nic inequities 9 mat]nal heal? outcomes2 & 7,c7 is op]at+ 9 an area ) a high pov]ty rate4 7#d7 ,activities ,an eligible entity t receives a grant "u ?is subsection may use funds receiv$ ?r\gh ! grant to-- 7,a7 hire & reta9 /aff2 7,b7 develop & di/ribute a li/ ( available res\rces ) respect to social s]vice programs 9 a community2 7,c7 e/abli% a res\rce c5t] t provides multiple social s]vice programs 9 a s+le location2 7,d7 (f] programs & res\rces 9 ! communities 9 :i* ! respective eligible entities are locat$ to address social det]m9ants ( heal? = pregnant & po/p>tum individuals2 & 7,e7 consult ) su* pregnant & po/p>tum individuals to conduct an assessm5t ( ! activities "u ?is p>agraph4 7#e7 ,te*nical assi/ance ,! ,secret>y %all provide to grant recipi5ts "u ?is subsection te*nical assi/ance to plan = su/a9+ programs to address social det]m9ants ( mat]nal heal? among pregnant & po/p>tum individuals aft] ! p]iod ( ! grant4 7#f7 ,report+ 7,a7 ,grantees ,n lat] ?an #a ye> aft] ! date on :i* an eligible entity fir/ receives a grant "u ?is subsection1 & annually !reaft]1 an eligible entity %all submit to ! ,secret>y1 & make publicly available1 a report on ! /atus ( activities conduct$ us+ ! grant4 ,ea* su* report %all include data on ! effects ( su* activities1 disaggregat$ by race1 e?nicity1 g5d]1 & o!r relevant factors4 7,b7 ,secret>y ,n lat] ?an ! end ( fiscal ye> #bjbf1 ! ,secret>y %all submit to ,congress a report t includes-- 7i7 a summ>y ( ! reports receiv$ "u subp>agraph 7,a72 & 7ii7 recomm5dations =-- 7,i7 improv+ mat]nal heal? outcomes2 & 7,,ii7 r$uc+ or elim9at+ racial & e?nic inequities 9 mat]nal heal? outcomes4 7#g7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is subsection #ae1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 7h7 ,def9itions ,9 ?is section3 7#a7 ,culturally congru5t ,! t]m culturally congru5t1 ) respect to c>e or mat]nity c>e provid$ to a heal? c>e consum]1 means c>e t is 9 agreem5t ) ! pref]r$ cultural values1 beliefs1 worldview1 language1 & practices ( ! heal? c>e consum] & o!r relevant /akehold]s4 7#b7 ,mat]nity c>e provid] ,! t]m mat]nity c>e provid] means a heal? c>e provid] :o-- 7,a7 is a physician1 physician assi/ant1 midwife :o meets at a m9imum ! int]national def9ition ( ! midwife & global /&>ds = midwif]y education z e/abli%$ by ! ,int]national ,conf$]ation ( ,midwives1 nurse practition]1 or cl9ical nurse speciali/2 & 7,b7 has a focus on mat]nal or p]9atal heal?4 7#c7 ,mat]nal mortality ,! t]m mat]nal mortality means a dea? occurr+ dur+ or )9 a "o-ye> p]iod aft] pregnancy1 caus$ by pregnancy-relat$ or *ildbir? complications1 includ+ a suicide1 ov]dose1 or o!r dea? result+ f a m5tal heal? or sub/ance use disord] attribut$ to or aggravat$ by pregnancy-relat$ or *ildbir? complications4 7#d7 ,p]9atal heal? work] ,! t]m p]9atal heal? work] means a d\la1 community heal? work]1 pe] support]1 brea/fe$+ & lactation educator or c\nselor1 nutritioni/ or dietitian1 *ildbir? educator1 social work]1 home visitor1 language int]pret]1 or navigator4 7#e7 ,po/p>tum & po/p>tum p]iod ,! t]ms po/p>tum & po/p>tum p]iod ref] to ! #a-ye> p]iod beg9n+ on ! la/ day ( ! pregnancy ( an individual4 7#f7 ,racial & e?nic m9ority gr\p ,! t]m racial & e?nic m9ority gr\p has ! mean+ giv5 su* t]m 9 section #agjg7;g77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a774 7#g7 ,sev]e mat]nal morbidity ,! t]m sev]e mat]nal morbidity means a heal? condition1 includ+ m5tal heal? conditions & sub/ance use disord]s1 attribut$ to or aggravat$ by pregnancy or *ildbir? t results 9 significant %ort-t]m or long-t]m consequ5ces to ! heal? ( ! individual :o 0 pregnant4 7#h7 ,social det]m9ants ( mat]nal heal? def9$ ,! t]m social det]m9ants ( mat]nal heal? means non-cl9ical factors t impact mat]nal heal? outcomes1 includ+-- 7,a7 economic factors1 :i* may include pov]ty1 employm5t1 food security1 support = & access to lactation & o!r infant fe$+ options1 h\s+ /ability1 & relat$ factors2 7,b7 neighborhood factors1 :i* may include quality ( h\s+1 access to transportation1 access to *ild c>e1 availability ( heal?y foods & nutrition c\nsel+1 availability ( clean wat]1 air & wat] quality1 ambi5t temp]atures1 neighborhood crime & viol5ce1 access to broadb&1 & relat$ factors2 7,c7 social & community factors1 :i* may include sy/emic racism1 g5d] discrim9ation or discrim9ation bas$ on o!r protect$ classes1 workplace conditions1 inc>c]ation1 & relat$ factors2 7,d7 h\sehold factors1 :i* may include ability to conduct lead te/+ & abatem5t1 c> seat in/allation1 indoor air temp]atures1 & relat$ factors2 7,e7 education access & quality factors1 :i* may include educational atta9m5t1 language & lit]acy1 & relat$ factors2 & 7,f7 heal? c>e access factors1 includ+ heal? insurance cov]age1 access to culturally congru5t heal? c>e s]vices1 provid]s1 & non-cl9ical support1 access to home visit+ s]vices1 access to wellness & /ress managem5t programs1 heal? lit]acy1 access to teleheal? & items requir$ to receive teleheal? s]vices1 & relat$ factors4 #ebjh4 ,data ,to ,save ,moms 7a7 ,%ort title ,?is section may be cit$ z ! ,data ,to ,save ,moms ,act4 7b7 ,fund+ = mat]nal mortality review committees ,to promote repres5tative community engagem5t 7#a7 ,9 g5]al ,section #cag,k7d7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;d77 is am5d$ by add+ at ! end ! foll[+3 7#i7 ,grants to promote repres5tative community engagem5t 9 mat]nal mortality review committees 7,a7 ,9 g5]al ,! ,secret>y may1 us+ funds made available pursuant to subp>agraph 7,c71 provide assi/ance to an applicable mat]nal mortality review committee ( a ,/ate1 ,indian tribe1 tribal organization1 or ,urban ,indian organization 7z su* t]m is def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc77-- 7i7 to select = inclusion 9 ! memb]%ip ( su* a committee community memb]s f ! ,/ate1 ,indian tribe1 tribal organization1 or ,urban ,indian organization by-- 7,i7 prioritiz+ community memb]s :o c increase ! div]sity ( ! committee's memb]%ip ) respect to race & e?nicity1 location1 & pr(essional backgr\nd1 includ+ memb]s ) non-cl9ical exp]i5ces2 & 7,,ii7 to ! ext5t applicable1 us+ funds res]v$ "u subsection 7f71 to address b>ri]s to mat]nal mortality review committee p>ticipation = community memb]s1 includ+ ?r\gh provid+ requir$ tra9+1 r$uc+ transportation b>ri]s1 provid+ comp5sation1 & provid+ o!r supports z may be necess>y2 7ii7 to e/abli% initiatives to conduct outrea* & community engagem5t ef=ts )9 communities ?r\gh\t ! ,/ate or ,indian tribe to seek input f community memb]s on ! "w ( su* mat]nal mortality review committee1 ) a p>ticul> focus on outrea* to p :o are memb]s ( m9ority gr\ps2 & 7iii7 to release public reports assess+-- 7,i7 ! pregnancy-relat$ dea? & pregnancy-associat$ dea? review processes ( ! mat]nal mortality review committee1 ) a p>ticul> focus on ! mat]nal mortality review committee's s5sitivity to ! unique circum/ances ( pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps 7z su* t]m is def9$ 9 section #agjg7;g77#a77 :o h suff]$ pregnancy-relat$ dea?s2 & 7,,ii7 ! impact ( ! use ( funds made available pursuant to p>agraph 7,c7 on increas+ ! div]sity ( ! mat]nal mortality review committee memb]%ip & promot+ community engagem5t ef=ts ?r\gh\t ! ,/ate or ,indian tribe4 7,b7 ,te*nical assi/ance ,! ,secret>y %all provide 7ei!r directly ?r\gh ! ,dep>tm5t ( ,heal? & ,human ,s]vices or by contract7 te*nical assi/ance to any mat]nal mortality review committee receiv+ a grant "u ?is p>agraph on be/ practices = increas+ ! div]sity ( ! mat]nal mortality review committee's memb]%ip & = conduct+ effective community engagem5t ?r\gh\t ! ,/ate or ,indian tribe4 7,c7 ,au?orization ( appropriations ,9 addition to any funds made available "u subsection 7f71 !re are au?oriz$ to be appropriat$ to c>ry out ?is p>agraph #aj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 4 7#b7 ,res]vation ( funds ,section #cag,k7f7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;f77 is am5d$ by add+ at ! end ! foll[+3 ,( ! am\nt made available "u ! prec$+ s5t5ce = a fiscal ye>1 n less ?an #a1ejj1jjj %all be res]v$ = grants aw>d$ "u subsection 7d77#i7 to ,indian tribes1 tribal organizations1 or ,urban ,indian organizations 7z ^? t]ms are def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc7744 7c7 ,data collection & review ,section #cag,k7d77#c77;,a77i7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;d77#c77;,a77i77 is am5d$-- 7#a7 by r$esignat+ subclauses 7,,ii7 & 7,,iii7 z subclauses 7,v7 & 7,,vi71 respectively2 & 7#b7 by ins]t+ aft] subclause 7,i7 ! foll[+3 7,,ii7 to ! ext5t practicable1 review+ cases ( sev]e mat]nal morbidity1 accord+ to ! mo/ up-to-date indicators2 7,,iii7 to ! ext5t practicable1 review+ dea?s dur+ pregnancy or up to #a ye> aft] ! end ( a pregnancy f suicide1 ov]dose1 or o!r dea? f a m5tal heal? condition or sub/ance use disord] attribut$ to1 or aggravat$ by1 pregnancy or *ildbir? complications2 7,,iv7 to ! ext5t practicable1 consult+ ) local community-bas$ organizations repres5t+ pregnant & po/p>tum individuals f demographic gr\ps disproportionately impact$ by poor mat]nal heal? outcomes to ensure t1 9 addition to cl9ical factors1 non-cl9ical factors t might h contribut$ to a pregnancy-relat$ dea? are appropriately consid]$2 4 7d7 ,review ( mat]nal heal? data collection processes & quality measures 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,adm9i/rator = ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices & ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 %all consult ) relevant /akehold]s-- 7,a7 to review exi/+ mat]nal heal? data collection processes & quality measures2 & 7,b7 to make recomm5dations to improve su* processes & measures1 includ+ topics describ$ "u p>agraph 7#c74 7#b7 ,collaboration ,9 c>ry+ out ?is subsection1 ! ,secret>y %all consult ) a div]se gr\p ( mat]nal heal? /akehold]s1 :i* may include-- 7,a7 pregnant & po/p>tum individuals & _! family memb]s1 & nonpr(it organizations repres5t+ su* individuals1 ) a p>ticul> focus on pati5ts f racial & e?nic m9ority gr\ps2 7,b7 community-bas$ organizations t provide support = pregnant & po/p>tum individuals1 ) a p>ticul> focus on pati5ts f racial & e?nic m9ority gr\ps2 7,c7 memb]%ip organizations = mat]nity c>e provid]s2 7,d7 organizations repres5t+ p]9atal heal? work]s2 7,e7 organizations t focus on mat]nal m5tal or behavioral heal?2 7,f7 organizations t focus on intimate p>tn] viol5ce2 7,g7 in/itutions ( high] education1 ) a p>ticul> focus on m9ority-s]v+ in/itutions2 7,h7 lic5s$ & accr$it$ hospitals1 bir? c5t]s1 midwif]y practices1 or o!r m$ical practices t provide mat]nal heal? c>e s]vices to pregnant & po/p>tum pati5ts2 7,i7 relevant ,/ate & local public ag5cies1 includ+ ,/ate mat]nal mortality review committees2 & 7,j7 ! ,national ,quality ,=um1 or su* o!r /&>d-sett+ organizations specifi$ by ! ,secret>y4 7#c7 ,topics ,! review ( mat]nal heal? data collection processes & recomm5dations to improve su* processes & measures requir$ "u p>agraph 7#a7 %all assess all available relevant in=mation1 includ+ in=mation f ,/ate-level s\rces1 & %all consid] at lea/ ! foll[+3 7,a7 ,curr5t ,/ate & ,tribal practices = mat]nal heal?1 mat]nal mortality1 & sev]e mat]nal morbidity data collection & dissem9ation1 includ+ consid]ation (-- 7i7 ! timel9ess ( processes = am5d+ a dea? c]tificate :5 new in=mation p]ta9+ to ! dea? becomes available to reflect :e!r ! dea? 0 a pregnancy-relat$ dea?2 7ii7 relevant data collect$ ) electronic heal? records1 includ+ data on race1 e?nicity1 socioeconomic /atus1 insurance type1 & o!r relevant demographic in=mation2 7iii7 mat]nal heal? data collect$ & publicly report$ by hospitals1 heal? sy/ems1 midwif]y practices1 & bir? c5t]s2 7iv7 ! b>ri]s prev5t+ ,/ates f correlat+ mat]nal outcome data ) race & e?nicity data2 7v7 processes = det]m9+ ! cause ( a pregnancy-associat$ dea? 9 ,/ates t d n h a mat]nal mortality review committee2 7vi7 :e!r mat]nal mortality review committees include multidiscipl9>y & div]se memb]%ip 7z describ$ 9 section #cag,k7d77#a77;,a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;d77#a77;,a7772 7vii7 :e!r memb]s ( mat]nal mortality review committees p>ticipate 9 tra9+s on bias1 racism1 or discrim9ation1 & ! quality ( su* tra9+s2 7viii7 ! ext5t to :i* ,/ates h implem5t$ sy/ematic processes ( li/5+ to ! /ories ( pregnant & po/p>tum individuals & _! family memb]s1 ) a p>ticul> focus on pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps & _! family memb]s1 to fully und]/& ! causes (1 & in=m pot5tial solutions to1 ! mat]nal mortality & sev]e mat]nal morbidity crisis )9 _! respective ,/ates2 7ix7 ! ext5t to :i* mat]nal mortality review committees are consid]+ social det]m9ants ( mat]nal heal? :5 exam9+ ! causes ( pregnancy-associat$ & pregnancy-relat$ dea?s2 7x7 ! ext5t to :i* mat]nal mortality review committees are mak+ actionable recomm5dations bas$ on _! reviews ( adv]se mat]nal heal? outcomes & ! ext5t to :i* su* recomm5dations are be+ implem5t$ by appropriate /akehold]s2 7xi7 ! legal & adm9i/rative b>ri]s prev5t+ ! collection1 collation1 & dissem9ation ( ,/ate mat]nity c>e data2 7xii7 ! effectiv5ess ( data collection & report+ processes 9 sep>at+ pregnancy-associat$ dea?s f pregnancy-relat$ dea?s2 & 7xiii7 ! curr5t ,f$]al1 ,/ate1 local1 & ,tribal fund+ support = ! activities ref]r$ to 9 clauses 7i7 ?r\gh 7xii74 7,b7 ,:e!r ! fund+ support ref]r$ to 9 subp>agraph 7,a77xiii7 is adequate = ,/ates to c>ry out optimal data collection & dissem9ation processes ) respect to mat]nal heal?1 mat]nal mortality1 & sev]e mat]nal morbidity4 7,c7 ,curr5t quality measures = mat]nity c>e1 includ+ pr5atal measures1 labor & deliv]y measures1 & po/p>tum measures1 includ+ topics su* z-- 7i7 effective quality measures = mat]nity c>e us$ by hospitals1 heal? sy/ems1 midwif]y practices1 bir? c5t]s1 heal? plans1 & o!r relevant entities2 7ii7 ! suffici5cy ( curr5t outcome measures us$ to evaluate mat]nity c>e = driv+ improv$ c>e1 exp]i5ces1 & outcomes 9 mat]nity c>e paym5t & deliv]y sy/em models2 7iii7 mat]nal heal? quality measures t o!r c\ntries effectively use2 7iv7 validat$ measures t h be5 us$ = rese>* purposes t c\ld be te/$1 ref9$1 & submitt$ = national endorsem5t2 7v7 b>ri]s prev5t+ mat]nity c>e provid]s & insur]s f implem5t+ quality measures t are align$ ) be/ practices2 7vi7 ! frequ5cy ) :i* mat]nity c>e quality measures are review$ & revis$2 7vii7 ! /r5g?s & weaknesses ( ! ,pr5atal & ,po/p>tum ,c>e measures ( ! ,heal? ,plan ,employ] ,data & ,in=mation ,set measures e/abli%$ by ! ,national ,committee = ,quality ,assurance2 7viii7 ! /r5g?s & weaknesses ( mat]nity c>e quality measures "u ! ,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 seq471 includ+ ! ext5t to :i* ,/ates volunt>ily report relevant measures2 7ix7 ! ext5t to :i* mat]nity c>e quality measures are in=m$ by pati5t exp]i5ces t include measures ( pati5t-report$ exp]i5ce ( c>e2 7x7 ! curr5t processes = collect+ /ratifi$ data on ! race & e?nicity ( pregnant & po/p>tum individuals 9 hospitals1 heal? sy/ems1 midwif]y practices1 & bir? c5t]s1 & = incorporat+ su* racially & e?nically /ratifi$ data 9 mat]nity c>e quality measures2 7xi7 ! ext5t to :i* mat]nity c>e quality measures acc\nt = ! unique exp]i5ces ( pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps2 & 7xii7 ! ext5t to :i* hospitals1 heal? sy/ems1 midwif]y practices1 & bir? c5t]s are implem5t+ exi/+ mat]nity c>e quality measures4 7,d7 ,recomm5dations on au?oriz+ additional funds & provid+ additional te*nical assi/ance to improve mat]nal mortality review committees & ,/ate & ,tribal mat]nal heal? data collection & report+ processes4 7,e7 ,recomm5dations = new au?orities t may be grant$ to mat]nal mortality review committees to be able to-- 7i7 access records f o!r ,f$]al & ,/ate ag5cies & dep>tm5ts t may be necess>y to id5tify causes ( pregnancy-associat$ & pregnancy-relat$ dea?s t are unique to pregnant & po/p>tum individuals f specific populations1 su* z vet]ans & individuals :o are inc>c]at$2 & 7ii7 "w ) relevant exp]ts :o are n memb]s ( ! mat]nal mortality review committee to assi/ 9 ! review ( pregnancy-associat$ dea?s ( pregnant & po/p>tum individuals f specific populations1 su* z vet]ans & individuals :o are inc>c]at$4 7,f7 ,recomm5dations to improve & /&>dize curr5t quality measures = mat]nity c>e1 ) a p>ticul> focus on racial & e?nic inequities 9 mat]nal heal? outcomes4 7,g7 ,recomm5dations to improve ! coord9ation by ! ,dep>tm5t ( ,heal? & ,human ,s]vices ( ! ef=ts und]tak5 by ! ag5cies & organizations )9 ! ,dep>tm5t relat$ to mat]nal heal? data & quality measures4 7#d7 ,report ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ! ,congress1 & make publicly available1 a report on ! results ( ! review ( mat]nal heal? data collection processes & quality measures & recomm5dations to improve su* processes & measures requir$ "u p>agraph 7#a74 7#e7 ,def9itions ,9 ?is subsection3 7,a7 ,mat]nal mortality review committee ,! t]m mat]nal mortality review committee means a mat]nal mortality review committee duly au?oriz$ by a ,/ate & receiv+ fund+ "u section #cag,k7a77#b77;,d7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;a77#b77;,d774 7,b7 ,pregnancy-associat$ dea? ,! t]m pregnancy-associat$1 ) respect to a dea?1 means a dea? ( a pregnant or po/p>tum individual1 by any cause1 t occurs dur+1 or )9 #a ye> foll[+1 ! individual's pregnancy1 reg>dless ( ! outcome1 duration1 or site ( ! pregnancy4 7,c7 ,pregnancy-relat$ dea? ,! t]m pregnancy-relat$1 ) respect to a dea?1 means a dea? ( a pregnant or po/p>tum individual t occurs dur+1 or )9 #a ye> foll[+1 ! individual's pregnancy1 f a pregnancy complication1 a *a9 ( ev5ts initiat$ by pregnancy1 or ! aggravation ( an unrelat$ condition by ! physiologic effects ( pregnancy4 7#f7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ su* sums z may be necess>y to c>ry out ?is subsection = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 7e7 ,indian ,heal? ,s]vice /udy on mat]nal mortality & sev]e mat]nal morbidity 7#a7 ,9 g5]al ,! ,director ( ! ,indian ,heal? ,s]vice 7ref]r$ to 9 ?is subsection z ! ,director7 %all1 9 coord9ation ) entities describ$ 9 p>agraph 7#b7-- 7,a7 n lat] ?an #ij days aft] ! date ( enactm5t ( ?is ,act1 ent] into a contract ) an indep5d5t rese>* organization or ,tribal ,epidemiology ,c5t] to conduct a compreh5sive /udy on mat]nal mortality & sev]e mat]nal morbidity 9 ! populations ( ,am]ican ,indian & ,alaska ,native individuals2 & 7,b7 n lat] ?an #c ye>s aft] ! date ( ! enactm5t ( ?is ,act1 submit to ,congress a report on su* /udy t conta9s recomm5dations = policies & practices t c be adopt$ to improve mat]nal heal? outcomes = pregnant & po/p>tum ,am]ican ,indian & ,alaska ,native individuals4 7#b7 ,p>ticipat+ entities ,! entities describ$ 9 ?is p>agraph %all consi/ ( #ab memb]s1 select$ by ! ,director f among individuals nom9at$ by ,indian ,tribes & ,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 & ,urban ,indian organizations 7z su* t]m is def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc774 ,9 select+ su* memb]s1 ! ,director %all ensure t ea* ( ! #ab s]vice areas ( ! ,indian ,heal? ,s]vice is repres5t$4 7#c7 ,cont5ts ( /udy ,! /udy conduct$ pursuant to p>agraph 7#a7 %all-- 7,a7 exam9e ! causes ( mat]nal mortality & sev]e mat]nal morbidity t are unique to ,am]ican ,indian & ,alaska ,native individuals2 7,b7 include a sy/ematic process ( li/5+ to ! /ories ( ,am]ican ,indian & ,alaska ,native pregnant & po/p>tum individuals to fully und]/& ! causes (1 & in=m pot5tial solutions to1 ! mat]nal mortality & sev]e mat]nal morbidity crisis )9 _! respective communities2 7,c7 di/+ui% betwe5 ! causes (1 l&scape ( mat]nity c>e at1 & recomm5dations to improve mat]nal heal? outcomes )91 ! diff]5t sett+s 9 :i* ,am]ican ,indian & ,alaska ,native pregnant & po/p>tum individuals receive mat]nity c>e1 su* z-- 7i7 facilities op]at$ by ! ,indian ,heal? ,s]vice2 7ii7 an ,indian heal? program op]at$ by an ,indian ,tribe or ,tribal organization pursuant to a contract1 grant1 coop]ative agreem5t1 or compact ) ! ,indian ,heal? ,s]vice pursuant to ! ,indian ,self-,det]m9ation ,act2 & 7iii7 an ,urban ,indian heal? program op]at$ by an ,urban ,indian organization pursuant to a grant or contract ) ! ,indian ,heal? ,s]vice pursuant to title ,v ( ! ,indian ,heal? ,c>e ,improvem5t ,act2 7,d7 review processes = coord9at+ programs ( ! ,indian ,heal? ,s]vice ) social s]vices provid$ ?r\gh o!r programs adm9i/]$ by ! ,secret>y ( ,heal? & ,human ,s]vices 7o!r ?an ! ,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 & ! ,*ildr5's ,heal? ,insurance ,program "u title ,,xxi ( su* ,act 7#db ,u4,s4,c4 #acig;aa et seq4772 7,e7 review curr5t data collection & quality measurem5t processes & practices2 7,f7 assess causes & frequ5cy ( mat]nal m5tal heal? conditions & sub/ance use disord]s2 7,g7 consid] social det]m9ants ( heal?1 includ+ pov]ty1 lack ( heal? insurance1 unemploym5t1 sexual viol5ce1 & environm5tal conditions 9 ,tribal areas2 7,h7 consid] ! role t hi/orical mi/reatm5t ( ,am]ican ,indian & ,alaska ,native p has play$ 9 caus+ curr5tly high rates ( mat]nal mortality & sev]e mat]nal morbidity2 7,i7 consid] h[ curr5t fund+ ( ! ,indian ,heal? ,s]vice affects ! ability ( ! ,s]vice to deliv] quality mat]nity c>e2 7,j7 consid] ! ext5t to :i* ! deliv]y ( mat]nity c>e s]vices is culturally appropriate = ,am]ican ,indian & ,alaska ,native pregnant & po/p>tum individuals2 7,k7 make recomm5dations to r$uce misclassification ( ,am]ican ,indian & ,alaska ,native pregnant & po/p>tum individuals1 includ+ consid]ation ( be/ practices 9 tra9+ = mat]nal mortality review committee memb]s to be able to correctly classify ,am]ican ,indian & ,alaska ,native individuals2 & 7,l7 make recomm5dations in=m$ by ! /ories %>$ by ,am]ican ,indian & ,alaska ,native pregnant & po/p>tum individuals pursuant to subp>agraph 7,b7 to improve mat]nal heal? outcomes = su* individuals4 7#d7 ,report ,! agreem5t ent]$ into "u p>agraph 7#a7 ) an indep5d5t rese>* organization or ,tribal ,epidemiology ,c5t] %all require t ! organization or c5t] transmit to ,congress a report on ! results ( ! /udy conduct$ pursuant to t agreem5t n lat] ?an #cf mon?s aft] ! date ( ! enactm5t ( ?is ,act4 7#e7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is subsection #b1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbe4 7f7 ,grants to m9ority-,s]v+ in/itutions ,to /udy mat]nal mortality1 sev]e mat]nal morbidity1 & o!r adv]se mat]nal heal? outcomes 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices %all e/abli% a program "u :i* ! ,secret>y %all aw>d grants to rese>* c5t]s1 heal? pr(essions s*ools & programs1 & o!r entities at m9ority-s]v+ in/itutions to /udy specific aspects ( ! mat]nal heal? crisis among pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps4 ,su* rese>* may-- 7,a7 include ! developm5t & implem5tation ( sy/ematic processes ( li/5+ to ! /ories ( pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps1 & p]9atal heal? work]s support+ su* individuals1 to fully und]/& ! causes (1 & in=m pot5tial solutions to1 ! mat]nal mortality & sev]e mat]nal morbidity crisis )9 _! respective communities2 7,b7 assess ! pot5tial causes ( relatively l[ rates ( mat]nal mortality among ,hispanic individuals1 includ+ pot5tial racial misclassification & o!r data collection & report+ issues t might be misrepres5t+ mat]nal mortality rates among ,hispanic individuals 9 ! ,unit$ ,/ates2 & 7,c7 assess diff]5ces 9 rates ( adv]se mat]nal heal? outcomes among subgr\ps id5tify+ z ,hispanic4 7#b7 ,application ,to be eligible to receive a grant "u p>agraph 7#a71 an entity describ$ 9 su* p>agraph %all submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7#c7 ,te*nical assi/ance ,! ,secret>y may use n m ?an #aj p]c5t ( ! funds made available "u p>agraph 7#g7-- 7,a7 to conduct outrea* to m9ority-s]v+ in/itutions to raise aw>5ess ( ! availability ( grants "u p>agraph 7#a72 7,b7 to provide te*nical assi/ance 9 ! application process = su* a grant2 & 7,c7 to promote capacity build+1 z ne$$ to enable entities describ$ 9 su* p>agraph to submit su* an application4 7#d7 ,report+ requirem5t ,ea* entity aw>d$ a grant "u ?is subsection %all p]iodically submit to ! ,secret>y a report on ! /atus ( activities conduct$ us+ ! grant4 7#e7 ,evaluation ,beg9n+ "o ye> aft] ! date on :i* ! fir/ grant is aw>d$ "u ?is subsection1 ! ,secret>y %all submit to ,congress an annual report summ>iz+ ! f9d+s ( rese>* conduct$ us+ funds made available "u ?is subsection4 7#f7 ,m9ority-,s]v+ in/itutions def9$ ,9 ?is subsection1 ! t]m m9ority-s]v+ in/itution means an eligible in/itution describ$ 9 section #cga7;a7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajfgq7a774 7#g7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is subsection #aj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 7g7 ,def9itions ,9 ?is section3 7#a7 ,culturally congru5t ,! t]m culturally congru5t1 ) respect to c>e or mat]nity c>e1 means c>e t is 9 agreem5t ) ! pref]r$ cultural values1 beliefs1 worldview1 language1 & practices ( ! heal? c>e consum] & o!r /akehold]s4 7#b7 ,mat]nity c>e provid] ,! t]m mat]nity c>e provid] means a heal? c>e provid] :o-- 7,a7 is a physician1 physician assi/ant1 midwife :o meets at a m9imum ! int]national def9ition ( ! midwife & global /&>ds = midwif]y education z e/abli%$ by ! ,int]national ,conf$]ation ( ,midwives1 nurse practition]1 or cl9ical nurse speciali/2 & 7,b7 has a focus on mat]nal or p]9atal heal?4 7#c7 ,mat]nal mortality ,! t]m mat]nal mortality means a dea? occurr+ dur+ or )9 a "o-ye> p]iod aft] pregnancy1 caus$ by pregnancy-relat$ or *ildbir? complications1 includ+ a suicide1 ov]dose1 or o!r dea? result+ f a m5tal heal? or sub/ance use disord] attribut$ to or aggravat$ by pregnancy-relat$ or *ildbir? complications4 7#d7 ,p]9atal heal? work] ,! t]m p]9atal heal? work] means a d\la1 community heal? work]1 pe] support]1 brea/fe$+ & lactation educator or c\nselor1 nutritioni/ or dietitian1 *ildbir? educator1 social work]1 home visitor1 language int]pret]1 or navigator4 7#e7 ,po/p>tum & po/p>tum p]iod ,! t]ms po/p>tum & po/p>tum p]iod ref] to ! #a-ye> p]iod beg9n+ on ! la/ day ( ! pregnancy ( an individual4 7#f7 ,pregnancy-associat$ dea? ,! t]m pregnancy-associat$ dea? means a dea? ( a pregnant or po/p>tum individual1 by any cause1 t occurs dur+1 or )9 #a ye> foll[+1 ! individual's pregnancy1 reg>dless ( ! outcome1 duration1 or site ( ! pregnancy4 7#g7 ,pregnancy-relat$ dea? ,! t]m pregnancy-relat$ dea? means a dea? ( a pregnant or po/p>tum individual t occurs dur+1 or )9 #a ye> foll[+1 ! individual's pregnancy1 f a pregnancy complication1 a *a9 ( ev5ts initiat$ by pregnancy1 or ! aggravation ( an unrelat$ condition by ! physiologic effects ( pregnancy4 7#h7 ,racial & e?nic m9ority gr\p ,! t]m racial & e?nic m9ority gr\p has ! mean+ giv5 su* t]m 9 section #agjg7;g77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a774 7#i7 ,sev]e mat]nal morbidity ,! t]m sev]e mat]nal morbidity means a heal? condition1 includ+ m5tal heal? conditions & sub/ance use disord]s1 attribut$ to or aggravat$ by pregnancy or *ildbir? t results 9 significant %ort-t]m or long-t]m consequ5ces to ! heal? ( ! individual :o 0 pregnant4 7#aj7 ,social det]m9ants ( mat]nal heal? def9$ ,! t]m social det]m9ants ( mat]nal heal? means non-cl9ical factors t impact mat]nal heal? outcomes1 includ+-- 7,a7 economic factors1 :i* may include pov]ty1 employm5t1 food security1 support = & access to lactation & o!r infant fe$+ options1 h\s+ /ability1 & relat$ factors2 7,b7 neighborhood factors1 :i* may include quality ( h\s+1 access to transportation1 access to *ild c>e1 availability ( heal?y foods & nutrition c\nsel+1 availability ( clean wat]1 air & wat] quality1 ambi5t temp]atures1 neighborhood crime & viol5ce1 access to broadb&1 & relat$ factors2 7,c7 social & community factors1 :i* may include sy/emic racism1 g5d] discrim9ation or discrim9ation bas$ on o!r protect$ classes1 workplace conditions1 inc>c]ation1 & relat$ factors2 7,d7 h\sehold factors1 :i* may include ability to conduct lead te/+ & abatem5t1 c> seat in/allation1 indoor air temp]atures1 & relat$ factors2 7,e7 education access & quality factors1 :i* may include educational atta9m5t1 language & lit]acy1 & relat$ factors2 & 7,f7 heal? c>e access factors1 includ+ heal? insurance cov]age1 access to culturally congru5t heal? c>e s]vices1 provid]s1 & non-cl9ical support1 access to home visit+ s]vices1 access to wellness & /ress managem5t programs1 heal? lit]acy1 access to teleheal? & items requir$ to receive teleheal? s]vices1 & relat$ factors4 #ebji4 ,kira ,johnson ,act 7a7 ,inve/m5ts 9 community-,bas$ organizations ,to improve ,black mat]nal heal? outcomes 7#a7 ,aw>ds ,foll[+ ! #a-ye> p]iod describ$ 9 p>agraph 7#c71 ! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is subsection ref]r$ to z ! ,secret>y7 %all aw>d grants to eligible entities to e/abli% or exp& programs to prev5t mat]nal mortality & sev]e mat]nal morbidity among ,black pregnant & po/p>tum individuals4 7#b7 ,eligibility ,to be eligible to seek a grant "u ?is subsection1 an entity %all be a community-bas$ organization (f]+ programs & res\rces align$ ) evid5ce-bas$ practices = improv+ mat]nal heal? outcomes = ,black pregnant & po/p>tum individuals4 7#c7 ,outrea* & te*nical assi/ance p]iod ,dur+ ! #a-ye> p]iod beg9n+ on ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all-- 7,a7 conduct outrea* to enc\rage eligible entities to apply = grants "u ?is subsection2 & 7,b7 provide te*nical assi/ance to eligible entities on be/ practices = apply+ = grants "u ?is subsection4 7#d7 ,special consid]ation 7,a7 ,outrea* ,9 conduct+ outrea* "u p>agraph 7#c71 ! ,secret>y %all give special consid]ation to eligible entities t-- 7i7 are bas$ 91 & provide support =1 communities ) high rates ( adv]se mat]nal heal? outcomes or significant racial & e?nic inequities 9 mat]nal heal? outcomes1 to ! ext5t su* data are available2 7ii7 are l$ by ,black p2 & 7iii7 (f] programs & res\rces t are align$ ) evid5ce-bas$ practices = improv+ mat]nal heal? outcomes = ,black pregnant & po/p>tum individuals4 7,b7 ,aw>ds ,9 aw>d+ grants "u ?is subsection1 ! ,secret>y %all give special consid]ation to eligible entities t-- 7i7 are describ$ 9 clauses 7i71 7ii71 & 7iii7 ( subp>agraph 7,a72 7ii7 (f] programs & res\rces design$ 9 consultation ) & int5d$ = ,black pregnant & po/p>tum individuals2 & 7iii7 (f] programs & res\rces 9 ! communities 9 :i* ! respective eligible entities are locat$ t-- 7,i7 promote mat]nal m5tal heal? & mat]nal sub/ance use disord] treatm5ts & supports t are align$ ) evid5ce-bas$ practices = improv+ mat]nal m5tal & behavioral heal? outcomes = ,black pregnant & po/p>tum individuals2 7,,ii7 address social det]m9ants ( mat]nal heal? = pregnant & po/p>tum individuals2 7,,iii7 promote evid5ce-bas$ heal? lit]acy & pregnancy1 *ildbir?1 & p>5t+ education = pregnant & po/p>tum individuals2 7,,iv7 provide support f p]9atal heal? work]s to pregnant & po/p>tum individuals2 7,v7 provide culturally congru5t tra9+ to p]9atal heal? work]s2 7,,vi7 conduct or support rese>* on mat]nal heal? issues disproportionately impact+ ,black pregnant & po/p>tum individuals2 7,,vii7 provide support to family memb]s ( individuals :o suff]$ a pregnancy-associat$ dea? or pregnancy-relat$ dea?2 7,,viii7 op]ate midwif]y practices t provide culturally congru5t mat]nal heal? c>e & support1 includ+ = ! purposes (-- 7aa7 support+ additional education1 tra9+1 & c]tification programs1 includ+ support = di/ance le>n+2 7bb7 provid+ f9ancial support to curr5t & future midwives to address education co/s1 debts1 & o!r ne$s2 7cc7 cl9ical site inve/m5ts2 7dd7 support+ preceptor developm5t tra9+s2 7ee7 exp&+ ! midwif]y practice2 or 7ff7 relat$ ne$s id5tifi$ by ! midwif]y practice & describ$ 9 ! practice's application2 or 7,,ix7 h develop$ o!r programs & res\rces t address community-specific ne$s = pregnant & po/p>tum individuals & are align$ ) evid5ce-bas$ practices = improv+ mat]nal heal? outcomes = ,black pregnant & po/p>tum individuals4 7#e7 ,te*nical assi/ance ,! ,secret>y %all provide to grant recipi5ts "u ?is subsection te*nical assi/ance on-- 7,a7 capacity build+ to e/abli% or exp& programs to prev5t adv]se mat]nal heal? outcomes among ,black pregnant & po/p>tum individuals2 7,b7 be/ practices 9 data collection1 measurem5t1 evaluation1 & report+2 & 7,c7 plann+ = su/a9+ programs to prev5t mat]nal mortality & sev]e mat]nal morbidity among ,black pregnant & po/p>tum individuals aft] ! p]iod ( ! grant4 7#f7 ,evaluation ,n lat] ?an ! end ( fiscal ye> #bjbf1 ! ,secret>y %all submit to ! ,congress an evaluation ( ! grant program "u ?is subsection t-- 7,a7 assesses ! effectiv5ess ( outrea* ef=ts dur+ ! application process 9 div]sify+ ! pool ( grant recipi5ts2 7,b7 makes recomm5dations = future outrea* ef=ts to div]sify ! pool ( grant recipi5ts = ,dep>tm5t ( ,heal? & ,human ,s]vices grant programs & fund+ opportunities relat$ to mat]nal heal?2 7,c7 assesses ! effectiv5ess ( programs fund$ by grants "u ?is subsection 9 improv+ mat]nal heal? outcomes = ,black pregnant & po/p>tum individuals1 to ! ext5t practicable2 & 7,d7 makes recomm5dations = future ,dep>tm5t ( ,heal? & ,human ,s]vices grant programs & fund+ opportunities t deliv] fund+ to community-bas$ organizations t provide programs & res\rces t are align$ ) evid5ce-bas$ practices = improv+ mat]nal heal? outcomes = ,black pregnant & po/p>tum individuals4 7#g7 ,au?orization ( appropriations ,to c>ry out ?is subsection1 !re is au?oriz$ to be appropriat$ #aj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 7b7 ,inve/m5ts 9 community-,bas$ organizations ,to improve mat]nal heal? outcomes 9 und]s]v$ communities 7#a7 ,aw>ds ,foll[+ ! #a-ye> p]iod describ$ 9 p>agraph 7#c71 ! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is subsection ref]r$ to z ! ,secret>y7 %all aw>d grants to eligible entities to e/abli% or exp& programs to prev5t mat]nal mortality & sev]e mat]nal morbidity among und]s]v$ gr\ps4 7#b7 ,eligibility ,to be eligible to seek a grant "u ?is subsection1 an entity %all be a community-bas$ organization (f]+ programs & res\rces align$ ) evid5ce-bas$ practices = improv+ mat]nal heal? outcomes = pregnant & po/p>tum individuals4 7#c7 ,outrea* & te*nical assi/ance p]iod ,dur+ ! #a-ye> p]iod beg9n+ on ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all-- 7,a7 conduct outrea* to enc\rage eligible entities to apply = grants "u ?is subsection2 & 7,b7 provide te*nical assi/ance to eligible entities on be/ practices = apply+ = grants "u ?is subsection4 7#d7 ,special consid]ation 7,a7 ,outrea* ,9 conduct+ outrea* "u p>agraph 7#c71 ! ,secret>y %all give special consid]ation to eligible entities t-- 7i7 are bas$ 91 & provide support =1 communities ) high rates ( adv]se mat]nal heal? outcomes or significant racial & e?nic inequities 9 mat]nal heal? outcomes1 to ! ext5t su* data are available2 7ii7 are l$ by individuals f racially1 e?nically1 & geographically div]se backgr\nds2 & 7iii7 (f] programs & res\rces t are align$ ) evid5ce-bas$ practices = improv+ mat]nal heal? outcomes = pregnant & po/p>tum individuals4 7,b7 ,aw>ds ,9 aw>d+ grants "u ?is subsection1 ! ,secret>y %all give special consid]ation to eligible entities t-- 7i7 are describ$ 9 clauses 7i71 7ii71 & 7iii7 ( subp>agraph 7,a72 7ii7 (f] programs & res\rces design$ 9 consultation ) & int5d$ = pregnant & po/p>tum individuals f und]s]v$ gr\ps2 & 7iii7 (f] programs & res\rces 9 ! communities 9 :i* ! respective eligible entities are locat$ t-- 7,i7 promote mat]nal m5tal heal? & mat]nal sub/ance use disord] treatm5ts & support t are align$ ) evid5ce-bas$ practices = improv+ mat]nal m5tal & behavioral heal? outcomes = pregnant & po/p>tum individuals2 7,,ii7 address social det]m9ants ( mat]nal heal? = pregnant & po/p>tum individuals2 7,,iii7 promote evid5ce-bas$ heal? lit]acy & pregnancy1 *ildbir?1 & p>5t+ education = pregnant & po/p>tum individuals2 7,,iv7 provide support f p]9atal heal? work]s to pregnant & po/p>tum individuals2 7,v7 provide culturally congru5t tra9+ to p]9atal heal? work]s2 7,,vi7 conduct or support rese>* on mat]nal heal? outcomes & inequities2 7,,vii7 provide support to family memb]s ( individuals :o suff]$ a pregnancy-associat$ dea? or pregnancy-relat$ dea?2 or 7,,viii7 op]ate midwif]y practices t provide culturally congru5t mat]nal heal? c>e & support1 includ+ = ! purposes (-- 7aa7 support+ additional education1 tra9+1 & c]tification programs1 includ+ support = di/ance le>n+2 7bb7 provid+ f9ancial support to curr5t & future midwives to address education co/s1 debts1 & o!r ne$s2 7cc7 cl9ical site inve/m5ts2 7dd7 support+ preceptor developm5t tra9+s2 7ee7 exp&+ ! midwif]y practice2 or 7ff7 relat$ ne$s id5tifi$ by ! midwif]y practice & describ$ 9 ! practice's application2 or 7iv7 h develop$ o!r programs & res\rces t address community-specific ne$s = pregnant & po/p>tum individuals & are align$ ) evid5ce-bas$ practices = improv+ mat]nal heal? outcomes = pregnant & po/p>tum individuals4 7#e7 ,te*nical assi/ance ,! ,secret>y %all provide to grant recipi5ts "u ?is subsection te*nical assi/ance on-- 7,a7 capacity build+ to e/abli% or exp& programs to prev5t adv]se mat]nal heal? outcomes among pregnant & po/p>tum individuals f und]s]v$ gr\ps2 7,b7 be/ practices 9 data collection1 measurem5t1 evaluation1 & report+2 & 7,c7 plann+ = su/a9+ programs to prev5t mat]nal mortality & sev]e mat]nal morbidity among pregnant & po/p>tum individuals f und]s]v$ gr\ps aft] ! p]iod ( ! grant4 7#f7 ,evaluation ,n lat] ?an ! end ( fiscal ye> #bjbf1 ! ,secret>y %all submit to ! ,congress an evaluation ( ! grant program "u ?is subsection t-- 7,a7 assesses ! effectiv5ess ( outrea* ef=ts dur+ ! application process 9 div]sify+ ! pool ( grant recipi5ts2 7,b7 makes recomm5dations = future outrea* ef=ts to div]sify ! pool ( grant recipi5ts = ,dep>tm5t ( ,heal? & ,human ,s]vices grant programs & fund+ opportunities relat$ to mat]nal heal?2 7,c7 assesses ! effectiv5ess ( programs fund$ by grants "u ?is subsection 9 improv+ mat]nal heal? outcomes = pregnant & po/p>tum individuals f und]s]v$ gr\ps1 to ! ext5t practicable2 & 7,d7 makes recomm5dations = future ,dep>tm5t ( ,heal? & ,human ,s]vices grant programs & fund+ opportunities t deliv] fund+ to community-bas$ organizations t provide programs & res\rces t are align$ ) evid5ce-bas$ practices = improv+ mat]nal heal? outcomes = pregnant & po/p>tum individuals4 7#g7 ,def9ition ,9 ?is subsection1 ! t]m und]s]v$ gr\ps ref]s to pregnant & po/p>tum individuals-- 7,a7 f racial & e?nic m9ority gr\ps2 7,b7 ^: h\sehold income is equal to or less ?an #aej p]c5t ( ! ,f$]al pov]ty l9e2 7,c7 :o live 9 heal? pr(essional %ortage areas 7z su* t]m is def9$ 9 section #ccb ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;e772 7,d7 :o live 9 c\nties ) no hospital (f]+ ob/etric c>e1 no bir? c5t]1 & no ob/etric provid]2 or 7,e7 :o live 9 c\nties ) a level ( vuln]ability ( mod]ate-to-high or high]1 accord+ to ! ,social ,vuln]ability ,index ( ! ,c5t]s = ,disease ,control & ,prev5tion4 7#h7 ,au?orization ( appropriations ,to c>ry out ?is subsection1 !re is au?oriz$ to be appropriat$ #aj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 7c7 ,respectful mat]nity c>e tra9+ = all employees 9 mat]nity c>e sett+s ,"p ,b ( title ,,vii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bic et seq471 z am5d$ by section #cjjb1 is fur!r am5d$ by add+ at ! end ! foll[+ new section3 #gdc4 ,respectful mat]nity c>e tra9+ = all employees 9 mat]nity c>e sett+s 7a7 ,grants ,! ,secret>y %all aw>d grants = programs to r$uce & prev5t bias1 racism1 & discrim9ation 9 mat]nity c>e sett+s & to advance respectful1 culturally congru5t1 trauma-in=m$ c>e4 7b7 ,special consid]ation ,9 aw>d+ grants "u subsection 7a71 ! ,secret>y %all give special consid]ation to applications = programs t w\ld-- 7#a7 apply to all mat]nity c>e provid]s & any employees :o int]act ) pregnant & po/p>tum individuals 9 ! provid] sett+1 includ+ front desk employees1 sonograph]s1 s*$ul]s1 heal? c>e pr(essionals1 hospital or heal? sy/em adm9i/rators1 security /aff1 & o!r employees2 7#b7 emphasize p]iodic1 z oppos$ to "o-"t1 tra9+s = all bir?+ pr(essionals & employees describ$ 9 p>agraph 7#a72 7#c7 address implicit bias1 racism1 & cultural humility2 7#d7 be deliv]$ 9 ongo+ education sett+s = provid]s ma9ta9+ _! lic5ses1 ) a pref]5ce = tra9+s t provide cont9u+ education units2 7#e7 include trauma-in=m$ c>e be/ practices & an emphasis on %>$ decision mak+ betwe5 provid]s & pati5ts2 7#f7 include antiracism tra9+ & programs2 7#g7 be deliv]$ 9 und]graduate programs t funnel into heal? pr(essions s*ools2 7#h7 be deliv]$ 9 sett+s t apply to provid]s ( ! special supplem5tal nutrition program = wom51 infants1 & *ildr5 "u section #ag ( ! ,*ild ,nutrition ,act ( #aiff2 7#i7 integrate bias tra9+ 9 ob/etric em]g5cy simulation tra9+s or relat$ tra9+s2 7#aj7 include tra9+ = em]g5cy dep>tm5t employees & em]g5cy m$ical te*nicians on recogniz+ w>n+ signs = sev]e pregnancy-relat$ complications2 7#aa7 (f] tra9+ to all mat]nity c>e provid]s on ! value ( racially1 e?nically1 & pr(essionally div]se mat]nity c>e teams to provide culturally congru5t c>e2 or 7#ab7 be bas$ on "o or m programs design$ by a hi/orically ,black college or univ]sity or o!r m9ority-s]v+ in/itution4 7c7 ,application ,to seek a grant "u subsection 7a71 an entity %all submit an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7d7 ,report+ to ,secret>y ,ea* recipi5t ( a grant "u ?is section %all annually submit to ! ,secret>y a report on ! /atus ( activities conduct$ us+ ! grant1 includ+1 z applicable1 a description ( ! impact ( tra9+ provid$ ?r\gh ! grant on pati5t outcomes & pati5t exp]i5ce = pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps & _! families4 7e7 ,dissem9ation ( f9d+s ,bas$ on ! annual reports submitt$ pursuant to subsection 7d71 ! ,secret>y-- 7#a7 %all produce an annual report on ! f9d+s result+ f programs fund$ ?r\gh ?is section2 7#b7 %all dissem9ate su* report to all recipi5ts ( grants "u ?is section & to ! public2 & 7#c7 may include 9 su* report f9d+s on be/ practices = improv+ pati5t outcomes & pati5t exp]i5ce = pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps & _! families 9 mat]nity c>e sett+s4 7f7 ,def9itions ,9 ?is section3 7#a7 ,! t]m po/p>tum means ! "o-ye> p]iod beg9n+ on ! la/ day ( an individual's pregnancy4 7#b7 ,! t]m culturally congru5t means 9 agreem5t ) ! pref]r$ cultural values1 beliefs1 _w view1 language1 & practices ( ! heal? c>e consum] & o!r /akehold]s4 7#c7 ,! t]m mat]nity c>e provid] means a heal? c>e provid] :o-- 7,a7 is a physician1 physician assi/ant1 midwife :o meets at a m9imum ! int]national def9ition ( ! midwife & global /&>ds = midwif]y education z e/abli%$ by ! ,int]national ,conf$]ation ( ,midwives1 nurse practition]1 or cl9ical nurse speciali/2 & 7,b7 has a focus on mat]nal or p]9atal heal?4 7#d7 ,! t]m racial & e?nic m9ority gr\p has ! mean+ giv5 su* t]m 9 section #agjg7;g77#a74 7g7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re is au?oriz$ to be appropriat$ #e1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 4 7d7 ,/udy on r$uc+ & prev5t+ bias1 racism1 & discrim9ation 9 mat]nity c>e sett+s 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices %all seek to ent] into an agreem5t1 n lat] ?an #ij days aft] ! date ( enactm5t ( ?is ,act1 ) ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e 7ref]r$ to 9 ?is subsection z ! ,national ,academies7 "u :i* ! ,national ,academies agree to-- 7,a7 conduct a /udy on ! design & implem5tation ( programs to r$uce & prev5t bias1 racism1 & discrim9ation 9 mat]nity c>e sett+s & to advance respectful1 culturally congru5t1 trauma-in=m$ c>e2 & 7,b7 n lat] ?an #bd mon?s aft] ! date ( ! enactm5t ( ?is ,act-- 7i7 complete ! /udy2 & 7ii7 transmit a report on ! results ( ! /udy to ! ,congress4 7#b7 ,possible topics ,! agreem5t ent]$ into pursuant to p>agraph 7#a7 may provide = ! /udy ( any ( ! foll[+3 7,a7 ,! developm5t ( a scorec>d or o!r evaluation /&>ds = programs design$ to r$uce & prev5t bias1 racism1 & discrim9ation 9 mat]nity c>e sett+s to assess ! effectiv5ess ( su* programs 9 improv+ pati5t outcomes & pati5t exp]i5ce = pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps & _! families4 7,b7 ,det]m9ation ( ! types & frequ5cy ( tra9+ to r$uce & prev5t bias1 racism1 & discrim9ation 9 mat]nity c>e sett+s t are demon/rat$ to improve pati5t outcomes or pati5t exp]i5ce = pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps & _! families4 7e7 ,respectful mat]nity c>e compliance program 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is subsection z ! ,secret>y7 %all aw>d grants to accr$it$ hospitals1 heal? sy/ems1 & o!r mat]nity c>e sett+s to e/abli% z an integral "p ( quality implem5tation initiatives )9 "o or m hospitals or o!r bir? sett+s a respectful mat]nity c>e compliance program4 7#b7 ,program requirem5ts ,a respectful mat]nity c>e compliance program fund$ ?r\gh a grant "u ?is subsection %all-- 7,a7 in/itutionalize me*anisms to all[ pati5ts receiv+ mat]nity c>e s]vices1 ! families ( su* pati5ts1 or p]9atal heal? work]s support+ su* pati5ts to report in/ances ( racism or evid5ce ( bias on ! basis ( race1 e?nicity1 or ano!r protect$ class2 7,b7 in/itutionalize response me*anisms ?r\gh :i* repres5tatives ( ! program c directly foll[ up ) ! pati5t1 if possible1 & ! pati5t's family 9 a timely mann]2 7,c7 prep>e1 & make publicly available1 a hospital- or heal? sy/em-wide /rategy to r$uce bias on ! basis ( race1 e?nicity1 or ano!r protect$ class 9 ! deliv]y ( mat]nity c>e t includes-- 7i7 in=mation on ! tra9+ programs to r$uce & prev5t bias1 racism1 & discrim9ation on ! basis ( race1 e?nicity1 or ano!r protect$ class = all employees 9 mat]nity c>e sett+s2 7ii7 in=mation on ! numb] ( cases report$ to ! compliance program2 & 7iii7 ! developm5t ( me?ods to r\t9ely assess ! ext5t to :i* bias1 racism1 or discrim9ation on ! basis ( race1 e?nicity1 or ano!r protect$ class are pres5t 9 ! deliv]y ( mat]nity c>e to pati5ts f racial & e?nic m9ority gr\ps2 7,d7 develop me*anisms to r\t9ely collect & publicly report hospital-level data relat$ to pati5t-report$ exp]i5ce ( c>e2 & 7,e7 provide annual reports to ! ,secret>y ) in=mation ab\t ea* case report$ to ! compliance program ov] ! c\rse ( ! ye> conta9+ su* in=mation z ! ,secret>y may require1 su* z-- 7i7 de-id5tifi$ demographic in=mation on ! pati5t 9 ! case1 su* z race1 e?nicity1 g5d] id5tity1 & prim>y language2 7ii7 ! cont5t ( ! report f ! pati5t or ! family ( ! pati5t to ! compliance program2 7iii7 ! response f ! compliance program2 & 7iv7 to ! ext5t applicable1 in/itutional *anges made z a result ( ! case4 7#c7 ,secret>y requirem5ts 7,a7 ,processes ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all e/abli% processes =-- 7i7 dissem9at+ be/ practices = e/abli%+ & implem5t+ a respectful mat]nity c>e compliance program )9 a hospital or o!r bir? sett+2 7ii7 promot+ coord9ation & collaboration betwe5 hospitals1 heal? sy/ems1 & o!r mat]nity c>e deliv]y sett+s on ! e/abli%m5t & implem5tation ( respectful mat]nity c>e compliance programs2 & 7iii7 evaluat+ ! effectiv5ess ( respectful mat]nity c>e compliance programs on mat]nal heal? outcomes & pati5t & family exp]i5ces1 especially = pati5ts f racial & e?nic m9ority gr\ps & _! families4 7,b7 ,/udy 7i7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all1 ?r\gh a contract ) an indep5d5t rese>* organization1 conduct a /udy on /rategies to address-- 7,i7 racism or bias on ! basis ( race1 e?nicity1 or ano!r protect$ class 9 ! deliv]y ( mat]nity c>e s]vices2 & 7,,ii7 successful implem5tation ( respectful c>e initiatives4 7ii7 ,compon5ts ( /udy ,! /udy %all include ! foll[+3 7,i7 ,an assessm5t ( ! reports submitt$ to ! ,secret>y f ! respectful mat]nity c>e compliance programs pursuant to p>agraph 7#b77;,e74 7,,ii7 ,bas$ on su* assessm5t1 recomm5dations = pot5tial acc\ntability me*anisms relat$ to cases ( racism or bias on ! basis ( race1 e?nicity1 or ano!r protect$ class 9 ! deliv]y ( mat]nity c>e s]vices at hospitals & o!r bir? sett+s4 ,su* recomm5dations %all take into consid]ation m$ical & non-m$ical factors t contribute to adv]se pati5t exp]i5ces & mat]nal heal? outcomes4 7iii7 ,report ,! ,secret>y %all submit to ! ,congress1 & make publicly available1 a report on ! results ( ! /udy "u ?is subp>agraph4 7#d7 ,au?orization ( appropriations ,to c>ry out ?is subsection1 !re is au?oriz$ to be appropriat$ su* sums z may be necess>y = fiscal ye>s #bjbc ?r\gh #bjbh4 7f7 ,,gao report 7#a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act & annually !reaft]1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ! ,congress1 & make publicly available1 a report on ! e/abli%m5t ( respectful mat]nity c>e compliance programs )9 hospitals1 heal? sy/ems1 & o!r mat]nity c>e sett+s4 7#b7 ,matt]s includ$ ,! report "u p>agraph 7#a7 %all include ! foll[+3 7,a7 ,in=mation reg>d+ ! ext5t to :i* hospitals1 heal? sy/ems1 & o!r mat]nity c>e sett+s h elect$ to e/abli% respectful mat]nity c>e compliance programs1 includ+-- 7i7 :i* hospitals & o!r bir? sett+s elect to e/abli% compliance programs & :5 su* programs are e/abli%$2 7ii7 to ! ext5t practicable1 impacts ( ! e/abli%m5t ( su* programs on mat]nal heal? outcomes & pati5t & family exp]i5ces 9 ! hospitals & o!r bir? sett+s t h e/abli%$ su* programs1 especially = pati5ts f racial & e?nic m9ority gr\ps & _! families2 7iii7 in=mation on geographic areas1 & types ( hospitals or o!r bir? sett+s1 :]e respectful mat]nity c>e compliance programs are n be+ e/abli%$ & in=mation on factors contribut+ to decisions to n e/abli% su* programs2 & 7iv7 recomm5dations = e/abli%+ respectful mat]nity c>e compliance programs 9 geographic areas1 & types ( hospitals or o!r bir? sett+s1 :]e su* programs are n be+ e/abli%$4 7,b7 ,:e!r ! fund+ made available to c>ry out ?is subsection has be5 suffici5t &1 if applicable1 recomm5dations = additional appropriations to c>ry out ?is subsection4 7,c7 ,su* o!r in=mation z ! ,comptroll] ,g5]al det]m9es appropriate4 7g7 ,def9itions ,9 ?is section3 7#a7 ,culturally congru5t ,! t]m culturally congru5t1 ) respect to c>e or mat]nity c>e1 means c>e t is 9 agreem5t ) ! pref]r$ cultural values1 beliefs1 worldview1 language1 & practices ( ! heal? c>e consum] & o!r /akehold]s4 7#b7 ,mat]nity c>e provid] ,! t]m mat]nity c>e provid] means a heal? c>e provid] :o-- 7,a7 is a physician1 physician assi/ant1 midwife :o meets at a m9imum ! int]national def9ition ( ! midwife & global /&>ds = midwif]y education z e/abli%$ by ! ,int]national ,conf$]ation ( ,midwives1 nurse practition]1 or cl9ical nurse speciali/2 & 7,b7 has a focus on mat]nal or p]9atal heal?4 7#c7 ,mat]nal mortality ,! t]m mat]nal mortality means a dea? occurr+ dur+ or )9 a "o-ye> p]iod aft] pregnancy1 caus$ by pregnancy-relat$ or *ildbir? complications1 includ+ a suicide1 ov]dose1 or o!r dea? result+ f a m5tal heal? or sub/ance use disord] attribut$ to or aggravat$ by pregnancy-relat$ or *ildbir? complications4 7#d7 ,p]9atal heal? work] ,! t]m p]9atal heal? work] means a d\la1 community heal? work]1 pe] support]1 brea/fe$+ & lactation educator or c\nselor1 nutritioni/ or dietitian1 *ildbir? educator1 social work]1 home visitor1 language int]pret]1 or navigator4 7#e7 ,po/p>tum & po/p>tum p]iod ,! t]ms po/p>tum & po/p>tum p]iod ref] to ! #a-ye> p]iod beg9n+ on ! la/ day ( ! pregnancy ( an individual4 7#f7 ,pregnancy-associat$ dea? ,! t]m pregnancy-associat$ dea? means a dea? ( a pregnant or po/p>tum individual1 by any cause1 t occurs dur+1 or )9 #a ye> foll[+1 ! individual's pregnancy1 reg>dless ( ! outcome1 duration1 or site ( ! pregnancy4 7#g7 ,pregnancy-relat$ dea? ,! t]m pregnancy-relat$ dea? means a dea? ( a pregnant or po/p>tum individual t occurs dur+1 or )9 #a ye> foll[+1 ! individual's pregnancy1 f a pregnancy complication1 a *a9 ( ev5ts initiat$ by pregnancy1 or ! aggravation ( an unrelat$ condition by ! physiologic effects ( pregnancy4 7#h7 ,racial & e?nic m9ority gr\p ,! t]m racial & e?nic m9ority gr\p has ! mean+ giv5 su* t]m 9 section #agjg7;g77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a774 7#i7 ,sev]e mat]nal morbidity ,! t]m sev]e mat]nal morbidity means a heal? condition1 includ+ m5tal heal? conditions & sub/ance use disord]s1 attribut$ to or aggravat$ by pregnancy or *ildbir? t results 9 significant %ort-t]m or long-t]m consequ5ces to ! heal? ( ! individual :o 0 pregnant4 7#aj7 ,social det]m9ants ( mat]nal heal? def9$ ,! t]m social det]m9ants ( mat]nal heal? means non-cl9ical factors t impact mat]nal heal? outcomes1 includ+-- 7,a7 economic factors1 :i* may include pov]ty1 employm5t1 food security1 support = & access to lactation & o!r infant fe$+ options1 h\s+ /ability1 & relat$ factors2 7,b7 neighborhood factors1 :i* may include quality ( h\s+1 access to transportation1 access to *ild c>e1 availability ( heal?y foods & nutrition c\nsel+1 availability ( clean wat]1 air & wat] quality1 ambi5t temp]atures1 neighborhood crime & viol5ce1 access to broadb&1 & relat$ factors2 7,c7 social & community factors1 :i* may include sy/emic racism1 g5d] discrim9ation or discrim9ation bas$ on o!r protect$ classes1 workplace conditions1 inc>c]ation1 & relat$ factors2 7,d7 h\sehold factors1 :i* may include ability to conduct lead te/+ & abatem5t1 c> seat in/allation1 indoor air temp]atures1 & relat$ factors2 7,e7 education access & quality factors1 :i* may include educational atta9m5t1 language & lit]acy1 & relat$ factors2 & 7,f7 heal? c>e access factors1 includ+ heal? insurance cov]age1 access to culturally congru5t heal? c>e s]vices1 provid]s1 & non-cl9ical support1 access to home visit+ s]vices1 access to wellness & /ress managem5t programs1 heal? lit]acy1 access to teleheal? & items requir$ to receive teleheal? s]vices1 & relat$ factors4 #ebaj4 ,moms matt] 7a7 ,mat]nal m5tal heal? equity grant program 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use1 %all e/abli% a program to aw>d grants to eligible entities to address mat]nal m5tal heal? conditions & sub/ance use disord]s ) respect to pregnant & po/p>tum individuals1 ) a focus on racial & e?nic m9ority gr\ps4 7#b7 ,application ,to be eligible to receive a grant "u ?is subsection1 an eligible entity %all submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may provide1 includ+ h[ su* entity w use funds = activities describ$ 9 p>agraph 7#d7 t are culturally congru5t4 7#c7 ,priority ,9 aw>d+ grants "u ?is subsection1 ! ,secret>y %all give priority to an eligible entity t-- 7,a7 is1 or w p>tn] )1 a community-bas$ organization to address mat]nal m5tal heal? conditions & sub/ance use disord]s describ$ 9 p>agraph 7#a72 7,b7 is op]at+ 9 an area ) high rates (-- 7i7 adv]se mat]nal heal? outcomes2 or 7ii7 significant racial or e?nic inequities 9 mat]nal heal? outcomes2 & 7,c7 is op]at+ 9 a heal? pr(essional %ortage area designat$ "u section #ccb ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;e74 7#d7 ,use ( funds ,an eligible entity t receives a grant "u ?is subsection %all use funds = ! foll[+3 7,a7 ,e/abli%+ or exp&+ mat]nity c>e programs to improve ! integration ( mat]nal heal? & behavioral heal? c>e s]vices into prim>y c>e sett+s :]e pregnant individuals regul>ly receive heal? c>e s]vices4 7,b7 ,e/abli%+ or exp&+ gr\p pr5atal c>e programs or po/p>tum c>e programs4 7,c7 ,exp&+ exi/+ programs t improve mat]nal m5tal & behavioral heal? dur+ ! pr5atal & po/p>tum p]iods1 ) a focus on individuals f racial & e?nic m9ority gr\ps4 7,d7 ,provid+ s]vices & support = pregnant & po/p>tum individuals ) mat]nal m5tal heal? conditions & sub/ance use disord]s1 includ+ ref]rals to addiction treatm5t c5t]s t (f] evid5ce-bas$ treatm5t options4 7,e7 ,address+ /igma associat$ ) mat]nal m5tal heal? conditions & sub/ance use disord]s1 ) a focus on racial & e?nic m9ority gr\ps4 7,f7 ,rais+ aw>5ess ( w>n+ signs ( mat]nal m5tal heal? conditions & sub/ance use disord]s1 ) a focus on pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps4 7,g7 ,e/abli%+ or exp&+ programs to prev5t suicide or self-h>m among pregnant & po/p>tum individuals4 7,h7 ,(f]+ evid5ce-align$ programs at free/&+ bir? c5t]s t provide mat]nal m5tal & behavioral heal? c>e education1 treatm5ts1 & s]vices1 & o!r s]vices = individuals ?r\gh\t ! pr5atal & po/p>tum p]iod4 7,i7 ,e/abli%+ or exp&+ programs to provide education & tra9+ to mat]nity c>e provid]s ) respect to-- 7i7 id5tify+ pot5tial w>n+ signs = mat]nal m5tal heal? conditions or sub/ance use disord]s 9 pregnant & po/p>tum individuals1 ) a focus on individuals f racial & e?nic m9ority gr\ps2 & 7ii7 9 ! case :]e su* provid]s id5tify su* w>n+ signs1 (f]+ ref]rals to m5tal & behavioral heal? c>e pr(essionals4 7,j7 ,develop+ a website1 or o!r s\rce1 t includes in=mation on heal? c>e provid]s :o treat mat]nal m5tal heal? conditions & sub/ance use disord]s4 7,k7 ,e/abli%+ or exp&+ programs 9 communities to improve coord9ation betwe5 mat]nity c>e provid]s & m5tal & behavioral heal? c>e provid]s :o treat mat]nal m5tal heal? conditions & sub/ance use disord]s1 includ+ ?r\gh ! use ( toll-free hotl9es4 7,l7 ,c>ry+ out o!r programs align$ ) evid5ce-bas$ practices = address+ mat]nal m5tal heal? conditions & sub/ance use disord]s = pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps4 7#e7 ,report+ 7,a7 ,eligible entities ,an eligible entity t receives a grant "u p>agraph 7#a7 %all submit annually to ! ,secret>y1 & make publicly available1 a report on ! activities conduct$ us+ funds receiv$ ?r\gh a grant "u ?is subsection4 ,su* reports %all include quantitative & qualitative evaluations ( su* activities1 includ+ ! exp]i5ce ( individuals :o receiv$ heal? c>e ?r\gh su* grant4 7,b7 ,secret>y ,n lat] ?an ! end ( fiscal ye> #bjbd1 ! ,secret>y %all submit to ,congress a report t includes-- 7i7 a summ>y ( ! reports receiv$ "u subp>agraph 7,a72 7ii7 an evaluation ( ! effectiv5ess ( grants aw>d$ "u ?is subsection2 7iii7 recomm5dations ) respect to exp&+ cov]age ( evid5ce-bas$ scre5+s & treatm5ts = mat]nal m5tal heal? conditions & sub/ance use disord]s2 & 7iv7 recomm5dations ) respect to ensur+ activities describ$ "u p>agraph 7#d7 cont9ue aft] ! end ( a grant p]iod4 7#f7 ,def9itions ,9 ?is subsection3 7,a7 ,culturally congru5t ,! t]m culturally congru5t1 ) respect to c>e or mat]nity c>e1 means c>e t is 9 agreem5t ) ! pref]r$ cultural values1 beliefs1 worldview1 language1 & practices ( ! heal? c>e consum] & o!r /akehold]s4 7,b7 ,eligible entity ,! t]m eligible entity means-- 7i7 a community-bas$ organization s]v+ pregnant & po/p>tum individuals1 includ+ su* organizations s]v+ individuals f racial & e?nic m9ority gr\ps & o!r und]s]v$ populations2 7ii7 a nonpr(it or pati5t advocacy organization ) exp]tise 9 mat]nal m5tal & behavioral heal?2 7iii7 a mat]nity c>e provid]2 7iv7 a m5tal or behavioral heal? c>e provid] :o treats mat]nal m5tal heal? conditions or sub/ance use disord]s2 7v7 a ,/ate or local gov]nm5tal entity1 includ+ a ,/ate or local public heal? dep>tm5t2 7vi7 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 #ecjd772 & 7vii7 an ,urban ,indian organization 7z su* t]m is def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc774 7,c7 ,free/&+ bir? c5t] ,! t]m free/&+ bir? c5t] has ! mean+ giv5 t t]m "u section #aije7l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7#a774 7,d7 ,mat]nity c>e provid] ,! t]m mat]nity c>e provid] means a heal? c>e provid] :o-- 7i7 is a physician1 physician assi/ant1 midwife :o meets at a m9imum ! int]national def9ition ( ! midwife & global /&>ds = midwif]y education z e/abli%$ by ! ,int]national ,conf$]ation ( ,midwives1 nurse practition]1 or cl9ical nurse speciali/2 & 7ii7 has a focus on mat]nal or p]9atal heal?4 7,e7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#g7 ,au?orization ( appropriations ,to c>ry out ?is subsection1 !re is au?oriz$ to be appropriat$ #be1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbf4 7b7 ,grants ,to gr[ & div]sify ! mat]nal m5tal & behavioral heal? c>e work=ce ,title ,,vii ( ! ,public ,heal? ,s]vice ,act is am5d$ by ins]t+ aft] section #geg ( su* ,act 7#db ,u4,s4,c4 #bid;f7 ! foll[+ new section3 #geh4 ,mat]nal m5tal & behavioral heal? c>e work=ce grants 7a7 ,9 g5]al ,! ,secret>y may aw>d grants to entities to e/abli% or exp& programs describ$ 9 subsection 7b7 to gr[ & div]sify ! mat]nal m5tal & behavioral heal? c>e work=ce4 7b7 ,use ( funds ,recipi5ts ( grants "u ?is section %all use ! grants to gr[ & div]sify ! mat]nal m5tal & behavioral heal? c>e work=ce by-- 7#a7 e/abli%+ s*ools or programs t provide education & tra9+ to individuals seek+ appropriate lic5s+ or c]tification z m5tal or behavioral heal? c>e provid]s :o w specialize 9 mat]nal m5tal heal? conditions or sub/ance use disord]s2 or 7#b7 exp&+ ! capacity ( exi/+ s*ools or programs describ$ 9 p>agraph 7#a71 = ! purposes ( increas+ ! numb] ( /ud5ts enroll$ 9 su* s*ools or programs1 includ+ by aw>d+ s*ol>%ips = /ud5ts4 7c7 ,prioritization ,9 aw>d+ grants "u ?is section1 ! ,secret>y %all give priority to any entity t-- 7#a7 has demon/rat$ a commitm5t to recruit+ & reta9+ /ud5ts & faculty f racial & e?nic m9ority gr\ps2 7#b7 has develop$ a /rategy to recruit & reta9 a div]se pool ( /ud5ts into ! mat]nal m5tal or behavioral heal? c>e work=ce program or s*ool support$ by funds receiv$ ?r\gh ! grant1 p>ticul>ly f racial & e?nic m9ority gr\ps & o!r und]s]v$ populations2 7#c7 has develop$ a /rategy to recruit & reta9 /ud5ts :o plan to practice 9 a heal? pr(essional %ortage area designat$ "u section #ccb2 7#d7 has develop$ a /rategy to recruit & reta9 /ud5ts :o plan to practice 9 an area ) significant racial & e?nic inequities 9 mat]nal heal? outcomes1 to ! ext5t practicable2 & 7#e7 includes 9 ! /&>d curriculum = all /ud5ts )9 ! mat]nal m5tal or behavioral heal? c>e work=ce program or s*ool a bias1 racism1 or discrim9ation tra9+ program t includes tra9+ on implicit bias & racism4 7d7 ,report+ ,z a condition on receipt ( a grant "u ?is section = a mat]nal m5tal or behavioral heal? c>e work=ce program or s*ool1 an entity %all agree to submit to ! ,secret>y an annual report on ! activities conduct$ ?r\gh ! grant1 includ+-- 7#a7 ! numb] & demographics ( /ud5ts p>ticipat+ 9 ! program or s*ool2 7#b7 ! ext5t to :i* /ud5ts 9 ! program or s*ool are ent]+ c>e]s 9-- 7,a7 heal? pr(essional %ortage areas designat$ "u section #ccb2 & 7,b7 areas ) significant racial & e?nic inequities 9 mat]nal heal? outcomes1 to ! ext5t su* data are available2 & 7#c7 :e!r ! program or s*ool has includ$ 9 ! /&>d curriculum = all /ud5ts a bias1 racism1 or discrim9ation tra9+ program t includes tra9+ on implicit bias & racism1 & if s ! effectiv5ess ( su* tra9+ program4 7e7 ,p]iod ( grants ,! p]iod ( a grant "u ?is section %all be up to #e ye>s4 7f7 ,application ,to seek a grant "u ?is section1 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+ any in=mation necess>y = prioritization "u subsection 7c74 7g7 ,te*nical assi/ance ,! ,secret>y %all provide1 directly or by contract1 te*nical assi/ance to entities seek+ or receiv+ a grant "u ?is section on ! developm5t1 use1 evaluation1 & po/-grant p]iod su/a9ability ( ! mat]nal m5tal or behavioral heal? c>e work=ce programs or s*ools propos$ to be1 or be+1 e/abli%$ or exp&$ ?r\gh ! grant4 7h7 ,report by ! ,secret>y ,n lat] ?an #d ye>s aft] ! date ( enactm5t ( ?is section1 ! ,secret>y %all prep>e & submit to ! ,congress1 & po/ on ! int]net website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 a report on ! effectiv5ess ( ! grant program "u ?is section at-- 7#a7 recruit+ /ud5ts f racial & e?nic m9ority gr\ps & o!r und]s]v$ populations2 7#b7 increas+ ! numb] ( m5tal or behavioral heal? c>e provid]s specializ+ 9 mat]nal m5tal heal? conditions or sub/ance use disord]s f racial & e?nic m9ority gr\ps & o!r und]s]v$ populations2 7#c7 increas+ ! numb] ( m5tal or behavioral heal? c>e provid]s specializ+ 9 mat]nal m5tal heal? conditions or sub/ance use disord]s work+ 9 heal? pr(essional %ortage areas designat$ "u section #ccb2 & 7#d7 increas+ ! numb] ( m5tal or behavioral heal? c>e provid]s specializ+ 9 mat]nal m5tal heal? conditions or sub/ance use disord]s work+ 9 areas ) significant racial & e?nic inequities 9 mat]nal heal? outcomes1 to ! ext5t su* data are available4 7i7 ,def9itions ,9 ?is section3 7#a7 ,racial & e?nic m9ority gr\p ,! t]m racial & e?nic m9ority gr\p has ! mean+ giv5 su* t]m 9 section #agjg7;g77#a74 7#b7 ,m5tal or behavioral heal? c>e provid] ,! t]m m5tal or behavioral heal? c>e provid] ref]s to a heal? c>e provid] 9 ! field ( m5tal & behavioral heal?1 includ+ sub/ance use disord]s1 act+ 9 accordance ) ,/ate law4 7j7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re is au?oriz$ to be appropriat$ #ae1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 4 #ebaa4 ,task=ce ,recomm5d+ ,improvem5ts = ,unaddress$ ,m5tal ,p]9atal ,po/p>tum ,heal? 7,,triumph7 = ,new ,moms ,"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,l-#a 7#db ,u4,s4,c4 #bdg;b-#ac;a7 ! foll[+3 #cag,l-#b4 ,task ,=ce on ,mat]nal ,m5tal ,heal? 7a7 ,e/abli%m5t ,n lat] ?an #ij days aft] ! date ( enactm5t ( ?is section1 ! ,secret>y %all e/abli% a task =ce1 to be kn[n z ! ,task ,=ce on ,mat]nal ,m5tal ,heal? 79 ?is section ref]r$ to z ! ,task ,=ce7 to id5tify1 evaluate1 & make recomm5dations to coord9ate & improve1 ,f$]al responses to mat]nal m5tal heal? conditions4 7b7 ,memb]%ip 7#a7 ,composition ,! ,task ,=ce %all be compos$ (-- 7,a7 ! ,assi/ant ,secret>y = ,heal? ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices 7or ! ,assi/ant ,secret>y's designee7 :o %all s]ve z ! ,*air ( ! ,task ,=ce2 7,b7 ! ,f$]al memb]s "u p>agraph 7#b72 & 7,c7 ! non-,f$]al memb]s "u p>agraph 7#c74 7#b7 ,f$]al memb]s ,9 addition to ! ,assi/ant ,secret>y = ,heal?1 ! ,f$]al memb]s ( ! ,task ,=ce %all consi/ ( ! heads ( ! foll[+ ,f$]al dep>tm5ts & ag5cies 7or _! designees73 7,a7 ,! ,adm9i/ration = ,*ildr5 & ,families4 7,b7 ,! ,ag5cy = ,heal?c>e ,rese>* & ,quality4 7,c7 ,! ,c5t]s = ,disease ,control & ,prev5tion4 7,d7 ,! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 7,e7 ,! ,heal? ,res\rces & ,s]vices ,adm9i/ration4 7,f7 ,! ,food & ,drug ,adm9i/ration4 7,g7 ,! ,indian ,heal? ,s]vice4 7,h7 ,! ,(fice ( ! ,assi/ant ,secret>y = ,plann+ & ,evaluation ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7,i7 ,! ,(fice ( ,m9ority ,heal? ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7,j7 ,! ,(fice ( ! ,surgeon ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7,k7 ,! ,(fice on ,wom5's ,heal? ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7,l7 ,! ,national ,in/itutes ( ,heal?4 7,m7 ,! ,sub/ance ,abuse & ,m5tal ,heal? ,s]vices ,adm9i/ration4 7,n7 ,su* o!r ,f$]al dep>tm5ts & ag5cies z ! ,secret>y det]m9es t s]ve individuals ) mat]nal m5tal heal? conditions1 su* z ! ,dep>tm5t ( ,vet]ans ,affairs1 ! ,dep>tm5t ( ,ju/ice1 ! ,dep>tm5t ( ,labor1 ! ,dep>tm5t ( ,h\s+ & ,urban ,developm5t1 & ! ,dep>tm5t ( ,def5se4 7#c7 ,non-,f$]al memb]s ,! non-,f$]al memb]s ( ! ,task ,=ce %all-- 7,a7 compose n m ?an "o-half1 & n less ?an "o-?ird1 ( ! total memb]%ip ( ! ,task ,=ce2 7,b7 be appo9t$ by ! ,secret>y2 & 7,c7 include-- 7i7 repres5tatives ( m$ical societies ) exp]tise 9 mat]nal or m5tal heal?2 7ii7 repres5tatives ( nonpr(it organizations ) exp]tise 9 mat]nal or m5tal heal?2 7iii7 relevant indu/ry repres5tatives2 & 7iv7 o!r repres5tatives1 z appropriate4 7#d7 ,deadl9e = designat+ designees ,if ! ,assi/ant ,secret>y = ,heal?1 or ! head ( a ,f$]al dep>tm5t or ag5cy s]v+ z a memb] ( ! ,task ,=ce "u p>agraph 7#b71 *ooses to be repres5t$ on ! ,task ,=ce by a designee1 ! ,assi/ant ,secret>y or head %all designate su* designee n lat] ?an #ij days aft] ! date ( ! enactm5t ( ?is section4 7c7 ,duties ,! ,task ,=ce %all-- 7#a7 create & regul>ly update a report t id5tifies1 analyzes1 & evaluates ! /ate ( national mat]nal m5tal heal? policy & programs at ! ,f$]al1 ,/ate1 & local levels1 & id5tifies be/ practices includ+-- 7,a7 a set ( evid5ce-bas$1 evid5ce-in=m$1 & promis+ practices ) respect to-- 7i7 prev5tion /rategies = individuals at risk ( exp]i5c+ a mat]nal m5tal heal? condition1 includ+ /rategies & recomm5dations to address social det]m9ants ( heal?2 7ii7 ! id5tification1 scre5+1 diagnosis1 int]v5tion1 & treatm5t ( individuals & families affect$ by a mat]nal m5tal heal? condition2 7iii7 ! exp$iti\s ref]ral to1 & implem5tation (1 practices & supports t prev5t & mitigate ! effects ( a mat]nal m5tal heal? condition1 includ+ /rategies & recomm5dations to elim9ate ! racial & e?nic inequities t exi/ 9 mat]nal m5tal heal?2 & 7iv7 community-bas$ or multig5]ational practices t support individuals & families affect$ by a mat]nal m5tal heal? condition2 & 7,b7 ,f$]al & ,/ate programs & activities to prev5t1 scre51 diagnose1 int]v5e1 & treat mat]nal m5tal heal? conditions2 7#b7 develop & regul>ly update a national /rategy = mat]nal m5tal heal?1 tak+ into consid]ation ! f9d+s ( ! reports "u p>agraph 7#a71 on h[ ! ,task ,=ce & ,f$]al dep>tm5ts & ag5cies repres5t$ on ! ,task ,=ce w prioritize options =1 & implem5t a coord9at$ approa* to1 address+ mat]nal m5tal heal? conditions1 includ+ by-- 7,a7 increas+ prev5tion1 scre5+1 diagnosis1 int]v5tion1 treatm5t1 & access to c>e1 includ+ cl9ical & noncl9ical c>e su* z pe]-support & community heal? work]s1 ?r\gh ! public & private sectors2 7,b7 provid+ support = pregnant or po/p>tum individuals :o are at risk = or exp]i5c+ a mat]nal m5tal heal? condition1 & _! families z appropriate2 7,c7 r$uc+ racial1 e?nic1 geographic1 & o!r heal? inequities = prev5tion1 diagnosis1 int]v5tion1 treatm5t1 & access to c>e2 7,d7 id5tify+ opportunities = local- & ,/ate-level p>tn]%ips2 7,e7 id5tify+ options = modify+1 /r5g!n+1 & coord9at+ ,f$]al programs & activities1 includ+ exi/+ infant & mat]nity programs1 su* z ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act & ! ,/ate ,*ildr5's ,heal? ,insurance ,program "u title ,,xxi ( su* ,act1 9 ord] to increase rese>*1 prev5tion1 id5tification1 int]v5tion1 & treatm5t ) respect to mat]nal m5tal heal?2 7,f7 provid+ recomm5dations to ensure rese>*1 s]vices1 supports1 & prev5tion activities are n unnecess>ily duplicative2 & 7,g7 plann+1 data %>+1 & communication )9 & across ,f$]al dep>tm5ts1 ag5cies1 (fices1 & programs2 7#c7 solicit public comm5ts f /akehold]s = ! report "u p>agraph 7#a7 & ! national /rategy "u p>agraph 7#b71 includ+ comm5ts f frontl9e s]vice provid]s1 m5tal heal? pr(essionals1 rese>*]s1 exp]ts 9 mat]nal m5tal heal?1 in/itutions ( high] education1 public heal? ag5cies 7includ+ mat]nal & *ild heal? programs71 & indu/ry repres5tatives1 9 ord] to in=m ! activities & reports ( ! ,task ,=ce2 & 7#d7 disaggregate any data collect$ "u ?is section by race1 e?nicity1 geographical location1 age1 m>ital /atus1 socioeconomic level1 & o!r factors z det]m9$ appropriate by ! ,secret>y4 7d7 ,meet+s ,! ,task ,=ce %all-- 7#a7 meet n less ?an two times ea* ye>2 & 7#b7 conv5e public meet+s1 z appropriate1 to fulfill its duties "u ?is section4 7e7 ,reports to public & ,f$]al lead]s ,! ,task ,=ce %all make publicly available & submit to ! heads ( relevant ,f$]al dep>tm5ts & ag5cies1 ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives1 ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate1 & o!r relevant congressional committees1 ! foll[+3 7#a7 ,n lat] ?an #a ye> aft] ! fir/ meet+ ( ! ,task ,=ce1 an initial report "u subsection 7c77#a74 7#b7 ,n lat] ?an #b ye>s aft] ! fir/ meet+ ( ! ,task ,=ce1 an initial national /rategy "u subsection 7c77#b74 7#c7 ,ea* ye> !reaft]-- 7,a7 an updat$ report "u subsection 7c77#a72 7,b7 an updat$ national /rategy "u subsection 7c77#b72 or 7,c7 if no su* update is made1 a report summ>iz+ ! activities ( ! ,task ,=ce4 7f7 ,reports to ,gov]nors ,^u f9aliz+ ! initial national /rategy "u subsection 7c77#b71 & ^u mak+ relevant updates to su* /rategy1 ! ,task ,=ce %all submit a report to ! ,gov]nors ( all ,/ates describ+ opportunities = local- & ,/ate-level p>tn]%ips id5tifi$ "u subsection 7c77#b77;,d74 7g7 ,sunset ,! ,task ,=ce %all t]m9ate on ! date t is #f ye>s aft] ! date on :i* ! ,task ,=ce is e/abli%$ "u subsection 7a74 4 #ebab4 ,protect moms f dome/ic viol5ce 7a7 ,/udy by ,dep>tm5t ( ,heal? & ,human ,s]vices 7#a7 ,/udy ,! ,secret>y1 9 collaboration ) ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 ! ,sub/ance ,abuse & ,m5tal ,heal? ,s]vices ,adm9i/ration1 & ! ,adm9i/ration = ,*ildr5 & ,families1 & 9 consultation ) ! ,attorney ,g5]al ( ! ,unit$ ,/ates1 ! ,director ( ! ,indian ,heal? ,s]vice1 & /akehold]s 7includ+ community-bas$ organizations1 culturally specific organizations1 & ,tribal public heal? au?orities71 %all conduct a /udy on ! ext5t to :i* individuals are m at risk ( mat]nal mortality or sev]e mat]nal morbidity z a result ( be+ a victim ( dome/ic viol5ce1 dat+ viol5ce1 sexual assault1 /alk+1 human traffick+1 sex traffick+1 *ild sexual abuse1 or =c$ m>riage4 7#b7 ,reports ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all complete ! /udy "u p>agraph 7#a7 & submit a report to ! ,congress on ! results ( su* /udy4 ,su* report %all include-- 7,a7 an analysis ( ! ext5t to :i* dome/ic viol5ce1 dat+ viol5ce1 sexual assault1 /alk+1 human traffick+1 sex traffick+1 *ild sexual abuse1 & =c$ m>riage contribute to1 or result 91 mat]nal mortality2 7,b7 an analysis ( ! impact ( dome/ic viol5ce1 dat+ viol5ce1 sexual assault1 /alk+1 human traffick+1 sex traffick+1 *ild sexual abuse1 & =c$ m>riage on access to heal? c>e 7includ+ m5tal heal? c>e7 & sub/ance use disord] treatm5t & recov]y support2 7,c7 a breakd[n 7includ+ by race & e?nicity7 ( categories ( individuals :o are disproportionately victims ( dome/ic viol5ce1 dat+ viol5ce1 sexual assault1 /alk+1 human traffick+1 sex traffick+1 *ild sexual abuse1 or =c$ m>riage t contributes to1 or results 91 pregnancy-relat$ dea?2 7,d7 an analysis ( ! impact on heal?1 m5tal heal?1 & sub/ance use result+ f dome/ic viol5ce1 dat+ viol5ce1 sexual assault1 /alk+1 human traffick+1 sex traffick+1 *ild sexual abuse1 & =c$ m>riage among ,alaskan ,natives1 ,native ,hawaiians1 & ,am]ican ,indians dur+ ! pr5atal & po/p>tum p]iod2 7,e7 an assessm5t ( ! factors t increase or decrease risks = mat]nal mortality or sev]e mat]nal morbidity among victims ( dome/ic viol5ce1 dat+ viol5ce1 sexual assault1 /alk+1 human traffick+1 sex traffick+1 *ild sexual abuse1 or =c$ m>riage2 7,f7 an assessm5t ( increas$ risk ( mat]nal mortality or sev]e mat]nal morbidity /emm+ f suicide1 sub/ance use disord]s1 or drug ov]dose due to dome/ic viol5ce1 dat+ viol5ce1 sexual assault1 /alk+1 human traffick+1 sex traffick+1 *ild sexual abuse1 or =c$ m>riage2 7,g7 recomm5dations = legislative or policy *anges-- 7i7 to r$uce mat]nal mortality rates2 & 7ii7 to address heal? inequities t contribute to inequities 9 su* rates & dea?s2 7,h7 be/ practices to r$uce mat]nal mortality & sev]e mat]nal morbidity among victims ( dome/ic viol5ce1 dat+ viol5ce1 sexual assault1 /alk+1 human traffick+1 sex traffick+1 *ild sexual abuse1 & =c$ m>riage1 includ+-- 7i7 r$uc+ reproductive co]cion1 m5tal heal? conditions1 & sub/ance use co]cion2 & 7ii7 r\t9ely assess+ pregnant p = dome/ic viol5ce & o!r =ms ( reproductive viol5ce2 & 7,i7 any o!r in=mation on mat]nal mortality or sev]e mat]nal morbidity ! ,secret>y det]m9es appropriate to include 9 ! report4 7b7 ,/udy by ,national ,academy ( m$ic9e 7#a7 ,9 g5]al ,! ,secret>y %all seek to ent] into an arrangem5t ) ! ,national ,academy ( ,m$ic9e 7or1 if ! ,academy decl9es to ent] into su* arrangem5t1 ano!r appropriate entity7 to /udy-- 7,a7 ! impact ( dome/ic viol5ce1 dat+ viol5ce1 sexual assault1 /alk+1 human traffick+1 sex traffick+1 *ild sexual abuse1 & =c$ m>riage on an individual's heal?2 relative to 7,b7 mat]nal mortality & sev]e mat]nal morbidity4 7#b7 ,topics ,! /udy "u p>agraph 7#a7 %all-- 7,a7 exam9e-- 7i7 :e!r dome/ic viol5ce1 dat+ viol5ce1 sexual assault1 /alk+1 human traffick+1 sex traffick+1 *ild sexual abuse1 or =c$ m>riage1 or g5]ational intimate p>tn] viol5ce1 trauma1 & psy*iatric disord]s1 increase ! risk ( suicide1 sub/ance use1 & drug ov]dose among pregnant & po/p>tum p]sons2 & 7ii7 ! int]section ( dome/ic viol5ce1 dat+ viol5ce1 sexual assault1 /alk+1 human traffick+1 sex traffick+1 *ild sexual abuse1 & =c$ m>riage z a social det]m9ant ( heal?2 & 7,b7 give p>ticul> focus to impacts among ,african ,am]ican1 ,am]ican ,indian1 ,native ,hawaiian1 ,alaskan ,native1 & ,,lgbtq bir?+ p]sons4 7c7 ,grants = innovative approa*es 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 & 9 collaboration ) ! ,adm9i/ration = ,*ildr5 & ,families1 ! ,indian ,heal? ,s]vice1 & ! ,sub/ance ,abuse & ,m5tal ,heal? ,s]vices ,adm9i/ration1 %all aw>d grants to eligible entities = develop+ & implem5t+ innovative approa*es to improve mat]nal & *ild heal? outcomes ( victims ( dome/ic viol5ce1 dat+ viol5ce1 sexual assault1 /alk+1 human traffick+1 sex traffick+1 *ild sexual abuse1 or =c$ m>riage4 7#b7 ,eligible entity ,to seek a grant "u ?is subsection1 an entity %all be-- 7,a7 a ,/ate1 local1 or f$]ally recogniz$ ,tribal gov]nm5t2 7,b7 a nonpr(it organization or community-bas$ organization t provides prev5tion or int]v5tion s]vices relat$ to dome/ic viol5ce1 dat+ viol5ce1 sexual assault1 /alk+1 human traffick+1 sex traffick+1 *ild sexual abuse1 or =c$ m>riage2 7,c7 a tribal organization or ,urban ,indian organization 7z su* t]ms are def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc772 7,d7 an entity1 ! pr9cipal purpose ( :i* is to provide heal? c>e1 su* z a hospital1 cl9ic1 heal? dep>tm5t1 free/&+ bir?+ c5t]1 p]9atal heal? work]1 or mat]nity c>e provid]2 7,e7 an in/itution ( high] education2 or 7,f7 a compreh5sive sub/ance use disord] p>5t+ program4 7#c7 ,priority ,9 aw>d+ grants "u ?is subsection1 ! ,secret>y %all give priority to applicants propos+ to address-- 7,a7 m5tal heal? & sub/ance use disord]s among pregnant p]sons2 or 7,b7 pregnant & po/p>tum p]sons exp]i5c+ intimate p>tn] viol5ce4 7#d7 ,free/&+ bir? c5t] def9$ ,9 ?is subsection1 ! t]m free/&+ bir? c5t] has ! mean+ giv5 t t]m 9 section #aije7l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7#a774 7#e7 ,au?orization ( appropriations ,to c>ry out ?is subsection1 !re is au?oriz$ to be appropriat$ #be1jjj1jjj = ! p]iod ( fiscal ye>s #bjbc ?r\gh #bjbe4 7d7 ,guidance ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all issue & dissem9ate guidance to ,/ates1 ,tribes1 t]ritories1 mat]nity c>e provid]s1 & manag$ c>e entities on-- 7#a7 provid+ univ]sal education on heal?y relation%ips & intimate p>tn] viol5ce2 7#b7 develop+ protocols on-- 7,a7 r\t9e assessm5t ( intimate p>tn] viol5ce2 & 7,b7 heal? promotion & /rategies = trauma-in=m$ c>e plans2 & 7#c7 creat+ su/a9able p>tn]%ips ) community-bas$ organizations t address dome/ic viol5ce1 dat+ viol5ce1 sexual assault1 /alk+1 human traffick+1 sex traffick+1 *ild sexual abuse1 or =c$ m>riage4 7e7 ,def9itions ,9 ?is section3 7#a7 ,! t]m mat]nal mortality-- 7,a7 means dea? t-- 7i7 occurs dur+1 or )9 ! #a-ye> p]iod aft]1 pregnancy2 & 7ii7 is attribut$ to or aggravat$ by pregnancy-relat$ or *ildbir? complications2 & 7,b7 includes a suicide1 drug ov]dose dea?1 homicide 7includ+ a dome/ic viol5ce-relat$ homicide71 or o!r dea? result+ f a m5tal heal? or sub/ance use disord] attribut$ to or aggravat$ by pregnancy-relat$ or *ildbir? complications4 7#b7 ,! t]m mat]nity c>e provid] means a heal? c>e provid] :o-- 7,a7 is a physician1 physician assi/ant1 nurse1 midwife :o meets at a m9imum ! int]national def9ition ( ! midwife & global /&>ds = midwif]y education z e/abli%$ by ! ,int]national ,conf$]ation ( ,midwives1 nurse practition]1 or cl9ical nurse speciali/2 & 7,b7 has a focus on mat]nal or p]9atal heal?4 7#c7 ,! t]m p]9atal heal? work] means a work] :o-- 7,a7 is a d\la1 community heal? work]1 pe] support]1 brea/fe$+ & lactation educator or c\nselor1 nutritioni/ or dietitian1 *ildbir? educator1 social work]1 home visitor1 language int]pret]1 or navigator2 & 7,b7 provides assi/ance ) p]9atal heal?4 7#d7 ,! t]m po/p>tum ref]s to ! #ab-mon? p]iod foll[+ *ildbir?4 7#e7 ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#f7 ,! t]m sev]e mat]nal morbidity means a heal? condition1 includ+ a m5tal heal? condition or sub/ance use disord]1 t-- 7,a7 is attribut$ to or aggravat$ by pregnancy or *ildbir?2 & 7,b7 results 9 significant %ort-t]m or long-t]m consequ5ces to ! heal? ( ! individual :o 0 pregnant4 #ebac4 ,p]9atal work=ce 7a7 ,,hhs ag5cy directives 7#a7 ,guidance to ,/ates 7,a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all issue & dissem9ate guidance to ,/ates to educate provid]s1 manag$ c>e entities1 & o!r insur]s ab\t ! value & process ( deliv]+ respectful mat]nal heal? c>e ?r\gh div]se & multidiscipl9>y c>e provid] models4 7,b7 ,cont5ts ,! guidance requir$ by subp>agraph 7,a7 %all address h[ ,/ates c enc\rage & inc5tivize hospitals1 heal? sy/ems1 midwif]y practices1 free/&+ bir? c5t]s1 o!r mat]nity c>e provid] gr\ps1 manag$ c>e entities1 & o!r insur]s-- 7i7 to recruit & reta9 mat]nity c>e provid]s1 m5tal & behavioral heal? c>e provid]s act+ 9 accordance ) ,/ate law1 regi/]$ dietitians or nutrition pr(essionals 7z su* t]m is def9$ 9 section #ahfa7vv77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7vv77#b7771 & lactation consultants c]tifi$ by ! ,int]national ,bo>d ( ,lactation ,consultants ,exam9]s-- 7,i7 f racially1 e?nically1 & l+ui/ically div]se backgr\nds2 7,,ii7 ) exp]i5ce practic+ 9 racially & e?nically div]se communities2 & 7,,iii7 :o h und]gone tra9+ on implicit bias & racism2 7ii7 to incorporate into mat]nity c>e teams-- 7,i7 midwives :o meet1 at a m9imum1 ! int]national def9ition ( ! midwife & global /&>ds = midwif]y education1 z e/abli%$ by ! ,int]national ,conf$]ation ( ,midwives2 & 7,,ii7 p]9atal heal? work]s2 7iii7 to provide collaborative1 culturally congru5t c>e2 & 7iv7 to provide opportunities = individuals enroll$ 9 accr$it$ midwif]y education programs to p>ticipate 9 job %ad[+ ) mat]nity c>e teams 9 hospitals1 heal? sy/ems1 midwif]y practices1 & free/&+ bir? c5t]s4 7#b7 ,/udy on respectful & culturally congru5t mat]nity c>e 7,a7 ,/udy ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,national ,in/itutes ( ,heal? 79 ?is p>agraph ref]r$ to z ! ,secret>y71 %all conduct a /udy on be/ practices 9 respectful & culturally congru5t mat]nity c>e4 7,b7 ,report ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all-- 7i7 complete ! /udy requir$ by subp>agraph 7,a72 7ii7 submit to ! ,congress1 & make publicly available1 a report on ! results ( su* /udy2 & 7iii7 include 9 su* report-- 7,i7 a comp5dium ( examples ( hospitals1 heal? sy/ems1 midwif]y practices1 free/&+ bir? c5t]s1 o!r mat]nity c>e provid] gr\ps1 manag$ c>e entities1 & o!r insur]s t are deliv]+ respectful & culturally congru5t mat]nal heal? c>e2 7,,ii7 a comp5dium ( examples ( hospitals1 heal? sy/ems1 midwif]y practices1 free/&+ bir? c5t]s1 o!r mat]nity c>e provid] gr\ps1 manag$ c>e entities1 & o!r insur]s t h made progress 9 r$uc+ inequities 9 mat]nal heal? outcomes & improv+ bir?+ exp]i5ces = pregnant & po/p>tum individuals f racial & e?nic m9ority gr\ps2 & 7,,iii7 recomm5dations to hospitals1 heal? sy/ems1 midwif]y practices1 free/&+ bir? c5t]s1 o!r mat]nity c>e provid] gr\ps1 manag$ c>e entities1 & o!r insur]s1 = be/ practices 9 respectful & culturally congru5t mat]nity c>e4 7b7 ,grants ,to gr[ & div]sify ! p]9atal work=ce ,title ,,vii ( ! ,public ,heal? ,s]vice ,act is am5d$ by ins]t+ aft] section #geh1 z add$ by section #ebaj7;b71 ! foll[+ new section3 #geh;,a4 ,p]9atal work=ce grants 7a7 ,9 g5]al ,! ,secret>y %all aw>d grants to entities to e/abli% or exp& programs describ$ 9 subsection 7b7 to gr[ & div]sify ! p]9atal work=ce4 7b7 ,use ( funds ,recipi5ts ( grants "u ?is section %all use ! grants to gr[ & div]sify ! p]9atal work=ce by-- 7#a7 e/abli%+ s*ools or programs t provide education & tra9+ to individuals seek+ appropriate lic5s+ or c]tification z-- 7,a7 physician assi/ants :o w complete cl9ical tra9+ 9 ! field ( mat]nal & p]9atal heal?2 or 7,b7 p]9atal heal? work]s2 & 7#b7 exp&+ ! capacity ( exi/+ s*ools or programs describ$ 9 p>agraph 7#a71 = ! purposes ( increas+ ! numb] ( /ud5ts enroll$ 9 su* s*ools or programs1 includ+ by aw>d+ s*ol>%ips = /ud5ts4 7c7 ,prioritization ,9 aw>d+ grants "u ?is section1 ! ,secret>y %all give priority to any entity t-- 7#a7 has demon/rat$ a commitm5t to recruit+ & reta9+ /ud5ts & faculty f racial & e?nic m9ority gr\ps2 7#b7 has develop$ a /rategy to recruit & reta9 a div]se pool ( /ud5ts into ! p]9atal work=ce program or s*ool support$ by funds receiv$ ?r\gh ! grant1 p>ticul>ly f racial & e?nic m9ority gr\ps & o!r und]s]v$ populations2 7#c7 has develop$ a /rategy to recruit & reta9 /ud5ts :o plan to practice 9 a heal? pr(essional %ortage area designat$ "u section #ccb2 7#d7 has develop$ a /rategy to recruit & reta9 /ud5ts :o plan to practice 9 an area ) significant racial & e?nic inequities 9 mat]nal heal? outcomes1 to ! ext5t practicable2 & 7#e7 includes 9 ! /&>d curriculum = all /ud5ts )9 ! p]9atal work=ce program or s*ool a bias1 racism1 or discrim9ation tra9+ program t includes tra9+ on implicit bias & racism4 7d7 ,report+ ,z a condition on receipt ( a grant "u ?is section = a p]9atal work=ce program or s*ool1 an entity %all agree to submit to ! ,secret>y an annual report on ! activities conduct$ ?r\gh ! grant1 includ+-- 7#a7 ! numb] & demographics ( /ud5ts p>ticipat+ 9 ! program or s*ool2 7#b7 ! ext5t to :i* /ud5ts 9 ! program or s*ool are ent]+ c>e]s 9-- 7,a7 heal? pr(essional %ortage areas designat$ "u section #ccb2 & 7,b7 areas ) significant racial & e?nic inequities 9 mat]nal heal? outcomes1 to ! ext5t su* data are available2 & 7#c7 :e!r ! program or s*ool has includ$ 9 ! /&>d curriculum = all /ud5ts a bias1 racism1 or discrim9ation tra9+ program t includes explicit & implicit bias1 & if s ! effectiv5ess ( su* tra9+ program4 7e7 ,p]iod ( grants ,! p]iod ( a grant "u ?is section %all n exce$ #e ye>s4 7f7 ,application ,to seek a grant "u ?is section1 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+ any in=mation necess>y = prioritization "u subsection 7c74 7g7 ,te*nical assi/ance ,! ,secret>y %all provide1 directly or by contract1 te*nical assi/ance to entities seek+ or receiv+ a grant "u ?is section on ! developm5t1 use1 evaluation1 & po/-grant p]iod su/a9ability ( ! p]9atal work=ce programs or s*ools propos$ to be1 or be+1 e/abli%$ or exp&$ ?r\gh ! grant4 7h7 ,report by ! ,secret>y ,n lat] ?an #d ye>s aft] ! date ( enactm5t ( ?is section1 ! ,secret>y %all prep>e & submit to ! ,congress1 & po/ on ! int]net website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 a report on ! effectiv5ess ( ! grant program "u ?is section at-- 7#a7 recruit+ /ud5ts f racial & e?nic m9ority gr\ps2 7#b7 increas+ ! numb] ( physician assi/ants :o w complete cl9ical tra9+ 9 ! field ( mat]nal & p]9atal heal?1 & p]9atal heal? work]s1 f racial & e?nic m9ority gr\ps & o!r und]s]v$ populations2 7#c7 increas+ ! numb] ( physician assi/ants :o w complete cl9ical tra9+ 9 ! field ( mat]nal & p]9atal heal?1 & p]9atal heal? work]s1 work+ 9 heal? pr(essional %ortage areas designat$ "u section #ccb2 & 7#d7 increas+ ! numb] ( physician assi/ants :o w complete cl9ical tra9+ 9 ! field ( mat]nal & p]9atal heal?1 & p]9atal heal? work]s1 work+ 9 areas ) significant racial & e?nic inequities 9 mat]nal heal? outcomes1 to ! ext5t su* data are available4 7i7 ,def9ition ,9 ?is section1 ! t]m racial & e?nic m9ority gr\p has ! mean+ giv5 su* t]m 9 section #agjg7;g74 7j7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re is au?oriz$ to be appropriat$ #ae1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 4 7c7 ,grants ,to gr[ & div]sify ! nurs+ work=ce 9 mat]nal & p]9atal heal? ,title ,,viii ( ! ,public ,heal? ,s]vice ,act is am5d$ by ins]t+ aft] section #haa ( t ,act 7#db ,u4,s4,c4 #bif;j7 ! foll[+3 #hab4 ,p]9atal nurs+ work=ce grants 7a7 ,9 g5]al ,! ,secret>y %all aw>d grants to s*ools ( nurs+ to gr[ & div]sify ! p]9atal nurs+ work=ce4 7b7 ,use ( funds ,recipi5ts ( grants "u ?is section %all use ! grants to gr[ & div]sify ! p]9atal nurs+ work=ce by provid+ s*ol>%ips to /ud5ts seek+ to become-- 7#a7 nurse practition]s ^: education includes a focus on mat]nal & p]9atal heal?2 or 7#b7 cl9ical nurse speciali/s ^: education includes a focus on mat]nal & p]9atal heal?4 7c7 ,prioritization ,9 aw>d+ grants "u ?is section1 ! ,secret>y %all give priority to any s*ool ( nurs+ t-- 7#a7 has develop$ a /rategy to recruit & reta9 a div]se pool ( /ud5ts seek+ to ent] c>e]s focus$ on mat]nal & p]9atal heal?1 p>ticul>ly /ud5ts f racial & e?nic m9ority gr\ps & o!r und]s]v$ populations2 7#b7 has develop$ a p>tn]%ip ) a practice sett+ 9 a heal? pr(essional %ortage area designat$ "u section #ccb = ! cl9ical placem5ts ( ! s*ool's /ud5ts2 7#c7 has develop$ a /rategy to recruit & reta9 /ud5ts :o plan to practice 9 an area ) significant racial & e?nic inequities 9 mat]nal heal? outcomes1 to ! ext5t practicable2 & 7#d7 includes 9 ! /&>d curriculum = all /ud5ts seek+ to ent] c>e]s focus$ on mat]nal & p]9atal heal? a bias1 racism1 or discrim9ation tra9+ program t includes education on implicit bias & racism4 7d7 ,report+ ,z a condition on receipt ( a grant "u ?is section1 a s*ool ( nurs+ %all agree to submit to ! ,secret>y an annual report on ! activities conduct$ ?r\gh ! grant1 includ+1 to ! ext5t practicable-- 7#a7 ! numb] & demographics ( /ud5ts 9 ! s*ool ( nurs+ seek+ to ent] c>e]s focus$ on mat]nal & p]9atal heal?2 7#b7 ! ext5t to :i* su* /ud5ts are prep>+ to ent] c>e]s 9-- 7,a7 heal? pr(essional %ortage areas designat$ "u section #ccb2 & 7,b7 areas ) significant racial & e?nic inequities 9 mat]nal heal? outcomes1 to ! ext5t su* data are available2 & 7#c7 :e!r ! /&>d curriculum = all /ud5ts seek+ to ent] c>e]s focus$ on mat]nal & p]9atal heal? includes a bias1 racism1 or discrim9ation tra9+ program t includes education on implicit bias & racism4 7e7 ,p]iod ( grants ,! p]iod ( a grant "u ?is section %all be up to #e ye>s4 7f7 ,application ,to seek a grant "u ?is section1 an entity %all submit to ! ,secret>y an application1 at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require1 includ+ any in=mation necess>y = prioritization "u subsection 7c74 7g7 ,te*nical assi/ance ,! ,secret>y %all provide1 directly or by contract1 te*nical assi/ance to s*ools ( nurs+ seek+ or receiv+ a grant "u ?is section on ! processes ( aw>d+ & evaluat+ s*ol>%ips ?r\gh ! grant4 7h7 ,report by ! ,secret>y ,n lat] ?an #d ye>s aft] ! date ( enactm5t ( ?is section1 ! ,secret>y %all prep>e & submit to ! ,congress1 & po/ on ! int]net website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 a report on ! effectiv5ess ( ! grant program "u ?is section at-- 7#a7 recruit+ /ud5ts f racial & e?nic m9ority gr\ps & o!r und]s]v$ populations2 7#b7 increas+ ! numb] ( nurse practition]s & cl9ical nurse speciali/s ent]+ c>e]s focus$ on mat]nal & p]9atal heal? f racial & e?nic m9ority gr\ps & o!r und]s]v$ populations2 7#c7 increas+ ! numb] ( nurse practition]s & cl9ical nurse speciali/s ent]+ c>e]s focus$ on mat]nal & p]9atal heal? work+ 9 heal? pr(essional %ortage areas designat$ "u section #ccb2 & 7#d7 increas+ ! numb] ( nurse practition]s & cl9ical nurse speciali/s ent]+ c>e]s focus$ on mat]nal & p]9atal heal? work+ 9 areas ) significant racial & e?nic inequities 9 mat]nal heal? outcomes1 to ! ext5t su* data are available4 7i7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re is au?oriz$ to be appropriat$ #ae1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 4 7d7 ,,gao report 7#a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 & e #e ye>s !reaft]1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report on b>ri]s to mat]nal heal? education & access to c>e 9 ! ,unit$ ,/ates4 ,su* report %all include ! in=mation & recomm5dations describ$ 9 p>agraph 7#b74 7#b7 ,cont5t ( report ,! report "u p>agraph 7#a7 %all include-- 7,a7 an assessm5t ( curr5t b>ri]s to ent]+ accr$it$ midwif]y education programs1 & recomm5dations = address+ su* b>ri]s1 p>ticul>ly = l[-income p & p f racial & e?nic m9ority gr\ps2 7,b7 an assessm5t ( curr5t b>ri]s to ent]+ & successfully complet+ accr$it$ education programs = o!r heal? pr(essional c>e]s relat$ to mat]nity c>e1 includ+ mat]nity c>e provid]s1 m5tal & behavioral heal? c>e provid]s act+ 9 accordance ) ,/ate law1 regi/]$ dietitians or nutrition pr(essionals 7z su* t]m is def9$ 9 section #ahfa7vv77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7vv77#b7771 & lactation consultants c]tifi$ by ! ,int]national ,bo>d ( ,lactation ,consultants ,exam9]s1 p>ticul>ly = l[-income p & p f racial & e?nic m9ority gr\ps2 7,c7 an assessm5t ( curr5t b>ri]s t prev5t midwives f meet+ ! int]national def9ition ( ! midwife & global /&>ds = midwif]y education z e/abli%$ by ! ,int]national ,conf$]ation ( ,midwives1 & recomm5dations = address+ su* b>ri]s1 p>ticul>ly = l[-income p & p f racial & e?nic m9ority gr\ps2 7,d7 an assessm5t ( inequities 9 access to mat]nity c>e provid]s1 m5tal or behavioral heal? c>e provid]s act+ 9 accordance ) ,/ate law1 regi/]$ dietitians or nutrition pr(essionals 7z su* t]m is def9$ 9 section #ahfa7vv77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7vv77#b7771 lactation consultants c]tifi$ by ! ,int]national ,bo>d ( ,lactation ,consultants ,exam9]s1 & p]9atal heal? work]s1 /ratifi$ by race1 e?nicity1 g5d] id5tity1 geographic location1 & insurance type & recomm5dations to promote great] access equity2 & 7,e7 recomm5dations to promote great] equity 9 comp5sation = p]9atal heal? work]s "u public & private insur]s1 p>ticul>ly = su* individuals f racially & e?nically div]se backgr\nds4 7e7 ,def9itions ,9 ?is section3 7#a7 ,culturally congru5t ,! t]m culturally congru5t1 ) respect to c>e or mat]nity c>e1 means c>e t is 9 agreem5t ) ! pref]r$ cultural values1 beliefs1 worldview1 language1 & practices ( ! heal? c>e consum] & o!r /akehold]s4 7#b7 ,mat]nity c>e provid] ,! t]m mat]nity c>e provid] means a heal? c>e provid] :o-- 7,a7 is a physician1 physician assi/ant1 midwife :o meets at a m9imum ! int]national def9ition ( ! midwife & global /&>ds = midwif]y education z e/abli%$ by ! ,int]national ,conf$]ation ( ,midwives1 nurse practition]1 or cl9ical nurse speciali/2 & 7,b7 has a focus on mat]nal or p]9atal heal?4 7#c7 ,p]9atal heal? work] ,! t]m p]9atal heal? work] means a d\la1 community heal? work]1 pe] support]1 brea/fe$+ & lactation educator or c\nselor1 nutritioni/ or dietitian1 *ildbir? educator1 social work]1 home visitor1 language int]pret]1 or navigator4 7#d7 ,po/p>tum & po/p>tum p]iod ,! t]ms po/p>tum & po/p>tum p]iod ref] to ! #a-ye> p]iod beg9n+ on ! la/ day ( ! pregnancy ( an individual4 7#e7 ,racial & e?nic m9ority gr\p ,! t]m racial & e?nic m9ority gr\p has ! mean+ giv5 su* t]m 9 section #agjg7;g77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a774 #ebad4 ,midwives s*ools & programs expansion 7a7 ,midwif]y s*ools & programs 7#a7 ,9 g5]al ,title ,,vii ( ! ,public ,heal? ,s]vice ,act is am5d$ by ins]t+ aft] section #gfj ( su* ,act 7#db ,u4,s4,c4 #bidk7 ! foll[+3 #gfj;,a4 ,midwif]y s*ools & programs 7a7 ,9 g5]al ,! ,secret>y may aw>d grants to in/itutions ( high] education 7z def9$ 9 subsections 7a7 & 7b7 ( section #aja ( ! ,high] ,education ,act ( #aife7 = ! foll[+3 7#a7 ,direct support ( /ud5ts 9 an accr$it$ midwif]y s*ool or program4 7#b7 ,e/abli%m5t or expansion ( an accr$it$ midwif]y s*ool or program4 7#c7 ,secur+1 prep>+1 or provid+ support = increas+ ! numb] (1 qualifi$ preceptors = tra9+ ! /ud5ts ( an accr$it$ midwif]y s*ool or program4 7b7 ,special consid]ations ,9 aw>d+ grants "u subsection 7a71 ! ,secret>y %all give special consid]ation to any in/itution ( high] education t-- 7#a7 agrees to prioritize /ud5ts :o plan to practice 9 a heal? pr(essional %ortage area designat$ "u section #ccb2 & 7#b7 demon/rates a focus on increas+ racial & e?nic m9ority repres5tation 9 midwif]y education4 7c7 ,re/riction ,! ,secret>y %all n provide any assi/ance "u ?is section to be us$ ) respect to a midwif]y s*ool or program )9 a s*ool ( nurs+ 7z def9$ 9 section #hja74 7d7 ,au?orization ( appropriations 7#a7 ,9 g5]al ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #ae1jjj1jjj = ! p]iod ( fiscal ye>s #bjbc ?r\gh #bjbg4 7#b7 ,allocation ,( ! am\nts made available to c>ry out ?is section = any fiscal ye>1 ! ,secret>y %all use-- 7,a7 #ej p]c5t to aw>d grants = purposes specifi$ 9 subsection 7a77#a72 7,b7 #be p]c5t to aw>d grants = purposes specifi$ 9 subsection 7a77#b72 & 7,c7 #be p]c5t to aw>d grants = purposes specifi$ 9 subsection 7a77#c74 4 7#b7 ,def9itions 7,a7 ,midwif]y s*ool or program ,section #gii;,b7#a77;,a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #biep7#a77;,a77 is am5d$-- 7i7 by ins]t+ midwif]y s*ool or program1 be=e & s*ool ( *iropractic2 7ii7 by ins]t+ a degree or c]tificate 9 midwif]y or an equival5t degree or c]tificate1 be=e & a degree ( doctor ( *iropractic or an equival5t degree2 & 7iii7 by /rik+ any su* s*ool & ins]t+ any su* s*ool or program4 7,b7 ,accr$it$ ,section #gii;,b7#a77;,e7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #biep7#a77;,e77 is am5d$ by ins]t+ a midwif]y s*ool or program1 be=e or a graduate program 9 heal? adm9i/ration4 7b7 ,nurse-,midwives ,title ,,viii ( ! ,public ,heal? ,s]vice ,act1 z am5d$ by section #ebac1 is fur!r am5d$ by ins]t+ aft] section #hab ( t ,act1 z add$ by section #ebac1 ! foll[+3 #hab;,a4 ,midwif]y expansion program 7a7 ,9 g5]al ,! ,secret>y may aw>d grants to s*ools ( nurs+ = ! foll[+3 7#a7 ,direct support ( /ud5ts 9 an accr$it$ nurse-midwif]y s*ool or program4 7#b7 ,e/abli%m5t or expansion ( an accr$it$ nurse-midwif]y s*ool or program4 7#c7 ,secur+1 prep>+1 or provid+ support = increas+ ! numb]s (1 preceptors at cl9ical tra9+ sites to precept /ud5ts tra9+ to become c]tifi$ nurse-midwives4 7b7 ,special consid]ations ,9 aw>d+ grants "u subsection 7a71 ! ,secret>y %all give special consid]ation to any s*ool ( nurs+ t-- 7#a7 agrees to prioritize /ud5ts :o *oose to pursue an advanc$ education degree 9 nurse-midwif]y to practice 9 a heal? pr(essional %ortage area designat$ "u section #ccb2 & 7#b7 demon/rates a focus on increas+ racial & e?nic m9ority repres5tation 9 nurse-midwif]y education4 7c7 ,au?orization ( appropriations 7#a7 ,9 g5]al ,to c>ry out ?is section1 !re is au?oriz$ to be appropriat$ #bj1jjj1jjj = ! p]iod ( fiscal ye>s #bjbc ?r\gh #bjbg4 7#b7 ,allocation ,( ! am\nts made available to c>ry out ?is section = any fiscal ye>1 ! ,secret>y %all use-- 7,a7 #ej p]c5t to aw>d grants = purposes specifi$ 9 subsection 7a77#a72 7,b7 #be p]c5t to aw>d grants = purposes specifi$ 9 subsection 7a77#b72 & 7,c7 #be p]c5t to aw>d grants = purposes specifi$ 9 subsection 7a77#c74 4 #ebae4 ,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 #bjbc ?r\gh #bjbg4 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 #bjbc ?r\gh #bjbg4 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 #ebaf4 ,consum] education campaign ,section #bbi7;b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bcg;a7b771 z am5d$-- 7#a7 9 p>agraph 7#f71 at ! end1 by /rik+ &2 7#b7 9 p>agraph 7#g71 at ! end1 by /rik+ ! p]iod & ins]t+ a semicolon2 & 7#c7 by add+ at ! end ! foll[+3 7#h7 n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ?is p>agraph1 develop & implem5t a #d-ye> culturally & l+ui/ically appropriate multim$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 & indiscrim9ately2 7,d7 emphasizes ! non9vasive mat]nity practices t h prov5 correlation or may be associat$ ) 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-- 7i7 ! qualifications ( lic5s$ provid]s ( mat]nity c>e1 includ+ ob/etrician-gynecologi/s1 family physicians1 c]tifi$ nurse-midwives1 c]tifi$ midwives1 & c]tifi$ pr(essional midwives2 & 7ii7 ! be/ evid5ce ab\t ! safety1 satisfaction1 outcomes1 & co/s ( su* provid]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 heal?y & 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 in=ms consum]s ab\t-- 7i7 ! effects ( sy/emic1 in/itutional1 & int]p]sonal racism on ! heal?1 well-be+1 & outcomes ( bir?+ p2 7ii7 ! importance ( respectful1 culturally & l+ui/ically appropriate1 & culturally congru5t c>e2 & 7iii7 ! value ( community-bas$ & community-l$ mat]nal c>e & support2 & 7,i7 is pilot te/$ = consum] compreh5sion1 cultural s5sitivity1 & acceptance ( ! messages across geographically1 racially1 e?nically1 & l+ui/ically div]se populations2 4 #ebag4 ,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 act+ ?r\gh ! ,director ( ! ,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 ,reviews2 & 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 #bjbc ?r\gh #bjbe = ! 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 #ebah4 ,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 7ref]r$ to 9 ?is section z ! ,commission7 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$ical & midwif]y /ud5t exposure to out-(-hospital bir?2 7#d7 curriculum & /rategies = cont9u+ education ( practic+ p]9atal pr(essionals :o h complet$ _! und]graduate & graduate education2 & 7#e7 pilot demon/rations ( int]pr(essional educational models4 7b7 ,p>ticipants 7#a7 ,pr(essions ,! ,commission %all include mat]nity c>e educators1 curriculum develop]s1 s]vice lead]s1 c]tification lead]s1 & accr$itation lead]s f ! v>i\s pr(essions t provide or support mat]nity c>e 9 ! ,unit$ ,/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 nurses1 d\las1 lactation p]sonnel1 & community heal? work]s4 7#b7 ,consum] advocates ,! ,commission %all also 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>+ & p]son & family c5t]$ c>e2 7#c7 reflect ! ext5sive1 gr[+ rese>* evid5ce ab\t-- 7,a7 ! innate abilities & processes ( ! bir?+ p]son & ! fetus or newborn = labor1 bir?1 po/p>tum transition1 brea/fe$+1 & atta*m5t1 :5 promot$1 support$1 & protect$2 & 7,b7 ! effects ( factors t di/urb & disrupt ^! processes2 7#d7 integrate /rategies to r$uce mat]nal & infant morbidity & mortality2 7#e7 incorporate recomm5dations to ensure respectful1 safe1 & seamless consultation1 ref]ral1 transport1 & transf] ( c>e :5 necess>y2 7#f7 include cultural s5sitivity & /rategies to decrease inequities 9 mat]nity outcomes2 & 7#g7 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 #bjbc & #bjbd1 & su* sums z are necess>y = ea* ( ! fiscal ye>s #bjbe ?r\gh #bjbg4 #ebai4 ,dissem9ation ( ! quality family plann+ guidel9es 7a7 ,9 g5]al ,n lat] ?an #ahj days 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 7z def9$ 9 section #ahfa7;aa77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#d777 & bran*es ( ! ,indian ,heal? ,s]vice1 ab\t ! quality family plann+ guidel9es ref]r$ to 9 section #ecjd2 & 7#b7 aw>d grants to eligible entities to implem5t su* 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 ,d ,f$]al ,ag5cy ,coord9ation on ,mat]nal ,heal? #ecja4 ,int]ag5cy ,coord9at+ ,committee on ! ,promotion ( ,optimal ,mat]nity ,outcomes 7a7 ,9 g5]al ,"p ,a ( title ,,ii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bjb et seq47 is am5d$ 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 inequities ) respect to ea* ( su* problems2 7,c7 ! ext5t ( progress 9 r$uc+ mat]nal mortality & infant mortality1 l[ bir? weight1 & prematurity at ,/ate & national levels2 & 7,d7 su* o!r in=mation reg>d+ optimal mat]nity c>e 7su* z quality & p]=mance measures7 z ! ,secret>y det]m9es to be appropriate4 7#b7 ,r$uc+ inequities ) respect to indig5\s /atus ,! in=mation specifi$ 9 p>agraph 7#a77;,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$uc+ racial & e?nic inequities & inequities relat$ to indig5\s /atus4 7#c7 ,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[+ rates1 tr5ds1 & co/s by ,/ate3 7,a7 ,! rate & tr5d ( prim>y ces>ean deliv]ies & repeat ces>ean deliv]ies4 7,b7 ,! rate & tr5d ( vag9al bir?s aft] ces>ean4 7,c7 ,! rate & tr5d ( vag9al bree* bir?s4 7,d7 ,! rate & tr5d ( induction ( labor4 7,e7 ,! rate & tr5d ( free/&+ bir? c5t] bir?s4 7,f7 ,! rate & tr5d ( plann$ & unplann$ home bir?4 7,g7 ,! rate & tr5ds ( att5d$ bir?s by diff]5t types ( mat]nity c>e provid]s1 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 ,! rate & tr5d ( sev]e mat]nal morbidity4 7,i7 ,! rates & tr5ds ( pr5atal & po/p>tum anxiety & depression4 7,j7 ,! rate & tr5d ( pre-t]m bir?4 7,k7 ,! rate & tr5d ( l[ bir? weight4 7,l7 ,! 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 #bjbc ?r\gh #bjbg4 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 #ebaf1 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 #ecjb4 ,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]vices %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$uction ( ces>ean bir? rates1 e>ly elective inductions1 prematurity rates1 & l[ bir? weight rates )9 an und]s]v$ 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 midwives1 c]tifi$ nurse-midwives1 or c]tifi$ 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 use disord] 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 #bjbc ?r\gh #bjbg4 #ecjc4 ,exp&+ models to be te/$ by ,c5t] = ,m$ic>e & ,m$icaid ,innovation to explicitly include mat]nity c>e & *ildr5's heal? models ,section #aaae;,a7b77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b771 z am5d$ by section #ebjf7;b71 is am5d$-- 7#a7 9 subp>agraph 7,b71 by add+ at ! end ! foll[+3 7xxix7 ,promot+ evid5ce-bas$ models ( c>e t h be5 associat$ ) r$uctions 9 pregnancy-relat$ & infant heal? inequities1 includ+ incorporat+ ! use ( & paym5t = d\las1 p>ticul>ly community-bas$ d\las1 & promot+ support = p dur+ pregnancy & = ! "o-ye> p]iod aft] ! la/ day ( su* p]son's pregnancy1 ?r\gh evid5ce-bas$ models ( antep>tum1 bir?1 po/p>tum c>e1 & two-g5]ation bir?+ p]son & newborn c>e models1 & support+ ! risk-appropriate use ( out-(-hospital bir? models1 includ+ bir?s at home & 9 free/&+ bir? c5t]s4 ,su* models %all be select$ & evaluat$ bas$ on _! impact on quality1 equity1 & developm5tal outcomes1 not)/&+ any o!r provision ( ?is section4 2 7#b7 9 subp>agraph 7,c71 by add+ at ! end ! foll[+3 7ix7 ,:e!r ! model includes a regul> process = ensur+ ! provision ( culturally & l+ui/ically appropriate s]vices4 7x7 ,:e!r heal? c>e s]vices & supportive s]vices includ$ 9 ! model are tailor$ to community heal? & heal?-relat$ social ne$s & provid$ by community-bas$ & community-l$ provid]s4 7xi7 ,:e!r ! model is design$ to mitigate h>mful effects ( discrim9ation on ! basis ( race1 sex1 disability1 e?nicity1 language1 & age4 2 & 7#c7 by add+ at ! end ! foll[+3 7,d7 ,m&atory heal? equity models to be te/$ ,! ,secret>y %all select-- 7i7 ,m$icaid global & episode-bas$ paym5t models = culturally & l+ui/ically appropriate antep>tum1 labor & deliv]y1 & po/p>tum d\la s]vices1 includ+ community-bas$ d\la s]vices1 t are-- 7,i7 /ructur$ to provide paym5t to d\las z individuals1 heal? c>e entity /aff1 or memb]s ( a d\la gr\p or collective1 or ?r\gh a ?ird-p>ty adm9i/rator2 7,,ii7 design$ to r$uce racial & int]sect+ heal? inequities2 7,,iii7 design$ to provide d\las provid+ support ) an equitable & su/a9able reimbursem5t rate2 7,,iv7 design$ to r$uce b>ri]s to work=ce entry = culturally & l+ui/ically compet5t & racially congru5t d\las to provide s]vices to ,m$icaid enrollees2 & 7,v7 design$ ) input f community-bas$ d\las1 mat]nal heal? advocates1 reproductive ju/ice advocates1 & ,m$icaid b5efici>ies2 7ii7 a ,m$icaid episode-bas$ paym5t model = pregnancy-relat$ s]vices1 includ+ heal? c>e s]vices & supportive s]vices to address heal?-relat$ social ne$s1 dur+ ! pr5atal1 intrap>tum1 & po/p>tum p]iods1 to improve heal? outcomes & r$uce racial heal? inequities1 & to be design$ ) input f mat]nity c>e provid]s1 mat]nal heal? advocates1 reproductive ju/ice advocates1 & ,m$icaid b5efici>ies2 7iii7 a ,m$icaid alt]native paym5t model = a pregnancy-relat$ heal? home s]vice to improve heal? outcomes dur+ & = "o ye> aft] pregnancy & dur+ ! newborn p]iod1 & to r$uce racial heal? inequities1 design$ ) input f mat]nity c>e provid]s1 mat]nal heal? advocates1 reproductive ju/ice advocates1 & ,m$icaid b5efici>ies2 7iv7 a ,m$icaid p]9atal heal? work] s]vice deliv]y model = culturally & l+ui/ically appropriate & respectful heal? c>e & supportive s]vices t are tailor$ to community heal? & heal?-relat$ social ne$s1 design$ to improve heal? outcomes & mitigate h>mful effects ( racism & o!r =ms ( discrim9ation1 & provid$ by community-bas$ & community-l$ provid]s2 & 7v7 "o or m models exclusively focus$ on e>ly int]v5tion & prev5tion = *ildr5 enroll$ 9 a ,/ate plan 7or waiv] ( su* plan7 "u title ,,xix or a ,/ate *ild heal? plan "u title ,,xxi us+ evid5ce-bas$ int]v5tions includ+ p>5t+ support programs1 home-visit+ s]vices1 & dyadic !rapy treatm5t = *ildr5 & adolesc5ts at risk4 ,su* models %all be select$ & evaluat$ bas$ on _! impact on quality1 equity1 & developm5tal outcomes1 not)/&+ any o!r provision ( ?is section4 4 #ecjd4 ,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? inequities2 & 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? inequities1 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 ,e ,reproductive & ,sexual ,heal? #edja4 ,f9d+s2 s5se ( ,congress on urg5t b>ri]s to abortion access & vital solutions 7a7 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,af=dable1 compreh5sive heal? insurance t includes cov]age = a full range ( pregnancy-relat$ c>e1 includ+ abortion1 is critical to ! heal? ( e p]son reg>dless ( actual or p]ceiv$ race1 color1 national orig91 immigration /atus1 sex 7includ+ sexual ori5tation1 g5d] id5tity1 pregnancy1 *ildbir?1 a m$ical condition relat+ to pregnancy or *ildbir?1 or sex /]eotyp+71 age1 or disability /atus4 7#b7 ,abortion s]vices are ess5tial to heal? c>e & access to ^? s]vices is c5tral to p's ability to p>ticipate equally 9 ! economic & social life ( ! ,unit$ ,/ates4 ,abortion access all[s p :o are pregnant to make _! own decisions ab\t _! pregnancies1 _! families1 & _! lives4 7#c7 ,reproductive ju/ice seeks to address re/rictions on reproductive heal?1 includ+ abortion1 t p]petuate sy/ems ( oppression1 lack ( bodily autonomy1 ,:ite supremacy1 & anti-,black racism4 ,! viol5t legacy ( ^! sy/ems ( oppression has manife/$ 9 policies includ+ enslavem5t1 rape1 & exp]im5tation on ,black p1 =c$ /]ilizations1 m$ical exp]im5tation on l[-income p's reproductive sy/ems1 & ! =cible removal ( ,indig5\s *ildr54 ,access to equitable reproductive heal? c>e1 includ+ abortion s]vices1 has always be5 defici5t 9 ! ,unit$ ,/ates = ,black1 ,indig5\s1 & o!r ,p ( ,color 7,,bipoc7 & _! families4 ,transg5d]1 nonb9>y1 & g5d] expansive individuals1 & specifically ^? :o are ,black1 disabl$1 & at ! int]sections ( multiple =ms ( oppression1 also exp]i5ce inequitable access to abortion s]vices due to sy/emic viol5ce4 ,c5t]+ abortion rights & access z a wom5's heal? issue re/ricts access to ^? ) reproductive ne$s :o d n id5tify z cisg5d] wom54 ,9 ord] to "w t[>ds reproductive ju/ice = all communities1 transg5d]1 nonb9>y1 & g5d] expansive individuals mu/ be c5t]$ 9 conv]sations ( abortion access4 ,improv+ abortion access = ?is community requires a g5d]-neutral approa* to abortion c>e1 rights1 & ju/ice policy4 7#d7 ,! legacy ( re/rictions on reproductive heal?1 rights1 & ju/ice is n a dat$ ve/ige ( a d>k hi/ory4 ,access to abortion s]vices is ob/ruct$ across ! ,unit$ ,/ates 9 v>i\s ways1 includ+ blockades ( heal? c>e facilities & associat$ viol5ce1 prohibitions (1 & re/rictions on1 insurance cov]age1 p>5tal involvem5t laws 7notification & cons5t71 re/rictions t %ame & /igmatize p seek+ abortion s]vices1 & m$ically unnecess>y regulations t nei!r conf] any heal? b5efit nor fur!r ! safety ( abortion s]vices1 b :i* h>m p by delay+1 complicat+ access to1 & r$uc+ ! availability (1 abortion s]vices4 ,z ( ,decemb] #b1 #bjba1 #ai ,/ates h enact$ #ajf re/rictions1 includ+ #ab new abortion bans1 mak+ #bjba ! ye> ) ! highe/ numb] ( re/rictions pass$ s9ce ,roe v4 ,wade 0 decid$ 9 #aigc4 ,additionally1 #ba ,/ates are pois$ to imm$iately ban or significantly re/rict access to abortion s]vices if ! ,supreme ,c\rt *ooses to ov]turn or weak5 ,roe v4 ,wade4 ,^! unprec$5t$ attacks on abortion rights & access fall especially heavily on p ) l[ incomes1 ,,bipoc1 immigrants1 "y p1 p ) disabilities1 ^? liv+ 9 rural & o!r m$ically und]s]v$ areas1 & transg5d]1 nonb9>y1 & g5d] expansive individuals4 7#e7 ,s9ce #aigf1 ! ,f$]al ,gov]nm5t has )held funds = abortion cov]age 9 mo/ circum/ances ?r\gh ! ,hyde am5dm5t & simil> cov]age re/rictions1 affect+ individuals ( reproductive age 9 ! ,unit$ ,/ates :o are insur$ ?r\gh ! ,m$icaid program1 z well z individuals :o receive insurance or c>e ?r\gh o!r ,f$]al heal? plans & programs4 ,( wom5 ag$ #ae to #dd enroll$ 9 ,m$icaid 9 #bjag1 #ee p]c5t liv$ 9 ! #ce ,/ates & ! ,di/rict ( ,columbia t d n cov] abortion1 except 9 limit$ circum/ances4 ,?is am\nts to r\ghly #g1cjj1jjj wom5 ( reproductive age1 includ+ #c1ajj1jjj wom5 liv+ bel[ ! ,f$]al pov]ty level4 ,wom5 ( color are disproportionately likely to be insur$ by ! ,m$icaid program1 & nationwide1 #cb p]c5t ( ,black wom5 & #bg p]c5t ( ,hispanic wom5 ag$ #ae to #dd 7 enroll$ 9 ,m$icaid 9 #bjag1 comp>$ ) #af p]c5t ( ,:ite wom54 7#f7 ,abortion-specific re/rictions are ev5 m comp\nd$ by ! ongo+ crim9alization ( p :o are pregnant1 includ+ ^? :o are inc>c]at$1 liv+ ) ,,hiv1 or ) sub/ance use disord]s4 ,^! communities already exp]i5ce heal? inequities due to social1 political1 & environm5tal inequities1 & re/rictions on abortion s]vices exac]bate ^! h>ms4 ,remov+ m$ically unju/ifi$ re/rictions on abortion s]vices w\ld con/itute "o important /ep on ! pa? t[>d realiz+ reproductive ju/ice by ensur+ t ! full range ( reproductive heal? c>e is accessible to all :o ne$ x4 7#g7 ,abortion-specific re/rictions are a tool ( g5d] oppression1 z !y t>get heal? c>e s]vices t are us$ prim>ily by individuals ) reproductive ne$s4 ,^! pat]nali/ic re/rictions rely on & re9=ce h>mful /]eotypes ab\t g5d] roles1 p's decision mak+1 & p's ne$ = protection in/ead ( support1 und]m9+ _! ability to control _! own lives & well-be+4 ,^! re/rictions h>m ! basic autonomy1 dignity1 & equality ( individuals ) reproductive heal? ne$s1 & _! ability to p>ticipate 9 ! social & economic life ( ! ,nation4 7#h7 ,_m abortion-specific re/rictions d n conf] any heal? or safety b5efits on ! pati5t4 ,in/ead1 ^! re/rictions h ! purpose & effect ( unduly burd5+ p's p]sonal & private m$ical decisions to end _! pregnancies by mak+ access to abortion s]vices m difficult1 invasive1 & co/ly1 (t5 =c+ p to travel significant di/ances & make multiple unnecess>y visits to ! provid]1 & 9 "s cases1 =eclos+ ! option altoge!r4 7#i7 ,congress has us$ its au?ority 9 ! pa/ to protect access to abortion s]vices & heal? c>e provid]s' ability to provide abortion s]vices4 ,9 ! e>ly #aiijs1 prote/s & blockades at heal? c>e facilities :]e abortion s]vices 7 provid$1 & associat$ viol5ce1 increas$ dramatically & rea*$ crisis level1 requir+ congressional action4 ,congress pass$ ! ,fre$om ( ,access to ,cl9ic ,entrances ,act 7,public ,law #ajc-bei2 #ajh ,/at4 #fid7 to address t situation & protect physical access to abortion s]vices4 7#aj7 ,congressional action is necess>y to put an end to h>mful re/rictions1 to f$]ally protect access to abortion s]vices = ev]yone reg>dless ( :]e !y live1 & to protect ! ability ( heal? c>e provid]s to provide ^! s]vices 9 a safe & accessible mann]4 7#aa7 ,! ,equal ,access to ,abortion ,cov]age 9 ,heal? ,insurance ,act ( #bjba or ! ,,ea* ,act ( #bjba 7,h4,r4 #bbcd1 ,s4 #ajba7 introduc$ 9 ! #aag? ,congress1 w\ld rev]se ! ,hyde am5dm5t & relat$ abortion cov]age re/rictions4 ,x w\ld create an en=ceable /atutory "r = p :o receive heal? cov]age or c>e ?r\gh enum]at$ ,f$]al programs 7includ+ ,m$icaid1 ! ,*ildr5's ,heal? ,insurance ,program1 ,m$ic>e1 & ! ,indian ,heal? ,s]vice1 among o!rs7 & plans 7includ+ gov]nm5t-sponsor$ heal? insurance due to a curr5t or =m] employm5t relation%ip7 to receive abortion cov]age4 ,x w\ld require ! ,f$]al ,gov]nm5t to facilitate abortion access = individuals eligible to receive heal? c>e 9 ,f$]al facilities or 9 facilities ) :i* x contracts to provide heal? c>e1 su* z immigration det5tion c5t]s4 ,x also prohibits ! ,f$]al ,gov]nm5t f prohibit+1 re/rict+1 or o!rwise inhibit+ ,/ate or local gov]nm5ts or private heal? insurance issu]s f provid+ abortion cov]age4 7#ab7 ,! ,wom5's ,heal? ,protection ,act ( #bjba 7,h4,r4 #cgee1 ,s4 #aige7 introduc$ 9 ! #aag? ,congress1 w\ld e/abli% an en=ceable /atutory "r = heal? c>e provid]s to provide1 & abortion pati5ts to receive1 abortions free f m$ically unnecess>y re/rictions1 limitations1 & bans t delay1 & at times1 completely ob/ruct1 access to abortion4 7b7 ,s5se ( congress ,x is ! s5se ( ,congress t elim9at+ ! ,hyde am5dm5t1 enact+ ! ,equal ,access to ,abortion ,cov]age 9 ,heal? ,insurance ,act ( #bjba1 & enact+ ! ,wom5's ,heal? ,protection ,act ( #bjba1 are critical to-- 7#a7 promot+ equitable abortion access1 includ+ cov]age1 = all :o seek c>e2 7#b7 creat+ en=ceable rights to receive1 & receive cov]age =1 su* c>e2 7#c7 advanc+ equitable access to compreh5sive heal? cov]age1 :i* _c be a*iev$ )\t abortion cov]age2 & 7#d7 alleviat+ urg5t racial1 g5d]1 & o!r inequities 9 heal? & heal? c>e & correspond+ reproductive inju/ices4 #edjb4 ,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]s1 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 to su* contraceptives )\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 #bjbc ?r\gh #bjbg4 #edjc4 ,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 #edjd4 ,real education & access = heal?y y\? 7a7 ,purpose ,! purpose ( ?is section is to provide "y p ) sex education & sexual heal? s]vices t-- 7#a7 promote & uphold ! rights ( "y p to in=mation & s]vices t emp[] !m to make decisions ab\t _! bodies1 heal?1 sexuality1 families1 & communities 9 all areas ( life2 7#b7 are evid5ce-in=m$1 compreh5sive 9 scope1 confid5tial1 equitable1 accessible1 m$ically accurate & complete1 age & developm5tally appropriate1 culturally responsive1 & trauma-in=m$ & resili5ce-ori5t$2 7#c7 provide in=mation ab\t ! prev5tion1 treatm5t1 & c>e ( pregnancy1 sexually transmitt$ infections1 & int]p]sonal viol5ce2 7#d7 provide in=mation ab\t ! importance ( cons5t z a basis = heal?y relation%ips & = autonomy 9 heal? c>e2 7#e7 provide in=mation on g5d] roles & g5d] discrim9ation2 7#f7 provide in=mation on ! hi/orical & curr5t condition 9 :i* education & heal? sy/ems1 policies1 programs1 s]vices1 & practices h uniquely & adv]sely impact$ ,black1 ,indig5\s1 ,lat9x1 ,asian1 ,asian ,am]ican & ,pacific ,isl&]1 & o!r ,p ( ,color2 & 7#g7 r$ress inequities 9 ! deliv]y ( sex education & sexual heal? s]vices to m>g9aliz$ "y p4 7b7 ,def9itions ,9 ?is section3 7#a7 ,age & developm5tally appropriate ,! t]m age & developm5tally appropriate means topics1 messages1 & tea*+ me?ods suitable to p>ticul> ages1 age gr\ps1 or developm5tal levels1 bas$ on cognitive1 emotional1 social1 & behavioral capacity ( mo/ "y p at t age level4 7#b7 ,*>act]i/ics ( effective programs ,! t]m *>act]i/ics ( effective programs means ! aspects ( evid5ce-in=m$ 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+ 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 un9t5d$ pregnancy1 & int]p]sonal viol5ce among "y p4 7#c7 ,cons5t ,! t]m cons5t means affirmative1 consci\s1 & volunt>y agreem5t to engage 9 int]p]sonal1 physical1 or sexual activity4 7#d7 ,culturally responsive ,! t]m culturally responsive means education & s]vices t-- 7,a7 embrace & actively engage & adju/ to "y p & _! v>i\s cultural id5tities2 7,b7 recognize ! ways 9 :i* _m m>g9aliz$ "y p face unique b>ri]s 9 our society t result 9 increas$ adv]se heal? outcomes & associat$ /]eotypes2 & 7,c7 may address ! ways 9 :i* racism has %ap$ national heal? c>e policy1 ! la/+ hi/orical trauma associat$ ) reproductive heal? exp]im5ts & =c$ /]ilizations ( ,black1 ,lat9x1 & ,indig5\s communities1 or sexual /]eotypes assign$ to "y ,p ( ,color or ,,lgbtq p4 7#e7 ,evid5ce-in=m$ ,! t]m evid5ce-in=m$ means incorporates *>act]i/ics1 cont5t1 or skills t h be5 prov5 to be effective ?r\gh evaluation 9 *ang+ sexual behavior4 7#f7 ,g5d] expression ,! t]m g5d] expression 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#g7 ,g5d] id5tity ,! t]m g5d] id5tity 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?4 7#h7 ,inclusive ,! t]m inclusive means cont5t & skills t ensure m>g9aliz$ "y p are valu$1 respect$1 c5t]$1 & support$ 9 sex education in/ruction & mat]ials4 7#i7 ,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#aj7 ,int]p]sonal viol5ce ,! t]m int]p]sonal viol5ce means abuse1 assault1 bully+1 dat+ viol5ce1 dome/ic viol5ce1 h>assm5t1 intimate p>tn] viol5ce1 or /alk+4 7#aa7 ,m>g9aliz$ "y p ,! t]m m>g9aliz$ "y p means "y p :o are disadvantag$ by und]ly+ /ructural b>ri]s & social inequities1 includ+ "y p :o are-- 7,a7 ,black1 ,indig5\s1 & o!r ,p ( ,color2 7,b7 immigrants2 7,c7 9 contact ) ! fo/] c>e sy/em2 7,d7 9 contact ) ! juv5ile ju/ice sy/em2 7,e7 exp]i5c+ homelessness2 7,f7 pregnant or p>5t+2 7,g7 lesbian1 gay1 bisexual1 transg5d]1 or que]2 7,h7 liv+ ) ,,hiv2 7,i7 liv+ ) disabilities2 7,j7 f families ) l[ incomes2 or 7,k7 liv+ 9 rural areas4 7#ab7 ,m$ically accurate & complete ,! t]m m$ically accurate & complete means t-- 7,a7 ! in=mation provid$ ?r\gh ! education 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 ! education conta9s in=mation t lead+ pr(essional organizations & ag5cies ) relevant exp]tise 9 ! field recognize z accurate1 objective1 & complete4 7#ac7 ,resili5ce ,! t]m resili5ce means ! ability to adapt to trauma & trag$y4 7#ad7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#ae7 ,sex education ,! t]m sex education means high-quality tea*+ & le>n+ t-- 7,a7 is deliv]$1 to ! maximum ext5t practicable1 foll[+ ! ,national ,sexuality ,education ,/&>ds ( ! ,future ( ,sex ,education ,initiative2 7,b7 is ab\t a broad v>iety ( topics relat$ to sex & sexuality1 includ+-- 7i7 pub]ty & adolesc5t developm5t2 7ii7 sexual & reproductive anatomy & physiology2 7iii7 sexual ori5tation1 g5d] id5tity1 & g5d] expression2 7iv7 contraception1 pregnancy1 & reproduction2 7v7 ,,hiv & o!r ,s,t,is2 7vi7 cons5t & heal?y relation%ips2 & 7vii7 int]p]sonal viol5ce2 7,c7 explores values & beliefs ab\t su* topics2 & 7,d7 helps "y p 9 ga9+ ! skills t are ne$$ to navigate relation%ips & manage "o's own sexual heal?4 7#af7 ,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#ag7 ,sexual heal? s]vices ,! t]m sexual heal? s]vices includes-- 7,a7 sexual heal? in=mation1 education1 & c\nsel+2 7,b7 all me?ods ( contraception approv$ by ! ,food & ,drug ,adm9i/ration2 7,c7 r\t9e gynecological c>e1 includ+ human papillomavirus 7,,hpv7 vacc9es & canc] scre5+s2 7,d7 pre-exposure prophylaxis or po/-exposure prophylaxis2 7,e7 sub/ance use & m5tal heal? s]vices2 7,f7 int]p]sonal viol5ce survivor s]vices2 & 7,g7 o!r prev5tion1 c>e1 or treatm5t s]vices4 7#ah7 ,sexual ori5tation ,! t]m sexual ori5tation means an individual's romantic1 emotional1 or sexual attraction to o!r p4 7#ai7 ,trauma ,! t]m trauma means a response to an ev5t1 s]ies ( ev5ts1 or set ( circum/ances t is exp]i5c$ or witness$ by an individual or gr\p ( p z physically or emotionally h>mful or life-?reat5+ ) la/+ adv]se effects on _! function+ & m5tal1 physical1 social1 emotional1 or spiritual well-be+4 7#bj7 ,trauma-in=m$ & resili5ce-ori5t$ ,! t]m trauma-in=m$ & resili5ce-ori5t$ means an approa* t realizes ! preval5ce ( trauma1 recognizes ! v>i\s ways individuals1 organizations1 & communities may respond to trauma diff]5tly1 recognizes t resili5ce c be built1 & responds by putt+ ?is k into practice4 7#ba7 ,"y p ,! t]m "y p means individuals :o are ages #aj ?r\gh #bi at ! "t ( comm5cem5t ( p>ticipation 9 a project support$ "u ?is section4 7#bb7 ,y\?-fri5dly sexual heal? s]vices ,! t]m y\?-fri5dly sexual heal? s]vices means sexual heal? s]vices t are provid$ 9 a confid5tial1 equitable1 & accessible mann] t makes x easy & com=table = "y p to seek out & receive s]vices4 7c7 ,grants = sex education at elem5t>y & second>y s*ools & y\?-,s]v+ organizations 7#a7 ,program au?oriz$ ,! ,secret>y1 9 coord9ation ) ! ,secret>y ( ,education1 %all aw>d grants1 on a competitive basis1 to eligible entities to enable su* eligible entities to c>ry out projects t provide "y p ) sex education4 7#b7 ,duration ,grants aw>d$ "u ?is subsection %all be = a p]iod ( #e ye>s4 7#c7 ,eligible entity ,9 ?is subsection1 ! t]m eligible entity means a public or private entity t deliv]s heal? education to "y p4 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 require4 7#e7 ,priority ,9 aw>d+ grants "u ?is subsection1 ! ,secret>y %all give priority to eligible entities t are-- 7,a7 ,/ate educational ag5cies or local educational ag5cies2 or 7,b7 ,indian ,tribes or ,tribal organizations1 z def9$ 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #ecjd74 7#f7 ,use ( funds ,ea* eligible entity t receives a grant "u ?is subsection %all use ! grant funds to c>ry out a project t provides "y p ) sex education4 7d7 ,grants = 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 /ud5ts ) age & developm5tally appropriate sex education4 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 require4 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$om9antly ,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 ,an in/itution ( high] education or consortium ( su* in/itutions receiv+ a grant "u ?is subsection %all use grant funds to develop & implem5t a project to integrate sex education into ! in/itution ( high] education 9 ord] to rea* a l>ge numb] ( /ud5ts1 by c>ry+ out #a or m ( ! foll[+ activities3 7,a7 ,adopt+ & incorporat+ age & developm5tally appropriate sex education into /ud5t ori5tation1 g5]al education1 or c\rses4 7,b7 ,develop+ or adopt+ & implem5t+ educational programm+ outside ( class t deliv]s age & developm5tally appropriate sex education to /ud5ts4 7,c7 ,develop+ or adopt+ & implem5t+ innovative te*nology-bas$ approa*es to deliv] age & developm5tally appropriate sex education to /ud5ts4 7,d7 ,develop+ or adopt+ & implem5t+ pe]-l$ activities to g5]ate discussion1 educate1 & raise aw>5ess among /ud5ts ab\t age & developm5tally appropriate sex education4 7,e7 ,develop+ or adopt+ & implem5t+ policies & practices to l9k /ud5ts to sexual heal? s]vices4 7e7 ,grants = educator tra9+ 7#a7 ,program au?oriz$ ,! ,secret>y1 9 coord9ation ) ! ,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 subsection %all be = a p]iod ( #e ye>s4 7#c7 ,eligible entity ,9 ?is subsection1 ! t]m eligible entity means-- 7,a7 a ,/ate educational ag5cy or local educational ag5cy2 7,b7 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,c7 a ,/ate or local dep>tm5t ( heal?2 7,d7 an educational s]vice ag5cy2 7,e7 a nonpr(it in/itution ( high] education or a consortium ( su* in/itutions2 or 7,f7 a national or /atewide nonpr(it organization or consortium ( nonpr(it organizations t has z its prim>y purpose ! improvem5t ( provision ( sex education ?r\gh tra9+ & effective tea*+ ( 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 require4 7#e7 ,au?oriz$ activities 7,a7 ,requir$ activity ,ea* eligible entity receiv+ a grant "u ?is subsection %all use grant funds = pr(essional developm5t & tra9+ ( relevant tea*]s1 heal? educators1 faculty1 adm9i/rators1 & /aff1 9 ord] to increase effective tea*+ ( sex education to "y p4 7,b7 ,p]missible activities ,ea* eligible entity receiv+ a grant "u ?is subsection may use grant funds to-- 7i7 provide tra9+ & support = educators ab\t ! cont5t1 skills1 & pr(essional disposition ne$$ to implem5t sex education effectively2 7ii7 develop & provide tra9+ & support to educators on incorporat+ anti-raci/ & g5d]-inclusive policies & practices 9 sex education2 7iii7 support ! dissem9ation ( in=mation on effective practices & rese>* f9d+s conc]n+ ! tea*+ ( sex education2 7iv7 support rese>* on-- 7,i7 effective sex education tea*+ practices2 & 7,,ii7 ! developm5t ( assessm5t in/rum5ts & /rategies to docum5t-- 7aa7 "y p's und]/&+ ( sex education2 & 7bb7 ! effects ( sex education2 7v7 conv5e conf]5ces on sex education1 9 ord] to effectively tra9 educators 9 ! provision ( sex education2 & 7vi7 develop & dissem9ate appropriate rese>*-bas$ mat]ials to fo/] 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 tea*]s1 heal? educators1 faculty1 adm9i/rators1 & /aff on sex education to-- 7i7 tra9 educators 9 sex education2 7ii7 support int]net or di/ance le>n+ relat$ to sex education2 7iii7 promote rigor\s academic /&>ds & assessm5t te*niques to guide & measure /ud5t p]=mance 9 sex education2 7iv7 enc\rage replication ( be/ practices & model programs to promote sex education2 7v7 develop & dissem9ate effective1 rese>*-bas$ sex education le>n+ mat]ials2 or 7vi7 develop academic c\rses on ! p$agogy ( sex education at in/itutions ( high] education4 7f7 ,au?orization ( grants ,to support ! deliv]y ( sexual heal? s]vices to m>g9aliz$ "y p 7#a7 ,program au?oriz$ ,! ,secret>y %all aw>d grants1 on a competitive basis1 to eligible entities to enable su* entities to provide y\?-fri5dly sexual heal? s]vices to m>g9aliz$ "y p4 7#b7 ,duration ,grants aw>d$ "u ?is subsection %all be = a p]iod ( #e ye>s4 7#c7 ,eligible entity ,9 ?is subsection1 ! t]m eligible entity means-- 7,a7 a public or private y\?-s]v+ organization2 or 7,b7 a cov]$ entity1 z def9$ 9 section #cdj;,b ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bef;b74 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 require4 7#e7 ,uses ( funds ,ea* eligible entity t receives a grant "u ?is subsection may use ! grant funds to-- 7,a7 develop & implem5t an evid5ce-in=m$ project to deliv] sexual heal? s]vices to m>g9aliz$ "y p2 7,b7 e/abli%1 alt]1 or modify /aff positions1 s]vice deliv]y policies & practices1 s]vice deliv]y locations1 s]vice deliv]y environm5ts1 s]vice deliv]y s*$ules1 or o!r s]vices compon5ts 9 ord] to increase y\?-fri5dly sexual heal? s]vices to m>g9aliz$ "y p2 7,c7 conduct outrea* to m>g9aliz$ "y p to invite !m to p>ticipate 9 ! eligible entity's sexual heal? s]vices & to provide fe$back to in=m improvem5ts 9 ! deliv]y ( su* s]vices2 7,d7 e/abli% & ref9e sy/ems ( ref]ral to connect m>g9aliz$ "y p to o!r sexual heal? s]vices & supportive s]vices2 7,e7 e/abli% p>tn]%ips & collaborations ) entities provid+ s]vices to m>g9aliz$ "y p to l9k su* "y p to sexual heal? s]vices1 su* z by deliv]+ heal? s]vices at locations :]e !y congregate1 provid+ transportation to locations :]e sexual heal? s]vices are provid$1 or o!r l9kages to s]vices approa*es2 7,f7 provide evid5ce-in=m$1 compreh5sive 9 scope1 confid5tial1 equitable1 accessible1 m$ically accurate & complete1 age & developm5tally appropriate1 culturally responsive1 & trauma-in=m$ & resili5ce-ori5t$ sexual heal? in=mation to m>g9aliz$ "y p 9 ! languages & cultural contexts t are mo/ appropriate = ! m>g9aliz$ "y p to be s]v$ by ! eligible entity2 7,g7 promote effective communication reg>d+ sexual heal? among m>g9aliz$ "y p2 & 7,h7 provide tra9+ & support = eligible entity p]sonnel & community memb]s :o "w ) m>g9aliz$ "y p ab\t ! cont5t1 skills1 & pr(essional disposition ne$$ to provide y\?-fri5dly sex education & y\?-fri5dly sexual heal? s]vices4 7g7 ,report+ & impact evaluation 7#a7 ,grantee report to secret>y ,= ea* ye> an eligible entity receives grant funds "u subsection 7c71 7d71 7e71 or 7f71 ! eligible entity %all submit to ! ,secret>y a report t includes-- 7,a7 ! use ( grant funds by ! eligible entity2 7,b7 h[ ! use ( grant funds has increas$ ! access ( "y p to sex education or sexual heal? s]vices2 & 7,c7 su* o!r in=mation z ! ,secret>y may require4 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 ,congress a report on ! activities 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 7a72 & 7,b7 in=mation ab\t-- 7i7 ! numb] ( eligible entities t are receiv+ grant funds "u subsections 7c71 7d71 7e71 & 7f72 7ii7 ! specific activities support$ by grant funds aw>d$ "u subsections 7c71 7d71 7e71 & 7f72 7iii7 ! numb] ( "y p s]v$ by projects fund$ "u subsections 7c71 7d71 7e71 & 7f71 9 ! aggregate & disaggregat$ & cross-tabulat$ by grant program1 race & e?nicity1 sex1 sexual ori5tation1 g5d] id5tity1 & o!r *>act]i/ics det]m9$ by ! ,secret>y 7except t su* disaggregation or cross-tabulation %all n be requir$ 9 a case 9 :i* ! results w\ld reveal p]sonally id5tifiable in=mation ab\t an individual "y p]son72 7iv7 ! numb] ( tea*]s1 heal? educators1 faculty1 s*ool adm9i/rators1 & /aff tra9$ "u subsection 7e72 & 7v7 ! /atus ( ! evaluation requir$ "u p>agraph 7#c74 7#c7 ,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 evaluations to conduct a multi-ye> evaluation on ! impact ( ! projects fund$ "u subsections 7c71 7d71 7e71 & 7f7 & to report to ,congress & ! ,secret>y on ! f9d+s ( su* evaluation4 7,b7 ,evaluation ,! evaluation conduct$ "u ?is p>agraph %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 7c71 7d71 7e71 or 7f72 & 7iv7 be design$ to provide in=mation on output measures & outcome measures to be det]m9$ by ! ,secret>y4 7,c7 ,report ,n lat] ?an #f ye>s aft] ! date ( enactm5t ( ?is ,act1 ! organization conduct+ ! evaluation "u ?is p>agraph %all prep>e & submit to ! appropriate committees ( ,congress & ! ,secret>y a report on su* evaluation4 ,su* report %all be made publicly available1 includ+ on ! website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7h7 ,nondiscrim9ation ,activities fund$ "u ?is section %all n discrim9ate on ! basis ( actual or p]ceiv$ sex 7includ+ sexual ori5tation & g5d] id5tity71 age1 p>5tal /atus1 race1 color1 e?nicity1 national orig91 disability1 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 7i7 ,limitation ,no ,f$]al funds provid$ "u ?is section may be us$ = sex education or sexual heal? s]vices 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 incomplete2 7#c7 promote g5d] or racial /]eotypes or are unresponsive to g5d] or racial inequities2 7#d7 fail to address ! ne$s ( sexually active "y p2 7#e7 fail to address ! ne$s ( pregnant or p>5t+ "y p2 7#f7 fail to address ! ne$s ( survivors ( int]p]sonal viol5ce2 7#g7 fail to address ! ne$s ( "y p ( all physical1 developm5tal1 or m5tal abilities2 7#h7 fail to be inclusive ( individuals ) v>y+ g5d] id5tities1 g5d] expressions1 & sexual ori5tations2 or 7#i7 are inconsi/5t ) ! e?ical imp]atives ( m$ic9e & public heal?4 7j7 ,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 use4 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>agraphs 7#c71 7#e71 & 7#f72 7,b7 9 p>agraph 7#b71 by ins]t+ or aft] ! semicolon2 7,c7 by r$esignat+ p>agraph 7#d7 z p>agraph 7#c72 & 7,d7 9 p>agraph 7#c71 z r$esignat$ by subp>agraph 7,c71 by /rik+ ! semicolon & ins]t+ a p]iod4 7k7 ,fund+ 7#a7 ,au?orization ,= ! purpose ( c>ry+ out ?is section1 !re is au?oriz$ to be appropriat$ #ajj1jjj1jjj = ea* ( fiscal ye>s #bjbb ?r\gh #bjbg4 ,am\nts appropriat$ "u ?is p>agraph %all rema9 available until exp5d$4 7#b7 ,res]vations ( funds 7,a7 ,9 g5]al ,( ! am\nt au?oriz$ "u p>agraph 7#a71 ! ,secret>y %all res]ve-- 7i7 n m ?an #cj p]c5t = ! purposes ( aw>d+ grants = sex education at elem5t>y & second>y s*ools & y\?-s]v+ organizations "u subsection 7c72 7ii7 n m ?an #aj p]c5t = ! purpose ( aw>d+ grants = sex education at in/itutions ( high] education "u subsection 7d72 7iii7 n m ?an #ae p]c5t = ! purpose ( aw>d+ grants = educator tra9+ "u subsection 7e72 7iv7 n m ?an #cj p]c5t = ! purpose ( aw>d+ grants = sexual heal? s]vices = m>g9aliz$ y\? "u subsection 7f72 & 7v7 n less ?an #e p]c5t = ! purpose ( c>ry+ out ! report+ & impact evaluation requir$ "u subsection 7g74 7,b7 ,rese>*1 tra9+ & te*nical assi/ance ,! ,secret>y %all res]ve n less ?an #aj p]c5t ( ! am\nt au?oriz$ "u p>agraph 7#a7 = 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 sex education & sexual heal? s]vices /&>ds sett+1 design1 developm5t1 deliv]y1 rese>*1 monitor+1 & evaluation4 7#c7 ,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#d7 ,repeal ( ab/95ce only until m>riage program ,section #eaj ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gaj et seq47 is repeal$4 #edje4 ,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 ( subsection 7a77#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 #bjbb1 &-- 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 h be5 approv$ by ! ,food & ,drug ,adm9i/ration = individuals & are a safe & effective way to prev5t pregnancy aft] unprotect$ int]c\rse or contraceptive failure if tak5 9 a timely mann]2 7,,ii7 are m effective ! soon] x is tak52 & 7,,iii7 d n cause an abortion & _c int]rupt an e/abli%$ pregnancy2 7iv7 meet su* conditions reg>d+ ! provision ( su* in=mation 9 languages o!r ?an ,engli% z ! ,secret>y may e/abli%2 & 7v7 are 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 su* individual accepts su* (f]1 imm$iate provision to su* 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$iate (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 ! heal? ( su* individual4 ,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;b7i771 z am5d$ by section #dajf7;b77#b71 is fur!r am5d$-- 7#a7 9 p>agraph 7#bg71 by /rik+ or aft] ! semicolon2 7#b7 9 p>agraph 7#bh71 by /rik+ ! p]iod & ins]t+ 2 or2 & 7#c7 by ins]t+ aft] p>agraph 7#bh7 ! foll[+ new p>agraph3 7#bi7 ) respect to any am\nt exp5d$ = c>e or s]vices furni%$ "u ! plan by a hospital on or aft] ,janu>y #a1 #bjbc1 unless su* hospital meets ! requirem5ts specifi$ 9 section #ahff7l7 = purposes ( title ,,xviii4 4 #edjf4 ,m5/rual ,equity = ,all ,act ( #bjbb 7a7 ,%ort title ,?is section may be cit$ z ! ,m5/rual ,equity = ,all ,act ( #bjbb4 7b7 ,m5/rual products = /ud5ts at elem5t>y & second>y s*ools 7#a7 ,9 g5]al ,section #dajh7e77;,c7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #gaah7e77;,c77 is am5d$-- 7,a7 9 clause 7vi71 by /rik+ or aft] ! semicolon2 7,b7 9 clause 7vii71 by ins]t+ or aft] ! semicolon2 & 7,c7 by add+ at ! end ! foll[+3 7viii7 provide free m5/rual products to /ud5ts :o use m5/rual products2 4 7#b7 ,def9itions ,section #dajb ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #gaab7 is am5d$-- 7,a7 by r$esignat+ p>agraphs 7#f7 ?r\gh 7#h7 z p>agraphs 7#g7 ?r\gh 7#i71 respectively2 & 7,b7 by ins]t+ aft] p>agraph 7#e7 ! foll[+3 7#f7 ,m5/rual products ,! t]m m5/rual products means sanit>y napk9s & tampons t con=m to applicable indu/ry /&>ds4 4 7#c7 ,rulemak+ ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is section1 ! ,secret>y ( ,education1 9 consultation ) ! ,secret>y ( ,heal? & ,human ,s]vices1 %all promulgate rules ) respect to ! def9ition ( m5/rual products 9 p>agraph 7#f7 ( section #dajb ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #gaab71 z am5d$ by p>agraph 7#b74 7c7 ,m5/rual products = /ud5ts at in/itutions ( high] education 7#a7 ,purpose ,! purpose ( ?is section is to alleviate-- 7,a7 ! b>ri]s to academic success fac$ by _m college & graduate /ud5ts due to ! inability ( su* /ud5ts to af=d to pur*ase m5/rual products2 & 7,b7 ! unique set ( burd5s t college & graduate /ud5ts exp]i5c+ p]iod pov]ty face t c be comp\nd$ by lack ( access to basic ne$s su* z h\s+1 food1 transportation1 & access to physical & m5tal heal? s]vices4 7#b7 ,9 g5]al ,! ,secret>y ( ,education %all e/abli% a program to aw>d grants1 on a competitive basis1 to at lea/ #d in/itutions ( high] education1 to-- 7,a7 support programs t provide free m5/rual products to /ud5ts2 & 7,b7 report on be/ practices ( su* programs4 7#c7 ,application ,to apply = a grant "u ?is subsection1 an in/itution ( high] education %all submit to ! ,secret>y an application 9 su* =m1 at su* "t1 & conta9+ su* in=mation z ! ,secret>y det]m9es appropriate1 includ+ an assurance t su* grant w be us$ to c>ry out ! activities describ$ 9 p>agraph 7#e74 7#d7 ,community colleges ,at lea/ #ej p]c5t ( ! grants aw>d$ "u ?is subsection %all be aw>d$ to community colleges4 7#e7 ,grant uses ,a grant aw>d$ "u ?is subsection may only be us$ to-- 7,a7 c>ry out or exp& activities t fund programs t support direct provision ( free m5/rual products to /ud5ts 9 appropriate campus locations1 includ+-- 7i7 campus re/room facilities2 7ii7 wellness c5t]s2 & 7iii7 on-campus resid5tial build+s2 7,b7 report on be/ practices ( su* programs2 7,c7 conduct outrea* to /ud5ts to enc\rage p>ticipation 9 m5/rual equity programs & s]vices2 7,d7 help eligible /ud5ts apply = & enroll 9 local1 ,/ate1 & ,f$]al public assi/ance programs2 & 7,e7 coord9ate & collaborate ) gov]nm5t or community-bas$ organizations to c>ry out ! activities describ$ 9 subp>agraphs 7,a7 ?r\gh 7,d74 7#f7 ,priority ,9 aw>d+ grants "u ?is subsection1 ! ,secret>y %all prioritize-- 7,a7 in/itutions ) ,f$]al ,pell ,grant enrollm5t t is at lea/ #be p]c5t ( ! total enrollm5t ( su* in/itution2 & 7,b7 hi/orically ,black colleges & univ]sities1 ,hispanic-s]v+ in/itutions1 ,asian ,am]ican & ,native ,am]ican ,pacific ,isl&]-s]v+ in/itutions1 & o!r m9ority s]v+ in/itutions4 7#g7 ,m5/rual product def9$ ,9 ?is subsection1 ! t]m m5/rual product means a sanit>y napk9 or tampon t con=ms to indu/ry /&>ds4 7#h7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$1 out ( funds appropriat$ = a fiscal ye> to ! ,fund = ! ,improvem5t ( ,po/second>y ,education "u section #gda ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #aach71 #e1jjj1jjj to c>ry out ! grant program "u ?is subsection4 7d7 ,m5/rual products = inc>c]at$ individuals & deta9ees 7#a7 ,requirem5t = ,/ates ,n lat] ?an #ahj days aft] ! date ( enactm5t ( ?is section1 & annually !reaft]1 ! *ief executive (fic] ( ea* ,/ate t receives a grant "u subp>t #a ( "p ,e ( title ,i ( ! ,omnibus ,crime ,control & ,safe ,/reets ,act ( #aifh 7#cd ,u4,s4,c4 #ajaea et seq47 7commonly ref]r$ to z ! ,edw>d ,byrne ,memorial ,ju/ice ,assi/ance ,grant ,program7 %all submit to ! ,attorney ,g5]al a c]tification1 9 su* =m & conta9+ su* in=mation z ! ,attorney ,g5]al may require1 t-- 7,a7 all inc>c]at$ individuals & deta9ees 9 ! cu/ody ( t ,/ate1 a political subdivision !re(1 or an ag5t ( t ,/ate or a political subdivision !re( h access to m5/rual products-- 7i7 on dem&2 & 7ii7 at no co/ to su* individuals & deta9ees2 & 7,b7 no visitor is prohibit$ f visit+ an inc>c]at$ individual due to ! visitor's use ( m5/rual products4 7#b7 ,r$uction 9 ,grant ,fund+ ,if ! *ief executive (fic] ( a ,/ate fails to submit a c]tification requir$ "u p>agraph 7#a7 dur+ a fiscal ye>1 ! ,attorney ,g5]al %all r$uce ! am\nt t ! ,/ate w\ld h o!rwise receiv$ "u section #eje ( title ,i ( ! ,omnibus ,crime ,control & ,safe ,/reets ,act ( #aifh 7#cd ,u4,s4,c4 #ajaef7 by #bj p]c5t = ! foll[+ fiscal ye>4 7#c7 ,reallocation ,am\nts n allocat$ to a ,/ate "u section #eje ( title ,i ( ! ,omnibus ,crime ,control & ,safe ,/reets ,act ( #aifh 7#cd ,u4,s4,c4 #ajaef7 = a fiscal ye> pursuant to p>agraph 7#b7 %all be reallocat$ "u su* section to ,/ates t submit su* c]tifications4 7#d7 ,m5/rual products ,= ! purposes ( p>agraph 7#a71 ! t]m m5/rual products means sanit>y napk9s & tampons t con=m to applicable indu/ry /&>ds4 7#e7 ,availability = ,f$]al prison]s ,! ,attorney ,g5]al %all issue rules requir+1 & ! ,director ( ! ,bureau ( ,prisons %all take su* actions z may be necess>y to ensure-- 7,a7 ! di/ribution & accessibility 7)\t *>ge7 ( m5/rual products to prison]s 9 ! cu/ody ( ! ,bureau ( ,prisons1 includ+ any prison] 9 a ,f$]al p5al or correctional in/itution1 any ,f$]al prison] 9 a ,/ate p5al or correctional in/itution1 & any ,f$]al prison] 9 a facility adm9i/]$ by a private det5tion entity2 & 7,b7 t ea* prison] describ$ 9 subp>agraph 7,a7 :o requires m5/rual products may receive !m 9 suffici5t quantity4 7#f7 ,availability = deta9ees ,! ,secret>y ( ,homel& ,security %all take su* actions z may be necess>y to ensure t m5/rual products are di/ribut$ & made accessible to ea* ali5 deta9$ by ! ,secret>y ( ,homel& ,security1 includ+ any ali5 9 a facility adm9i/]$ by a private det5tion entity1 at no exp5se to ! ali54 7e7 ,m5/rual products availability = homeless individuals "u ,em]g5cy ,food & ,%elt] ,grant ,program ,section #caf7;a7 ( ! ,mc,kinney-,v5to ,homeless ,assi/ance ,act 7#db ,u4,s4,c4 #aacdf7;a77 is am5d$-- 7#a7 9 p>agraph 7#e71 by /rik+ & at ! end2 7#b7 9 p>agraph 7#f71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7#c7 by add+ at ! end ! foll[+ new p>agraph3 7#g7 guidel9es t ensure t am\nts provid$ "u ! program to private nonpr(it organizations & local gov]nm5ts may be us$ to provide sanit>y napk9s & tampons t con=m to applicable indu/ry /&>ds4 4 7f7 ,m5/rual products cov]$ by ,m$icaid 7#a7 ,9 g5]al ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 z am5d$ by sections #bjjg7;d77#c7 & #ebja7;a77#e77;,g77i71 is am5d$-- 7,a7 9 subsection 7a7-- 7i7 by r$esignat+ p>agraph 7#cb7 z p>agraph 7#cc72 7ii7 9 p>agraph 7#ca71 by /rik+ & aft] ! semicolon2 & 7iii7 by ins]t+ aft] p>agraph 7#ca7 ! foll[+ new p>agraph3 7#cb7 m5/rual products 7z def9$ 9 subsection 7oo772 & 2 & 7,b7 by add+ at ! end ! foll[+3 7oo7 ,m5/rual products ,= purposes ( subsection 7a77#cb71 ! t]m m5/rual products means sanit>y napk9s1 tampons1 l9]s1 cups1 & simil> items us$ by individuals ) respect to m5/ruation & t con=m to indu/ry /&>ds4 4 7#b7 ,effective date 7,a7 ,9 g5]al ,subject to subp>agraph 7,b71 ! am5dm5ts made by ?is subsection %all apply ) respect to m$ical assi/ance furni%$ dur+ or aft] ! fir/ cal5d> qu>t] beg9n+ on or aft] ! date t is #a ye> aft] ! date ( ! enactm5t ( ?is section4 7,b7 ,exception = ,/ate legislation ,9 ! case ( a ,/ate plan "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 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 section1 ! 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 section4 ,= 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 7g7 ,m5/rual products = employees ,section #f ( ! ,occupational ,safety & ,heal? ,act ( #aigj 7#bi ,u4,s4,c4 #fee7 is am5d$ by add+ at ! end ! foll[+3 7h7 ,! ,secret>y %all by rule promulgate a requirem5t t ea* employ] ) n less ?an #ajj employees provide m5/rual products free ( *>ge = employees ( ! employ]4 ,= purposes ( ! prec$+ s5t5ce1 m5/rual products means sanit>y napk9s & tampons t con=m to applicable indu/ry /&>ds4 4 7h7 ,m5/rual products 9 ,f$]al build+s 7#a7 ,def9itions ,9 ?is subsection3 7,a7 ,appropriate au?ority ,! t]m appropriate au?ority means ! head ( a ,f$]al ag5cy1 ! ,ar*itect ( ! ,capitol1 or any o!r (ficial au?ority responsible = ! op]ation ( a cov]$ public build+4 7,b7 ,cov]$ public build+ 7i7 ,9 g5]al ,! t]m cov]$ public build+ means a public build+ 7z def9$ 9 section #ccja7;a7 ( title #dj1 ,unit$ ,/ates ,code7 t is op5 to ! public & conta9s a public re/room4 7ii7 ,inclusions ,! t]m cov]$ public build+ includes specifi$ build+s & gr\nds 7z def9$ 9 section #fcja ( title #dj1 ,unit$ ,/ates ,code7 & ! ,capitol ,build+s 7z def9$ 9 section #eaja ( t title74 7,c7 ,cov]$ re/room ,! t]m cov]$ re/room means a public re/room 9 a cov]$ public build+4 7,d7 ,m5/rual products ,! t]m m5/rual products means sanit>y napk9s & tampons t con=m to applicable indu/ry /&>ds4 7#b7 ,requirem5t ,ea* appropriate au?ority %all ensure t m5/rual products are /ock$ 91 & available free ( *>ge 91 ea* cov]$ re/room 9 ea* cov]$ public build+ "u ! jurisdiction ( t au?ority4 #edjg4 ,additional focus area = ! ,(fice on ,wom5's ,heal? ,section #bbi7;b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bcg;a7b771 z am5d$ by sections #ebaf & #ecja1 is fur!r am5d$ by add+ at ! end ! foll[+3 7#aj7 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 p1 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 a docum5t$ correlation ) consid]able improvem5t 9 outcomes ) no detrim5tal side effects1 su* z smok+ cessation programs 9 pregnancy1 mat]nal immunizations1 & prov5 models 7includ+ gr\p pr5atal c>e1 midwif]y c>e1 & d\la support7 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 ( mat]nity 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 a %>$ und]/&+ ( ! importance = ! safety & *oices ( bir?+ families ( an integrat$ mat]nity c>e sy/em ) seamless processes = consultation1 %>$ c>e1 transf] & transport across mat]nity c>e sett+s1 & provid]s :5 bir?+ p & _! newborns require a high] level ( c>e2 7,g7 high-quality1 evid5ce-bas$ *ildbir? education t-- 7i7 promotes a heal?y & safe approa* to pregnancy1 *ildbir?1 & e>ly p>5t+2 7ii7 is taught by c]tifi$ educators1 pe] c\nselors1 & heal? pr(essionals2 & 7iii7 promotes in=m$ decision mak+ by *ildbe>+ individuals2 & 7,h7 develop+ measures t enable a m robu/1 balanc$ set ( /&>diz$ mat]nity c>e measures1 includ+ p]=mance & quality measures4 4 #edjh4 ,includ+ s]vices furni%$ by c]ta9 /ud5ts1 int]ns1 & resid5ts sup]vis$ by c]tifi$ nurse midwives or c]tifi$ 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 or c]tifi$ 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 or c]tifi$ 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 or c]tifi$ 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 #edji4 ,grants to pr(essional organizations & m9ority-s]v+ in/itutions to increase div]sity 9 mat]nal1 reproductive1 & sexual heal? pr(essionals 7a7 ,grants to heal? pr(essional organizations 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?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> #bjbc1 plann+ grants describ$ 9 p>agraph 7#b72 & 7,b7 = ! subsequ5t #d-ye> p]iod1 implem5tation grants describ$ 9 p>agraph 7#c74 7#b7 ,plann+ grants 7,a7 ,9 g5]al ,plann+ grants describ$ 9 ?is p>agraph are grants = ! foll[+ purposes3 7i7 ,to collect data & id5tify any work=ce inequalities1 ) respect to a heal? pr(ession1 at ea* ( ! foll[+ areas along ! heal? pr(essional cont9uum3 7,i7 ,pipel9e availability1 ) respect to /ud5ts at ! high s*ool & college or univ]sity levels consid]+1 & work+ t[>d1 entrance 9 ! pr(ession1 includ+ b>ri]s trigg]$ by crim9al records4 7,,ii7 ,entrance into ! tra9+ program = ! pr(ession4 7,,iii7 ,graduation f su* tra9+ program4 7,,iv7 ,entrance into practice1 includ+ b>ri]s trigg]$ by crim9al records4 7,v7 ,ret5tion 9 practice = m ?an a #e-ye> p]iod4 7ii7 ,to develop "o or m /rategies to address ! work=ce inequalities )9 ! heal? pr(ession1 z id5tifi$ "u 7& 9 response to ! f9d+s pursuant to7 clause 7i74 7,b7 ,application ,to be eligible to receive a grant "u ?is p>agraph1 an eligible heal? pr(essional organization %all submit to ! ,secret>y 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 p>agraph %all be = an am\nt n to exce$ #cjj1jjj4 7,d7 ,report ,ea* recipi5t ( a grant "u ?is p>agraph %all submit to ! ,secret>y a report conta9+-- 7i7 in=mation on ! ext5t & di/ribution ( work=ce inequities id5tifi$ ?r\gh ! grant2 & 7ii7 reasonable objectives & /rategies develop$ to address su* inequalities )9 a #e-1 #aj-1 & #be-ye> p]iod4 7#c7 ,implem5tation grants 7,a7 ,9 g5]al ,implem5tation grants describ$ 9 ?is p>agraph are grants to implem5t "o or m ( ! /rategies develop$ pursuant to a plann+ grant aw>d$ "u p>agraph 7#b74 7,b7 ,application ,to be eligible to receive a grant "u ?is p>agraph1 an eligible heal? pr(essional organization %all submit to ! ,secret>y an application 9 su* =m & mann] z specifi$ by ! ,secret>y4 ,ea* su* application %all conta9 in=mation on-- 7i7 ! capability ( ! organization to c>ry out a /rategy describ$ 9 subp>agraph 7,a72 7ii7 ! involvem5t ( p>tn]s or coalitions2 & 7iii7 ! organization's plans = develop+ su/a9ability ( ! ef=ts aft] ! culm9ation ( ! grant cycle1 & any o!r in=mation specifi$ by ! ,secret>y4 7,c7 ,am\nt2 duration ,ea* grant aw>d$ "u ?is p>agraph %all be = an am\nt n to exce$ #ejj1jjj ea* ye> ( ! grant4 ,! t]m ( a grant "u ?is subsection %all n exce$ #d ye>s4 7,d7 ,reports ,= ea* ( ! fir/ #c ye>s = :i* an eligible heal? pr(essional organization is aw>d$ a grant "u ?is p>agraph1 ! 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 p>agraph1 ! 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 ( ! organization's outrea* ef=ts4 7#d7 ,eligible heal? pr(essional organization def9$ ,= purposes ( ?is subsection1 ! 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 7b7 ,grants to m9ority-,s]v+ in/itutions 7#a7 ,9 g5]al ,! ,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 c>ry out a grant program "u :i* ! ,secret>y may make to eligible m9ority-s]v+ in/itutions-- 7,a7 = fiscal ye>s #bjbc & #bjbd1 plann+ grants describ$ 9 p>agraph 7#b72 & 7,b7 = ! subsequ5t t5-ye> p]iod1 implem5tation grants describ$ 9 p>agraph 7#c74 7#b7 ,plann+ grants 7,a7 ,9 g5]al ,plann+ grants describ$ 9 ?is p>agraph are grants = plans relat+ to ! foll[+ purposes3 7i7 ,to develop or exp& academic programs to educate mat]nity c>e cl9icians & mat]nity c>e support p]sonnel1 includ+-- 7,i7 nurses ) ! int5tion ( provid+ mat]nity1 newborn1 or sexual & reproductive heal? c>e2 7,,ii7 nurse-practition]s ^: scope ( practice includes mat]nity1 newborn1 or sexual & reproductive heal? c>e2 & 7,,iii7 mat]nity c>e support p]sonnel1 su* z d\las & lactation c\nselors4 7ii7 ,to develop or exp& academic programs to educate ob/etrician-gynecologi/s4 7,b7 ,application ,to be eligible to receive a grant "u ?is p>agraph1 an eligible m9ority-s]v+ in/itution %all submit to ! ,secret>y 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 p>agraph %all be = an am\nt n to exce$ #djj1jjj = ea* ( two ye>s4 7,d7 ,report ,ea* recipi5t ( a grant "u ?is p>agraph %all submit to ! ,secret>y an annual report describ+ ! plann$ developm5t or expansion ( educational programs1 includ+-- 7i7 ! types ( cl9ical or support p]sonnel & ! degrees or c]tificates to be conf]r$2 7ii7 ! associat$ curricula2 7iii7 ! faculty & _! capabilities & commitm5ts1 includ+ any plans = recruitm5t2 7iv7 ! anticipat$ numb] ( /ud5ts to be enroll$ & plans = _! recruitm5t & social1 emotional1 & f9ancial support2 & 7v7 ! objectives & /rategies = address+ inequities & prep>+ /ud5ts to provide high-quality culturally congru5t c>e4 7#c7 ,implem5tation grants 7,a7 ,9 g5]al ,implem5tation grants describ$ 9 ?is p>agraph are grants to implem5t ! /rategies develop$ "u p>agraph 7#b74 7,b7 ,application ,to be eligible to receive a grant "u ?is p>agraph1 an eligible m9ority-s]v+ in/itution %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 ( ! in/itution to c>ry out a /rategy describ$ 9 p>agraph 7#b71 plans = su/a9ability ( ! program aft] ! culm9ation ( ! grant cycle1 & any o!r in=mation specifi$ by ! ,secret>y4 7,c7 ,am\nt ,ea* grant "u ?is p>agraph %all be = an am\nt n to exce$ #a1jjj1jjj ea* ye> dur+ ! #aj-ye> p]iod ( ! grant4 7,d7 ,reports 7i7 ,initial p]iod ,= ea* ( ! fir/ #i ye>s = :i* an eligible m9ority-s]v+ in/itution is aw>d$ a grant "u ?is p>agraph1 ! in/itution %all submit a report to ! ,secret>y on ! activities c>ri$ out by su* in/itution ?r\gh ! grant dur+ su* ye> & objectives = ! subsequ5t ye>4 7ii7 ,f9al ye> ,= ! t5? ye> = :i* an eligible m9ority-s]v+ in/itution is aw>d$ a grant "u ?is p>agraph1 ! organization %all submit to ! ,secret>y a report t includes an analysis ( all ! activities c>ri$ out by ! in/itution ?r\gh ! grant & a detail$ plan = cont9uation ( ! educational program4 7#d7 ,eligible m9ority-s]v+ in/itutions def9$ ,= ! purposes ( ?is subsection1 ! t]m m9ority-s]v+ in/itution means a hi/orically ,black college or univ]sity1 ,tribal college or univ]sity1 ,lat9o-s]v+ in/itution1 ,asian ,am]ican & ,pacific ,isl&] s]v+ in/itution1 or o!r m9ority-s]v+ in/itution ( high] education4 7c7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out-- 7#a7 subsection 7a71 #b1jjj1jjj = fiscal ye> #bjbc & #c1jjj1jjj = ea* ( ! fiscal ye>s #bjbd ?r\gh #bjbg2 & 7#b7 subsection 7b71 #d1jjj1jjj = ea* ( fiscal ye>s #bjbc & #bjbd & #aj1jjj1jjj = ea* ( fiscal ye>s #bjbe ?r\gh #bjcd4 ,f ,*ildr5's ,heal? #eeja4 ,,c>+ = ,kids ,act 7a7 ,p]man5t ext5sion ( ,*ildr5's ,heal? ,insurance ,program 7#a7 ,9 g5]al ,section #bajd7;a77#bh7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7a77#bh77 is am5d$ to read z foll[s3 7#bh7 = fiscal ye> #bjbg & ea* subsequ5t ye>1 su* sums z are necess>y to fund allotm5ts to ,/ates "u subsections 7c7 & 7m74 4 7#b7 ,allotm5ts 7,a7 ,9 g5]al ,section #bajd7m7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7m77 is am5d$-- 7i7 9 p>agraph 7#b77;,b77i71 by /rik+ 11 #bjbc1 & #bjbg & ins]t+ & #bjbc2 7ii7 9 p>agraph 7#g7-- 7,i7 9 subp>agraph 7,a71 by /rik+ & end+ ) fiscal ye> #bjbg12 & 7,,ii7 9 ! flu% left matt] at ! end1 by /rik+ or fiscal ye> #bjbf & ins]t+ fiscal ye> #bjbf1 or a subsequ5t ev5-numb]$ fiscal ye>2 7iii7 9 p>agraph 7#i7-- 7,i7 by /rik+ 7#aj71 or 7#aa7 & ins]t+ or 7#aj72 & 7,,ii7 by /rik+ #bjbc1 or #bjbg1 & ins]t+ or #bjbc2 & 7iv7 by /rik+ p>agraph 7#aa74 7,b7 ,con=m+ am5dm5t ,section #ejaja7;b77#b7 ( ! ,bip>tisan ,budget ,act ( #bjah 7,public ,law #aae-abc7 is repeal$4 7b7 ,p]man5t ext5sions ( o!r programs & demon/ration projects 7#a7 ,p$iatric quality measures program ,section #aaci;,a7i77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;a7i77#a77 is am5d$-- 7,a7 9 subp>agraph 7,c71 by /rik+ at ! end &2 7,b7 9 subp>agraph 7,d71 by /rik+ ! p]iod at ! end & ins]t a semicolon2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraphs3 7,e7 = fiscal ye> #bjbh1 #ae1jjj1jjj = ! purpose ( c>ry+ out ?is section 7o!r ?an subsections 7e71 7f71 & 7g772 & 7,f7 = a subsequ5t fiscal ye>1 ! am\nt appropriat$ "u ?is p>agraph = ! previ\s fiscal ye>1 increas$ by ! p]c5tage increase 9 ! consum] price index = all urban consum]s 7all items2 ,unit$ ,/ates city av]age7 ov] su* previ\s fiscal ye>1 = ! purpose ( c>ry+ out ?is section 7o!r ?an subsections 7e71 7f71 & 7g774 4 7#b7 ,express lane eligibility option ,section #aijb7;e77#ac7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#ac77 is am5d$ by /rik+ subp>agraph 7,i74 7#c7 ,assurance ( af=dability /&>d = *ildr5 & families 7,a7 ,9 g5]al ,section #baje7;d77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7d77#c77 is am5d$-- 7i7 9 ! p>agraph head+1 by /rik+ ?r\gh ,septemb] #cj1 #bjbg2 & 7ii7 9 subp>agraph 7,a71 9 ! matt] prec$+ clause 7i7-- 7,i7 by /rik+ ,dur+ ! p]iod t beg9s on ! date ( enactm5t ( ! ,pati5t ,protection & ,af=dable ,c>e ,act & ends on ,septemb] #cj1 #bjbg & ins]t+ ,beg9n+ on ! date ( ! enactm5t ( ! ,pati5t ,protection & ,af=dable ,c>e ,act2 7,,ii7 by /rik+ ,dur+ ! p]iod t beg9s on ,octob] #a1 #bjai1 & ends on ,septemb] #cj1 #bjbg & ins]t+ ,beg9n+ on ,octob] #a1 #bjai2 & 7,,iii7 by /rik+ ,! prec$+ s5t5ces %all n be con/ru$ z prev5t+ a ,/ate dur+ any su* p]iods f & ins]t+ ,! prec$+ s5t5ces %all n be con/ru$ z prev5t+ a ,/ate f4 7,b7 ,con=m+ am5dm5ts ,section #aijb7;gg77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7gg77#b77 is am5d$-- 7i7 9 ! p>agraph head+1 by /rik+ ?r\gh ,septemb] #cj1 #bjbg2 & 7ii7 by /rik+ ?r\gh ,septemb] #cj & all t foll[s ?r\gh ends on ,septemb] #cj1 #bjbg & ins]t+ 7b beg9n+ on ,octob] #a1 #bjai14 7#d7 ,qualify+ /ates option ,section #baje7;g77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7g77#d77 is am5d$-- 7,a7 9 ! p>agraph head+1 by /rik+ = fiscal ye>s #bjji ?r\gh #bjbg & ins]t+ aft] fiscal ye> #bjjh2 & 7,b7 9 subp>agraph 7,a71 by /rik+ = any ( fiscal ye>s #bjji ?r\gh #bjbg & ins]t+ = any fiscal ye> aft] fiscal ye> #bjjh4 7#e7 ,outrea* & enrollm5t program ,section #baac ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acigmm7 is am5d$-- 7,a7 9 subsection 7a7-- 7i7 9 p>agraph 7#a71 by /rik+ dur+ ! p]iod ( fiscal ye>s #bjji ?r\gh #bjbg & ins]t+ 1 beg9n+ ) fiscal ye> #bjji12 7ii7 9 p>agraph 7#b7-- 7,i7 by /rik+ #aj p]c5t ( su* am\nts & ins]t+ #aj p]c5t ( su* am\nts = ! p]iod or ! fiscal ye> = :i* su* am\nts are appropriat$2 & 7,,ii7 by /rik+ dur+ su* p]iod & ins]t+ 1 dur+ su* p]iod or su* fiscal ye>12 & 7iii7 9 p>agraph 7#c71 by /rik+ ,= ! p]iod ( fiscal ye>s #bjbd ?r\gh #bjbg1 an am\nt equal to #aj p]c5t ( su* am\nts & ins]t+ ,beg9n+ ) fiscal ye> #bjbd1 an am\nt equal to #aj p]c5t ( su* am\nts = ! p]iod or ! fiscal ye> = :i* su* am\nts are appropriat$2 & 7,b7 9 subsection 7g7-- 7i7 by /rik+ #bjag11 & ins]t+ #bjag12 7ii7 by /rik+ & #dh1jjj1jjj & ins]t+ #dh1jjj1jjj2 & 7iii7 by ins]t+ aft] ?r\gh #bjbg ! foll[+3 1 #ab1jjj1jjj = fiscal ye> #bjbh1 &1 = ea* fiscal ye> aft] fiscal ye> #bjbh1 ! am\nt appropriat$ "u ?is subsection = ! previ\s fiscal ye>1 increas$ by ! p]c5tage increase 9 ! consum] price index = all urban consum]s 7all items2 ,unit$ ,/ates city av]age7 ov] su* previ\s fiscal ye>4 7#f7 ,*ild enrollm5t cont+5cy fund ,section #bajd7n7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7n77 is am5d$-- 7,a7 9 p>agraph 7#b7-- 7i7 9 subp>agraph 7,a77ii7-- 7,i7 by /rik+ & #bjbd ?r\gh #bjbf & ins]t+ beg9n+ ) fiscal ye> #bjbd2 & 7,,ii7 by /rik+ #bjbc1 & #bjbg & ins]t+ 1 & #bjbc2 & 7ii7 9 subp>agraph 7,b7-- 7,i7 by /rik+ #bjbd ?r\gh #bjbf & ins]t+ beg9n+ ) fiscal ye> #bjbd2 & 7,,ii7 by /rik+ #bjbc1 & #bjbg & ins]t+ 1 & #bjbc2 & 7,b7 9 p>agraph 7#c77;,a7-- 7i7 by /rik+ fiscal ye>s #bjbd ?r\gh #bjbf & ins]t+ beg9n+ ) fiscal ye> #bjbd2 & 7ii7 by /rik+ #bjbc1 or #bjbg & ins]t+ 1 or #bjbc4 #eejb4 ,end ,diap] ,ne$ ,act ( #bjbb 7a7 ,t>get$ fund+ = diap] assi/ance 7,includ+ diap]+ supplies & adult incont95ce mat]ials & supplies7 ?r\gh ! ,social ,s]vices ,block ,grant ,program 7#a7 ,increase 9 fund+ = ,social ,s]vices ,block ,grant ,program 7,a7 ,9 g5]al ,! am\nt specifi$ 9 subsection 7c7 ( section #bjjc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;b7 = purposes ( subsections 7a7 & 7b7 ( su* section is deem$ to be #a1ijj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbf1 ( :i*1 ! am\nt equal to #bjj1jjj1jjj1 r$uc$ by ! am\nts res]v$ "u subp>agraph 7,b77ii7 = ea* su* fiscal ye>1 %all be obligat$ by ,/ates 9 accordance ) p>agraph 7#b74 7,b7 ,appropriation 7i7 ,9 g5]al ,out ( any money 9 ! ,treasury ( ! ,unit$ ,/ates n o!rwise appropriat$1 !re is appropriat$ #bjj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbf1 to c>ry out ?is subsection4 7ii7 ,res]vations 7,i7 ,purposes ,! ,secret>y %all res]ve1 f ! am\nt appropriat$ "u clause 7i7 to c>ry out ?is subsection-- 7aa7 = ea* ( fiscal ye>s #bjbc ?r\gh #bjbf1 n m ?an #b p]c5t ( ! am\nt appropriat$ = ! fiscal ye> = purposes ( ent]+ into an agreem5t ) a national entity describ$ 9 clause 7iii7 to assi/ 9 provid+ te*nical assi/ance & tra9+1 to support effective policy1 practice1 rese>*1 & cross-sy/em collaboration among grantees & subgrantees1 & to assi/ 9 ! adm9i/ration ( ! program describ$ 9 ?is subsection2 & 7bb7 = fiscal ye> #bjbc1 an am\nt1 n to exce$ #b1jjj1jjj1 = purposes ( conduct+ an evaluation "u p>agraph 7#d74 7,,ii7 ,no ,/ate entitlem5t to res]v$ funds ,! ,/ate entitlem5t "u section #bjjb7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;a7a77 %all n apply to ! am\nts res]v$ "u subclause 7,i74 7iii7 ,national entity describ$ ,a national entity describ$ 9 ?is clause is a nonpr(it organization describ$ 9 section #eja7;c77#c7 ( ! ,int]nal ,rev5ue ,code ( #aihf & exempt f taxation "u section #eja7;a7 ( su* ,code1 t-- 7,i7 has exp]i5ce 9 m ?an #a ,/ate 9 ! area (-- 7aa7 community di/ributions ( basic ne$ s]vices1 includ+ exp]i5ce collect+1 w>eh\s+1 & di/ribut+ basic necessities su* z diap]s1 food1 or m5/rual products2 7bb7 *ild c>e2 7cc7 *ild developm5t activities 9 l[-income communities2 or 7dd7 mo!rhood1 fa!rhood1 or p>5t education ef=ts s]v+ l[-income p>5ts ( "y *ildr52 7,,ii7 demon/rates compet5cy to implem5t a project1 provide fiscal acc\ntability1 collect data1 & prep>e reports & o!r necess>y docum5tation2 & 7,,iii7 demon/rates a will+ness to %>e in=mation ) rese>*]s1 practition]s1 & o!r int]e/$ p>ties4 7#b7 ,rules gov]n+ use ( additional funds 7,a7 ,9 g5]al ,funds are us$ 9 accordance ) ?is p>agraph if-- 7i7 ! ,/ate1 9 consultation ) relevant /akehold]s1 includ+ ag5cies1 pr(essional associations1 & nonpr(it organizations1 di/ributes ! funds to eligible entities to-- 7,i7 decrease ! ne$ = diap]s & diap]+ supplies & adult incont95ce mat]ials & supplies 9 l[-income families & meet su* unmet ne$s ( infants & toddl]s1 m$ically complex *ildr51 & l[-income adults & adults ) disabilities 9 su* families ?r\gh-- 7aa7 ! di/ribution ( free diap]s & diap]+ supplies1 m$ically necess>y diap]s1 & adult incont95ce mat]ials & supplies2 7bb7 community outrea* to assi/ 9 p>ticipation 9 exi/+ diap] di/ribution programs or programs t di/ribute m$ically necess>y diap]s or adult incont95ce mat]ials & supplies2 or 7cc7 improv+ access to diap]s & diap]+ supplies1 m$ically necess>y diap]s1 & adult incont95ce mat]ials & supplies2 & 7,,ii7 increase ! ability ( communities & l[-income families 9 su* communities to provide = ! ne$ = diap]s & diap]+ supplies1 m$ically necess>y diap]s1 & adult incont95ce mat]ials & supplies1 ( infants & toddl]s1 m$ically complex *ildr51 & l[-income adults & adults ) disabilities2 7ii7 ! funds are us$ subject to ! limitations 9 section #bjje ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;d72 7iii7 ! funds are us$ to supplem5t1 n supplant1 ,/ate g5]al rev5ue funds provid$ = ! purposes describ$ 9 clause 7i72 & 7iv7 ! funds are n us$ = co/s t are reimbursable by ! ,f$]al ,em]g5cy ,managem5t ,ag5cy1 "u a contract = insurance1 or by self-insurance4 7,b7 ,all[able uses by eligible entities ,an eligible entity receiv+ funds made available "u p>agraph 7#a7 %all use ! funds = any ( ! foll[+3 7i7 ,to pay = ! pur*ase & di/ribution ( diap]s & diap]+ supplies1 m$ically necess>y diap]s1 & fund+ diap] 7includ+ m$ically necess>y diap]s7 di/ribution t s]ves l[-income families )-- 7,i7 #a or m *ildr5 #c ye>s ( age or y\ng]2 or 7,,ii7 #a or m m$ically complex *ildr54 7ii7 ,to pay = ! pur*ase & di/ribution ( adult incont95ce mat]ials & supplies & fund+ di/ribution ( su* mat]ials & supplies t s]ves l[-income families ) #a or m l[-income adults or adults ) disabilities :o rely on adult incont95ce mat]ials & supplies4 7iii7 ,to integrate activities c>ri$ out "u clause 7i7 ) o!r basic ne$s assi/ance programs s]v+ eligible *ildr5 & _! families1 includ+ ! foll[+3 7,i7 ,programs fund$ by ! tempor>y assi/ance = ne$y families program "u "p ,a ( title ,,iv ( ! ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq471 includ+ ! ,/ate ma9t5ance ( ef=t provisions ( su* program4 7,,ii7 ,programs design$ to support ! heal? ( eligible *ildr51 su* z ! ,*ildr5's ,heal? ,insurance ,program "u title ,,xxi ( ! ,social ,security ,act1 ! ,m$icaid program "u title ,,xix ( su* ,act1 or ,/ate-fund$ heal? c>e programs4 7,,iii7 ,programs fund$ ?r\gh ! special supplem5tal nutrition program = wom51 infants1 & *ildr5 "u section #ag ( ! ,*ild ,nutrition ,act ( #aiff4 7,,iv7 ,programs t (f] e>ly home visit+ s]vices1 includ+ ! mat]nal1 infant1 & e>ly *ildhood home visit+ program 7includ+ ! ,tribal home visit+ program7 "u section #eaa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gaa74 7,v7 ,programs to provide improv$ & af=dable access to *ild c>e1 includ+ programs fund$ ?r\gh ! ,*ild ,c>e & ,developm5t ,fund1 ! tempor>y assi/ance = ne$y families program "u "p ,a ( title ,,iv ( ! ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq471 or a ,/ate-fund$ program4 7,c7 ,availability ( funds 7i7 ,funds di/ribut$ to eligible entities ,funds made available "u p>agraph 7#a7 t are di/ribut$ to an eligible entity by a ,/ate = a fiscal ye> may be exp5d$ by ! eligible entity only 9 su* fiscal ye> or ! succe$+ fiscal ye>4 7ii7 ,evaluation ,funds res]v$ "u p>agraph 7#a77;,b77ii77,i77aa7 to c>ry out ! evaluation "u p>agraph 7#d7 %all be available = exp5diture dur+ ! #c-ye> p]iod t beg9s on ! date ( enactm5t ( ?is ,act4 7,d7 ,no effect on o!r programs ,any assi/ance or b5efits receiv$ by a family ?r\gh funds made available "u p>agraph 7#a7 %all be disreg>d$ = purposes ( det]m9+ ! family's eligibility =1 or am\nt (1 b5efits "u any o!r ,f$]al ne$s-bas$ programs4 7#c7 ,annual reports ,a ,/ate %all include 9 ! annual report requir$ "u section #bjjf ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;e7 cov]+ ea* ( fiscal ye>s #bjbb ?r\gh #bjbe1 in=mation detail+ h[ eligible entities1 includ+ subgrantees1 us$ funds made available "u p>agraph 7#a7 to di/ribute diap]s & diap]+ supplies & adult incont95ce mat]ials & supplies to families 9 ne$4 ,ea* su* report %all include ! foll[+3 7,a7 ,! numb] & age ( infants1 toddl]s1 m$ically complex *ildr51 & l[-income adults & adults ) disabilities :o receiv$ assi/ance or b5efits ?r\gh su* funds4 7,b7 ,! numb] ( families t h receiv$ assi/ance or b5efits ?r\gh su* funds4 7,c7 ,! numb] ( diap]s1 m$ically necess>y diap]s1 or adult incont95ce mat]ials & supplies 7su* z adult diap]s1 briefs1 protective und]we>1 pull-ons1 pull-ups1 l9]s1 %ields1 gu>ds1 pads1 und]g>m5ts71 & ! numb] ( ea* type ( diap]+ or adult incont95ce supply1 di/ribut$ ?r\gh ! use ( su* funds4 7,d7 ,! ,,zip ,code or ,,zip ,codes :]e ! eligible entity 7or subgrantee7 di/ribut$ diap]s & diap]+ supplies & adult incont95ce mat]ials & supplies4 7,e7 ,! me?od or me?ods ! eligible entity 7or subgrantee7 uses to di/ribute diap]s & diap]+ supplies &1 adult incont95ce mat]ials & supplies4 7,f7 ,su* o!r in=mation z ! ,secret>y may specify4 7#d7 ,evaluation ,! ,secret>y1 9 consultation ) ,/ates1 ! national entity describ$ 9 p>agraph 7#a77;,b77iii71 & eligible entities receiv+ funds made available "u ?is subsection1 %all-- 7,a7 n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act-- 7i7 complete an evaluation ( ! effectiv5ess ( ! assi/ance program c>ri$ out pursuant to ?is subsection1 su* z ! effect ( activities c>ri$ out "u ?is section on mitigat+ ! heal? & developm5tal risks ( unmet diap] ne$ among infants1 toddl]s1 m$ically complex *ildr51 & o!r family memb]s 9 l[-income families1 includ+ ! risks ( diap] d]matitis1 ur9>y tract infections1 & p>5tal & *ild depression & anxiety2 7ii7 submit to ! relevant congressional committees a report on ! results ( su* evaluation2 & 7iii7 publi% ! results ( ! evaluation on ! int]net website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices2 7,b7 n lat] ?an #c ye>s aft] ! date ( enactm5t ( ?is ,act1 update ! evaluation requir$ by subp>agraph 7,a77i72 & 7,c7 n lat] ?an #ij days aft] completion ( ! updat$ evaluation "u subp>agraph 7,b7-- 7i7 submit to ! relevant congressional committees a report describ+ ! results ( su* updat$ evaluation2 & 7ii7 publi% ! results ( su* evaluation on ! int]net website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7#e7 ,guidance ,n lat] ?an #ahj days aft] enactm5t ( ?is ,act1 ! ,secret>y %all issue guidance reg>d+ h[ ! provisions ( ?is subsection %\ld be c>ri$ out1 includ+ in=mation reg>d+ eligible entities1 all[able use ( funds1 & report+ requirem5ts4 7#f7 ,def9itions ,9 ?is subsection3 7,a7 ,adult incont95ce mat]ials & supplies ,! t]m adult incont95ce mat]ials & supplies means ^? supplies t are us$ to assi/ l[-income adults or adults ) disabilities & includes adult diap]s1 briefs1 protective und]we>1 pull-ons1 pull-ups1 l9]s1 %ields1 gu>ds1 pads1 und]g>m5ts1 disposable wipes1 ov]-!-c\nt] adult diap] ra% cream products1 int]mitt5t ca!t]ization1 indwell+ ca!t]s1 condom ca!t]s1 ur9>y dra9age bags1 ext]nal collection devices1 we>able ur9als1 & p5ile clamps4 7,b7 ,adults ) disabilities ,! t]m adults ) disabilities means individuals :o-- 7i7 h atta9$ age #ah2 & 7ii7 h a disability 7z su* t]m is def9$1 ) respect to an individual1 9 section #c ( ! ,am]icans ) ,disabilities ,act ( #aiij 7#db ,u4,s4,c4 #abajb774 7,c7 ,diap] ,! t]m diap] means an absorb5t g>m5t t-- 7i7 is wa%able or disposable t may be worn by an infant or toddl] :o is n toilet-tra9$2 & 7ii7 if disposable-- 7,i7 does n use any latex or common all]g5s2 & 7,,ii7 meets or exce$s ! quality /&>ds = diap]s comm]cially available ?r\gh retail sale 9 ! foll[+ categories3 7aa7 ,absorb5cy 7) acceptable rates = fir/ & second wett+74 7bb7 ,wat]pro( out] cov]4 7cc7 ,flexible leg op5+s4 7dd7 ,refa/5+ closures4 7,d7 ,diap]+ supplies ,! t]m diap]+ supplies means items1 includ+ diap] wipes & diap] cream1 necess>y to ensure t-- 7i7 an eligible *ild us+ a diap] is prop]ly clean$ & protect$ f diap] ra%2 or 7ii7 a m$ically complex *ild :o uses a m$ically necess>y diap] is prop]ly clean$ & protect$ f diap] ra%4 7,e7 ,eligible *ild ,! t]m eligible *ild means a *ild :o-- 7i7 has n atta9$ #d ye>s ( age2 & 7ii7 is a memb] ( a l[-income family4 7,f7 ,eligible entities ,! t]m eligible entity means a ,/ate or local gov]nm5tal entity1 an ,indian tribe or tribal organization 7z def9$ 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act71 or a nonpr(it organization describ$ 9 section #eja7;c77#c7 ( ! ,int]nal ,rev5ue ,code ( #aihf & exempt f taxation "u section #eja7;a7 ( su* ,code t-- 7i7 has exp]i5ce 9 ! area (-- 7,i7 community di/ributions ( basic ne$ s]vices1 includ+ exp]i5ce collect+1 w>eh\s+1 & di/ribut+ basic necessities su* z diap]s1 food1 or m5/rual products2 7,,ii7 *ild c>e2 7,,iii7 *ild developm5t activities 9 l[-income communities2 or 7,,iv7 mo!rhood1 fa!rhood1 or p>5t education ef=ts s]v+ l[-income p>5ts ( "y *ildr52 7ii7 demon/rates compet5cy to implem5t a project1 provide fiscal acc\ntability1 collect data1 & prep>e reports & o!r necess>y docum5tation2 & 7iii7 demon/rates a will+ness to %>e in=mation ) rese>*]s1 practition]s1 & o!r int]e/$ p>ties4 7,g7 ,f$]al pov]ty l9e ,! t]m ,f$]al pov]ty l9e means ! ,f$]al pov]ty l9e z def9$ by ! ,(fice ( ,managem5t & ,budget & revis$ annually 9 accordance ) section #fgc7b7 ( ! ,omnibus ,budget ,reconciliation ,act ( #aiha applicable to a family ( ! size involv$4 7,h7 ,l[-income ,! t]m l[-income1 ) respect to a family1 means a family ^: self-c]tifi$ income is n m ?an #bjj p]c5t ( ! ,f$]al pov]ty l9e4 7,i7 ,m$ically complex *ild ,! t]m m$ically complex *ild means an individual :o has atta9$ age #c & = :om a lic5s$ heal? c>e provid] has provid$ a diagnosis ( b[el or bladd] incont95ce1 a b[el or bladd] condition t causes excess ur9e or /ool 7su* z %ort gut syndrome or diabetes insipidus71 or a sev]e sk9 condition t causes sk9 erosions 7su* z epid]molysis bullosa74 7,j7 ,m$ically necess>y diap] ,! t]m m$ically necess>y diap] means an absorb5t g>m5t t is-- 7i7 wa%able or disposable2 7ii7 worn by a m$ically complex *ild :o has be5 diagnos$ ) b[el or bladd] incont95ce1 a b[el or bladd] condition t causes excess ur9e or /ool 7su* z %ort gut syndrome or diabetes insipidus71 or a sev]e sk9 condition t causes sk9 erosions 7su* z epid]molysis bullosa7 & ne$s su* g>m5t to correct or ameliorate su* condition2 & 7iii7 if disposable-- 7,i7 does n use any latex or common all]g5s2 & 7,,ii7 meets or exce$s ! quality /&>ds = diap]s comm]cially available ?r\gh retail sale 9 ! foll[+ categories3 7aa7 ,absorb5cy 7) acceptable rates = fir/ & second wett+74 7bb7 ,wat]pro( out] cov]4 7cc7 ,flexible leg op5+s4 7dd7 ,refa/5+ closures4 7#g7 ,exemption ( program f seque/ration 7,a7 ,9 g5]al ,section #bee7;h7 ( ! ,balanc$ ,budget & ,em]g5cy ,deficit ,control ,act ( #aihe 7#b ,u4,s4,c4 #ije7;h77 is am5d$ by ins]t+ aft] ,supplem5tal ,security ,income ,program 7#bh-jdjf-j-a-fji74 ! foll[+3 ,t>get$ fund+ = ,/ates = diap] assi/ance 7includ+ diap]+ supplies & adult incont95ce mat]ials & supplies7 ?r\gh ! ,social ,s]vices ,block ,grant ,program4 4 7,b7 ,applicability ,! am5dm5t made by ?is p>agraph %all apply to any seque/ration ord] issu$ "u ! ,balanc$ ,budget & ,em]g5cy ,deficit ,control ,act ( #aihe 7#b ,u4,s4,c4 #ijj et seq47 on or aft] ! date ( enactm5t ( ?is ,act4 7b7 ,improv+ access to diap]s = m$ically complex *ildr5 ,section #aiae7;c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifn7c77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#aa7 7,a7 ,9 ! case ( any waiv] "u ?is subsection t provides m$ical assi/ance to a m$ically complex *ild :o has be5 diagnos$ ) b[el or bladd] incont95ce1 a b[el or bladd] condition t causes excess ur9e or /ool 7su* z %ort gut syndrome or diabetes insipidus71 or a sev]e sk9 condition t causes sk9 erosions 7su* z epid]molysis bullosa71 su* m$ical assi/ance %all include1 = ! duration ( ! waiv]1 ! provision ( #bjj m$ically necess>y diap]s p] mon? & diap]+ supplies4 ,su* m$ical assi/ance may include ! provision ( m$ically necess>y diap]s 9 am\nts great] ?an #bjj if a lic5s$ heal? c>e provid] 7su* z a physician1 nurse practition]1 or physician assi/ant7 specifies t su* great] am\nts are necess>y = su* m$ically complex *ild4 7,b7 ,= purposes ( ?is p>agraph3 7i7 ,! t]m m$ically complex *ild means an individual :o has atta9$ age #c & = :om a lic5s$ heal? c>e provid] has provid$ a diagnosis ( #a or m significant *ronic conditions4 7ii7 ,! t]m m$ically necess>y diap] means an absorb5t g>m5t t is-- 7,i7 wa%able or disposable2 7,,ii7 worn by a m$ically complex *ild :o has be5 diagnos$ ) a condition describ$ 9 subp>agraph 7,a7 & ne$s su* g>m5t to correct or ameliorate su* condition2 & 7,,iii7 if disposable-- 7aa7 does n use any latex or common all]g5s2 & 7bb7 meets or exce$s ! quality /&>ds = diap]s comm]cially available ?r\gh retail sale 9 ! foll[+ categories3 7,,aa7 ,absorb5cy 7) acceptable rates = fir/ & second wett+74 7,,bb7 ,wat]pro( out] cov]4 7,,cc7 ,flexible leg op5+s4 7,,dd7 ,refa/5+ closures4 7iii7 ,! t]m diap]+ supplies means items1 includ+ diap] wipes & diap] creams1 necess>y to ensure t a m$ically complex *ild :o has be5 diagnos$ ) a condition describ$ 9 subp>agraph 7,a7 & uses a m$ically necess>y diap] is prop]ly clean$ & protect$ f diap] ra%4 4 7c7 ,inclusion ( diap]s & diap]+ supplies z qualifi$ m$ical exp5ses 7#a7 ,heal? sav+s acc\nts ,section #bbc7;d77#b7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7,a7 by ins]t+ 1 m$ically necess>y diap]s1 & diap]+ supplies aft] m5/rual c>e products 9 ! la/ s5t5ce ( subp>agraph 7,a72 & 7,b7 by add+ at ! end ! foll[+ new subp>agraph3 7,e7 ,m$ically necess>y diap]s & diap]+ supplies ,= purposes ( ?is p>agraph-- 7i7 ,m$ically necess>y diap]s ,! t]m m$ically necess>y diap] means an absorb5t g>m5t :i* is wa%able or disposable & :i* is worn by an individual :o has atta9$ #c ye>s ( age because ( m$ical necessity1 su* z someone :o has be5 diagnos$ ) b[el or bladd] incont95ce1 a b[el or bladd] condition t causes excess ur9e or /ool 7su* z %ort gut syndrome or diabetes insipidus71 or a sev]e sk9 condition t causes sk9 erosions 7su* z epid]molysis bullosa7 & ne$s su* g>m5t to correct or ameliorate su* condition1 to s]ve a prev5tative m$ical purpose1 or to correct or ameliorate defects or physical or m5tal illnesses or conditions diagnos$ by a lic5s$ heal? c>e provid]1 &1 if disposable-- 7,i7 does n use any latex or common all]g5s2 & 7,,ii7 meets or exce$s ! quality /&>ds = diap]s comm]cially available ?r\gh retail sale 9 ! foll[+ categories3 7aa7 ,absorb5cy 7) acceptable rates = fir/ & second wett+74 7bb7 ,wat]pro( out] cov]4 7cc7 ,flexible leg op5+s4 7dd7 ,refa/5+ closures4 7ii7 ,diap]+ supplies ,! t]m diap]+ supplies means items1 includ+ diap] wipes & diap] creams1 necess>y to ensure t an individual we>+ m$ically necess>y diap]s is prop]ly clean$ & protect$ f diap] ra%4 4 7#b7 ,ar*] ,m,s,as ,! la/ s5t5ce ( section #bbj7;d77#b77;,a7 ( su* ,code is am5d$ by ins]t+ 1 m$ically necess>y diap]s 7z def9$ 9 section #bbc7;d77#b77;,e771 & diap]+ supplies 7z def9$ 9 section #bbc7;d77#b77;,e77 aft] m5/rual c>e products 7z def9$ 9 section #bbc7;d77#b77;,d774 7#c7 ,heal? flexible sp5d+ arrangem5ts & heal? reimbursem5t arrangem5ts ,section #ajf7;f7 ( su* ,code is am5d$-- 7,a7 by ins]t+ 1 m$ically necess>y diap]s 7z def9$ 9 section #bbc7;d77#b77;,e771 & diap]+ supplies 7z def9$ 9 section #bbc7;d77#b77;,e77 aft] m5/rual c>e products 7z def9$ 9 section #bbc7;d77#b77;,d772 & 7,b7 9 ! head+1 by ins]t+ 1 m$ically necess>y diap]s1 & diap]+ supplies aft] m5/rual c>e products4 7#d7 ,effective dates 7,a7 ,di/ributions f c]ta9 acc\nts ,! am5dm5ts made by p>agraphs 7#a7 & 7#b7 %all apply to am\nts paid aft] ,decemb] #ca1 #bjbc4 7,b7 ,reimbursem5ts ,! am5dm5t made by p>agraph 7#c7 %all apply to exp5ses incurr$ aft] ,decemb] #ca1 #bjbc4 #eejc4 ,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? inequities ?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 p1 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 #bjbc ?r\gh #bjbg4 ,g ,nutrition = ,wom51 ,*ildr51 ,families #efja4 ,clos+ ! meal gap 7a7 ,elim9ation ( "t limit 7#a7 ,9 g5]al ,section #f ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjae7 is am5d$-- 7,a7 by /rik+ subsection 7o72 & 7,b7 by r$esignat+ subsections 7p7 ?r\gh 7s7 z subsections 7o7 ?r\gh 7r71 respectively4 7#b7 ,additional allocations = /ates t ensure availability ( "w opportunities ,section #af7;h7 ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjbe7;h77 is am5d$-- 7,a7 9 p>agraph 7#a7-- 7i7 9 subp>agraph 7,c77iv77,i7-- 7,i7 by /rik+ 7,f77viii7 ea* place x appe>s & ins]t+ 7,e77viii72 7,,ii7 by /rik+ 7,f77vii77,i7 ea* place x appe>s & ins]t+ 7,e77vii77,i72 7,,iii7 9 item 7bb77,,bb71 by /rik+ 7,f77vii77,,ii7 & ins]t+ 7,e77vii77,,ii72 & 7,,iv7 9 item 7cc71 by /rik+ 7,f77vii7 & ins]t+ 7,e77vii72 7ii7 by /rik+ subp>agraph 7,e72 & 7iii7 by r$esignat+ subp>agraph 7,f7 z subp>agraph 7,e72 7,b7 9 p>agraphs 7#c7 & 7#d71 by /rik+ 7#a77;,f7 ea* place x appe>s & ins]t+ 7#a77;,e72 & 7,c7 9 p>agraph 7#e77;,c7-- 7i7 9 clause 7ii71 by add+ & at ! end2 7ii7 9 clause 7iii71 by /rik+ 2 & & ins]t+ a p]iod2 & 7iii7 by /rik+ clause 7iv74 7#c7 ,con=m+ am5dm5ts 7,a7 ,section #e ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjad7 is am5d$-- 7i7 9 subsection 7a71 9 ! second s5t5ce1 by /rik+ 7r7 & ins]t+ 7q72 & 7ii7 9 subsection 7g77#c71 9 ! fir/ s5t5ce1 by /rik+ #af7;h77#a77;,f7 & ins]t+ #af7;h77#a77;,e74 7,b7 ,section #f7;d77#d7 ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjae7;d77#d77 is am5d$-- 7i7 9 subp>agraph 7,b77ii77,i77bb77,,dd71 by /rik+ or subsection 7o72 & 7ii7 9 subp>agraph 7,n71 by /rik+ or subsection 7o7 ea* place x appe>s4 7,c7 ,section #g ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjaf7 is am5d$-- 7i7 9 subsection 7a71 by /rik+ ,except z provid$ 9 subsection 7i71 ,,ebt & ins]t+ ,,ebt2 7ii7 9 subsection 7f77#c7-- 7,i7 by /rik+ subp>agraph 7,b72 & 7,,ii7 by r$esignat+ subp>agraph 7,c7 z subp>agraph 7,b72 7iii7 9 subsection 7h7-- 7,i7 9 p>agraph 7#ac77;,b71 by /rik+ subsection 7j77#a77;,h7 & ins]t+ subsection 7i77#a72 & 7,,ii7 9 p>agraph 7#ad77;,b77ii77,,iii71 by /rik+ section #g7;f77#b77;,b7 & ins]t+ subsection 7f77#b77;,b72 7iv7 by /rik+ subsection 7i72 & 7v7 by r$esignat+ subsections 7j7 & 7k7 z subsections 7i7 & 7j71 respectively4 7,d7 ,section #af7;h77#a7 ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjbe7;h77 is am5d$-- 7i7 9 subp>agraph 7,b71 9 ! matt] prec$+ clause 7i71 by /rik+ t-- & all t foll[s ?r\gh ! p]iod at ! end ( clause 7ii7 & ins]t+ t is det]m9$ & adju/$ by ! ,secret>y42 & 7ii7 9 clause 7ii77,,iii77ee77,,aa7 ( subp>agraph 7,e7 7z r$esignat$ by p>agraph 7#b77;,a77iii771 by /rik+ 1 individuals subject to ! requirem5ts "u section #f7o714 7,e7 ,section #ag7;b77#a77;,b77iv7 ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjbf7;b77#a77;,b77iv77 is am5d$-- 7i7 9 subclause 7,v71 by add+ or at ! end aft] ! semicolon2 7ii7 9 subclause 7,,vi71 by /rik+ 2 or & ins]t+ a p]iod2 & 7iii7 by /rik+ subclause 7,,vii74 7,f7 ,section #ea7;d77#h77;,a77ii7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7i7 9 subclause 7,i71 by /rik+ 1 or at ! end & ins]t+ a p]iod2 7ii7 9 ! matt] prec$+ subclause 7,i71 by /rik+ family-- & all t foll[s ?r\gh receiv+ 9 subclause 7,i7 & ins]t+ family receiv+2 & 7iii7 by /rik+ subclause 7,,ii74 7,g7 ,section #ajc7;a77#b7 ( ! ,work=ce ,innovation & ,opportunity ,act 7#bi ,u4,s4,c4 #caac7 is am5d$-- 7i7 by /rik+ subp>agraph 7,d72 & 7ii7 by r$esignat+ subp>agraphs 7,e7 ?r\gh 7,k7 z subp>agraphs 7,d7 ?r\gh 7,j71 respectively4 7,h7 ,section #aba7;b77#b77;,b7 ( ! ,work=ce ,innovation & ,opportunity ,act 7#bi ,u4,s4,c4 #caea7 is am5d$-- 7i7 by /rik+ clause 7iv72 & 7ii7 by r$esignat+ clauses 7v7 ?r\gh 7vii7 z clauses 7iv7 ?r\gh 7vi71 respectively4 7#d7 ,section #gjc7;c77#a7 ( division ,n ( ! ,consolidat$ ,appropriations ,act1 #bjba 7#g ,u4,s4,c4 #bjaf note2 ,public ,law #aaf-bfj71 is am5d$ by /rik+ section #g7k77#ad7 ( ! ,food & ,nutrition ,act ( #bjjh & ins]t+ section #g7;j77#d7 ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjaf7;j77#d774 7b7 ,p>ticipation ( pu]to rico1 am]ican samoa1 & ! nor!rn m>iana isl&s 9 supplem5tal nutrition assi/ance program 7#a7 ,def9itions 7,a7 ,/ate ,section #c7r7 ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjab7r77 is am5d$ by ins]t+ ! ,commonweal? ( ,pu]to ,rico1 ,am]ican ,samoa1 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 aft] ,guam14 7,b7 ,?rifty food plan ,section #c7u77#c7 ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjab7u77#c77 is am5d$ by ins]t+ ! ,commonweal? ( ,pu]to ,rico1 ,am]ican ,samoa1 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 aft] ,guam14 7#b7 ,eligible h\seholds ,section #e ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjad7 7z am5d$ by section #djjc7;g77#a77;,a77iv77 is am5d$-- 7,a7 9 subsection 7c71 9 ! undesignat$ matt] at ! end1 by /rik+ ,/ates or ,guam & ins]t+ ,/ates1 ,guam1 ! ,commonweal? ( ,pu]to ,rico1 ,am]ican ,samoa1 or ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s2 7,b7 9 subsection 7e77#a77;,b7-- 7i7 9 ! subp>agraph head+1 by /rik+ ,guam & ins]t+ ,guam1 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa2 7ii7 9 clause 7i71 9 ! matt] prec$+ subclause 7,i71 by ins]t+ 1 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa aft] ,guam2 & 7iii7 9 clause 7ii71 9 ! matt] prec$+ subclause 7,i71 by ins]t+ 1 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa aft] ,guam2 & 7,c7 by add+ at ! end ! foll[+3 7n7 ,pu]to rico1 am]ican samoa1 & ! nor!rn m>iana isl&s ,not)/&+ any o!r provision ( ?is ,act1 includ+ ! requirem5ts "u ?is section1 ! ,commonweal? ( ,pu]to ,rico1 ,am]ican ,samoa1 & ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s %all ea* e/abli% _! own /&>ds ( eligibility = p>ticipation by h\seholds 9 ! supplem5tal nutrition assi/ance program4 4 7#c7 ,effective date 7,a7 ,9 g5]al ,! am5dm5ts made by p>agraphs 7#a7 & 7#b7 %all be effective ) respect to ! ,commonweal? ( ,pu]to ,rico1 ,am]ican ,samoa1 & ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 z applicable1 on ! date describ$ 9 subp>agraph 7,b7 if ! ,secret>y ( ,agriculture submits to ,congress a c]tification "u subsection 7f77#b77;,b7 ( section #ai ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjbh74 7,b7 ,date describ$ ,! date ref]r$ to 9 subp>agraph 7,a7 is1 ) respect to ! ,commonweal? ( ,pu]to ,rico1 ,am]ican ,samoa1 & ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 ! date e/abli%$ by ! ,commonweal? ( ,pu]to ,rico1 ,am]ican ,samoa1 or ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 respectively1 9 ! applicable plan ( op]ation submitt$ to ! ,secret>y ( ,agriculture "u subsection 7f77#a7 ( section #ai ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjbh74 7c7 ,transition ( pu]to rico1 am]ican samoa1 & ! nor!rn m>iana isl&s to supplem5tal nutrition assi/ance program ,section #ai ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjbh7 is am5d$-- 7#a7 9 subsection 7a77#a7-- 7,a7 9 subp>agraph 7,a71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,b71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+3 7,c7 ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s4 2 & 7#b7 by add+ at ! end ! foll[+3 7f7 ,transition ( ,pu]to ,rico1 ,am]ican ,samoa1 & ! ,nor!rn ,m>iana ,isl&s to supplem5tal nutrition assi/ance program 7#a7 ,reque/ = p>ticipation ,a gov]nm5tal entity may submit to ! ,secret>y a reque/ to p>ticipate 9 ! supplem5tal nutrition assi/ance program1 :i* %all include a plan ( op]ation describ$ 9 section #aa7;d71 :i* %all include ! date on :i* ! gov]nm5tal entity int5ds to beg9 p>ticipation 9 ! program4 7#b7 ,c]tification by ,secret>y 7,a7 ,9 g5]al ,! ,secret>y %all c]tify a gov]nm5tal entity t submits a reque/ "u p>agraph 7#a7 z qualifi$ to p>ticipate 9 ! supplem5tal nutrition assi/ance program if ! ,secret>y-- 7i7 approves ! plan ( op]ation submitt$ ) ! reque/1 9 accordance ) ?is subsection2 & 7ii7 approves ! applications describ$ 9 p>agraph 7#d7 9 accordance ) t p>agraph4 7,b7 ,submission ( c]tification to ,congress ,! ,secret>y %all submit ea* c]tification "u subp>agraph 7,a7 to ,congress4 7#c7 ,det]m9ation ( plan ( op]ation 7,a7 ,approval ,! ,secret>y %all approve a plan ( op]ation submitt$ ) a reque/ "u p>agraph 7#a7 if ! plan satisfies ! requirem5ts "u ?is ,act = a plan ( op]ation4 7,b7 ,disapproval ,if ! ,secret>y does n approve a plan ( op]ation submitt$ ) a reque/ "u p>agraph 7#a71 ! ,secret>y %all provide to ! gov]nm5tal entity a /atem5t t describes ea* requirem5t "u ?is ,act t is n satisfi$ by ! plan4 7#d7 ,approval ( retail food /ores 7,a7 ,solicitation ( applications ,if ! ,secret>y approves a plan ( op]ation "u p>agraph 7#c77;,a7 = a gov]nm5tal entity1 ! ,secret>y %all accept applications f retail food /ores locat$ 9 t gov]nm5tal entity to be au?oriz$ "u section #i to p>ticipate 9 ! supplem5tal nutrition assi/ance program4 7,b7 ,det]m9ation ,! ,secret>y %all au?orize a retail food /ore apply+ to p>ticipate 9 ! supplem5tal nutrition assi/ance program "u subp>agraph 7,a7 if ! application satisfies ! requirem5ts "u ?is ,act = au?orization ( a retail food /ore4 7#e7 ,pu]to ,rico ,9 ! case ( a reque/ "u p>agraph 7#a7 by ! ,commonweal? ( ,pu]to ,rico1 not)/&+ subsection 7g71 ! ,secret>y %all all[ ! ,commonweal? ( ,pu]to ,rico to cont9ue to c>ry out "u ! supplem5tal nutrition assi/ance program ! ,family ,m>ket ,program e/abli%$ pursuant to ?is section4 7#f7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to ! ,secret>y to c>ry out ?is subsection su* sums z are necess>y = fiscal ye> #bjbc1 to rema9 available until exp5d$4 7g7 ,t]m9ation ( effectiv5ess 7#a7 ,9 g5]al ,subsections 7a7 ?r\gh 7e7 %all cease to be effective ) respect to ! ,commonweal? ( ,pu]to ,rico1 ,am]ican ,samoa1 & ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 z applicable1 on ! date describ$ 9 p>agraph 7#b7 if ! ,secret>y submits to ,congress a c]tification "u subsection 7f77#b77;,b7 = t gov]nm5tal entity4 7#b7 ,date describ$ ,! date ref]r$ to 9 p>agraph 7#a7 is1 ) respect to ! ,commonweal? ( ,pu]to ,rico1 ,am]ican ,samoa1 & ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 ! date e/abli%$ by ! ,commonweal? ( ,pu]to ,rico1 ,am]ican ,samoa1 or ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 respectively1 9 ! applicable plan ( op]ation submitt$ to ! ,secret>y "u subsection 7f77#a74 4 #efjb4 ,repeal ( d5ial ( ,supplem5tal ,nutrition ,assi/ance ,program b5efits ,section #aae ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#ba ,u4,s4,c4 #hfb;a7 is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 by /rik+ p>agraph 7#b72 7,b7 9 p>agraph 7#a71 by /rik+ 1 or & ins]t+ a p]iod2 & 7,c7 9 ! matt] prec$+ p>agraph 7#a71 by /rik+ =-- & all t foll[s ?r\gh assi/ance 9 p>agraph 7#a7 & ins]t+ = assi/ance2 7#b7 9 subsection 7b7-- 7,a7 by /rik+ p>agraph 7#b72 7,b7 9 p>agraph 7#a71 by /rik+ ! p>agraph designation & head+ & all t foll[s ?r\gh ,! am\nt & ins]t+ ,! am\nt2 & 7#c7 9 subsection 7e7-- 7,a7 by /rik+ p>agraph 7#b72 7,b7 9 p>agraph 7#a71 by /rik+ 1 & & ins]t+ a p]iod2 & 7,c7 9 ! matt] prec$+ p>agraph 7#a71 by /rik+ x-- & all t foll[s ?r\gh 9 section #dai7e7 9 p>agraph 7#a7 & ins]t+ ! t]m 9 section #dai7e74 ,h ,univ]sal ,s*ool ,meals ,program #egja4 ,%ort title ,?is subtitle may be cit$ z ! ,univ]sal ,s*ool ,meals ,program ,act ( #bjbb4 #egjb4 ,effective date ,unless o!rwise provid$1 ?is subtitle1 & ! am5dm5ts made by ?is subtitle1 %all take effect #a ye> aft] ! date ( enactm5t ( ?is ,act4 #egjc4 ,free s*ool breakfa/ program 7a7 ,9 g5]al ,section #d7;a7 ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aggc7;a77 is am5d$1 9 ! fir/ s5t5ce-- 7#a7 by /rik+ is h]eby & ins]t+ are2 & 7#b7 by ins]t+ to provide free breakfa/ to all *ildr5 enroll$ at ^? s*ools be=e 9 accordance4 7b7 ,apportionm5t to ,/ates ,section #d7;b7 ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aggc7;b77 is am5d$-- 7#a7 9 p>agraph 7#a7-- 7,a7 9 subp>agraph 7,a77i71 by /rik+ subclause 7,,ii7 & ins]t+ ! foll[+3 7,,ii7 ! national av]age paym5t = free breakfa/s1 z specifi$ 9 subp>agraph 7,b74 2 7,b7 by /rik+ subp>agraph 7,b7 & ins]t+ ! foll[+3 7,b7 ,paym5t am\nts 7i7 ,9 g5]al ,! national av]age paym5t = ea* free breakfa/ %all be #b4gb1 adju/$ annually = inflation 9 accordance ) clause 7ii7 & r\nd$ 9 accordance ) clause 7iii74 7ii7 ,inflation adju/m5t 7,i7 ,9 g5]al ,! annual inflation adju/m5t "u clause 7i7 %all reflect *anges 9 ! co/ ( op]at+ ! free breakfa/ program "u ?is section1 z indicat$ by ! *ange 9 ! ,consum] ,price ,index = food away f home = all urban consum]s4 7,,ii7 ,basis ,ea* inflation annual adju/m5t "u clause 7i7 %all reflect ! *anges 9 ! ,consum] ,price ,index = food away f home = ! mo/ rec5t #ab-mon? p]iod = :i* t data is available4 7iii7 ,r\nd+ ,on ,july #a1 #bjbb1 & annually !reaft]1 ! national av]age paym5t rate = free breakfa/ %all be-- 7,i7 adju/$ to ! ne>e/ l[]-c5t increm5t2 & 7,,ii7 bas$ on ! unr\nd$ am\nts = ! prec$+ #ab-mon? p]iod4 2 7,c7 by /rik+ subp>agraphs 7,c7 & 7,e72 & 7,d7 by r$esignat+ subp>agraph 7,d7 z subp>agraph 7,c72 7#b7 by /rik+ p>agraphs 7#b7 & 7#c72 7#c7 by r$esignat+ p>agraphs 7#d7 & 7#e7 z p>agraphs 7#b7 & 7#c71 respectively2 & 7#d7 9 p>agraph 7#c7 7z s r$esignat$71 by /rik+ p>agraph 7#c7 or 7#d7 & ins]t+ p>agraph 7#b74 7c7 ,/ate disbursem5t to s*ools ,section #d ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aggc7 is am5d$ by /rik+ subsection 7c7 & ins]t+ ! foll[+3 7c7 ,/ate disbursem5t to s*ools ,funds apportion$ & paid to any ,/ate = ! purpose ( ?is section %all be disburs$ by ! ,/ate educational ag5cy to s*ools select$ by ! ,/ate educational ag5cy to assi/ ^? s*ools 9 op]at+ a breakfa/ program4 4 7d7 ,no collection ( debt 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #agga et seq47 or any o!r provision ( law1 effective beg9n+ on ! date ( enactm5t ( ?is ,act1 z a condition ( p>ticipation 9 ! breakfa/ program "u section #d ( t ,act 7#db ,u4,s4,c4 #aggc71 a s*ool-- 7,a7 %all n collect any debt ow$ to ! s*ool = unpaid meal *>ges2 & 7,b7 %all cont9ue to accrue debt = unpaid meal *>ges-- 7i7 = ! purpose ( receiv+ reimbursem5t "u section #egae2 & 7ii7 until ! effective date specifi$ 9 section #egjb4 7#b7 ,*ild ,nutrition ,act ( #aiff 7,a7 ,9 g5]al ,section #d ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aggc7 is am5d$ by /rik+ subsection 7d7 & ins]t+ ! foll[+3 7d7 ,no collection ( debt ,a s*ool p>ticipat+ 9 ! free breakfa/ program "u ?is section %all n collect any debt ow$ to ! s*ool = unpaid meal *>ges4 4 7,b7 ,con=m+ am5dm5t ,section #bc7;a7 ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #agic7;a77 is am5d$ by /rik+ s*ool 9 sev]e ne$1 z describ$ 9 section #d7;d77#a7 & ins]t+ ! foll[+3 s*ool-- 7#a7 t has a free breakfa/ program "u section #d or seeks to initiate a free breakfa/ program "u t section2 & 7#b7 ( :i* n less ?an #dj p]c5t ( ! /ud5ts are id5tifi$ /ud5ts 7z def9$ 9 p>agraph 7#h7 ( section #aaac7;a7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #fcac7;a777 4 7e7 ,nutritional & o!r program requirem5ts ,section #d7;e7 ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aggc7;e77 is am5d$-- 7#a7 9 p>agraph 7#a77;,a71 9 ! second s5t5ce1 by /rik+ free or & all t foll[s ?r\gh ! p]iod at ! end & ins]t+ free to all *ildr5 enroll$ at a s*ool p>ticipat+ 9 ! s*ool breakfa/ program42 & 7#b7 9 p>agraph 7#b71 9 ! second s5t5ce1 by /rik+ ! full *>ge to ! /ud5t = a breakfa/ meet+ ! requirem5ts ( ?is section or4 7f7 ,prohibition on breakfa/ %am+1 meal d5ial 7#a7 ,9 g5]al ,effective beg9n+ on ! date ( enactm5t ( ?is ,act1 a s*ool or s*ool food au?ority-- 7,a7 %all n-- 7i7 physically segregate or o!rwise discrim9ate aga9/ any *ild p>ticipat+ 9 ! breakfa/ program "u section #d ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aggc72 or 7ii7 ov]tly id5tify a *ild describ$ 9 clause 7i7 by a special tok5 or ticket1 an ann\nc$ or publi%$ li/ ( names1 or any o!r means2 & 7,b7 %all provide ! program meal to any *ild eligible "u ! program4 7#b7 ,*ild ,nutrition ,act ( #aiff ,section #d ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aggc7 is am5d$ by add+ at ! end ! foll[+3 7f7 ,prohibition on breakfa/ %am+ ,a s*ool or s*ool food au?ority %all n-- 7#a7 physically segregate or o!rwise discrim9ate aga9/ any *ild p>ticipat+ 9 ! free breakfa/ program "u ?is section2 or 7#b7 ov]tly id5tify a *ild describ$ 9 p>agraph 7#a7 by a special tok5 or ticket1 an ann\nc$ or publi%$ li/ ( names1 or any o!r means4 4 7g7 ,dep>tm5t ( ,def5se ,ov]seas ,dep5d5ts' ,s*ools ,section #bj7;b7 ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aghi7;b77 is am5d$-- 7#a7 by /rik+ & r$uc$-price2 & 7#b7 by /rik+ & %all & all t foll[s ?r\gh section4 7h7 ,con=m+ am5dm5ts ,! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #agga et seq47 is am5d$-- 7#a7 by /rik+ or r$uc$ price ea* place x appe>s2 7#b7 by /rik+ & r$uc$ price ea* place x appe>s2 & 7#c7 by /rik+ a r$uc$ price ea* place x appe>s4 #egjd4 ,apportionm5t to ,/ates ,section #d7;b7 ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agec7;b77 is am5d$-- 7#a7 by /rik+ p>agraph 7#b7 & ins]t+ ! foll[+3 7#b7 ,paym5t am\nts 7,a7 ,9 g5]al ,! national av]age paym5t = ea* free lun* %all be #c4ha1 adju/$ annually = inflation 9 accordance ) subp>agraph 7,c7 & r\nd$ 9 accordance ) subp>agraph 7,d74 7,b7 ,additional paym5t = local food 7i7 ,def9ition ( locally s\rc$ f>m product ,9 ?is subp>agraph1 ! t]m locally s\rc$ f>m product means a f>m product t-- 7,i7 is m>ket$ to consum]s-- 7aa7 directly2 or 7bb7 ?r\gh int]m$iat$ *annels 7su* z food hubs & coop]atives72 & 7,,ii7 ) respect to ! s*ool food au?ority pur*as+ ! f>m product1 is produc$ & di/ribut$-- 7aa7 9 ! ,/ate 9 :i* ! s*ool food au?ority is locat$2 or 7bb7 n m ?an #bej miles f ! location ( ! s*ool food au?ority4 7ii7 ,additional paym5t eligibility ,dur+ a s*ool ye>1 a s*ool food au?ority %all receive an additional paym5t describ$ 9 clause 7iii7 if ! ,/ate c]tifies t ! s*ool food au?ority s]v$ meals 7includ+ breakfa/s1 lun*es1 supp]s1 & supplem5ts7 dur+ ! la/ s*ool ye> ( :i* n less ?an #be p]c5t 7 made ) locally s\rc$ f>m products4 7iii7 ,paym5t am\nt 7,i7 ,9 g5]al ,! additional paym5t am\nt "u ?is subp>agraph %all be-- 7aa7 #j4cj = ea* free lun* & supp]2 7bb7 #j4ba = ea* free breakfa/2 & 7cc7 #j4jh = ea* free supplem5t4 7,,ii7 ,adju/m5ts ,ea* additional paym5t am\nt "u subclause 7,i7 %all be adju/$ annually 9 accordance ) subp>agraph 7,c7 & r\nd$ 9 accordance ) subp>agraph 7,d74 7iv7 ,disbursem5t ,! ,/ate ag5cy %all disburse funds made available "u ?is clause to s*ool food au?orities eligible to receive additional reimbursem5t4 7,c7 ,inflation adju/m5t 7i7 ,9 g5]al ,! annual inflation adju/m5t "u subp>agraphs 7,a7 & 7,b77iii7 %all reflect *anges 9 ! co/ ( op]at+ ! free lun* program "u ?is ,act1 z indicat$ by ! *ange 9 ! ,consum] ,price ,index = food away f home = all urban consum]s4 7ii7 ,basis ,ea* annual inflation adju/m5t "u subp>agraphs 7,a7 & 7,b77iii7 %all reflect ! *anges 9 ! ,consum] ,price ,index = food away f home = ! mo/ rec5t #ab-mon? p]iod = :i* t data is available4 7,d7 ,r\nd+ ,on ,july #a1 #bjbb1 & annually !reaft]1 ! national av]age paym5t rate = free lun* & ! additional paym5t am\nt = free breakfa/1 lun*1 supp]1 & supplem5t "u subp>agraph 7,b7 %all be-- 7i7 adju/$ to ! ne>e/ l[]-c5t increm5t2 & 7ii7 bas$ on ! unr\nd$ am\nts = ! prec$+ #ab-mon? p]iod4 2 & 7#b7 by /rik+ p>agraph 7#c74 #egje4 ,nutritional & o!r program requirem5ts 7a7 ,elim9ation ( free lun* eligibility requirem5ts 7#a7 ,9 g5]al ,section #i ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #ageh7 is am5d$ by /rik+ subsection 7b7 & ins]t+ ! foll[+3 7b7 ,eligibility ,all *ildr5 enroll$ 9 a s*ool t p>ticipates 9 ! s*ool lun* program "u ?is ,act %all be eligible to receive free lun* "u ?is ,act4 4 7#b7 ,con=m+ am5dm5ts 7,a7 ,section #i ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #ageh7 is am5d$-- 7i7 9 subsection 7c71 9 ! ?ird s5t5ce1 by /rik+ or at a r$uc$ co/2 & 7ii7 9 subsection 7e71 by /rik+ 1 r$uc$ price14 7,b7 ,section #ah ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agfi7 is am5d$-- 7i7 by /rik+ subsection 7j72 & 7ii7 by r$esignat+ subsection 7k7 z subsection 7j74 7,c7 ,section #bh7;b77#d7 ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agfi;i7b77#d77 is am5d$-- 7i7 by /rik+ subp>agraph 7,b72 & 7ii7 9 subp>agraph 7,a71 by /rik+ ! subp>agraph designation & head+ & all t foll[s ?r\gh ! ,secret>y & ins]t+ ,! ,secret>y4 7,d7 ,section #ag ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aghf7 is am5d$-- 7i7 9 subsection 7d77#b77;,a7-- 7,i7 by /rik+ clause 7i72 & 7,,ii7 by r$esignat+ clauses 7ii7 & 7iii7 z clauses 7i7 & 7ii71 respectively2 & 7ii7 9 subsection 7f77#ag71 by /rik+ ,not)/&+ subsection 7d77#b77;,a77i71 n lat] & ins]t+ ,n lat]4 7,e7 ,section #aijb7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77 is am5d$ by /rik+ p>agraph 7#g7 & ins]t+ ! foll[+3 7#g7 provide safegu>ds :i* re/rict ! use or disclosure ( in=mation conc]n+ applicants & recipi5ts to purposes directly connect$ ) ! adm9i/ration ( ! plan2 4 7,f7 ,section #aaed7;a77#b77;,a77i7 ( title #aj1 ,unit$ ,/ates ,code1 is am5d$ by /rik+ 9 accordance ) section #i7;b77#a7 ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #ageh7;b77#a74 7,g7 ,section #dcja ( ! ,food1 ,cons]vation1 & ,en]gy ,act ( #bjjh 7#db ,u4,s4,c4 #ageh;a7 is repeal$4 7b7 ,no collection ( debt 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agea et seq47 or any o!r provision ( law1 effective beg9n+ on ! date ( enactm5t ( ?is ,act1 z a condition ( p>ticipation 9 ! s*ool lun* program "u t ,act1 a s*ool-- 7,a7 %all n collect any debt ow$ to ! s*ool = unpaid meal *>ges2 & 7,b7 %all cont9ue to accrue debt = unpaid meal *>ges-- 7i7 = ! purpose ( receiv+ reimbursem5t "u section #egae2 & 7ii7 until ! effective date specifi$ 9 section #egjb4 7#b7 ,national ,s*ool ,lun* ,act ,section #i ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #ageh7 is am5d$ by /rik+ subsection 7d7 & ins]t+ ! foll[+3 7d7 ,no collection ( debt ,a s*ool p>ticipat+ 9 ! s*ool lun* program "u ?is ,act %all n collect any debt ow$ to ! s*ool = unpaid meal *>ges4 4 #egjf4 ,special assi/ance program 7a7 ,9 g5]al ,section #aa ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agei;a7 is repeal$4 7b7 ,con=m+ am5dm5ts 7#a7 ,section #f ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agee7 is am5d$-- 7,a7 9 subsection 7a77#b71 by /rik+ sections #aa & #ac & ins]t+ section #ac2 & 7,b7 9 subsection 7e77#a71 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ section #d1 ?is section1 & section #aa & ins]t+ ?is section & section #d4 7#b7 ,section #g7;d7 ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agef7;d77 is am5d$ by /rik+ or #aa4 7#c7 ,section #h7;g7 ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #ageg7;g77 is am5d$ by /rik+ & "u section #aa ( ?is ,act4 7#d7 ,section #ab7;f7 ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agfj7;f77 is am5d$ by /rik+ #aa14 7#e7 ,section #g7;a7 ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #agff7;a77 is am5d$-- 7,a7 9 p>agraph 7#a77;,a71 by /rik+ #d1 #aa1 & #ag & ins]t+ #d & #ag2 & 7,b7 9 p>agraph 7#b77;,a71 by /rik+ sections #d & #aa & ins]t+ section #d4 #egjg4 ,price = a paid lun* ,section #ab ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agfj7 is am5d$-- 7#a7 by /rik+ subsection 7p72 & 7#b7 by r$esignat+ subsections 7q7 & 7r7 z subsections 7p7 & 7q71 respectively4 #egjh4 ,summ] food s]vice program = *ildr5 ,section #ac ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agfa7 is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 9 p>agraph 7#b71 by add+ at ! end ! foll[+3 7,c7 ,waiv] ,if ! ,secret>y det]m9es t a program requirem5t "u ?is section limits ! access ( *ildr5 to meals s]v$ "u ?is section1 ! ,secret>y may waive t program requirem5t4 7,d7 ,eligibility ,all *ildr5 %all be eligible to p>ticipate 9 ! program "u ?is section4 2 & 7,b7 9 p>agraph 7#e71 by /rik+ only = & all t foll[s ?r\gh ! p]iod at ! end & ins]t+ = meals s]v$ to all *ildr542 7#b7 9 subsection 7b77#b71 by /rik+ may only s]ve & all t foll[s ?r\gh migrant *ildr52 7#c7 by /rik+ subsection 7c7 & ins]t+ ! foll[+3 7c7 ,paym5ts 7#a7 ,9 g5]al ,paym5ts %all be made to s]vice in/itutions = meals s]v$-- 7,a7 dur+ ! mon?s ( ,may ?r\gh ,septemb]2 7,b7 dur+ s*ool vacation at any "t dur+ an academic s*ool ye>2 7,c7 dur+ a tea*] 9-s]vice day2 & 7,d7 on days t s*ool is clos$ dur+ ! mon?s ( ,octob] ?r\gh ,april due to a natural disa/]1 build+ repair1 c\rt ord]1 or simil> cause1 z det]m9$ by ! ,secret>y4 7#b7 ,limitation on paym5ts ,a s]vice in/itution %all receive paym5ts "u ?is section = n m ?an #c meals & #a supplem5t p] *ild p] day4 2 & 7#d7 9 subsection 7f77#c71 by /rik+ 1 except t & all t foll[s ?r\gh section4 #egji4 ,summ] ,electronic ,b5efit ,transf] = ,*ildr5 ,program ,section #ac7;a7 ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agfa7;a77 is am5d$ by add+ at ! end ! foll[+3 7#ac7 ,summ] ,electronic ,b5efit ,transf] = ,*ildr5 ,program 7,a7 ,def9itions ,9 ?is p>agraph3 7i7 ,,ebt c>d ,! t]m ,,ebt c>d means an electronic b5efit transf] c>d4 7ii7 ,eligible h\sehold ,! t]m eligible h\sehold means a h\sehold )-- 7,i7 an income t does n exce$ #bjj p]c5t ( ! pov]ty l9e 7z def9$ 9 section #fgc ( ! ,community ,s]vices ,block ,grant ,act 7#db ,u4,s4,c4 #iijb772 & 7,,ii7 #a or m *ildr54 7iii7 ,program ,! t]m ,program means ! ,summ] ,electronic ,b5efit ,transf] = ,*ildr5 ,program e/abli%$ "u subp>agraph 7,b74 7,b7 ,e/abli%m5t ,! ,secret>y %all e/abli% a national program1 to be kn[n z ! ,summ] ,electronic ,b5efit ,transf] = ,*ildr5 ,program1 "u :i* ! ,secret>y %all issue ,,ebt c>ds to eligible h\seholds to provide food assi/ance dur+ ! summ] mon?s4 7,c7 ,,ebt am\nt 7i7 ,9 g5]al ,! value ( an ,,ebt c>d provid$ "u ! ,program to an eligible h\sehold %all be #fj p] mon? p] *ild 7adju/$ = inflation74 7ii7 ,annual limitation ,no eligible h\sehold %all receive b5efits "u ! ,program = m ?an #c mon?s 9 a cal5d> ye>4 7,d7 ,adm9i/ration 7i7 ,9 g5]al ,except z provid$ "u ?is p>agraph1 ! ,program %all be bas$ on ! summ] electronic b5efit transf] = *ildr5 demon/ration program c>ri$ out pursuant to section #gdi7;g7 ( ! ,agriculture1 ,rural ,developm5t1 ,food & ,drug ,adm9i/ration1 & ,relat$ ,ag5cies ,appropriations ,act1 #bjaj 7,public ,law #aaa-hj2 #abc ,/at4 #bacb74 7ii7 ,,snap or ,,wic 7,i7 ,9 g5]al ,subject to subclause 7,,ii71 a ,/ate %all adm9i/] ! ,program ?r\gh ! supplem5tal nutrition assi/ance program e/abli%$ "u ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjaa et seq474 7,,ii7 ,,wic option ,if a ,/ate has p>ticipat$ 9 ! demon/ration program describ$ 9 clause 7i7 be=e ! effective date specifi$ 9 section #egjb ( ! ,univ]sal ,s*ool ,meals ,program ,act ( #bjbb1 ! ,/ate may elect to adm9i/] ! ,program ?r\gh ! special supplem5tal nutrition program = wom51 infants1 & *ildr5 e/abli%$ by section #ag ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aghf74 7,e7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to ! ,secret>y to c>ry out ?is p>agraph su* sums z are necess>y = fiscal ye> #bjbb & ea* fiscal ye> !reaft]4 4 #egaj4 ,*ild & adult c>e food program ,section #ag ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agff7 is am5d$-- 7#a7 9 subsection 7a77#b71 by /rik+ subp>agraph 7,b7 & ins]t+ ! foll[+3 7,b7 any o!r private organization provid+ nonresid5tial *ild c>e or day c>e outside s*ool h\rs = s*ool *ildr52 2 7#b7 by /rik+ subsection 7c7 & ins]t+ ! foll[+3 7c7 ,free meals ,not)/&+ any o!r provision ( law-- 7#a7 all meals & supplem5ts s]v$ "u ! program au?oriz$ "u ?is section %all be provid$ = free to p>ticipants ( ! program2 & 7#b7 an in/itution t s]ves ^? meals & supplem5ts %all be reimburs$-- 7,a7 9 ! case ( breakfa/1 at ! rate e/abli%$ = free breakfa/ "u section #d7;b77#a77;,b77i7 ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aggc7;b77#a77;,b77i772 7,b7 9 ! case ( lun*1 at ! rate e/abli%$ = free lun* "u section #d7;b77#b77;,a72 & 7,c7 9 ! case ( a supplem5tal meal1 #j4if1 adju/$ = inflation 9 accordance ) section #d7;b77#b77;,c74 2 7#c7 9 subsection 7f7-- 7,a7 9 p>agraph 7#b71 by /rik+ subp>agraph 7,b7 & ins]t+ ! foll[+3 7,b7 ,limitation to reimbursem5ts ,an in/itution may claim reimbursem5t "u ?is p>agraph = n m ?an #c meals & #a supplem5t p] day p] *ild4 2 7,b7 by /rik+ p>agraph 7#c72 & 7,c7 by r$esignat+ p>agraph 7#d7 z p>agraph 7#c72 & 7#d7 9 subsection 7r7-- 7,a7 9 ! subsection head+1 by /rik+ ,program = at-,risk s*ool *ildr5 & ins]t+ ,aft]s*ool meal & snack program2 7,b7 by /rik+ at-risk s*ool ea* place x appe>s & ins]t+ eligible2 7,c7 9 p>agraph 7#a7-- 7i7 9 ! p>agraph head+1 by /rik+ at-risk s*ool & ins]t+ eligible2 & 7ii7 9 subp>agraph 7,b71 by /rik+ op]at$ & all t foll[s ?r\gh ! p]iod at ! end & ins]t+ a p]iod2 & 7,d7 9 p>agraph 7#d77;,a71 by /rik+ only = & all t foll[s ?r\gh ! p]iod at ! end & ins]t+ ! foll[+3 =-- 7i7 n m ?an #a meal & #a supplem5t p] *ild p] day s]v$ on a regul> s*ool day2 & 7ii7 n m ?an #c meals & #a supplem5t p] *ild p] day s]v$ on any day o!r ?an a regul> s*ool day4 4 #egaa4 ,meals & supplem5ts = *ildr5 9 aft]s*ool c>e ,section #ag;,a ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agff;a7 is am5d$-- 7#a7 9 ! section head+1 by /rik+ ,meal supplem5ts & ins]t+ ,meals & supplem5ts2 7#b7 9 subsection 7a77#a71 by /rik+ meal supplem5ts & ins]t+ free meals & supplem5ts2 7#c7 9 subsection 7b71 by ins]t+ meals & be=e supplem5ts2 & 7#d7 by /rik+ subsection 7c7 & ins]t+ ! foll[+3 7c7 ,reimbursem5t 7#a7 ,9 g5]al 7,a7 ,meals ,a free meal provid$ "u ?is section to a *ild %all be reimburs$ at a rate ( #c4ha1 adju/$ annually = inflation 9 accordance ) p>agraph 7#c77;,a7 & r\nd$ 9 accordance ) p>agraph 7#c77;,b74 7,b7 ,supplem5ts ,a free supplem5t provid$ "u ?is section to a *ild %all be reimburs$ at ! rate at :i* free supplem5ts are reimburs$ "u section #ag7;c77#b77;,c74 7#b7 ,limitation to reimbursem5ts ,an in/itution may claim reimbursem5t "u ?is section = n m ?an #a meal & #a supplem5t p] day p] *ild s]v$ on a regul> s*ool day4 7#c7 ,inflation2 r\nd+ 7,a7 ,inflation adju/m5t 7i7 ,9 g5]al ,! annual inflation adju/m5t "u p>agraph 7#a77;,a7 %all reflect *anges 9 ! co/ ( op]at+ ! program "u ?is section1 z indicat$ by ! *ange 9 ! ,consum] ,price ,index = food away f home = all urban consum]s4 7ii7 ,basis ,ea* inflation annual adju/m5t "u p>agraph 7#a77;,a7 %all reflect ! *anges 9 ! ,consum] ,price ,index = food away f home = ! mo/ rec5t #ab-mon? p]iod = :i* t data is available4 7,b7 ,r\nd+ ,on ,july #a1 #bjbb1 & annually !reaft]1 ! reimbursem5t rate = a free meal "u ?is section %all be-- 7i7 adju/$ to ! ne>e/ l[]-c5t increm5t2 & 7ii7 bas$ on ! unr\nd$ am\nts = ! prec$+ #ab-mon? p]iod4 4 #egab4 ,access to local foods3 f>m to s*ool program ,section #ah7;g77#e7 ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agfi7;g77#e77 is am5d$ by /rik+ subp>agraph 7,b7 & ins]t+ ! foll[+3 7,b7 s]ve a high proportion ( id5tifi$ /ud5ts 7z def9$ 9 p>agraph 7#h7 ( section #aaac7;a7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #fcac7;a7772 4 #egac4 ,fre% fruit & vegetable program ,section #ai7;d7 ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agfi;a7d77 is am5d$-- 7#a7 9 p>agraph 7#a7-- 7,a7 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ p>agraph 7#b7 ( ?is subsection &2 7,b7 9 subp>agraph 7,a71 9 ! matt] prec$+ clause 7i71 by /rik+ s*ool-- & all t foll[s ?r\gh submits 9 clause 7ii7 & ins]t+ s*ool t submits2 7,c7 9 subp>agraph 7,b71 by /rik+ s*ools & all t foll[s ?r\gh ,act & ins]t+ high-ne$ s*ools 7z def9$ 9 section #bbaa7;b7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #ffca7;b7772 & 7,d7 9 subp>agraph 7,d7-- 7i7 by /rik+ clause 7i72 & 7ii7 by r$esignat+ clauses 7ii7 ?r\gh 7iv7 z clauses 7i7 ?r\gh 7iii71 respectively2 & 7#b7 by /rik+ p>agraphs 7#b7 & 7#c7 & ins]t+ ! foll[+3 7#b7 ,outrea* to high-ne$ s*ools ,prior to mak+ decisions reg>d+ s*ool p>ticipation 9 ! program1 a ,/ate ag5cy %all in=m high-ne$ s*ools 7z def9$ 9 section #bbaa7;b7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #ffca7;b7771 includ+ ,tribal s*ools1 ( ! eligibility ( ! s*ools = ! program4 4 #egad4 ,tra9+1 te*nical assi/ance1 & ,food ,s]vice ,managem5t ,in/itute ,section #ba7;a77#a77;,b7 ( ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agfi;b-#a7;a77#a77;,b77 is am5d$ 9 ! matt] prec$+ clause 7i7 by /rik+ c]tifi$ to receive free or r$uc$ price meals & ins]t+ :o are id5tifi$ /ud5ts 7z def9$ 9 p>agraph 7#h7 ( section #aaac7;a7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #fcac7;a774 #egae4 ,reimbursem5t ( s*ool meal del9qu5t debt program 7a7 ,def9itions ,9 ?is section3 7#a7 ,del9qu5t debt ,! t]m del9qu5t debt means ! debt ow$ by a p>5t or gu>dian ( a *ild to a s*ool-- 7,a7 z ( ! effective date specifi$ 9 section #egjb2 & 7,b7 = meals s]v$ by ! s*ool "u-- 7i7 ! s*ool breakfa/ program "u section #d ( ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #aggc72 7ii7 ! s*ool lun* program e/abli%$ "u ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agea et seq472 or 7iii7 bo? ( ! programs describ$ 9 clauses 7i7 & 7ii74 7#b7 ,program ,! t]m program means ! program e/abli%$ "u subsection 7b77#a74 7#c7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,agriculture4 7b7 ,reimbursem5t program 7#a7 ,e/abli%m5t ,n lat] ?an #fj days aft] ! effective date specifi$ 9 section #egjb1 ! ,secret>y %all e/abli% a program "u :i* ! ,secret>y %all reimburse ea* s*ool p>ticipat+ 9 a program describ$ 9 clause 7i7 or 7ii7 ( subsection 7a77#a77;,b7 = all del9qu5t debt4 7#b7 ,=m = reimbursem5t ,to c>ry out ! program1 ! ,secret>y %all design & di/ribute a =m to ,/ate ag5cies to collect data on all del9qu5t debt 9 applicable s*ools 9 ! ,/ate1 gr\p$ by s*ool food au?ority4 7#c7 ,completion date ,! ,secret>y %all provide all reimbursem5ts "u ! program n lat] ?an #ahj days aft] ! effective date specifi$ 9 section #egjb4 7c7 ,report ,n lat] ?an #b ye>s aft] ! effective date specifi$ 9 section #egjb1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress & make publicly available a report t describes ! successes & *all5ges ( ! program4 #egaf4 ,con=m+ am5dm5ts ,! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agea et seq47 is am5d$-- 7#a7 by /rik+ or r$uc$ price ea* place x appe>s2 7#b7 by /rik+ or a r$uc$ price ea* place x appe>s2 7#c7 by /rik+ & r$uc$ price ea* place x appe>s2 & 7#d7 by /rik+ a r$uc$ price ea* place x appe>s4 #egag4 ,measure ( pov]ty ,section #aaac7;a7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #fcac7;a77 is am5d$-- 7#a7 9 p>agraph 7#e77;,a71 by /rik+ ! numb] ( *ildr5 eligible = a free or r$uc$ price lun* "u ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agea et seq47 & ins]t+ ! numb] ( id5tifi$ /ud5ts2 & 7#b7 by add+ at ! end ! foll[+3 7#h7 ,id5tifi$ /ud5ts def9$ 7,a7 ,9 g5]al ,9 ?is subsection1 ! t]m id5tifi$ /ud5ts means ! numb] ( /ud5ts-- 7i7 :o are-- 7,i7 homeless *ildr5 & y\?s1 z def9$ "u section #gbe7b7 ( ! ,mc,kinney-,v5to ,homeless ,assi/ance ,act 7#db ,u4,s4,c4 #aadcd;a7#b772 7,,ii7 runaway & homeless y\? s]v$ by programs e/abli%$ "u ! ,runaway & ,homeless ,y\? ,act 7#cd ,u4,s4,c4 #aabja et seq472 7,,iii7 migratory *ildr51 z def9$ "u section #acji2 or 7,,iv7 fo/] *ildr52 7ii7 :o are eligible = & receiv+ m$ical assi/ance "u ! program ( m$ical assi/ance e/abli%$ "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq472 or 7iii7 :o p>ticipate 7or :o are "p ( a h\sehold t p>ticipates7 9 at lea/ "o ( ! foll[+3 7,i7 ,! supplem5tal nutrition assi/ance program e/abli%$ "u ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjaa et seq474 7,,ii7 ,a ,/ate program fund$ "u ! program ( block grants to ,/ates = tempor>y assi/ance = ne$y families e/abli%$ "u "p ,a ( title ,,iv ( ! ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq474 7,,iii7 ,! food di/ribution program on ,indian res]vations e/abli%$ "u section #d7;b7 ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjac7;b774 7,,iv7 ,a ,head ,/>t program au?oriz$ "u ! ,head ,/>t ,act 7#db ,u4,s4,c4 #ihca et seq47 or a comp>able ,/ate-fund$ ,head ,/>t or pre-k9d]g>t5 program4 7,b7 ,multipli] ,9 det]m9+ ! numb] ( id5tifi$ /ud5ts "u subp>agraph 7,a71 ! local educational ag5cy %all multiply ! numb] det]m9$ "u su* subp>agraph by #a4f4 4 #egah4 ,supplem5tal nutrition assi/ance program 7a7 ,agreem5t = direct c]tification 7#a7 ,9 g5]al ,section #aa ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjbj7 is am5d$-- 7,a7 by /rik+ subsection 7u72 & 7,b7 by r$esignat+ subsections 7v7 ?r\gh 7x7 z subsections 7u7 ?r\gh 7w71 respectively4 7#b7 ,con=m+ am5dm5ts ,section #aa7;e7 ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjbj7;e77 is am5d$-- 7,a7 9 p>agraph 7#h77;,f71 by /rik+ or subsection 7u72 & 7,b7 9 p>agraph 7#bf77;,b71 by /rik+ 7x7 & ins]t+ 7w74 7b7 ,nutrition education & obesity prev5tion grant program ,section #bh7;a7 ( ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjcf;a7a77 is am5d$ by /rik+ p>agraph 7#a7 & ins]t+ ! foll[+3 7#a7 an individual eligible = b5efits "u ?is ,act2 4 #egai4 ,high] ,education ,act ( #aife 7a7 ,tea*] quality enhancem5t ,subp>agraph 7,a7 ( section #bjj7aa7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajba7aa77 is am5d$ to read z foll[s3 7,a7 ,9 g5]al ,! t]m high-ne$ s*ool means a s*ool t is 9 ! highe/ qu>tile ( s*ools 9 a rank+ ( all s*ools s]v$ by a local educational ag5cy1 rank$ 9 desc5d+ ord] by p]c5tage ( /ud5ts f l[-income families enroll$ 9 su* s*ools1 z det]m9$ by ! local educational ag5cy bas$ on "o ( ! foll[+ measures ( pov]ty3 7i7 ,! p]c5tage ( /ud5ts ag$ #e ?r\gh #ag 9 pov]ty c\nt$ 9 ! mo/ rec5t c5sus data approv$ by ! ,secret>y4 7ii7 ,! p]c5tage ( /ud5ts 9 families receiv+ assi/ance "u ! ,/ate program fund$ "u ! program ( block grants to ,/ates = tempor>y assi/ance = ne$y families e/abli%$ "u "p ,a ( title ,,iv ( ! ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq474 7iii7 ,! p]c5tage ( /ud5ts eligible to receive m$ical assi/ance "u ! program ( m$ical assi/ance e/abli%$ "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7iv7 ,a composite ( two or m ( ! measures describ$ 9 clauses 7i7 ?r\gh 7iii74 4 7b7 ,,ge> ,up ,subp>agraph 7,a7 ( section #djd;,b7d77#a7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajgj;a-#bb7;d77#a77 is am5d$ to read z foll[s3 7,a7 provide s]vices "u ?is *apt] to at lea/ "o grade level ( /ud5ts1 beg9n+ n lat] ?an #g? grade1 9 a p>ticipat+ s*ool-- 7i7 t has a #g? grade2 & 7ii7 9 :i*-- 7,i7 at lea/ #ej p]c5t ( ! /ud5ts enroll$ are id5tifi$ /ud5ts 7z describ$ 9 clause 7i71 7ii71 or 7iii7 ( section #aaac7;a77#h77;,a7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife72 or 7,,ii7 if an eligible entity det]m9es t x w\ld promote ! effectiv5ess ( a program1 an entire grade level ( /ud5ts1 beg9n+ n lat] ?an ! #g? grade1 reside 9 public h\s+1 z def9$ 9 section #c7;b77#a7 ( ! ,unit$ ,/ates ,h\s+ ,act ( #aicg 7#db ,u4,s4,c4 #adcg;a7b77#a774 4 7c7 ,simplifi$ ne$s te/ ,section #dgi7;d77#b7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajhgss7d77#b77 is am5d$-- 7#a7 by /rik+ subp>agraph 7,c72 & 7#b7 by r$esignat+ subp>agraphs 7,d7 ?r\gh 7,f7 z subp>agraphs 7,c7 ?r\gh 7,e71 respectively4 7d7 ,e>ly ,f$]al ,pell ,grant commitm5t demon/ration program ,section #hid7;b7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #aafay7b77 is am5d$-- 7#a7 9 p>agraph 7#a77;,b71 by /rik+ qualify = a free or r$uc$ price s*ool lun* "u ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agea et seq47 or ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #agga et seq47 & ins]t+ are id5tifi$ /ud5ts 7z describ$ 9 clause 7i71 7ii71 or 7iii7 ( section #aaac7;a77#h77;,a7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife72 & 7#b7 9 p>agraph 7#e71 by /rik+ eligible = a free or r$uc$ price s*ool lun* "u ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agea et seq47 or ! ,*ild ,nutrition ,act ( #aiff 7#db ,u4,s4,c4 #agga et seq47 & ins]t+ id5tifi$ /ud5ts 7z describ$ 9 clause 7i71 7ii71 or 7iii7 ( section #aaac7;a77#h77;,a7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife74 #egbj4 ,elem5t>y & ,second>y ,education ,act ( #aife 7a7 ,lit]acy education = all ,section #bbba7;b77#c77;,b7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #ffda7;b77#c77;,b77 is am5d$-- 7#a7 by /rik+ clause 7i72 & 7#b7 by r$esignat+ clauses 7ii7 & 7iii7 z clauses 7i7 & 7ii71 respectively4 7b7 ,grants = education innovation & rese>* ,section #dfaa7;d77#b7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #gbfa7;d77#b77 is am5d$-- 7#a7 by /rik+ subp>agraph 7,b72 & 7#b7 by r$esignat+ subp>agraphs 7,c7 & 7,d7 z subp>agraphs 7,b7 & 7,c71 respectively4 7c7 ,eligibility = heavily impact$ local educational ag5cies ,item 7bb7 ( section #gjjc7;b77#b77;,b77i77,,iii7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #ggjc7;b77#b77;,b77i77,,iii77 is am5d$ to read z foll[s3 7bb7 has an enrollm5t ( *ildr5 describ$ 9 subsection 7a77#a7 t con/itutes a p]c5tage ( ! total /ud5t enrollm5t ( ! ag5cy t is n less ?an #cj p]c5t2 or 4 #egba4 ,am]ica ,,competes ,act ,section #fabb7c7 ( ! ,am]ica ,,competes ,act 7#bj ,u4,s4,c4 #ihcb7c77 is am5d$ by /rik+ data on *ildr5 eligible = free or r$uc$-price lun*es "u ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act14 #egbb4 ,work=ce ,innovation & ,opportunity ,act ,section #c7cf77;,a7 ( ! ,work=ce ,innovation & ,opportunity ,act 7#bi ,u4,s4,c4 #cajb7cf77;,a77 is am5d$-- 7#a7 by /rik+ clause 7iv72 & 7#b7 by r$esignat+ clauses 7v7 & 7vi7 z clauses 7iv7 & 7v71 respectively4 #egbc4 ,national ,sci5ce ,f\ndation ,au?orization ,act ( #bjjb ,section #d7h7 ( ! ,national ,sci5ce ,f\ndation ,au?orization ,act ( #bjjb 7#db ,u4,s4,c4 #ahfbn note7 is am5d$-- 7#a7 by /rik+ subp>agraph 7,a72 & 7#b7 by r$esignat+ subp>agraphs 7,b7 & 7,c7 z subp>agraphs 7,a7 & 7,b71 respectively4 #egbd4 ,*ild c>e & developm5t block grant ,section #feh,o7b7 ( ! ,*ild ,c>e & ,developm5t ,block ,grant ,act ( #aiij 7#db ,u4,s4,c4 #ihehm7b77 is am5d$-- 7#a7 9 p>agraph 7#a77;,b71 by /rik+ s*ool lun* factor & ins]t+ id5tifi$ /ud5ts factor2 & 7#b7 by /rik+ p>agraph 7#c7 & ins]t+ ! foll[+3 7#c7 ,id5tifi$ /ud5ts factor ,! t]m id5tifi$ /ud5ts factor means ! ratio ( ! numb] ( *ildr5 :o are id5tifi$ /ud5ts 7z det]m9$ "u p>agraph 7#h7 ( section #aaac7;a7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #fcac7;a777 9 ! ,/ate to ! numb] ( su* *ildr5 9 all ! ,/ates z det]m9$ annually by ! ,secret>y ( ,education4 4 #egbe4 ,*ildr5's ,heal? ,act ( #bjjj ,section #adjd7;b7 ( ! ,*ildr5's ,heal? ,act ( #bjjj 7#db ,u4,s4,c4 #ihei;c7b77 is am5d$-- 7#a7 9 p>agraph 7#a77;,b71 by /rik+ s*ool lun* factor & ins]t+ id5tifi$ /ud5ts factor2 & 7#b7 by am5d+ p>agraph 7#c7 to read z foll[s3 7#c7 ,id5tifi$ /ud5ts factor ,9 ?is subsection1 ! t]m id5tifi$ /ud5ts factor means ! ratio ( ! numb] ( *ildr5 :o are id5tifi$ /ud5ts 7z det]m9$ "u p>agraph 7#h7 ( section #aaac7;a7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #fcac7;a777 9 ! ,/ate to ! numb] ( su* *ildr5 9 all ! ,/ates z det]m9$ annually by ! ,secret>y ( ,education4 4 #egbf4 ,juv5ile ju/ice & del9qu5cy prev5tion ,section #beb7;i7 ( ! ,juv5ile ,ju/ice & ,del9qu5cy ,prev5tion ,act ( #aigd 7#cd ,u4,s4,c4 #aaafb7;i77 is am5d$ to read z foll[s3 7i7 ,free s*ool lun*es = inc>c]at$ juv5iles 7#a7 ,eligible juv5ile det5tion c5t] def9$ ,9 ?is subsection1 ! t]m eligible juv5ile det5tion c5t] does n include any private1 =-pr(it det5tion c5t]4 7#b7 ,eligibility = free lun* ,a juv5ile :o is inc>c]at$ 9 an eligible juv5ile det5tion c5t] is eligible to receive free lun* "u ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agea et seq474 7#c7 ,guidance ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,univ]sal ,s*ool ,meals ,program ,act ( #bjbb1 ! ,attorney ,g5]al1 9 consultation ) ! ,secret>y ( ,agriculture1 %all provide guidance to ,/ates relat+ to ! options = s*ool food au?orities 9 ! ,/ates to apply = reimbursem5t = free lun*es "u ! ,ri*>d ,b4 ,russell ,national ,s*ool ,lun* ,act 7#db ,u4,s4,c4 #agea et seq47 = juv5iles :o are inc>c]at$4 4 ,i ,eld] ,c>e #ehja4 ,exp5ses = h\sehold & eld] c>e s]vices necess>y = ga9ful employm5t 7a7 ,9 g5]al ,subp>t ,a ( "p ,,iv ( sub*apt] ,a ( *apt] #a ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ aft] section #be;,d ! foll[+ new section3 #be;,e4 ,exp5ses = h\sehold & eld] c>e s]vices necess>y = ga9ful employm5t 7a7 ,all[ance ( cr$it 7#a7 ,9 g5]al ,9 ! case ( an individual = :i* !re are "o or m qualify+ individuals 7z def9$ 9 subsection 7b77#a77 ) respect to su* individual1 !re %all be all[$ z a cr$it aga9/ ! tax impos$ by ?is *apt] = ! taxable ye> an am\nt equal to ! applicable p]c5tage ( ! employm5t-relat$ exp5ses 7z def9$ 9 subsection 7b77#c77 paid by su* individual dur+ ! taxable ye>4 7#b7 ,applicable p]c5tage def9$ ,= purposes ( p>agraph 7#a71 ! t]m applicable p]c5tage means #ce p]c5t r$uc$ 7b n bel[ #bj p]c5t7 by #a p]c5tage po9t = ea* #b1jjj 7or fraction !re(7 by :i* ! taxpay]'s adju/$ gross income = ! taxable ye> exce$s #ae1jjj4 7b7 ,def9itions ( qualify+ individual & employm5t-,relat$ exp5ses ,= purposes ( ?is section-- 7#a7 ,qualify+ individual ,! t]m qualify+ individual means an individual :o-- 7,a7 has atta9$ age #ej1 & 7,b7 satisfies ! requirem5ts ( any ( ! foll[+ clauses3 7i7 ,an individual :o be>s a relation%ip to ! taxpay] describ$ 9 subp>agraph 7,c7 or 7,d7 ( section #aeb7;d77#b7 7relat+ to fa!rs1 mo!rs1 & ance/ors74 7ii7 ,an individual :o w\ld be a dep5d5t ( ! taxpay] 7z def9$ 9 section #aeb1 det]m9$ )\t reg>d to subsections 7b77#a7 & 7b77#b77 z a qualify+ relative describ$ 9 section #aeb7;d77#a7 if-- 7,i7 9 lieu ( ! requirem5ts "u subp>agraphs 7,b7 & 7,c7 ( su* section1 ) respect to su* individual-- 7aa7 ! taxpay] has provid$ ov] "o-half ( ! individual's support = ! cal5d> ye> 9 :i* su* taxable ye> beg9s & ea* ( ! prec$+ #d taxable ye>s1 & 7bb7 ! individual's modifi$ adju/$ gross income = ! cal5d> ye> 9 :i* su* taxable ye> beg9s is less ?an ! exemption am\nt 7z def9$ 9 section #aea7;d771 7,,ii7 ! individual is physically or m5tally incapable ( c>+ = himself or h]self1 & 7,,iii7 ! individual has ! same pr9cipal place ( abode z ! taxpay] = m ?an "o-half ( su* taxable ye>4 7iii7 ,! sp\se ( ! taxpay]1 if su* sp\se is physically or m5tally incapable ( c>+ = himself or h]self4 7#b7 ,modifi$ adju/$ gross income ,! t]m modifi$ adju/$ gross income means adju/$ gross income det]m9$ )\t reg>d to section #hf4 7#c7 ,employm5t-relat$ exp5ses 7,a7 ,9 g5]al ,! t]m employm5t-relat$ exp5ses means am\nts paid = ! foll[+ exp5ses1 b only if su* exp5ses are incurr$ to enable ! taxpay] to be ga9fully employ$ = any p]iod = :i* !re are "o or m qualify+ individuals ) respect to ! taxpay]3 7i7 ,exp5ses = h\sehold s]vices ) respect to ! qualify+ individual4 7ii7 ,exp5ses = ! c>e ( a qualify+ individual1 includ+ exp5ses = respite c>e & hospice c>e4 7,b7 ,exception ,! t]m employm5t-relat$ exp5ses %all n include s]vices provid$ outside ! taxpay]'s h\sehold unless su* exp5ses are incurr$ = ! c>e (-- 7i7 a qualify+ individual describ$ 9 p>agraph 7#a77;,a71 or 7ii7 a qualify+ individual 7n describ$ 9 p>agraph 7#a77;,a77 :o regul>ly sp5ds at lea/ #h h\rs ea* day 9 ! taxpay]'s h\sehold4 7,c7 ,dep5d5t c>e c5t]s ,! t]m employm5t-relat$ exp5ses %all n include s]vices provid$ outside ! taxpay]'s h\sehold by a dep5d5t c>e c5t] 7z def9$ 9 subp>agraph 7,d77 unless-- 7i7 su* c5t] complies ) all applicable laws & regulations ( ! ,/ate & local gov]nm5t 9 :i* su* c5t] is locat$1 & 7ii7 ! requirem5ts ( subp>agraph 7,b7 are met4 7,d7 ,dep5d5t c>e c5t] def9$ ,= purposes ( ?is p>agraph1 ! t]m dep5d5t c>e c5t] means any facility :i*-- 7i7 provides c>e = m ?an #f individuals 7o!r ?an individuals :o reside at ! facility71 & 7ii7 receives a fee1 paym5t1 or grant = provid+ s]vices = any ( ! individuals 7reg>dless ( :e!r su* facility is op]at$ = pr(it74 7c7 ,doll> limit on am\nt cr$itable ,! am\nt ( ! employm5t-relat$ exp5ses incurr$ dur+ any taxable ye> :i* may be tak5 into acc\nt "u subsection 7a7 %all n exce$-- 7#a7 if !re is #a qualify+ individual ) respect to ! taxpay] = su* taxable ye>1 #c1jjj1 or 7#b7 if !re are #b or m qualify+ individuals ) respect to ! taxpay] = su* taxable ye>1 #f1jjj4 ,! am\nt det]m9$ "u ?is subsection %all be r$uc$ by ! aggregate am\nt excludable f gross income "u section #abi = ! taxable ye>4 7d7 ,e>n$ income limitation ,! am\nt ( ! employm5t-relat$ exp5ses incurr$ dur+ any taxable ye> :i* may be tak5 into acc\nt "u subsection 7a7 %all n exce$-- 7#a7 9 ! case ( an individual :o is n m>ri$ at ! close ( su* ye>1 su* individual's e>n$ income = su* ye>1 or 7#b7 9 ! case ( an individual :o is m>ri$ at ! close ( su* ye>1 ! less] ( su* individual's e>n$ income or ! e>n$ income ( 8 sp\se = su* ye>4 7e7 ,special rules ,= purposes ( ?is section-- 7#a7 ,place ( abode ,an individual %all n be treat$ z hav+ ! same pr9cipal place ( abode ( ! taxpay] if at any "t dur+ ! taxable ye> ( ! taxpay] ! relation%ip betwe5 ! individual & ! taxpay] is 9 violation ( local law4 7#b7 ,m>ri$ c\ples mu/ file jo9t return ,9 ! case ( an individual :o is m>ri$ z ( ! close ( ! taxable ye>1 ! cr$it %all be all[$ "u subsection 7a7 only if a jo9t return is fil$ = ! taxable ye> "u section #fjac4 7#c7 ,m>ital /atus ,an individual legally sep>at$ f 8 or h] sp\se "u a decree ( divorce or ( sep>ate ma9t5ance %all n be consid]$ z m>ri$4 7#d7 ,c]ta9 m>ri$ individuals liv+ ap>t ,9 ! case ( an individual :o is m>ri$ & does n file a jo9t return = ! taxable ye>1 if-- 7,a7 su* individual-- 7i7 ma9ta9s z 8 or h] home a h\sehold :i* con/itutes = m ?an "o-half ( ! taxable ye> ! pr9cipal place ( abode ( a qualify+ individual1 7ii7 furni%es ov] half ( ! co/ ( ma9ta9+ su* h\sehold dur+ ! taxable ye>1 & 7,b7 dur+ ! la/ #f mon?s ( su* taxable ye>1 su* individual's sp\se is n a memb] ( su* h\sehold1 su* individual %all n be consid]$ z m>ri$4 7#e7 ,paym5ts to relat$ individuals ,no cr$it %all be all[$ "u subsection 7a7 = any am\nt paid by ! taxpay] to an individual-- 7,a7 ) respect to :om1 = ! taxable ye>1 a d$uction "u section #aea7;c7 7relat+ to d$uction = p]sonal exemptions = dep5d5ts7 is all[able ei!r to ! taxpay] or ! taxpay]'s sp\se1 or 7,b7 :o-- 7i7 is a *ild ( ! taxpay] 7)9 ! mean+ ( section #aeb7;f77#a771 & 7ii7 has n atta9$ ! age ( #ai at ! close ( ! taxable ye>4 ,= purposes ( ?is p>agraph1 ! t]m taxable ye> means ! taxable ye> ( ! taxpay] 9 :i* ! s]vice 7z describ$ 9 clause 7i7 ( subsection 7b77#c77;,a77 is p]=m$ or ! c>e 7z describ$ 9 clause 7ii7 ( su* subsection7 is provid$4 7#f7 ,id5tify+ in=mation requir$ ) respect to s]vice provid] ,no cr$it %all be all[$ "u subsection 7a7 = any am\nt paid to any p]son unless-- 7,a7 ! "n1 address1 & taxpay] id5tification numb] ( su* p]son are includ$ on ! return ( tax = ! taxable ye> 9 :i* ! cr$it "u ?is section is be+ claim$1 or 7,b7 if su* p]son is an organization describ$ 9 section #eja7;c77#c7 & exempt f tax "u section #eja7;a71 ! "n & address ( su* p]son are includ$ on ! return ( tax = ! taxable ye> 9 :i* ! cr$it "u ?is section is be+ claim$4 ,9 ! case ( a failure to provide ! in=mation requir$ "u ! prec$+ s5t5ce1 ! prec$+ s5t5ce %all n apply if x is %[n t ! taxpay] ex]cis$ due dilig5ce 9 attempt+ to provide ! in=mation s requir$4 7#g7 ,id5tify+ in=mation requir$ ) respect to qualify+ individuals ,no cr$it %all be all[$ "u ?is section ) respect to any qualify+ individual unless ! ,,t9 ( su* individual is includ$ on ! return ( tax = ! taxable ye> 9 :i* ! cr$it "u ?is section is be+ claim$4 7f7 ,regulations ,! ,secret>y %all prescribe su* regulations z may be necess>y to c>ry out ! purposes ( ?is section4 4 7b7 ,cl]ical am5dm5t ,! table ( sections = subp>t ,a ( "p ,,iv ( sub*apt] ,a ( *apt] #a ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ aft] ! item relat+ to section #be;,d ! foll[+ new item3 ,sec4 #be;,e4 ,exp5ses = h\sehold & eld] c>e s]vices necess>y = ga9ful employm5t4 4 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ! date ( ! enactm5t ( ?is ,act4 ,j ,miscellane\s provisions #eija4 ,cl>ification support+ p]missible use ( funds = /illbir? prev5tion activities ,section #eja7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gja7;a77 is am5d$-- 7#a7 9 p>agraph 7#a77;,b71 by ins]t+ to r$uce ! incid5ce ( /illbir?1 aft] among *ildr512 & 7#b7 9 p>agraph 7#b71 by ins]t+ aft] foll[-up s]vices ! foll[+3 1 & = evid5ce-bas$ programs & activities & outcome rese>* to r$uce ! incid5ce ( /illbir? 7includ+ track+ & aw>5ess ( fetal movem5ts1 improvem5t ( bir? tim+ = pregnancies ) risk factors1 initiatives t enc\rage safe sleep+ positions dur+ pregnancy1 scre5+ & surveillance = fetal gr[? re/riction1 ef=ts to a*ieve smok+ cessation dur+ pregnancy1 community-bas$ programs t provide home visits or o!r types ( support1 & any o!r rese>* or evid5ce-bas$ programm+ to prev5t /illbir?s74 ,,vi ,m5tal ,heal? & ,sub/ance ,use ,disord]s #fjja4 ,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 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 & l+ui/ically 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 economic1 & o!r conditions1 o!rwise kn[n z social det]m9ants ( heal?1 9 communities c h trem5d\s influ5ce on daily /ressors t %ape m5tal heal? outcomes4 7#g7 ,significant b>ri]s include ! co/ ( & access to quality c>e1 societal /igma1 m5tal heal? work=ce %ortages1 ! fragm5t$ organization ( s]vices & ne$$ social supports1 & ! hi/ory ( racism & discrim9ation 9 ! m5tal heal? sy/em4 7#h7 ,p ) sev]e & p]si/5t m5tal illness :o are racial or e?nic m9orities (t5 h co-occurr+ heal? & m5tal heal? conditions & exp]i5ce direct inequities 9 access to necess>y supports1 res\rces1 & s]vices :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 ,middle ,ea/]n & ,nor? ,african 7,,m5a71 & o!r p ( color communities are m likely to exp]i5ce sy/emic discrim9ation by heal? c>e & social s]vice provid]s & may be reluctant to seek m5tal heal? c>e & o!r heal? int]v5tions4 7#aj7 ,m5tal heal? conditions & sub/ance abuse disord]s reta9 consid]able /igma 9 _m communities ( color & seek+ treatm5t is n always enc\rag$4 7#aa7 ,address+ m5tal heal? /igma & increas+ access to culturally & l+ui/ically appropriate treatm5ts & supports 9 communities w help to increase utilization ( m5tal heal? s]vices = p :o h functional difficulties because ( m5tal heal? *all5ges4 7#ab7 ,!re is a l9k betwe5 a m5tal heal? diagnosis & ! likelihood ( an individual committ+ suicide4 7#ac7 ,a compreh5sive public heal? approa* to behavioral heal? is "o t fo/]s & f9ances protective factors 9 racial & e?nic communities t support m5tal heal?4 7#ad7 ,approa*es to m5tal heal? & trauma mu/ keep 9 m9d ! hi/orical & pres5t day & cultural trauma t impacts _m communities ( color1 includ+ trauma & loss caus$ by adv]se wea!r ev5ts & /ructural viol5ce4 7#ae7 ,culturally & l+ui/ically appropriate treatm5ts & supports mu/ keep approa*es ( individual communities to m5tal heal? 9 m9d1 includ+ by consid]+-- 7,a7 approa*es to cultural heal+ practices2 & 7,b7 ! div]se 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 exp]i5ce _m inequities t %ape ! way !y process & exp]i5ce ev]yday life4 #fjjb4 ,s5se ( ,congress ,x is ! s5se ( ! ,congress t x is imp]ative t a compreh5sive public heal? approa* to address+ trauma & m5tal heal? c>e be focus$ on c>e deliv]y t is culturally & l+ui/ically appropriate4 ,a ,access to ,c>e & ,fund+ ,/reams #fjaa4 ,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 #dbea7;c77#a71 is am5d$-- 7,a7 9 subp>agraph 7,,hh71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,,ii71 by add+ & at ! end2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,,jj7 m>riage & family !rapi/ s]vices 7z def9$ 9 subsection 7ooo77#a771 m5tal heal? c\nselor s]vices 7z def9$ 9 subsection 7ooo77#c771 sub/ance abuse c\nselor s]vices 7z def9$ 9 subsection 7ooo77#e771 & pe] support speciali/ s]vices 7z def9$ 9 subsection 7ooo77#g772 4 7#b7 ,def9itions ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 z am5d$ by sections #bjjg7;b71 #dbba7;a71 & #dbea7;c77#b71 is am5d$ by add+ at ! end ! foll[+ new subsection3 7ooo7 ,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 heal? conditions & disabilities 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 #dbea7;c77#c71 is am5d$-- 7,a7 by /rik+ & be=e 7,,ee72 & 7,b7 by ins]t+ be=e ! semicolon at ! end ! foll[+3 1 & 7,,ff7 ) 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#g771 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 #bjbc4 #fjab4 ,reau?orization ( ,m9ority ,fell[%ip ,program ,section #eig7;c7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bigll7c77 is am5d$ by /rik+ #ab1ffi1jjj = ea* ( fiscal ye>s #bjah ?r\gh #bjbb & ins]t+ #be1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 #fjac4 ,additional funds = ,national ,in/itutes ( ,heal? 7a7 ,9 g5]al ,9 addition to am\nts o!rwise au?oriz$ to be appropriat$ to ! ,national ,in/itutes ( ,heal?1 !re is au?oriz$ to be appropriat$ to su* ,in/itutes #ajj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg to build relations ) communities & conduct or support cl9ical rese>*1 includ+ cl9ical rese>* on racial or e?nic disp>ities 9 physical & m5tal heal?4 7b7 ,def9ition ,9 ?is section1 ! t]m cl9ical rese>* has ! mean+ giv5 to su* t]m 9 section #dji ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhd;d74 #fjad4 ,additional funds = ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities ,9 addition to am\nts o!rwise au?oriz$ to be appropriat$ to ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities1 !re is au?oriz$ to be appropriat$ to su* ,in/itute #fej1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 #fjae4 ,grants = increas+ racial & e?nic m9ority access to high-quality trauma support s]vices & m5tal heal? c>e 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y71 act+ ?r\gh ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use1 %all aw>d grants to eligible entities to e/abli% or exp& programs = ! purpose ( increas+ racial & e?nic m9ority access to high-quality trauma support s]vices & m5tal heal? c>e4 7b7 ,eligible entities ,to seek a grant "u ?is section1 an entity %all be a community-bas$ program or organization t-- 7#a7 provides culturally & l+ui/ically appropriate programs & res\rces t are align$ ) evid5ce-bas$ practices = trauma-in=m$ c>e2 & 7#b7 has demon/rat$ exp]tise 9 s]v+ communities ( color or c p>tn] ) a program t has su* demon/rat$ exp]tise4 7c7 ,use ( funds ,z a condition on receipt ( a grant "u ?is section1 a grantee %all agree to use ! grant to increase racial & e?nic m9ority access to high-quality trauma support s]vices & m5tal heal? c>e1 su* z by-- 7#a7 e/abli%+ & ma9ta9+ community-bas$ programs provid+ evid5ce-bas$ s]vices 9 trauma-in=m$ c>e & culturally specific s]vices & o!r res\rces2 7#b7 develop+ innovative1 culturally specific /rategies & projects to enhance access to trauma-in=m$ c>e & res\rces = racial & e?nic m9orities :o face ob/acles to us+ m traditional s]vices & res\rces 7su* z ob/acles 9 geographic access to provid]s1 insurance cov]age1 & access to audio & video te*nologies72 7#c7 work+ ) ,/ate & local gov]nm5ts & social s]vice ag5cies to develop & enhance effective /rategies to provide culturally specific s]vices to racial & e?nic m9orities2 7#d7 increas+ communities' capacity to provide culturally specific res\rces & support = communities ( color2 7#e7 work+ 9 coop]ation ) ! community to develop education & prev5tion /rategies highlight+ culturally specific issues & res\rces reg>d+ racial & e?nic m9orities2 7#f7 provid+ culturally specific programs = racial & e?nic m9orities expos$ to law en=cem5t viol5ce2 & 7#g7 exam9+ ! dynamics ( culture & its impact on victimization & heal+4 7d7 ,priority ,9 aw>d+ grants "u ?is section1 ! ,secret>y %all give priority to eligible entities propos+ to s]ve communities t h fac$ high rates ( community trauma1 includ+ f exposure to law en=cem5t viol5ce1 int]g5]ational pov]ty1 civil unre/1 discrim9ation1 or oppression4 7e7 ,grant p]iod ,! p]iod ( a grant "u ?is section %all be #d ye>s4 7f7 ,evaluation ,n lat] ?an #f mon?s aft] ! end ( ! p]iod ( all grants "u ?is section1 ! ,secret>y %all-- 7#a7 conduct an evaluation ( ! programs fund$ by a grant "u ?is section2 7#b7 include 9 su* evaluation an assessm5t ( ! outcomes ( ea* su* program2 & 7#c7 submit a report on ! results ( su* evaluation to ! ,congress4 7g7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re is au?oriz$ to be appropriat$ #bj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 #fjaf4 ,grants = un>m$ #i-a-a response programs ,"p ,d ( title ,v ( ! ,public ,heal? ,s]vice ,act1 z am5d$ by sections #fjbb1 #fjbc1 & #fjeb1 is fur!r am5d$ by add+ at ! end ! foll[+ new section3 #eef4 ,grants = un>m$ #i-a-a response programs 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use1 may aw>d grants to ,/ates1 t]ritories1 political subdivisions ( ,/ates & t]ritories1 ,tribal gov]nm5ts1 & consortia ( ,tribal gov]nm5ts to e/abli% an un>m$ #i-a-a response program "u :i* nonviol5t #i-a-a calls are ref]r$ to un>m$ pr(essional s]vice provid]s = response1 in/ead ( to a law en=cem5t ag5cy4 7b7 ,program requirem5ts ,an un>m$ #i-a-a response program fund$ "u ?is section %all-- 7#a7 dispat* un>m$ pr(essional s]vice provid]s 9 gr\ps ( two or m 9 a timely mann]2 7#b7 be capable ( provid+ scre5+1 assessm5t1 de-escalation1 trauma-in=m$ culturally & l+ui/ically appropriate s]vices1 ref]rals to treatm5t provid]s1 & transportation to imm$iately necess>y treatm5t2 7#c7 :5 necess>y1 coord9ate ) heal? or social s]vices2 7#d7 n be subject to ov]sight ( ,/ate or local law en=cem5t ag5cies2 & 7#e7 cle>ly outl9e ! scope ( calls t mu/ or may be ref]r$ to ! un>m$ #i-a-a response program4 7c7 ,uses ( funds ,a grant "u ?is section may be us$ =-- 7#a7 hir+ un>m$ pr(essional s]vice provid]s & #i-a-a dispat*]s2 7#b7 tra9+ un>m$ pr(essional s]vice provid]s to respond to #i-a-a calls by id5tify+1 und]/&+1 & respond+ to signs ( m5tal illnesses1 developm5tal or intellectual disabilities1 & sub/ance use disord]s1 includ+ by means (-- 7,a7 de-escalation2 7,b7 crisis int]v5tion2 & 7,c7 connect+ individuals to local social s]vice provid]s1 heal? c>e provid]s1 community-bas$ organizations1 & ! full range ( o!r available provid]s & res\rces1 ) a focus on culturally & l+ui/ically appropriate s]vice provid]s2 7#c7 updat+ #i-a-a response sy/ems to enable triage betwe5 nonviol5t #i-a-a calls & ^? t require a response f law en=cem5t2 7#d7 tra9+ #i-a-a dispat*]s on call div]sion2 7#e7 build+ ! capacity-- 7,a7 to coord9ate ) local social s]vice provid]s1 heal? c>e provid]s1 suicide hotl9e op]ators1 & community-bas$ organizations2 & 7,b7 to provide multil+ual & culturally & l+ui/ically appropriate s]vices2 & 7#f7 collect+ data = reports to ! ,secret>y4 7d7 ,application ,an applicant seek+ a grant "u ?is section %all submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may reasonably require1 includ+ ! applicant's plan to tra9 #i-a-a dispat*]s to det]m9e :5 a call %\ld be div]t$ to ! un>m$ #i-a-a response program4 7e7 ,reports to ,secret>y ,a recipi5t ( a grant "u ?is section %all submit to ! ,secret>y1 on a biannual basis1 a report on ! foll[+3 7#a7 ,! numb] ( calls plac$ to #i-a-a t 7 div]t$ to ! grantee's un>m$ #i-a-a response program4 7#b7 ,demographic in=mation on ! individuals s]v$ by ! grantee's un>m$ #i-a-a response program1 disaggregat$ by race1 e?nicity1 age1 sex1 sexual ori5tation1 g5d] id5tity1 & location4 7#c7 ,! effects ( ! grantee's un>m$ #i-a-a response program on em]g5cy room visits1 hospitalizations1 use ( ambulances1 & involvem5t ( law en=cem5t 9 m5tal heal? or sub/ance use disord] crises4 7#d7 ,an assessm5t ( ! types ( ev5ts & crises to :i* ! grantee's un>m$ #i-a-a response program respond$ & ! s]vices provid$1 includ+-- 7,a7 ! numb] ( individuals to :om s]vices 7 provid$ :o 7 involunt>ily committ$ = treatm5t2 7,b7 ! numb] ( individuals successfully transf]r$ to an alt]native de/9ation2 7,c7 ! "t betwe5 notification by a #i-a-a dispat*] & arrival at ! sc5e by a provid]2 & 7,d7 ! "t sp5t by provid]s at sc5e4 7#e7 ,a co/ analysis ( ! grantee's un>m$ #i-a-a response program4 7#f7 ,an assessm5t ( data %>+ limitations or problems associat$ ) adh]5ce to-- 7,a7 ,f$]al regulations 7conc]n+ ! privacy ( individually id5tifiable heal? in=mation7 promulgat$ "u section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif2 & 7,b7 "p #b ( title #db1 ,code ( ,f$]al ,regulations4 7f7 ,reports to ,congress ,! ,secret>y %all submit to ! ,congress1 on a biannual basis1 a report on ! program "u ?is section1 includ+ a summ>y ( ! reports submitt$ by grantees pursuant to subsection 7e74 7g7 ,grant am\nt ,! ,secret>y may make grants to applicants t d n meet all ( ! crit]ia "u subsection 7b71 b applicants t d n meet all su* crit]ia may n receive ! full grant am\nt4 7h7 ,def9itions ,9 ?is section3 7#a7 ,! t]m alt]native de/9ation-- 7,a7 means any s]vice- or c>e-provid+ site o!r ?an a hospital em]g5cy dep>tm5t or jail2 & 7,b7 includes a cl9ic1 prim>y c>e (fice1 crisis c5t]1 & community c>e c5t]4 7#b7 ,! t]m nonviol5t #i-a-a call means a #i-a-a call t-- 7,a7 relates to m5tal heal?1 homelessness1 addiction problems1 social s]vices1 truancy1 intellectual & developm5tal disabilities1 or public intoxication2 & 7,b7 does n involve obvi\s viol5t behavior4 7#c7 ,! t]m un>m$ pr(essional s]vice provid] means a pr(essional 7:i* may include a nurse1 social work]1 em]g5cy m$ical te*nician1 c\nselor1 community heal? work]1 trauma-in=m$ p]sonnel1 social s]vice provid]1 or pe] support speciali/7 :o-- 7,a7 is tra9$ to deal ) m5tal heal? or sub/ance abuse crises or intellectual & developm5tal disabilities2 & 7,b7 does n c>ry a fire>m4 4 ,b ,int]pr(essional ,c>e #fjba4 ,heal? pr(essions compet5cies to address racial & e?nic m5tal heal? inequities 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 programs1 culturally & l+ui/ically appropriate 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? inequities 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 compos$ ( exp]ts f accr$it$ heal? pr(essions s*ools to id5tify core compet5cies relat+ to m5tal heal? inequities among racial & e?nic m9ority gr\ps4 7#b7 ,plann+ ( work%ops 9 collaboration ) community-bas$ organizations & communities ( color 9 national =a to directly facilitate public input1 includ+ input f communities ( color ) liv$ exp]i5ce1 into ! educational ne$s associat$ ) m5tal heal? inequities 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 & lead]%ip f communities ( color ) liv$ exp]i5ce ( ! impacts ( m5tal heal? inequities4 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 sub/ance use c\nsel+1 & 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;g771 z am5d$ by title ,i ( ?is ,act4 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 #bjbc ?r\gh #bjbg4 #fjbb4 ,int]pr(essional heal? c>e teams = behavioral heal? c>e ,"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>y1 %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$ & div]se 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>* available1 includ+ in=mation on language accessibility1 cultural humility1 div]sity ( practition]s1 & consid]ation ( social det]m9ants ( heal?4 7e7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re is au?oriz$ to be appropriat$ #bj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 4 #fjbc4 ,integrat$ ,heal? ,c>e ,demon/ration ,program ,"p ,d ( title ,v ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bij;dd et seq471 z am5d$ by sections #fjbb & #fjeb1 is fur!r am5d$ by add+ at ! end ! foll[+3 #eee4 ,int]pr(essional heal? c>e teams = provision ( behavioral heal? c>e 9 prim>y c>e sett+s 7a7 ,grants ,! ,secret>y %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 or behavioral heal? program1 s]v+ a high proportion ( individuals f racial & e?nic m9ority gr\ps 7z def9$ 9 section #agjg7;g774 7c7 ,sci5tifically bas$ ,integrat$ heal? c>e fund$ ?r\gh ?is section %all be sci5tifically bas$1 tak+ into consid]ation ! results ( ! mo/ rec5t pe]-review$ rese>* available4 7d7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re is au?oriz$ to be appropriat$ #bj1jjj1jjj = ea* ( ! fir/ #e fiscal ye>s foll[+ ! date ( enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act4 4 ,c ,work=ce ,developm5t #fjca4 ,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 & advocacy & behavioral & m5tal heal? organizations s]v+ vuln]able populations1 includ+ y\? & "y adults1 p ) l[ incomes1 & p ( color1 %all-- 7#a7 develop1 /r5g!n1 & implem5t /rategies to bol/] c>e] pa?ways = div]se m5tal heal? pr(essionals2 7#b7 id5tify ! bread? ( sett+s :]e m5tal heal? c>e & behavioral heal? c>e c take place2 & 7#c7 id5tify curr5t m5tal heal? pr(essional work=ce %ortages1 inclusive ( %ortages ( div]se m5tal heal? pr(essionals4 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 div]se 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 = div]se lay heal? work]s su* z community heal? work]s & o!r pe] support speciali/s to ensure t c>e]s pay a liv+ wage2 7#e7 creat+ inc5tives = /ud5ts 9 ! fields ( occupational !rapy1 social "w1 psy*ology1 m$ic9e1 & nurs+ to le>n m ab\t m5tal heal?1 & to include a m5tal heal? rotation1 ) a p>ticul> focus 9 racially & e?nically div]se communities1 z a "p ( ! heal? pr(essional curricula2 7#f7 includ+ tra9+ & education = tea*]s ab\t ! basics ( section #ejd ( ! ,rehabilitation ,act ( #aigc 7#bi ,u4,s4,c4 #gid7 & individualiz$ 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 7c7 ,use ( funds ,programs & activities fund$ "u ?is section %all be consi/5t ) subsection 7a77#a7 & %all include ! foll[+3 7#a7 ,subgrants to entities s]v+ y\? & "y adults :i* demon/rate a ne$ = an increas$ m5tal heal? work=ce1 us+ /rategies m5tion$ 9 subsection 7a77#a74 7#b7 ,fund+ t[>ds ! ,heal? ,res\rces & ,s]vices ,adm9i/ration's ,behavioral ,heal? ,work=ce ,education & ,tra9+ ,program4 7#c7 ,fund+ t[>ds ! developm5t & implem5tation ( a ,national ,heal? ,s]vice ,corps program focus$ on community trauma4 7d7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section1 #ej1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjcc4 #fjcb4 ,pilot program to increase language access at ,f$]ally qualifi$ heal? c5t]s 7a7 ,loan repaym5ts to qualifi$ heal? c>e pr(essionals 7#a7 ,9 g5]al ,= ! purpose ( increas+ language access to m5tal heal? s]vices1 ! ,secret>y %all c>ry out a demon/ration project "u :i*-- 7,a7 ! ,secret>y mat*es qualifi$ m5tal heal? pr(essionals ) ,f$]ally qualifi$ heal? c5t]s2 7,b7 ! qualifi$ m5tal heal? pr(essionals ea* agree to a p]iod ( obligat$ s]vice at a ,f$]ally qualifi$ heal? c5t] ) :i* !y are s mat*$2 & 7,c7 ! ,secret>y agrees to make loan repaym5ts "u section #cch;,b ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bedl-#a7 on behalf ( su* qualifi$ m5tal heal? pr(essionals4 7#b7 ,pref]5ce ,9 mat*+ qualifi$ m5tal heal? pr(essionals ) ,f$]ally qualifi$ heal? c5t]s "u p>agraph 7#a71 ! ,secret>y %all give pref]5ce to placem5t at ,f$]ally qualifi$ heal? c5t]s at :i* at lea/ #bj p]c5t ( ! pati5ts are be/ s]v$ 9 a language o!r ?an ,engli%1 z indicat$ by data 9 ! ,uni=m ,data ,sy/em 7or any successor database74 7#c7 ,enhanc$ comp5sation ,= ea* ye> ( obligat$ s]vice t a qualifi$ m5tal heal? pr(essional contracts to s]ve "u p>agraph 7#a7 at a ,f$]ally qualifi$ heal? c5t] at :i* at lea/ #bj p]c5t ( ! pati5ts are be/ s]v$ 9 a language o!r ?an ,engli%1 z indicat$ by data 9 ! ,uni=m ,data ,sy/em 7or any successor database71 ! ,secret>y may pay ! high] (-- 7,a7 #aj1jjj above ! maximum am\nt o!rwise applicable "u section #cch;,b7g77#b77;,a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bedl-#a7;g77#b77;,a772 or 7,b7 if ! qualifi$ heal? pr(essional is flu5t 9 a language o!r ?an ,engli% t is ne$$ by su* ,f$]ally qualifi$ heal? c5t]1 #ae1jjj above su* maximum am\nt4 7#d7 ,a*iev+ flu5cy ,a qualifi$ m5tal heal? pr(essional eligible to receive ! enhanc$ pay am\nt specifi$ 9 p>agraph 7#c77;,a7 at ! beg9n+ ( ! pr(essional's p]iod ( obligat$ s]vice may transition to be+ eligible to receive ! enhanc$ high] pay am\nt specifi$ 9 p>agraph 7#c77;,b7 if ! pr(essional is det]m9$ by ! ,f$]ally qualifi$ heal? c5t] at :i* ! pr(essional s]ves to h a*iev$ flu5cy 9 a language o!r ?an ,engli% ne$$ by t heal? c5t]4 7b7 ,grants to heal? c5t]s 7#a7 ,9 g5]al ,! ,secret>y %all c>ry out a demon/ration program consi/+ ( aw>d+ grants "u section #ccj ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;b7 to ,f$]ally qualifi$ heal? c5t]s to recruit1 hire1 employ1 & sup]vise qualifi$ m5tal heal? pr(essionals :o are flu5t 9 a language o!r ?an ,engli% to provide m5tal heal? s]vices 9 su* o!r language4 7#b7 ,pref]5ce ,9 select+ grant recipi5ts "u p>agraph 7#a71 ! ,secret>y %all give pref]5ce to ,f$]ally qualifi$ heal? c5t]s at :i* at lea/ #bj p]c5t ( ! pati5ts are be/ s]v$ 9 a language o!r ?an ,engli%1 z indicat$ by data 9 ! ,uni=m ,data ,sy/em 7or any successor database74 7#c7 ,m>ket+ ,a ,f$]ally qualifi$ heal? c5t] receiv+ a grant "u ?is subsection %all use a portion ( ! grant funds to dissem9ate in=mation ab\t1 & o!rwise m>ket1 ! m5tal heal? s]vices support$ ?r\gh ! grant4 7c7 ,reports 7#a7 ,initial report ,n lat] ?an #f mon?s aft] aw>d+ loan repaym5t agreem5ts "u subsection 7a7 & grants "u subsection 7b71 ! ,secret>y %all submit to ! ,committees on ,appropriations ( ! ,h\se ( ,repres5tatives & ! ,s5ate1 & to o!r appropriate congressional committees1 a report on ! implem5tation ( ! programs "u ?is section4 ,su* report %all include-- 7,a7 ! languages spok5 by ! qualifi$ m5tal heal? pr(essionals receiv+ loan repaym5ts pursuant to subsection 7a7 or recruit$ pursuant to a grant "u subsection 7b72 7,b7 ! ,f$]ally qualifi$ heal? c5t]s at :i* su* pr(essionals 7 plac$2 7,c7 h[ _m ,f$]ally qualifi$ heal? c5t]s receiv$ fund+ ?r\gh ! grant program "u subsection 7b72 7,d7 an analysis1 conduct$ 9 consultation ) ! ,f$]ally qualifi$ heal? c5t]s receiv+ grants "u section 7b71 ( ! effectiv5ess ( su* grants at increas+ language access to m5tal heal? s]vices2 & 7,e7 be/ practices1 develop$ 9 consultation ) ,f$]ally qualifi$ heal? c5t]s receiv+ grants "u section 7b71 = ! recruitm5t & ret5tion ( m5tal heal? pr(essionals at ,f$]ally qualifi$ heal? c5t]s4 7#b7 ,f9al report ,n lat] ?an ! end ( fiscal ye> #bjbg1 ! ,secret>y %all submit to ! ,committees on ,appropriations ( ! ,h\se ( ,repres5tatives & ! ,s5ate1 & to o!r appropriate congressional committees1 a f9al report on ! implem5tation ( ! programs "u ?is section1 includ+ ! in=mation1 analysis1 & be/ practices li/$ 9 subp>agraphs 7,a7 ?r\gh 7,e7 ( p>agraph 7#a74 7d7 ,def9itions ,9 ?is section3 7#a7 ,! t]m ,f$]ally qualifi$ heal? c5t] has ! mean+ giv5 ! t]m 9 section #ahfa7;aa7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa774 7#b7 ,! t]m qualifi$ m5tal heal? pr(essional means-- 7,a7 physicians1 allopa?ic physicians1 o/eopa?ic physicians1 nurse practition]s1 & physician assi/ants ) a specialty 9 m5tal heal? & psy*iatry2 7,b7 heal? s]vice psy*ologi/s2 7,c7 lic5s$ cl9ical social work]s2 7,d7 psy*iatric nurse speciali/s2 7,e7 m>riage & family !rapi/s2 7,f7 lic5s$ pr(essional c\nselors2 7,g7 sub/ance use disord] c\nselors2 7,h7 occupational !rapi/s2 & 7,i7 o!r individuals :o-- 7i7 h n yet be5 lic5s$ or c]tifi$ to s]ve z a pr(essional li/$ 9 any ( subp>agraphs 7,a7 ?r\gh 7,h72 & 7ii7 w s]ve at ! ,f$]ally qualifi$ heal? c5t] "u ! sup]vision ( a lic5s$ individual or c]tifi$ pr(essional s li/$4 7#c7 ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7e7 ,au?orization ( appropriations 7#a7 ,9 g5]al ,to c>ry out ?is section1 !re is au?oriz$ to be appropriat$ #ge1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 7#b7 ,supplem5t1 n supplant ,am\nts made available to c>ry out ?is section %all be 9 addition to am\nts o!rwise available to provide m5tal heal? s]vices at ,f$]ally qualifi$ heal? c5t]s pursuant to sections #cch;,b & #ccj ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bedl-#a1 #bed;b74 #fjcc4 ,heal? pr(essions compet5cies to address racial & e?nic m9ority m5tal heal? disp>ities 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices may aw>d grants to qualifi$ national organizations = ! purposes (-- 7#a7 develop+1 & dissem9at+ to heal? pr(essional educational programs1 be/ practices or core compet5cies address+ m5tal heal? disp>ities 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 & sub/ance abuse c\nsel+2 & 7#b7 c]tify+ community heal? work]s & pe] wellness speciali/s ) respect to su* be/ practices & core compet5cies & integrat+ & exp&+ ! use ( su* work]s & speciali/s into heal? c>e to address m5tal heal? disp>ities among racial & e?nic m9ority gr\ps4 7b7 ,be/ practices2 core compet5cies ,organizations receiv+ funds "u subsection 7a7 may use ! funds to engage 9 ! foll[+ activities relat$ to ! developm5t & dissem9ation ( be/ practices or core compet5cies describ$ 9 subsection 7a77#a73 7#a7 ,=mation ( committees or work+ gr\ps compos$ ( exp]ts f accr$it$ heal? pr(essions s*ools to id5tify be/ practices & core compet5cies relat+ to m5tal heal? disp>ities among racial & e?nic m9ority gr\ps4 7#b7 ,plann+ ( work%ops at ! national level to all[ = public input into ! educational ne$s associat$ ) m5tal heal? disp>ities among racial & e?nic m9ority gr\ps4 7#c7 ,dissem9ation & promotion ( ! use ( be/ practices or core compet5cies = culturally & l+ui/ically appropriate m5tal heal? s]vices 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$uce m5tal heal? disp>ities among racial & e?nic m9ority gr\ps4 7c7 ,def9itions ,9 ?is section3 7#a7 ,qualifi$ national organization ,! t]m qualifi$ national organization means a national organization t focuses on ! education ( /ud5ts 9 "o or m ( ! pr(essions ( social "w1 psy*ology1 psy*iatry1 m>riage & family !rapy1 m5tal heal? c\nsel+1 & sub/ance misuse c\nsel+4 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 ,d ,*ildr5's ,m5tal ,heal? #fjda4 ,p$iatric behavioral heal? c>e ,subp>t ,v ( "p ,d ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bef et seq47 is am5d$ by add+ at ! end ! foll[+3 #cdj;,a-#a4 ,grants to support p$iatric behavioral heal? c>e integration & coord9ation 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all aw>d grants to eligible entities = ! purpose ( support+ p$iatric behavioral heal? c>e integration & coord9ation )9 communities to meet local community ne$s4 7b7 ,eligible entities ,entities eligible = grants "u subsection 7a7 include-- 7#a7 p$iatricians2 7#b7 *ildr5's hospitals2 7#c7 p$iatric behavioral heal? provid]s ) ! capacity to organize & implem5t activities work+ ) community organizations & provid]s2 & 7#d7 o!r entities z det]m9$ appropriate by ! ,secret>y4 7c7 ,prioritization ,9 aw>d+ grants "u subsection 7a71 ! ,secret>y %all prioritize applicants t demon/rate ! highe/ ne$s at ! local level along ! c>e cont9uum = /r5g!n+ *ildr5's behavioral heal? crisis c>e & access4 7d7 ,use ( funds ,activities t may be fund$ ?r\gh a grant "u subsection 7a7 include-- 7#a7 ! recruitm5t & ret5tion ( community heal? work]s or navigators to coord9ate family access to p$iatric m5tal1 emotional1 & behavioral heal? s]vices2 7#b7 tra9+ ! p$iatric m5tal1 emotional1 & behavioral heal? c>e work=ce1 relevant /akehold]s1 & community memb]s2 7#c7 exp&+ evid5ce-bas$1 integrat$ models ( c>e = p$iatric m5tal1 emotional1 & behavioral heal? s]vices2 7#d7 p$iatric practice integration = ! provision ( p$iatric m5tal1 emotional1 & behavioral heal? s]vices2 7#e7 address+ surge capacity = p$iatric m5tal1 emotional1 & behavioral heal? ne$s2 7#f7 provid+ p$iatric m5tal1 emotional1 & behavioral heal? s]vices to *ildr5 z deliv]$ by behavioral1 emotional1 & m5tal heal? pr(essionals utiliz+ teleheal? s]vices2 7#g7 e/abli%+ or ma9ta9+ initiatives to decompress em]g5cy dep>tm5ts1 includ+ p>tial hospitalization1 /ep d[n resid5cy programs1 & int5sive outpati5t programs2 7#h7 support+1 enhanc+1 or exp&+ p$iatric m5tal1 emotional1 & behavioral heal? prev5tive & crisis int]v5tion s]vices2 7#i7 e/abli%+ or ma9ta9+ p$iatric m5tal1 emotional1 & behavioral heal? urg5t c>e2 7#aj7 e/abli%+ or ma9ta9+ community-bas$ initiatives1 su* z s*ool-bas$ p>tn]%ips2 & 7#aa7 address+ o!r access & coord9ation gaps to m5tal1 emotional1 & behavioral heal? s]vices 9 ! community = *ildr54 7e7 ,fund+ ,to c>ry out ?is section1 !re is h]eby appropriat$1 out ( am\nts 9 ! ,treasury n o!rwise obligat$1 #ejj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 #cdj;,a-#b4 ,p$iatric behavioral heal? work=ce tra9+ program 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all aw>d grants to eligible entities = ! purpose ( support+ evid5ce-bas$ p$iatric behavioral heal? work=ce tra9+4 7b7 ,eligible entities ,entities eligible = grants "u subsection 7a7 include-- 7#a7 *ildr5's hospitals2 & 7#b7 o!r p$iatric heal? c>e provid]s z det]m9$ appropriate by ! ,secret>y4 7c7 ,use ( funds ,! tra9+ t may be support$ ?r\gh a grant "u subsection 7a7 includes exp&$ tra9+ 9 p$iatric behavioral heal? = physicians & nonphysician practition]s1 includ+ ! foll[+ practition] types3 7#a7 ,*ild & adolesc5t psy*iatri/s4 7#b7 ,psy*iatric nurses4 7#c7 ,psy*ologi/s4 7#d7 ,advanc$ practice nurses4 7#e7 ,family !rapi/s4 7#f7 ,social work]s4 7#g7 ,m5tal heal? c\nselors4 7#h7 ,o!r practition] types z det]m9$ appropriate by ! ,secret>y4 7d7 ,fund+ ,to c>ry out ?is section1 !re is h]eby appropriat$1 out ( am\nts 9 ! ,treasury n o!rwise obligat$1 #ajj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 4 #fjdb4 ,m5tal heal? 9 s*ools 7a7 ,purpose ,x is ! purpose ( ?is section to-- 7#a7 revise1 increase fund+ =1 & exp& ! scope ( ! ,project ,,aw>e ,/ate ,educational ,ag5cy ,grant ,program c>ri$ 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 :o h a high likelihood ( develop+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]s1 co-occurr+ conditions1 or disabilities2 & 7#g7 e/abli% =mal work+ relation%ips among heal?1 human s]vice1 & educational entities t support ! m5tal & emotional heal? ( *ildr5 & adolesc5ts 9 ! s*ool sett+ or t h a *ild or y\? focus4 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 7b71 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 & ! risk ( exp]i5c+ community or int]p]sonal viol5ce1 su* z abuse or neglect4 ,all s]vices & supports provid$ "u su* a grant1 contract1 or coop]ative agreem5t %all-- 7#a7 be developm5tally1 l+ui/ically1 & culturally appropriate2 7#b7 be 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]ational cont9uum ( impacts ( trauma on populations2 7,b7 tra9 appropriate /aff to id5tify1 & scre5 =1 signs ( trauma exposure1 m5tal heal? & co-occurr+ conditions1 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+ div]se community p>tn]%ips among families1 /ud5ts1 educational 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 z well z unmet m5tal heal? ne$s2 & 7#d7 e/abli%+ & promot+ be/ practices t are ei!r evid5ce bas$ or culturally bas$ = *ildr5 & adolesc5ts to %>e _! exp]i5ces ( individual & community trauma1 includ+ _! exposure to community & dome/ic 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 *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 section4 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 made pursuant to ?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 #bjbc ?r\gh #bjbf4 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$1 9 ! "p head+ by /rik+ ,projects = ,*ildr5 & ,viol5ce & ins]t+ ! foll[+3 ,s*ool-bas$ m5tal heal?4 7e7 ,s*ool-,bas$ m5tal heal? s]vices 7#a7 ,9 g5]al ,! ,secret>y ( ,education %all aw>d grants to ,/ate educational ag5cies to support s]vices provid$ by s*ool-bas$ m5tal heal? s]vices provid]s at s*ools receiv+ funds "u "p ,a ( title ,i ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #fcaa et seq474 7#b7 ,use ( funds ,grants "u ?is subsection %all be us$ to help meet ! recomm5d$ ratios (-- 7,a7 #bej /ud5ts p] s*ool c\nselor2 7,b7 #ejj /ud5ts p] s*ool psy*ologi/2 & 7,c7 #bej /ud5ts p] s*ool social work]4 7#c7 ,condition ,! ,secret>y %all ensure t funds made available "u ?is subsection are us$ to provide s]vices t are developm5tally1 l+ui/ically1 & culturally appropriate1 are trauma-in=m$1 & incorporate positive behavioral int]v5tions & supports4 7#d7 ,def9itions ,= purposes ( ?is subsection3 7,a7 ,! t]m s*ool-bas$ m5tal heal? s]vices provid] has ! mean+ giv5 su* t]m 9 section #dajb ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #gaab74 7,b7 ,! t]m ,/ate educational ag5cy has ! mean+ giv5 su* t]m 9 section #haja ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #ghja74 #fjdc4 ,additional support = y\? & "y adult m5tal heal? s]vice provision ,section #aijc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7cc7 ,y\? & "y adult int]v5tion s]vices 7#a7 ,9 g5]al ,not)/&+ section #aijb7;a77#a7 7relat+ to ,/atewid5ess71 section #aijb7;a77#aj77;,b7 7relat+ to comp>ability71 section #aijb7;a77#bc77;,a7 7relat+ to fre$om ( *oice ( provid]s71 or section #aijb7;a77#bg7 7relat+ to provid] agreem5ts71 a ,/ate may1 dur+ ! #e-ye> p]iod beg9n+ on ! fir/ day ( ! fiscal ye> qu>t] t beg9s on or aft] ,janu>y #a1 #bjbd1 provide m$ical assi/ance = qualify+ y\? & "y adult m5tal heal? & sub/ance use int]v5tion s]vices 7z def9$ 9 p>agraph 7#b77;,c77 "u a ,/ate plan am5dm5t or waiv] approv$ "u section #aaae or #aiae7;c74 7#b7 ,def9itions ,= ! purposes ( ?is subsection3 7,a7 ,priority s]vice ,! t]m priority s]vice means any ( ! foll[+ if volunt>ily receiv$ & provid$ 9 a mann] t ma9ta9s ! privacy & confid5tiality ( pati5t in=mation consi/5t ) ,f$]al & ,/ate requirem5ts3 7i7 ,community-bas$ mobile crisis int]v5tion s]vices1 z def9$ 9 section #aidg4 7ii7 ,teleheal?4 7iii7 ,y\? pe] support4 7iv7 ,scre5+ = adv]se *ildhood exp]i5ces4 7v7 ,trauma responsive c>e4 7vi7 ,o!r priority s]vices = y\?1 z def9$ by ! ,secret>y4 7,b7 ,qualifi$ m5tal heal? provid]s ,! t]m qualifi$ m5tal heal? provid]s means a behavioral heal? c>e pr(essional :o is capable ( conduct+ an assessm5t ( ! individual1 9 accordance ) ! pr(essional's p]mitt$ scope ( practice "u ,/ate law1 & o!r pr(essionals or p>apr(essionals ) appropriate exp]tise 9 y\? & "y adult behavioral heal? or m5tal heal?1 includ+ social work]s1 pe] support speciali/s1 recov]y coa*es1 community heal? work]s1 m5tal heal? cl9icians1 & o!rs1 z designat$ by ! ,/ate & approv$ by ! ,secret>y4 7,c7 ,qualify+ y\? & "y adult m5tal heal? & sub/ance use int]v5tion s]vices def9$ ,! t]m qualify+ y\? & "y adult m5tal heal? & sub/ance use int]v5tion s]vices means1 ) respect to a ,/ate1 items & s]vices = :i* m$ical assi/ance is available "u ! ,/ate plan "u ?is title or a waiv] ( su* plan1 t are-- 7i7 furni%$ to an individual #af to #be ye>s ( age :o is-- 7,i7 exp]i5c+ a m5tal heal? or sub/ance use disord] crisis2 7,,ii7 subject to ! juv5ile or adult ju/ice sy/em z def9$ 9 section #cajb ( title #bi1 ,unit$ ,/ates ,code2 7,,iii7 7aa7 exp]i5c+ homelessness 7z def9$ 9 section #dadjc7f7 ( ! ,viol5ce ,aga9/ ,wom5 ,act ( #aiid 7#db ,u4,s4,c4 #adjdc;e-#b7f7772 7bb7 a homeless *ild or y\? 7z def9$ 9 section #gbe7b7 ( ! ,mc,kinney-,v5to ,homeless ,assi/ance ,act 7#db ,u4,s4,c4 #aadcd;a7#b7772 7cc7 a runaway1 9 fo/] c>e1 or has ag$ out ( ! fo/] c>e sy/em2 7dd7 a *ild eligible = assi/ance "u section #dgg ( ! ,social ,security ,act 7#db ,u4,s4,c4 #fgg72 or 7ee7 9 an out-(-home placem5t2 7,,iv7 pregnant or p>5t+ z def9$ 9 section #cajb ( title #bi1 ,unit$ ,/ates ,code2 7,v7 a y\? :o is an individual ) a disability z def9$ 9 section #cajb ( title #bi1 ,unit$ ,/ates ,code2 7,,vi7 a l[-income y\? requir+ additional assi/ance to ent] or complete an educational program or to secure or hold employm5t z def9$ 9 section #cajb ( title #bi1 ,unit$ ,/ates ,code2 or 7,,vii7 liv+ 9 a community t has fac$ acute or long-t]m exposure to sub/antial discrim9ation1 hi/orical oppression1 int]g5]ational pov]ty1 civil unre/1 or a high rate ( viol5ce or drug ov]dose dea?s2 7ii7 furni%$ by qualifi$ m5tal heal? provid]s2 & 7iii7 a priority s]vice4 7,d7 ,teleheal? ,! t]m teleheal? means use ( electronic in=mation & telecommunications te*nologies1 includ+ voice only audio1 text1 remote pati5t monitor+1 & m,health via applications1 to support cl9ical m5tal heal? c>e1 pati5t & pr(essional heal?-relat$ education1 public heal?1 & heal? adm9i/ration4 7#c7 ,paym5ts ,not)/&+ section #aije7;b71 beg9n+ ,janu>y #a1 #bjbd1 dur+ ea* ( ! fir/ #bj fiscal qu>t]s t a ,/ate meets ! requirem5ts describ$ 9 p>agraph 7#d71 ! ,f$]al m$ical assi/ance p]c5tage applicable to am\nts exp5d$ by ! ,/ate = m$ical assi/ance = qualify+ y\? & "y adult m5tal heal? & sub/ance use int]v5tion s]vices furni%$ dur+ su* qu>t] %all be equal to #ajj p]c5t4 7#d7 ,requirem5ts ,! requirem5ts describ$ 9 ?is p>agraph are ! foll[+3 7,a7 ,! ,/ate demon/rates1 to ! satisfaction ( ! ,secret>y-- 7i7 t x w be able to support ! provision ( qualify+ y\? & "y adult m5tal heal? & sub/ance use int]v5tion s]vices t meet ! conditions specifi$ 9 p>agraphs 7#a7 & 7#b72 & 7ii7 h[ x w support coord9ation betwe5 qualifi$ m5tal heal? provid]s & sub/ance use teams & community p>tn]s1 includ+ heal? c>e provid]s1 to enable ! provision ( s]vices1 ne$$ ref]rals1 & o!r activities id5tifi$ by ! ,secret>y4 7,b7 ,! ,/ate provides assurances satisfactory to ! ,secret>y t-- 7i7 any additional ,f$]al funds receiv$ by ! ,/ate = qualify+ y\? & "y adult m5tal heal? & sub/ance use int]v5tion s]vices provid$ "u ?is subsection t are attributable to ! increas$ ,f$]al m$ical assi/ance p]c5tage "u p>agraph 7#c77;,a7 w be us$ to supplem5t1 & n supplant1 ! level ( ,/ate funds exp5d$ = su* s]vices = fiscal ye> #bjbd2 7ii7 if ! ,/ate made qualify+ y\? & "y adult m5tal heal? & sub/ance use int]v5tion s]vices available 9 a region ( ! ,/ate 9 fiscal ye> #bjbc ! ,/ate w cont9ue to make su* s]vices available 9 su* region "u ?is subsection at ! same level t ! ,/ate made su* s]vices available 9 su* fiscal ye>2 & 7iii7 ! ,/ate w conduct ! evaluation & assessm5t1 & submit ! report requir$ "u p>agraph 7#e74 7#e7 ,/ate evaluation & report 7,a7 ,/ate evaluation ,n lat] ?an #d fiscal qu>t]s aft] a ,/ate beg9s provid+ qualify+ y\? & "y adult m5tal heal? & sub/ance use int]v5tion s]vices 9 accordance ) ?is subsection1 ! ,/ate %all ent] into a contract ) an indep5d5t entity or organization to conduct an evaluation = ! purposes (-- 7i7 det]m9+ ! effect ( ! provision ( su* s]vices on-- 7,i7 em]g5cy room visits2 7,,ii7 use ( ambulatory s]vices2 7,,iii7 hospitalizations2 7,,iv7 ! involvem5t ( law en=cem5t 9 m5tal heal? or sub/ance use disord] crisis ev5ts2 & 7,v7 ! div]sion ( individuals f jails or simil> sett+s2 & 7ii7 assess+-- 7,i7 ! types ( s]vices provid$ to individuals2 7,,ii7 ! types ( ev5ts respond$ to2 7,,iii7 co/ sav+s or co/-effectiv5ess attributable to su* s]vices2 7,,iv7 ! exp]i5ces ( individuals :o receive qualify+ y\? & "y adult m5tal heal? & sub/ance use int]v5tion s]vices2 7,v7 ! successful connection ( individuals ) foll[-up s]vices2 & 7,,vi7 o!r relevant outcomes id5tifi$ by ! ,secret>y4 7,b7 ,comp>ison to hi/orical measures ,! contract describ$ 9 subp>agraph 7,a7 %all specify t ! evaluation is bas$ on a comp>ison ( ! hi/orical measures ( ,/ate p]=mance ) respect to ! outcomes specifi$ "u su* subp>agraph to ! ,/ate's p]=mance ) respect to su* outcomes dur+ ! p]iod beg9n+ ) ! fir/ qu>t] 9 :i* ! ,/ate beg9s provid+ qualify+ y\? & "y adult m5tal heal? & sub/ance use int]v5tion s]vices 9 accordance ) ?is subsection4 7,c7 ,report ,n lat] ?an #b ye>s aft] a ,/ate beg9s to provide qualify+ y\? & "y adult m5tal heal? & sub/ance use int]v5tion s]vices 9 accordance ) ?is subsection1 ! ,/ate %all submit a report to ! ,secret>y on ! foll[+3 7i7 ,! results ( ! evaluation c>ri$ out "u subp>agraph 7,a74 7ii7 ,! numb] ( individuals :o receiv$ qualify+ y\? & "y adult m5tal heal? & sub/ance use int]v5tion s]vices4 7iii7 ,demographic in=mation reg>d+ su* individuals :5 available1 includ+ ! race & e?nicity1 age1 sex1 sexual ori5tation1 g5d] id5tity1 & geographic location ( su* individuals4 7iv7 ,! processes & models develop$ by ! ,/ate to provide qualify+ y\? & "y adult m5tal heal? & sub/ance use int]v5tion s]vices "u su* ! ,/ate plan or waiv]1 includ+ ! processes develop$ to provide ref]rals =1 or coord9ation )1 foll[-up c>e & s]vices4 7v7 ,lessons le>n$ reg>d+ ! provision ( su* s]vices4 7,d7 ,public availability ,! ,/ate %all make ! report requir$ "u subp>agraph 7,c7 publicly available1 includ+ on ! website ( ! appropriate ,/ate ag5cy1 ^u submission ( su* report to ! ,secret>y4 7#f7 ,be/ practices report 7,a7 ,9 g5]al ,n lat] ?an #c ye>s aft] ! fir/ ,/ate beg9s to provide qualify+ y\? & "y adult m5tal heal? & sub/ance use int]v5tion s]vices 9 accordance ) ?is subsection1 ! ,secret>y %all submit a report to ,congress t-- 7i7 id5tifies ! ,/ates t elect$ to provide s]vices 9 accordance ) ?is subsection2 7ii7 summ>izes ! in=mation report$ by su* ,/ates "u p>agraph 7#e77;,c72 & 7iii7 id5tifies be/ practices = ! effective deliv]y ( y\? & "y adult m5tal heal? & sub/ance use int]v5tion s]vices4 7,b7 ,public availability ,! report requir$ "u subp>agraph 7,a7 %all be made publicly available1 includ+ on ! website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 ^u submission to ,congress4 7#g7 ,nondiscrim9ation 7,a7 ,f$]ally fund$ activities 7i7 ,= ! purpose ( apply+ ! prohibitions aga9/ discrim9ation on ! basis ( age "u ! ,age ,discrim9ation ,act ( #aige 7#db ,u4,s4,c4 #faja et seq471 on ! basis ( h&icap "u section #ejd ( ! ,rehabilitation ,act ( #aigc 7#bi ,u4,s4,c4 #gid71 on ! basis ( sex "u title ,,ix ( ! ,education ,am5dm5ts ( #aigb 7#bj ,u4,s4,c4 #afha et seq471 or on ! basis ( race1 color1 or national orig9 "u title ,,vi ( ! ,civil ,rights ,act ( #aifd 7#db ,u4,s4,c4 #bjjj;d et seq471 programs & activities fund$ 9 :ole or 9 "p ) funds made available "u ?is sub*apt] are consid]$ to be programs & activities receiv+ ,f$]al f9ancial assi/ance4 7ii7 ,no p]son %all on ! gr\nd ( sex or religion be exclud$ f p>ticipation 91 be d5i$ ! b5efits (1 or be subject$ to discrim9ation "u1 any program or activity fund$ 9 :ole or 9 "p ) funds made available "u ?is title4 7,b7 ,compliance ,:5ev] ! ,secret>y f9ds t a ,/ate1 or an entity t has receiv$ a paym5t f an allotm5t to a ,/ate "u section #gjb7;c7 ( ?is title1 has fail$ to comply ) a provision ( law ref]r$ to 9 subsection 7a77#a71 ) subsection 7a77#b71 or ) an applicable regulation 7includ+ "o prescrib$ to c>ry out subsection 7a77#b771 he %all notify ! *ief executive (fic] ( ! ,/ate & %all reque/ him to secure compliance4 ,if )9 a reasonable p]iod ( "t1 n to exce$ #fj days1 ! *ief executive (fic] fails or refuses to secure compliance1 ! ,secret>y may-- 7i7 ref] ! matt] to ! ,attorney ,g5]al ) a recomm5dation t an appropriate civil action be in/itut$2 7ii7 ex]cise ! p[]s & functions provid$ by title ,,vi ( ! ,civil ,rights ,act ( #aifd 7#db ,u4,s4,c4 #bjjj;d et seq471 ! ,age ,discrim9ation ,act ( #aige 7#db ,u4,s4,c4 #faja et seq471 or section #ejd ( ! ,rehabilitation ,act ( #aigc 7#bi ,u4,s4,c4 #gid71 z may be applicable2 or 7iii7 take su* o!r action z may be provid$ by law4 7,c7 ,au?ority ( attorney g5]al2 civil actions ,:5 a matt] is ref]r$ to ! ,attorney ,g5]al pursuant to subsection 7b77#a71 or :5ev] he has reason to believe t ! entity is engag$ 9 a patt]n or practice 9 violation ( a provision ( law ref]r$ to 9 subsection 7a77#a7 or 9 violation ( subsection 7a77#b71 ! ,attorney ,g5]al may br+ a civil action 9 any appropriate di/rict c\rt ( ! ,unit$ ,/ates = su* relief z may be appropriate1 includ+ injunctive relief4 4 #fjdd4 ,e>ly int]v5tion & prev5tion programs = transition-age y\? 7a7 ,9 g5]al ,section #aiab7;b77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjjx-#a7;b77#a77 is am5d$-- 7#a7 by r$esignat+ subp>agraph 7,e7 z subp>agraph 7,f72 & 7#b7 by ins]t+ aft] subp>agraph 7,d7 ! foll[+3 7,e7 ,e>ly int]v5tion & prev5tion programs = transition-age y\? ,! plan %all describe ! ,/ate's plans to c>ry out demon/ration grants or contracts = e>ly int]v5tion & prev5tion programs = transition-age y\? ( #af to #be ye>s ( age :o meet "o or m ( ! crit]ia specifi$ 9 section #abi7;a77#a77;,b7 ( ! ,work=ce ,innovation & ,opportunity ,act to be consid]$ out-(-s*ool y\?4 4 7b7 ,set-,aside ,section #aibj ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjjx-#i7 is am5d$ by add+ at ! end ! foll[+3 7d7 ,e>ly int]v5tion & prev5tion programs = transition-,age y\? 7#a7 ,9 g5]al ,except z provid$ 9 p>agraph 7#b71 a ,/ate %all exp5d at lea/ #ae p]c5t ( ! am\nt ( ! allotm5t ( ! ,/ate pursuant to a fund+ agreem5t "u section #aiaa = ea* fiscal ye> to support programs describ$ 9 section #aiab7;b77#a77;,e74 7#b7 ,/ate flexibility ,9 lieu ( exp5d+ #ae p]c5t ( ! am\nt ( ! allotm5t = a fiscal ye> z requir$ by p>agraph 7#a71 a ,/ate may elect to exp5d n less ?an #cj p]c5t ( su* am\nt to support su* programs by ! end ( two consecutive fiscal ye>s4 4 #fjde4 ,/rategies to increase access to teleheal? "u ,m$icaid & ,*ildr5's ,heal? ,insurance ,program 7a7 ,guidance ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all issue & dissem9ate guidance to ,/ates to cl>ify /rategies to ov]come exi/+ b>ri]s & increase access to teleheal? "u ! ,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 seq474 ,su* guidance %all include te*nical assi/ance & be/ practices reg>d+-- 7#a7 teleheal? deliv]y ( cov]$ s]vices2 7#b7 recomm5d$ volunt>y bill+ codes1 modifi]s1 & place-(-s]vice designations = teleheal? & o!r virtual heal? c>e s]vices2 7#c7 ! simplification or alignm5t 7includ+ ?r\gh reciprocity7 ( provid] lic5s+1 cr$5tial+1 & enrollm5t protocols ) respect to teleheal? across ,/ates1 ,/ate ,m$icaid plans "u su* title ,,xix1 & ,m$icaid manag$ c>e organizations1 includ+ dur+ national public heal? em]g5cies2 7#d7 exi/+ /rategies ,/ates c use to integrate teleheal? & o!r virtual heal? c>e s]vices into value-bas$ heal? c>e models2 & 7#e7 examples ( ,/ates t h us$ waiv]s "u ! ,m$icaid program to te/ exp&$ access to teleheal?1 includ+ dur+ ! em]g5cy p]iod describ$ 9 section #aace7;g77#a77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#e7;g77#a77;,b774 7b7 ,/udies 7#a7 ,teleheal? impact on heal? c>e access ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,m$icaid & ,,*ip ,paym5t & ,access ,commission %all conduct a /udy1 ) respect to a m9imum ( #aj ,/ates across geographic regions ( ! ,unit$ ,/ates1 & submit to ,congress a report1 on ! impact ( teleheal? on heal? c>e access1 utilization1 co/1 & outcomes1 brok5 d[n by race1 e?nicity1 sex1 age1 disability /atus1 & ,,zip ,code4 ,su* report %all-- 7,a7 evaluate co/1 access1 utilization1 outcomes1 & pati5t exp]i5ce data f across ! heal? c>e field1 includ+ ,/ates1 ,m$icaid manag$ c>e organizations1 provid] organizations1 & o!r organizations t provide or pay = teleheal? "u ! ,m$icaid program & ,*ildr5's ,heal? ,insurance ,program2 7,b7 id5tify b>ri]s & pot5tial solutions to provid] entry & p>ticipation 9 teleheal? t ,/ates are exp]i5c+1 z well z b>ri]s to provid+ teleheal? across ,/ate l9es1 includ+ dur+ times ( public heal? crisis or public heal? em]g5cy2 7,c7 det]m9e ! frequ5cy at :i* out-(-,/ate teleheal? is provid$ to pati5ts enroll$ 9 ! ,m$icaid program & ! pot5tial impact on access to teleheal? if ,/ate ,m$icaid policies 7 m align$2 & 7,d7 id5tify & evaluate opportunities = m alignm5t among su* policies to promote access to teleheal? across all ,/ates1 ,/ate ,m$icaid plans "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 ,/ate *ild heal? plans "u title ,,xxi ( su* ,act 7#db ,u4,s4,c4 #acig;aa et seq471 & ,m$icaid manag$ c>e organizations1 includ+ ! pot5tial = regional compacts or reciprocity agreem5ts4 7#b7 ,f$]al ag5cy teleheal? collaboration ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all conduct a /udy & submit to ,congress a report evaluat+ collaboration betwe5 ,f$]al ag5cies ) respect to teleheal? s]vices furni%$ "u ! ,m$icaid or ,,*ip program to individuals "u ! age ( #ah1 includ+ su* s]vices furni%$ to su* individuals 9 e>ly c>e & education sett+s4 ,su* report %all include recomm5dations on-- 7,a7 opportunities = ,f$]al ag5cies to improve collaboration ) respect to su* teleheal? s]vices2 & 7,b7 opportunities = collaboration betwe5 ,f$]al ag5cies to exp& teleheal? access to su* individuals enroll$ "u ! ,m$icaid or ,,*ip program1 includ+ 9 e>ly c>e & education sett+s4 #fjdf4 ,y\? & "y adult m5tal heal? promotion1 prev5tion1 int]v5tion1 & treatm5t ,title ,,iii ( ! ,public ,heal? ,s]vice ,act is am5d$ by ins]t+ aft] section #cii,z-#c1 z add$ by section #ejja1 ! foll[+3 #cii,z-#d4 ,y\? & "y adult m5tal heal? promotion1 prev5tion1 int]v5tion1 & treatm5t 7a7 ,grants ,! ,secret>y %all-- 7#a7 aw>d grants to eligible entities to develop1 ma9ta91 or enhance y\? & "y adult m5tal heal? promotion1 prev5tion1 int]v5tion1 & treatm5t programs1 includ+-- 7,a7 programs = y\? & "y adults :o may be likely to develop1 are %[+ e>ly signs (1 or h be5 diagnos$ ) a m5tal heal? condition1 includ+ a s]i\s emotional di/urbance2 & 7,b7 infra/ructure & organization *ange at a ,/ate1 tribal1 or t]ritorial level to improve cross-sy/em collaboration1 s]vice capacity1 & exp]tise relat$ to y\? & "y adults2 & 7#b7 ensure t programs fund$ ?r\gh grants "u ?is section use community-driv51 evid5ce-in=m$1 or evid5ce-bas$ models1 practices1 & me?ods t are1 z appropriate1 culturally & l+ui/ically appropriate1 & c be replicat$ 9 o!r appropriate sett+s4 7b7 ,eligible transition age y\? & entities ,9 ?is section3 7#a7 ,eligible entity ,! t]m eligible entity means-- 7,a7 a local educational ag5cy2 7,b7 a ,/ate educational ag5cy2 7,c7 an in/itution ( high] education 7or consortium ( su* in/itutions71 :i* may include a recov]y program at an in/itution ( high] education2 7,d7 a local bo>d1 or a "o-/op op]ator1 z def9$ 9 section #c ( ! ,work=ce ,innovation & ,opportunity ,act2 7,e7 a nonpr(it organization ) appropriate exp]tise 9 provid+ s]vices or programs = *ildr51 adolesc5ts1 or "y adults1 exclud+ a s*ool2 7,f7 a ,/ate1 political subdivision ( a ,/ate1 ,indian tribe1 or tribal organization2 or 7,g7 a high s*ool or dormitory s]v+ high s*ool /ud5ts t receives fund+ f ! ,bureau ( ,indian ,education4 7#b7 ,eligible transition age y\? ,! t]m eligible transition age y\? means a y\? or "y adult f age #af to n m ?an #be ye>s ( age :o is-- 7,a7 an out-(-s*ool y\? z def9$ 9 section #abi7;a77#a77;,b7 ( ! ,work=ce ,innovation & ,opportunity ,act2 7,b7 a homeless individual 7z def9$ 9 section #dadjc7f7 ( ! ,viol5ce ,aga9/ ,wom5 ,act ( #aiid71 a homeless *ild or y\? 7z def9$ 9 section #gbe7b7 ( ! ,mc,kinney-,v5to ,homeless ,assi/ance ,act7 a runaway1 9 fo/] c>e or has ag$ out ( ! fo/] c>e sy/em1 a *ild eligible = assi/ance "u section #dgg ( ! ,social ,security ,act1 or 9 an out-(-home placem5t2 7,c7 an individual :o is pregnant or p>5t+1 z ref]r$ to 9 section #abi7;a77#a77;,b7 ( ! ,work=ce ,innovation & ,opportunity ,act2 7,d7 a y\? :o is an individual ) a disability1 z ref]r$ to 9 section #abi7;a77#a77;,b7 ( ! ,work=ce ,innovation & ,opportunity ,act2 7,e7 a l[-income individual :o requires additional assi/ance to ent] or complete an educational program or to secure or hold employm5t1 z ref]r$ to 9 section #abi7;a77#a77;,b7 ( ! ,work=ce ,innovation & ,opportunity ,act2 or 7,f7 liv+ 9 a community t has fac$ acute or long-t]m exposure to sub/antial discrim9ation1 hi/orical oppression1 int]g5]ational pov]ty1 civil unre/1 a high rate ( viol5ce1 or drug ov]dose dea?s4 7c7 ,application ,an eligible entity seek+ a grant "u subsection 7a7 %all submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7d7 ,use ( funds = m5tal heal? promotion1 prev5tion1 int]v5tion & treatm5t programs ,an eligible entity may use am\nts aw>d$ "u a grant "u subsection 7a77#a7 to c>ry out ! foll[+3 7#a7 ,creation1 implem5tation1 & expansion ( s]vices & supports t are culturally & l+ui/ically appropriate & y\? guid$1 involve & include family & community memb]s 7includ+ bus9ess lead]s & fai?-bas$ organizations71 & provide = cont9uity ( c>e betwe5 *ild- & adult-s]v+ sy/ems to ensure seamless transition4 7#b7 ,infra/ructure & organization *ange at a ,/ate1 ,tribal1 or t]ritorial level to improve cross-sy/em collaboration1 s]vice capacity1 & exp]tise relat$ to y\? & "y adults )1 or at risk (1 m5tal heal? conditions & sub/ance use disord]s z !y transition into adult roles & responsibilities4 7#c7 ,public aw>5ess & cross-sy/em provid] tra9+ = individuals employ$ at in/itutions ( high] education & community colleges1 behavioral heal? provid]s1 individuals work+ 9 ! crim9al ju/ice sy/em1 prim>y c>e provid]s1 vocational s]vice provid]s1 & *ild welf>e work]s4 7e7 ,mat*+ funds ,! ,secret>y may n aw>d a grant "u ?is section to an eligible entity unless ! eligible entity agrees1 ) respect to ! co/s to be incurr$ by ! eligible entity 9 c>ry+ out ! activities describ$ 9 subsection 7d71 to make available non-,f$]al contributions 79 ca% or 9 k9d7 t[>d su* co/s 9 an am\nt t is n less ?an #aj p]c5t ( ! total am\nt ( ,f$]al funds provid$ 9 ! grant4 7f7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ #be1jjj1jjj = ea* ( fiscal ye>s #bjbd ?r\gh #bjcc4 4 #fjdg4 ,/udy on ! effects ( sm>tphone & social m$ia use on adolesc5ts 7a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all conduct or support rese>* on-- 7#a7 sm>tphone & social m$ia use by adolesc5ts2 & 7#b7 ! effects ( su* use on-- 7,a7 emotional1 behavioral1 & physical heal? & developm5t2 & 7,b7 disp>ities 9 m9ority & und]s]v$ populations4 7b7 ,report ,n lat] ?an #e ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ! ,congress1 & make publicly available1 a report on ! f9d+s ( rese>* describ$ 9 ?is section4 ,e ,community-,bas$ ,c>e #fjea4 ,m5tal heal? at ! bord] 7a7 ,%ort title ,?is section may be cit$ z ! ,immigrants' ,m5tal ,heal? ,act ( #bjbb4 7b7 ,def9itions ,9 ?is section3 7#a7 ,=w>d op]at+ base ,! t]m =w>d op]at+ base means a p]man5t facility-- 7,a7 e/abli%$ by ,u4,s4 ,cu/oms & ,bord] ,protection 9 =w>d or remote locations2 & 7,b7 designat$ z su* by ,u4,s4 ,cu/oms & ,bord] ,protection4 7#b7 ,! t]m ,u4,s4 ,cu/oms & ,bord] ,protection facility means any ( ! foll[+ facilities t typically deta9 migrants 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 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 requir$ "u subp>agraph 7,a7 %all-- 7i7 be (f]$ 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 ,requirem5t ,! tra9+ curriculum describ$ 9 subp>agraph 7,a7 %all be design$ to help ! ag5ts & (fic]s describ$ 9 su* subp>agraph-- 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+ 9 fiscal ye> #bjbc1 ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use %all-- 7,a7 conduct an annual review ( ! tra9+ requir$ "u 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 ! ,judici>y ( ! ,s5ate2 7vi7 ! ,committee on ,appropriations ( ! ,h\se ( ,repres5tatives2 7vii7 ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives2 7viii7 ! ,committee on ,homel& ,security ( ! ,h\se ( ,repres5tatives2 & 7ix7 ! ,committee on ! ,judici>y ( ! ,h\se ( ,repres5tatives4 7#d7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$-- 7,a7 #ej1jjj = fiscal ye> #bjbc to develop ! tra9+ curriculum requir$ "u p>agraphs 7#a7 & 7#b72 & 7,b7 = ea* ( ! fiscal ye>s #bjbd ?r\gh #bjbh-- 7i7 #bj1jjj to provide ! tra9+ requir$ "u p>agraphs 7#a7 & 7#b72 & 7ii7 su* sums z may be necess>y to conduct ! annual review ( 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 assign at lea/ #a qualifi$ m5tal or behavioral heal? exp]t to ea* ,u4,s4 ,cu/oms & ,bord] ,protection facility to adequately evaluate ! m5tal heal? ne$s ( immigrants1 refugees1 bord] patrol ag5ts1 & /aff4 7#b7 ,qualifications ,ea* m5tal or behavioral heal? exp]t assign$ pursuant to p>agraph 7#a7-- 7,a7 %all be bil+ual2 7,b7 %all be well-v]s$ 9 culturally & l+ui/ically appropriate & trauma-in=m$ int]v5tions2 & 7,c7 %all h 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 #bjbc ?r\gh #bjbg to c>ry out ?is subsection4 7e7 ,confid5tiality ( ,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 #fjeb4 ,asian ,am]ican1 ,african ,am]ican1 ,native ,hawaiian1 ,pacific ,isl&]1 ,indig5\s1 ,middle ,ea/]n & ,nor? ,african1 & ,hispanic & ,lat9o behavioral & m5tal heal? outrea* & education /rategy ,"p ,d ( title ,v ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bij;dd et seq471 z am5d$ by section #fjbb1 is fur!r am5d$ by add+ at ! end ! foll[+ new section3 #eed4 ,behavioral & m5tal heal? outrea* & education /rategy 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 ,african ,am]ican1 ,native ,hawaiian1 ,pacific ,isl&]1 ,indig5\s1 ,middle ,ea/]n & ,nor? ,african 79 ?is section ref]r$ to z ,,m5a71 & ,hispanic & ,lat9o_/a_/x individuals or communities1 develop & implem5t an outrea* & education /rategy to promote behavioral & m5tal heal?1 emphasize t behavioral & m5tal heal? conditions are treatable & t reasonable accommodations "u section #ejd ( ! ,rehabilitation ,act ( #aigc & titles ,,ii & ,,iii ( ! ,am]icans ) ,disabilities ,act ( #aiij are necess>y & may help1 z well z r$uce /igma associat$ ) m5tal heal? conditions & sub/ance abuse among ! ,asian ,am]ican1 ,african ,am]ican1 ,native ,hawaiian1 ,pacific ,isl&]1 ,indig5\s1 ,,m5a1 & ,hispanic & ,lat9o_/a_/x populations4 ,su* /rategy %all-- 7#a7 be design$ to-- 7,a7 meet ! div]se cultural & language ne$s ( ! v>i\s ,asian ,am]ican1 ,african ,am]ican1 ,indig5\s1 ,,m5a1 ,native ,hawaiian1 ,pacific ,isl&]1 & ,hispanic & ,lat9o_/a_/x populations2 & 7,b7 ensure t approa*es recomm5d$ 9 ! /rategy 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 repres5t+ ! communities ( focus 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 & m5tal 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 ,african ,am]ican1 ,native ,hawaiian1 ,pacific ,isl&]1 ,indig5\s1 ,,m5a1 & ,hispanic & ,lat9o_/a_/x populations4 7c7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #aj1jjj1jjj = ea* ( fiscal ye>s #bjbd ?r\gh #bjbh4 4 ,f ,reports #fjfa4 ,address+ racial & e?nic m5tal heal? inequities rese>* gaps 7a7 ,9 g5]al ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is ,act-- 7#a7 ! ,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 7b72 or 7#b7 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? inequities 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;g771 z am5d$ by title ,i ( ?is ,act72 & 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 & impacts ( ! co-occurr5ce ( m5tal conditions ) o!r disabilities 9 su* racial & e?nic gr\ps1 includ+ physical disabilities1 m5tal disabilities1 sub/ance use disord]s1 sev]e & p]si/5t m5tal illness1 & m5tal disord]s or m5tal heal? conditions :i* co-occur ) "o ano!r2 7,c7 a compilation ( in=mation on ! impact ( community viol5ce1 community trauma1 adv]se *ildhood exp]i5ces1 wea!r extremes wors5$ by climate *ange 7su* z heat waves1 flood+1 hurricanes1 & wildfires71 sub/ance use1 & o!r psy*ological traumas1 on m5tal disord]s 9 su* racial & e?nic m9ority gr\ps1 /ratifi$ by h\sehold income level2 7,d7 a compilation ( in=mation on ! impact ( ! int]sectionality ( transg5d] individuals1 g5d] nonb9>y individuals1 sexual ori5tation1 & age 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 #fjfb4 ,rese>* on adv]se heal? effects associat$ ) int]actions ) law en=cem5t 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y71 act+ ?r\gh ! ,director ( ! ,(fice ( ,m9ority ,heal? ( ! ,c5t]s = ,disease ,control & ,prev5tion 7e/abli%$ pursuant to section #agjg;,a ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f;a771 %all conduct rese>* on ! adv]se heal? effects associat$ ) int]actions ) law en=cem5t4 7b7 ,effects among racial & e?nic m9orities ,! rese>* "u subsection 7a7 %all include rese>* on-- 7#a7 ! heal? consequ5ces1 bo? individual & community-wide1 ( trauma relat$ to viol5ce committ$ by law en=cem5t among racial & e?nic m9orities2 & 7#b7 ! disproportionate burd5 ( morbidity & mortality associat$ ) su* trauma4 7c7 ,report ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all-- 7#a7 complete ! rese>* "u ?is section2 & 7#b7 submit to ! ,congress a report on ! f9d+s1 conclusions1 & recomm5dations result+ f su* rese>*4 #fjfc4 ,geo,access /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 ( racially & e?nically div]se m5tal heal? provid]s1 z well z m5tal heal? provid]s tra9$ to "w ) racially & e?nically div]se cli5ts & cli5ts ) multiple m5tal heal?1 cognitive1 & developm5tal disabilities2 & 7,b7 assess ! prep>$ness ( 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 #fjfd4 ,co-occurr+ conditions 7a7 ,,gao report ,n lat] ?an two ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report on b>ri]s to c>e = p]sons ) co-occurr+ conditions & access to c>e 9 ! ,unit$ ,/ates4 ,su* report %all include ! in=mation & recomm5dations describ$ 9 subsection 7b74 7b7 ,cont5t ( report ,! report "u subsection 7a7 %all include-- 7#a7 an assessm5t ( curr5t b>ri]s to behavioral heal? & sub/ance use disord] treatm5t = l[-income1 un9sur$1 & ,m$icaid-enroll$ adults1 & recomm5dations = address+ su* b>ri]s1 p>ticul>ly = wom5 & div]se racial & e?nic gr\ps2 7#b7 an assessm5t (-- 7,a7 h[ _m adults h a behavioral heal? condition & options = adults to receive behavioral heal? & sub/ance use disord] treatm5t 9 nonexpansion ,/ates2 7,b7 ,m$icaid expansion ,/ates :o provide behavioral heal? cov]age = newly eligible enrollees2 7,c7 h[ enrollm5t 9 cov]age affects treatm5t availability2 & 7,d7 ! impacts ( ,,covid-#ai to receiv+ & access+ treatm5t = behavioral heal?1 sub/ance use disord]s1 & div]se racial & e?nic gr\ps1 & recomm5dations = address+ su* b>ri]s2 7#c7 an assessm5t ( curr5t b>ri]s1 inclusive ( social det]m9ants ( heal? & cultural b>ri]s1 t prev5t adults f receiv+ behavioral heal? & sub/ance use disord] treatm5t1 & recomm5dations = address+ su* b>ri]s1 p>ticul>ly = l[-income wom5 & adults f racial & e?nic gr\ps2 7#d7 an assessm5t ( disp>ities 9 access to addiction c\nselors & m5tal or behavioral heal? c>e provid]s act+ 9 accordance ) ,/ate law1 /ratifi$ by race1 e?nicity1 g5d] id5tity1 geographic location1 & insurance type1 & recomm5dations to promote great] access equity2 & 7#e7 recomm5dations to promote great] equity 9 access to c>e = behavioral s]vices & sub/ance use disord]s1 p>ticul>ly = l[-income wom5 & adults f div]se racial & e?nic gr\ps4 #fjfe4 ,te*nical correction ,title ,v ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bij;aa et seq47 is am5d$-- 7#a7 by r$esignat+ ! second section #eej 7#db ,u4,s4,c4 #bij;ee-#aj7 7relat+ to ,sobriety ,treatm5t ,& ,recov]y ,teams7 z section #eeb;,a2 & 7#b7 by mov+ su* section1 z s r$esignat$1 s z to appe> aft] section #eeb 7#db ,u4,s4,c4 #bij;ee-#g74 ,g ,miscellane\s ,provisions #fjga4 ,*ildr5's ,m5tal ,heal? ,infra/ructure ,act ,"p ,d ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;b et seq47 is am5d$ by ins]t+ aft] subp>t ,v1 z am5d$ by section #fjda1 ! foll[+ new subp>t3 ,,vi ,increas+ ,inve/m5t 9 ,p$iatric ,behavioral ,heal? ,s]vices #cdj;,,aa-#a4 ,grants to *ildr5's hospitals 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all make grants to eligible entities = ! purpose ( improv+ _! ability to provide p$iatric behavioral heal? s]vices1 includ+ by-- 7#a7 con/ruct+ or mod]niz+ sites ( c>e = p$iatric behavioral heal? s]vices2 7#b7 exp&+ capacity to provide p$iatric behavioral heal? s]vices1 includ+ enhancem5ts to digital infra/ructure1 teleheal? capabilities1 or o!r improvem5ts to pati5t c>e infra/ructure2 & 7#c7 support+ ! reallocation ( exi/+ res\rces to accommodate p$iatric behavioral heal? pati5ts1 includ+ by-- 7,a7 conv]t+ or add+ a suffici5t numb] ( b$s to e/abli% or increase ! hospital's inv5tory ( lic5s$ & op]ational1 %ort-t]m psy*iatric & sub/ance use inpati5t b$s2 & 7,b7 ensur+ compliance ) safety /&>ds4 7b7 ,eligibility ,to be eligible to seek a grant "u ?is section1 an entity %all be a hospital t pr$om9antly treats individuals "u ! age ( #ba1 includ+ any hospital t receives funds "u section #cdj;,e4 7c7 ,fund+ ,to c>ry out ?is section1 !re is h]eby appropriat$1 out ( am\nts 9 ! ,treasury n o!rwise obligat$1 #b1jjj1jjj1jjj = ea* ( fiscal ye>s #bjbb ?r\gh #bjbf4 4 #fjgb4 ,m5tal heal? = ,lat9os ,"p ,d ( title ,v ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bij;dd et seq471 z am5d$ by sections #fjbb1 #fjbc1 #fjeb1 & #fjaf1 is fur!r am5d$ by add+ at ! end ! foll[+ new section3 #eeg4 ,behavioral & m5tal heal? outrea* & education /rategy 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,assi/ant ,secret>y1 %all1 9 coord9ation ) advocacy & behavioral & m5tal heal? organizations s]v+ populations ( ,hispanic & ,lat9o individuals or communities1 develop & implem5t an outrea* & education /rategy to promote behavioral & m5tal heal? & r$uce /igma associat$ ) m5tal heal? conditions & sub/ance abuse among ! ,hispanic & ,lat9o populations4 ,su* /rategy %all-- 7#a7 be design$ to-- 7,a7 meet ! div]se cultural & language ne$s ( ! v>i\s ,hispanic & ,lat9o populations2 & 7,b7 be developm5tally & age appropriate2 7#b7 increase aw>5ess ( symptoms ( m5tal illnesses common among su* populations1 tak+ into acc\nt diff]5ces )9 subgr\ps1 su* z g5d]1 g5d] id5tity1 age1 sexual ori5tation1 or e?nicity1 ( 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 ^! communities & /akehold]s s]v+ ^! 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?2 & 7#f7 address ! impact ( ! ,,s>s-,co,v-#b p&emic on ! m5tal & behavioral heal? ( ! ,hispanic & ,lat9o populations4 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 improv$ behavioral & m5tal heal? outcomes associat$ ) m5tal heal? conditions & sub/ance abuse among ,hispanic & ,lat9o populations4 7c7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #a1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbe4 4 #fjgc4 ,/r5g!n+ m5tal heal? supports = ,,bipoc communities 7a7 ,9 g5]al ,section #aidb7;a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjjx-#eb7;a77 is am5d$-- 7#a7 9 p>agraph 7#a71 by /rik+ & at ! end2 7#b7 by r$esignat+ p>agraph 7#b7 z p>agraph 7#e72 & 7#c7 by ins]t+ aft] p>agraph 7#a7 ! foll[+3 7#b7 s]vices provid$ by ! ,/ate to adults ) a s]i\s m5tal illness & *ildr5 ) a s]i\s emotional di/urbance :o are memb]s ( racial & e?nic m9ority gr\ps1 includ+-- 7,a7 ! ext5t to :i* su* s]vices are provid$ to su* adults & *ildr52 & 7,b7 ! outcomes exp]i5c$ by su* adults & *ildr5 z a result ( ! provision ( su* s]vices1 includ+ ) respect to-- 7i7 div]sions f hospitalization & crim9al ju/ice sy/em involvem5t2 7ii7 treatm5t = fir/ episode psy*osis or undef9$ psy*osis2 7iii7 r$uctions 9 suicide & increas$ utilization ( appropriate treatm5ts & int]v5tions = suicidal ideation2 7iv7 response ?r\gh crisis s]vices1 includ+ mobile crisis s]vices2 7v7 treatm5t ( individuals :o are exp]i5c+ homelessness or h\s+ insecurity & individuals resid+ 9 rural communities2 & 7vi7 increas$ pati5t family & c>egiv] engagem5t & education on s]i\s m5tal illness to r$uce social /igma & promote heal?y social support = pati5ts2 7#c7 any outrea* by ! ,/ate to1 & ! hir+ (1 provid]s ( m5tal heal? s]vices f multiple discipl9es 7su* z a psy*ologi/1 psy*iatri/1 pe] support provid]1 or social work]7 :o are memb]s ( racial & e?nic m9ority gr\ps2 7#d7 any outrea* by ! ,/ate to provid]s f multiple discipl9es ( m5tal heal? s]vices-- 7,a7 to provide tra9+ on culturally effective1 culturally affirm+1 & l+ui/ically compet5t s]vices2 & 7,b7 to increase aw>5ess ( community-def9$ practices by practition]s ( racial & e?nic m9ority gr\ps2 & 4 7b7 ,applicability ,! am5dm5ts made by subsection 7a7 %all apply ) respect to fund+ agreem5ts ent]$ into "u section #aiaa or #aiba ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjjx2 #db ,u4,s4,c4 #cjjx-#ba7 on or aft] ! date ( ! enactm5t ( ?is ,act4 #fjgd4 ,,/rong support = *ildr5 7a7 ,data analysis & /rategy implem5tation ,to prev5t & mitigate *ildhood trauma ,title ,,xxxi ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjjkk7 is am5d$ by add+ at ! end ! foll[+3 #cajb4 ,data analysis & /rategy implem5tation to prev5t & mitigate *ildhood trauma 7a7 ,9 g5]al ,! ,secret>y %all e/abli% a program-- 7#a7 to support ! developm5t & implem5tation ( programs t use data analysis me?ods to id5tify & facilitate /rategies = e>ly int]v5tion & prev5tion1 9 ord] to prev5t & mitigate *ildhood trauma & support communities & families1 includ+-- 7,a7 improv+ connections ?r\gh c>e coord9ation2 7,b7 align+ community initiatives 9 t>get$ areas ( ne$2 & 7,c7 exp&+ community capacity ?r\gh cross-sector collaboration2 & 7#b7 to evaluate ! effectiv5ess ( ^! programs 9 improv+ outcomes = *ildr54 7b7 ,grants ,! ,secret>y %all aw>d grants to up to #e eligible entities to c>ry out ! activities describ$ 9 subsection 7a74 7c7 ,use ( funds ,a grant = activities "u ?is section %all be us$ to support ! developm5t & implem5tation ( programs t use data analysis me?ods to id5tify & facilitate /rategies = e>ly int]v5tion & prev5tion1 9 ord] to prev5t & mitigate *ildhood trauma & support communities & families1 includ+ z foll[s3 7#a7 ,utilize data analysis me?ods to-- 7,a7 id5tify specific geographic areas1 su* z c5sus tracts1 ) a high preval5ce ( adv]se *ildhood exp]i5ces & significant risk factors = poor outcomes = *ildr5 7su* z increas$ risk ( exp]i5c+ adv]se *ildhood exp]i5ces71 includ+ areas ) high rates (-- 7i7 poor public heal? outcomes includ+ illness1 disease1 suicide1 & mortality2 7ii7 exclusion>y discipl9e practices1 includ+ susp5sions1 expulsions1 & ref]rals to law en=cem5t1 z well z l[ graduation rates2 7iii7 sub/ance use disord]s2 7iv7 pov]ty2 7v7 fo/] sy/em involvem5t or ref]rals2 7vi7 h\s+ in/ability & homelessness2 7vii7 food insecurity2 7viii7 inequity1 includ+ disp>ities 9 income1 weal?1 employm5t1 educational atta9m5t1 heal? c>e access1 & public heal? outcomes1 along l9es ( race1 sex1 sexuality & g5d] id5tity1 e?nicity1 or nationality2 7ix7 inc>c]ation rates2 or 7x7 o!r indicators ( adv]sity z def9$ by ! ,secret>y2 & 7,b7 id5tify /rategies to improve outcomes = *ildr5 ag$ #j ?r\gh #ag t build on /r5g?s 9 communities t c\ld be fur!r support$1 includ+-- 7i7 exi/+ support networks = families2 & 7ii7 enhanc$ connections to community-bas$ organizations4 7#b7 ,implem5t /rategies id5tifi$ pursuant to p>agraph 7#a77;,b7 to facilitate outrea* & involvem5t ( *ildr5 & _! c>egiv]s 9 ,f$]al1 ,/ate1 or local programs t provide rep>ative1 g5d]-responsive1 culturally specific1 & trauma-in=m$ prev5tion s]vices1 & = :i* *ildr5 & _! c>egiv]s are eligible1 includ+-- 7,a7 home visit+ programs2 7,b7 tra9+ & education on p>5t+ skills2 7,c7 sub/ance use disord] prev5tion & treatm5t t is volunt>y & nonco]cive2 7,d7 m5tal heal? supports & c>e t is volunt>y & nonco]cive2 7,e7 family & intimate p>tn] viol5ce prev5tion s]vices2 7,f7 *ild advocacy c5t] programm+2 7,g7 economic & nutrition support s]vices2 7,h7 h\s+ support s]vices1 includ+ em]g5cy & tempor>y %elt] = ^? exp]i5c+ homelessness & h\s+ insecurity1 z well z /able1 long-t]m h\s+2 7,i7 volunt>y1 nonco]cive1 g5d]-responsive1 & culturally specific m5tal heal? supports 9 s*ool & e>ly *ildhood education c5t]-bas$ sett+s2 7,j7 wrap>\nd programs = transition+ y\? & y\? curr5tly 9 ! fo/] sy/em2 7,k7 programm+ to support ! heal? & well-be+ ( lesbian1 gay1 bisexual1 transg5d]1 & int]sex *ildr5 & _! families2 & 7,l7 family res\rce c5t] s]vices4 7d7 ,special rules 7#a7 ,prim>y pay] re/riction ,! ,secret>y may n aw>d a grant "u ?is section to an eligible entity = a s]vice if ! s]vice to be provid$ is available pursuant to ! ,/ate plan approv$ "u title ,,xix ( ! ,social ,security ,act = ! ,/ate 9 :i* ! program fund$ by ! grant is be+ conduct$ unless ! ,/ate & all eligible subdivisions involv$-- 7,a7 w ent] into agreem5ts ) public or nonpr(it private entities "u :i* ! entities w provide ! s]vice2 & 7,b7 demon/rate t ! ,/ate & all eligible subdivisions w ensure t ! entities provid+ ! s]vice-- 7i7 w seek paym5t = ea* su* s]vice r5d]$ 9 accordance ) ! usual paym5t s*$ule "u ! ,/ate plan2 & 7ii7 ! entities h ent]$ into a p>ticipation agreem5t & are qualifi$ to receive paym5ts "u su* plan4 7#b7 ,implem5tation ,an eligible entity t receives a grant "u ?is section may use-- 7,a7 n m ?an #be p]c5t ( ! am\nts made available ?r\gh ! grant = ! fir/ #bd mon?s ( ! grant p]iod to utilize data analysis me?ods to-- 7i7 id5tify specific geographic areas :]e c>e coord9ation1 prev5tion & e>ly int]v5tion1 & facilitation s]vices w be provid$2 & 7ii7 id5tify support & int]v5tion s]vices to improve outcomes = *ildr5 locat$ 9 a geographic area id5tifi$ "u subsection 7c77#a77;,a72 & 7,b7 n m ?an #aj p]c5t ( ! grant 9 ea* subsequ5t ye> to cont9ue data analysis activities4 7#c7 ,adm9i/ration ,an eligible entity t receives a grant "u ?is section may n use m ?an #e p]c5t ( am\nts receiv$ ?r\gh ! grant = adm9i/ration1 report+1 & program ov]sight functions1 includ+ ! developm5t ( sy/ems to improve data collection & data %>+ = ! purposes ( improv+ s]vices & ! provision ( c>e4 7#d7 ,priority 7,a7 ,9 g5]al ,9 aw>d+ grants "u ?is section1 ! ,secret>y %all give priority1 to ! ext5t practical1 to eligible entities t use community-bas$ sy/em dynamic model+ z ! prim>y data analysis me?od4 7,b7 ,sy/em dynamic model+ def9$ ,! t]m sy/em dynamic model+ means a me?od ( data analysis & pr$ictive model+ t includes-- 7i7 utilization ( community-bas$ p>ticipatory rese>* me?ods = involv+ community 9 ! process ( und]/&+ & *ang+ sy/ems & evaluat+ outcomes ( grants2 7ii7 consid]ation ( a multitude ( environm5tal risk factors & asc]ta9m5t ( ! significance ( contribut+ community risk factors = purposes ( id5tify+ /rategies to r$uce adv]se *ild outcomes1 includ+-- 7,i7 maltreatm5t cases2 7,,ii7 involvem5t ) ! juv5ile crim9al legal sy/em or fo/] sy/em2 7,,iii7 exclusion>y s*ool discipl9e2 or 7,,iv7 exposure to viol5ce2 & 7iii7 id5tification ( cross-sector responses involv+ rep>ative1 trauma-in=m$1 culturally specific1 g5d]-responsive1 & community-bas$ organizations to r$uce adv]se *ild outcomes4 7#e7 ,subgrant 7,a7 ,9 g5]al ,an eligible entity t receives a grant "u ?is section %all use at lea/ #be p]c5t ( ! total am\nt ( ! grant to make subgrants to organizations t aid 9 implem5t+ ! /rategy id5tifi$ "u subsection 7c77#a77;,b7 = prev5t+ & mitigat+ *ildhood trauma & support+ communities & families4 7,b7 ,eligibility ,to be eligible to receive a subgrant "u ?is p>agraph1 an organization %all prep>e & submit to ! eligible entity an application 9 su* =m1 & conta9+ su* in=mation1 z ! eligible entity may require1 includ+ evid5ce t !-- 7i7 ne$s ( ! population to be s]v$ are urg5t & are n met by ! s]vices curr5tly available 9 ! geographic area2 & 7ii7 organization has ! capacity to provide ! s]vices li/$ 9 subsection 7c77#b74 7,c7 ,supplem5t1 n supplant ,subgrant funds receiv$ pursuant to ?is p>agraph by an organization %all be us$ to supplem5t & n supplant ,/ate or local funds provid$ to ! p>tn]%ip organization = s]vices li/$ 9 subsection 7c77#b74 7e7 ,application ,to be eligible to receive a grant "u ?is section1 an eligible entity %all submit to ! ,secret>y an application 9 su* =m1 & conta9+ su* in=mation1 z ! ,secret>y may require1 to include ! foll[+3 7#a7 ,a demon/ration t-- 7,a7 ! applicant utilizes trauma-in=m$1 culturally specific1 & g5d]-responsive practices1 includ+ a demon/ration ( ! ext5t to :i* ! applicant has tra9$ /aff 9 ^! practices2 7,b7 ! applicant has ! capacity to adm9i/] ! grant1 includ+ conduct+ all requir$ data analysis activities2 & 7,c7 s]vices w be provid$ to *ildr5 & families 9 an accessible1 culturally relevant1 & l+ui/ically specific mann] consi/5t ) local ne$s4 7#b7 ,a prelim9>y analysis ( h[ ! applicant w use ! grant to-- 7,a7 id5tify ! geographic area or areas to be s]v$ us+ data analysis me?ods2 7,b7 utilize data analysis me?ods to id5tify /rategies to improve outcomes = *ildr5 9 ! geographic area2 7,c7 facilitate /rategies id5tifi$ ?r\gh c>e coord9ation ef=ts2 & 7,d7 track data = evaluation ( outcomes4 7#c7 ,a detail$ project plan = ! use ( ! grant t includes anticipat$ te*nical assi/ance ne$s4 7#d7 ,additional fund+ s\rces1 includ+ ,/ate & local funds1 support+ ! prev5tion & mitigation ( adv]se *ildhood exp]i5ces4 7f7 ,grant am\nt ,! am\nt ( a grant "u ?is section %all n exce$ #i1ejj1jjj4 7g7 ,p]iod ( a grant ,! p]iod ( a grant "u ?is section %all n exce$ #g ye>s4 7h7 ,s]vice provision )\t reg>d to ability ,to pay ,z a condition on receipt ( a grant "u ?is section1 an eligible entity %all agree t any assi/ance provid$ to an individual ?r\gh ! grant w be provid$ )\t reg>d to-- 7#a7 ! ability ( ! individual to pay = su* s]vices2 7#b7 ! curr5t or pa/ heal? condition ( ! individual to be s]v$2 7#c7 ! immigration /atus ( ! individual to be s]v$2 7#d7 ! sexual ori5tation & g5d] id5tity ( ! individual to be s]v$2 & 7#e7 any prior involvem5t ( ! individual 9 ! crim9al legal sy/em4 7i7 ,prohibitions ,9 addition to any o!r prohibitions det]m9$ by ! ,secret>y1 an eligible entity may n use a grant "u ?is section to-- 7#a7 use data analysis me?ods to in=m individual case decisions1 includ+ *ild removal or placem5t decisions1 or to t>get s]vices at c]ta9 individuals or families2 7#b7 require any individual or family to p>ticipate 9 any s]vice or program z a condition ( receipt ( a b5efit to :i* ! individual or family is o!rwise eligible2 7#c7 increase ! pres5ce or fund+ ( law en=cem5t surveillance1 involvem5t1 or activity 9 implem5t+ ! /rategies id5tifi$ "u subsection 7c77#a77;,b72 or 7#d7 enable ! practice ( conv]sion !rapy4 7j7 ,evaluation 7#a7 ,data model evaluation ,n lat] ?an #cf mon?s aft] ! date ( enactm5t ( ?is section1 ! ,assi/ant ,secret>y = ,plann+ & ,evaluation ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 9 coord9ation ) ! grantees receiv+ a grant "u ?is section1 %all complete an evaluation ( ! effectiv5ess ( ! data model accuracy ( ! grant program "u ?is section to address ea* ( ! foll[+3 7,a7 ,det]m9+ ! effectiv5ess ( ! grantees' use ( data analysis me?ods to id5tify geographic areas pursuant to subsection 7c77#a74 7,b7 ,exam9+ ! grantees' developm5t & utilization ( data analysis me?ods4 7,c7 ,exam9+ ! grantees' ability to effectively utilize data analysis me?ods 9 future prev5tion "w4 7,d7 ,e/abli%+ a me?od = rigor\sly evaluat+ ! activities ( grantees & comp>+ ! r$uction ( *ild & family exposure to adv]se exp]i5ces 9 o!r communities ) simil> demographics4 7,e7 ,exam9+ ! grantees' utilization ( community-bas$ sy/em dynamics model+ me?ods & o!r community engagem5t me?ods4 7#b7 ,program evaluation ,n lat] ?an #f ye>s aft] ! date ( enactm5t ( ?is section1 ! ,assi/ant ,secret>y = ,plann+ & ,evaluation ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 9 coord9ation ) eligible entities receiv+ grants "u ?is section1 %all complete an evaluation ( ! effectiv5ess ( ! grant program "u ?is section4 7#c7 ,data ,collection 7,a7 ,9 g5]al ,! ,assi/ant ,secret>y = ,plann+ & ,evaluation ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices & ea* eligible entity receiv+ a grant "u ?is section %all collect any relevant data necess>y to complete ! evaluations requir$ by p>agraphs 7#a7 & 7#b7 to include-- 7i7 ! activities fund$ by ! grant "u ?is section1 includ+ developm5t & implem5tation data analysis me?ods2 7ii7 ! numb] ( *ildr5 & ( families receiv+ coord9ation & facilitation ( c>e & s]vices2 & 7iii7 ! effect ( activities support$ by ! grant "u ?is section on ! local area s]vic$ by ! program1 includ+ su* effects on-- 7,i7 *ildr5 & adolesc5ts' heal? & well-be+2 7,,ii7 ! numb] ( *ildr5 :o ent] into or dep>t f fo/] s]vices2 & 7,,iii7 homelessness & h\s+ insecurity4 7,b7 ,/udy 7i7 ,9 g5]al ,n lat] ?an #g ye>s aft] ! date ( enactm5t ( ?is section1 ! ,assi/ant ,secret>y = ,plann+ & ,evaluation ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices %all-- 7,i7 complete a /udy on ! results ( ! grant program "u ?is section us+ ! community-bas$ p>ticipatory action rese>* me?od1 :i* focuses on social1 /ructural1 & physical environm5tal inequities ?r\gh active involvem5t ( community memb]s1 cli5ts1 organizational repres5tatives1 & rese>*]s 9 all aspects ( ! rese>* process2 & 7,,ii7 submit a report on ! results ( ! /udy to ! ,congress4 7ii7 ,p>tn]s ,9 conduct+ ! /udy "u clause 7i71 ! ,assi/ant ,secret>y = ,plann+ & ,evaluation ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices %all ensure t p>tn]s & p]sons t h p>ticipat$ 9 ! grant program "u ?is section on e level1 especially ^? su* p>tn]s or p]sons receiv+ s]vices & support ?r\gh ! program1 h an opportunity to contribute _! exp]tise to evaluat+ ! /rategy & outcomes4 7k7 ,report ,n lat] ?an ?ree mon?s aft] ! completion ( ! evaluation requir$ by subsection 7j77#b71 ! ,assi/ant ,secret>y = ,plann+ & ,evaluation ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices %all submit to ,congress & make available to ! public on ! int]net website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices a report bas$ ^u ! evaluation "u subsection 7j77#b71 to include-- 7#a7 ! impact ( ! program "u ?is section on homelessness & h\s+ insecurity1 sub/ance use disord] & drug dea?s1 inc>c]ation1 fo/] sy/em involvem5t1 & o!r *ild & family outcomes z id5tifi$ by ! ,assi/ant ,secret>y = ,plann+ & ,evaluation ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices2 7#b7 an analysis ( :i* elem5ts ( ! program %\ld be replicat$ & scal$ by gov]nm5tal or non-gov]nm5tal entities2 & 7#c7 su* recomm5dations = legislation & adm9i/rative action z ! ,secret>y det]m9es appropriate4 7l7 ,def9itions ,9 ?is section3 7#a7 ,! t]m adv]se *ildhood exp]i5ce means a pot5tially traumatic exp]i5ce t occurs 9 *ildhood & c h a trem5d\s impact on ! *ild's lifelong heal? & opportunity outcomes1 su* z any ( ! foll[+3 7,a7 ,abuse1 su* z any ( ! foll[+3 7i7 ,emotional & psy*ological abuse4 7ii7 ,physical abuse4 7iii7 ,sexual abuse4 7,b7 ,h\sehold *all5ges su* z any ( ! foll[+3 7i7 ,a h\sehold memb] is treat$ viol5tly4 7ii7 ,a h\sehold memb] has a sub/ance use disord]4 7iii7 ,a h\sehold memb] has a m5tal heal? condition4 7iv7 ,p>5tal sep>ation or divorce4 7v7 ,a h\sehold memb] is inc>c]at$1 is plac$ 9 immigrant det5tion1 or has be5 deport$4 7vi7 ,a h\sehold memb] has a life-?reat5+ illness su* z ,,covid-#ai4 7,c7 ,neglect4 7,d7 ,liv+ 9-- 7i7 impov]i%$ communities t lack access to human s]vices2 7ii7 areas ( high unemploym5t neighborhoods2 or 7iii7 communities exp]i5c+ de facto segregation4 7,e7 ,exp]i5c+ food insecurity & poor nutrition4 7,f7 ,witness+ viol5ce4 7,g7 ,involvem5t ) ! fo/] sy/em4 7,h7 ,exp]i5c+ discrim9ation4 7,i7 ,deal+ ) hi/orical & ongo+ traumas due to sy/emic & int]p]sonal racism4 7,j7 ,deal+ ) hi/orical & ongo+ traumas reg>d+ sy/emic & int]p]sonal sexism1 homophobia1 biphobia1 & transphobia4 7,k7 ,deal+ ) ! ?reat ( deportation or det5tion z a result ( immigration /atus4 7,l7 ,! impacts ( multig5]ational pov]ty result+ f limit$ educational & economic opportunities4 7,m7 ,liv+ ?r\gh natural disa/]s su* z e>?quakes1 =e/ fires1 floods1 or hurricanes4 7#b7 ,! t]m eligible entity means a ,/ate or local heal? dep>tm5t4 7#c7 ,! t]m practice ( conv]sion !rapy-- 7,a7 means any practice or treatm5t by any p]son t seeks to *ange ano!r individual's sexual ori5tation or g5d] id5tity1 includ+ ef=ts to *ange behaviors or g5d] expressions1 or to elim9ate or r$uce sexual or romantic attractions or feel+s t[>d individuals ( ! same g5d]1 if su* p]son receives monet>y comp5sation 9 ex*ange = any su* practice or treatm5t2 & 7,b7 does n include any practice or treatm5t t does n seek to *ange sexual ori5tation or g5d] id5tity &-- 7i7 provides assi/ance to an individual und]go+ a g5d] transition2 or 7ii7 provides acceptance1 support1 & und]/&+ ( a cli5t or facilitation ( a cli5t's cop+1 social support1 & id5tity exploration & developm5t4 7m7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section = ! p]iod ( fiscal ye>s #bjbc ?r\gh #bjcj-- 7#a7 to c>ry out subsection 7a77#a7 ?r\gh ! aw>d ( grants "u subsection 7b7-- 7,a7 #dg1ejj1jjj = grants2 & 7,b7 su* sums z may be necess>y = ! adm9i/rative co/s ( c>ry+ out su* subsection2 & 7#b7 #g1ejj1jjj to c>ry out ! evaluation "u subsection 7a77#b74 4 7b7 ,c>e coord9ation grants ,"p ,e ( title ,,xii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;d-#ea et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #abee4 ,c>e coord9ation grants 7a7 ,9 g5]al ,! ,secret>y %all aw>d grants to eligible entities to e/abli% or exp& trauma-in=m$ c>e coord9ation s]vices to support-- 7#a7 *ildr5 ag$ #j ?r\gh #e at risk ( adv]se *ildhood exp]i5ces2 & 7#b7 _! c>egiv]s1 includ+ pr5atal p ( any age4 7b7 ,numb] ( grants ,subject to ! availability ( appropriations1 ! ,secret>y %all aw>d n few] ?an #i & n m ?an #dj grants "u ?is section4 7c7 ,am\nt ( grants ,subject to ! availability ( appropriations1 ! am\nt ( a grant "u ?is section = a fiscal ye> %all be-- 7#a7 n less ?an #bej1jjj2 & 7#b7 n m ?an #a1jjj1jjj4 7d7 ,eligible entities ,to be eligible to receive a grant "u ?is section1 an entity %all be a local gov]nm5t or ,indian ,tribe1 act+ ?r\gh ! public heal? dep>tm5t !re( if su* gov]nm5t or ,tribe has a public heal? dep>tm5t4 7e7 ,priority 7#a7 ,9 g5]al ,9 aw>d+ grants "u ?is section1 ! ,secret>y %all give priority to eligible entities propos+ to s]ve communities ) a high ne$ = trauma-in=m$ c>e coord9ation s]vices1 z demon/rat$ by indicators su* z-- 7,a7 pregnant p :o face b>ri]s to pr5atal c>e2 7,b7 mortality or morbidity ( p giv+ bir? or infants2 7,c7 c>etak]s & p>5ts :o are liv+ ) a m5tal heal? condition or sub/ance use disord]2 7,d7 a high preval5ce ( community viol5ce1 includ+ dome/ic viol5ce1 z demon/rat$ by in/ances ( homicide & public heal? /ati/ics1 includ+ treatm5t ( injury or trauma2 7,e7 high proportions ( l[-income *ildr52 7,f7 a high preval5ce ( *ild fatalities or ne> fatalities relat$ to *ild abuse & neglect2 7,g7 significant disp>ities 9 heal? outcomes = p giv+ bir? & infants2 7,h7 a high rate ( exclusion>y discipl9e & ref]rals to law en=cem5t2 & 7,i7 a high rate ( homelessness & h\s+ in/ability4 7#b7 ,data f ,tribal areas ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,indian ,heal? ,s]vice1 %all consult ) ,indian ,tribes to e/abli% crit]ia to measure indicators ( ne$1 = purposes ( p>agraph 7#a71 ) respect to ,tribal areas4 7f7 ,use ( funds 7#a7 ,requir$ uses 7,a7 ,9 g5]al ,a grant receiv$ "u ?is section %all be us$ to e/abli% or exp& g5d]-responsive1 culturally specific1 trauma-in=m$ c>e coord9ation s]vices1 includ+ by in/itut+ & conduct+ risk & ne$s assessm5ts includ+-- 7i7 us+ /r5g?s-bas$ approa*es focus$ on protective factors = *ildr5 & _! c>egiv]s1 includ+ pr5atal p ( any age2 & 7ii7 inputt+ scre5+ results into a c5traliz$ intake sy/em to promote a s+le po9t ( access sy/em across provid]s & s]vices4 7,b7 ,tra9+ ,a grant receiv$ "u ?is section %all be us$ to ensure t individuals employ$ ?r\gh ! grant funds1 9 :ole or 9 "p1 h receiv$ suffici5t & up-to-date tra9+ on trauma-in=m$ c>e & /rategies t are rep>ative1 culturally s5sitive1 g5d] responsive1 & heal+ c5t]$4 7#b7 ,p]missible uses ,a grant receiv$ "u ?is section may be us$ = any ( ! foll[+3 7,a7 ,employ+ c>e coord9ators1 case manag]s1 community heal? work]s1 c]tifi$ infant m5tal heal? speciali/s1 & outrea* & engagem5t speciali/s to "w ) *ildr5 & _! c>egiv]s1 includ+ pr5atal individuals1 to prev5t & respond to adv]se *ildhood exp]i5ces by connect+ cli5ts ) culturally specific1 trauma-in=m$ c>e treatm5t s]vices1 includ+ economic1 social1 food1 & h\s+ supports4 7,b7 ,provid+ tra9+ describ$ 9 p>agraph 7#a77;,b7 to community heal? provid]s & community p>tn]s4 7,c7 ,exp&+1 enhanc+1 modify+1 & connect+ ! exi/+ network ( community programs & s]vices to a*ieve a m compreh5sive & coord9at$ sy/em ( c>e approa*1 includ+-- 7i7 develop+ local infra/ructure to bol/] & %ape community support sy/ems & map & build access to s]vices 9 a coord9at$ & compreh5sive way2 & 7ii7 creat+ infra/ructure to conduct outrea* to *ildr5 & families1 includ+ ^? exp]i5c+ homelessness & h\s+ in/ability1 s !y acquire access to ! s]vices & supports !y ne$ & ! b5efits to :i* !y are entitl$4 7,d7 ,compil+ in=mation on res\rces 7includ+ any ref]ral s]vices7 available ?r\gh community-bas$ organizations & local1 ,/ate1 & ,f$]al ag5cies1 su* z-- 7i7 programs address+ social det]m9ants ( heal?1 includ+-- 7,i7 em]g5cy1 tempor>y1 & long-t]m h\s+2 7,,ii7 programs t (f] free or af=dable & nutriti\s food2 7,,iii7 vocational & work=ce developm5t2 & 7,,iv7 transportation supports2 7ii7 home visit+ programs = new p>5ts & _! infants2 7iii7 work=ce developm5t programs to support c>egiv]s 9 skill build+2 7iv7 trauma-responsive1 p>5t+ skills-build+ programs2 7v7 ! cont9uum ( sub/ance use prev5tion1 int]v5tion1 & treatm5t programs & m5tal heal? support programs1 includ+ programs ) trauma-in=m$1 g5d]-responsive1 & culturally specific c\nsel+2 & 7vi7 *ildc>e support & e>ly *ildhood education1 includ+ ,head ,/>t & ,e>ly ,head ,/>t programs4 7,e7 ,subject to subsection 7g77#a71 e/abli%+ or updat+ a database t compiles data us$ to track ! effectiv5ess ( ! c>e coord9ation s]vices fund$ ?r\gh ! grant4 7,f7 ,develop+ & implem5t+ ref]ral p>tn]%ip agreem5ts ) community-bas$ organizations1 p>5t organizations1 sub/ance use disord] treatm5t provid]s & facilities1 h\s+ & %elt] provid]s1 heal? c>e provid]s1 m5tal heal? c>e provid]s1 & ,f$]al & ,/ate (fices & programs t implem5t practices to support *ildr5 ages #j ?r\gh #e :o are at risk ( adv]se *ildhood exp]i5ces & _! c>egiv]s1 includ+ pr5atal p4 ,su* practices %all include-- 7i7 a bilat]al w>m h&(f sy/em :]eby a grantee und]/&s ! ne$s ( ! *ildr5 & _! families1 & families are involv$ 9 address+ ^! ne$s2 & 7ii7 an active s]vice connection :]eby ! *ildr5 & families are ea* actively connect$ ) a res\rce 9 a well-coord9at$ way t ensures availability & direct contact4 7,g7 ,support+ cross-sy/em plann+ & collaboration among employees :o may "w 9 em]g5cy m$ical s]vices1 heal? c>e s]vices1 public heal?1 e>ly *ildhood education1 & sub/ance use disord] treatm5t & recov]y support4 7,h7 ,provid+ or subsidiz+ s]vices to address b>ri]s t *ildr51 pr5atal individuals1 & c>egiv]s face to utiliz+ community res\rces & s]vices1 su* z by provid+ or subsidiz+ transportation or *ildc>e co/s z applicable & )9 reasonable am\nts4 7,i7 ,creat+ or exp&+ infra/ructure & inve/+ 9 te*nology1 includ+ ! provision ( communications te*nology & int]net s]vice to *ildr5 & _! c>egiv]s1 to enable increas$ telem$ic9e capabilities to rea* p>ticipants4 7#c7 ,indian tribes ,9 ! case ( an eligible entity t is an ,indian ,tribe1 ! ,secret>y may waive su* provisions ( ?is subsection z ! ,secret>y det]m9es appropriate4 7#d7 ,prohibitions ,9 addition to any o!r prohibitions det]m9$ by ! ,secret>y1 an eligible entity may n use a grant "u ?is section to-- 7,a7 use data analysis me?ods to in=m individual case decisions1 includ+ *ild removal or placem5t decisions1 or to t>get s]vices at c]ta9 individuals or families2 7,b7 require any individual or family to p>ticipate 9 any s]vice or program z a condition ( receipt ( a b5efit to :i* ! individual or family is o!rwise eligible2 or 7,c7 increase ! pres5ce or fund+ ( law en=cem5t surveillance1 involvem5t1 or activity 9 connection ) trauma-in=m$ c>e coord9ation s]vices support$ pursuant to ?is section4 7g7 ,requirem5ts ,z a condition on receipt ( a grant "u ?is section1 an eligible entity %all agree to ea* ( ! foll[+ fund+ conditions3 7#a7 ,re/riction ( fund+ allocation ,! eligible entity w n use m ?an #cj p]c5t ( ! funds made available to ! entity ?r\gh ! grant 7= ! total grant p]iod7 to e/abli% or update a database pursuant to subsection 7f77#b77;,e74 7#b7 ,accessible sett+ 7,a7 ,9 g5]al ,! eligible entity w ensure t all c>e coord9ation s]vices provid$ ?r\gh ! grant are provid$ 9 a sett+ t is accessible1 includ+ ?r\gh mobile sett+s1 to-- 7i7 l[-income or no-income individuals1 includ+ individuals exp]i5c+ homelessness or h\s+ in/ability2 & 7ii7 individuals 9 rural areas4 7,b7 ,community outrea* ,9 comply+ ) subp>agraph 7,a71 ! eligible entity w ensure t at lea/ #ej p]c5t ( ! c>e coord9ation s]vices provid$ ?r\gh ! grant occur 9 community sett+s t are conv5i5t to ! *ildr5 & c>egiv]s :o are be+ s]v$1 su* z homes1 s*ools1 & %elt]s1 :e!r = initial outrea* or z "p ( long-t]m c>e4 7#c7 ,supplem5t1 n supplant ,! grant w be us$ to supplem5t1 n supplant o!r ,f$]al1 ,/ate1 or local funds available = c>e coord9ation s]vices4 7#d7 ,confid5tiality ,! eligible entity w ma9ta9 ! confid5tiality ( individuals receiv+ s]vices ?r\gh ! grant 9 a mann] consi/5t ) applicable law4 7#e7 ,p>tn]+2 risk /ratification ,9 provid+ c>e coord9ation s]vices ?r\gh ! grant1 ! eligible entity w-- 7,a7 p>tn] ) community-bas$ organizations ) exp]i5ce s]v+ *ild populations pr5atally ?r\gh age #e2 7,b7 coord9ate ) ! local ag5cy responsible = adm9i/]+ ! ,/ate plan approv$ "u title ,,xix ( ! ,social ,security ,act2 & 7,c7 employ risk /ratification to develop diff]5t effective models ( c>e = diff]5t populations bas$ on _! ne$s4 7h7 ,application 7#a7 ,9 g5]al ,to seek a grant "u ?is section1 an eligible entity %all submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation1 z ! ,secret>y may require4 7#b7 ,cont5ts ,an application "u p>agraph 7#a7 %all1 at a m9imum1 conta9 ea* ( ! foll[+3 7,a7 ,goals to be a*iev$ ?r\gh ! grant1 includ+ ! activities t w be und]tak5 to a*ieve ^? goals4 7,b7 ,! numb] ( individuals likely to be s]v$ ?r\gh ! grant1 includ+ demographic data on ! populations to be s]v$4 7,c7 ,exi/+ programs & s]vices t c be us$ to significantly increase ! proportion ( *ildr5 & families :o receive ne$$ supports & s]vices4 7,d7 ,a plan = exp&+1 coord9at+1 or modify+ ! exi/+ network ( programs & s]vices to meet ! ne$s ( *ildr5 & families = prev5t+ & mitigat+ ! traumatic impact ( adv]se *ildhood exp]i5ces4 7,e7 ,a demon/ration ( ! ability ( ! eligible entity to rea* ! individuals to be s]v$1 includ+ by p>tn]+ ) local /akehold]s4 7,f7 ,an indication ( h[ ! p]sonnel involv$ are reflective ( ! communities to be s]v$4 7,g7 ,a li/ ( /akehold]s ) :om ! entity plans to p>tn] or consult4 7i7 ,report+ by grantees ,n lat] ?an #d ye>s aft] ! date ( enactm5t ( ?is section1 an eligible entity receiv+ a grant "u ?is section %all submit to ! ,secret>y a report on ! activities fund$ ?r\gh ! grant4 ,su* report %all include1 at a m9imum1 a description (-- 7#a7 ! numb] ( individuals s]v$ ?r\gh activities fund$ ?r\gh ! grant1 includ+ demographics z applicable2 7#b7 ! numb] ( ref]rals made ?r\gh ! grant & ! rate ( su* ref]rals successfully l9k$ or clos$2 7#c7 a qualitative analysis or numb] ( collaborative p>tn]%ips ) o!r organizations 9 c>ry+ out ! activities fund$ ?r\gh ! grant2 7#d7 ! numb] ( s]vices provid$ to individuals ?r\gh ! grant2 7#e7 aggregat$ & de-id5tifi$ outcomes exp]i5c$ by individuals s]v$ ?r\gh ! grant su* z-- 7,a7 ! rate ( successful s]vice connections2 7,b7 any increases 9 developm5t ( protective factors = *ildr52 7,c7 any increase 9 developm5t ( protective factors = ! c>egiv]s2 7,d7 any mitigation ( ! negative outcomes associat$ ) adv]se *ildhood exp]i5ces or decreas$ likelihood ( *ildr5 exp]i5c+ an adv]se *ildhood exp]i5ce z evid5c$ by-- 7i7 decreas$ pres5ce ( law en=cem5t or o!r punitive ,/ate surveillance 9 ! community2 7ii7 a p>5t complet+ sub/ance use treatm5t2 7iii7 a p>5t receiv+ volunt>y treatm5t = m5tal heal?-relat$ conditions2 7iv7 a family ent]+ into or ma9ta9+ a /able h\s+ situation2 7v7 a family a*iev+ or ma9ta9+ economic security2 7vi7 a p>5t a*iev+ or ma9ta9+ job /ability2 or 7vii7 a *ild meet+ developm5tal m>k]s = s*ool read9ess2 & 7,e7 reports ( satisfaction ) ! coord9ation ( c>e by p s]v$2 & 7#f7 any o!r in=mation requir$ by ! ,secret>y4 7j7 ,conv5+ p>ticipants = %>+ lessons le>n$ ,aft] ! p]iod ( all grants aw>d$ "u ?is section has conclud$1 ! ,assi/ant ,secret>y = ,plann+ & ,evaluation ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices %all provide an 9-p]son or onl9e opportunity = p]sons p>ticipat+ 9 ! programs fund$ ?r\gh ?is section to %>e ) ea* o!r-- 7#a7 lessons le>n$2 7#b7 *all5ges exp]i5c$2 & 7#c7 ideas = next /eps & solutions4 7k7 ,compil+ f9d+s & conclusions ,aft] provid+ ! opportunity requir$ by subsection 7j71 ! ,secret>y %all-- 7#a7 compile ! f9d+s & conclusions ( grantees "u ?is section on ! provision ( c>e coord9ation s]vices describ$ 9 subsection 7a72 7#b7 submit a report on su* f9d+s & conclusions to ! appropriate congressional committees2 & 7#c7 make su* report publicly available4 7l7 ,def9itions ,9 ?is section3 7#a7 ,adv]se *ildhood exp]i5ce ,! t]m adv]se *ildhood exp]i5ce means a pot5tially traumatic exp]i5ce t occurs 9 *ildhood & c h a trem5d\s impact on ! *ild's lifelong heal? & opportunity outcomes1 su* z any ( ! foll[+3 7,a7 ,abuse1 su* z any ( ! foll[+3 7i7 ,emotional & psy*ological abuse4 7ii7 ,physical abuse4 7iii7 ,sexual abuse4 7,b7 ,h\sehold *all5ges su* z any ( ! foll[+3 7i7 ,a h\sehold memb] is treat$ viol5tly4 7ii7 ,a h\sehold memb] has a sub/ance use disord]4 7iii7 ,a h\sehold memb] has a m5tal heal? condition4 7iv7 ,p>5tal sep>ation or divorce4 7v7 ,a h\sehold memb] is inc>c]at$1 is plac$ 9 immigrant det5tion1 or has be5 deport$4 7vi7 ,a h\sehold memb] has a life-?reat5+ illness su* z ,,covid-#ai4 7,c7 ,neglect4 7,d7 ,liv+ 9-- 7i7 impov]i%$ communities t lack access to human s]vices2 7ii7 areas ( high unemploym5t neighborhoods2 or 7iii7 communities exp]i5c+ de facto segregation4 7,e7 ,exp]i5c+ food insecurity & poor nutrition4 7,f7 ,witness+ viol5ce4 7,g7 ,involvem5t ) ! fo/] sy/em4 7,h7 ,exp]i5c+ discrim9ation4 7,i7 ,deal+ ) hi/orical & ongo+ traumas due to sy/emic & int]p]sonal racism4 7,j7 ,deal+ ) hi/orical & ongo+ traumas reg>d+ sy/emic & int]p]sonal sexism1 homophobia1 biphobia1 & transphobia4 7,k7 ,deal+ ) ! ?reat ( deportation or det5tion z a result ( immigration /atus4 7,l7 ,! impacts ( multig5]ational pov]ty result+ f limit$ educational & economic opportunities4 7,m7 ,liv+ ?r\gh natural disa/]s su* z e>?quakes1 =e/ fires1 floods1 or hurricanes4 7#b7 ,c>e coord9ation ,! t]m c>e coord9ation means an active1 ongo+ process t-- 7,a7 assi/s *ildr5 ages #j ?r\gh #e at risk (1 or :o h exp]i5c$1 an adv]se *ildhood exp]i5ce1 & _! c>egiv]s1 includ+ pr5atal p ( any age1 to id5tify1 access1 & use community res\rces & s]vices2 7,b7 is cli5t c5t]$ & compreh5sive ( ! s]vices a *ild or c>egiv] may ne$2 7,c7 ensures a clos$ loop ref]ral by obta9+ fe$back f ! families s]v$2 & 7,d7 works across sy/ems & s]vices to promote collaboration to effectively meet ! ne$s ( community memb]s4 7#c7 ,indian ,tribe ,! t]m ,indian ,tribe has ! mean+ giv5 su* t]m 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act4 7#d7 ,protective factors ,! t]m protective factors ref]s to any supportive elem5t 9 a *ild or c>etak]'s life t helps ! *ild or c>etak] to )/& trauma su* z a /able s*ool environm5t or supportive pe] relation%ips4 7m7 ,au?orization ( appropriations 7#a7 ,9 g5]al ,to c>ry out ?is section1 !re is au?oriz$ to be appropriat$ #ae1jjj1jjj = ea* ( ! #e fiscal ye>s foll[+ ! fiscal ye> 9 :i* ?is section is enact$4 7#b7 ,grants to ,indian tribes ,( ! am\nt made available to c>ry out ?is section = a fiscal ye>1 ! ,secret>y %all use n less ?an #aj p]c5t ( su* am\nt = grants to eligible entities t are ,indian ,tribes4 7#c7 ,adm9i/rative exp5ses ,( ! am\nt made available to c>ry out ?is section = a fiscal ye>1 ! ,secret>y may use n m ?an #ae p]c5t ( su* am\nt = adm9i/rative exp5ses1 includ+ ! exp5ses ( ! ,assi/ant ,secret>y = ,plann+ & ,evaluation ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices = compil+ & report+ in=mation4 7#d7 ,te*nical assi/ance ,( ! am\nt made available to c>ry out ?is section = a fiscal ye>1 ! ,secret>y may res]ve up to #e p]c5t ( su* am\nt to provide te*nical assi/ance to eligible entities 9 prep>+ & submitt+ applications "u ?is section4 4 #fjge4 ,improv+ access to m5tal heal? 7a7 ,access to cl9ical social work]s ,section #ahcc7;a77#a77;,f77ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77;,f77ii77 is am5d$ by /rik+ #ge p]c5t ( ! am\nt det]m9$ = paym5t ( a psy*ologi/ "u clause 7,l7 & ins]t+ #he p]c5t ( ! fee s*$ule am\nt provid$ "u section #ahdh4 7b7 ,access to cl9ical social work] s]vices provid$ to resid5ts ( skill$ nurs+ facilities 7#a7 ,9 g5]al ,section #ahhh7;e77#b77;,a77ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieyy7e77#b77;,a77ii771 z am5d$ by section #fjaa7;a77#e71 is am5d$ by ins]t+ cl9ical social work] s]vices1 aft] pe] support speciali/ s]vices 7z def9$ 9 section #ahfa7nnn77#g7714 7#b7 ,con=m+ am5dm5t ,section #ahfa7;hh77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7hh77#b77 is am5d$ by /rik+ & o!r ?an s]vices furni%$ to an inpati5t ( a skill$ nurs+ facility :i* ! facility is requir$ to provide z a requirem5t = p>ticipation4 7c7 ,access to ! complete set ( cl9ical social work] s]vices ,section #ahfa7;hh77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7hh77#b77 is fur!r am5d$ by /rik+ = ! diagnosis & treatm5t ( m5tal illnesses 7o!r ?an s]vices & ins]t+ 7includ+ s]vices = ! diagnosis & treatm5t ( m5tal illnesses or s]vices = heal? & behavior assessm5t & int]v5tion 7id5tifi$ z ( ,janu>y #a1 #bjbb1 by ,,hcpcs codes #ifaej ?r\gh #ifafa 7& any succe$+ codes771 b n includ+ s]vices4 7d7 ,effective date ,! am5dm5ts made by ?is section %all apply to items & s]vices furni%$ on or aft] ,janu>y #a1 #bjbc4 #fjgf4 ,m5tal ,heal? 9 ,s*ools ,excell5ce ,program 7a7 ,program ,to e/abli% public-,private contributions ,to increase ! available work=ce ( s*ool-,bas$ m5tal heal? s]vice provid]s 7#a7 ,program au?oriz$ ,! ,secret>y %all c>ry out a program "u :i* eligible graduate in/itutions may ent] into an agreem5t ) ! ,secret>y to cov] a portion ( ! co/ ( att5dance ( a p>ticipat+ /ud5t1 :i* contributions %all be mat*$ by equival5t contributions t[>ds su* co/ ( att5dance by ! ,secret>y4 7#b7 ,designation ( program ,! program "u ?is subsection %all be kn[n z ! ,m5tal ,heal? 9 ,s*ools ,excell5ce ,program4 7#c7 ,agreem5ts ,! ,secret>y %all ent] into an agreem5t ) ea* eligible graduate in/itution seek+ to p>ticipate 9 ! program "u ?is section4 ,ea* agreem5t %all specify ! foll[+3 7,a7 ,! mann] 7:e!r by direct grant1 s*ol>%ip1 or o!rwise7 9 :i* ! eligible graduate in/itution w contribute to ! co/ ( att5dance ( a p>ticipat+ /ud5t4 7,b7 ,! maximum am\nt ( ! contribution to be made by ! eligible graduate in/itution ) respect to any p>ticul> p>ticipat+ /ud5t 9 any giv5 academic ye>4 7,c7 ,! maximum numb] ( individuals = :om ! eligible graduate in/itution w make contributions 9 any giv5 academic ye>4 7,d7 ,t ! eligible graduate in/itution1 9 select+ p>ticipat+ /ud5ts to receive assi/ance "u ! program1 %all prioritize ! p>ticipat+ /ud5ts describ$ 9 p>agraph 7#d77;,b74 7,e7 ,su* o!r matt]s z ! ,secret>y & ! eligible graduate in/itution det]m9e appropriate4 7#d7 ,outrea* ,! ,secret>y %all-- 7,a7 make publicly available & p]iodically update on ! int]net website ( ! ,dep>tm5t ( ,education a li/ ( ! eligible graduate in/itutions p>ticipat+ 9 ! program "u ?is subsection t %all specify1 = ea* su* graduate in/itution1 appropriate in=mation on ! agreem5t betwe5 ! ,secret>y & su* college or univ]sity "u p>agraph 7#c72 & 7,b7 conduct outrea* ab\t ! program "u ?is section to p>ticipat+ /ud5ts :o1 z und]graduates-- 7i7 receiv$ a ,f$]al ,pell ,grant "u section #dja ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajgj;a72 or 7ii7 att5d$ an in/itution li/$ 9 section #cga7;a7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajfgq7a774 7#e7 ,mat*+ contributions ,! ,secret>y may provide a contribution ( up to #ej p]c5t ( ! co/ ( att5dance ( a p>ticipat+ /ud5t if ! eligible graduate in/itution at :i* su* /ud5t is enroll$ ent]s into an agreem5t "u p>agraph 7#c7 ) ! ,secret>y to mat* su* contribution4 7b7 ,def9itions ,9 ?is section3 7#a7 ,co/ ( att5dance ,! t]m co/ ( att5dance has ! mean+ giv5 ! t]m 9 section #dgb ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajhgll74 7#b7 ,eligible graduate in/itution ,! t]m eligible graduate in/itution means an in/itution ( high] education t (f]s a program ( /udy t leads to a graduate degree-- 7,a7 9 s*ool psy*ology t is accr$it$ or approv$ by ! ,national ,association ( ,s*ool ,psy*ologi/s' ,program ,accr$itation ,bo>d or ! ,commission on ,accr$itation ( ! ,am]ican ,psy*ological ,association & t prep>es /ud5ts 9 su* program = ! ,/ate lic5s+ or c]tification exam9ation 9 s*ool psy*ology at ! speciali/ level2 7,b7 9 an accr$it$ s*ool c\nsel+ program t prep>es /ud5ts 9 su* program = ! ,/ate lic5s+ or c]tification exam9ation 9 s*ool c\nsel+2 7,c7 9 s*ool social "w t is accr$it$ by ! ,c\ncil on ,social ,"w ,education & t prep>es /ud5ts 9 su* program = ! ,/ate lic5s+ or c]tification exam9ation 9 s*ool social "w2 7,d7 9 ano!r s*ool-bas$ m5tal heal? field t prep>es /ud5ts 9 su* program = ! ,/ate lic5s+ or c]tification exam9ation 9 su* field1 if applicable2 or 7,e7 9 any comb9ation ( /udy describ$ 9 subp>agraphs 7,a7 ?r\gh 7,d74 7#c7 ,in/itution ( high] education ,! t]m in/itution ( high] education has ! mean+ giv5 su* t]m 9 section #aja ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajja71 b excludes any in/itution ( high] education describ$ 9 section #ajb7;a77#a77;,c7 ( su* ,act4 7#d7 ,p>ticipat+ /ud5t ,! t]m p>ticipat+ /ud5t means an individual :o is enroll$ 9 a graduate degree program 9 a s*ool-bas$ m5tal heal? field at a p>ticipat+ eligible graduate in/itution4 7#e7 ,s*ool-bas$ m5tal heal? field ,! t]m s*ool-bas$ m5tal heal? field means ea* ( ! foll[+ fields3 7,a7 ,s*ool c\nsel+4 7,b7 ,s*ool social "w4 7,c7 ,s*ool psy*ology4 7,d7 ,any o!r field ( /udy t leads to employm5t z a s*ool-bas$ m5tal heal? s]vices provid]1 z det]m9$ by ! ,secret>y4 7#f7 ,s*ool-bas$ m5tal heal? s]vices provid] ,! t]m s*ool-bas$ m5tal heal? s]vices provid] has ! mean+ giv5 ! t]m 9 section #dajb ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #gaab74 7#g7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,education4 #fjgg4 ,s*ool social work]s improv+ /ud5t success 7a7 ,s*ool ,social ,work] ,grants 7#a7 ,purposes ,! purpose ( ?is section is to assi/ ,/ates & local educational ag5cies 9 hir+ additional s*ool social work]s 9 ord] to increase access to m5tal heal? & o!r /ud5t support s]vices to /ud5ts 9 elem5t>y & second>y s*ools 9 ! ,unit$ ,/ates to ! m9imum ratios recomm5d$ by ! ,national ,association ( ,social ,work]s1 ! ,s*ool ,social ,"w ,association ( ,am]ica1 & ! ,am]ican ,c\ncil = ,s*ool ,social ,"w ( "o s*ool social work] = e #bej /ud5ts1 & "o s*ool social work] = e #ej /ud5ts :5 a social work] is provid+ s]vices to /ud5ts ) int5sive ne$s4 7#b7 ,,esea am5dm5t ,subp>t #d ( "p ,f ( title ,,iv ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #gbga et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #dfde4 ,grants = s*ool social work]s 7a7 ,grants au?oriz$ 7#a7 ,9 g5]al ,f ! am\nts appropriat$ "u subsection 7g71 ! ,secret>y %all aw>d grants to high-ne$ local educational ag5cies to enable su* ag5cies to reta9 s*ool social work]s employ$ by su* ag5cies or to hire additional s*ool social work]s4 7#b7 ,duration ,a grant aw>d$ "u ?is section %all be aw>d$ = a p]iod n to exce$ #d ye>s4 7#c7 ,supplem5t1 n supplant ,funds made available "u ?is section %all be us$ to supplem5t1 & n to supplant1 o!r ,f$]al1 ,/ate1 or local funds us$ = hir+ & reta9+ s*ool social work]s4 7b7 ,application 7#a7 ,9 g5]al ,to be eligible to receive a grant "u ?is section1 a high-ne$ local educational ag5cy %all submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7#b7 ,cont5ts ,an application submitt$ "u p>agraph 7#a7 %all include an assurance t ea* s*ool social work] :o receives assi/ance "u ! grant w provide ! s]vices describ$ 9 subsection 7d71 & a description ( ! specific s]vices to be provid$ by su* social work]4 7c7 ,use ( funds ,a high-ne$ local educational ag5cy receiv+ a grant "u ?is section-- 7#a7 %all use ! grant-- 7,a7 to a*ieve a ratio ( n less ?an #a s*ool social work] = e #bej /ud5ts s]v$ by ! ag5cy1 by-- 7i7 reta9+ s*ool social work]s employ$ by su* ag5cy2 or 7ii7 7,i7 employ+ additional s*ool social work]s2 or 7,,ii7 hir+ contractors to s]ve z s*ool social work]s only 9 a case 9 :i*-- 7aa7 ! local educational ag5cy demon/rates to ! ,secret>y t ! ag5cy-- 7,,aa7 has n be5 able to employ a suffici5t numb] ( s*ool social work]s "u subclause 7,i7 to a*ieve su* ratio despite /rong & cont9u+ ef=ts to recruit & employ s*ool social work]s2 & 7,,bb7 hir+ contractors is ! only viable option to ensure /ud5ts h adequate access to s*ool social "w s]vices2 & 7bb7 ea* su* contractor meets ! requirem5ts ( subp>agraphs 7,a7 & 7,b7 ( subsection 7h77#b72 & 7,b7 to ensure t ea* s*ool social work] :o receives assi/ance "u su* grant provides ! s]vices describ$ 9 subsection 7d72 & 7#b7 may use ! grant to reimburse s*ool social work]s :o receive assi/ance "u su* grant =-- 7,a7 9 ! case ( a s*ool s]v$ by ! ag5cy 9 :i* ! majority ( /ud5ts are high] risk /ud5ts1 to hire or reta9 additional s*ool social work]s 9 accordance ) clauses 7i7 & 7ii7 ( p>agraph 7#a77;,a7 to a*ieve a ratio ( n less ?an #a s*ool social work] = e #ej /ud5ts2 7,b7 travel exp5ses incurr$ dur+ home visits & o!r s*ool-relat$ trips2 7,c7 any additional exp5ses incurr$ by su* social work]s 9 r5d]+ any s]vice describ$ 9 subsection 7d72 & 7,d7 ! co/ ( cl9ical social "w sup]vision = su* social work]s4 7d7 ,responsibilities ( a s*ool social work] ,a s*ool social work] :o receives assi/ance "u a grant "u ?is section %all provide ! foll[+ s]vices3 7#a7 ,id5tify+ high-ne$ /ud5ts 9 ea* s*ool t ! social work] s]ves1 & t>get+ s]vices provid$ at ! s*ool to su* /ud5ts4 7#b7 ,provid+ /ud5ts 9 ea* s*ool t ! s*ool social work] s]ves1 social "w s]vices to promote s*ool engagem5t & improve academic outcomes1 includ+-- 7,a7 c\nsel+ & crisis int]v5tion2 7,b7 trauma-in=m$ s]vices2 7,c7 evid5ce-bas$ educational1 behavioral1 & m5tal heal? s]vices 7su* z implem5t+ multi-ti]$ programs & practices1 monitor+ progress1 & evaluat+ s]vice effectiv5ess72 7,d7 address+ ! social & emotional le>n+ ne$s ( /ud5ts2 7,e7 promot+ a s*ool climate & culture conducive to /ud5t le>n+ & tea*+ excell5ce 7su* z promot+ effective s*ool policies & adm9i/rative proc$ures1 enhanc+ ! pr(essional capacity ( s*ool p]sonnel1 & facilitat+ engagem5t betwe5 /ud5t1 family1 s*ool1 & community72 7,f7 provid+ access to s*ool-bas$ & community-bas$ res\rces 7su* z promot+ a cont9uum ( s]vices1 mobiliz+ res\rces & promot+ assets1 provid+ lead]%ip1 int]discipl9>y collaboration1 sy/ems coord9ation1 & pr(essional consultation1 & connect+ /ud5ts & families to res\rce sy/ems72 7,g7 work+ ) /ud5ts1 families1 s*ools1 & communities to address b>ri]s to educational atta9m5t 7su* z homelessness & h\s+ insecurity1 lack ( transportation1 food insecurity1 equity1 social ju/ice issues1 access to quality education1 & s*ool1 family1 & community risk factors72 7,h7 provid+ assi/ance to s*ools & tea*]s to design social-emotional1 educational1 behavioral1 & m5tal heal? int]v5tions2 7,i7 case managem5t activities to coord9ate ! deliv]y ( & access to ! appropriate social "w s]vices to ! highe/-ne$ /ud5ts2 7,j7 home visits to meet ! family ( /ud5ts 9 ne$ ( social "w s]vices 9 ! home environm5t2 7,k7 sup]vis+ or coord9at+ di/rict level s*ool social "w s]vices2 & 7,l7 o!r s]vices ! ,secret>y det]m9es1 9 p>tn]%ip ) /ud5ts1 educators1 & community memb] voices1 are necess>y to be c>ri$ out by su* a social work]4 7e7 ,grant r5ewal 7#a7 ,9 g5]al ,a grant aw>d$ "u ?is section may be r5ew$ = additional p]iods ) ! same duration z ! orig9al grant p]iod4 7#b7 ,cont9u+ eligibility application ,to be eligible = a r5ewal "u ?is section a high-ne$ local educational ag5cy %all submit to ! ,secret>y1 = ea* r5ewal1 a report on ! progress ( su* ag5cy 9 reta9+ & hir+ s*ool social work]s to a*ieve ! ratio ( n less ?an #a s*ool social work] = e #bej /ud5ts s]v$ by ! ag5cy1 & %all include-- 7,a7 a description ( ! /aff+ expansion ( s*ool social work]s fund$ ?r\gh ! orig9al grant receiv$ "u ?is section2 & 7,b7 a description ( ! "w conduct$ by su* social work]s = high] risk /ud5ts4 7f7 ,te*nical assi/ance 7#a7 ,9 g5]al ,! ,secret>y %all provide te*nical assi/ance to high-ne$ local educational ag5cies1 includ+ su* ag5cies t d n h adequate /aff1 9 apply+ = grants "u ?is section4 7#b7 ,ext5sion ( application p]iod ,! ,secret>y %all ext5d any application p]iod = a grant "u ?is section = any high-ne$ local educational ag5cy t-- 7,a7 submits to ! ,secret>y a writt5 notification ( ! int5t to apply = a grant "u ?is section be=e reque/+ te*nical assi/ance "u p>agraph 7#a72 & 7,b7 aft] submitt+ ! notification "u subp>agraph 7,a71 reque/s su* te*nical assi/ance4 7g7 ,au?orization = appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section1 #ajj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 7h7 ,def9itions ,9 ?is section3 7#a7 ,high-ne$ local educational ag5cy ,! t]m high-ne$ local educational ag5cy has ! mean+ giv5 ! t]m 9 section #bjj ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajba74 7#b7 ,s*ool social work] ,! t]m s*ool social work] means an individual :o-- 7,a7 has a graduate degree 9 social "w f a social "w program t is accr$it$ by ! ,c\ncil on ,social ,"w ,education2 & 7,b7 meets all o!r ,/ate & local cr$5tial+ requirem5ts = practic+ z a social work] 9 an elem5t>y s*ool or second>y s*ool4 4 7b7 ,national te*nical assi/ance c5t] = s*ool social "w 7#a7 ,9 g5]al ,! ,secret>y ( ,education %all e/abli% an evaluation1 docum5tation1 dissem9ation1 & te*nical assi/ance res\rce c5t] to provide appropriate in=mation1 tra9+1 & te*nical assi/ance to ,/ates1 political subdivisions ( ,/ates1 f$]ally recogniz$ ,indian ,tribes1 ,tribal organizations1 in/itutions ( high] education1 ,/ate & local educational ag5cies1 & individual /ud5ts & educators ) respect to hir+ & reta9+ s*ool social work]s at elem5t>y s*ools & second>y s*ools s]v$ by local educational ag5cies4 7#b7 ,responsibilities ( ! ,c5t] ,! c5t] e/abli%$ "u p>agraph 7#a7 %all conduct activities = ! purpose (-- 7,a7 develop+ & cont9u+ /atewide or ,tribal /rategies = improv+ ! effectiv5ess ( ! s*ool social "w work=ce2 7,b7 /udy+ ! co/s & effectiv5ess ( s*ool social "w programs at in/itutions ( high] education to id5tify areas ( improvem5t & provide in=mation on relevant issues ( importance to ,/ate1 ,tribal1 & national policymak]s2 7,c7 work+ ) ,f$]al ag5cies & o!r ,/ate1 ,tribal1 & national /akehold]s to collect1 evaluate1 & dissem9ate data reg>d+ s*ool social "w ratios1 outcomes & be/ practices ( s*ool-bas$ m5tal heal? s]vices1 & impact ( exp&+ ! numb] ( s*ool social work]s )9 elem5t>y s*ools & second>y s*ools2 & 7,d7 e/abli%+ p>tn]%ips among national1 ,/ate1 ,tribal1 & local gov]nm5ts1 & local educational ag5cies1 in/itutions ( high] education1 non-pr(it organizations1 & ,/ate & national trade associations = ! purposes (-- 7i7 data collection & dissem9ation2 7ii7 e/abli%+ a s*ool social "w work=ce developm5t program2 7iii7 docum5t+ ! success ( s*ool social "w me?ods on a national level2 & 7iv7 conduct+ o!r activities det]m9$ appropriate by ! ,secret>y4 7#c7 ,def9itions ,9 ?is subsection3 7,a7 ,,esea t]ms ,except z o!rwise provid$1 any t]m us$ 9 ?is subsection t is def9$ 9 section #haja ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #ghja7 %all h ! mean+ giv5 t t]m 9 su* section4 7,b7 ,s*ool social work] ,! t]m s*ool social work] has ! mean+ giv5 ! t]m 9 section #dfde7;h7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife1 z add$ by subsection 7a74 #fjgh4 ,opioid grants to support c>egiv]s1 k9%ip c>e families1 & k9%ip c>egiv]s 7a7 ,opioid grants ,section #ajjc7;b77#b7 ( ! #ba/ ,c5tury ,cures ,act 7#db ,u4,s4,c4 #bij;ee-#c note7 is am5d$-- 7#a7 by r$esignat+ subp>agraph 7,e7 z subp>agraph 7,f72 & 7#b7 by ins]t+ aft] subp>agraph 7,d7 ! foll[+3 7,e7 ,support+ opioid abuse prev5tion & treatm5t s]vices )9 a ,/ate provid$ by ,/ate & local ag5cies = *ildr5 & c>egiv]s1 k9%ip c>e families1 & k9%ip c>egiv]s ?r\gh-- 7i7 work=ce recruitm5t & tra9+2 7ii7 heal? c>e s]vices 7includ+ su* s]vices describ$ 9 subp>agraph 7,d772 & 7iii7 fo/] & adoptive p>5t recruitm5t & tra9+4 4 7b7 ,def9itions ,section #ajjc ( ! #ba/ ,c5tury ,cures ,act 7#db ,u4,s4,c4 #bij;ee-#c note7 is am5d$-- 7#a7 by r$esignat+ subsections 7h71 7i71 & 7j7 z subsections 7i71 7j71 & 7k71 respectively2 & 7#b7 by ins]t+ aft] subsection 7g7 ! foll[+3 7h7 ,def9itions ,9 ?is section3 7#a7 ,! t]m k9%ip c>e family means a family ) a k9%ip c>egiv]4 7#b7 ,! t]m k9%ip c>egiv] means a relative ( a *ild by blood1 m>riage1 or adoption1 :o-- 7,a7 lives ) ! *ild2 7,b7 is ! prim>y c>egiv] ( ! *ild because ! biological or adoptive p>5t ( ! *ild is unable or unwill+ to s]ve z ! prim>y c>egiv] ( ! *ild2 & 7,c7 has a legal relation%ip to ! *ild or is rais+ ! *ild in=mally4 4 7c7 ,au?orization ( appropriations ,section #ajjc7;i7 ( ! #ba/ ,c5tury ,cures ,act 7#db ,u4,s4,c4 #bij;ee-#c note71 z r$esignat$1 is am5d$ by ins]t+ 1 & #bee1jjj1jjj = ea* ( fiscal ye>s #bjbb ?r\gh #bjbf aft] #bjba4 7d7 ,set aside ,section #ajjc7;j7 ( ! #ba/ ,c5tury ,cures ,act 7#db ,u4,s4,c4 #bij;ee-#c note71 z r$esignat$1 is am5d$-- 7#a7 by /rik+ 1 & up to & ins]t+ 1 up to2 & 7#b7 by ins]t+ be=e ! p]iod at ! end 1 & #a p]c5t ( su* am\nt = su* fiscal ye> %all be made available to c>ry out subsection 7b77#b77;,e74 ,,vii ,address+ high-impact m9ority diseases ,a ,canc] #gjja4 ,lung canc] mortality r$uction 7a7 ,f9d+s ,congress makes ! foll[+ f9d+s3 7#a7 ,lung canc] is ! lead+ cause ( canc] dea? = bo? m5 & wom51 acc\nt+ = #be p]c5t ( all canc] dea?s4 7#b7 ,s9ce ! ,national ,canc] ,act ( #aiga 7,public ,law #ib-bah2 #he ,/at4 #ggh71 coord9at$ & 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#c7 ,! #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#d7 ,sixty p]c5t ( lung canc] cases are n[ diagnos$ 9 nonsmok]s or =m] smok]s4 7#e7 ,two-?irds ( nonsmok]s diagnos$ ) lung canc] are wom54 7#f7 ,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#g7 ,memb]s ( ! ,baby ,boom] ,g5]ation are ent]+ _! #fjs1 ! mo/ common age at :i* p develop lung canc]4 7#h7 ,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#i7 ,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#aj7 ,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#aa7 ,additional /rategies are necess>y to fur!r enhance ! exi/+ te/s & !rapies available to diagnose & treat lung canc] 9 ! future4 7#ab7 ,! ,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#ac7 ,! ,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#ad7 ,! ,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$uce ! lung canc] mortality rate by #ej p]c5t by #bjbc & t>get$ fund+ to support ?is coord9at$ ef=t4 7b7 ,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$uce lung canc] mortality4 7c7 ,lung ,canc] ,mortality ,r$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$uction ,program 7a7 ,9 ,g5]al ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb1 ! ,secret>y1 9 consultation ) ! ,secret>y ( ,def5se1 ! ,secret>y ( ,vet]ans ,affairs1 ! ,director ( ! ,national ,in/itutes ( ,heal?1 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 ! ,commission] ( ,food & ,drugs1 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 ! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities1 ! ,adm9i/rator ( ! ,environm5tal ,protection ,ag5cy1 & o!r memb]s ( ! ,lung ,canc] ,advisory ,bo>d e/abli%$ "u section #gjja ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb1 %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 #bjbg4 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 specifi$ 9 subsection 7a72 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$ispositions to lung canc]1 ! int]relation%ip betwe5 lung canc] & o!r pulmon>y & c>diac disease1 & ! diagnosis & treatm5t ( su* diseases2 7,c7 ! provision ( funds to enable ! ,national ,in/itute ( ,biom$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 program2 & 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 condition 7z def9$ 9 section #ebf74 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 #gjja ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb %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 7d7 ,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 ,affairs1 z ! case may be1 ( an e>ly detection & disease managem5t rese>* program = memb]s ( ! ,arm$ ,=ces & vet]ans ^: smok+ hi/ory & exposure to c>c9og5s dur+ s]vice on active duty 9 ! ,arm$ ,=ces has increas$ _! risk = lung canc]2 & 7#b7 9 ! implem5tation ( coord9at$ c>e programs = memb]s ( ! ,arm$ ,=ces & vet]ans diagnos$ ) lung canc]4 7e7 ,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 compos$ (-- 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 7f7 ,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> #bjbc & su* sums z may be necess>y = ea* ( fiscal ye>s #bjbd ?r\gh #bjbf4 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> #bjbc1 & su* sums z may be necess>y = ea* ( fiscal ye>s #bjbd ?r\gh #bjbf1 = ! activities describ$ 9 section #dag;,h7b77#a77;,b7 ( ! ,public ,heal? ,s]vice ,act1 z add$ by subsection 7d72 7,b7 #be1jjj1jjj = fiscal ye> #bjbc1 & su* sums z may be necess>y = ea* ( fiscal ye>s #bjbd ?r\gh #bjbf1 = ! activities describ$ 9 section #dag;,h7b77#a77;,c7 ( ! ,public ,heal? ,s]vice ,act2 7,c7 #aj1jjj1jjj = fiscal ye> #bjbc1 & su* sums z may be necess>y = ea* ( fiscal ye>s #bjbd ?r\gh #bjbf1 = ! activities describ$ 9 section #dag;,h7b77#a77;,d7 ( ! ,public ,heal? ,s]vice ,act2 & 7,d7 #ae1jjj1jjj = fiscal ye> #bjbc1 & su* sums z may be necess>y = ea* ( fiscal ye>s #bjbd ?r\gh #bjbf1 = ! activities describ$ 9 section #dag;,h7b77#c7 ( ! ,public ,heal? ,s]vice ,act4 #gjjb4 ,expansion ( pro/ate canc] rese>*1 outrea*1 scre5+1 te/+1 access1 & treatm5t effectiv5ess 7a7 ,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 7b7 ,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* mat]ials are updat$2 & 7,f7 n lat] ?an two ye>s aft] ! date ( ! e/abli%m5t ( ! ,pro/ate ,canc] ,task ,=ce1 submit to ! exp]t advisory panels appo9t$ "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 on 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$ 91 & support$ ?r\gh1 ?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 ! recomm5dations specifi$ 9 clauses 7i7 ?r\gh 7vi72 & 7viii7 ) respect to ! level ( fund+ ne$$ by ea* ag5cy to implem5t su* recomm5dations4 7#c7 ,memb]s ( ! ,pro/ate ,canc] ,task ,=ce ,! ,pro/ate ,canc] ,task ,=ce %all be compos$ ( repres5tatives f su* ,f$]al ag5cies 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 ( ea* ( ! 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-- 7,a7 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!rs2 & 7,b7 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 7c7 ,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 a 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 su* program4 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 = ! treatm5t ( pro/ate canc] to pati5ts4 7d7 ,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% f\r-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 & facilities adm9i/]$ by an ,urban ,indian organization 7z def9$ 9 section #d ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afjc77 pursuant to title ,v ( t ,act 7#be ,u4,s4,c4 #afea et seq471 & ^? 9 rural areas4 7#c7 ,evaluation ,! ,secret>ies %all1 ?r\gh ! pilot projects e/abli%$ "u ?is subsection1 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 "o 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 7e7 ,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 7b7 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 7f7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section = ! p]iod ( fiscal ye>s #bjbc ?r\gh #bjbg 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 #gjjc4 ,pro/ate rese>*1 imag+1 & m5's education 7a7 ,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 ,national ,canc] ,in/itute /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 7b7 ,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 subsection1 #ajj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 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 us$ to c>ry out ! grant program "u p>agraph 7#b72 & 7ii7 no m ?an #a p]c5t may be us$ to c>ry out p>agraph 7#d74 7c7 ,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 subsection #aj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 7d7 ,improv+ pro/ate canc] scre5+ blood te/s 7#a7 ,9 ,g5]al ,! ,secret>y1 9 coord9ation ) ! ,secret>y ( ,def5se1 %all support 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 subsection1 #bj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 7e7 ,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 #gjjd4 ,pro/ate canc] detection rese>* & education 7a7 ,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 compos$ ( ! 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 ( ! ,director ( ! ,national ,in/itutes ( ,heal?4 7,,ix7 ,a designee ( ! ,commission] ( ,food & ,drugs4 7,x7 ,a designee ( ! ,director ( ! ,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 #bjbf4 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 #bjbc ?r\gh #bjbg to c>ry out ?is subsection4 7b7 ,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 7a77#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 #bjbd ?r\gh #bjbh to c>ry out ?is subsection4 #gjje4 ,national ,pro/ate ,canc] ,c\ncil 7a7 ,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 ! ,secret>y's designee & compos$ ( ! 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 #bjbg4 #gjjf4 ,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> #bjbc1 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 #bjbc4 #gjjg4 ,canc] prev5tion & treatm5t demon/ration = e?nic & racial m9orities 7a7 ,demon/ration 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to 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 & colorectal 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* ( ! #e 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 #gjjh4 ,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 ,b ,viral ,hepatitis & ,liv] ,canc] ,control & ,prev5tion #gjea4 ,viral hepatitis & liv] canc] control & prev5tion 7a7 ,%ort title ,?is section may be cit$ z ! ,viral ,hepatitis & ,liv] ,canc] ,control & ,prev5tion ,act ( #bjbb4 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 ,! ,c5t]s = ,disease ,control & ,prev5tion 7ref]r$ to 9 ?is section z ! ,,cdc71 has recogniz$ ,,hcv z ! ,nation's mo/ common *ronic bloodborne virus infection & ,,hbv z ! deadlie/ vacc9e-prev5table disease4 7#c7 ,,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#d7 ,9 ! ,unit$ ,/ates1 *ronic ,,hbv & ,,hcv are ! mo/ common causes ( liv] canc]1 ! second deadlie/ & fa/e/ gr[+ canc] 9 ?is c\ntry4 ,^! viruses are ! mo/ common cause ( *ronic liv] disease1 liv] cirrhosis1 & ! mo/ common indications = liv] transplantation4 ,9 #bjai1 ne>ly #af1jjj dea?s p] ye> 9 ! ,unit$ ,/ates 7 attribut$ to *ronic ,,hbv & ,,hcv4 ,*ronic ,,hcv is also a lead+ cause ( dea? 9 ,am]icans liv+ ) ,,hiv_/,,aids1 _m ( ^? liv+ ) ,,hiv_/,,aids are co9fect$ ) *ronic ,,hbv1 *ronic ,,hcv1 or bo?4 7#e7 ,! ,,cdc e/imates t 9 #bjai1 #eg1ejj p 9 ! ,unit$ ,/ates 7 newly infect$ ) ,,hcv & #bj1gjj 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 ,! ,,cdc report$ a #cgd p]c5t increase 9 hepatitis ,c cases f #bjaj to #bjag1 /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#g7 ,,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#h7 ,liv] canc] is a lead+ cause ( canc] dea? among ! ,asian ,am]ican & ,pacific ,isl&] community4 ,asian & ,pacific ,isl&] m5 & wom5 are m ?an twice z likely to develop liv] canc] comp>$ to ! non-,hispanic ,:ite population4 ,! high] incid5ce rate ( liv] canc] is p>tially expla9$ by high] incid5ce rates ( hepatitis ,b & diabetes1 :i* are comorbidities %[n to increase an individual's risk ( develop+ liv] canc]4 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 ,= ^? *ronically infect$ ) ,,hbv or ,,hcv1 regul> monitor+ c lead to ! e>ly detection ( liv] canc] at a /age :]e a treatm5t is /ill possible4 7#aj7 ,= 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#aa7 ,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#ab7 ,! 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/ ( ,,hbv1 be=e ! availability ( mo/ curr5t !rapies1 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]1 & 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#ac7 ,9 #bjba1 ! ,dep>tm5t ( ,heal? & ,human ,s]vices releas$ its ,viral ,hepatitis ,national ,/rategic ,plan3 ,a ,roadmap = ,elim9ation = ! ,unit$ ,/ates1 #bjba-bjbe 7ref]r$ to 9 ?is section z ! ,,hhs ,/rategic ,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#ad7 ,accord+ to ! ,,nas report1 *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#ae7 ,scre5+ & te/+ = ,,hbv & ,,hcv is align$ ) ! goals ( ,heal?y ,p #bjcj to increase immunization rates1 r$uce rates ( infecti\s diseases1 & improve heal? = p ) *ronic infections4 ,aw>5ess ( disease & access to prev5tion & treatm5t rema9 ess5tial compon5ts = r$uc+ infecti\s disease transmission4 7#af7 ,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#ag7 ,! ,secret>y ( ,heal? & ,human ,s]vices has ! discretion to c>ry out ?is section 7includ+ ! am5dm5ts made by ?is section7 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 seq47 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 ,v ! foll[+3 ,w ,bi5nial assessm5t ( ,,hhs ,hepatitis ,b & ,hepatitis ,c prev5tion1 education1 rese>*1 & m$ical managem5t plan #cii,,oo4 ,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 subsection 7a74 ,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,,oo-#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,,oo7a71 %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-- 7,a7 ! value ( hepatitis ,a & hepatitis ,b immunization2 7,b7 risk factors1 transmission1 & prev5tion ( hepatitis ,b & hepatitis ,c2 7,c7 ! value ( scre5+ = ! e>ly detection ( hepatitis ,b & hepatitis ,c2 & 7,d7 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 p *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+ hepatitis ,b vacc9ation = infants1 *ildr51 & adults2 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$4 #cii,,oo-#b4 ,grants 7a7 ,9 g5]al ,! ,secret>y may aw>d grants to1 or ent] into contracts or coop]ative agreem5ts )1 ,/ates1 political subdivisions ( ,/ates1 t]ritories1 ,indian ,tribes1 or nonpr(it entities t h special exp]tise relat+ to hepatitis ,b1 hepatitis ,c1 or bo?1 to c>ry out activities "u ?is "p4 7b7 ,application ,to be eligible = a grant1 contract1 or coop]ative agreem5t "u subsection 7a71 an entity %all prep>e & submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 #cii,,oo-#c4 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is "p #ij1jjj1jjj = fiscal ye> #bjbc1 #aaj1jjj1jjj = fiscal ye> #bjbd1 #acj1jjj1jjj = fiscal ye> #bjbe1 & #aej1jjj1jjj = fiscal ye> #bjbf4 4 #gjeb4 ,liv] canc] & disease prev5tion1 aw>5ess1 & pati5t track+ grants ,subp>t ,i ( "p ,d ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;b et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #ccj,q4 ,liv] canc] & disease prev5tion1 aw>5ess1 & pati5t track+ grants 7a7 ,prev5tion initiative grant program 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 may aw>d grants & ent] into coop]ative agreem5ts ) entities = ! purpose ( exp&+ & support+-- 7,a7 prev5tion activities 7includ+ provid+ scre5+s1 vacc9ations1 or o!r prev5tative int]v5tions7 = conditions kn[n to increase an individual's risk ( develop+ a major liv] disease1 su* z liv] canc]1 hepatitis ,b1 hepatitis ,c1 nonalcoholic fatty liv] disease1 nonalcoholic /eatohepatitis1 & cirrhosis ( ! liv]2 7,b7 activities relat+ to detection & provision ( guidance = individuals at high risk = contract+ liv] canc] & o!r liv] diseases2 & 7,c7 viral hepatitis surveillance to provide = timely & accurate in=mation reg>d+ progress to elim9ate viral hepatitis4 7#b7 ,report ,an entity t receives a grant or coop]ative agreem5t "u p>agraph 7#a7 %all submit to ! ,secret>y1 at a "t specifi$ by ! ,secret>y1 a report describ+ ea* activity c>ri$ out pursuant to su* p>agraph & evaluat+ ! effectiv5ess ( su* activity 9 promot+ prev5tion & treatm5t ( liv] canc] & o!r liv] diseases4 7#c7 ,au?orization ( appropriations ,= purposes ( c>ry+ out ?is subsection1 !re is au?oriz$ to be appropriat$ #ij1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 7b7 ,aw>5ess initiative grant program 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 may aw>d grants to eligible entities = ! purpose ( rais+ aw>5ess = liv] canc] & o!r liv] diseases1 :i* may include ! production1 dissem9ation1 & di/ribution ( in=mational mat]ials t>get$ t[>ds communities & populations ) a high] risk = develop+ liv] canc] & o!r liv] diseases4 7#b7 ,eligible entities ,to be eligible to receive a grant "u p>agraph 7#a71 an entity %all submit to ! ,secret>y an application1 at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require1 includ+ a description ( h[ ! entity1 9 dissem9at+ in=mation on liv] canc] & o!r liv] diseases pursuant to p>agraph 7#a71 w-- 7,a7 ) respect to any community or population1 consult ) memb]s ( su* community or population & provide su* in=mation 9 a mann] t is culturally & l+ui/ically appropriate = su* community or population2 7,b7 highlight ! range ( prev5tative measures & treatm5ts available = liv] canc] & o!r liv] diseases2 7,c7 integrate in=mation on available hepatitis ,b & hepatitis ,c te/+ programs into any liv] canc] pres5tations c>ri$ out by ! entity2 & 7,d7 address communities & populations ) a high] risk = contract+ liv] canc] & o!r liv] diseases4 7#c7 ,pref]5ce ,9 aw>d+ grants "u p>agraph 7#a71 ! ,secret>y %all give pref]5ce to entities t-- 7,a7 "w ) a ,f$]ally qualifi$ heal? c5t]2 7,b7 are community-bas$ organizations2 or 7,c7 s]ve communities & populations ) a high] risk = contract+ liv] canc] & o!r liv] diseases4 7#d7 ,report ,an entity t receives a grant "u p>agraph 7#a7 %all submit to ! ,secret>y1 at a "t specifi$ by ! ,secret>y1 a report describ+ ea* activity c>ri$ out pursuant to su* p>agraph & evaluat+ ! effectiv5ess ( su* activity 9 rais+ aw>5ess = liv] canc] & o!r liv] diseases4 7#e7 ,au?orization ( appropriations ,= purposes ( c>ry+ out ?is subsection1 !re is au?oriz$ to be appropriat$ #aj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 4 ,c ,acquir$ ,bone ,m>r[ ,failure ,diseases #gaja4 ,acquir$ bone m>r[ failure diseases 7a7 ,%ort title ,?is section may be cit$ z ! ,bone ,m>r[ ,failure ,disease ,rese>* & ,treatm5t ,act4 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,v1 z add$ by section #ajji1 ! 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 #bjbc ?r\gh #bjbg4 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 ( ,heal? & ,human ,s]vices 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 subsection #a1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 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 subsection %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 #bjbc ?r\gh #bjbg 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 subsection #b1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 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 #gaea4 ,guidel9es = disease scre5+ = m9ority pati5ts 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y71 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 diseases1 includ+ lupus2 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 #bjbc ?r\gh #bjbg4 #gaeb4 ,,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> #bjbc1 #be1cjj1jjj = fiscal ye> #bjbd1 #bg1hjj1jjj = fiscal ye> #bjbe1 #cj1hjj1jjj = fiscal ye> #bjbf1 & #cd1jjj1jjj = fiscal ye> #bjbg44 #gaec4 ,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 #ebja7;a77#f71 is am5d$ by add+ at ! end ! foll[+3 #cii,v-#i4 ,report on c>diovascul> c>e = wom5 & m9orities ,n lat] ?an ,septemb] #cj1 #bjbc1 & 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 #gaed4 ,cov]age ( compreh5sive tobacco cessation s]vices 9 ,m$icaid1 ,,*ip1 & private heal? insurance 7a7 ,requir+ ,m$icaid cov]age ( c\nsel+ & ph>maco!rapy = cessation ( tobacco use & tempor>y enhanc$ ,,fmap = cov]age ( tobacco cessation s]vices ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is am5d$-- 7#a7 by am5d+ subsection 7a77#d77;,d7 to read z foll[s3 7,d7 c\nsel+ & ph>maco!rapy = cessation ( tobacco use by individuals :o are eligible "u ! ,/ate plan 7z def9$ 9 subsection 7bb772 & 2 7#b7 9 subsection 7b71 by ins]t+ 7bb77#b71 aft] 7aa712 & 7#c7 by /rik+ subsection 7bb7 & ins]t+ ! foll[+3 7bb7 ,c\nsel+ & ph>maco!rapy = cessation ( tobacco use 7#a7 ,9 g5]al ,= purposes ( ?is title1 ! t]m c\nsel+ & ph>maco!rapy = cessation ( tobacco use by individuals :o are eligible "u ! ,/ate plan means diagno/ic1 !rapy1 & c\nsel+ s]vices & ph>maco!rapy 7includ+ ! cov]age ( prescription & nonprescription tobacco cessation ag5ts approv$ by ! ,food & ,drug ,adm9i/ration7 = ! cessation ( tobacco use by individuals :o use tobacco products or :o are be+ treat$ = tobacco use t is furni%$-- 7,a7 by or "u ! sup]vision ( a physician2 or 7,b7 by any o!r heal? c>e pr(essional :o-- 7i7 is legally au?oriz$ to furni% su* s]vices "u ,/ate law 7or ! ,/ate regulatory me*anism provid$ by ,/ate law7 ( ! ,/ate 9 :i* ! s]vices are furni%$2 & 7ii7 is au?oriz$ to receive paym5t = o!r s]vices "u ?is title or is designat$ by ! ,secret>y = ?is purpose2 :i* is recomm5d$ 9 ! guidel9e entitl$1 ,treat+ ,tobacco ,use & ,dep5d5ce3 #bjjh ,update3 ,a ,cl9ical ,practice ,guidel9e publi%$ by ! ,public ,heal? ,s]vice 9 ,may #bjjh 7or any subsequ5t modification ( su* guidel9e7 or is recomm5d$ = ! cessation ( tobacco use by ! ,unit$ ,/ates ,prev5tive ,s]vices ,task ,=ce or any additional int]v5tion approv$ by ! ,food & ,drug ,adm9i/ration z safe & effective 9 help+ smok]s quit4 7#b7 ,tempor>y enhanc$ ,,fmap = cov]age ( tobacco cessation s]vices ,not)/&+ subsection 7b71 = cal5d> qu>t]s occurr+ dur+ ! p]iod beg9n+ on ! date ( ! enactm5t ( ?is p>agraph & end+ #b ye>s aft] ! la/ day ( ! em]g5cy p]iod describ$ 9 section #aace7;g77#a77;,b71 ! ,f$]al m$ical assi/ance p]c5tage ) respect to am\nts exp5d$ by a ,/ate = m$ical assi/ance = c\nsel+ & ph>maco!rapy = cessation ( tobacco use by individuals :o are eligible "u ! ,/ate plan 7z def9$ 9 p>agraph 7#a77 %all be equal to #ajj p]c5t4 4 7b7 ,no co/ %>+ 7#a7 ,9 g5]al ,subsections 7a77#b7 & 7b77#b7 ( section #aiaf ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifo71 z am5d$ by section #bjjg7;d77#d71 are ea* am5d$-- 7,a7 9 subp>agraph 7,b71 by /rik+ 1 & c\nsel+ & all t foll[s ?r\gh section #aije7;bb77#b77;,a72 7,b7 9 subp>agraph 7,i71 by /rik+ or aft] ! comma2 7,c7 9 subp>agraph 7,j71 by /rik+ 2 & & ins]t+ 1 or2 & 7,d7 by add+ at ! end ! foll[+ new subp>agraph3 7,k7 c\nsel+ & ph>maco!rapy = cessation ( tobacco use by individuals :o are eligible "u ! ,/ate plan 7z def9$ 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+ tobacco cessation 9 accordance ) ! guidel9e specifi$ 9 section #aije7;bb72 & 4 7#b7 ,application to alt]native co/ %>+ ,section #aiaf;,a7b77#c77;,b7 ( ! ,social ,security ,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[+ new clause3 7xiv7 ,c\nsel+ & ph>maco!rapy = cessation ( tobacco use by individuals :o are eligible "u ! ,/ate plan 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+ tobacco cessation 9 accordance ) ! guidel9e specifi$ 9 section #aije7;bb74 4 7c7 ,exception f optional re/riction "u ,m$icaid prescription drug cov]age ,section #aibg7;d77#b77;,f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7;d77#b77;,f77 is am5d$ to read z foll[s3 7,f7 ,nonprescription drugs1 except1 :5 recomm5d$ 9 accordance ) ! guidel9e ref]r$ to 9 section #aije7;bb71 ag5ts approv$ by ! ,food & ,drug ,adm9i/ration "u ! ov]-!-c\nt] monograph process = purposes ( promot+ tobacco cessation4 4 7d7 ,/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 #dbea7;d77#c77;,a71 is am5d$-- 7#a7 9 p>agraph 7#hg71 by /rik+ & at ! end2 7#b7 9 p>agraph 7#hh71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7#c7 by ins]t+ aft] p>agraph 7#h7 ! foll[+ new p>agraph3 7#hi7 provide = ! ,/ate to monitor & promote ! use ( compreh5sive tobacco cessation s]vices "u ! ,/ate plan 7includ+ conduct+ an outrea* campaign to increase aw>5ess ( ! b5efits ( us+ su* s]vices7 among-- 7,a7 individuals entitl$ 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$ical assi/ance "u ! ,/ate plan4 4 7e7 ,f$]al reimbursem5t = outrea* campaign ,section #aijc7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77 is am5d$-- 7#a7 9 p>agraph 7#f77;,b71 by /rik+ plus at ! end2 7#b7 9 p>agraph 7#g71 by /rik+ ! p]iod at ! end & ins]t+ 2 plus2 & 7#c7 by ins]t+ aft] p>agraph 7#g7 ! foll[+ new p>agraph3 7#h7 ) respect to ! developm5t1 implem5tation1 & evaluation ( an outrea* campaign to-- 7,a7 increase aw>5ess ( compreh5sive tobacco cessation s]vices cov]$ 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]vices2 = cal5d> qu>t]s occurr+ dur+ ! p]iod beg9n+ on ! date ( ! enactm5t ( ?is p>agraph & end+ on #b ye>s aft] ! la/ day ( ! em]g5cy p]iod describ$ 9 section #aace7;g77#a77;,b71 an am\nt equal to #ajj p]c5t ( ! sums exp5d$ dur+ ea* qu>t] :i* are attributable to su* developm5t1 implem5tation1 & evaluation1 & = cal5d> qu>t]s succe$+ su* p]iod1 an am\nt equal to ,f$]al m$ical assi/ance p]c5tage det]m9$ "u section #aije7;b7 ( ! sums exp5d$ dur+ ea* qu>t] :i* are s attributable4 4 7f7 ,no prior au?orization = tobacco cessation drugs "u ,m$icaid ,section #aibg7;d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7;d77 is am5d$-- 7#a7 9 p>agraph 7#a77;,a71 by /rik+ ,a ,/ate & ins]t+ ,subject to p>agraph 7#h71 a ,/ate2 & 7#b7 by add+ at ! end ! foll[+ new p>agraph3 7#h7 ,no prior au?orization programs = tobacco cessation drugs ,a ,/ate plan may n require1 z a condition ( cov]age or paym5t = a cov]$ outpati5t drug1 ! approval ( an ag5t to promote smok+ cessation 7includ+ ag5ts approv$ by ! ,food & ,drug ,adm9i/ration7 or tobacco cessation4 4 7g7 ,exclusion ( enhanc$ paym5ts f t]ritorial caps ,not)/&+ any o!r provision ( law1 = purposes ( section #aajh ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acjh71 ) respect to any additional am\nt paid to a t]ritory z a result ( ! application ( section #aije7;bb77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7bb77#b77-- 7#a7 ! limitation on paym5ts to t]ritories "u subsections 7f7 & 7g7 ( su* section #aajh %all n apply to su* additional am\nts2 & 7#b7 su* additional am\nts %all be disreg>d$ 9 apply+ su* subsections4 7h7 ,requir+ ,,*ip cov]age ( c\nsel+ & ph>maco!rapy = cessation ( tobacco use 7#a7 ,9 g5]al ,section #bajc7;c77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7c77#b77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,d7 ,c\nsel+ & ph>maco!rapy = cessation ( tobacco use by individuals :o are eligible "u ! ,/ate *ild heal? plan4 4 7#b7 ,c\nsel+ & ph>maco!rapy = cessation ( tobacco use def9$ ,section #baaj7;c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;jj7c77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#aj7 ,c\nsel+ & ph>maco!rapy = cessation ( tobacco use ,! t]m c\nsel+ & ph>maco!rapy = cessation ( tobacco use means diagno/ic1 !rapy1 & c\nsel+ s]vices & ph>maco!rapy 7includ+ ! cov]age ( prescription & nonprescription tobacco cessation ag5ts approv$ by ! ,food & ,drug ,adm9i/ration7 = ! cessation ( tobacco use by individuals :o use tobacco products or :o are be+ treat$ = tobacco use t are furni%$-- 7,a7 by or "u ! sup]vision ( a physician2 or 7,b7 by any o!r heal? c>e pr(essional :o-- 7i7 is legally au?oriz$ to furni% su* s]vices "u ,/ate law 7or ! ,/ate regulatory me*anism provid$ by ,/ate law7 ( ! ,/ate 9 :i* ! s]vices are furni%$2 & 7ii7 is au?oriz$ to receive paym5t = o!r s]vices "u ?is title or is designat$ by ! ,secret>y = ?is purpose2 :i* is recomm5d$ 9 ! guidel9e entitl$1 ,treat+ ,tobacco ,use & ,dep5d5ce3 #bjjh ,update3 ,a ,cl9ical ,practice ,guidel9e publi%$ by ! ,public ,heal? ,s]vice 9 ,may #bjjh 7or any subsequ5t modification ( su* guidel9e7 or is recomm5d$ = ! cessation ( tobacco use by ! ,unit$ ,/ates ,prev5tive ,s]vices ,task ,=ce or any additional int]v5tion approv$ by ! ,food & ,drug ,adm9i/ration z safe & effective 9 help+ smok]s quit4 4 7i7 ,no co/ %>+ ,section #bajc7;e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7e77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#e7 ,no co/ %>+ on b5efits = c\nsel+ & ph>maco!rapy = cessation ( tobacco use ,! ,/ate *ild heal? plan may n impose d$uctibles1 co9surance1 or o!r co/ %>+ ) respect to b5efits = c\nsel+ & ph>maco!rapy = cessation ( tobacco use 7z def9$ 9 section #baaj7;c77#aj77 & prescription drugs t are cov]$ "u a ,/ate *ild heal? plan t are prescrib$ = purposes ( promot+ tobacco cessation 9 accordance ) ! guidel9e specifi$ 9 section #baaj7;c77#aj77;,b74 4 7j7 ,exception f optional re/riction "u ,,*ip prescription drug cov]age ,section #bajc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7g7 ,exception f optional re/riction "u ,,*ip prescription drug cov]age ,! ,/ate *ild heal? plan may exclude or o!rwise re/rict nonprescription drugs1 except1 9 ! case (-- 7#a7 pregnant wom5 :5 recomm5d$ 9 accordance ) ! guidel9e specifi$ 9 section #baaj7;c77#aj77;,b71 ag5ts approv$ by ! ,food & ,drug ,adm9i/ration "u ! ov]-!-c\nt] monograph process = purposes ( promot+ tobacco cessation2 & 7#b7 individuals :o are eligible "u ! ,/ate *ild heal? plan :5 recomm5d$ 9 accordance ) ! ,guidel9e ref]r$ to 9 section #baaj7;c77#aj77;,b71 ag5ts approv$ by ! ,food & ,drug ,adm9i/ration "u ! ov]-!-c\nt] monograph process = purposes ( promot+ tobacco cessation4 4 7k7 ,/ate monitor+ & promot+ ( compreh5sive tobacco cessation s]vices "u ,,*ip ,section #bajb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;bb7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7d7 ,/ate monitor+ & promot+ ( compreh5sive tobacco cessation s]vices "u ,,*ip ,a ,/ate *ild heal? plan %all include a description ( ! proc$ures to be us$ by ! ,/ate to monitor & promote ! use ( compreh5sive tobacco cessation s]vices "u ! ,/ate plan 7includ+ conduct+ an outrea* campaign to increase aw>5ess ( ! b5efits ( us+ su* s]vices7 among-- 7#a7 individuals entitl$ to m$ical assi/ance "u ! ,/ate *ild heal? plan :o use tobacco products2 & 7#b7 cl9icians & o!rs :o provide s]vices to individuals entitl$ to m$ical assi/ance "u ! ,/ate *ild heal? plan4 4 7l7 ,f$]al reimbursem5t = ,,*ip cov]age & outrea* campaign 7#a7 ,9 g5]al ,section #baje7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7a77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#e7 ,f$]al reimbursem5t = ,,*ip cov]age ( compreh5sive tobacco cessation s]vices & outrea* campaign ,9 addition to ! paym5ts made "u p>agraph 7#a7 = cal5d> qu>t]s occurr+ dur+ ! p]iod beg9n+ on ! date ( ! enactm5t ( ?is p>agraph & end+ on #b ye>s aft] ! la/ day ( ! em]g5cy p]iod describ$ 9 section #aace7;g77#a77;,b71 ! ,secret>y %all pay-- 7,a7 an am\nt equal to #ajj p]c5t ( ! sums exp5d$ dur+ ea* qu>t] :i* are attributable to ! co/ ( furni%+ c\nsel+ & ph>maco!rapy = cessation ( tobacco use by individuals :o are eligible "u ! ,/ate *ild heal? plan 7net ( any paym5ts made to ! ,/ate "u p>agraph 7#a7 ) respect to su* c\nsel+ & ph>maco!rapy72 plus 7,b7 an am\nt equal to #ajj p]c5t ( ! sums exp5d$ dur+ ea* qu>t] :i* are attributable to ! developm5t1 implem5tation1 & evaluation ( an outrea* campaign to-- 7i7 increase aw>5ess ( compreh5sive tobacco cessation s]vices cov]$ 9 ! ,/ate *ild heal? plan among-- 7,i7 individuals :o are likely to be eligible = m$ical assi/ance "u ! ,/ate *ild heal? plan2 & 7,,ii7 cl9icians & o!rs :o provide s]vices to individuals :o are likely to be eligible = m$ical assi/ance "u ! ,/ate *ild heal? plan2 & 7ii7 increase aw>5ess ( ! b5efits ( us+ compreh5sive tobacco cessation s]vices cov]$ 9 ! ,/ate *ild heal? plan among-- 7,i7 individuals :o are likely to be eligible = m$ical assi/ance "u ! ,/ate *ild heal? plan2 & 7,,ii7 cl9icians & o!rs :o provide s]vices to individuals :o are likely to be eligible = m$ical assi/ance "u ! ,/ate *ild heal? plan ab\t ! b5efits ( us+ compreh5sive tobacco cessation s]vices4 4 7#b7 ,adju/m5t ( ,,*ip allotm5ts ,section #bajd7m7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7m77 is am5d$-- 7,a7 9 p>agraph 7#b77;,b71 by /rik+ & 7#ab7 & ins]t+ 7#ab71 & 7#ac72 & 7,b7 by add+ at ! end ! foll[+ new p>agraph3 7#ac7 ,adju/+ allotm5ts to acc\nt = ,f$]al paym5ts = ,,*ip cov]age ( compreh5sive tobacco cessation s]vices & outrea* campaign ,if a ,/ate 7includ+ ! ,di/rict ( ,columbia & ea* commonweal? & t]ritory7 receives a paym5t = a fiscal ye> "u section #baje7;a77#e71 ! allotm5t det]m9$ = ! ,/ate = su* fiscal ye> %all be increas$ by ! am\nt ( su* paym5t4 4 7m7 ,no prior au?orization = tobacco cessation drugs "u ,,*ip ,section #bajc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc71 z am5d$ by subsection 7h71 is fur!r am5d$-- 7#a7 9 subsection 7c77#b77;,a71 by ins]t+ 79 accordance ) subsection 7h77 aft] ,cov]age ( prescription drugs2 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7h7 ,no prior au?orization programs = tobacco cessation drugs ,a ,/ate *ild heal? plan may n require1 z a condition ( cov]age or paym5t = prescription drugs1 ! approval ( an ag5t to promote smok+ cessation 7includ+ ag5ts approv$ by ! ,food & ,drug ,adm9i/ration7 or tobacco cessation4 4 7n7 ,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 7o7 ,rule ( con/ruction ,none ( ! am5dm5ts made by ?is section %all be con/ru$ to limit cov]age ( any c\nsel+ or ph>maco!rapy = individuals "u #ah ye>s ( age4 7p7 ,effective date ,! am5dm5ts made by ?is section %all take effect on ! fir/ day ( ! fir/ fiscal ye> t beg9s on or aft] ! date ( enactm5t ( ?is ,act4 #gaee4 ,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 canc] & 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 #gaef4 ,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 9 section #d ( ! ,indian ,self-,det]m9ation & ,education ,assi/ance ,act 7#be ,u4,s4,c4 #ecjd74 #gaeg4 ,/ephanie ,tubbs ,jones ,ut]9e ,fibroid ,rese>* & ,education ,act 7a7 ,rese>* ) respect to ut]9e fibroids 7#a7 ,rese>* ,! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is section z ! ,secret>y7 %all exp&1 int5sify1 & coord9ate programs = ! conduct & support ( rese>* ) respect to ut]9e fibroids4 7#b7 ,adm9i/ration & coord9ation ,! ,secret>y %all c>ry out ! conduct & support ( rese>* pursuant to p>agraph 7#a71 9 coord9ation ) ! appropriate in/itutes1 (fices1 & c5t]s ( ! ,national ,in/itutes ( ,heal? & any o!r relevant ,f$]al ag5cy1 z det]m9$ by ! ,director ( ! ,national ,in/itutes ( ,heal?4 7#c7 ,au?orization ( appropriations ,= ! purpose ( c>ry+ out ?is subsection1 !re are au?oriz$ to be appropriat$ #cj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 7b7 ,rese>* ) respect to ,m$icaid cov]age ( ut]9e fibroids treatm5t 7#a7 ,rese>* ,! ,secret>y 7or ! ,secret>y's designee7 %all e/abli% a rese>* database1 or exp& an exi/+ rese>* database1 to collect data on s]vices furni%$ to individuals diagnos$ ) ut]9e fibroids "u a ,/ate plan 7or a waiv] ( su* a plan7 "u ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 or "u a ,/ate *ild heal? plan 7or a waiv] ( su* a plan7 "u ! ,*ildr5's ,heal? ,insurance ,program "u title ,,xxi ( su* ,act 7#db ,u4,s4,c4 #acig;aa et seq47 = ! treatm5t ( su* fibroids = purposes ( assess+ ! frequ5cy at :i* su* individuals are furni%$ su* s]vices4 7#b7 ,report 7,a7 ,9 g5]al ,n lat] ?an ! date t is two ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all submit to ,congress a report on ! am\nt ( ,f$]al & ,/ate exp5ditures ) respect to s]vices furni%$ = ! treatm5t ( ut]9e fibroids "u ,/ate plans 7or waiv]s ( su* plans7 "u ! ,m$icaid program "u su* title ,,xix & ,/ate *ild heal? plans 7or waiv]s ( su* plans7 "u ! ,*ildr5's ,heal? ,insurance ,program "u su* title ,,xxi4 7,b7 ,coord9ation ,! ,secret>y %all coord9ate ! developm5t & submission ( ! report requir$ "u subp>agraph 7,a7 ) any o!r relevant ,f$]al ag5cy1 z det]m9$ by ! ,secret>y4 7c7 ,education & dissem9ation ( in=mation ) respect to ut]9e fibroids 7#a7 ,ut]9e fibroids public education program ,! ,secret>y %all develop & dissem9ate to ! public in=mation reg>d+ ut]9e fibroids1 includ+ in=mation on-- 7,a7 ! aw>5ess1 incid5ce1 & preval5ce ( ut]9e fibroids among individuals1 includ+ all m9ority individuals2 7,b7 ! elevat$ risk = m9ority individuals to develop ut]9e fibroids2 & 7,c7 ! availability1 z m$ically appropriate1 ( ! range ( treatm5t options = symptomatic ut]9e fibroids1 includ+ non-hy/]ectomy treatm5ts & proc$ures4 7#b7 ,dissem9ation ( in=mation ,! ,secret>y may dissem9ate in=mation "u p>agraph 7#a7 directly or ?r\gh arrangem5ts ) intra-ag5cy initiatives1 nonpr(it organizations1 consum] gr\ps1 in/itutions ( high] education 7z def9$ 9 section #aja ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajja771 or ,f$]al1 ,/ate1 or local public private p>tn]%ips4 7#c7 ,au?orization ( appropriations ,= ! purpose ( c>ry+ out ?is subsection1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 ,e ,,hiv_/,,aids #gbja4 ,/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 tools1 includ+ preexposure prophylaxis1 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 & treatm5ts1 tools1 a cure1 & a vacc9e2 & 7#e7 respect ! human rights & dignity ( p]sons liv+ ) ,,hiv4 #gbjb4 ,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 ,! ,c5t]s = ,disease ,control & ,prev5tion e/imates t1 9 #bjai1 !re 7 approximately #cd1hjj p newly diagnos$ ) ,,hiv4 ,new ,,hiv infections decl9$ #h p]c5t f #cg1hjj 9 #bjae1 aft] a p]iod ( g5]al /ability4 ,f #bjae to #bjai1 new infections among "y gay & bisexual m5 7ages #ac to #bd7 dropp$ #cc p]c5t ov]all1 ) decl9es 9 "y m5 ( all races1 b ,african ,am]icans1 ,hispanics1 & ,lat9os cont9ue to be sev]ely & disproportionately affect$4 7#c7 ,,hiv disproportionately affects c]ta9 populations 9 ! ,unit$ ,/ates4 ,?\gh ,blacks_/,african ,am]icans repres5t approximately #ac p]c5t ( ! population1 !y acc\nt = almo/ half 7#dd p]c5t7 ( all p liv+ ) ,,hiv 9 ! ,unit$ ,/ates4 ,black_/,african-,am]ican m5 :o h sex ) m5 acc\nt = #bf p]c5t ( all new ,,hiv infections & h rema9$ /able f #bjaj to #bjai4 7#d7 ,disp>ities cont9ue to exi/ among ,lat9os & ,hispanics2 9 #bjai1 ,lat9os & ,hispanics made up #ah p]c5t ( ! ,unit$ ,/ates population & #cj p]c5t ( new infections4 7#e7 ,?\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 #bjae to #bjai1 ! annual numb] ( ,,hiv diagnoses increas$ among ,am]ican ,indians & ,alaska ,natives4 7#f7 ,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] ( ,asian ,am]icans receiv+ an ,,hiv diagnosis increas$ by #db p]c5t4 7#g7 ,! late/ data f ! ,c5t]s = ,disease ,control & ,prev5tion indicates t new infections among wom5 rema9$ /able 9 #bjai4 7#h7 ,! 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$ical c>e4 7#i7 ,f #bjae ?r\gh #bjai 9 ! ,unit$ ,/ates & #f dep5d5t areas1 ! numb] ( diagnoses ( ,,hiv infection = transg5d] adults & adolesc5ts increas$4 ,9 #bjai1 among transg5d] adults & adolesc5ts1 ! l>ge/ p]c5tage 7#ic p]c5t7 ( diagnoses ( ,,hiv infections 0 = transg5d] male-to-female 7,,mtf7 p4 ,by age1 9 #bjai1 ! l>ge/ p]c5tage 7#bd p]c5t7 ( diagnoses ( ,,hiv infection among transg5d] p]sons 0 = transg5d] ,,mtf adults & adolesc5ts ag$ #bj to #bd ye>s1 foll[$ by transg5d] ,,mtf adults & adolesc5ts ag$ #be to #bi ye>s 7#bc p]c5t74 7#aj7 ,/igma & discrim9ation contribute to su* disp>ities4 7#aa7 ,! ,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 recomm5ds r\t9e ,,hiv scre5+ 9 heal? c>e sett+s = all pati5ts ag$ #ac to #fd1 reg>dless ( risk4 7#ab7 ,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#ac7 ,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 be a place :]e new ,,hiv infections are prev5t$1 e p]son kn[s _! /atus1 & e p]son ) ,,hiv has high-quality c>e & treatm5t1 lives free f /igma & discrim9ation1 & c a*ieve _! full pot5tial = heal? & well-be+ across _! lifespan4 ,?is vision includes all p1 reg>dless ( age1 sex1 g5d] id5tity1 sexual ori5tation1 race1 e?nicity1 religion1 disability1 geographic location1 or socioeconomic circum/ance44 7#ad7 ,9 ,janu>y #bjai1 ! ,dep>tm5t ( ,heal? & ,human ,s]vices began implem5t+ ! initiative ,end+ ! ,,hiv ,epidemic3 ,a ,plan = ,am]ica4 ,! initiative seeks to r$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$4 7#ae7 ,at pres5t1 _m ,/ates & ,unit$ ,/ates t]ritories h crim9al /atutes bas$ on exposure to ,,hiv4 ,mo/ ( ^! laws 7 adopt$ be=e ! availability ( effective antiretroviral treatm5t = ,,hiv_/,,aids4 7#af7 ,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$ical c>e4 7#ag7 ,due to advances 9 treatm5t1 _m p liv+ ) ,,hiv today are liv+ heal?y lives & h ! ability & desire to fully p>ticipate 9 all aspects ( community life1 includ+ employm5t4 ,rese>* associates be+ employ$ ) trem5d\s economic1 social1 & heal? b5efits = _m p liv+ ) ,,hiv4 7#ah7 ,despite ! trem5d\s progress made 9 ! treatm5t & prev5tion ( ,,hiv_/,,aids1 discrim9atory policies /emm+ f cont9u$ /igmatization ( ,,hiv_/,,aids & ! ,,lgbtq community cont9ue to plague ! sci5tific community4 ,?is includes blood donation guidance updat$ by ,food & ,drug ,adm9i/ration 9 #bjbj t recomm5ds a #c-mon? def]ral policy = gay & bisexual m5 be=e !y are eligible to donate blood4 ,heal? ag5cies 9 ! ,unit$ ,/ates mu/ implem5t blood donation policies t are gr\nd$ 9 sci5ce & t d n unfairly s+le out any gr\p ( individuals4 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 #gbjc4 ,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 #bjbc ?r\gh #bjbf4 4 #gbjd4 ,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 program "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 ! ,m$ic>e program "u title ,,xviii ( su* ,act 7#db ,u4,s4,c4 #acie et seq471 ! program "u title ,,xxvi ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq42 commonly ref]r$ to z ! ,ryan ,:ite ,,hiv_/,,aids ,program71 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 #bjbc ?r\gh #bjbf4 #gbje4 ,evid5ce-bas$ /rategies = improv+ l9kage to1 & ret5tion 91 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$e disease /atus aw>5ess ) respect to ,,hiv_/,,aids & l9kage to1 & ret5tion 91 appropriate c>e1 tak+ into consid]ation heal? c>e sy/ems issues1 cl9ic & provid] issues1 & individual psy*osocial1 environm5tal1 & o!r contextual factors2 7#b7 support ! wide-scale implem5tation ( ! evid5ce-bas$ /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 ,ex*ange e/abli%$ "u title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh72 & 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 #bjbc ?r\gh #bjbf4 #gbjf4 ,improv+ entry into1 & ret5tion 91 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 ( individuals f receiv+ new diagnoses ( ,,hiv2 & 7#c7 _h broad b5efits t ext5d f> beyond help+ p at risk =1 or liv+ )1 ,,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 #bjbc ?r\gh #bjbf4 #gbjg4 ,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/+ activities2 & 7#d7 public heal? education campaigns on access+ ,,hiv prev5tion m$ication4 7b7 ,au?orization ( appropriations ,to c>ry out ?is section1 !re are au?oriz$ to be appropriat$ su* sums z may be necess>y = fiscal ye>s #bjbc ?r\gh #bjbf4 #gbjh4 ,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/em2 7#g7 transg5d] individuals2 & 7#h7 nonb9>y individuals4 7d7 ,au?orization ( appropriations ,= c>ry+ out ?is section1 !re are au?oriz$ to be appropriat$ #faj1jjj1jjj = fiscal ye> #bjbc & su* sums z may be necess>y = ea* ( fiscal ye>s #bjbd ?r\gh #bjbg4 #gbji4 ,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$ical provid] c>e team models t promote high-quality c>e1 ) p>ticul> emphasis on c>e to racial & e?nic m9orities4 7#g7 ,tra9+ heal? c>e pr(essionals to make !m aw>e ( ! high rates ( *ronic hepatitis ,b & *ronic hepatitis ,c 9 adult racial & e?nic m9ority populations1 & ! importance ( prev5tion1 detection1 & m$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 #bjbc ?r\gh #bjbf4 #gbaj4 ,,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 repaym5ts provid$ ?r\gh ! program4 7#c7 ,! placem5t location ( loan repaym5t recipi5ts at facilities describ$ 9 subsection 7a77#a74 7#d7 ,! default rate on su* loans & actions requir$4 7#e7 ,! am\nt ( out/&+ default funds ) respect to su* loans4 7#f7 ,to ! ext5t t x c be det]m9$1 ! reason = ! default on su* a loan4 7#g7 ,! demographics ( individuals p>ticipat+ 9 ! program4 7#h7 ,an evaluation ( ! ov]all co/s & b5efits ( ! program4 7e7 ,def9itions ,9 ?is section3 7#a7 ,,hiv_/,,aids ,! t]m ,,hiv_/,,aids means human immunodefici5cy virus & acquir$ 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$ic9e1 s*ool ( nurs+1 or physician assi/ant tra9+ program2 & 7,b7 includes only ! portion ( ! loan t is out/&+ on ! date ! physician1 nurse practition]1 or physician assi/ant involv$ 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 #bjbc ?r\gh #bjbf4 #gbaa4 ,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 repaym5ts provid$ ?r\gh ! program4 7#c7 ,! placem5t location ( loan repaym5t recipi5ts at facilities describ$ 9 subsection 7a77#a74 7#d7 ,! default rate on su* loans & actions requir$4 7#e7 ,! am\nt ( out/&+ default funds ) respect to su* loans4 7#f7 ,to ! ext5t t x c be det]m9$1 ! reason = ! default on su* a loan4 7#g7 ,! demographics ( individuals p>ticipat+ 9 ! program4 7#h7 ,an evaluation ( ! ov]all co/s & b5efits ( ! program4 7e7 ,def9itions ,9 ?is section3 7#a7 ,d5tal education loan ,! t]m d5tal education loan-- 7,a7 means a loan t is incurr$ = ! 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 #bjbc ?r\gh #bjbf4 #gbab4 ,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 #bjbc ?r\gh #bjbf4 #gbac4 ,report on impact ( ,,hiv_/,,aids 9 vuln]able populations 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices %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$uctions 9 ,,hiv_/,,aids 9 racial & e?nic m9ority communities4 #gbad4 ,national ,,hiv_/,,aids obs]vance days 7a7 ,national obs]vance days ,x is ! s5se ( ,congress t national obs]vance days highlight+ ! impact ( ,,hiv on communities ( color include ! foll[+3 7#a7 ,national ,black ,,hiv_/,,aids ,aw>5ess ,day4 7#b7 ,national ,lat9o ,,aids ,aw>5ess ,day4 7#c7 ,national ,asian & ,pacific ,isl&] ,,hiv_/,,aids ,aw>5ess ,day4 7#d7 ,national ,native ,am]ican ,,hiv_/,,aids ,aw>5ess ,day4 7#e7 ,national ,y\? ,,hiv_/,,aids ,aw>5ess ,day4 7b7 ,call to action ,x is ! s5se ( ,congress t ! ,presid5t %\ld call on memb]s ( communities ( color-- 7#a7 to become involv$ 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 #gbae4 ,review ( all ,f$]al & ,/ate laws1 policies1 & regulations reg>d+ ! crim9al prosecution ( individuals = ,,hiv-relat$ (f5ses 7a7 ,f9d+s ,congress makes ! foll[+ f9d+s3 7#a7 ,at pres5t1 #cb ,/ates & #b ,unit$ ,/ates t]ritories h crim9al /atutes bas$ on p]ceiv$ exposure to ,,hiv1 r ?an behaviors motivat$ by an int5t to h>m1 pres5t+ a significant risk ( transmission & result+ 9 actual transmission ( ,,hiv to ano!r4 #aa ,/ates h ,,hiv-specific laws t make spitt+ or bit+ a felony1 ev5 ?\gh x is n possible to transmit ,,hiv via saliva4 #bd ,/ates require p]sons :o are aw>e t !y h ,,hiv to disclose _! /atus to sexual p>tn]s1 reg>dless ( :e!r !y are non9fecti\s4 #ad ( ^! #bd ,/ates also require disclosure to ne$le-%>+ p>tn]s4 #be ,/ates crim9alize #a or m behaviors t pose a l[ or negligible risk = ,,hiv transmission4 7#b7 ,,hiv-specific crim9al laws are classifi$ z felonies 9 #bh ,/ates4 ,9 #c ,/ates1 a p]son's exposure to ano!r to ,,hiv does n subject ! p]son to crim9al prosecution = t act alone b may result 9 a s5t5ce enhancem5t4 #ah ,/ates impose s5t5ces ( up to #aj ye>s p] violation1 #g ,/ates impose s5t5ces betwe5 #aa & #bj ye>s1 & #e ,/ates impose s5t5ces ( great] ?an #bj ye>s4 7#c7 ,:5 memb]s ( ! ,arm$ ,=ces acquire ,,hiv1 !y are issu$ ord]s t require !m to disclose & use a condom "u all circum/ances1 includ+ :5 ! kn[n risk ( transmission is #j4 ,failure to disclose c result 9 prosecution "u ! ,uni=m ,code ( ,milit>y ,ju/ice 7,,ucmj74 7#d7 ,! numb] ( prosecutions1 arre/s1 & in/ances :]e ,,hiv-bas$ *>ges are us$ to induce plea agreem5ts is unkn[n4 ,because ,/ate-level prosecution & arre/ data are n readily available 9 any national legal database1 ! societal impact ( ^! laws may be und]e/imat$1 & mo/ cases t g to trial are n r$uc$ to writt51 publi%$ op9ions4 7#e7 ,/ate & ,f$]al crim9al law does n curr5tly reflect ! #d decades ( m$ical advances & discov]ies made ) reg>d to transmission & treatm5t ( ,,hiv_/,,aids4 7#f7 ,accord+ to ! ,,cdc1 correct & consi/5t male or female condom use1 or adh]5ce to a preexposure prophylaxis 7,pr,e,p7 regim5 t results 9 viral suppression1 are v effective 9 prev5t+ ,,hiv transmission4 ,h[ev]1 mo/ ,/ate ,,hiv-specific laws & prosecutions d n treat ! use ( a condom dur+ sexual int]c\rse or adh]5ce to ,pr,e,p z a mitigat+ factor or evid5ce t ! def5dant did n int5d to transmit ,,hiv4 7#g7 ,crim9al laws & prosecutions d n take into acc\nt ! b5efits ( effective antiretroviral m$ications1 :i* suppress ! virus to extremely l[ levels & fur!r r$uce ! already l[ risk ( transmitt+ ,,hiv to ne> #j4 7#h7 ,9 addition to ,,hiv-specific crim9al laws1 g5]al crim9al laws are (t5 misus$ to prosecute p bas$ on _! ,,hiv /atus4 ,al?\gh ,,hiv1 & ev5 ,,aids1 curr5tly is view$ z a treatable1 *ronic1 m$ical condition1 p liv+ ) ,,hiv h be5 *>g$ "u aggravat$ assault1 attempt$ murd]1 & ev5 biot]rorism /atutes because prosecutors1 c\rts1 & legislators cont9ue to view & *>act]ize ! blood1 sem51 & saliva ( p liv+ ) ,,hiv z a deadly weapon4 7#i7 ,multiple pe]-review$ /udies demon/rate t ,,hiv-specific laws d n r$uce risk-tak+ behavior or increase disclosure by p liv+ ) or at risk ( ,,hiv1 & !re is increas+ evid5ce t ^! laws r$uce ! will+ness to get te/$4 ,fur!rmore1 plac+ legal responsibility = prev5t+ ! transmission ( ,,hiv & o!r pa?og5s t c be sexually transmitt$ exclusively on p diagnos$ ) a sexually transmitt$ infection und]m9es ! public heal? message t all p are responsible = practic+ behaviors t protect !mselves f ,,hiv & o!r sexually transmitt$ infections4 ,un=tunately1 "s ,/ate laws t create an expectation ( disclosure "w aga9/ public heal? communication & disc\rage risk-r$uction measures t c\ld prev5t transmission z a result ( ^? :o are acutely infect$ & unaw>e ( _! /atus4 7#aj7 ,! id5tity ( an individual subject to an ,,hiv-bas$ prosecution is broadca/ ?r\gh m$ia reports1 pot5tially de/roy+ employm5t opportunities & relation%ips & violat+ ! p]son's "r to privacy4 7#aa7 ,individuals :o are convict$ aft] an ,,hiv-bas$ prosecution (t5 mu/ regi/] z sex (f5d]s1 ev5 9 cases involv+ cons5sual sexual activity4 ,_! employability is de/roy$1 & _! family relation%ips are fractur$4 7#ab7 ,! ,unit$ ,nations1 includ+ ! ,jo9t ,unit$ ,nations ,programme on ,,hiv_/,,aids 7,,unaids71 urges gov]nm5ts to limit crim9alization to cases ( int5tional transmission4 ,?is requirem5t w\ld limit prosecutions to situations :]e a p]son kn[s 8 or h] ,,hiv-positive /atus1 acts ) ! int5tion to transmit ,,hiv1 & does 9 fact transmit x4 ,,unaids also recomm5ds t crim9al law %\ld n be appli$ to cases :]e !re is no significant risk ( transmission4 7#ac7 ,9 #bjaj1 ! ,f$]al ,gov]nm5t releas$ ! fir/ ev] ,national ,,hiv_/,,aids ,/rategy 7,,nhas71 :i* address$ ,,hiv-specific crim9al laws1 /at+3 ,:ile we und]/& ! int5t beh9d ^! laws1 !y may n h ! desir$ effect & !y may make p less will+ to disclose _! /atus by mak+ p feel at ev5 great] risk ( discrim9ation4 ,9 "s cases1 x may be appropriate = legislators to reconsid] :e!r exi/+ laws cont9ue to fur!r ! public int]e/ & public heal?4 ,9 _m in/ances1 ! cont9u$ exi/5ce & en=cem5t ( ^! types ( laws run c\nt] to sci5tific evid5ce ab\t r\tes ( ,,hiv transmission & may und]m9e ! public heal? goals ( promot+ ,,hiv scre5+ & treatm5t44 ,! ,,nhas also /ates t ,/ate legislatures %\ld consid] review+ ,,hiv-specific crim9al /atutes to ensure t !y are consi/5t ) curr5t k ( ,,hiv transmission & support public heal? approa*es to prev5t+ & treat+ ,,hiv4 7#ad7 ,! ,global ,commission on ,,hiv & ! ,law 0 laun*$ 9 ,june #bjaj to exam9e laws & practices t crim9alize p liv+ ) & vuln]able to ,,hiv & to develop evid5ce-bas$ recomm5dations = effective ,,hiv responses4 ,! ,commission calls = gov]nm5ts1 civil society & int]national bodies to repeal punitive laws & enact laws t facilitate & enable effective responses to ,,hiv prev5tion1 c>e & treatm5t s]vices = all :o ne$ !m4 ,! ,commission recomm5ds aga9/ ! enactm5t ( laws t explicitly crim9alize ,,hiv transmission1 exposure or non-disclosure ( ,,hiv /atus1 :i* are c\nt]productive4 7#ae7 ,9 ,febru>y #bjai1 ! ,dep>tm5t ( ,heal? & ,human ,s]vices 7,,hhs7 laun*$ ,end+ ! ,,hiv ,epidemic3 ,a ,plan = ,am]ica1 a new initiative ) an ambiti\s goal to end ! dome/ic ,,hiv epidemic 9 #aj ye>s by r$uc+ new cases ( ,,hiv by #ge p]c5t by #bjbe & by #ij p]c5t by #bjcj4 ,9 ?is plan1 ,,hhs notes t /igma c be a debilitat+ b>ri] prev5t+ p liv+ )1 or at risk =1 ,,hiv f receiv+ ! heal? c>e1 s]vices1 & respect !y ne$ & des]ve4 ,_m ( ! ,/ates & jurisdictions id5tifi$ z a priority = ! fir/ #e ye>s ( ! plan h /igma-bas$ crim9al /atutes = p]ceiv$ exposure to ,,hiv4 ,^! /atutes run c\nt] to ! goals ( ?is new initiative & /& 9 ! way ( end+ ! dome/ic ,,hiv epidemic4 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 ( demon/rat$ ,,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 laws1 policies1 regulations1 & judicial prec$5ts & decisions on public heal?1 on p liv+ ) or affect$ by ,,hiv1 & on _! families & communities4 7c7 ,review ( ,f$]al & ,/ate laws 7#a7 ,review ( ,f$]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 section ref]r$ to z ! designat$ (ficials7 %all initiate a national review ( ,f$]al & ,/ate laws1 includ+ ! ,uni=m ,code ( ,milit>y ,ju/ice 7ref]r$ to 9 ?is section z ! ,,ucmj71 policies1 regulations1 & judicial prec$5ts & decisions reg>d+ crim9al & relat$ civil commitm5t cases involv+ p liv+ ) ,,hiv_/,,aids4 7,b7 ,consultation ,9 c>ry+ out ! review "u subp>agraph 7,a71 ! designat$ (ficials %all seek to include div]se p>ticipation f1 & consultation )1 ea* ( ! foll[+3 7i7 ,ea* ,/ate4 7ii7 ,/ate attorneys g5]al 7or _! repres5tatives74 7iii7 ,/ate public heal? (ficials 7or _! repres5tatives74 7iv7 ,/ate judicial & c\rt sy/em (fic]s1 includ+ judges1 di/rict attorneys1 prosecutors1 def5se attorneys1 law en=cem5t1 & correctional (fic]s4 7v7 ,memb]s ( ! ,unit$ ,/ates ,arm$ ,=ces1 includ+ memb]s ( o!r ,f$]al s]vices subject to ! ,,ucmj4 7vi7 ,p liv+ ) ,,hiv_/,,aids1 p>ticul>ly ^? :o h be5 subject to ,,hiv-relat$ prosecution or :o are f m9ority communities ^: memb]s h be5 disproportionately subject to ,,hiv-specific arre/s & prosecution4 7vii7 ,legal advocacy & ,,hiv_/,,aids s]vice organizations t "w ) p liv+ ) ,,hiv_/,,aids4 7viii7 ,nongov]nm5tal heal? organizations t "w on behalf ( p liv+ ) ,,hiv_/,,aids1 includ+ syr+e s]vices programs1 ,,lgbtq-focus$ heal? organizations1 & organizations :o s]ve p :o engage 9 sex "w4 7ix7 ,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]m9es t su* reviews 7 conduct$ 9 accordance ) ! pr9ciples set =? 9 subsection 7b74 7#b7 ,report ,n lat] ?an #ahj days aft] initiat+ ! review requir$ "u 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 & = ! ,,ucmj1 a summ>y ( ! relevant laws1 policies1 regulations1 & judicial prec$5ts & decisions reg>d+ crim9al cases involv+ p liv+ ) ,,hiv1 includ+ ! 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\tes1 includ+ t a p]son t has an undetectable viral load _c transmit ,,hiv2 7,,iii7 ! curr5t heal? implications ( liv+ ) ,,hiv1 includ+ data disaggregat$ by race & e?nicity2 7,,iv7 ! curr5t /atus ( provid+ protection to p :o engage 9 survival sex "w aga9/ :om condom possession has be5 us$ z evid5ce ( int5t to commit a crime2 7,v7 ,/ates t h ! classification ( m&atory sex (f5d]s2 7,,vi7 ! associat$ b5efits ( treatm5t & support s]vices = p liv+ ) ,,hiv2 & 7,,vii7 ! impact ( punitive ,,hiv-specific laws & policies on public heal?1 on p liv+ ) or affect$ by ,,hiv1 & on _! families & communities1 includ+ p :o are 9 abusive1 dep5d5t1 viol5t1 or noncons5sual relation%ips & are unable to bo? negotiate ! use ( condoms & /atus disclosure4 7iii7 ,an analysis ( ! public heal? & legal implications ( su* laws1 policies1 regulations1 & judicial prec$5ts & decisions1 includ+ an analysis ( ! consequ5ces ( hav+ a simil> p5al s*eme appli$ 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 %>$ betwe5 ,/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$5ts reg>d+ p liv+ ) ,,hiv are 9 accordance ) ! pr9ciples set =? 9 subsection 7b74 7,d7 ,recomm5dations = adju/m5ts to ! ,,ucmj1 includ+ discont9u+ ! use ( a s]vice memb]'s ,,hiv diagnosis z ! basis = prosecution1 enhanc$ p5alties1 or dis*>ge f milit>y s]vice1 9 ord] to ensure t laws1 policies1 regulations1 & judicial prec$5ts reg>d+ p liv+ ) ,,hiv are 9 accordance ) ! pr9ciples set =? 9 subsection 7b74 ,su* recomm5dations %\ld include any necess>y & appropriate *anges to ,ord]s to ,foll[ ,prev5tative ,m$ic9e ,requirem5ts4 7#c7 ,guidance ,n lat] ?an #ij days aft] ! date ( ! release ( ! report requir$ by p>agraph 7#b71 ! ,attorney ,g5]al & ! ,secret>y ( ,heal? & ,human ,s]vices %all jo9tly develop & publicly release updat$ guidance = ,/ates bas$ on ! set ( be/ practice recomm5dations requir$ "u 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 ,n lat] ?an #fj days aft] ! date ( ! release ( ! guidance requir$ "u p>agraph 7#c71 ! ,attorney ,g5]al & ! ,secret>y ( ,heal? & ,human ,s]vices %all jo9tly e/abli% an integrat$ monitor+ & evaluation sy/em t includes1 :]e appropriate1 objective & quantifiable p]=mance goals & indicators to measure progress t[>d /atewide implem5tation 9 ea* ,/ate ( ! be/ practice recomm5dations requir$ "u p>agraph 7#b77;,c74 7#e7 ,mod]nization ( ,f$]al laws1 policies1 & regulations ,n lat] ?an #ij days aft] ! date ( ! release ( ! report requir$ "u p>agraph 7#b71 ! designat$ (ficials %all develop & transmit to ! ,presid5t & ! ,congress1 & make publicly available1 su* proposals z may be necess>y to implem5t adju/m5ts to ,f$]al laws1 policies1 or regulations1 includ+ ! ,,ucmj1 bas$ on ! recomm5dations requir$ "u p>agraph 7#b77;,d71 ei!r ?r\gh ,executive ord] or ?r\gh *anges to /atutory law4 7d7 ,rule ( con/ruction ,no?+ 9 ?is section %all be con/ru$ to disc\rage ! prosecution ( individuals :o int5tionally transmit or attempt to transmit ,,hiv to ano!r individual4 7e7 ,no additional appropriations au?oriz$ ,?is section %all n be con/ru$ to increase ! am\nt ( appropriations t are au?oriz$ to be appropriat$ = any fiscal ye>4 #gbaf4 ,exp&+ support = condoms 9 prisons 7a7 ,s5se ( congress reg>d+ di/ribution ( sexual b>ri] protection devices 9 /ate prison sy/ems ,x is ! s5se ( ! ,congress t ,/ates %all all[ = ! legal di/ribution ( sexual b>ri] protection devices 9 ,/ate correctional facilities to r$uce ! preval5ce & spread ( ,s,t,is 9 ^? facilities4 7b7 ,au?ority ,to all[ community organizations ,to provide ,,/i c\nsel+1 ,,/i prev5tion education1 & sexual b>ri] protection devices 9 ,f$]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$]al laws & regulations t gov]n visitation 9 ,f$]al 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 ,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 correctional facility /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 ( ,,/i te/$ =2 7ii7 ! race & e?nicity ( an individual te/$2 7iii7 ! age ( an individual te/$2 & 7iv7 ! g5d] ( ! individual 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$icaid b5efits ,:e!r-- 7i7 ! correctional facility assi/s inc>c]at$ individuals t 7 enroll$ 9 ! ,/ate ,m$icaid program prior to _! inc>c]ation 9 re9/at+ _! enrollm5t ^u release2 & 7ii7 su* individuals receive ref]rals z describ$ 9 subp>agraph 7,g7 to entities t accept ! ,/ate ,m$icaid program1 includ+1 if applicable-- 7,i7 ! numb] ( su* individuals1 includ+ ^? diagnos$ ) ,,hiv1 t h be5 re9/at$2 7,,ii7 a li/ ( ob/acles to re9/at+ enrollm5t or to mak+ det]m9ations ( eligibility = re9/atem5t1 if any2 & 7,,iii7 ! numb] ( individuals d5i$ 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 7d7 ,/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 n lat] ?an #ahj days aft] ! transmission ( ! fir/ report requir$ "u subsection 7c77#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 /aff4 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 release 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 community & 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 7e7 ,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 #bjbc ?r\gh #bjbg4 7#b7 ,availability ( funds ,am\nts made available "u p>agraph 7#a7 are au?oriz$ to rema9 available until exp5d$4 7f7 ,def9itions ,9 ?is section3 7#a7 ,community organization ,! t]m community organization means a public heal? c>e facility or a nonpr(it organization t provides heal?- or ,,/i-relat$ 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$1 cle>$1 or o!rwise au?oriz$ 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 7#h7 ,/ate ,m$icaid program ,! t]m ,/ate ,m$icaid program means ! ,/ate plan 7or a waiv] ( su* plan7 "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 #gbag4 ,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#ag7 ,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[+ ! la/ numb]$ p>agraph ( 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$icaid b5efits 7#a7 ,9 g5]al ,subject to p>agraph 7#c71 ) respect to a ,/ate1 = ea* ( ! fir/ #d cal5d> qu>t]s 9 :i* ! ,/ate plan meets ! requirem5ts ( p>agraph 7#ag7 ( section #aijb7;e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77 7z add$ 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#ag7 ( 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 #gbah4 ,/op ,,hiv 9 prison 7a7 ,%ort title ,?is section may be cit$ z ! ,/op ,,hiv 9 ,prison ,act4 7b7 ,,hiv policy ,! ,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 gu>ds & o!r p]sonnel at correctional facilities 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 a correctional facility4 7d7 ,consultation ,! ,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 ( ! 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 ,) respect to all inmates admitt$ to a facility prior to ! effective date ( ! policy-- 7i7 heal? c>e p]sonnel %all provide r\t9e ,,hiv te/+ by n lat] ?an #ahj days aft] su* effective date2 & 7ii7 ,,hiv te/+ describ$ 9 clause 7i7 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 provision "u p>agraph 7#i74 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 !mselves at risk ( infection or committ$ a violation ( ! rules ( ! correctional facility4 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 provision "u p>agraph 7#i74 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 ) ,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$ical s]vices4 7#h7 ,te/+1 c\nsel+1 & ref]ral prior to re5try 7,a7 ,heal? c>e p]sonnel %all provide r\t9e ,,hiv te/+ to all inmates n e>li] ?an #ij days prior to _! release & re5try into ! community4 ,inmates :o are already kn[n to be infect$ ne$ n be te/$ aga94 ,?is requirem5t may be waiv$ if an inmate's release occurs )\t suffici5t notice to ! ,director 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 provision "u p>agraph 7#i74 7,c7 ,) respect 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 ( ! rules ( ! correctional facility or result 9 discipl9>y action4 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 provision "u p>agraph 7#i74 ,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 f t inc>c]ation 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 submit to ,congress a report 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 & annually !reaft]1 ! ,director submit to ,congress a report 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 subp>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 subp>agraph 7,a7 %all also include-- 7i7 ! numb] ( inmates :o te/$ positive = ,,hiv ^u intake2 7ii7 ! numb] ( inmates :o te/$ positive = ,,hiv prior to re5try2 7iii7 ! numb] ( inmates :o 7 n te/$ = ,,hiv prior to re5try because !y 7 releas$ )\t suffici5t notice2 7iv7 ! numb] ( inmates :o opt$ out ( tak+ an ,,hiv 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 ! ,(fice ( ,national ,,aids ,policy1 & ! ,c5t]s = ,disease ,control & ,prev5tion reg>d+ ! developm5t ( ea* report "u subp>agraph 7,a74 #gbai4 ,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 7#db ,u4,s4,c4 #bch;j7 ! 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$4 4 #gbbj4 ,pr,e,p access & cov]age 7a7 ,cov]age ( ,,hiv te/+ & prev5tion s]vices 7#a7 ,private insurance 7,a7 ,9 g5]al ,section #bgac7;a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ac7;a77 is am5d$-- 7i7 9 p>agraph 7#b71 by /rik+ 2 & & ins]t+ a semicolon2 7ii7 9 p>agraph 7#c71 by /rik+ ! p]iod & ins]t+ a semicolon2 7iii7 9 p>agraph 7#d71 by /rik+ ! p]iod & ins]t+ a semicolon2 7iv7 9 p>agraph 7#e71 by /rik+ ! p]iod & ins]t+ 2 &2 & 7v7 by add+ at ! end ! foll[+3 7#f7 any prescription drug approv$ by ! ,food & ,drug ,adm9i/ration = ! prev5tion ( ,,hiv 7o!r ?an a drug subject to preau?orization requirem5ts consi/5t ) section #bgbi;,a71 adm9i/rative fees = su* drugs1 laboratory & o!r diagno/ic proc$ures associat$ ) ! use ( su* drugs1 & cl9ical foll[-up & monitor+1 includ+ any relat$ s]vices recomm5d$ 9 curr5t ,unit$ ,/ates ,public ,heal? ,s]vice cl9ical practice guidel9es1 )\t limitation4 4 7,b7 ,prohibition on preau?orization requirem5ts ,subp>t ,,ii ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq471 z am5d$ by section #gfjb7;d71 is am5d$ by add+ at ! end ! foll[+3 #bgbi;,a4 ,prohibition on preau?orization requirem5ts ) respect to c]ta9 s]vices ,a gr\p heal? plan or a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all n impose any preau?orization requirem5ts ) respect to cov]age ( ! s]vices describ$ 9 section #bgac7;a77#a77;,e71 except t a plan or issu] may impose preau?orization requirem5ts ) respect to cov]age ( a p>ticul> drug approv$ "u section #eje7;c7 ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act or section #cea7;a7 ( ?is ,act if su* plan or issu] provides cov]age )\t any preau?orization requirem5ts = a drug t is !rapeutically equival5t4 4 7#b7 ,cov]age "u ,f$]al employees heal? b5efits program ,section #hijd ( title #e1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+3 7c7 ,any heal? b5efits plan (f]$ "u ?is *apt] %all include b5efits =1 & may n impose any co/ %>+ requirem5ts =1 any prescription drug approv$ by ! ,food & ,drug ,adm9i/ration = ! prev5tion ( ,,hiv1 adm9i/rative fees = su* drugs1 laboratory & o!r diagno/ic proc$ures associat$ ) ! use ( su* drugs1 & cl9ical foll[-up & monitor+1 includ+ any relat$ s]vices recomm5d$ 9 curr5t ,unit$ ,/ates ,public ,heal? ,s]vice cl9ical practice guidel9es1 )\t limitation4 4 7#c7 ,m$icaid 7,a7 ,9 g5]al ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 z previ\sly am5d$ by ?is ,act1 is am5d$-- 7i7 9 subsection 7a77#d7-- 7,i7 by /rik+ 2 & 7,d7 & ins]t+ 2 7,d72 7,,ii7 by /rik+ 2 & 7,e7 & ins]t+ 2 7,e72 7,,iii7 by /rik+ 2 & 7,f7 & ins]t+ 2 7,f72 & 7,,iv7 by /rik+ ! semicolon at ! end & ins]t+ 2 & 7,g7 ,,hiv prev5tion s]vices22 & 7ii7 by add+ at ! end ! foll[+ new subsection3 7pp7 ,,hiv prev5tion s]vices ,= purposes ( subsection 7a77#d77;,g71 ! t]m ,,hiv prev5tion s]vices means prescription drugs = ! prev5tion ( ,,hiv acquisition1 adm9i/rative fees = su* drugs1 laboratory & o!r diagno/ic proc$ures associat$ ) ! use ( su* drugs1 & cl9ical foll[-up & monitor+1 includ+ any relat$ s]vices recomm5d$ 9 curr5t ,unit$ ,/ates ,public ,heal? ,s]vice cl9ical practice guidel9es1 )\t limitation4 4 7,b7 ,no co/-%>+ ,title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is am5d$-- 7i7 9 section #aiaf1 by ins]t+ ,,hiv prev5tion s]vices describ$ 9 section #aije7;a77#d77;,g71 aft] section #aije7;a77#d77;,c71 ea* place x appe>s2 & 7ii7 9 section #aiaf;,a7b77#c77;,b71 by add+ at ! end ! foll[+ new clause3 7xii7 ,,hiv prev5tion s]vices describ$ 9 section #aije7;a77#d77;,g74 4 7,c7 ,inclusion 9 b5*m>k cov]age ,section #aicg7;b77#g7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#g7;b77#g77 is am5d$-- 7i7 9 ! p>agraph head]1 by ins]t+ & ,,hiv prev5tion s]vices aft] supplies2 & 7ii7 by /rik+ includes = any individual describ$ 9 section #aije7;a77#d77;,c71 m$ical assi/ance = family plann+ s]vices & supplies 9 accordance ) su* section & ins]t+ includes m$ical assi/ance = ,,hiv prev5tion s]vices describ$ 9 section #aije7;a77#d77;,g71 & includes1 = any individual describ$ 9 section #aije7;a77#d77;,c71 m$ical assi/ance = family plann+ s]vices & supplies 9 accordance ) su* section4 7#d7 ,,*ip 7,a7 ,9 g5]al ,section #bajc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc71 z am5d$ by section #bjjg7;d77#e71 is am5d$-- 7i7 9 subsection 7a71 by /rik+ & 7#ab7 & ins]t+ 7#ab71 & 7#ac72 & 7ii7 9 subsection 7c71 by add+ at ! end ! foll[+ new p>agraph3 7#ac7 ,,hiv prev5tion s]vices ,reg>dless ( ! type ( cov]age elect$ by a ,/ate "u subsection 7a71 ! *ild heal? assi/ance provid$ = a t>get$ l[-income *ild1 &1 9 ! case ( a ,/ate t elects to provide pregnancy-relat$ assi/ance pursuant to section #baab1 ! pregnancy-relat$ assi/ance provid$ = a t>get$ l[-income pregnant woman 7z su* t]ms are def9$ = purposes ( su* section71 %all include cov]age ( ,,hiv prev5tion s]vices 7z def9$ 9 section #aije7;jj774 4 7,b7 ,no co/-%>+ ,section #bajc7;e77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7e77#b77 is am5d$ by ins]t+ ,,hiv prev5tion s]vices describ$ 9 subsection 7c77#ac71 be=e or = pregnancy-relat$ assi/ance4 7,c7 ,effective date 7i7 ,9 g5]al ,subject to clause 7ii71 ! am5dm5ts made by p>agraph 7#c7 & ?is p>agraph %all take effect on ,janu>y #a1 #bjbc4 7ii7 ,delay p]mitt$ if ,/ate legislation requir$ ,9 ! case ( a ,/ate plan approv$ "u title ,,xix or ,,xxi ( ! ,social ,security ,act :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 ?is subsection1 ! ,/ate plan %all n be reg>d$ z fail+ to comply ) ! requirem5ts ( su* title solely on ! basis ( ! failure ( ! plan to meet su* additional requirem5ts be=e ! #a/ day ( ! #a/ cal5d> qu>t] beg9n+ aft] ! close ( ! #a/ regul> session ( ! ,/ate legislature t ends aft] ! #a-ye> p]iod beg9n+ ) ! date ( ! enactm5t ( ?is ,act4 ,= purposes ( ! prec$+ s5t5ce1 9 ! case ( a ,/ate t has a #b-ye> legislative session1 ea* ye> ( ! session is deem$ to be a sep>ate regul> session ( ! ,/ate legislature4 7#e7 ,cov]age & elim9ation ( co/-%>+ "u ,m$ic>e 7,a7 ,cov]age ( ,,hiv prev5tion s]vices "u ,"p ,b 7i7 ,cov]age 7,i7 ,9 g5]al ,section #ahfa7s77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b771 z am5d$ by section #dbea7;c77#a7 & #fjaa7;a77#a71 is am5d$-- 7aa7 9 subp>agraph 7,,ii71 by /rik+ & at ! end2 7bb7 9 subp>agraph 7,,jj71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7cc7 by add+ at ! end ! foll[+ new subp>agraph3 7,,kk7 ,,hiv prev5tion s]vices 7z def9$ 9 subsection 7ppp772 4 7,,ii7 ,def9ition ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 z am5d$ by sections #bjjg7;b71 #dbba7;a71 #dbea7;c77#b71 & #fjaa7;a77#b71 is am5d$ by add+ at ! end ! foll[+ new subsection3 7ppp7 ,,hiv prev5tion s]vices ,! t]m ,,hiv prev5tion s]vices means-- 7#a7 drugs or biologicals approv$ by ! ,food & ,drug ,adm9i/ration = ! prev5tion ( ,,hiv2 7#b7 adm9i/rative fees = su* drugs2 7#c7 laboratory & o!r diagno/ic proc$ures associat$ ) ! use ( su* drugs2 & 7#d7 cl9ical foll[-up & monitor+1 includ+ any relat$ s]vices recomm5d$ 9 curr5t ,unit$ ,/ates ,public ,heal? ,s]vice cl9ical practice guidel9es1 )\t limitation4 4 7ii7 ,elim9ation ( co9surance ,section #ahcc7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a771 z am5d$ by sections #dbea7;c77#c7 & #fjaa7;a77#d71 is am5d$-- 7,i7 by /rik+ & & be=e 7,,ff72 & 7,,ii7 by ins]t+ be=e ! semicolon at ! end ! foll[+3 & 7,,gg7 ) respect to ,,hiv prev5tion s]vices 7z def9$ 9 section #ahfa7ppp771 ! am\nt paid %all be #ajj p]c5t ( 7i7 except z provid$ 9 clause 7ii71 ! less] ( ! actual *>ge = ! s]vice or ! am\nt det]m9$ "u ! fee s*$ule t applies to su* s]vices "u ?is "p1 & 7ii7 9 ! case ( su* s]vices t are cov]$ ,,opd s]vices 7z def9$ 9 subsection 7t77#a77;,b771 ! am\nt det]m9$ "u subsection 7t74 7iii7 ,exemption f "p b d$uctible ,section #ahcc7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7b77 is am5d$-- 7,i7 9 p>agraph 7#aa71 by /rik+ & at ! end2 & 7,,ii7 9 p>agraph 7#ab71 by /rik+ ! p]iod at ! end & ins]t+ 1 & 7#ac7 su* d$uctible %all n apply ) respect to ,,hiv prev5tion s]vices 7z def9$ 9 section #ahfa7lll744 7iv7 ,effective date ,! am5dm5ts made by ?is subp>agraph %all apply to items & s]vices furni%$ on or aft] ,janu>y #a1 #bjbc4 7,b7 ,elim9ation ( co/-%>+ = drugs = ! prev5tion ( ,,hiv "u ,"p ,d 7i7 ,9 g5]al ,section #ahfj;,d-#b7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;b77 is am5d$-- 7,i7 9 p>agraph 7#a77;,a71 9 ! matt] prec$+ clause 7i71 by /rik+ ,! cov]age & ins]t+ ,subject to p>agraph 7#h71 ! cov]age2 7,,ii7 9 p>agraph 7#b7-- 7aa7 9 subp>agraph 7,a71 9 ! matt] prec$+ clause 7i71 by /rik+ & 7,d7 & ins]t+ & 7,d7 & p>agraph 7#h72 7bb7 9 subp>agraph 7,c77i71 9 ! matt] prec$+ subclause 7,i71 by /rik+ p>agraph 7#d7 & ins]t+ p>agraphs 7#d7 & 7#h72 & 7cc7 9 subp>agraph 7,d77i71 9 ! matt] prec$+ subclause 7,i71 by /rik+ p>agraph 7#d7 & ins]t+ p>agraphs 7#d7 & 7#h72 7,,iii7 9 p>agraph 7#c77;,a71 9 ! matt] prec$+ clause 7i71 by /rik+ & 7#d7 & ins]t+ 7#d71 & 7#h72 7,,iv7 9 p>agraph 7#d77;,a77i71 9 ! matt] prec$+ subclause 7,i71 by /rik+ ,! cov]age & ins]t+ ,subject to p>agraph 7#h71 ! cov]age2 & 7,v7 by add+ at ! end ! foll[+ new p>agraph3 7#h7 ,elim9ation ( co/-%>+ = drugs = ! prev5tion ( ,,hiv 7,a7 ,9 g5]al ,= plan ye> #bjbc & ea* subsequ5t plan ye>1 !re %all be no co/-%>+ "u ?is "p 7includ+ "u section #ahad;,d-#ad7 = cov]$ "p ,d drugs t are = ! prev5tion ( ,,hiv4 7,b7 ,co/-%>+ ,= purposes ( subp>agraph 7,a71 ! elim9ation ( co/-%>+ %all include ! foll[+3 7i7 ,no application ( d$uctible ,! waiv] ( ! d$uctible "u p>agraph 7#a74 7ii7 ,no application ( co9surance ,! waiv] ( co9surance "u p>agraph 7#b74 7iii7 ,no application ( initial cov]age limit ,! initial cov]age limit "u p>agraph 7#c7 %all n apply4 7iv7 ,no co/-%>+ above annual out-(-pocket ?re%old ,! waiv] ( co/-%>+ "u p>agraph 7#d74 4 7ii7 ,con=m+ am5dm5ts to co/-%>+ = l[-income individuals ,section #ahfj;,d-#ad7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77 is am5d$-- 7,i7 9 p>agraph 7#a71 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ ,9 ! case & ins]t+ ,subject to section #ahfj;,d-#b7;b77#h71 9 ! case2 & 7,,ii7 9 p>agraph 7#b71 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ ,9 ! case & ins]t+ ,subject to section #ahfj;,d-#b7;b77#h71 9 ! case4 7#f7 ,cov]age ( ,,hiv prev5tion treatm5t by ,dep>tm5t ( ,vet]ans ,affairs 7,a7 ,elim9ation ( m$ication copaym5ts ,section #agbb;,a7a7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#e7 ,p>agraph 7#a7 does n apply to a m$ication = ! prev5tion ( ,,hiv4 4 7,b7 ,elim9ation ( hospital c>e & m$ical s]vices copaym5ts ,section #agaj ( su* title is am5d$-- 7i7 9 subsection 7f7-- 7,i7 by r$esignat+ p>agraph 7#e7 z p>agraph 7#f72 & 7,,ii7 by ins]t+ aft] p>agraph 7#d7 ! foll[+ new p>agraph 7#e73 7#e7 ,a vet]an %all n be liable to ! ,unit$ ,/ates "u ?is subsection = any am\nts = laboratory & o!r diagno/ic proc$ures associat$ ) ! use ( any prescription drug approv$ by ! ,food & ,drug ,adm9i/ration = ! prev5tion ( ,,hiv1 adm9i/rative fees = su* drugs1 or = laboratory or o!r diagno/ic proc$ures associat$ ) ! use ( su* drugs1 or cl9ical foll[-up & monitor+1 includ+ any relat$ s]vices recomm5d$ 9 curr5t ,unit$ ,/ates ,public ,heal? ,s]vice cl9ical practice guidel9es1 )\t limitation4 2 & 7ii7 9 subsection 7g77#c71 by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,any prescription drug approv$ by ! ,food & ,drug ,adm9i/ration = ! prev5tion ( ,,hiv1 adm9i/rative fees = su* drugs1 laboratory & o!r diagno/ic proc$ures associat$ ) ! use ( su* drugs1 & cl9ical foll[-up & monitor+1 includ+ any relat$ s]vices recomm5d$ 9 curr5t ,unit$ ,/ates ,public ,heal? ,s]vice cl9ical practice guidel9es1 )\t limitation4 4 7,c7 ,inclusion z prev5tive heal? s]vice ,section #agja7i7 ( su* title is am5d$-- 7i7 9 subp>agraph 7,k71 by /rik+ 2 & & ins]t+ a semicolon2 7ii7 by r$esignat+ subp>agraph 7,l7 z subp>agraph 7,m72 & 7iii7 by ins]t+ aft] subp>agraph 7,k7 ! foll[+ new subp>agraph 7,l73 7,l7 any prescription drug approv$ by ! ,food & ,drug ,adm9i/ration = ! prev5tion ( ,,hiv1 adm9i/rative fees = su* drugs1 laboratory & o!r diagno/ic proc$ures associat$ ) ! use ( su* drugs1 & cl9ical foll[-up & monitor+1 includ+ any relat$ s]vices recomm5d$ 9 curr5t ,unit$ ,/ates ,public ,heal? ,s]vice cl9ical practice guidel9es1 )\t limitation2 & 4 7#g7 ,cov]age ( ,,hiv prev5tion treatm5t by ,dep>tm5t ( ,def5se 7,a7 ,9 g5]al ,*apt] #ee ( title #aj1 ,unit$ ,/ates ,code1 is am5d$ by ins]t+ aft] section #ajgi;c ! foll[+ new section3 #ajgi;d4 ,cov]age ( ,,hiv prev5tion treatm5t 7a7 ,9 g5]al ,! ,secret>y ( ,def5se %all ensure cov]age "u ! ,,tric>e program ( ,,hiv prev5tion treatm5t describ$ 9 subsection 7b7 = any b5efici>y "u section #ajgd7;a7 ( ?is title4 7b7 ,,hiv prev5tion treatm5t describ$ ,,hiv prev5tion treatm5t describ$ 9 ?is subsection includes any prescription drug approv$ by ! ,food & ,drug ,adm9i/ration = ! prev5tion ( ,,hiv1 adm9i/rative fees = su* drugs1 laboratory & o!r diagno/ic proc$ures associat$ ) ! use ( su* drugs1 & cl9ical foll[-up & monitor+1 includ+ any relat$ s]vices recomm5d$ 9 curr5t ,unit$ ,/ates ,public ,heal? ,s]vice cl9ical practice guidel9es1 )\t limitation4 7c7 ,no co/-,%>+ ,not)/&+ section #ajge1 #ajge;a1 or #ajgd;g7a77#f7 ( ?is title or any o!r provision ( law1 !re is no co/-%>+ requirem5t = ,,hiv prev5tion treatm5t cov]$ "u ?is section4 4 7,b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt] is am5d$ by ins]t+ aft] ! item relat+ to section #ajgi;c ! foll[+ new item3 #ajgi;d4 ,cov]age ( ,,hiv prev5tion treatm5t4 4 7#h7 ,indian ,heal? ,s]vice te/+1 monitor+1 & prescription drugs = ! prev5tion ( ,,hiv ,title ,,ii ( ! ,indian ,heal? ,c>e ,improvem5t ,act is am5d$ by ins]t+ aft] section #bbc 7#be ,u4,s4,c4 #afbav7 ! foll[+3 #bbd4 ,te/+1 monitor+1 & prescription drugs = ! prev5tion ( ,,hiv 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,s]vice1 ,indian tribes1 & tribal organizations1 %all provide1 )\t limitation1 fund+ = any prescription drug approv$ by ! ,food & ,drug ,adm9i/ration = ! prev5tion ( human immunodefici5cy virus 7commonly kn[n z ,,hiv71 adm9i/rative fees = t drug1 laboratory & o!r diagno/ic proc$ures associat$ ) ! use ( t drug1 & cl9ical foll[-up & monitor+1 includ+ any relat$ s]vices recomm5d$ 9 curr5t ,unit$ ,/ates ,public ,heal? ,s]vice cl9ical practice guidel9es4 7b7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ su* sums z may be necess>y to c>ry out ?is section4 4 7#i7 ,effective date ,! am5dm5ts made by p>agraphs 7#a71 7#b71 7#e71 7#f71 7#g71 & 7#h7 %all take effect ) respect to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbc4 7b7 ,prohibition on d5ial ( cov]age or increase 9 premiums ( life1 disability1 or long-,t]m c>e insurance = individuals tak+ m$ication = ! prev5tion ( ,,hiv acquisition 7#a7 ,prohibition ,not)/&+ any o!r provision ( law1 x %all be unlawful to-- 7,a7 decl9e or limit cov]age ( a p]son "u any life insurance policy1 disability insurance policy1 or long-t]m c>e insurance policy1 on acc\nt ( ! individual tak+ m$ication = ! purpose ( prev5t+ ! acquisition ( ,,hiv2 7,b7 preclude an individual f tak+ m$ication = ! purpose ( prev5t+ ! acquisition ( ,,hiv z a condition ( receiv+ a life insurance policy1 disability insurance policy1 or long-t]m c>e insurance policy2 7,c7 consid] :e!r an individual is tak+ m$ication = ! purpose ( prev5t+ ! acquisition ( ,,hiv 9 det]m9+ ! premium rate = cov]age ( su* individual "u a life insurance policy1 disability insurance policy1 or long-t]m c>e insurance policy2 or 7,d7 o!rwise discrim9ate 9 ! (f]+1 issuance1 cancellation1 am\nt ( su* cov]age1 price1 or any o!r condition ( a life insurance policy1 disability insurance policy1 or long-t]m c>e insurance policy = an individual1 bas$ solely & )\t any additional actu>ial risks ^u :e!r ! individual is tak+ m$ication = ! purpose ( prev5t+ ! acquisition ( ,,hiv4 7#b7 ,en=cem5t ,a ,/ate insurance regulator may take su* actions to en=ce p>agraph 7#a7 z are specifically au?oriz$ "u ! laws ( su* ,/ate4 7#c7 ,def9itions ,9 ?is subsection3 7,a7 ,disability insurance policy ,! t]m disability insurance policy means a contract "u :i* an entity promises to pay a p]son a sum ( money 9 ! ev5t t an illness or injury result+ 9 a disability prev5ts su* p]son f work+4 7,b7 ,life insurance policy ,! t]m life insurance policy means a contract "u :i* an entity promises to pay a designat$ b5efici>y a sum ( money ^u ! dea? ( ! insur$4 7,c7 ,long-t]m c>e insurance policy ,! t]m long-t]m c>e insurance policy means a contract = :i* ! only insurance protection provid$ "u ! contract is cov]age ( qualifi$ long-t]m c>e s]vices 7z def9$ 9 section #ggjb;,b7c7 ( ! ,int]nal ,rev5ue ,code ( #aihf74 7c7 ,pati5t confid5tiality ,! ,secret>y ( ,heal? & ,human ,s]vices %all am5d ! regulations promulgat$ "u section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif 7#db ,u4,s4,c4 #acbj;d-#b note71 z necess>y1 to ensure t individuals are able to access ! b5efits describ$ 9 section #bgac7;a77#a77;,e7 ( ! ,public ,heal? ,s]vice ,act 7z am5d$ by section #gfjb7;d77 "u a family plan )\t any o!r individual enroll$ 9 su* family plan1 includ+ a prim>y subscrib] or policyhold] ( su* plan1 be+ in=m$ ( su* use ( su* b5efits4 7d7 ,pre-,exposure prophylaxis & po/-,exposure prophylaxis fund+ ,"p ,p ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhj;g et seq471 z am5d$ by section #gaec1 is fur!r am5d$ by add+ at ! end ! foll[+3 #cii,v-#aj4 ,pre-exposure prophylaxis & po/-exposure prophylaxis fund+ 7a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is section1 ! ,secret>y %all e/abli% a program t aw>ds grants to ,/ates1 t]ritories1 ,indian ,tribes1 & directly eligible entities = ! e/abli%m5t & support ( pre-exposure prophylaxis 7ref]r$ to 9 ?is section z ,pr,e,p7 & po/-exposure prophylaxis 7ref]r$ to 9 ?is section z ,,pep7 ,,hiv programs4 7b7 ,applications ,to be eligible to receive a grant "u subsection 7a71 a ,/ate1 t]ritory1 ,indian ,tribe1 or directly eligible entity %all-- 7#a7 submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require1 includ+ a plan describ+ h[ any funds aw>d$ w be us$ to increase access to ,pr,e,p = un9sur$ & und]9sur$ individuals & r$uce disp>ities 9 access to ,pr,e,p & ,,pep = un9sur$ & und]9sur$ individuals & r$uce disp>ities 9 access to ,pr,e,p & ,,pep2 & 7#b7 appo9t a ,pr,e,p & ,,pep grant adm9i/rator to manage ! program4 7c7 ,directly eligible entity ,= purposes ( ?is section1 ! t]m directly eligible entity-- 7#a7 means a ,f$]ally qualifi$ heal? c5t] or o!r nonpr(it entity engag$ 9 provid+ ,pr,e,p & ,,pep in=mation & s]vices2 & 7#b7 may include-- 7,a7 a ,f$]ally qualifi$ heal? c5t] 7z def9$ 9 section #ahfa7;aa77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#d7772 7,b7 a family plann+ grantee 7o!r ?an ,/ates7 fund$ "u section #ajja ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj72 7,c7 a rural heal? cl9ic 7z def9$ 9 section #ahfa7;aa77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#b7772 7,d7 a heal? facility op]at$ by or pursuant to a contract ) ! ,indian ,heal? ,s]vice2 7,e7 a community-bas$ organization1 cl9ic1 hospital1 or o!r heal? facility t provides s]vices to individuals at risk = or liv+ ) ,,hiv2 & 7,f7 a nonpr(it private entity provid+ compreh5sive prim>y c>e to populations at risk ( ,,hiv1 includ+ fai?-bas$ & community-bas$ organizations4 7d7 ,aw>ds ,9 det]m9+ :e!r to aw>d a grant1 & ! grant am\nt = ea* grant aw>d$1 ! ,secret>y %all consid] ! grant application & ! ne$ = ,pr,e,p & ,,pep s]vices 9 ! area1 ! numb] ( un9sur$ & und]9sur$ individuals 9 ! area1 & h[ ! ,/ate1 t]ritory1 or ,indian ,tribe coord9ates ,pr,e,p & ,,pep activities ) ! directly fund$ entity1 if ! ,/ate1 t]ritory1 or ,indian ,tribe applies = ! funds4 7e7 ,use ( funds 7#a7 ,9 g5]al ,any ,/ate1 t]ritory1 ,indian ,tribe1 or directly eligible entity t is aw>d$ funds "u subsection 7a7 %all use su* funds = eligible ,pr,e,p & ,,pep exp5ses4 7#b7 ,eligible prep exp5ses ,! ,secret>y %all publi% a li/ ( exp5ses t qualify z eligible ,pr,e,p & ,,pep exp5ses = purposes ( ?is section1 :i* %all include-- 7,a7 any prescription drug approv$ by ! ,food & ,drug ,adm9i/ration = ! prev5tion ( ,,hiv1 adm9i/rative fees = su* drugs1 laboratory & o!r diagno/ic proc$ures associat$ ) ! use ( su* drugs1 & cl9ical foll[-up & monitor+1 includ+ any relat$ s]vices recomm5d$ 9 curr5t ,unit$ ,/ates ,public ,heal? ,s]vice cl9ical practice guidel9es1 )\t limitation2 7,b7 outrea* & public education activities direct$ t[>d populations ov]repres5t$ 9 ! dome/ic ,,hiv epidemic t increase aw>5ess ab\t ! exi/5ce ( ,pr,e,p & ,,pep1 provide education ab\t access to & heal? c>e cov]age ( ,pr,e,p & ,,pep1 ,pr,e,p & ,,pep adh]5ce programs1 & c\nt] /igma associat$ ) ! use ( ,pr,e,p & ,,pep2 & 7,c7 outrea* activities direct$ t[>d physicians & o!r provid]s t provide education ab\t ,pr,e,p & ,,pep4 7f7 ,report to ,congress ,! ,secret>y %all1 9 ea* ( ! fir/ #e ye>s beg9n+ "o ye> aft] ! date ( ! enactm5t ( ?is section1 submit to ,congress1 & make public on ! int]net website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 a report on ! impact ( any grants provid$ to ,/ates1 t]ritories1 & ,indian ,tribes & directly eligible entities = ! e/abli%m5t & support ( pre-exposure prophylaxis programs "u ?is section4 7g7 ,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 #bjbc ?r\gh #bjbh4 4 7e7 ,cl>ification ,?is section1 includ+ ! am5dm5ts made by ?is section1 %all apply not)/&+ any o!r provision ( law1 includ+ ,public ,law #ajc-ada4 7f7 ,private "r ( action ,any p]son aggriev$ by a violation ( ?is section1 includ+ ! am5dm5ts made by ?is section1 may comm5ce a civil action 9 an appropriate ,unit$ ,/ates ,di/rict ,c\rt or o!r c\rt ( compet5t jurisdiction to obta9 relief z all[$ by law z ei!r an individual or memb] ( a class4 ,if ! pla9tiff is ! prevail+ p>ty 9 su* an action1 ! c\rt %all ord] ! def5dant to pay ! co/s & reasonable attorney fees ( ! pla9tiff4 ,f ,diabetes #gbea4 ,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 socioeconomic1 & environm5tal factors2 7ii7 prev5tion ( diabetes )9 ^! populations & :o h individuals at increas$ risk ( develop+ diabetes2 7iii7 prev5tion ( complications among individuals 9 ^! populations :o h already develop$ diabetes2 & 7iv7 b>ri]s to heal? c>e access & diabetes treatm5t )9 populations at increas$ risk ( 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 m$ical education program = heal? c>e pr(essionals to be m involv$ 9 weight c\nsel+1 obesity rese>*1 nutrition1 & %>$ decision mak+2 & 7,b7 provide = ! p>ticipation ( m9ority heal? pr(essionals 9 diabetes-focus$ rese>* programs2 & 7#b7 make grants to programs t e/abli% a pr(essional pipel9e t w increase ! p>ticipation ( m9ority individuals 9 diabetes-focus$ heal? fields by exp&+ ,m9ority ,access to ,rese>* ,c>e]s program int]n%ips & m5tor+ opportunities = ! purposes ( 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 #gbeb4 ,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 #gaja1 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 initiatives1 & 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 & initiatives 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 #gbec4 ,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 #gbbj1 is fur!r am5d$ by add+ at ! end ! foll[+ new section3 #cii,v-#aa4 ,programs to educate heal? provid]s on ! causes & effects ( diabetes 9 m9ority populations 7a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,adm9i/rator ( ! ,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$ical education specific to diabetes c>e4 4 #gbed4 ,rese>*1 education1 & o!r activities reg>d+ diabetes 9 ,am]ican ,indian populations ,"p ,p ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhj;g et seq471 z am5d$ by section #gbec1 is fur!r am5d$ by add+ at ! end ! foll[+ section3 #cii,v-#ab4 ,rese>*1 education1 & o!r activities reg>d+ diabetes 9 ,am]ican ,indian populations ,9 addition to activities "u sections #cag,x1 #cii,v-#aa1 & #dcd;,b1 ! ,secret>y1 act+ ?r\gh ! ,indian ,heal? ,s]vice & 9 collaboration ) o!r appropriate ,f$]al ag5cies1 %all-- 7#a7 conduct & support rese>* & o!r activities ) respect to diabetes2 & 7#b7 coord9ate ! collection ( data on cl9ically & culturally appropriate diabetes treatm5t1 c>e1 prev5tion1 & s]vices by heal? c>e pr(essionals to ! ,am]ican ,indian population4 4 #gbee4 ,updat$ 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 #gcja4 ,national a/hma burd5 ,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 #gcjb4 ,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 ( data among p ) a/hma to monitor ! impact on heal? & quality ( life2 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 7#a7 ,9 g5]al ,! ,c5t]s = ,disease ,control & ,prev5tion may collaborate ) national1 ,/ate1 & local nonpr(it organizations to provide in=mation & education ab\t a/hma1 & to /r5g!n su* collaborations :5 possible4 7#b7 ,specific activities ,! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 act+ ?r\gh ! ,division ( ,population ,heal? ( ! ,c5t]s1 may exp& activities relat+ to a/hma ) non-,f$]al p>tn]s1 especially ,/ate-level entities4 7f7 ,reports to ,congress 7#a7 ,9 g5]al ,n lat] ?an #c ye>s aft] ! date ( ! enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb1 & once #b ye>s !reaft]1 ! ,secret>y %all1 9 consultation ) pati5t gr\ps1 nonpr(it organizations1 m$ical societies1 & o!r relevant gov]nm5tal & nongov]nm5tal entities1 submit to ,congress a report t-- 7,a7 catalogs1 ) respect to a/hma prev5tion1 managem5t1 & surveillance-- 7i7 ! activities ( ! ,f$]al ,gov]nm5t1 includ+ an assessm5t ( ! progress ( ! ,f$]al ,gov]nm5t & ,/ates1 ) respect to a*iev+ ! goals ( ! ,heal?y ,p #bjcj initiative2 & 7ii7 ! activities ( o!r entities t p>ticipate 9 ! program "u ?is section1 includ+ nonpr(it organizations1 pati5t advocacy gr\ps1 & m$ical societies2 & 7,b7 makes recomm5dations = ! future direction ( a/hma activities1 9 consultation ) rese>*]s f ! ,national ,in/itutes ( ,heal? & o!r memb] bodies ( ! ,a/hma ,disp>ities ,subcommittee1 includ+-- 7i7 a description ( h[ ! ,f$]al ,gov]nm5t may improve its response to a/hma1 includ+ id5tify+ any b>ri]s t may exi/2 7ii7 a description ( h[ ! ,f$]al ,gov]nm5t may cont9ue1 exp&1 & improve its private-public p>tn]%ips ) respect to a/hma includ+ id5tify+ any b>ri]s t may exi/2 7iii7 id5tification ( /eps t may be tak5 to r$uce !-- 7,i7 morbidity1 mortality1 & ov]all preval5ce ( a/hma2 7,,ii7 f9ancial burd5 ( a/hma on society2 7,,iii7 burd5 ( a/hma on disproportionately affect$ areas1 p>ticul>ly ^? 9 m$ically und]s]v$ populations 7z def9$ 9 section #ccj7;b77#c772 & 7,,iv7 burd5 ( a/hma z a *ronic disease t c be wors5$ by environm5tal exposures2 7iv7 ! id5tification ( programs & policies t h a*iev$ ! /eps describ$ "u clause 7iii71 & /eps t may be tak5 to exp& su* programs & policies to b5efit l>g] populations2 & 7v7 recomm5dations = future rese>* & int]v5tions4 7#b7 ,subsequ5t reports 7,a7 ,congressional reque/ ,dur+ ! #e-ye> p]iod foll[+ ! submission ( ! second report "u p>agraph 7#a71 ! ,secret>y %all submit updates & revisions ( ! report ^u ! reque/ ( ! ,congress4 7,b7 ,five-ye> reevaluation ,at ! end ( ! #e-ye> p]iod ref]r$ to 9 subp>agraph 7,a71 ! ,secret>y %all-- 7i7 evaluate ! analyses & recomm5dations made 9 previ\s reports2 & 7ii7 det]m9e :e!r an additional report is ne$$ & if s submit su* an updat$ report to ! ,congress1 includ+ appropriate recomm5dations4 7g7 ,au?orization ( appropriations 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 is au?oriz$ to be appropriat$ to su* ,c5t]s #fe1jjj1jjj = ! p]iod ( fiscal ye>s #bjbc ?r\gh #bjbg = ! purpose ( c>ry+ out ?is section4 4 #gcjc4 ,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 #bjbc ?r\gh #bjbg4 #gcjd4 ,*ronic ob/ructive pulmon>y disease 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] #af1jjj1jjj adults 9 ! ,unit$ ,/ates h ,,copd4 7#e7 ,,copd is a lead+ cause ( dea? 9 ! ,unit$ ,/ates1 claim+ ov] #aef1jjj lives 9 #bjai4 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$4 ,fur!rmore1 rese>* has %[n t ,african ,am]icans develop ,,copd ) less cumulative smoke exposure & at a y\ng] age4 7b7 ,9 g5]al ,! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all conduct1 support1 & exp& public heal? /rategies1 prev5tion1 diagnosis1 surveillance1 & public & pr(essional aw>5ess activities reg>d+ *ronic ob/ructive pulmon>y disease4 7c7 ,*ronic disease prev5tion programs ,! ,director ( ! ,national ,he>t1 ,lung1 & ,blood ,in/itute %all c>ry out ! foll[+3 7#a7 ,conduct public education & aw>5ess activities ) pati5t & pr(essional organizations to /imulate e>li] diagnosis & improve pati5t outcomes f treatm5t ( *ronic ob/ructive pulmon>y disease4 ,to ! ext5t kn[n & relevant1 su* public education & aw>5ess activities %all reflect diff]5ces 9 *ronic ob/ructive pulmon>y disease by cause 7tobacco1 environm5tal1 occupational1 biological1 & g5etic7 & include a focus on outrea* to undiagnos$ &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 7d7 ,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 7e7 ,data ,collection ,n lat] ?an #ahj days aft] ! date ( 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 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 #bjbc ?r\gh #bjbg4 ,h ,tub]culosis #gcea4 ,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 #g1agd p 7 diagnos$ ) tub]culosis 7ref]r$ to 9 ?is section z ,,tb7 9 #bjbj4 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 #hi p]c5t ( p diagnos$ ) ,,tb disease 9 #bjbj self-id5tifi$ z racial & e?nic m9orities4 7#c7 ,african ,am]icans compris$ #ai4f p]c5t ( p diagnos$ ) ,,tb disease dur+ #bjbj4 ,! population-adju/$ rate ( ,,tb among ,african ,am]icans is #a4e times high] ?an ! national total1 & #h4j times high] ?an among ,:ites4 7#d7 ,asian ,am]icans1 ,native ,hawaiians1 & o!r ,pacific ,isl&]s compris$ #cg4d p]c5t ( p diagnos$ ) ,,tb disease dur+ #bjbj4 ,! population-adju/$ rate ( ,,tb among ,asian ,am]icans is #f times high] ?an ! national total1 & #cc4be times high] ?an among ,:ites4 ,! population-adju/$ rate ( ,,tb among ,native ,hawaiians & o!r ,pacific ,isl&]s is #h4e times high] ?an ! national total1 & #df4ge times high] ?an among ,:ites4 7#e7 ,hispanics & ,lat9os compris$ #bi4g p]c5t ( p diagnos$ ) ,,tb disease dur+ #bjbj4 ,! population-adju/$ rate ( ,,tb among ,hispanics & ,lat9os is #a4f times high] ?an ! national total1 & #h4ge 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 ,liv+ conditions relat$ to pov]ty1 su* z cr[d$ h\s+ & poor v5tilation1 c greatly increase ! risk ( transmission4 ,)\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 ,_m ( ! communities plac$ at highe/ risk ( o!r adv]se heal? outcomes & inju/ices are also disproportionately impact$ by ,,tb1 & ^! include p exp]i5c+ homelessness & h\s+ in/ability1 p 9 congregate liv+ & c>c]al sett+s1 & p born outside ( ! ,unit$ ,/ates4 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 fluoroqu9olone1 & at lea/ "o additional gr\p ,a second-l9e m$ic9e is classifi$ z ext5sively drug-resi/ant ,,tb 7ref]r$ to 9 ?is section z ,,xdr-,,tb74 7#aa7 ,approximately #ef p 9 ! ,unit$ ,/ates 7 diagnos$ ) ,,mdr-,,tb 9 #bjbj4 ,"o p]son 0 diagnos$ ) ,,xdr-,,tb 9 ! same ye>4 7#ab7 ,9 ! ,unit$ ,/ates1 #ejc1jjj1jjj 0 sp5t 9 #bjbj to treat ,,tb2 direct treatm5t co/s av]age #bj1baa to treat a pati5t ) ,,ds-,,tb1 #ahb1ahf to treat a pati5t ) ,,mdr-,,tb1 & #efg1gjh to treat a pati5t ) ,,xdr-,,tb4 ,:5 factor+ 9 productivity losses dur+ treatm5t1 ,,ds-,,tb av]ages #bd1ffa1 ,,mdr-,,tb av]ages #cdg1cbd1 & ,,xdr-,,tb av]ages #gbi1jci4 ,treatm5t is (t5 difficult1 ) daily complex multi-pill regim5s1 ) side effects rang+ f he>+ & vision loss to m5tal heal? issues4 7#ac7 ,recogniz+ ! public heal?1 economic1 & 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/ics1 & 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 #gceb4 ,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 #bjbc ?r\gh #bjbd4 4 #gcec4 ,/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$iatric populations & 9 pregnant & lactat+ p2 7#b7 rese>* to develop rapid diagno/ic te/s = all =ms ( ,,tb1 includ+ diagno/ics t c be us$ = 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 #gdja4 ,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 ( knee ar?ritis4 7#b7 ,ar?ritis affects #eh1ejj1jjj p 9 ! ,unit$ ,/ates1 & t numb] w rise to #gh1jjj1jjj by ! ye> #bjdj4 7#c7 #cb1ejj1jjj 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 #d p 9 ! ,unit$ ,/ates & is ! s+le greate/ cause ( *ronic pa9 & disability 9 ! ,unit$ ,/ates4 7#f7 ,wom51 ,black ,am]icans1 & ,hispanics h m sev]e ar?ritis & functional limitations4 ,^! same individuals are m likely to be obese & diabetic1 & h a high] incid5ce ( he>t diseases4 7#g7 ,ar?ritis co/s #cjd1jjj1jjj1jjj a ye>1 includ+ #adj1jjj1jjj1jjj 9 direct co/s 7m$ical7 & #afd1jjj1jjj1jjj 9 indirect co/s 7lo/ e>n+s74 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?op$ic surgeon recomm5d+ ,,tka to a male pati5t ) mod]ate ar?ritis are #bb times t ( a female pati5t4 7#ae7 ,black ,am]icans ) doctor-diagnos$ ar?ritis h a high] preval5ce ( sev]e pa9 attributable to ar?ritis1 comp>$ ) ,:ite ,am]icans 7#cd4j p]c5t v]sus #bb4f p]c5t74 ,black ,am]icans1 comp>$ to ,:ite ,am]icans1 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 ,black ,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 ,black ,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 ,black ,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 & ,black ,am]icans are almo/ #ej p]c5t less likely to und]go total knee replacem5t ?an ,:ites4 #gdjb4 ,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?ritis1 lupus1 & 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> #bjbc & ea* subsequ5t fiscal ye>4 #gdjc4 ,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 lupus1 & 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+ a grant "u ?is section2 7,b7 ! specific activities support$ by grants "u ?is section2 7,c7 ! numb] ( /ud5ts s]v$ by programs support$ by grants "u ?is section2 & 7,d7 ! /atus ( evaluations ( su* programs4 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 #gdea4 ,%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 ,an e/imat$ #be1jjj1jjj adults 9 ! ,unit$ ,/ates 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 #ce p]c5t ( p 9 ! ,unit$ ,/ates get few] ?an #g h\rs ( sleep p] night1 & r\ghly #a1eej fatal motor vehicle cra%es p] ye> 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]ty1 race1 & social det]m9ants ( heal?4 ,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 ,black ,am]icans sleep worse ?an ,:ite ,am]icans4 ,black ,am]icans take long] to fall asleep1 report poor] sleep quality1 h m light & less deep sleep1 & nap m (t5 & long]4 7#f7 ,black ,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 ,black ,am]icans1 ! likelihood ( hav+ sleep disord]$ brea?+ & exhibit+ risk factors = poor sleep is twice t 9 "y ,:ite ,am]icans4 ,frequ5t snor+ is m common among ,black ,am]ican & ,hispanic wom5 & ,hispanic m5 comp>$ to non-,hispanic ,:ite ,am]icans1 indep5d5t ( o!r factors includ+ obesity4 7#h7 ,black ,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 ,und]repres5t$ m9orities 9 ! ,unit$ ,/ates report an insomnia rate ( #ab4i p]c5t comp>$ to only #f4f p]c5t = ,:ite ,am]icans4 7#aa7 ,black wom5 h a high] incid5ce ( insomnia ?an ,black m51 p]haps relat$ 9 "p to high] risk = *ronic p]si/+ symptoms4 #gdeb4 ,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 7involv+ exi/+ or anticipat$ cohorts7 & ex*ang+ sci5tific data & ideas 7includ+ ?r\gh cross-ov] into sci5tific meet+s72 & 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> #bjbc & ea* subsequ5t fiscal ye>4 #gdec4 ,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> #bjbc & ea* subsequ5t fiscal ye>4 #gded4 ,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+ a grant "u ?is section2 7,b7 ! specific activities support$ by grants "u ?is section2 7,c7 ! numb] ( /ud5ts s]v$ by programs support$ by grants "u ?is section2 & 7,d7 ! /atus ( evaluations ( programs support$ by su* grants4 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 #gdee4 ,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 #geja4 ,kidney disease1 rese>*1 surveillance1 prev5tion1 & treatm5t 7a7 ,%ort title ,?is subtitle may be cit$ z ! ,kidney ,disease ,rese>*1 ,surveillance1 ,prev5tion & ,treatm5t ,improvem5t ,act ( #bjbb4 7b7 ,f9d+s ,congress makes ! foll[+ f9d+s3 7#a7 ,kidney diseases impact #cg1jjj1jjj individuals 9 ! ,unit$ ,/ates4 7#b7 ,black ,am]icans comprise j #ac p]c5t ( ! ,unit$ ,/ates population1 b #cc p]c5t ( ! ,unit$ ,/ates dialysis pati5t population4 ,comp>$ to ,:ite ,am]icans1 kidney failure preval5ce is ab\t #c4g times great] 9 ,black ,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 ,black ,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 ,black ,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 ,black ,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 = ,black ,am]ican1 ,hispanic1 & ,asian pati5ts ) kidney failure h be5 l>gely 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 recognize ! ne$ = m transplants1 bett] prev5tion & education1 & improv$ access to treatm5t modalities4 #gejb4 ,kidney disease rese>* 9 m9ority populations 7a7 ,9 g5]al 7#a7 ,rese>* & tra9+ c5t]s ,section #dca7;c77#c7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhe;c-#e7;c77#c77 is am5d$-- 7,a7 9 subp>agraph 7,b71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,c71 by /rik+ & at ! end2 & 7,c7 by add+ at ! end ! foll[+3 7,d7 improv+ data sci5ce ?r\gh improvem5t 9 bio9=matics1 data integration1 & data %>+2 7,e7 def9+ ! *ronic kidney disease me*anism & id5tify+ new !rapeutic t>gets = *ronic kidney disease us+ specific tools1 includ+ mapp+ ! g5etic ar*itecture ( kidney function & disease & translat+ g5etic maps to disease-caus+ g5es & me*anisms1 especially among m9ority populations2 7,f7 improv+ models ( human disease includ+ bett] humaniz$ animal models1 improv$ reproducibility1 & functional *>act]ization ( kidney organoids1 & accel]at+ ! developm5t ( 9 vivo imag+ te*nologies2 & 7,g7 develop+ cell-specific drug deliv]y sy/ems & g5e edit+1 includ+ t>get$ sy/ems = ! deliv]y ( !rapeutic comp\nds to specific kidney comp>tm5ts or cell types & accel]at+ ! implem5tation ( g5e edit+ & g5e !rapy = ! treatm5t ( kidney diseases 9 vivo2 & 4 7#b7 ,inclusion ( m9ority p>ticipants ,9 conduct+ & support+ rese>* describ$ 9 ! am5dm5t made by p>agraph 7#a71 ! ,director ( ! ,national ,in/itutes ( ,heal? %all "w ) ! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities to improve ! numb] ( m9ority p>ticipants z /udy subjects 9 cl9ical trials4 ,su* "w may include-- 7,a7 develop+ & su/a9+ cl9ical trial consortia t c recruit pati5ts ) *ronic kidney disease to ensure adequate capacity = assessm5t ( kidney outcomes & increase ! enrollm5t ( und]repres5t$ populations2 7,b7 enc\rag+ ! use ( novel designs 9 cl9ical trials to enhance ! recruitm5t & ret5tion ( und]repres5t$ populations :i* w enhance ! g5]alizability ( /udy f9d+s2 7,c7 support+ outrea* initiatives t incorporate ackn[l$gm5t ( bo? hi/orical & curr5t gr\nds = p>ticipation reluctance1 & t prioritize demon/rat+ tru/wor?9ess1 9 ord] to enhance ! ability to promote & effectively convey ! b5efits ( cl9ical rese>* p>ticipation2 7,d7 complet+ cl9ical trials t te/ int]v5tions to improve pati5t quality ( life & address pati5t-report$ outcomes2 & 7,e7 enc\rag+ inclusion ( p]sons ) *ronic kidney disease 9 cl9ical trials ( treatm5ts = nonkidney diseases4 7b7 ,report2 compreh5sive plan ,section #dbi ( ! ,public ,heal? ,s]vices ,act 7#db ,u4,s4,c4 #bhe;c-#c7 is am5d$ by add+ at ! end ! foll[+3 7c7 ,report by ,kidney1 ,urologic1 & ,hematologic ,diseases ,coord9at+ ,committee 7#a7 ,9 g5]al ,! ,kidney1 ,urologic1 & ,hematologic ,diseases ,coord9at+ ,committee1 9 coord9ation ) ! ,*ronic ,kidney ,disease ,initiative at ! ,c5t]s = ,disease ,control & ,prev5tion1 %all-- 7,a7 prep>e & submit to ! ,congress1 n lat] ?an #f mon?s aft] ! date ( enactm5t ( ?is subsection1 a report on ,f$]al rese>* & public heal? activities ) respect to kidney disease 9 m9ority populations2 & 7,b7 develop & submit to ! ,congress1 ! ,secret>y1 ! ,director ( ! ,national ,in/itutes ( ,heal?1 & ! ,advisory ,bo>d e/abli%$ "u section #dcj = ! diseases = :i* ! ,committee 0 e/abli%$1 n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is subsection1 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 disease2 7iii7 ! deliv]y ( evid5c$-bas$ c>e = all *ronic kidney disease /ages1 especially 9 und]repres5t$ & und]s]v$ populations2 7iv7 exp&+ support = a root-cause analysis approa* to disp>ities1 includ+ causes1 detection1 & managem5t ( *ronic kidney disease = und]s]v$ populations2 7v7 develop+ rese>* teams t engage ) community organizations to develop & implem5t int]v5tions :i* halt or delay developm5t & progression ( *ronic kidney disease2 & 7vi7 cont9u$ support ( obs]vational /udies ( kidney disease measures & outcomes4 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 bases = 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? ,sy/ems ,bureau4 ,?is %all include-- 7i7 id5tification ( effective /rategies to increase implem5tation ( prov5 !rapies to sl[ *ronic kidney disease incid5ce & progression1 especially 9 high-risk und]repres5t$ populations2 & 7ii7 id5tification ( effective practice improvem5t /rategies 9 l>ge & small heal? sy/ems to r$uce *ronic kidney disease incid5ce & progression4 4 #gejc4 ,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 ,pursuant to section #dbf ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhe;c71 n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,director ( ! ,national ,in/itute ( ,diabetes & ,dige/ive & ,kidney ,diseases1 9 consultation ) ! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities & ! ,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 ( ! ,c5t]s = ,disease ,control & ,prev5tion1 ?r\gh ! ,*ronic ,kidney ,disease ,initiative1 %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 lupus nephritis1 ,,covid-#ai1 & polycy/ic kidney disease7 & include a focus on outrea* to undiagnos$ &1 z appropriate1 m9ority populations4 7#b7 ,supplem5t & exp& ^u ! activities ( ! ,c5t]s = ,disease ,control & ,prev5tion 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 ) ! ,national ,in/itute ( ,diabetes & ,dige/ive & ,kidney ,diseases1 ! ,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> #bjbc1 #a1jjj1jjj = fiscal ye> #bjbd1 #a1jjj1jjj = fiscal ye> #bjbe1 #a1jjj1jjj = fiscal ye> #bjbf1 & #a1jjj1jjj = fiscal ye> #bjbg4 #gejd4 ,home dialysis & increas+ end-/age r5al disease treatm5t modalities 9 m9ority communities action plan 7a7 ,9 g5]al ,section #ahha7;b77#ad7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#ad77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,j7 7i7 ,= s]vices furni%$ on or aft] ! date :i* is #a ye> aft] ! date ( ! enactm5t ( ?is subp>agraph :i* are /aff-assi/$ home dialysis 7z def9$ 9 clause 7iv77,,iii771 ! ,secret>y %all increase ! s+le paym5t t w\ld o!rwise apply "u ?is p>agraph = r5al dialysis s]vices furni%$ to new & respite individuals 9 accordance ) ! paym5t sy/em e/abli%$ "u clause 7iii7 by qualifi$ provid]s4 7ii7 7,i7 ,subject to subclause 7,,ii71 /aff-assi/$ home dialysis may only be furni%$ dur+-- 7aa7 ) respect to an individual describ$ 9 subclause 7iv77,i77aa71 "o #ij-;day p]iod :i* may be r5ew$ up to two #cj-;day p]iods2 & 7bb7 ) respect to an individual describ$ 9 subclause 7iv77,i77bb7 & not)/&+ :e!r su* an individual receives any respite c>e "u "p ,a1 any #cj-;day p]iod4 7,,ii7 ,not)/&+ ! limits describ$ 9 subclause 7,i71 /aff-assi/$ home dialysis may be furni%$ = z long z ! ,secret>y det]m9es appropriate to an individual :o-- 7aa7 is bl9d2 7bb7 has a cognitive or neurological impairm5t 7includ+ a /roke1 ,alzheim]'s1 dem5tia1 amyotrophic lat]al scl]osis1 or any o!r impairm5t det]m9$ by ! ,secret>y72 or 7cc7 has any o!r illness or injury t r$uces mobility 7includ+ c]ebral palsy1 sp9al cord injuries1 or any o!r illness or injury det]m9$ by ! ,secret>y74 7iii7 ,! ,secret>y %all e/abli% an add-on to ! s+le paym5t "u ?is p>agraph ?r\gh regulations to det]m9e ! am\nts payable to qualifi$ provid]s = /aff-assi/$ home dialysis4 ,9 e/abli%+ su* sy/em add-on paym5t1 ! ,secret>y may consid]-- 7,i7 ! co/s ( furni%+ /aff-assi/$ home dialysis2 7,,ii7 consultations ) dialysis provid]s1 dialysis pati5ts1 private pay]s1 & ,m$ic>e ,advantage plans2 7,,iii7 paym5t am\nts = simil> items & s]vices "u p>ts ,a & ,b2 & 7,,iv7 paym5t am\nts e/abli%$ by ,m$ic>e ,advantage plans "u "p ,c1 gr\p heal? plans1 & heal? insurance cov]age (f]$ by heal? insurance issu]s4 7iv7 ,9 ?is subp>agraph3 7,i7 ,! t]m new & respite individual means an individual describ$ 9 subsection 7a7 :o is-- 7aa7 initiat+ ei!r p]itoneal or home hemodialysis2 7bb7 receiv+ home dialysis & is unable to self-dialyze due to illness1 injury1 c>egiv] issues1 or o!r tempor>y circum/ances2 or 7cc7 return+ to home dialysis aft] a p]iod ( hospitalization4 7,,ii7 ,! t]m qualifi$ provid] means a tra9$ pr(essional 7z det]m9$ by ! ,secret>y1 includ+ nurses & c]tifi$ pati5t te*nicians7 :o furni%es r5al dialysis s]vices &-- 7aa7 meets requirem5ts 7z det]m9$ by ! ,secret>y7 t ensures compet5cy 9 pati5t c>e & modality usage2 & 7bb7 provides 9-p]son assi/ance to a pati5t = an appropriate numb] ( dialysis sessions 7z det]m9$ by ! ,secret>y7 at lea/ #ge p]c5t ( /aff-assi/$ home dialysis sessions dur+ a p]iod describ$ 9 clause 7ii77,i74 7,,iii7 7aa7 ,! t]m /aff-assi/$ home dialysis means home dialysis us+ tra9$ pr(essionals to assi/ individuals :o h be5 det]m9$ to h end /age r5al disease1 & ! frequ5cy ( su* home dialysis is det]m9$ by su* pr(essionals 9 coord9ation ) ! pati5t & 8 or h] c>e p>tn]1 & outl9$ 9 a pati5t plan ( c>e4 7bb7 ,! t]m c>e p>tn] means anyone :o is designat$ by ! pati5t :o assi/s ! individual ) ! furni%+ ( home dialysis4 7cc7 ,! t]m pati5t plan ( c>e has ! mean+ giv5 su* t]m 9 section #did4ij ( title #db1 ,code ( ,f$]al ,regulations4 4 7b7 ,pati5t education & tra9+ relat+ to /aff-,assi/$ home dialysis ,section #ahha7;b77#e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#e77 is am5d$-- 7#a7 9 subp>agraph 7,c71 by /rik+ at ! end &2 7#b7 9 subp>agraph 7,d71 by /rik+ ! p]iod at ! end & ins]t+ a semicolon2 & 7#c7 by add+ at ! end ! foll[+3 7,e7 educate pati5ts ( ! opportunity to receive /aff-assi/$ home dialysis 7z def9$ 9 p>agraph 7#ad77;,j77iv77,,iii77 dur+ ! p]iod beg9n+ #cj days aft] ! fir/ day su* facility furni%es r5al dialysis s]vices to an individual & end+ #fj days aft] su* day2 & 7,f7 provide = nurses1 c]tifi$ pati5t te*nicians1 social work]s & or o!r pr(essionals to tra9 pati5ts & _! c>e p>tn]s 9 skills & proc$ures ne$$ to p]=m home dialysis 7z def9$ 9 p>agraph 7#ad77;,j77iv77,,iii77 treatm5t-- 7i7 regul>ly & indep5d5tly2 7ii7 ?r\gh teleheal? s]vices or ?r\gh gr\p tra9+ 7z describ$ 9 ! int]pretive guidance relat+ to tag numb] ,v#eij ( ,advance ,copy-,end ,/age ,r5al ,disease 7,,esrd7 ,program ,int]pretive ,guidance ,v]sion #a4a 7publi%$ on ,octob] #c1 #bjjh77 9 accordance ) ! ,f$]al regulations 7conc]n+ ! privacy ( individually id5tifiable heal? in=mation7 promulgat$ "u section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif2 & 7iii7 9 ! home or resid5ce ( a pati5t1 9 a dialysis facility1 or 9 ! place 9 :i* ! pati5t int5ds to receive /aff-assi/$ home dialysis4 4 7c7 ,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 7d7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section #a1jjj1jjj = fiscal ye> #bjbc1 #a1jjj1jjj = fiscal ye> #bjbd1 #a1jjj1jjj = fiscal ye> #bjbe1 #a1jjj1jjj = fiscal ye> #bjbf1 & #a1jjj1jjj = fiscal ye> #bjbg4 #geje4 ,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 ,,cms data collection & report+ ,! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices %all collect & report annual data on dialysis facility & nephrologi/ p]=mance on transplant ref]ral1 ) an emphasis on data relat+ to pati5ts ( color4 7c7 ,,optn data collection & report+ ,! ,organ ,procurem5t & ,transplantation ,network %all collect & ! ,sci5tific ,regi/ry ( ,transplant ,recipi5ts %all report annual data1 brok5 d[n by demographic & socioeconomic *>act]i/ics1 on individual transplant c5t] p]=mance z x relates to pati5ts ref]r$1 evaluat$1 waitli/$1 & successfully transplant$4 7d7 ,transplant c5t] data ,ea* organ transplant c5t] %all report on ! p]c5t ( appropriate waitli/$ pati5ts 7includ+ socioeconomic & demographic data7 giv+ & receiv+ annual in=m$ cons5t = (f]s = suboptimal kidneys 7su* z kidneys ) a kidney donor pr(ile index ( great] ?an #he p]c5t or kidney age #ej ) diabetes1 or age great] ?an #fj74 7e7 ,organ procurem5t organization data ,ea* organ procurem5t organization %all report annual data on ref]rals1 refusals 7pati5t or doctor71 & acceptance ( organs by hospital1 ,,zip ,code1 race1 e?nicity1 & age /rata except z prohibit$ by ne$ = confid5tiality4 7f7 ,data ,transp>5cy = ,pati5ts ,ea* organ transplant c5t] %all provide to ea* pati5t ( su* c5t]1 on an annual basis-- 7#a7 ! numb] ( times an organ 0 (f]$ to ! pati5t1 decl9$1 & transplant$ into ano!r pati5t f organs )9 a #ejj-mile radius2 & 7#b7 ! numb] ( times an organ 0 (f]$ to & decl9$ = ! pati5t f a l[-risk donor :i* 0 subsequ5tly transplant$ into ano!r pati5t4 7g7 ,improv$ transplantation education ,! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices %all c]tify a nonbias$1 ?ird-p>ty organization to accr$it organ transplant education4 7h7 ,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 7i7 ,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? ,sy/ems ,bureau4 #gejf4 ,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 #gejg4 ,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$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 "u ! ,m$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 #gejh4 ,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+ nephrology1 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 kidney 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 kidney heal? pr(essionals be=e ! p]iod at ! end4 #geji4 ,! ,jack ,reynolds ,memorial ,m$igap ,expansion ,act2 ,m$igap cov]age = b5efici>ies ) end-/age r5al disease 7a7 ,gu>ante$ availability ( ,m$igap policies to all ,,esrd ,m$ic>e b5efici>ies 7#a7 ,9 g5]al ,section #ahhb7s7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77 is am5d$-- 7,a7 9 p>agraph 7#b7-- 7i7 9 subp>agraph 7,a71 by /rik+ is #fe & all t foll[s ?r\gh ! p]iod at ! end & ins]t+ ! foll[+3 is-- 7i7 #fe ye>s ( age or old] & is enroll$ = b5efits "u "p ,b2 or 7ii7 is entitl$ to b5efits "u #bbf;,a7b7 & is enroll$ = b5efits "u "p ,b4 2 & 7ii7 9 subp>agraph 7,d71 9 ! matt] prec$+ clause 7i71 by ins]t+ 7or is entitl$ to b5efits "u #bbf;,a7b77 aft] is #fe ye>s ( age or old]2 & 7,b7 9 p>agraph 7#c77;,b7-- 7i7 9 clause 7ii71 by ins]t+ 7or is entitl$ to b5efits "u #bbf;,a7b77 aft] is #fe ye>s ( age or old]2 & 7ii7 9 clause 7vi71 by ins]t+ 7or "u #bbf;,a7b77 aft] at age #fe4 7#b7 ,effective date ,! am5dm5ts made by p>agraph 7#a7 %all apply to ,m$ic>e supplem5tal policies effective on or aft] ,janu>y #a1 #bjbc4 7b7 ,additional enrollm5t p]iod = c]ta9 individuals 7#a7 ,"o-"t enrollm5t p]iod 7,a7 ,9 g5]al ,9 ! case ( an individual describ$ 9 p>agraph 7#b71 ! ,secret>y ( ,heal? & ,human ,s]vices %all e/abli% a "o-"t enrollm5t p]iod dur+ :i* su* an individual may enroll 9 any ,m$ic>e supplem5tal policy "u section #ahhb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciess7 ( ! individual's *oos+4 7,b7 ,enrollm5t p]iod ,! enrollm5t p]iod e/abli%$ "u subp>agraph 7,a7 %all beg9 on ,janu>y #a1 #bjbc1 & %all end ,june #cj1 #bjbc4 7#b7 ,individual describ$ ,an individual describ$ 9 ?is p>agraph is an individual :o-- 7,a7 is entitl$ to hospital insurance b5efits "u "p ,a ( title ,,xviii ( ! ,social ,security ,act "u section #bbf;,a7b7 ( su* ,act 7#db ,u4,s4,c4 #dbf-a7;b772 7,b7 is enroll$ = b5efits "u "p ,b ( su* title ,,xviii2 & 7,c7 w\ld n1 b = ! provisions (1 & am5dm5ts made by1 subsection 7a7 be eligible = ! gu>ante$ issue ( a ,m$ic>e supplem5tal policy "u p>agraph 7#b7 or 7#c7 ( section #ahhb7s7 ( su* ,act 7#db ,u4,s4,c4 #aciess7s774 ,l ,div]sity 9 ,cl9ical ,trials #geea4 ,,fda review ( cl9ical trial be/ practices ,! ,commission] ( ,food & ,drugs %all-- 7#a7 aggregate in=mation on ! accumulat$ exp]i5ce ( sponsors ( drugs t develop & execute cl9ical trial div]sity plans dur+ drug developm5t2 7#b7 include 9 su* aggregat$ in=mation an analysis f ! p]spectives ( ! ,food & ,drug ,adm9i/ration & su* sponsors ( :i* actions work$ or :i* did n "w to enhance cl9ical trial div]sity2 7#c7 n lat] ?an ,septemb] #cj1 #bjbd1 conv5e a public meet+1 includ+ repres5tatives f ! regulat$ indu/ry & pati5t organizations1 to discuss f9d+s & recomm5dations = specific actions t h l$ to measurable improvem5ts 9 ! repres5tation ( racial & e?nic populations 9 cl9ical rese>*2 & 7#d7 n lat] ?an ,septemb] #cj1 #bjbe1 update ! guidance ( ! ,food & ,drug ,adm9i/ration titl$ ,enhanc+ ! ,div]sity ( ,cl9ical ,trial ,populations--,eligibility ,crit]ia1 ,enrollm5t ,practices1 & ,trial ,designs to align su* guidance ) f9d+s & recomm5dations t 7 discuss$ at ! meet+ "u p>agraph 7#c74 #geeb4 ,div]sify+ ,inve/igations ,via ,equitable ,rese>* ,/udies = ,ev]yone ,trials ,act 7a7 ,guidance on dec5traliz$ cl9ical trials 7#a7 ,def9ition ,9 ?is subsection1 ! t]m dec5traliz$ cl9ical trials includes cl9ical trials t are execut$ ?r\gh a broad spectrum ( options1 su* z telem$ic9e or o!r mobile or digital te*nologies1 to all[ = ! remote collection & assessm5t ( cl9ical trial data f p>ticipants1 includ+ 9 ! home or (fice sett+4 7#b7 ,guidance ,n lat] ?an #f mon?s aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is section z ! ,secret>y71 act+ ?r\gh ! ,commission] ( ,food & ,drugs 7ref]r$ to 9 ?is section z ! ,commission]71 %all issue a draft guidance t addresses h[ to conduct dec5traliz$ cl9ical trials ) mean+ful demographic div]sity1 includ+ racial1 e?nic1 age1 g5d]1 & geographic div]sity 9 pati5t engagem5t1 enrollm5t1 & p>ticipation1 includ+ h[ to appropriately use digital heal? te*nologies or o!r remote assessm5t options1 su* z telem$ic9e1 to support su* trials4 ,n lat] ?an #f mon?s aft] ! date ! public comm5t p]iod = ! draft guidance ends1 ! ,secret>y %all issue a f9al guidance4 7#c7 ,cont5t ( guidance ,! guidance "u p>agraph 7#b7 %all address ! foll[+3 7,a7 ,/rategies to engage ) prospective cl9ical trial p>ticipants & community p>tn]s1 su* z pati5t advocacy gr\ps ) div]se repres5tation1 to incorporate input ( su* pati5ts & p>tn]s into ! design ( dec5traliz$ cl9ical trials4 7,b7 ,recomm5dations =-- 7i7 protocol design approa*es2 7ii7 appropriate cl9ical endpo9ts2 7iii7 in/itutional review bo>d composition & ensur+ t su* bo>ds include memb]s ) exp]tise 9 dec5traliz$ cl9ical trials2 7iv7 delegation ( cl9ical rese>* organization responsibilities & suitable proxies = cl9ical rese>* organizations2 & 7v7 simplify+ in=m$ cons5t4 7,c7 ,recomm5dations = h[ digital heal? te*nology or o!r remote assessm5t options1 su* z telem$ic9e1 c\ld support dec5traliz$ cl9ical trials1 includ+ guidance on appropriate te*nological plat=ms & m$iums1 data collection & use1 data integrity1 & communication to /udy p>ticipants ?r\gh digital te*nology4 7,d7 ,recomm5dations = appropriate me?ods ( pati5t recruitm5t & ret5tion1 includ+ in/itutional review bo>d ov]sight1 pati5t communication1 & ! role ( /udy p>ticipants & community p>tn]s z advocates to facilitate cl9ical trial recruitm5t1 p>ticul>ly ) respect to und]repres5t$ populations4 7,e7 ,in=mation reg>d+ :5 & h[ a /udy sponsor may solicit a meet+ ) ! ,secret>y reg>d+ ! issues describ$ 9 subp>agraphs 7,a7 ?r\gh 7,d74 7#d7 ,int]national ,h>monization ,aft] issu+ ! f9al guidance "u p>agraph 7#b71 ! ,secret>y1 act+ ?r\gh ! ,commission]1 may "w ) =eign regulators pursuant to exi/+ memor&a ( und]/&+ gov]n+ ex*ange ( in=mation to facilitate int]national h>monization ( ! regulation ( dec5traliz$ cl9ical trials & use ( digital heal? te*nology or o!r remote assessm5t options4 7b7 ,enc\ragem5t ( cl9ical trial enrollm5t by racially & e?nically div]se populations 7#a7 ,no co/ provision ( digital heal? te*nologies ,! free provision ( digital heal? te*nologies by drug or device manufactur]s to _! cl9ical trial p>ticipants %all n be consid]$ a violation ( section #aabh;,a ( ! ,social ,security ,act 7commonly kn[n z ! ,civil ,monet>y ,p5alties ,law7 7#db ,u4,s4,c4 #acbj;a-#g;a71 section #aabh;,b ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b71 or sections #cgbi ?r\gh #cgcc ( title #ca1 ,unit$ ,/ates ,code 7commonly kn[n z ! ,false ,claims ,act71 provid$ t-- 7,a7 ! use ( digital heal? te*nologies w facilitate 9 any phase ( cl9ical developm5t ! inclusion ( div]sity ( pati5t populations1 su* z und]repres5t$ racial & e?nic m9orities1 l[-income populations1 & ! eld]ly2 7,b7 ! digital heal? te*nologies w facilitate individuals' p>ticipation1 or are necess>y to su* p>ticipation2 7,c7 all features ( ! digital heal? te*nologies t are unrelat$ to use 9 ! cl9ical trial are disabl$ or only all[$ to rema9 activat$ to model real-_w usage ( ! digital te*nology2 & 7,d7 ! cl9ical trial sponsor requires p>ticipants to return1 pur*ase1 or disable ! digital heal? te*nologies by ! conclusion ( ! trial4 7#b7 ,grants & contracts 7,a7 ,9 g5]al ,! ,secret>y may issue grants to1 & ent] into contracts )1 entities to support community education1 outrea*1 & recruitm5t activities = cl9ical trials ) respect to drugs1 includ+ vacc9es = diseases or conditions :i* h a disproportionate impact on und]repres5t$ populations 7includ+ on racial & e?nic m9ority populations71 includ+ = ! diagnosis1 prev5tion1 or treatm5t ( ,,covid-#ai4 ,su* activities may include-- 7i7 work+ ) community cl9ical trial sites1 includ+ community heal? c5t]s1 academic heal? c5t]s1 & o!r facilities2 7ii7 tra9+ heal? c>e p]sonnel includ+ pot5tial cl9ical trial inve/igators1 ) a focus on significantly increas+ ! numb] ( und]repres5t$ racial & e?nic m9ority heal? c>e p]sonnel :o are cl9ical trial inve/igators at ! community sites = ongo+ cl9ical trials2 7iii7 engag+ community /akehold]s to enc\rage p>ticipation 9 cl9ical trials1 especially 9 und]repres5t$ racial & e?nic m9ority communities2 & 7iv7 fo/]+ p>tn]%ips ) community-bas$ organizations s]v+ und]repres5t$ racial & e?nical m9ority populations1 includ+ labor organizations & frontl9e heal? c>e work]s4 7,b7 ,priority = grant & contract aw>ds ,9 aw>d+ grants & contracts "u ?is p>agraph1 ! ,secret>y %all prioritize entities t-- 7i7 develop educational1 recruitm5t1 & tra9+ mat]ials 9 multiple languages2 or 7ii7 und]take cl9ical trial outrea* ef=ts 9 m div]se racial & e?nic communities t are traditionally und]repres5t$ 9 cl9ical trials1 su* z ,tribal areas4 7,c7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ = fiscal ye>s #bjbc & #bjbd su* sums z may be necess>y to c>ry out ?is p>agraph4 7c7 ,cl>ification t c]ta9 remun]ation relat$ to p>ticipation 9 cl9ical trials does n con/itute remun]ation "u ! ,f$]al civil money p5alties law 7#a7 ,9 g5]al ,section #aabh;,a7i77#f77;,f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7i77#f77;,f77 is am5d$ by ins]t+ 7includ+ remun]ation (f]$ or transf]r$ to an individual to promote ! p>ticipation 9 an approv$ cl9ical trial1 z def9$ 9 subsection 7d7 ( ! fir/ section #bgji ( ! ,public ,heal? ,s]vice ,act 7relat+ to cov]age = individuals p>ticipat+ 9 approv$ cl9ical trials71 z s designat$ by section #aefc7;c77#aj77;,c7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 t is regi/]$ ) ! database ( cl9ical trials ma9ta9$ by ! ,national ,libr>y ( ,m$ic9e 7or any successor database71 s long z su* remun]ation facilitates equitable inclusion ( pati5ts f all relevant demographic & socioeconomic populations & is relat$ to pati5t p>ticipation 9 ! approv$ cl9ical trial7 aft] promotes access to c>e4 7#b7 ,effective date ,! am5dm5t made by p>agraph 7#a7 %all apply to remun]ation provid$ on or aft] ! date ( ! enactm5t ( ?is ,act4 7d7 ,national academy ( m$ic9e /udy 7#a7 ,9 g5]al ,! ,secret>y %all seek to ent] into an arrangem5t ) ! ,national ,academy ( ,m$ic9e "u :i* ! ,national ,academy agrees to /udy & propose a design = a national int]op]able data plat=m to improve access to heal? data1 & o!r relevant data ne$s1 dur+ public heal? em]g5cies4 7#b7 ,report ,! arrangem5t "u p>agraph 7#a7 %all provide = submission by ! ,national ,academy ( ,m$ic9e to ! ,secret>y & ,congress1 n lat] ?an #abj days aft] ! date ( enactm5t ( ?is ,act1 ( a report on ! results ( ! /udy "u p>agraph 7#a7 & ! design propos$ bas$ on su* /udy4 #geec4 ,cl9ical trial div]sity 7a7 ,div]sity requirem5ts = applications = ,f$]al fund+ = cl9ical trials 7#a7 ,applications ,beg9n+ on ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,national ,in/itutes ( ,heal? 79 ?is subsection ref]r$ to z ! ,secret>y71 %all require t an entity seek+ to conduct a cl9ical trial inve/igat+ a drug or device 7z ^? t]ms are def9$ 9 section #bja ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act 7#ba ,u4,s4,c4 #cba77 or biological product 7z def9$ 9 section #cea7;i7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bfb7;i777 t is fund$ by ! ,national ,in/itutes ( ,heal? & conduct$ at any national rese>* in/itute or national c5t]1 submit an application 7or r5ewal !re(7 = su* fund+ t includes-- 7,a7 cle> & measurable goals = ! recruitm5t & ret5tion ( p>ticipants t reflect-- 7i7 ! race1 e?nicity1 age1 & g5d] or sex ( pati5ts ) ! disease or condition be+ inve/igat$2 or 7ii7 ! race1 e?nicity1 age1 & g5d] or sex ( ! g5]al population ( ! ,unit$ ,/ates if ! preval5ce ( ! disease or condition is n kn[n2 7,b7 a rationale = ! goals specifi$ "u subp>agraph 7,a7 t specifies-- 7i7 h[ inve/igators w calculate ! numb] ( p>ticipants = ea* population category t reflect ! population gr\ps specifi$ 9 subp>agraph 7,a72 & 7ii7 /rategies t w be us$ to enroll & reta9 p>ticipants across ! diff]5t racial1 e?nic1 age1 & g5d] or sex categories2 7,c7 a detail$ plan = h[ ! cl9ical trial w a*ieve ! goals specifi$ "u subp>agraph 7,a7 t specifies-- 7i7 ! requirem5ts = rese>*]s1 9 conduct+ ! trial to analyze ! population gr\ps specifi$ 9 subp>agraph 7,a7 sep>ately2 7ii7 ! role ( community p>tn]s or community in/itutional review bo>ds 9 review+ ! plans2 & 7iii7 h[ ! trial w recruit a /udy population t is-- 7,i7 9 proportion to ! preval5ce ( ! disease or condition 9 su* gr\ps relative to ! preval5ce ( ! disease or condition 9 ! ov]all population ( ! ,unit$ ,/ates2 7,,ii7 9 suffici5t numb]s to obta9 cl9ically & /ati/ically mean+ful det]m9ations ( ! safety & effectiv5ess ( ! drug be+ /udi$ 9 ! respective race1 e?nicity1 age1 & g5d] or sex gr\ps2 & 7,,iii7 consi/5t ) ! guidance "u section #eje7;b77#a7 ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act 7#ba ,u4,s4,c4 #cee7;b77#a77 & guidance issu$ by ! ,national ,in/itutes ( ,heal? on ! inclusion ( wom5 & m9orities 9 cl9ical trials2 7,d7 ! entity's plan = implem5t+1 or an explanation ( :y ! entity _c implem5t1 alt]native cl9ical trial foll[-up requirem5ts t are less burd5some = trial p>ticipants1 su* z-- 7i7 requir+ few] foll[-up visits2 7ii7 all[+ phone foll[-up or home visits by nurse trial coord9ators 79 lieu ( 9-p]son visits by pati5ts72 7iii7 all[+ = onl9e foll[-up options2 7iv7 p]mitt+ ! pati5t's prim>y c>e provid] to p]=m "s ( ! foll[-up visit requirem5ts & to reimburse ! pati5t = any out-(-pocket co/s incurr$ by ! pati5t = su* foll[-up visits2 7v7 all[+ = week5d h\rs = requir$ foll[-up visits2 7vi7 all[+ virtual or telem$ic9e visits2 7vii7 use ( we>able te*nology to record key heal? p>amet]s2 & 7viii7 use ( alt]nate labs or imag+ c5t]s1 :i* may be clos] to ! resid5ce ( ! pati5ts p>ticipat+ 9 ! trial2 & 7,e7 ! entity's education & tra9+ requirem5ts = rese>*]s & o!r individuals conduct+ or support+ ! cl9ical trial ) respect to div]sity & heal? inequities 9 und]repres5t$ populations1 includ+ a requirem5t to consult )1 & review mat]ials made available by1 su* committees1 task =ces1 & work+ gr\ps o!r entities ! ,secret>y det]m9es are appropriate1 includ+ ! foll[+3 7i7 ,! ,equity ,committee ( ! ,national ,in/itutes ( ,heal?4 7ii7 ,! ,national ,advisory ,c\ncil on ,m9ority ,heal? & ,heal? ,disp>ities4 7iii7 ,! ,advisory ,committee on ,rese>* on ,wom5's ,heal?4 7iv7 ,! ,sexual ,g5d] ,m9ority ,rese>* ,coord9at+ ,committee ( ! ,national ,in/itutes ( ,heal?4 7v7 ,! ,tribal ,heal? ,rese>* ,coord9at+ ,committee ( ! ,national ,in/itutes ( ,heal?4 7#b7 ,t]ms 7,a7 ,9 g5]al ,z a condition on ! receipt ( fund+ ?r\gh ! ,national ,in/itutes ( ,heal?1 z describ$ 9 p>agraph 7#a71 ) respect to a cl9ical trial1 ! sponsor ( ! cl9ical trial %all agree to t]ms requir+ t-- 7i7 ! aggregate demographic in=mation ( trial p>ticipants be %>$ on an annual basis ) ! ,secret>y :ile p>ticipant recruitm5t & data collection 9 su* trial is ongo+1 & t su* in=mation is provid$ ) respect to-- 7,i7 und]repres5t$ populations1 includ+ populations gr\p$ by race1 e?nicity1 age1 sex1 g5d] id5tity & expression1 geographic region1 prim>y writt5 & spok5 language1 disability /atus1 sexual ori5tation1 socioeconomic /atus1 occupation1 & o!r relevant factors2 & 7,,ii7 su* populations t reflect ! preval5ce ( ! disease or condition t is ! subject ( ! cl9ical trial involv$ 7z available & z appropriate to ! sci5tific objective = ! /udy1 z det]m9$ by ! ,director ( ! ,national ,in/itutes ( ,heal?72 7ii7 ! sponsor submits to ! program (fic] & grants managem5t speciali/ ( ! specific ,national ,in/itutes ( ,heal? national rese>* in/itute or national c5t]1 z frequ5tly z su* (fic] or speciali/ det]m9es necess>y1 ! ret5tion rate ( p>ticipants 9 ! cl9ical trial1 disaggregat$ by race1 e?nicity1 g5d] or sex1 & age2 7iii7 bo? ! cl9ical trial rese>*]s & ! applicant review]s complete education & tra9+ programs on div]sity 9 cl9ical trials2 & 7iv7 at ! conclusion ( ! trial1 ! sponsor submits to ! ,secret>y ! numb] ( p>ticipants 9 ! trial1 disaggregat$ by race1 e?nicity1 age1 & g5d] or sex4 7,b7 ,privacy protections ,any data %>$ "u subp>agraph 7,a7 may n include any individually id5tifiable in=mation or protect$ heal? in=mation ) respect to cl9ical trial p>ticipants & %all only be disclos$ to ! ext5t all[$ "u ,f$]al privacy laws4 7#c7 ,exception ,9 lieu ( submitt+ an application "u p>agraph 7#a7 & docum5tation ( goals z requir$ by subp>agraph 7,a7 ( su* p>agraph1 an applicant may provide reason+ 7o!r ?an co/7 = :y ! recruitm5t ( ea* ( ! population gr\ps specifi$ 9 subp>agraph 7,a7 ( p>agraph 7#a7 is n necess>y & :y su* recruitm5t is n sci5tifically ju/ifi$ or possible4 7#d7 ,publication ,! ,secret>y %all-- 7,a7 publi% on a public website ( ! ,national ,in/itutes ( ,heal?1 ^u receipt ( an application to :i* p>agraph 7#a7 applies or reason+ "u p>agraph 7#c7-- 7i7 a summ>y ( ! disease be+ t>get$ 9 ! cl9ical trial t is ! subject ( ! application & ! preval5ce ( su* disease across race1 e?nicity1 g5d] or sex1 age1 & cl9ical trial repres5tation 9 ea* su* category2 7ii7 ! goals specifi$ 9 su* application1 z requir$ by p>agraph 7#a77;,a72 or 7iii7 ! reason+ describ$ 9 p>agraph 7#c72 & 7,b7 ensure t1 9 publi%+ in=mation relat+ to an application or reason+ "u subp>agraph 7,a71 ! design ( ! /udy involv$ is n disclos$4 7#e7 ,rem$iation 7,a7 ,9 g5]al ,9 ! case ( a cl9ical trial subject to p>agraph 7#a7 t fails to meet ! condition specifi$ pursuant to p>agraph 7#a7 by su* date z may be agre$ ^u by ! sponsor ( ! trial & ! program (fic] & grants managem5t speciali/ ( ! specific ,national ,in/itutes ( ,heal? national rese>* in/itute or national c5t]1 ! ,secret>y %all require ! sponsor ( t cl9ical trial1 n lat] ?an #fj days aft] su* date occurs-- 7i7 to develop1 9 consultation ) ! ,secret>y & advocacy & community-bas$ organizations repres5t+ individuals :o are memb]s ( relevant demographic gr\ps specifi$ 9 p>agraph 7#a77;,a71 a /rategic plan to increase p>ticipation 9 su* cl9ical trial ( su* individuals2 & 7ii7 to submit to ! ,secret>y1 su* /rategic plan4 7,b7 ,publication ,! ,secret>y %all make publicly available on ! website ( ! ,national ,in/itutes ( ,heal?1 ! /rategic plan receiv$ "u subp>agraph 7,a7 z soon z possible aft] receipt4 ,! ,secret>y %all ensure t1 9 publi%+ su* plan "u ! prec$+ s5t5ce1 ! design ( ! /udy involv$ is n disclos$4 7,c7 ,implem5tation ,! sponsor ( ! cl9ical trial t is ! subject ( ! /rategic plan publi%$ "u subp>agraph 7,b71 %all1 n lat] ?an #fj days aft] su* date z may be agre$ ^u by ! sponsor ( ! trial & ! appropriate program (fic] & grants managem5t speciali/ ( ! ,national ,in/itutes ( ,heal?1 implem5t ! /rategic plan4 7,d7 ,te*nical assi/ance ,! ,secret>y may provide te*nical assi/ance to a sponsor ( a cl9ical trial1 z necess>y = ! sponsor to meet ! requirem5ts ( subp>agraph 7,c74 7#f7 ,p5alties 9 case ( failure ( rem$iation 7,a7 ,9 g5]al ,9 ! case ( a cl9ical trial subject to p>agraph 7#a7 t1 aft] ! close ( ! #fj-;day p]iod specifi$ 9 p>agraph 7#e77;,c71 cont9ues to fail to meet ! condition specifi$ pursuant to p>agraph 7#a77;,a71 ! ,secret>y %all-- 7i7 hold ! noncompet+ cont9uation ( fund+ receiv$ ?r\gh ! grant involv$2 7ii7 apply specific conditions on ! aw>d ( funds to su* sponsor to conduct su* cl9ical trial2 or 7iii7 t]m9ate su* fund+4 7,b7 ,waiv] 7i7 ,9 g5]al ,9 ! case ( a cl9ical trial subject to ! p5alty "u subp>agraph 7,a7 t fails to meet ! condition ref]r$ to 9 su* subp>agraph1 ! sponsor ( su* cl9ical trial may1 prior to ! conclusion ( ! #fj-;day p]iod ref]r$ to 9 subp>agraph 7,a71 submit an application to ! relevant program (fic] & grants speciali/ reque/+ a waiv] ( su* condition4 ,su* an application %all specify reason+ = :y ! recruitm5t ( ea* ( ! population gr\ps specifi$ 9 subp>agraph 7,a7 ( p>agraph 7#a7 is n necess>y or :y su* recruitm5t is n sci5tifically ju/ifi$ or possible4 7ii7 ,review ,n lat] ?an #cj days aft] a date agre$ ^u by ! sponsor ( ! trial & ! appropriate program (fic] & grants managem5t speciali/ ( ! ,national ,in/itutes ( ,heal?1 ! ,secret>y %all-- 7,i7 complete ! review ( su* application2 & 7,,ii7 make a det]m9ation to approve or d5y ! application4 7iii7 ,no additional p5alties ,no additional p5alties may be appli$ ) respect to a sponsor ( a cl9ical trial "u subp>agraph 7,a7 dur+ ! #cj-;day p]iod specifi$ 9 clause 7ii74 7,c7 ,t]m9ation ( fund+ ,9 ! case ( a cl9ical trial describ$ 9 subp>agraph 7,b77i71 ! ,secret>y may elect to t]m9ate fund+ describ$ 9 p>agraph 7#a7 = ! cl9ical trial if no reque/ = a waiv] "u subp>agraph 7,b7 is receiv$ by ! conclusion #fj-;day p]iod ref]r$ to 9 subp>agraph 7,a74 7#g7 ,waiv] = c]ta9 cl9ical trials 7,a7 ,9 g5]al ,9 ! case ( a cl9ical trial t receiv$ fund+ ?r\gh ! ,national ,in/itutes ( ,heal? & is ongo+ z ( ! date ( ! enactm5t ( ?is ,act1 ! sponsor ( su* cl9ical trial is exempt f ! requirem5ts ( 7& associat$ p5alties impos$ by7 ?is section4 7,b7 ,report ,! ,secret>y %all include 9 ! tri5nial report requir$ to be submitt$ "u section #djc ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhc71 a li/ ( all cl9ical trials receiv+ fund+ ?r\gh ! ,national ,in/itutes ( ,heal?-- 7i7 t reque/$ & receiv$ waiv]s "u ?is subsection2 or 7ii7 ) respect to :i* fund+ has be5 t]m9at$ pursuant to ?is subsection4 7#h7 ,/udy 7,a7 ,9 g5]al ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all conduct a /udy t-- 7i7 exam9es :i* actions ,f$]al ag5cies h tak5 to address b>ri]s to p>ticipation 9 f$]ally fund$ cl9ical trials by ! demographic gr\ps specifi$ 9 p>agraph 7#a77;,a72 & 7ii7 id5tifies *all5ges1 if any1 9 implem5t+ su* actions4 7,b7 ,report ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report on ! f9d+s ( ! /udy conduct$ "u subp>agraph 7,a74 7#i7 ,nondiscrim9ation ,section #aeeg ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahaaf7 %all apply ) respect to a cl9ical trial subject to p>agraph 7#a74 7b7 ,elim9at+ co/ b>ri]s 7#a7 ,/udy on mod]nization ( human subject regulations ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,national ,in/itutes ( ,heal? 7ref]r$ to 9 ?is subsection z ! ,secret>y71 %all conduct & complete a /udy on-- 7,a7 ! ne$ = review ( human subject regulations specifi$ 9 "p #df ( title #de1 ,code ( ,f$]al ,regulations 7or successor regulations71 & relat$ guidance2 7,b7 ! mod]nization ( su* regulations & guidance to e/abli% updat$ guidel9es = reimbursem5t ( out-(-pocket exp5ses ( human subjects1 comp5sation ( human subjects = "t sp5t p>ticipat+ 9 ! cl9ical trial1 & inc5tives = recruitm5t ( human subjects2 & 7,c7 ! ne$ = updat$ safe h>bor rules "u section #ajja4ieb ( title #db1 ,code ( ,f$]al ,regulations 7or successor regulations7 & section #aabh;,b ( ! ,social ,security ,act 7commonly ref]r$ to z ! ,f$]al ,anti-,kickback ,/atute 7#db ,u4,s4,c4 #acbj;a-#g;b77 ) respect to ! assi/ance provid$ "u ?is subsection4 7#b7 ,reimbursem5t = co/s associat$ ) cl9ical trial p>ticipation ,z a condition on receipt ( any fund+ provid$ ?r\gh ! ,national ,in/itutes ( ,heal? to conduct a cl9ical trial inve/igat+ a drug or device 7z ^? t]ms are def9$ 9 section #bja ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act 7#ba ,u4,s4,c4 #cba77 or biological product 7z def9$ 9 section #cea7;i7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bfb7;i7771 ! ,secret>y %all require t ! sponsor ( su* cl9ical trial-- 7,a7 works ) in/itutional review bo>ds & program (fic]s ( ! ,national ,in/itutes ( ,heal? to det]m9e :5 reimbursem5t = ! co/s associat$ ) cl9ical trial p>ticipation is w>rant$2 & 7,b7 subject to p>agraph 7#c71 provides to cl9ical trial p>ticipants reimbursem5t = exp5ses 7us+ funds o!r ?an funds suppli$ ?r\gh ! ,national ,in/itutes ( ,heal?7 incurr$ z a result ( t p>ticipation1 :i* may include-- 7i7 miss$ or =gone sal>y2 7ii7 language assi/ance1 includ+ int]pret] s]vices2 7iii7 food exp5ses2 7iv7 *ildc>e exp5ses2 7v7 lodg+ exp5ses2 7vi7 transportation exp5ses2 or 7vii7 o!r exp5ses z id5tifi$ by ! p>ticipant1 subject to review by ! cl9ical trial sponsor1 at its discretion1 on a case-by-case basis4 7#c7 ,provision ( co/s associat$ ) cl9ical trial p>ticipation 7,a7 ,application & docum5tation 7i7 ,9 g5]al ,a sponsor ( a cl9ical trial to :i* subsection 7a77#a7 applies1 may require t1 9 ord] to receive reimbursem5t z describ$ 9 p>agraph 7#b71 a p>ticipant complete an application & %>e ) ! sponsor su* docum5tation ( exp5ses describ$ 9 su* p>agraph1 z ! sponsor may require4 7ii7 ,tim+ ,n lat] ?an #cj days aft] ! date on :i* a sponsor ( a cl9ical trial receives an application "u clause 7i71 ! sponsor %all-- 7,i7 review ! application2 & 7,,ii7 provide = reimbursem5t ( eligible exp5ses docum5t$ 9 su* application1 z det]m9$ at ! discretion ( ! cl9ical trial sponsor on a case-by-case basis4 7,b7 ,en=cem5t ,a sponsor ( a cl9ical trial to :i* subsection 7a77#a7 applies1 %all submit on an annual basis1 z "p ( ! progress reports submitt$ to ! ,secret>y pursuant to section #djb7;j7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhb7;j771 dur+ ! data collection p]iod ( ! cl9ical trial1 to ! ,secret>y an acc\nt+ ( ! reimbursem5ts made to cl9ical trial p>ticipants "u subp>agraph 7,a74 ,su* data %all-- 7i7 include relevant aggregate data ) respect to ea* population gr\p specifi$ 9 subsection 7a77#b77;,a77i7 :5 su* data w n compromise ! id5tities ( /udy p>ticipants & 9 a mann] consi/5t ) applicable privacy protections2 & 7ii7 n lat] ?an #f mon?s aft] receipt by ! ,secret>y1 be publi%$ on a public website ( ! ,national ,in/itutes ( ,heal?4 7c7 ,public aw>5ess & education campaign 7#a7 ,national campaign ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,national ,in/itutes ( ,heal? & ! ,commission] ( ,food & ,drugs 7ref]r$ to 9 ?is subsection z ! ,secret>y71 9 consultation ) ! /akehold]s specifi$ 9 p>agraph 7#e71 %all c>ry out a national campaign to increase ! aw>5ess & k ( individuals 9 ! ,unit$ ,/ates ) respect to ! ne$ = div]se cl9ical trials among ! demographic gr\ps id5tifi$ pursuant to subsection 7a77#a77;,a74 7#b7 ,requirem5ts ,! national campaign conduct$ %all include-- 7,a7 ! developm5t & di/ribution ( writt5 educational mat]ials1 & ! developm5t & plac+ ( public s]vice ann\ncem5ts1 t are int5d$ to enc\rage individuals :o are memb]s ( ! demographic gr\ps id5tifi$ pursuant to subsection 7a77#b77;,a77i77,i7 to seek to p>ticipate 9 cl9ical trials2 7,b7 su* ef=ts z are reasonable & necess>y to ensure mean+ful access by consum]s ) limit$ ,engli% pr(ici5cy2 7,c7 ! developm5t & di/ribution ( be/ practices & tra9+ = recruit+ und]repres5t$ /udy populations1 includ+ a me?od = %>+ su* be/ practices among cl9ical trial sponsors1 provid]s1 community-bas$ organizations :o assi/ ) recruitm5t1 & ) ! public2 & 7,d7 ! conduct ( focus gr\ps to bett] und]/& ! conc]ns & fe>s ( c]ta9 und]repres5t$ gr\ps :o may be reluctant to p>ticipate 9 cl9ical trials4 7#c7 ,heal? inequities ,9 develop+ ! national campaign "u p>agraph 7#a71 ! ,secret>y %all recognize & address-- 7,a7 heal? inequities among individuals :o are memb]s ( ! population gr\ps specifi$ 9 subsection 7a77#b77;,a77i7 ) respect to access to c>e & p>ticipation 9 cl9ical trials2 & 7,b7 any b>ri]s 9 access to c>e & p>ticipation 9 cl9ical trials t are specific to individuals :o are memb]s ( su* gr\ps4 7#d7 ,grants ,! ,secret>y %all e/abli% a program to aw>d grants to nonpr(it private entities1 includ+ community-bas$ organizations & fai? communities1 in/itutions ( high] education eligible to receive funds "u section #cga ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajfgq7 & national organizations t s]ve und]repres5t$ populations & community ph>macies to enable su* entities-- 7,a7 to te/ alt]native outrea* & education /rategies to increase ! aw>5ess & k ( individuals 9 ! ,unit$ ,/ates1 ) respect to ! ne$ = div]se cl9ical trials t reflect ! race1 e?nicity1 age1 & g5d] or sex ( pati5ts ) ! disease or condition be+ inve/igat$2 & 7,b7 to cov] adm9i/rative co/s ( su* entities 9 assi/+ 9 div]sify+ cl9ical trials subject to subsection 7a74 7#e7 ,/akehold]s specifi$ ,! /akehold]s specifi$ 9 ?is p>agraph are ! foll[+3 7,a7 ,repres5tatives ( ! ,heal? ,res\rces ,s]vices ,adm9i/ration1 ! ,(fice ( ,m9ority ,heal? ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices1 ! ,c5t]s = ,disease ,control & ,prev5tion1 & ! ,national ,in/itutes ( ,heal?4 7,b7 ,community-bas$ res\rces & advocates4 7#f7 ,au?orization ( ,appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is subsection #aj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbf4 7d7 ,def9itions ,9 ?is section3 7#a7 ,cl9ical trial ,! t]m cl9ical trial means a rese>* /udy 9 :i* "o or m human subjects are prospectively assign$ to "o or m int]v5tions 7:i* may include placebo or o!r control7 to evaluate ! effects ( ^? int]v5tions on heal?-relat$ biom$ical or behavioral outcomes4 7#b7 ,sponsor ,! t]m sponsor has ! mean+ giv5 su* t]m 9 section #ej4c ( title #ba1 ,code ( ,f$]al ,regulations 7or successor regulations74 #geed4 ,pati5t exp]i5ce data 7a7 ,policy ,section #efi;,c ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act 7#ba ,u4,s4,c4 #cfj;bbb-#h;c7 is am5d$-- 7#a7 by r$esignat+ subsections 7b7 & 7c7 z subsections 7c7 & 7d71 respectively2 & 7#b7 by ins]t+ aft] subsection 7a7 ! foll[+ new subsection3 7b7 ,collection1 submission1 & use ( data 7#a7 ,9 g5]al ,! ,secret>y %all-- 7,a7 = any drug = :i* an exemption is grant$ = inve/igational use "u section #eje7;i7 ( ?is ,act or section #cea7;a7 ( ! ,public ,heal? ,s]vice ,act1 require ! sponsor ( ! drug to collect /&>diz$ pati5t exp]i5ce data z "p ( ! cl9ical trials conduct$ pursuant to su* exemption2 7,b7 require any application = ! approval or lic5s+ ( su* drug "u section #eje7;b7 ( ?is ,act or section #cea7;a7 ( ! ,public ,heal? ,s]vice ,act to include-- 7i7 ! /&>diz$ pati5t exp]i5ce data s collect$2 & 7ii7 su* relat$ in=mation z ! ,secret>y may require2 & 7,c7 consid] pati5t exp]i5ce data & relat$ in=mation t is submitt$ pursuant to subp>agraph 7,b7 9 decid+ :e!r to approve or lic5se1 z applicable1 ! drug involv$4 7#b7 ,applicability ,p>agraph 7#a7 applies only ) respect to drugs = :i* a reque/ = an exemption describ$ 9 p>agraph 7#a77;,a7 is submitt$ on or aft] ! date ( ! enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb1 or an application "u section #eje7;b7 ( ?is ,act or section #cea7;a7 ( ! ,public ,heal? ,s]vice ,act is fil$1 z applicable1 on or aft] ! day t is #b ye>s aft] ! date ( ! enactm5t ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb4 4 7b7 ,regulations ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,commission] ( ,food & ,drugs1 %all promulgate f9al regulations to implem5t section #efi;,c7b7 ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act1 z add$ by ?is section4 ,m ,additional ,provisions ,address+ ,high-,impact ,m9ority ,diseases #gfja4 ,m$ic>e cov]age ( multi-canc] e>ly detection scre5+ te/s 7a7 ,cov]age ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 z am5d$ be sections #bjjg1 #dbba1 #dbea1 #fjaa1 & #gbbj1 is am5d$-- 7#a7 9 subsection 7s77#b7-- 7,a7 9 subp>agraph 7,,jj71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,,kk71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,,ll7 multi-canc] e>ly detection scre5+ te/s 7z def9$ 9 subsection 7qqq772 2 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7qqq7 ,multi-,canc] e>ly detection scre5+ te/s ,! t]m multi-canc] e>ly detection scre5+ te/ means any ( ! foll[+ te/s1 approv$ or cle>$ by ! ,food & ,drug ,adm9i/ration1 furni%$ to an individual = ! purpose ( e>ly detection ( canc] across _m canc] types 7z categoriz$ 9 ! ,annual ,report to ! ,nation on ! ,/atus ( ,canc] issu$ by ! ,national ,canc] ,in/itute73 7#a7 ,a g5omic sequ5c+ blood or blood product te/ t includes ! analysis ( cell-free nucleic acids4 7#b7 ,su* o!r equival5t te/s 7:i* are bas$ on ur9e or ano!r sample ( biological mat]ial7 z ! ,secret>y det]m9es appropriate4 4 7b7 ,paym5t & frequ5cy limit 7#a7 ,paym5t "u fee s*$ule ,section #ahcc7;h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7h77 is am5d$-- 7,a7 9 p>agraph 7#a77;,a71 by ins]t+ aft] 7includ+ ! foll[+3 multi-canc] e>ly detection scre5+ te/s "u section #ahfa7qqq7 & includ+2 & 7,b7 by add+ at ! end ! foll[+ new p>agraph3 7#aj7 ,no paym5t may be made "u ?is "p = a multi-canc] e>ly detection scre5+ te/ 7z def9$ 9 section #ahfa7qqq77 = an individual if su* a te/ 0 furni%$ to ! individual dur+ ! previ\s #aa mon?s4 4 7#b7 ,con=m+ am5dm5t ,section #ahfb7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77 is am5d$-- 7,a7 9 p>agraph 7#a7-- 7i7 9 subp>agraph 7,o71 by /rik+ & at ! end2 7ii7 9 subp>agraph 7,p71 by /rik+ ! semicolon at ! end & ins]t+ 1 &2 & 7iii7 by add+ at ! end ! foll[+ new subp>agraph3 7,q7 9 ! case ( multi-canc] e>ly detection scre5+ te/s 7z def9$ 9 section #ahfa7qqq771 :i* are p]=m$ m frequ5tly ?an is cov]$ "u section #ahcc7;h77#aj72 2 & 7,b7 9 p>agraph 7#g71 by /rik+ or 7,p7 & ins]t+ 7,p71 or 7,q74 7c7 ,rule ( con/ruction relat+ to o!r canc] scre5+ te/s ,no?+ 9 ?is section1 includ+ ! am5dm5ts made by ?is section1 %all be con/ru$-- 7#a7 9 ! case ( an individual :o und]goes a multi-canc] e>ly detection scre5+ te/1 to affect cov]age "u "p ,b = o!r canc] scre5+ te/s cov]$ "u ?is section1 su* z scre5+ te/s = brea/1 c]vical1 colorectal1 lung1 or pro/ate canc]2 or 7#b7 9 ! case ( an individual :o und]goes ano!r canc] scre5+ te/1 to affect cov]age = a multi-canc] e>ly detection scre5+ te/ or ! use ( su* a te/ z a diagno/ic or confirmatory te/ = a result ( ! o!r canc] scre5+ te/4 #gfjb4 ,amputation ,r$uction & ,compassion ,act 7a7 ,p]iph]al art]y disease education program ,"p ,p ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhj;g et seq471 z am5d$ by section #gbed1 is fur!r am5d$ by add+ at ! end ! foll[+ new section3 #cii,v-#ac4 ,p]iph]al art]y disease education program 7a7 ,e/abli%m5t ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 9 collaboration ) ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices & ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all e/abli% & coord9ate a p]iph]al art]y disease education program to support1 develop1 & implem5t educational initiatives & outrea* /rategies t in=m heal? c>e pr(essionals & ! public ab\t ! exi/5ce ( p]iph]al art]y disease & me?ods to r$uce amputations relat$ to su* disease1 p>ticul>ly ) respect to at-risk populations4 7b7 ,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 #bjbc ?r\gh #bjbg4 4 7b7 ,m$ic>e cov]age ( p]iph]al art]y disease scre5+ te/s furni%$ to at-,risk b5efici>ies )\t imposition ( co/ %>+ requirem5ts 7#a7 ,9 g5]al ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 z am5d$ by sections #bjjg1 #dbba1 #dbea1 #fjaa1 #gbbj1 & #gfja1 is am5d$-- 7,a7 9 subsection 7s77#b7-- 7i7 9 subp>agraph 7,,kk71 by /rik+ & at ! end2 7ii7 9 subp>agraph 7,,ll71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7iii7 by add+ at ! end ! foll[+ new subp>agraph3 7,,mm7 p]iph]al art]y disease scre5+ te/s furni%$ to at-risk b5efici>ies 7z su* t]ms are def9$ 9 subsection 7rrr774 2 & 7,b7 by add+ at ! end ! foll[+ new subsection3 7rrr7 ,p]iph]al art]y disease scre5+ te/2 ,at-,risk b5efici>y 7#a7 ,! t]m p]iph]al art]y disease scre5+ te/ means-- 7,a7 non9vasive physiologic /udies ( extremity art]ies 7commonly ref]r$ to z ankle-bra*ial index te/+72 7,b7 art]ial duplex scans ( l[] extremity art]ies vascul>2 & 7,c7 su* o!r items & s]vices z ! ,secret>y det]m9es1 9 consultation ) relevant /akehold]s1 to be appropriate = scre5+ = p]iph]al art]y disease = at-risk b5efici>ies4 7#b7 ,! t]m at-risk b5efici>y means an individual entitl$ to1 or enroll$ =1 b5efits "u "p ,a & enroll$ = b5efits "u "p ,b-- 7,a7 :o is #fe ye>s ( age or old]2 7,b7 :o is at lea/ #ej ye>s ( age b n old] ?an #fd ye>s ( age ) risk factors = a!roscl]osis 7su* z diabetes mellitus1 a hi/ory ( smok+1 hyp]lipidemia1 & hyp]t5sion7 or a family hi/ory ( p]iph]al art]y disease2 7,c7 :o is y\ng] ?an #ej ye>s ( age ) diabetes mellitus & "o additional risk factor = a!roscl]osis2 or 7,d7 ) a kn[n a!roscl]otic disease 9 ano!r vascul> b$ su* z coron>y1 c>otid1 subclavian1 r5al1 or mes5t]ic art]y /5osis1 or abdom9al aortic aneurysm4 7#c7 ,! ,secret>y %all1 9 consultation ) appropriate organizations1 e/abli% /&>ds reg>d+ ! frequ5cy = p]iph]al art]y disease scre5+ te/s describ$ 9 subsection 7s77#b77;,,ii7 = purposes ( cov]age "u ?is title4 4 7#b7 ,inclusion ( p]iph]al art]y disease scre5+ te/s 9 initial prev5tive physical exam9ation ,section #ahfa7ww77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ww77#b77 is am5d$-- 7,a7 9 subp>agraph 7,n71 by mov+ ! m>g9s ( su* subp>agraph #b ems to ! left2 7,b7 by r$esignat+ subp>agraph 7,o7 z subp>agraph 7,p72 & 7,c7 by ins]t+ aft] subp>agraph 7,n7 ! foll[+ new subp>agraph3 7,o7 ,p]iph]al art]y disease scre5+ te/s furni%$ to at-risk b5efici>ies 7z su* t]ms are def9$ 9 subsection 7rrr774 4 7#c7 ,paym5t 7,a7 ,9 g5]al ,section #ahcc7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a771 z am5d$ by sections #dbea7;c77#c71 #fjaa7;a77#d71 & #gbbj1 is am5d$-- 7i7 9 p>agraph 7#a7-- 7,i7 9 subp>agraph 7,n71 by ins]t+ & o!r ?an p]iph]al art]y disease scre5+ te/s furni%$ to at-risk b5efici>ies 7z su* t]ms are def9$ 9 section #ahfa7lll77 aft] o!r ?an p]sonaliz$ prev5tion plan s]vices 7z def9$ 9 section #ahfa7;hhh77#a772 7,,ii7 by /rik+ & be=e 7,,gg72 & 7,,iii7 by ins]t+ be=e ! semicolon at ! end ! foll[+3 1 & 7,,hh7 ) respect to p]iph]al art]y disease scre5+ te/s furni%$ to at-risk b5efici>ies 7z su* t]ms are def9$ 9 section #ahfa7rrr771 ! am\nt paid %all be #ajj p]c5t ( ! less] ( ! actual *>ge = ! s]vices or ! am\nt det]m9$ "u ! paym5t basis det]m9$ "u section #ahdh2 & 7ii7 9 p>agraph 7#b7-- 7,i7 9 subp>agraph 7,g71 by /rik+ & at ! end2 7,,ii7 9 subp>agraph 7,h71 by /rik+ ! comma at ! end & ins]t+ 2 &2 & 7,,iii7 by ins]t+ aft] subp>agraph 7,h7 ! foll[+ new subp>agraph3 7,i7 ) respect to p]iph]al art]y disease scre5+ te/s 7z def9$ 9 p>agraph 7#a7 ( section #ahfa7rrr77 furni%$ by an outpati5t dep>tm5t ( a hospital to at-risk b5efici>ies 7z def9$ 9 p>agraph 7#b7 ( su* section71 ! am\nt det]m9$ "u p>agraph 7#a77;,,ee71 4 7,b7 ,no d$uctible ,section #ahcc7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7b771 z am5d$ by section #fjge1 is am5d$1 9 ! fir/ s5t5ce-- 7i7 by /rik+ & be=e 7#ac72 & 7ii7 by ins]t+ 1 & 7#ad7 su* d$uctible %all n apply ) respect to p]iph]al art]y disease scre5+ te/s furni%$ to at-risk b5efici>ies 7z su* t]ms are def9$ 9 section #ahfa7rrr77 be=e ! p]iod at ! end4 7,c7 ,exclusion f prospective paym5t sy/em = hospital outpati5t dep>tm5t s]vices ,section #ahcc7t77#a77;,b77iv7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#a77;,b77iv77 is am5d$-- 7i7 by /rik+ 1 or p]sonaliz$ & ins]t+ 1 p]sonaliz$2 & 7ii7 by ins]t+ 1 or p]iph]al art]y disease scre5+ te/s furni%$ to at-risk b5efici>ies 7z su* t]ms are def9$ 9 section #ahfa7rrr77 aft] p]sonaliz$ prev5tion plan s]vices 7z def9$ 9 section #ahfa7;hhh77#a774 7,d7 ,paym5t "u physician fee s*$ule ,section #ahdh7;j77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c771 z am5d$ by section #dbea7;c77#d71 is am5d$ by ins]t+ 1 7#b77,,mm71 aft] 7#b77;,,ii74 7#d7 ,exclusion f cov]age & ,m$ic>e z second>y pay] = te/s p]=m$ m frequ5tly ?an all[$ ,section #ahfb7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#a771 z am5d$ by section #gfja1 is am5d$-- 7,a7 9 subp>agraph 7,p71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,q71 by /rik+ ! semicolon at ! end & ins]t+ 1 &2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,r7 9 ! case ( p]iph]al art]y disease scre5+ te/s furni%$ to at-risk b5efici>ies 7z su* t]ms are def9$ 9 section #ahfa7rrr771 :i* are p]=m$ m frequ5tly ?an is cov]$ "u su* section2 4 7#e7 ,au?ority ,to modify or elim9ate cov]age ( c]ta9 prev5tive s]vices ,section #ahcd7n7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7n77 is am5d$-- 7,a7 by r$esignat+ subp>agraphs 7,a7 & 7,b7 ( p>agraph 7#a7 z clauses 7i7 & 7ii71 respectively1 & mov+ ! m>g9s ( su* clauses1 z s r$esignat$1 #b ems to ! "r2 7,b7 by r$esignat+ p>agraphs 7#a7 & 7#b7 z subp>agraphs 7,a7 & 7,b71 respectively1 & mov+ ! m>g9s ( su* subp>agraphs1 z s r$esignat$1 #b ems to ! "r2 7,c7 by /rik+ ,c]ta9 ,prev5tive ,s]vices & all t foll[s ?r\gh any o!r provision ( ?is title & ins]t+3 ,c]ta9 ,prev5tive ,s]vices4-- 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( ?is title 2 & 7,d7 by add+ at ! end ! foll[+ new p>agraph3 7#b7 ,inapplicability ,! ,secret>ial au?ority describ$ 9 p>agraph 7#a7 %all n apply ) respect to prev5tive s]vices describ$ 9 section #ahfa7ww77#b77,o74 4 7#f7 ,effective date ,! am5dm5ts made by ?is subsection %all apply ) respect to items & s]vices furni%$ on or aft] ,janu>y #a1 #bjbc4 7c7 ,m$icaid cov]age ( p]iph]al art]y disease scre5+ te/s furni%$ to at-,risk b5efici>ies )\t imposition ( co/ %>+ requirem5ts 7#a7 ,9 g5]al ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 z am5d$ by sections #bjjg7;d77#c7 & #ebja7;a77#e77;,g77i71 is am5d$-- 7,a7 9 subsection 7a7-- 7i7 by r$esignat+ p>agraph 7#cc7 z p>agraph 7#cd72 7ii7 9 p>agraph 7#cb71 by /rik+ & aft] ! semicolon2 & 7iii7 by ins]t+ aft] p>agraph 7#cb7 ! foll[+ new p>agraph3 7#cc7 p]iph]al art]y disease scre5+ te/s furni%$ to at-risk b5efici>ies 7z su* t]ms are def9$ 9 subsection 7qq772 & 2 & 7,b7 by add+ at ! end ! foll[+ new subsection3 7qq7 ,p]iph]al art]y disease scre5+ te/2 ,at-,risk b5efici>y 7#a7 ,p]iph]al art]y disease scre5+ te/ ,! t]m p]iph]al art]y disease scre5+ te/ means-- 7,a7 non9vasive physiologic /udies ( extremity art]ies 7commonly ref]r$ to z ankle-bra*ial index te/+72 7,b7 art]ial duplex scans ( l[] extremity art]ies vascul>2 & 7,c7 su* o!r items & s]vices z ! ,secret>y det]m9es1 9 consultation ) relevant /akehold]s1 to be appropriate = scre5+ = p]iph]al art]y disease = at-risk b5efici>ies4 7#b7 ,at-risk b5efici>y ,! t]m at-risk b5efici>y means an individual enroll$ "u a ,/ate plan 7or a waiv] ( su* plan7-- 7,a7 :o is #fe ye>s ( age or old]2 7,b7 :o is at lea/ #ej ye>s ( age b n old] ?an #fd ye>s ( age ) risk factors = a!roscl]osis 7su* z diabetes mellitus1 a hi/ory ( smok+1 hyp]lipidemia1 & hyp]t5sion7 or a family hi/ory ( p]iph]al art]y disease2 7,c7 :o is y\ng] ?an #ej ye>s ( age ) diabetes mellitus & "o additional risk factor = a!roscl]osis2 or 7,d7 ) a kn[n a!roscl]otic disease 9 ano!r vascul> b$ su* z coron>y1 c>otid1 subclavian1 r5al1 or mes5t]ic art]y /5osis1 or abdom9al aortic aneurysm4 7#c7 ,frequ5cy ,! ,secret>y %all1 9 consultation ) appropriate organizations1 e/abli% /&>ds reg>d+ ! frequ5cy = p]iph]al art]y disease scre5+ te/s describ$ 9 subsection 7a77#cc7 = purposes ( cov]age "u a ,/ate plan "u ?is title4 4 7#b7 ,no co/ %>+ 7,a7 ,9 g5]al ,subsections 7a77#b7 & 7b77#b7 ( section #aiaf ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifo71 z am5d$ by section #gaed7;b77#a71 are ea* am5d$-- 7i7 9 subp>agraph 7,j71 by /rik+ or aft] ! comma at ! end2 7ii7 9 subp>agraph 7,k71 by /rik+ 2 & & ins]t+ 1 or2 & 7iii7 by add+ at ! end ! foll[+ new subp>agraph3 7,l7 p]iph]al art]y disease scre5+ te/s furni%$ to at-risk b5efici>ies 7z su* t]ms are def9$ 9 section #aije7;hh772 & 4 7,b7 ,application to alt]native co/ %>+ ,section #aiaf;,a7b77#c77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifo-#a7;b77#c77;,b771 z am5d$ by section #gaed7;b77#b71 is am5d$ by add+ at ! end ! foll[+ new clause3 7xv7 ,p]iph]al art]y disease scre5+ te/s furni%$ to at-risk b5efici>ies 7z su* t]ms are def9$ 9 section #aije7qq774 4 7#c7 ,m&atory cov]age ,section #aijb7;a77#aj77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a771 z am5d$ by section #bjjg7;d77#b71 is am5d$ by /rik+ & 7#ca7 & ins]t+ 7#ca71 & 7#cc74 7d7 ,requirem5t = gr\p heal? plans & heal? insurance issu]s (f]+ gr\p or individual heal? insurance cov]age ,to provide cov]age = p]iph]al art]y disease scre5+ te/s furni%$ to at-,risk enrollees )\t imposition ( co/ %>+ requirem5ts 7#a7 ,9 g5]al ,section #bgac ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ac7 is am5d$-- 7,a7 by am5d+ subsection 7a71 z am5d$ by section #gbbj7;a77#a77;,a71 to read z foll[s3 7a7 ,cov]age ( prev5tive heal? s]vices 7#a7 ,9 g5]al ,a gr\p heal? plan & a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all1 at a m9imum1 provide cov]age = & %all n impose any co/ %>+ requirem5ts =-- 7,a7 evid5ce-bas$ items or s]vices t h 9 effect a rat+ ( ,a or ,b 9 ! curr5t recomm5dations ( ! ,unit$ ,/ates ,prev5tive ,s]vices ,task ,=ce2 7,b7 immunizations t h 9 effect a recomm5dation f ! ,advisory ,committee on ,immunization ,practices ( ! ,c5t]s = ,disease ,control & ,prev5tion ) respect to ! individual involv$2 7,c7 ) respect to infants1 *ildr51 & adolesc5ts1 evid5ce-in=m$ prev5tive c>e & scre5+s provid$ = 9 ! compreh5sive guidel9es support$ by ! ,heal? ,res\rces & ,s]vices ,adm9i/ration2 7,d7 ) respect to wom51 su* additional prev5tive c>e & scre5+s n describ$ 9 subp>agraph 7,a7 z provid$ = 9 compreh5sive guidel9es support$ by ! ,heal? ,res\rces & ,s]vices ,adm9i/ration = purposes ( ?is subp>agraph2 7,e7 any prescription drug approv$ by ! ,food & ,drug ,adm9i/ration = ! prev5tion ( ,,hiv 7o!r ?an a drug subject to preau?orization requirem5ts consi/5t ) section #bgbi;,a71 adm9i/rative fees = su* drugs1 laboratory & o!r diagno/ic proc$ures associat$ ) ! use ( su* drugs1 & cl9ical foll[-up & monitor+1 includ+ any relat$ s]vices recomm5d$ 9 curr5t ,unit$ ,/ates ,public ,heal? ,s]vice cl9ical practice guidel9es1 )\t limitation2 & 7,f7 ) respect to at-risk enrollees1 p]iph]al art]y disease scre5+ te/s4 7#b7 ,p]iph]al art]y disease scre5+ te/2 ,at-risk enrollee ,= purposes ( p>agraph 7#a77;,e73 7,a7 ,p]iph]al art]y disease scre5+ te/ ,! t]m p]iph]al art]y disease scre5+ te/ means-- 7i7 non9vasive physiologic /udies ( extremity art]ies 7commonly ref]r$ to z ankle-bra*ial index te/+72 7ii7 art]ial duplex scans ( l[] extremity art]ies vascul>2 & 7iii7 su* o!r items & s]vices z ! ,secret>y det]m9es1 9 consultation ) relevant /akehold]s1 to be appropriate = scre5+ = p]iph]al art]y disease = at-risk enrollees4 7,b7 ,at-risk enrollee ,! t]m at-risk enrollee means an individual enroll$ 9 a gr\p heal? plan or gr\p or individual heal? insurance cov]age-- 7i7 :o is #fe ye>s ( age or old]2 7ii7 :o is at lea/ #ej ye>s ( age b n old] ?an #fd ye>s ( age ) risk factors = a!roscl]osis 7su* z diabetes mellitus1 a hi/ory ( smok+1 hyp]lipidemia1 & hyp]t5sion7 or a family hi/ory ( p]iph]al art]y disease2 7iii7 :o is y\ng] ?an #ej ye>s ( age ) diabetes mellitus & "o additional risk factor = a!roscl]osis2 or 7iv7 ) a kn[n a!roscl]otic disease 9 ano!r vascul> b$ su* z coron>y1 c>otid1 subclavian1 r5al1 or mes5t]ic art]y /5osis1 or abdom9al aortic aneurysm4 7,c7 ,frequ5cy ,! ,secret>y %all1 9 consultation ) appropriate organizations1 e/abli% /&>ds reg>d+ ! frequ5cy = p]iph]al art]y disease scre5+ te/s describ$ 9 p>agraph 7#a77;,e7 = purposes ( cov]age "u ?is section4 7#c7 ,cl>ification reg>d+ brea/ canc] scre5+1 mammography1 & prev5tion recomm5dations ,= ! purposes ( ?is ,act1 & = ! purposes ( any o!r provision ( law1 ! curr5t recomm5dations ( ! ,unit$ ,/ates ,prev5tive ,s]vice ,task ,=ce reg>d+ brea/ canc] scre5+1 mammography1 & prev5tion %all be consid]$ ! mo/ curr5t o!r ?an ^? issu$ 9 or ar\nd ,novemb] #bjji4 7#d7 ,rule ( con/ruction ,no?+ 9 ?is subsection %all be con/ru$ to prohibit a plan or issu] f provid+ cov]age = s]vices 9 addition to ^? recomm5d$ by ! ,unit$ ,/ates ,prev5tive ,s]vices ,task ,=ce or to d5y cov]age = s]vices t are n recomm5d$ by su* ,task ,=ce4 2 & 7,b7 9 subsection 7b77#a7-- 7i7 by /rik+ subsection 7a77#a7 or 7a77#b7 or a guidel9e "u subsection 7a77#c7 & ins]t+ subp>agraph 7,a7 or 7,b7 ( subsection 7a77#a7 or a guidel9e "u subp>agraph 7,c7 ( su* subsection2 & 7ii7 by /rik+ describ$ 9 subsection 7a7 & ins]t+ describ$ 9 subsection 7a77#a74 7#b7 ,effective date ,! am5dm5ts made by p>agraph 7#a7 %all apply ) respect to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbc4 7e7 ,disall[ance ( paym5t = nontraumatic amputation s]vices furni%$ )\t anatomical te/+ s]vices ,section #ahcd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem71 z am5d$ by section #dbba7;b77#b71 is am5d$ by add+ at ! end ! foll[+ new subsection3 7aa7 ,disall[ance ( paym5t = nontraumatic amputation s]vices furni%$ )\t anatomical te/+ s]vices 7#a7 ,9 g5]al ,9 ! case ( nontraumatic amputation s]vices furni%$ by a suppli] on or aft] ,janu>y #a1 #bjbc1 to an individual entitl$ to1 or enroll$ =1 b5efits "u "p ,a & enroll$ = b5efits "u ?is "p1 = :i* paym5t is made "u ?is "p1 paym5t may only be made "u ?is "p if-- 7,a7 su* suppli] furni%es anatomical te/+ s]vices to su* individual dur+ ! #c-mon? p]iod prec$+ ! date on :i* su* nontraumatic amputation s]vices is furni%$2 or 7,b7 su* individual has a pre-exi/+ dysfunctional or unsalvageable limb1 life-?reat5+ sepsis1 intractable infection1 ext5sive gangr5e or necrotic tissue loss beyond salvage1 a poor functional /atus1 sev]e dem5tia1 or a %ort life expectancy aft] %>$ decision mak+ ) a heal? c>e team & pati5t1 family1 or c>egiv]4 7#b7 ,def9itions ,9 ?is subsection3 7,a7 ,anatomical te/+ s]vices ,! t]m anatomical te/+ s]vices means art]ial duplex scann+1 comput$ tomography angiography1 & magnetic resonance angiography4 7,b7 ,nontraumatic amputation s]vices ,! t]m nontraumatic amputation s]vices means amputations z a result ( a!roscl]otic vascul> disease or a relat$ comorbidity ( su* disease 7includ+ diabetes74 4 7f7 ,developm5t & implem5tation ( quality measures 7#a7 ,developm5t ,! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is subsection z ! ,secret>y7 %all1 9 consultation ) relevant /akehold]s1 develop quality measures = nontraumatic1 l[]-limb1 major amputation t utilize appropriate diagno/ic scre5+ 7includ+ p]iph]al art]y disease scre5+7 9 ord] to enc\rage alt]native treatm5ts 7includ+ revascul>ization7 9 lieu ( su* an amputation4 7#b7 ,implem5tation ,aft] appropriate te/+ & validation ( ! measures develop$ "u p>agraph 7#a71 ! ,secret>y %all incorporate su* measures 9 quality report+ programs = appropriate provid]s ( s]vices & suppli]s "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 includ+ = purposes (-- 7,a7 ! m]it-bas$ inc5tive paym5t sy/em "u section #ahdh7q7 ( su* ,act 7#db ,u4,s4,c4 #aciew-#d7q772 7,b7 inc5tive paym5ts = p>ticipation 9 eligible alt]native paym5t models "u section #ahcc7z7 ( su* ,act 7#db ,u4,s4,c4 #aciel7z772 7,c7 ! %>$ sav+s program "u section #ahii ( su* ,act 7#db ,u4,s4,c4 #acie;jjj72 7,d7 models "u section #aaae;,a ( su* ,act 7#db ,u4,s4,c4 #acae;a72 & 7,e7 su* o!r paym5t sy/ems or models z ! ,secret>y may specify4 #gfjc4 ,elim9at+ ! co9surance requirem5t = c]ta9 colorectal canc] scre5+ te/s furni%$ "u ! ,m$ic>e program ,section #ahcc7;dd7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7dd77 is am5d$-- 7#a7 9 p>agraph 7#a71 by /rik+ & be=e ,janu>y #a1 #bjcj12 & 7#b7 9 p>agraph 7#b7-- 7,a7 9 subp>agraph 7,a71 by add+ & at ! end2 7,b7 9 subp>agraph 7,b71 by /rik+ ?r\gh #bjbf1 #he p]c5t2 & & ins]t+ & ea* subsequ5t ye>1 #ajj p]c5t42 & 7,c7 by /rik+ subp>agraph 7,c74 #gfjd4 ,exp&+ ! availability ( m$ical nutrition !rapy s]vices "u ! ,m$ic>e program 7a7 ,9 g5]al ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is am5d$-- 7#a7 9 subsection 7s77#b77,v71 by /rik+ 9 ! case ( & all t foll[s ?r\gh organizations2 & 7#b7 9 subsection 7vv7-- 7,a7 9 p>agraph 7#a7-- 7i7 by /rik+ disease managem5t & ins]t+ ! prev5tion1 managem5t1 or treatm5t ( a disease or condition specifi$ 9 p>agraph 7#d72 & 7ii7 by /rik+ by a physician & all t foll[s ?r\gh ! p]iod at ! end & ins]t+ ! foll[+3 by a-- 7,a7 physician 7z def9$ 9 subsection 7r77#a772 7,b7 physician assi/ant2 7,c7 nurse practition]2 7,d7 cl9ical nurse speciali/ 7z def9$ 9 subsection 7aa77#e77;,b772 or 7,e7 9 ! case ( su* s]vices furni%$ to manage su* a disease or condition t is an eat+ disord]1 a cl9ical psy*ologi/ 7z def9$ by ! ,secret>y74 ,su* t]m %all n include any s]vices furni%$ to an individual = ! prev5tion1 managem5t1 or treatm5t ( a r5al disease if su* individual is receiv+ ma9t5ance dialysis = :i* paym5t is made "u section #ahha4 2 & 7,b7 by add+ at ! end ! foll[+ new p>agraph3 7#d7 ,= purposes ( p>agraph 7#a71 ! diseases & conditions specifi$ 9 ?is p>agraph are ! foll[+3 7,a7 ,diabetes & pr$iabetes4 7,b7 ,a r5al disease4 7,c7 ,obesity 7z def9$ = purposes ( subsection 7yy77#b77;,c7 or z o!rwise def9$ by ! ,secret>y74 7,d7 ,hyp]t5sion4 7,e7 ,dyslipidemia4 7,f7 ,malnutrition4 7,g7 ,eat+ disord]s4 7,h7 ,canc]4 7,i7 ,ga/ro9te/9al diseases1 includ+ celiac disease4 7,j7 ,,hiv4 7,k7 ,,aids4 7,l7 ,c>diovascul> disease4 7,m7 ,any o!r disease or condition-- 7i7 specifi$ by ! ,secret>y relat+ to un9t5tional weight loss2 7ii7 = :i* ! ,secret>y det]m9es ! s]vices describ$ 9 p>agraph 7#a7 to be m$ically necess>y & appropriate = ! prev5tion1 managem5t1 or treatm5t ( su* disease or condition1 consi/5t ) any applicable recomm5dations ( ! ,unit$ ,/ates ,prev5tive ,s]vices ,task ,=ce2 or 7iii7 = :i* ! ,secret>y det]m9es ! s]vices describ$ 9 p>agraph 7#a7 are m$ically necess>y1 consi/5t ) ei!r protocols e/abli%$ by regi/]$ dietitians or nutrition pr(essional organizations or ) accept$ cl9ical guidel9es id5tifi$ by ! ,secret>y4 4 7b7 ,exclusion modification ,section #ahfb7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#a771 z am5d$ by sections #gfja & #gfjb1 is am5d$-- 7#a7 9 subp>agraph 7,q71 by /rik+ & at ! end2 7#b7 9 subp>agraph 7,r71 by /rik+ ! semicolon at ! end & ins]t+ 1 &2 & 7#c7 by add+ at ! end ! foll[+ new subp>agraph3 7,s7 9 ! case ( m$ical nutrition !rapy s]vices 7z def9$ 9 section #ahfa7vv771 :i* are n furni%$ = ! prev5tion1 managem5t1 or treatm5t ( a disease or condition specifi$ 9 p>agraph 7#d7 ( su* section2 4 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply ) respect to items & s]vices furni%$ on or aft] ,janu>y #a1 #bjbc4 #gfje4 ,enc\rag+ ! developm5t & use ( ,,dis>m antimicrobial drugs 7a7 ,additional paym5t = ,,dis>m antimicrobial drugs "u ,m$ic>e 7#a7 ,9 g5]al ,section #ahhf7;d77#e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,n7 7i7 7,i7 ,effective = dis*>ges beg9n+ on or aft] ,octob] #a1 #bjbc1 or su* soon] date z specifi$ by ! ,secret>y1 subject to subclause 7,,ii71 ! ,secret>y %all1 aft] notice & opportunity = public comm5t 79 ! publications requir$ by subsection 7e77#e7 = a fiscal ye> or o!rwise71 provide = an additional paym5t "u a me*anism 7sep>ate f ! me*anism e/abli%$ "u subp>agraph 7,k771 ) respect to su* dis*>ges involv+ any ,,dis>m antimicrobial drug1 9 an am\nt equal to-- 7aa7 ! am\nt payable "u section #ahdg;,a = su* drug dur+ ! cal5d> qu>t] 9 :i* ! dis*>ge occurr$2 or 7bb7 if no am\nt = su* drug is det]m9$ "u section #ahdg;,a1 an am\nt to be det]m9$ by ! ,secret>y 9 a mann] simil> to ! mann] 9 :i* paym5t am\nts are det]m9$ "u section #ahdg;,a bas$ on in=mation submitt$ by ! manufactur] or sponsor ( su* drug 7z requir$ "u clause 7v774 7,,ii7 ,9 det]m9+ ! am\nt payable "u section #ahdg;,a = purposes ( items 7aa7 & 7bb7 ( subclause 7,i71 subp>agraphs 7,a7 & 7,b7 ( subsection 7b77#a7 ( su* section %all be appli$ by sub/itut+ #ajb p]c5t = #ajf p]c5t ea* place x appe>s & p>agraph 7#h77;,b7 ( su* section %all be appli$ by sub/itut+ #b p]c5t = #f p]c5t4 7ii7 ,= purposes ( ?is subp>agraph1 a ,,dis>m antimicrobial drug is-- 7,i7 a drug-- 7aa7 t-- 7,,aa7 is approv$ by ! ,food & ,drug ,adm9i/ration2 7,,bb7 is designat$ by ! ,food & ,drug ,adm9i/ration z a qualifi$ infecti\s disease product "u subsection 7d7 ( section #eje;,e ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act2 & 7,,cc7 has receiv$ an ext5sion ( its exclusivity p]iod pursuant to subsection 7a7 ( su* section2 & 7bb7 t has be5 designat$ by ! ,secret>y pursuant to ! process e/abli%$ "u clause 7iv77,i77bb72 or 7,,ii7 an antibact]ial or antifungal biological product-- 7aa7 t is lic5s$ = use1 or an antibact]ial or antifungal biological product = :i* an indication is fir/ lic5s$ = use1 by ! ,food & ,drug ,adm9i/ration on or aft] ,june #e1 #bjad1 "u section #cea7;a7 ( ! ,public ,heal? ,s]vice ,act = human use to treat s]i\s or life-?reat5+ infections1 z det]m9$ by ! ,food & ,drug ,adm9i/ration1 includ+ ^? caus$ by1 or likely to be caus$ by-- 7,,aa7 an antibact]ial or antifungal resi/ant pa?og51 includ+ novel or em]g+ infecti\s pa?og5s2 or 7,,bb7 a qualify+ pa?og5 7z def9$ "u section #eje;,e7f7 ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act72 & 7bb7 has be5 designat$ by ! ,secret>y pursuant to ! process e/abli%$ "u clause 7iv77,i77bb74 7iii7 ,! me*anism e/abli%$ pursuant to clause 7i7 %all provide t ! additional paym5t "u clause 7i7 %all-- 7,i7 ) respect to a dis*>ge1 only be made to a subsection 7d7 hospital t1 z det]m9$ by ! ,secret>y-- 7aa7 is p>ticipat+ 9 ! ,national ,heal?c>e ,safety ,network ,antimicrobial ,use & ,resi/ance ,module ( ! ,c5t]s = ,disease ,control & ,prev5tion2 & 7bb7 has an antimicrobial /ew>d%ip program t aligns ) ! ,core ,elem5ts ( ,hospital ,antibiotic ,/ew>d%ip ,programs ( ! ,c5t]s = ,disease ,control & ,prev5tion or ! ,antimicrobial ,/ew>d%ip ,/&>d set by ! ,jo9t ,commission2 & 7,,ii7 apply to dis*>ges occurr+ on or aft] ,octob] #a ( ! ye> 9 :i* ! drug or biological product is designat$ by ! ,secret>y z a ,,dis>m antimicrobial drug4 ,= purposes ( ?is clause1 9 ! case ( a simil> report+ program describ$ 9 item 7aa71 a subsection 7d7 hospital %all be treat$ z p>ticipat+ 9 su* a program if ! entity ma9ta9+ su* program id5tifies to ! ,secret>y su* hospital z s p>ticipat+4 7iv7 7,i7 ,! me*anism e/abli%$ pursuant to clause 7i7 %all provide = a process =-- 7aa7 a manufactur] or sponsor ( a drug or biological product to reque/ ! ,secret>y to designate ! drug or biological product z a ,,dis>m antimicrobial drug2 & 7bb7 ! designation 7& removal ( su* designation7 by ! ,secret>y ( drugs & biological products z ,,dis>m antimicrobial drugs4 7,,ii7 ,a designation ( a drug or biological product z a ,,dis>m antimicrobial drug may be revok$ by ! ,secret>y if ! ,secret>y det]m9es t-- 7aa7 ! drug or biological product no long] meets ! requirem5ts = a ,,dis>m antimicrobial drug "u clause 7ii72 7bb7 ! reque/ = su* designation conta9$ an untrue /atem5t ( mat]ial fact2 or 7cc7 cl9ical or o!r in=mation t 0 n available to ! ,secret>y at ! "t su* designation 0 made %[s t-- 7,,aa7 su* drug or biological product is unsafe = use or n %[n to be safe = use = individuals :o are entitl$ to b5efits "u "p ,a2 or 7,,bb7 an alt]native to su* drug or biological product is an advance t sub/antially improves ! diagnosis or treatm5t ( su* individuals4 7,,iii7 ,n lat] ?an ,octob] #a1 #bjbc1 ! ,secret>y %all publi% 9 ! ,f$]al ,regi/] a li/ ( ! ,,dis>m antimicrobial drugs designat$ "u ?is subp>agraph pursuant to ! process e/abli%$ "u subclause 7,i77bb74 ,! ,secret>y %all annually update su* li/4 7v7 7,i7 ,= purposes ( det]m9+ additional paym5t am\nts "u clause 7i71 a manufactur] or sponsor ( a drug or biological product t submits a reque/ describ$ 9 clause 7iv77,i77aa7 %all submit to ! ,secret>y in=mation describ$ 9 section #aibg7;b77#c77;,a77iii74 7,,ii7 ,! p5alties = failure to provide timely in=mation "u clause 7i7 ( subp>agraph 7,c7 section #aibg7;b77#c7 & = provid+ false in=mation "u clause 7ii7 ( su* subp>agraph %all apply to manufactur]s & sponsors ( a drug or biological product "u ?is section ) respect to in=mation "u subclause 7,i7 9 ! same mann] z su* p5alties apply to manufactur]s "u su* clauses ) respect to in=mation "u subp>agraph 7,a7 ( su* section4 7vi7 7,i7 ,! me*anism e/abli%$ pursuant to clause 7i7 %all provide t-- 7aa7 except z provid$ 9 item 7bb71 no additional paym5t %all be made "u ?is subp>agraph = dis*>ges involv+ a ,,dis>m antimicrobial drug if any additional paym5ts h be5 made = dis*>ges involv+ su* drug z a new m$ical s]vice or te*nology "u subp>agraph 7,k72 7bb7 additional paym5ts may be made "u ?is subp>agraph = dis*>ges involv+ a ,,dis>m antimicrobial drug if any additional paym5ts h be5 made = dis*>ges occurr+ prior to ! date ( enactm5t ( ?is subp>agraph involv+ su* drug z a new m$ical s]vice or te*nology "u subp>agraph 7,k72 & 7cc7 no additional paym5t %all be made "u subp>agraph 7,k7 = dis*>ges involv+ a ,,dis>m antimicrobial drug z a new m$ical s]vice or te*nology if any additional paym5ts = dis*>ges involv+ su* drug h be5 made "u ?is subp>agraph4 4 7#b7 ,con=m+ am5dm5t ,section #ahhf7;d77#e77,k77ii77,,iii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77,k77ii77,,iii77 is am5d$ by /rik+ provide & ins]t+ subject to subp>agraph 7,n77vii71 provide4 7b7 ,au?orization ( appropriations = ! ,c5t]s = ,disease ,control & ,prev5tion ,!re is au?oriz$ to be appropriat$ to ! ,c5t]s = ,disease ,control & ,prev5tion #ejj1jjj1jjj1 to rema9 available until exp5d$1 to support e/abli%m5t & implem5tation ( antimicrobial /ew>d%ip programs & data report+ capabilities to ! ,antimicrobial ,use & ,resi/ance option ( ! ,,cdc ,national ,heal?c>e ,safety ,network1 especially 9 critical access hospitals1 rural hospitals1 & community hospitals1 to support detection1 surveillance1 conta9m5t1 & prev5tion ( resi/ant pa?og5s 9 ! ,unit$ ,/ates & ov]seas4 7c7 ,/udy & reports on remov+ b>ri]s to ! developm5t ( ,,dis>m antimicrobial drugs 7#a7 ,/udy ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates 79 ?is subsection ref]r$ to z ! ,comptroll] ,g5]al7 %all1 9 consultation ) ! ,director ( ! ,national ,in/itutes ( ,heal?1 ! ,commission] ( ,food & ,drugs1 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 & ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 conduct a /udy ov] a #e-ye> p]iod ( ! b>ri]s t prev5t ! developm5t ( ,,dis>m antimicrobial drugs 7z def9$ 9 section #ahhf7;d77#e77,n77ii7 ( ! ,social ,security ,act1 z add$ by subsection 7a771 includ+-- 7,a7 pati5t outcomes 9 conjunction ) ! use ( ,,dis>m drugs1 includ+-- 7i7 duration ( /ay 9 ! int5sive c>e unit2 7ii7 recidivism )9 #cj days2 & 7iii7 measures ( additional foll[-up c>e2 7,b7 ! effectiv5ess ( antimicrobial /ew>d%ip & surveillance programs1 includ+-- 7i7 *anges 9 ! p]c5tage ( hospitals 9 ! ,unit$ ,/ates ) an antimicrobial /ew>d%ip program 9 place t aligns ) ! ,core ,elem5ts ( ,hospital ,antibiotic ,/ew>d%ip ,programs1 z outl9$ by ! ,c5t]s = ,disease ,control & ,prev5tion2 7ii7 *anges 9 inpati5t c>e ( clo/ridioides difficile infection2 & 7iii7 *anges 9 inpati5t rates ( resi/ance to key pa?og5s2 & 7,c7 consid]ations relat+ to ,m$ic>e paym5t re=m1 includ+-- 7i7 *anges 9 ! numb] ( qualifi$ antimicrobial products approv$2 7ii7 *anges 9 :olesale acquisition co/ ( individual qualifi$ antimicrobial products ov] "t2 7iii7 *anges 9 ye>-ov]-ye> volume ( individual qualifi$ antimicrobial products sold2 & 7iv7 ! ov]all co/ ( qualifi$ antimicrobial products to ! ,m$ic>e program z a proportion ( total ,m$ic>e "p ,a sp5d+4 7#b7 ,report ,n lat] ?an #e ye>s aft] ! date ( ! enactm5t ( ?is section1 ! ,comptroll] ,g5]al %all submit to ,congress a report conta9+ ! results ( ! /udy conduct$ "u p>agraph 7#a71 toge!r ) recomm5dations = su* legislation & adm9i/rative action z ! ,comptroll] ,g5]al det]m9es appropriate4 #gfjf4 ,treat & ,r$uce ,obesity ,act 7a7 ,au?ority ,to exp& heal? c>e provid]s qualifi$ ,to furni% int5sive behavioral !rapy ,section #ahfa7;ddd7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ddd77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#d7 7,a7 ,subject to subp>agraph 7,b71 ! ,secret>y may1 9 addition to qualifi$ prim>y c>e physicians & o!r prim>y c>e practition]s1 cov] int5sive behavioral !rapy = obesity furni%$ by any ( ! foll[+3 7i7 ,a physician 7z def9$ 9 subsection 7r77#a77 :o is n a qualifi$ prim>y c>e physician4 7ii7 ,any o!r appropriate heal? c>e provid] 7includ+ a physician assi/ant1 nurse practition]1 or cl9ical nurse speciali/ 7z ^? t]ms are def9$ 9 subsection 7aa77#e771 a cl9ical psy*ologi/1 a regi/]$ dietitian or nutrition pr(essional 7z def9$ 9 subsection 7vv7774 7iii7 ,an evid5ce-bas$1 community-bas$ life/yle c\nsel+ program approv$ by ! ,secret>y4 7,b7 ,9 ! case ( int5sive behavioral !rapy = obesity furni%$ by a provid] describ$ 9 clause 7ii7 or 7iii7 ( subp>agraph 7,a71 ! ,secret>y may only cov] su* !rapy if su* !rapy is furni%$-- 7i7 ^u ref]ral f1 & 9 coord9ation )1 a physician or prim>y c>e practition] op]at+ 9 a prim>y c>e sett+ or any o!r sett+ specifi$ by ! ,secret>y2 & 7ii7 9 an (fice sett+1 a hospital outpati5t dep>tm5t1 a community-bas$ site t complies ) ! ,f$]al regulations conc]n+ ! privacy ( individually id5tifiable heal? in=mation promulgat$ "u section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif1 or ano!r sett+ specifi$ by ! ,secret>y4 7,c7 ,9 ord] to ensure a collaborative ef=t1 ! coord9ation describ$ 9 subp>agraph 7,b77i7 %all include ! heal? c>e provid] or life/yle c\nsel+ program communicat+ to ! ref]r+ physician or prim>y c>e practition] any recomm5dations or treatm5t plans made reg>d+ ! !rapy4 4 7b7 ,m$ic>e "p ,d cov]age ( obesity m$ication 7#a7 ,9 g5]al ,section #ahfj;,d-#b7;e77#b77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;e77#b77;,a77 is am5d$1 9 ! fir/ s5t5ce-- 7,a7 by /rik+ & o!r ?an & ins]t+ o!r ?an2 & 7,b7 by ins]t+ aft] b5zodiazep9es71 ! foll[+3 & o!r ?an subp>agraph 7,a7 ( su* section if ! drug is us$ = ! treatm5t ( obesity 7z def9$ 9 section #ahfa7yy77#b77;,c77 or = weight loss managem5t = an individual :o is ov]weight 7z def9$ 9 section #ahfa7yy77#b77;,f77i77 & has "o or m relat$ comorbidities14 7#b7 ,effective date ,! am5dm5ts made by p>agraph 7#a7 %all apply to plan ye>s beg9n+ on or aft] ! date t is #b ye>s aft] ! date ( ! enactm5t ( ?is section4 7c7 ,report to ,congress ,n lat] ?an ! date t is #a ye> aft] ! date ( ! enactm5t ( ?is section1 & e #b ye>s !reaft]1 ! ,secret>y ( ,heal? & ,human ,s]vices %all submit a report to ,congress describ+ ! /eps ! ,secret>y has tak5 to implem5t ! provisions (1 & am5dm5ts made by1 ?is section4 ,su* report %all also include recomm5dations = bett] coord9ation & lev]ag+ ( programs )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices & o!r ,f$]al ag5cies t relate 9 any way to support+ appropriate rese>* & cl9ical c>e 7su* z any int]actions betwe5 physicians & o!r heal? c>e provid]s & _! pati5ts7 to treat1 r$uce1 & prev5t obesity 9 ! adult population4 #gfjg4 ,inc5tives1 improvem5ts1 & outrea* to increase div]sity 9 ,alzheim]'s disease rese>* 7a7 ,improv+ access = & outrea* to und]repres5t$ populations 7#a7 ,exp&+ access to ,alzheim]'s rese>* c5t]s 7,a7 ,9 g5]al ,section #dde7;a77#a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhe;e-#b7;a77#a77 is am5d$-- 7i7 by /rik+ 7a77#a7 ,! ,director ( ! ,in/itute may & ins]t+ ! foll[+3 7a7 7#a7 ,! ,director ( ! ,in/itute-- 7,a7 may 2 7ii7 by /rik+ disease4 & ins]t+ disease2 &2 & 7iii7 by add+ at ! end ! foll[+3 7,b7 beg9n+ ,janu>y #a1 #bjbc1 %all ent] into coop]ative agreem5ts & make grants to public or private nonpr(it entities "u ?is subsection = ! plann+1 e/abli%m5t1 & op]ation ( new su* c5t]s t are locat$ 9 areas ) a high] conc5tration ( m9ority gr\ps 7z det]m9$ "u section #ddd7;d77#c77;,d771 su* z entities t are hi/orically ,black colleges & univ]sities1 ,hispanic-s]v+ in/itutions1 ,tribal colleges & univ]sities1 or c5t]s ( excell5ce = o!r m9ority populations4 4 7,b7 ,use ( fund+ = cl9ics to op]ate cl9ical trials ,section #dde7;b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhe;e-#b7;b77 is am5d$ by add+ at ! end ! foll[+3 7#c7 ,f$]al paym5ts made "u a coop]ative agreem5t or grant "u subsection 7a7 f funds made available "u section #gfjg7;g7 ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb %all1 ) respect to ,alzheim]'s disease1 be us$ 9 "p to e/abli% & op]ate diagno/ic & treatm5t cl9ics design$-- 7,a7 to meet ! special ne$s ( m9ority & rural populations & o!r und]s]v$ populations2 & 7,b7 to op]ate cl9ical trials4 4 7#b7 ,outrea* 7,a7 ,alzheim]'s disease c5t]s ,section #dde7;b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhe;e-#b7;b771 z am5d$ by p>agraph 7#a77;,b71 is fur!r am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#d7 ,f$]al paym5ts made "u a coop]ative agreem5t or grant "u subsection 7a7 %all be us$ to e/abli% engagem5t c5t]s to c>ry out public outrea*1 education ef=ts1 & dissem9ation ( in=mation = memb]s ( m9ority gr\ps ab\t cl9ical trial p>ticipation4 ,activities fund$ pursuant to ! prec$+ s5t5ce %all include-- 7,a7 us+ e/abli%$ me*anisms to enc\rage memb]s ( m9ority gr\ps to p>ticipate 9 cl9ical trials on ,alzheim]'s disease2 7,b7 exp&+ education ef=ts to make memb]s ( m9ority gr\ps aw>e ( ongo+ cl9ical trials2 7,c7 work+ ) trial sponsors to increase ! numb] ( recruitm5t ev5ts = memb]s ( m9ority gr\ps2 7,d7 conduct+ outrea* to national1 ,/ate1 & local physician pr(essional organizations1 especially = memb]s ( su* organizations :o are prim>y c>e physicians or physicians :o specialize 9 dem5tia1 to increase aw>5ess ( cl9ical rese>* opportunities = memb]s ( m9ority gr\ps2 & 7,e7 us+ community-bas$ p>ticipatory rese>* me?odologies to engage ) m9ority populations4 4 7,b7 ,res\rce c5t]s = m9ority ag+ rese>* ,section #ddd7;c7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhe;e-#a7;c77 is am5d$-- 7i7 by /rik+ 7c7 & ins]t+ 7c77#a72 & 7ii7 by add+ at ! end ! foll[+ new p>agraph3 7#b7 ,! ,director ( ! ,in/itute1 act+ ?r\gh ! ,res\rce ,c5t]s = ,m9ority ,ag+ ,rese>* ( ! ,in/itute1 %all c>ry out public outrea*1 education ef=ts1 & dissem9ation ( in=mation = memb]s ( m9ority gr\ps ab\t p>ticipation 9 cl9ical rese>* on ,alzheim]'s disease c>ri$ out or support$ "u ?is subp>t4 4 7b7 ,inc5tives ,to increase div]sity 9 ,alzheim]'s disease rese>* ?r\gh pr9cipal inve/igators & rese>*]s f und]repres5t$ populations 7#a7 ,alzheim]'s cl9ical rese>* & tra9+ aw>ds ,section #dde;,i ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhe;e-#aj;a7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7d7 ,enhanc+ ! p>ticipation ( pr9cipal inve/igators & rese>*]s :o are memb]s ( und]repres5t$ populations 7#a7 ,9 g5]al ,! ,director ( ! ,in/itute %all enhance div]sity 9 ! conduct or support ( cl9ical rese>* on ,alzheim]'s disease "u ?is subp>t by enc\rag+ ! p>ticipation ( individuals f gr\ps t are und]repres5t$ 9 ! biom$ical1 cl9ical1 behavioral1 & social sci5ces z pr9cipal inve/igators ( su* cl9ical rese>*1 z rese>*]s = su* cl9ical rese>*1 or bo?4 7#b7 ,tra9+ = pr9cipal inve/igators ,! ,director ( ! ,in/itute %all provide tra9+ = pr9cipal inve/igators :o are memb]s ( a m9ority gr\p ) respect to skills =-- 7,a7 ! design & conduct ( cl9ical rese>* & cl9ical protocols2 7,b7 apply+ = grants = cl9ical rese>*2 & 7,c7 su* o!r areas z ! ,director ( ! ,in/itute det]m9es to be appropriate4 4 7#b7 ,s5ior rese>*] aw>ds ,section #dde;,b7a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhe;e-#d7;a77 is am5d$ by ins]t+ 1 includ+ s5ior rese>*]s :o are memb]s ( a m9ority gr\p be=e ! p]iod at ! end ( ! fir/ s5t5ce4 7c7 ,inc5tives ,to increase div]sity 9 ,alzheim]'s disease rese>* ?r\gh trial sites ,section #ddd7;d7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhe;e-#a7;d77 is am5d$-- 7#a7 by /rik+ 7d7 & ins]t+ 7d77#a72 & 7#b7 by add+ at ! end ! foll[+ new p>agraphs3 7#b7 ,9 conduct+ or support+ cl9ical rese>* on ,alzheim]'s disease = purposes ( ?is subp>t1 9 addition to requirem5ts o!rwise impos$ "u ?is title1 includ+ "u section #dib;,b1 ! ,director ( ! ,in/itute %all increase ! p>ticipation ( memb]s ( m9ority gr\ps 9 su* cl9ical rese>* ?r\gh "o or m ( ! activities describ$ 9 p>agraph 7#c74 7#c7 7,a7 ,! ,director ( ! ,in/itute %all provide inc5tives = ! support ( cl9ical rese>* on ,alzheim]'s disease ) cl9ical trial sites e/abli%$ 9 areas ) a high] conc5tration ( m9ority gr\ps1 includ+ rural areas if practicable4 7,b7 ,9 det]m9+ :e!r to conduct or support cl9ical rese>* on ,alzheim]'s disease1 ! ,director ( ! ,in/itute %all enc\rage ! conduct ( cl9ical rese>* ) cl9ical trial sites 9 areas describ$ 9 subp>agraph 7,a7 z a high]-level priority crit]ion among ! crit]ia e/abli%$ to evaluate :e!r to conduct or support cl9ical rese>*4 7,c7 ,9 det]m9+ ! am\nt ( fund+ to be provid$ = ! conduct or support ( su* cl9ical rese>*1 ! ,director ( ! ,in/itute %all provide additional fund+ = ! conduct ( su* cl9ical rese>* ) cl9ical trial sites 9 areas describ$ 9 subp>agraph 7,a74 7,d7 ,9 det]m9+ :e!r an area is an area ) a high] conc5tration ( m9ority gr\ps1 ! ,director ( ! ,in/itute-- 7i7 %all consid] ! mo/ rec5t data collect$ by ! ,bureau ( ! ,c5sus2 & 7ii7 may also consid]-- 7,i7 data f ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices on ! incid5ce ( ,alzheim]'s disease 9 ! ,unit$ ,/ates by region2 & 7,,ii7 su* o!r data z ! ,director det]m9es appropriate4 7#d7 ,9 ord] to facilitate ! p>ticipation ( memb]s ( m9ority gr\ps 9 cl9ical rese>* support$ "u ?is subp>t1 9 addition to activities describ$ 9 p>agraph 7#c71 ! ,director ( ! ,in/itute %all-- 7,a7 ensure t su* cl9ical rese>* uses community-bas$ p>ticipatory rese>* me?odologies2 & 7,b7 enc\rage ! use ( remote heal? te*nologies1 includ+ teleheal?1 remote pati5t monitor+1 & mobile te*nologies1 t r$uce or elim9ate b>ri]s to p>ticipation ( memb]s ( m9ority gr\ps 9 su* cl9ical rese>*4 7#e7 7,a7 ,cl9ical rese>* on ,alzheim]'s disease conduct$ or support$ "u ?is subp>t %all ensure t su* rese>* includes outrea* activities design$ to increase ! p>ticipation ( memb]s ( m9ority gr\ps 9 su* rese>*4 7,b7 7i7 ,ea* applicant = a grant "u ?is subp>t = cl9ical rese>* on ,alzheim]'s disease %all submit to ! ,director ( ! ,in/itute 9 ! application = su* grant-- 7,i7 a budget = outrea* activities to memb]s ( m9ority populations ) respect to p>ticipation 9 su* cl9ical rese>*2 & 7,,ii7 a description ( ! plan to conduct su* outrea*4 7ii7 ,! ,director ( ! ,in/itute %all enc\rage applicants =1 & recipi5ts (1 grants "u ?is subp>t to conduct cl9ical rese>* on ,alzheim]'s disease to engage ) community-bas$ organizations to increase p>ticipation ( m9ority populations 9 su* rese>*4 7#f7 ,= purposes ( ?is subp>t3 7,a7 ,! t]m cl9ical rese>* includes a cl9ical trial4 7,b7 ,! t]m m9ority gr\p has ! mean+ giv5 su* t]m "u section #dib;,b7g74 4 7d7 ,p>ticipant eligibility crit]ia ,section #dde;,i ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhe;e-#aj;a71 z am5d$ by subsection 7b77#a71 is fur!r am5d$ by add+ at ! end ! foll[+ new subsection3 7e7 ,p>ticipant eligibility crit]ia ,! ,director ( ! ,in/itute %all take su* actions z are necess>y to ensure t cl9ical rese>* on ,alzheim]'s disease conduct$ or support$ "u ?is subp>t is design$ ) eligibility crit]ia t ensure ! cl9ical trial population reflects ! div]sity ( ! prospective pati5t population4 ,su* actions may include ! foll[+3 7#a7 ,exam9ation ( crit]ia 7,a7 ,9 g5]al ,an exam9ation ( ea* exclusion crit]ion to det]m9e if ! crit]ion is necess>y to ensure ! safety ( trial p>ticipants or to a*ieve ! /udy objectives4 7,b7 ,modification ( crit]ia ,9 ! case ( an exclusion crit]ion t is n necess>y to ensure ! safety ( trial p>ticipants or to a*ieve ! /udy objectives-- 7i7 enc\rag+ ! modification or elim9ation ( ! crit]ion2 or 7ii7 enc\rag+ tailor+ ! crit]ion z n>r[ly z possible to avoid unnecess>y limits to ! population ( ! cl9ical /udy4 7#b7 ,requirem5t = /rong ju/ification = exclusion ,a review ( ea* exclusion crit]ion to ensure t populations are includ$ 9 cl9ical trials1 su* z old] adults1 individuals ) a mild =m ( disease1 individuals at ! extremes ( ! weight range1 or *ildr51 unless !re is a /rong cl9ical or sci5tific ju/ification to exclude !m4 7#c7 ,use ( adaptive design ,enc\rag+ ! use ( an adaptive cl9ical trial design t-- 7,a7 />ts ) a def9$ population :]e !re are conc]ns ab\t safety2 & 7,b7 may exp& to a broad] population bas$ on initial data f ! trial & ext]nal data4 4 7e7 ,res\rce c5t] = successful /rategies ,to increase p>ticipation ( und]repres5t$ populations 9 ,alzheim]'s disease cl9ical rese>* ,section #ddd ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhe;e-#a7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7e7 7#a7 ,act+ ?r\gh ! ,(fice ( ,special ,populations & 9 consultation ) ! ,division ( ,extramural ,activities1 ! ,director ( ! ,in/itute %all support res\rce in=mation & te*nical assi/ance to grantees "u section #dde 7relat+ to ,alzheim]'s disease c5t]s71 o!r grantees1 & prospective grantees1 design$ to increase ! p>ticipation ( m9ority populations 9 cl9ical rese>* on ,alzheim]'s disease conduct$ or support$ "u ?is subp>t4 7#b7 ,! res\rce in=mation & te*nical assi/ance provid$ "u p>agraph 7#a7 %all include ! ma9t5ance ( a c5tral res\rce libr>y 9 ord] to collect1 prep>e1 analyze1 & dissem9ate in=mation relat+ to /rategies & be/ practices us$ by recipi5ts ( grants "u ?is subp>t & o!r rese>*]s 9 ! developm5t ( ! cl9ical rese>* design$ to increase ! p>ticipation ( m9ority populations 9 su* cl9ical rese>*4 4 7f7 ,annual reports ,section #ddd ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhe;e-#a71 z am5d$ by subsection 7e71 is fur!r am5d$ by add+ at ! end ! foll[+ new subsection3 7f7 7#a7 7,a7 ,! ,director ( ! ,in/itute %all submit annual reports to ! ,congress on ! impact ( ! am5dm5ts made to ?is subp>t by ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb4 7,b7 ,! ,secret>y %all transmit a copy ( ea* su* report to ! ,advisory ,c\ncil on ,alzheim]'s ,rese>*1 ,c>e1 & ,s]vices e/abli%$ "u section #b7;e7 ( ! ,national ,alzheim]'s ,project ,act 7,public ,law #aaa-cge74 7#b7 ,9 ea* report "u p>agraph 7#a71 ! ,director ( ! ,in/itute %all include in=mation & data on ! foll[+ matt]s ) respect to cl9ical trials on ,alzheim]'s disease conduct$ dur+ ! prec$+ ye>3 7,a7 ,! numb] ( p>ticipants :o are memb]s ( a m9ority gr\p 9 su* cl9ical trials4 7,b7 ,! numb] ( su* cl9ical trials = :i* inc5tives "u subsection 7d77#c7 7 made available1 ! nature ( su* inc5tives1 ! am\nt ( increas$ fund+ 7if any7 made available = rese>* on ,alzheim]'s disease1 & ! tra9+ provid$ to pr9cipal inve/igators :o are memb]s ( a m9ority gr\p & ! am\nt ( fund+ 7if any7 = su* tra9+4 7,c7 ,! numb] ( su* cl9ical trials = :i* ! pr9cipal inve/igator is a memb] ( a m9ority gr\p4 7,d7 ,! numb] ( su* cl9ical trials = :i* a significant p]c5tage ( rese>*]s are memb]s ( a m9ority gr\p4 7,e7 ,modifications to pati5t eligibility crit]ia 9 cl9ical trial designs "u section #dde;,i7e74 7,f7 ,outrea* & education ef=ts conduct$ "u section #dde7;b77#d74 7#c7 ,! ,director ( ! ,in/itute %all make ea* report "u p>agraph 7#a7 available to ! public1 includ+ ?r\gh po/+ on ! appropriate website ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 4 7g7 ,au?orization ( appropriations ,= ea* ( fiscal ye>s #bjbc ?r\gh #bjbg1 !re is au?oriz$ to be appropriat$ to ! ,secret>y ( ,heal? & ,human ,s]vices #fj1jjj1jjj to c>ry out ! am5dm5ts made by ?is section1 to rema9 available until exp5d$4 ,,viii ,heal? ,in=mation ,te*nology #hjja4 ,def9itions ,9 ?is title3 7#a7 ,access ,! t]m access1 ) respect to heal? in=mation1 means access describ$ 9 section #afd4ebd ( title #de1 ,code ( ,f$]al ,regulations 7or any successor regulations74 7#b7 ,c]tifi$ electronic heal? record te*nology ,! t]m c]tifi$ ,,ehr te*nology-- 7,a7 has ! mean+ giv5 su* t]m 9 section #cjjj ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;jj72 7,b7 includes ! 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 seq472 & 7,c7 is n limit$ to electronic heal? records ma9ta9$ by doctors4 7#c7 ,,ehr ,! t]m ,,ehr-- 7,a7 means an electronic heal? record2 7,b7 includes ! 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 seq472 & 7,c7 is n limit$ to electronic heal? records ma9ta9$ by doctors4 7#d7 ,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 ,a ,r$uc+ ,heal? ,disp>ities ,?r\gh ,heal? ,,x #haja4 ,,hrsa assi/ance to heal? c5t]s = promotion ( ,heal? ,,x 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration1 %all exp& & int5sify ! programs & activities ( ! ,adm9i/ration 7directly or ?r\gh grants or contracts7 to provide te*nical assi/ance & res\rces to heal? c5t]s 7z def9$ 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$uction ( heal? disp>ities4 7b7 ,fund+ initiatives ,! activities "u subsection 7a7 may include fund+ initiatives1 includ+ e/abli%+ basic connectivity su* z #e;,g int]net = telem$ic9e capabilities1 grant fund+ to implem5t ! next g5]ation ( ,,ehr1 & fund+ = te*nology h>dw>e4 #hajb4 ,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 title 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? records2 7,b7 include 9 su* evaluation an indication ( :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,c7 publi% ! results ( su* evaluation includ+ ! indications "u subp>agraph 7,b71 ! race & e?nicity ( su* provid]s1 & ! populations s]v$ by su* provid]s4 7#b7 ,evaluation ( int]op]ability ,! evaluation ( ! level ( int]op]ability describ$ 9 p>agraph 7#a77;,a7 %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#c7 ,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 ! foll[+3 7,a7 ,subsection 7l77#c7 ( section #ahad7l77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;f74 7,b7 ,subsections 7a77#g7 & 7o7 ( section #ahdh ( su* ,act 7#db ,u4,s4,c4 #aciew-#d74 7,c7 ,subsections 7l7 & 7m7 ( section #ahec ( su* ,act 7#db ,u4,s4,c4 #aciew-#bc74 7,d7 ,subsections 7b77#c77;,b77ix77,i7 & 7n7 ( section #ahhf ( su* ,act 7#db ,u4,s4,c4 #acieww74 7,e7 ,subsections 7a77#c77;,f7 & 7t7 ( section #aijc su* ,act 7#db ,u4,s4,c4 #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 su* 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$]al ,gov]nm5t1 ,/ates1 private entities1 national nonpr(it int]m$i>ies1 & community-bas$ organizations to exp& outrea* & education = & ! adoption ( c]tifi$ ,,ehr te*nology 9 communities ) a high proportion ( individuals f racial & e?nic m9ority gr\ps 7z def9$ 9 section #agjg7;g771 :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 #hcjb ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb1 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$7 tak+ into acc\nt ! f9d+s 9 su* report2 & 7,,ii7 n lat] ?an #a ye> aft] ! submission ( su* report1 publi% ! results ( an evaluation ( su* impact4 4 #hajc4 ,nondiscrim9ation & heal? equity 9 heal? in=mation te*nology 7a7 ,9 g5]al ,cov]$ 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 #hajd4 ,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 #hbja4 ,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 ! colon at ! end2 & 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 #hbjb4 ,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 #hbjc4 ,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 #bjbc ?r\gh #bjbh4 ,c ,additional ,rese>* & ,/udies #hcja4 ,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 #hcjb4 ,/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$ areas2 & 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]vices1 :i* su* exam9ation %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]ability2 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 ,9 ?is section1 ! 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 #hcjc4 ,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 ( ,heal? ,in=mation ,te*nology to conduct a /udy1 9 consultation ) relevant /akehold]s1 on ! impact ( digital heal? te*nology on m$ically und]s]v$ areas 7z def9$ 9 section #hcjb7;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=mation 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=mation 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 7c7 ,def9ition ( protect$ heal? in=mation ,9 ?is section1 ! t]m protect$ heal? in=mation has ! mean+ giv5 su* t]m 9 section #afj4ajc1 title #de1 ,code ( ,f$]al ,regulations 7or any successor regulations74 ,d ,clos+ ,gaps 9 ,fund+ ,to ,adopt ,c]tifi$ ,e,h,rs #hdja4 ,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 describ$ 9 section #ahhf7;d77#a77;,b77iv72 or 7v7 a home heal? ag5cy 7z def9$ 9 section #ahfa7o774 4 7b7 ,effective date ,! am5dm5ts 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 #hdjb4 ,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 ,e ,exp&+ ,access to ,teleheal? ,s]vices #heja4 ,remov+ geographic requirem5ts = teleheal? s]vices ,section #ahcd7m77#d77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c77 is am5d$-- 7#a7 9 clause 7i71 9 ! matt] prec$+ subclause 7,i71 by /rik+ clause 7iii7 & ins]t+ clauses 7iii7 & 7iv72 & 7#b7 by add+ at ! end ! foll[+ new clause3 7iv7 ,removal ( geographic requirem5ts ,! geographic requirem5ts describ$ 9 clause 7i7 %all n apply ) respect to teleheal? s]vices furni%$ on or aft] ! fir/ day aft] ! end ( ! p]iod = :i* clause 7iii7 applies4 4 #hejb4 ,exp&+ orig9at+ sites 7a7 ,exp&+ ! home z an orig9at+ site ,section #ahcd7m77#d77;,c77ii77,x7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c77ii77,x77 is am5d$ to read z foll[s3 7,x7 7aa7 ,prior to ! date describ$ 9 item 7bb71 ! home ( an individual b only = purposes ( section #ahha7;b77#c77;,b7 or teleheal? s]vices describ$ 9 p>agraph 7#g7 or clause 7iii74 7bb7 ,on or aft] ! fir/ day aft] ! end ( ! p]iod = :i* clause 7iii7 applies1 ! home ( an individual4 4 7b7 ,all[+ additional orig9at+ sites ,section #ahcd7m77#d77;,c77ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c77ii77 is am5d$ by add+ at ! end ! foll[+ new subclause3 7,,xii7 ,any o!r site det]m9$ appropriate by ! ,secret>y at :i* an eligible teleheal? individual is locat$ at ! "t a teleheal? s]vice is furni%$ via a telecommunications sy/em4 4 7c7 ,p>amet]s = new orig9at+ sites ,section #ahcd7m77#d77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c771 z am5d$ by section #heja1 is am5d$ by add+ at ! end ! foll[+ new clause3 7v7 ,requirem5ts = new sites 7,i7 ,9 g5]al ,! ,secret>y may e/abli% requirem5ts = ! furni%+ ( teleheal? s]vices at sites describ$ 9 clause 7ii77,,xii7 to provide = b5efici>y & program integrity protections4 7,,ii7 ,cl>ification ,no?+ 9 ?is clause %all be con/ru$ to preclude ! ,secret>y f e/abli%+ requirem5ts = o!r orig9at+ sites describ$ 9 clause 7ii7 4 7d7 ,no orig9at+ site facility fee = new sites ,section #ahcd7m77#b77;,b77ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#b77;,b77ii77 is am5d$-- 7#a7 9 ! head+1 by /rik+ if orig9at+ site is ! home & ins]t+ = c]ta9 sites2 & 7#b7 by /rik+ p>agraph 7#d77;,c77ii77,x7 & ins]t+ subclause 7,x7 or 7,,xii7 ( p>agraph 7#d77;,c74 ,,ix ,acc\ntability & ,evaluation #ijja4 ,prohibition on discrim9ation 9 ,f$]al assi/$ heal? c>e s]vices & rese>* on ! basis ( sex 7includ+ sexual ori5tation1 g5d] id5tity1 & pregnancy1 includ+ t]m9ation ( pregnancy71 race1 color1 national orig91 m>ital /atus1 familial /atus1 or disability /atus 7a7 ,9 g5]al ,no p]son 9 ! ,unit$ ,/ates %all1 on ! basis ( sex 7includ+ sexual 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-- 7#a7 any heal? program or activity1 includ+ any heal? rese>* program or activity1 receiv+ ,f$]al f9ancial assi/ance1 includ+ cr$its1 subsidies1 or contracts ( insurance2 or 7#b7 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 #ijjb4 ,treatm5t ( ,m$ic>e paym5ts "u title ,,vi ( ! ,civil ,rights ,act ( #aifd ,= ! purposes ( title ,,vi ( ! ,civil ,rights ,act ( #aifd 7#db ,u4,s4,c4 #bjjj;d et seq471 a paym5t made "u "p ,a1 ,b1 ,c1 or ,d ( title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 to a provid] ( s]vices1 physician1 or o!r suppli] 7includ+ a paym5t made to a subcontractor ( ! provid] ( s]vices1 physician1 or o!r suppli]7 %all be deem$ a grant1 n a contract ( insurance or gu>anty4 #ijjc4 ,acc\ntability & transp>5cy )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices ,title ,,xxxiv ( ! ,public ,heal? ,s]vice ,act1 z am5d$ by titles ,i1 ,,ii1 ,,iii1 & ,,iv ( ?is ,act1 is fur!r am5d$ by ins]t+ aft] subtitle ,d ! foll[+3 ,e ,/r5g!n+ acc\ntability #cdea4 ,elevation ( ! ,(fice = ,civil ,rights & ,heal? ,equity 7a7 ,9 g5]al 7#a7 ,"n ( ,(fice ,beg9n+ on ! date ( enactm5t ( ?is subtitle1 ! ,(fice = ,civil ,rights ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices %all be kn[n z ! ,(fice = ,civil ,rights & ,heal? ,equity ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 ,any ref]5ce to ! ,(fice = ,civil ,rights ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices 9 any law1 regulation1 map1 docum5t1 record1 or o!r pap] ( ! ,unit$ ,/ates %all be deem$ to be a ref]5ce to ! ,(fice = ,civil ,rights & ,heal? ,equity4 7#b7 ,head ( ,(fice ,! head ( ! ,(fice = ,civil ,rights & ,heal? ,equity %all be ! ,director = ,civil ,rights & ,heal? ,equity1 to be appo9t$ by ! ,presid5t4 ,any ref]5ce to ! ,director ( ! ,(fice = ,civil ,rights ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices 9 any law1 regulation1 map1 docum5t1 record1 or o!r pap] ( ! ,unit$ ,/ates %all be deem$ to be a ref]5ce to ! ,director = ,civil ,rights & ,heal? ,equity4 7b7 ,purpose ,! ,director = ,civil ,rights & ,heal? ,equity %all ensure t ! heal? programs1 activities1 policies1 projects1 proc$ures1 & op]ations ( heal? entities t receive ,f$]al f9ancial assi/ance are 9 compliance ) title ,,vi ( ! ,civil ,rights ,act ( #aifd 7#db ,u4,s4,c4 #bjjj;d et seq471 includ+ ?r\gh ! foll[+ activities3 7#a7 ,! developm5t & implem5tation ( an action plan to address racial & e?nic heal? c>e disp>ities4 ,su* plan %all-- 7,a7 address conc]ns relat+ to ! ,(fice = ,civil ,rights & ,heal? ,equity z releas$ by ! ,unit$ ,/ates ,commission on ,civil ,rights 9 ! report entitl$ ,heal? ,c>e ,*all5ge3 ,ackn[l$g+ ,disp>ity1 ,confront+ ,discrim9ation1 & ,ensur+ ,equity 7,septemb] #aiii71 9 conjunction ) exi/+ & future reports ( ! ,national ,academy ( ,m$ic9e 7=m]ly kn[n z ! ,in/itute ( ,m$ic9e7 includ+ ! reports titl$ ,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 ( ! ,national ,academies ( ,sci5ces1 ,eng9e]+1 & ,m$ic9e2 7,b7 be issu$ 9 propos$ =m = public review & comm5t2 & 7,c7 be f9aliz$ tak+ into consid]ation any comm5ts or conc]ns t are receiv$ by ! ,(fice4 7#b7 ,inve/igative & en=cem5t actions aga9/ int5tional or 9 effect discrim9ation & policies & practices t h a disp>ate impact on racial or e?nic m9orities & communities ( color pursuant to section #ijjg ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb4 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 ,act ( #aifd1 includ+ ! process ( fil+ a compla9t 9 accordance ) section #ijjg ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb4 7#e7 ,! provision ( te*nical assi/ance = heal? entities to facilitate compliance ) title ,,vi ( ! ,civil ,rights ,act ( #aifd4 7#f7 ,coord9ation & ov]sight ( activities ( ! civil rights compliance (fices e/abli%$ "u section #cdeb4 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$]al ,data on ,race & ,e?nicity2 & 7,b7 consid]ation ( available data & language /&>ds su* z-- 7i7 ! /&>ds = collect+1 monitor+1 & report+ data "u section #caja2 & 7ii7 ! ,national ,/&>ds on ,culturally & ,l+ui/ically ,appropriate ,s]vices ( ! ,(fice ( ,m9ority ,heal?4 7c7 ,fund+ & /aff ,! ,secret>y %all ensure ! effectiv5ess ( ! ,(fice = ,civil ,rights & ,heal? ,equity by ensur+ t ! ,(fice is provid$ )-- 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 heal? equity2 7,f7 cultural & l+ui/ic compet5cy2 7,g7 civil rights2 & 7,h7 social1 political1 m5tal1 behavioral1 economic1 & relat$ det]m9ants ( heal?1 includ+ education access & quality1 heal? c>e access & quality1 neighborhood & built environm5t1 & social & community context4 7d7 ,advisory bo>d 7#a7 ,e/abli%m5t ,! ,secret>y1 9 collaboration ) ! ,director ,civil ,rights & ,heal? ,equity & ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal?1 %all e/abli% an advisory bo>d 79 ?is subsection ref]r$ to z ! advisory bo>d7 to report 9 accordance ) p>agraph 7#b74 7#b7 ,reports to ,congress ,n lat] ?an ,decemb] #ca1 #bjbc1 & annually !reaft]1 ! advisory bo>d %all publi% & submit to ! ,(fice1 o!r ,f$]al ag5cies1 & ! ,congress a report t includes-- 7,a7 ! numb] ( compla9ts fil$ 9 accordance ) section #ijjg ( ! ,heal? ,equity & ,acc\ntability ,act ( #bjbb dur+ ! report+ p]iod "u title ,,vi ( ! ,civil ,rights ,act ( #aifd1 brok5 d[n by category2 7,b7 ! numb] ( su* compla9ts inve/igat$ & clos$ by ! ,(fice2 7,c7 ! outcomes ( su* compla9ts inve/igat$2 7,d7 ! /aff+ levels ( ! ,(fice1 includ+ /aff cr$5tials2 7,e7 ! numb] ( su* compla9ts t are p5d+ 7includ+ backlogg$ compla9ts7 9 :i* civil rights inequities c be demon/rat$ & an explanation ( :y su* compla9ts rema9 p5d+2 & 7,f7 tr5ds among fil$ compla9ts & o!r sy/emic patt]ns or !mes1 includ+ an analysis f ! ,dep>tm5t ( ,ju/ice ab\t litigation conc]n+ su* compla9ts4 7#c7 ,composition ,! memb]s ( ! advisory bo>d %all include-- 7,a7 repres5tatives ( /akehold]s2 & 7,b7 subject matt]- & discipl9>y-appropriate exp]ts4 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 #bjbc ?r\gh #bjbg4 #cdeb4 ,e/abli%m5t ( heal? program (fices = civil rights )9 ag5cies ( ,dep>tm5t ( ,heal? & ,human ,s]vices 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 & det]m9e & implem5t policies1 s]vices1 & activities1 9 a mann] t-- 7#a7 does n discrim9ate1 ei!r int5tionally or 9 effect1 on ! basis ( race1 color1 national orig91 language1 e?nicity1 sex1 age1 disability /atus1 sexual ori5tation1 or g5d] id5tity2 & 7#b7 promotes ! r$uction & elim9ation ( disp>ities 9 heal? & heal? c>e bas$ on race1 color1 national orig91 language1 e?nicity1 sex1 age1 disability /atus1 sexual ori5tation1 or g5d] id5tity4 7c7 ,p[]s & duties ,! (fices e/abli%$ 9 subsection 7a7 %all1 ) respect to ! applicable ag5cy1 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 ! ag5cy1 includ+ ! e/abli%m5t ( disp>ity r$uction /&>ds to encompass disp>ities 9 heal? & heal? c>e relat$ to race1 color1 national orig91 language1 e?nicity1 sex1 age1 disability1 sexual ori5tation1 or g5d] id5tity4 7#b7 ,! developm5t & implem5tation ( policies1 proc$ures1 & program-specific guidel9es t int]pret & apply ,dep>tm5t ( ,heal? & ,human ,s]vices guidance "u title ,,vi ( ! ,civil ,rights ,act ( #aifd & section #aeeg ( ! ,pati5t ,protection & ,af=dable ,c>e ,act to ea* ,f$]al heal? program adm9i/]$ by ! ag5cy4 7#c7 ,! developm5t ( a disp>ity-r$uction impact analysis me?odology t %all-- 7,a7 be appli$ to e rule issu$ by ! ag5cy & publi%$ z "p ( ! =mal rulemak+ process "u sections #eee1 #eef1 & #eeg ( title #e1 ,unit$ ,/ates ,code2 & 7,b7 include an analysis ( ! int]sect+ =ms ( discrim9ation4 7#d7 ,ov]sight ( data collection1 report+1 analysis1 & publication requirem5ts = all recipi5ts ( ,f$]al f9ancial assi/ance "u ea* ,f$]al heal? program adm9i/]$ by ! ag5cy1 compliance )1 at a m9imum1 ! mo/ rec5t v]sion ( ! ,(fice ( ,managem5t & ,budget /ati/ical policy directive entitl$ ,/&>ds = ,ma9ta9+1 ,collect+1 & ,pres5t+ ,f$]al ,data on ,race & ,e?nicity1 & consid]ation ( available data & language /&>ds su* z-- 7,a7 ! /&>ds = collect+ & report+ data "u section #caja2 7,b7 ! ,national ,/&>ds on ,culturally & ,l+ui/ically ,appropriate ,s]vices ( ! ,(fice ( ,m9ority ,heal?2 & 7,c7 ! disaggregation ( all heal? & heal? c>e data by racial & e?nic m9ority population gr\p4 7#e7 ,! conduct ( publicly available /udies reg>d+ discrim9ation )9 ,f$]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 ea* civil rights compliance (fice e/abli%$ "u 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$]al heal? programs mean programs-- 7#a7 "u ! ,social ,security ,act 7#db ,u4,s4,c4 #cja et seq47 t pay = heal? c>e & s]vices2 & 7#b7 "u ?is ,act t-- 7,a7 provide ,f$]al f9ancial assi/ance = heal? c>e1 biom$ical rese>*1 or heal? s]vices rese>*2 or 7,b7 are design$ to improve ! public's heal?1 includ+ heal? s]vice programs4 4 #ijjd4 ,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 facilities1 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 ( ,ju/ice ,programs ( ! ,dep>tm5t ( ,ju/ice1 includ+ ! ,(fice = ,civil ,rights )9 t ,(fice2 7,b7 ! ,(fice = ,civil ,rights )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices2 & 7,c7 ! ,(fice ( ,m9ority ,heal? )9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 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> #bjbc1 & su* sums z may be necess>y = ea* ( ! fiscal ye>s #bjbd ?r\gh #bjbh44 #ijje4 ,s5se ( ,congress conc]n+ full fund+ ( activities to elim9ate racial & e?nic heal? disp>ities 7a7 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,! heal? /atus ( ! population ( ! ,unit$ ,/ates is decl9+1 & ! ,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 political1 & economic b>ri]s to obta9+ high-quality heal? c>e4 7#c7 ,racial & e?nic m9ority populations exp]i5ce & suff] f ! extreme & egregi\s heal? disp>ities & inequities t are caus$ by racism1 discrim9ation1 & implicit racial & e?nic bias 9 & ?r\gh\t ! heal? c>e sy/em4 7#d7 ,communities ( color ) int]sect+ id5tities & backgr\nds1 includ+ *ildr51 old] adults1 wom51 p ) disabilities1 p ) limit$ ,engli% pr(ici5cy1 immigrants1 lesbian1 gay1 bisexual1 transg5d]1 que]1 & que/ion+ populations1 & p ) l[] incomes exp]i5ce significant p]sonal & /ructural b>ri]s to obta9+ af=dable1 high-quality heal? c>e4 7#e7 ,ef=ts to r$uce & elim9ate racial & e?nic heal? disp>ities & inequities1 & improve m9ority heal?1 h be5 limit$ by inadequate res\rces 7su* z fund+1 /aff+1 & /ew>d%ip71 a lack ( prioritization1 & a lack ( acc\ntability f ! ,f$]al ,gov]nm5t1 p>ticul>ly due to /agnant or decl9+ appropriations t are n 9 l9e ) ! dire ne$ fac$ by communities t are impact$4 7b7 ,s5se ( ,congress ,x is ! s5se ( ! ,congress t-- 7#a7 heal? disp>ities negatively impact outcomes = heal? & human security ( ! ,nation2 7#b7 r$uc+ racial1 e?nic1 age1 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> #bjbc1 to effectively address racial & e?nic disp>ities elim9ation 9 heal? & heal? c>e z a matt] ( heal? & national security2 7#d7 adequate fund+ by fiscal ye> #bjbc1 & 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>* & ,quality1 & ! ,national ,heal? ,s]vice ,corps ,s*ol>%ip ,program initiatives1 programs1 policies1 projects1 & activities t are ! backbone ( ! ,nation's ag5da to elim9ate racial & e?nic heal? disp>ities & inequities2 7#e7 adequate fund+ = fiscal ye> #bjbc & 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#f7 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> #bjbc2 & 7#g7 /ew>d%ip & acc\ntability %\ld be provid$ to ! ,congress & ! ,presid5t = measurable & su/a9able progress t[>d heal? disp>ity elim9ation "u programs "u ?is ,act1 includ+ increas$ data collection & report+1 capacity build+ = impact$ communities1 te*nical assi/ance1 tra9+ programs1 & av5ues to dissem9ate program details & successes to ! public & to policymak]s4 #ijjf4 ,,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 #bjbc1 & end+ ,decemb] #ca1 #bjcb4 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 plan1 coord9ate1 review1 & evaluate 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]1 ! ,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 #ijjg4 ,inve/igative & en=cem5t actions 7a7 ,9 g5]al ,9 c>ry+ out ! inve/igative & en=cem5t actions ( section #cdea7;b77#b7 ( ! ,public ,heal? ,s]vice ,act1 z add$ by section #ijjc ( ?is ,act1 ! ,director = ,civil ,rights & ,heal? ,equity 7ref]r$ to 9 ?is section z ! ,director7 %all pursue su* inve/igative & en=cem5t actions pursuant to ?is section4 7b7 ,adm9i/rative compla9t & conciliation process 7#a7 ,compla9ts & answ]s 7,a7 ,9 g5]al ,an aggriev$ p]son may1 n lat] ?an #a ye> aft] an alleg$ violation ( subsection 7a7 has occurr$ or conclud$1 file a compla9t ) ! ,director alleg+ inequitable provision ( heal? c>e by a provid] describ$ 9 subsection 7a74 7,b7 ,compla9t ,a compla9t submitt$ pursuant to subp>agraph 7,a7 %all be 9 writ+ & %all conta9 su* in=mation & be 9 su* =m z ! ,director requires4 7,c7 ,oa? or affirmation ,! compla9t & any answ] made "u ?is subsection %all be made "u oa? or affirmation1 & may be reasonably & fairly modifi$ at any "t4 7#b7 ,response to compla9ts 7,a7 ,9 g5]al ,^u ! fil+ ( a compla9t "u ?is subsection1 ! foll[+ proc$ures %all apply3 7i7 ,compla9ant notice ,! ,director %all s]ve notice ^u ! compla9ant ackn[l$g+ receipt ( su* fil+ & advis+ ! compla9ant ( ! "t limits & proc$ures provid$ "u ?is section4 7ii7 ,respond5t notice ,! ,director %all1 n lat] ?an #cj days aft] receipt ( su* fil+-- 7,i7 s]ve on ! respond5t a notice ( ! compla9t1 toge!r ) a copy ( ! orig9al compla9t2 & 7,,ii7 advise ! respond5t ( ! proc$ural rights & obligations ( respond5ts "u ?is section4 7iii7 ,answ] ,! respond5t may file1 n lat] ?an #fj days aft] receipt ( ! notice f ! ,director1 an answ] to su* compla9t4 7iv7 ,inve/igative duties ,! ,director %all-- 7,i7 make an inve/igation ( ! alleg$ inequitable provision ( heal? c>e2 & 7,,ii7 complete su* inve/igation )9 #ahj days 7unless x is impracticable to complete su* inve/igation )9 #ahj days7 aft] ! fil+ ( ! compla9t4 7,b7 ,inve/igations 7i7 ,patt]n or practice ,9 ! c\rse ( inve/igat+ ! compla9t1 ! ,director may seek records ( c>e provid$ to pati5ts o!r ?an ! compla9ant if necess>y to demon/rate or disprove an allegation ( inequitable provision ( heal? c>e or to det]m9e :e!r !re is a patt]n or practice ( su* c>e4 7ii7 ,acc\nt+ = social det]m9ants ( heal? ,9 inve/igat+ ! compla9t & rea*+ a det]m9ation on ! validity ( ! compla9t1 ! ,director %all acc\nt = social det]m9ants ( heal? & ! effect ( su* social det]m9ants on heal? c>e outcomes4 7iii7 ,inability to complete inve/igation ,if ! ,director is unable to complete 7or f9ds x is impracticable to complete7 ! inve/igation )9 #ahj days aft] ! fil+ ( ! compla9t 7or1 if ! ,secret>y takes fur!r action "u p>agraph 7#f77;,b7 ) respect to a compla9t1 )9 #ahj days aft] ! comm5cem5t ( su* fur!r action71 ! ,director %all notify ! compla9ant & respond5t 9 writ+ ( ! reasons involv$4 7,c7 ,report 7i7 ,f9al report ,on complet+ ea* inve/igation "u ?is p>agraph1 ! ,director %all prep>e a f9al inve/igative report4 7ii7 ,modification ( report ,a f9al report "u ?is subp>agraph may be modifi$ if additional evid5ce is lat] discov]$4 7#c7 ,conciliation 7,a7 ,9 g5]al ,dur+ ! p]iod beg9n+ on ! date on :i* a compla9t is fil$ "u ?is subsection & end+ on ! date ( f9al disposition ( su* compla9t 7includ+ dur+ an inve/igation "u p>agraph 7#b77;,b771 ! ,director %all1 to ! ext5t feasible1 engage 9 conciliation ) respect to su* compla9t4 7,b7 ,conciliation agreem5t ,a conciliation agreem5t aris+ out ( su* conciliation %all be an agreem5t betwe5 ! respond5t & ! compla9ant1 & %all be subject to approval by ! ,director4 7,c7 ,rights protect$ ,! ,director %all approve a conciliation agreem5t only if ! agreem5t protects ! rights ( ! compla9ant & o!r p]sons simil>ly situat$4 7,d7 ,publicly available agreem5t 7i7 ,9 g5]al ,subject to clause 7ii71 ! ,secret>y %all make available to ! public a copy ( a conciliation agreem5t ent]$ into pursuant to ?is subsection unless ! compla9ant & respond5t o!rwise agree1 & ! ,secret>y det]m9es1 t disclosure is n requir$ to fur!r ! purposes ( ?is subsection4 7ii7 ,limitation ,a conciliation agreem5t t is made available to ! public pursuant to clause 7i7 may n disclose individually id5tifiable heal? in=mation4 7#d7 ,failure to comply ) conciliation agreem5t ,:5ev] ! ,director has reasonable cause to believe t a respond5t has brea*$ a conciliation agreem5t1 ! ,director %all ref] ! matt] to ! ,attorney ,g5]al to consid] fil+ a civil action to en=ce su* agreem5t4 7#e7 ,writt5 cons5t = disclosure ( in=mation ,no?+ said or done 9 ! c\rse ( conciliation "u ?is subsection may be made public1 or us$ z evid5ce 9 a subsequ5t proce$+ "u ?is subsection1 )\t ! writt5 cons5t ( ! p>ties to ! conciliation4 7#f7 ,prompt judicial action 7,a7 ,9 g5]al ,if ! ,director det]m9es at any "t foll[+ ! fil+ ( a compla9t "u ?is subsection t prompt judicial action is necess>y to c>ry out ! purposes ( ?is subsection1 ! ,director may recomm5d t ! ,attorney ,g5]al promptly comm5ce a civil action "u subsection 7d74 7,b7 ,imm$iate suit ,if ! ,director det]m9es at any "t foll[+ ! fil+ ( a compla9t "u ?is subsection t ! public int]e/ w\ld be s]v$ by all[+ ! compla9ant to br+ a civil action "u subsection 7c7 9 a ,/ate or ,f$]al c\rt imm$iately1 ! ,director %all c]tify t ! adm9i/rative process has conclud$ & t ! compla9ant may file su* a suit imm$iately4 7#g7 ,annual report ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 & annually !reaft]1 ! ,director %all make publicly available a report detail+ ! activities ( ! ,(fice = ,civil ,rights & ,heal? ,equity "u ?is subsection1 includ+-- 7,a7 ! numb] ( compla9ts fil$ & ! basis on :i* ! compla9ts 7 fil$2 7,b7 ! numb] ( inve/igations und]tak5 z a result ( su* compla9ts2 & 7,c7 ! disposition ( all su* inve/igations4 7c7 ,en=cem5t by private p]sons 7#a7 ,9 g5]al 7,a7 ,civil action 7i7 ,9 suit ,a compla9ant "u subsection 7b7 may comm5ce a civil action to obta9 appropriate relief ) respect to an alleg$ violation ( subsection 7a71 or = brea* ( a conciliation agreem5t "u subsection 7b71 9 an appropriate di/rict c\rt ( ! ,unit$ ,/ates or ,/ate c\rt-- 7,i7 n soon] ?an ! e>lie/ (-- 7aa7 ! date a conciliation agreem5t is rea*$ "u subsection 7b72 7bb7 ! date ( a f9al disposition ( a compla9t "u subsection 7b72 or 7cc7 #ahj days aft] ! fir/ day ( ! alleg$ violation2 & 7,,ii7 n lat] ?an #b ye>s aft] ! f9al day ( ! alleg$ violation4 7ii7 ,/atute ( limitations ,! computation ( su* #b-ye> p]iod %all n include any "t dur+ :i* an adm9i/rative proce$+ 7includ+ inve/igation or conciliation7 "u subsection 7b7 0 p5d+ ) respect to a compla9t "u su* subsection4 7,b7 ,b>r+ suit ,if ! ,director has obta9$ a conciliation agreem5t "u subsection 7b7 reg>d+ an alleg$ violation ( subsection 7a71 no action may be fil$ "u ?is p>agraph by ! compla9ant involv$ ) respect to ! alleg$ violation except = ! purpose ( en=c+ ! t]ms ( su* an agreem5t4 7#b7 ,relief :i* may be grant$ 7,a7 ,9 g5]al ,9 a civil action "u p>agraph 7#a71 if ! c\rt f9ds t a violation ( subsection 7a7 or brea* ( a conciliation agreem5t has occurr$1 ! c\rt may aw>d to ! pla9tiff actual & punitive damages1 & may grant z relief1 z ! c\rt det]m9es to be appropriate1 any p]man5t or tempor>y injunction1 tempor>y re/ra9+ ord]1 or o!r ord] 7includ+ an ord] enjo9+ ! def5dant f engag+ 9 a practice violat+ subsection 7a7 or ord]+ su* affirmative action z may be appropriate74 7,b7 ,fees & co/s ,9 a civil action "u p>agraph 7#a71 ! c\rt1 9 its discretion1 may all[ ! prevail+ p>ty1 o!r ?an ! ,unit$ ,/ates1 a reasonable attorney's fee & co/s4 ,! ,unit$ ,/ates %all be liable = su* fees & co/s to ! same ext5t z a private p]son4 7#c7 ,int]v5tion by ,attorney ,g5]al ,^u timely application1 ! ,attorney ,g5]al may int]v5e 9 a civil action "u p>agraph 7#a71 if ! ,attorney ,g5]al c]tifies t ! case is ( g5]al public importance4 7d7 ,en=cem5t by ! ,attorney ,g5]al 7#a7 ,comm5cem5t ( actions 7,a7 ,patt]n or practice cases ,! ,attorney ,g5]al may comm5ce a civil action 9 any appropriate di/rict c\rt ( ! ,unit$ ,/ates if ! ,attorney ,g5]al has reasonable cause to believe t any heal? c>e provid] cov]$ by subsection 7a7-- 7i7 is engag$ 9 a patt]n or practice t violates su* subsection2 or 7ii7 is engag$ 9 a violation ( su* subsection t raises an issue ( significant public importance4 7,b7 ,cases by ref]ral ,! ,director may det]m9e1 bas$ on a patt]n ( compla9ts1 a patt]n ( violations1 a review ( data report$ by a heal? c>e provid] cov]$ by subsection 7a71 or any o!r means1 t !re is reasonable cause to believe a heal? c>e provid] is engag$ 9 a patt]n or practice t violates subsection 7a74 ,if ! ,director makes su* a det]m9ation1 ! ,director %all ref] ! relat$ f9d+s to ! ,attorney ,g5]al4 ,if ! ,attorney ,g5]al f9ds t su* reasonable cause exi/s1 ! ,attorney ,g5]al may comm5ce a civil action 9 any appropriate di/rict c\rt ( ! ,unit$ ,/ates4 7#b7 ,en=cem5t ( subpo5as ,! ,attorney ,g5]al1 on behalf ( ! ,director1 or ano!r p>ty at ^: reque/ a subpo5a is issu$ "u ?is subsection1 may en=ce su* subpo5a 9 appropriate proce$+s 9 ! di/rict c\rt ( ! ,unit$ ,/ates = ! di/rict 9 :i* ! p]son to :om ! subpo5a 0 address$ resides1 0 s]v$1 or transacts bus9ess4 7#c7 ,relief :i* may be grant$ 9 civil actions 7,a7 ,9 g5]al ,9 a civil action "u p>agraph 7#a71 ! c\rt-- 7i7 may aw>d su* prev5tive relief1 includ+ a p]man5t or tempor>y injunction1 tempor>y re/ra9+ ord]1 or o!r ord] aga9/ ! p]son responsible = a violation ( subsection 7a7 z is necess>y to assure ! full enjoym5t ( ! rights grant$ by ?is subsection2 7ii7 may aw>d su* o!r relief z ! c\rt det]m9es to be appropriate1 includ+ monet>y damages1 to aggriev$ p]sons2 & 7iii7 may1 to v9dicate ! public int]e/1 assess punitive damages aga9/ ! respond5t-- 7,i7 9 an am\nt n exce$+ #ejj1jjj1 = a fir/ violation2 & 7,,ii7 9 an am\nt n exce$+ #a1jjj1jjj1 = any subsequ5t violation4 7,b7 ,fees & co/s ,9 a civil action "u ?is subsection1 ! c\rt1 9 its discretion1 may all[ ! prevail+ p>ty1 o!r ?an ! ,unit$ ,/ates1 a reasonable attorney's fee & co/s4 ,! ,unit$ ,/ates %all be liable = su* fees & co/s to ! ext5t provid$ by section #bdab ( title #bh1 ,unit$ ,/ates ,code4 7#d7 ,int]v5tion 9 civil actions ,^u timely application1 any p]son may int]v5e 9 a civil action comm5c$ by ! ,attorney ,g5]al "u p>agraphs 7#a7 & 7#b7 if ! action involves an alleg$ violation ( subsection 7a7 ) respect to :i* su* p]son is an aggriev$ p]son 7includ+ a p]son :o is a compla9ant "u subsection 7b77 or a conciliation agreem5t to :i* su* p]son is a p>ty4 #ijjh4 ,f$]al ,heal? ,equity ,commission 7a7 ,e/abli%m5t ( ,commission 7#a7 ,9 g5]al ,!re is e/abli%$ ! ,f$]al ,heal? ,equity ,commission 7h]e9aft] 9 ?is section ref]r$ to z ! ,commission74 7#b7 ,memb]%ip 7,a7 ,9 g5]al ,! ,commission %all be compos$ (-- 7i7 #h vot+ memb]s appo9t$ "u subp>agraph 7,b72 & 7ii7 ! nonvot+1 ex (ficio memb]s li/$ 9 subp>agraph 7,c74 7,b7 ,vot+ memb]s ,n m ?an #d ( ! memb]s describ$ 9 subp>agraph 7,a77i7 %all at any "o "t be ( ! same political p>ty4 ,su* memb]s %all h recogniz$ exp]tise 9 & p]sonal exp]i5ce ) racial & e?nic heal? inequities1 heal? c>e ne$s ( vuln]able & m>g9aliz$ populations1 & heal? equity z a vehicle = improv+ heal? /atus & heal? outcomes4 ,su* memb]s %all be appo9t$ to ! ,commission z foll[s3 7i7 ,f\r memb]s ( ! ,commission %all be appo9t$ by ! ,presid5t4 7ii7 ,two memb]s ( ! ,commission %all be appo9t$ by ! ,presid5t pro tempore ( ! ,s5ate1 ^u ! recomm5dations ( ! majority lead] & ! m9ority lead] ( ! ,s5ate4 ,ea* memb] appo9t$ to ! ,commission "u ?is clause %all be appo9t$ f a diff]5t political p>ty4 7iii7 ,two memb]s ( ! ,commission %all be appo9t$ by ! ,speak] ( ! ,h\se ( ,repres5tatives ^u ! recomm5dations ( ! majority lead] & ! m9ority lead] ( ! ,h\se ( ,repres5tatives4 ,ea* memb] appo9t$ to ! ,commission "u ?is clause %all be appo9t$ f a diff]5t political p>ty4 7,c7 ,ex (ficio memb] ,! ,commission %all h ! foll[+ nonvot+1 ex (ficio memb]s3 7i7 ,! ,director = ,civil ,rights & ,heal? ,equity ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7ii7 ,! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal? ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7iii7 ,! ,director ( ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities4 7iv7 ,! ,*airp]son ( ! ,advisory ,committee on ,m9ority ,heal? e/abli%$ "u section #agjg7;c7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f7;c774 7#c7 ,t]ms ,! t]m ( (fice ( ea* memb] appo9t$ "u p>agraph 7#b77;,b7 ( ! ,commission %all be #f ye>s4 7#d7 ,*airp]son2 ,vice ,*airp]son 7,a7 ,*airp]son ,! ,presid5t %all1 ) ! concurr5ce ( a majority ( ! memb]s ( ! ,commission appo9t$ "u p>agraph 7#b77;,b71 designate a ,*airp]son f among ! memb]s ( ! ,commission appo9t$ "u su* p>agraph4 7,b7 ,vice ,*airp]son 7i7 ,designation ,! ,speak] ( ! ,h\se ( ,repres5tatives %all1 9 consultation ) ! majority lead]s & ! m9ority lead]s ( ! ,s5ate & ! ,h\se ( ,repres5tatives & ) ! concurr5ce ( a majority ( ! memb]s ( ! ,commission appo9t$ "u p>agraph 7#b77;,b71 designate a ,vice ,*airp]son f among ! memb]s ( ! ,commission appo9t$ "u su* p>agraph4 ,! ,vice ,*airp]son may n be a memb] ( ! same political p>ty z ! ,*airp]son4 7ii7 ,duty ,! ,vice ,*airp]son %all act 9 place ( ! ,*airp]son 9 ! abs5ce ( ! ,*airp]son4 7#e7 ,removal ( memb]s ,! ,presid5t may remove a memb] ( ! ,commission only = neglect ( duty or malfeasance 9 (fice4 7#f7 ,quorum ,a majority ( memb]s ( ! ,commission appo9t$ "u p>agraph 7#b77;,b7 %all con/itute a quorum ( ! ,commission1 b a less] numb] ( memb]s may hold he>+s4 7b7 ,duties ( ! ,commission 7#a7 ,9 g5]al ,! ,commission %all-- 7,a7 monitor & report on ! implem5tation ( ?is ,act2 & 7,b7 inve/igate1 monitor1 & report on progress t[>ds heal? equity & ! elim9ation ( heal? disp>ities4 7#b7 ,annual report ,! ,commission %all-- 7,a7 submit to ! ,presid5t & ,congress at lea/ "o report annually on heal? equity & heal? disp>ities2 & 7,b7 include 9 su* report-- 7i7 a description ( actions tak5 by ! ,dep>tm5t ( ,heal? & ,human ,s]vices & any o!r ,f$]al ag5cy relat$ to heal? equity or heal? disp>ities2 & 7ii7 recomm5dations on ensur+ equitable heal? c>e & elim9at+ heal? disp>ities4 7c7 ,p[]s 7#a7 ,he>+s 7,a7 ,9 g5]al ,! ,commission or1 at ! direction ( ! ,commission1 any subcommittee or memb] ( ! ,commission1 may1 = ! purpose ( c>ry+ out ?is section1 z ! ,commission or ! subcommittee or memb] consid]s advisable-- 7i7 hold su* he>+s1 meet & act at su* times & places1 take su* te/imony1 receive su* evid5ce1 & adm9i/] su* oa?s2 & 7ii7 require1 by subpo5a or o!rwise1 ! att5dance & te/imony ( su* witnesses & ! production ( su* books1 records1 correspond5ce1 memor&a1 pap]s1 docum5ts1 tapes1 & mat]ials4 7,b7 ,limitation on he>+s ,! ,commission may hold a he>+ "u subp>agraph 7,a77i7 only if ! he>+ is approv$-- 7i7 by a majority ( ! memb]s ( ! ,commission appo9t$ "u subsection 7a77#b77;,b72 or 7ii7 by a majority ( su* memb]s pres5t at a meet+ :5 a quorum is pres5t4 7#b7 ,issuance & en=cem5t ( subpo5as 7,a7 ,issuance ,a subpo5a issu$ "u p>agraph 7#a7 %all-- 7i7 be> ! signature ( ! ,*airp]son ( ! ,commission2 & 7ii7 be s]v$ by any p]son or class ( p]sons designat$ by ! ,*airp]son = t purpose4 7,b7 ,en=cem5t ,9 ! case ( contumacy or failure to obey a subpo5a issu$ "u p>agraph 7#a71 ! ,unit$ ,/ates di/rict c\rt = ! di/rict 9 :i* ! subpo5a$ p]son resides1 is s]v$1 or may be f\nd may issue an ord] requir+ ! p]son to appe> at any designat$ place to te/ify or to produce docum5t>y or o!r evid5ce4 7,c7 ,noncompliance ,any failure to obey ! ord] ( ! c\rt may be puni%$ by ! c\rt z a contempt ( c\rt4 7#c7 ,witness all[ances & fees 7,a7 ,9 g5]al ,section #ahba ( title #bh1 ,unit$ ,/ates ,code1 %all apply to a witness reque/$ or subpo5a$ to appe> at a he>+ ( ! ,commission4 7,b7 ,exp5ses ,! p] diem & mileage all[ances = a witness %all be paid f funds available to pay ! exp5ses ( ! ,commission4 7#d7 ,po/al s]vices ,! ,commission may use ! ,unit$ ,/ates mails 9 ! same mann] & "u ! same conditions z o!r ag5cies ( ! ,f$]al ,gov]nm5t4 7#e7 ,gifts ,! ,commission may accept1 use1 & dispose ( gifts or donations ( s]vices or prop]ty4 7d7 ,adm9i/rative ,provisions 7#a7 ,/aff 7,a7 ,director ,!re %all be a full-"t /aff director = ! ,commission :o %all-- 7i7 s]ve z ! adm9i/rative head ( ! ,commission2 & 7ii7 be appo9t$ by ! ,*airp]son ) ! concurr5ce ( ! ,vice ,*airp]son4 7,b7 ,o!r p]sonnel ,! ,commission may-- 7i7 appo9t su* o!r p]sonnel z x consid]s advisable1 subject to ! provisions ( title #e1 ,unit$ ,/ates ,code1 gov]n+ appo9tm5ts 9 ! competitive s]vice1 & ! provisions ( *apt] #ea & sub*apt] ,,iii ( *apt] #ec ( t title relat+ to classification & ,g5]al ,s*$ule pay rates2 & 7ii7 may procure tempor>y & int]mitt5t s]vices "u section #caji7;b7 ( title #e1 ,unit$ ,/ates ,code1 at rates = individuals n 9 excess ( ! daily equival5t paid = positions at ! maximum rate = ,,gs-#ae ( ! ,g5]al ,s*$ule "u section #eccb ( title #e1 ,unit$ ,/ates ,code4 7#b7 ,comp5sation ( memb]s 7,a7 ,non-,f$]al employees ,ea* memb] ( ! ,commission :o is n an (fic] or employee ( ! ,f$]al ,gov]nm5t %all be comp5sat$ at a rate equal to ! daily equival5t ( ! annual rate ( basic pay prescrib$ = level ,,iv ( ! ,executive ,s*$ule "u section #ecae ( title #e1 ,unit$ ,/ates ,code1 = ea* day 7includ+ travel "t7 dur+ :i* ! memb] is engag$ 9 ! p]=mance ( ! duties ( ! ,commission4 7,b7 ,f$]al employees ,ea* memb] ( ! ,commission :o is an (fic] or employee ( ! ,f$]al ,gov]nm5t %all s]ve )\t comp5sation 9 addition to ! comp5sation receiv$ = ! s]vices ( ! memb] z an (fice or employee ( ! ,f$]al ,gov]nm5t4 7,c7 ,travel exp5ses ,a memb] ( ! ,commission %all be all[$ travel exp5ses1 includ+ p] diem 9 lieu ( subsi/5ce1 at rates au?oriz$ = an employee ( an ag5cy "u sub*apt] ,i ( *apt] #eg ( title #e1 ,unit$ ,/ates ,code1 :ile away f ! home or regul> place ( bus9ess ( ! memb] 9 ! p]=mance ( ! duties ( ! ,commission4 7#c7 ,coop]ation ,! ,commission may secure directly f any ,f$]al dep>tm5t or ag5cy su* in=mation z ! ,commission consid]s necess>y to c>ry out ?is ,act4 ,^u reque/ ( ! ,*airman ( ! ,commission1 ! head ( su* dep>tm5t or ag5cy %all furni% su* in=mation to ! ,commission4 7e7 ,p]man5t ,commission ,section #ad ( ! ,f$]al ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 %all n apply to ! ,commission4 7f7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ = fiscal ye> #bjbc & ea* fiscal ye> !reaft] su* sums z may be necess>y to c>ry out ! duties ( ! ,commission4 ,x ,address+ ,social ,det]m9ants & ,improv+ ,environm5tal ,ju/ice ,a ,9 ,g5]al #ajjja4 ,def9itions ,9 ?is title3 7#a7 ,adm9i/rator ,! t]m ,adm9i/rator means ! ,adm9i/rator ( ! ,environm5tal ,protection ,ag5cy4 7#b7 ,ag5cy ,! t]m ,ag5cy means ! ,environm5tal ,protection ,ag5cy4 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 ,det]m9ants ( heal? ,! t]m det]m9ants ( heal?-- 7,a7 means ! range ( noncl9ical factors inclusive ( p]sonal1 social1 economic1 & environm5tal factors t directly influ5ce heal? /atus2 & 7,b7 includes social det]m9ants ( heal?4 7#e7 ,economic det]m9ants ( heal? ,! t]m economic det]m9ants ( heal? means income & social /atus4 7#f7 ,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#g7 ,p]sonal det]m9ants ( heal? ,! t]m p]sonal det]m9ants ( heal? means an individual's behavior1 biology1 & g5etics4 7#h7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#i7 ,social det]m9ants ( heal? ,! t]m social det]m9ants ( heal?-- 7,a7 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 & plays2 & 7,b7 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?4 #ajjjb4 ,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 n 9 a m$ical sett+1 b 9 our families1 9 our s*ools & workplaces1 9 our neighborhoods1 9 ! air we brea!1 & 9 ! wat] we dr9k4 7#d7 7,a7 ,heal?y ,p #bjcj id5tifies heal? & heal? c>e quality z a function ( n only access to heal? c>e1 b also ! social det]m9ants ( heal?1 categoriz$ 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? inequities3 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 ( life1 b also a b>ri] 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$uc+ heal? inequities4 ,additionally1 ! anticipation ( racism itself causes high] psy*ological & c>diovascul> /ress levels t are l9k$ to poor heal? outcomes4 ,rem$y+ discrim9atory practices at ! individual & sy/emic levels w likely r$uce heal? inequities 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 ( inequities )9 & 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$ictor ( adult mortality4 ,x is a basic compon5t ( socioeconomic /atus t %apes e>n+ pot5tial1 & consequ5tly1 access to res\rces t promote heal?4 ,p ) m education are less likely to report t !y are 9 poor heal?1 & are also less likely to h diabetes & o!r *ronic diseases4 7vii7 ,individuals ) l[] levels ( educational atta9m5t are mu* m likely to report to be curr5t smok]s4 ,9 #bjag1 smok+ preval5ce 0 #cf4h p]c5t among adults ) a ,,g$ 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? inequities4 ,= 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$ ) obesity1 & 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? inequities 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] risk 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 #bjcj1 p ) disabilities1 z a gr\p1 exp]i5ce heal? inequities 9 r\t9e public heal? ar5as su* z heal? behaviors1 cl9ical prev5tive s]vices1 & *ronic conditions4 ,comp>$ ) p )\t disabilities1 p ) 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 #ajjjc4 ,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/] community lead]%ip1 own]%ip1 & 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 #gfjb7;a71 is fur!r am5d$ by add+ at ! end ! foll[+3 #cii,v-#ad4 ,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? inequity ,! t]m heal? inequity 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 ,/ates1 ,indian ,tribes1 & ,tribal organizations to support subgrantees 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[ ,/ates1 ,indian ,tribes1 & ,tribal organizations to aw>d subgrants to eligible entities to conduct heal? impact assessm5ts4 7c7 ,guidance 7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,correct+ ,hurtful & ,ali5at+ ,names 9 ,gov]nm5t ,expression ,act1 ! ,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$ures = heal? impact assessm5t4 7d7 ,grant program 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director & 9 collaboration ) ! ,adm9i/rator1 %all-- 7,a7 aw>d grants to ,/ates1 ,indian ,tribes1 & ,tribal organizations to aw>d subgrants to eligible entities = capacity build+ or to prep>e heal? impact assessm5ts2 & 7,b7 ensure t ,/ates1 ,indian ,tribes1 & ,tribal organizations receiv+ a grant "u ?is subsection fur!r support tra9+ & te*nical assi/ance = subgrantees "u subp>agraph 7,a7 by fund+ & ov]see+ appropriate exp]ts on heal? impact assessm5ts f local1 ,/ate1 & ,tribal gov]nm5ts1 ! ,f$]al ,gov]nm5t1 in/itutions ( high] education1 & nonpr(it organizations to provide su* tra9+ & te*nical assi/ance4 7#b7 ,applications = subgrants 7,a7 ,9 g5]al ,to be eligible to receive a subgrant "u ?is section1 an eligible entity %all-- 7i7 be a community-bas$ organization s]v+ individuals or populations ! heal? ( :i* are1 or w be1 affect$ by an activity or a propos$ activity2 & 7ii7 submit to ! grantee an application 9 accordance ) ?is subsection1 at su* "t1 9 su* mann]1 & conta9+ su* additional in=mation z ! ,secret>y 7act+ ?r\gh ! ,director & 9 collaboration ) ! ,adm9i/rator7 & ! grantee may require4 7,b7 ,inclusion ,an application = a subgrant "u ?is subsection %all include-- 7i7 a li/ ( propos$ activities t require or w\ld b5efit f conduct+ a heal? impact assessm5t )9 six mon?s ( receiv+ ! subgrant2 7ii7 support+ docum5tation1 includ+ lett]s ( support1 f pot5tial conductors ( heal? impact assessm5ts = ! li/$ propos$ activities2 7iii7 an assessm5t by ! applicant ( ! heal? ( ! population to be s]v$ ?r\gh ! subgrant2 & 7iv7 a description ( pot5tial adv]se or positive effects on heal? t ! propos$ activities may create4 7,c7 ,pref]5ce ,9 aw>d+ subgrants "u ?is subsection1 ,/ates may give pref]5ce 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 ,a ,/ate1 ,indian ,tribe1 or ,tribal organization receiv+ a grant "u ?is subsection %all use su* grant to conduct heal? impact assessm5t capacity build+ 9 support ( a subgrantee 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+ organizations1 & provide !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+ 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 ,a ,/ate1 ,indian ,tribe1 or ,tribal organization receiv+ a grant "u ?is section %all conduct an evaluation ( any activity propos$ to be fund$ ?r\gh ! grant1 includ+ ?r\gh a subgrant1 to det]m9e :e!r su* activity w h a significant adv]se or positive effect on ! heal? ( ! affect$ population to be s]v$1 bas$ 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? inequities4 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 ! population to be s]v$2 7,,iii7 any o!r significant pot5tial haz>d or enhancem5t to human heal?1 z det]m9$ by ! grantee2 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 a grantee 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 ,a subgrantee "u ?is section %all develop & implem5t a plan1 to be approv$ by ! ,secret>y 7act+ ?r\gh ! ,director & 9 collaboration ) ! ,adm9i/rator7 & ! grantee1 = 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 ,a grantee "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 ,a subgrantee "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$s & tim+ ( ! decision-mak+ process su* assessm5t evaluates4 7#aa7 ,me?odology ,9 prep>+ a heal? impact assessm5t fund$ "u ?is subsection1 a subgrantee "u ?is section %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 subgrantees to conduct heal? impact assessm5ts2 & 7#c7 guidance = subgrantees ) 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 & subgrantees ) ! provision ( tra9+ & te*nical assi/ance 9 ! conduct+ ( heal? impact assessm5ts2 7#b7 evaluate ! activities c>ri$ out ) grants & subgrants "u subsection 7d72 & 7#c7 assi/ ! ,secret>y 9 dissem9at+ evid5ce1 be/ practices1 & lessons le>n$ f grantees & subgrantees4 7g7 ,report to ,congress ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,correct+ ,hurtful & ,ali5at+ ,names 9 ,gov]nm5t ,expression ,act1 ! ,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-#ae4 ,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 ( ! impacts 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 #ajjjd4 ,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 & ! ,director ( ! ,national ,in/itute ( ,environm5tal ,heal? ,sci5ces4 7#b7 ,eligible entity ,! t]m eligible entity means a ,/ate1 ,indian ,tribe1 ,tribal organization1 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? inequities among all populations1 includ+ *ildr52 & 7#c7 to address racial & e?nic inequities 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 plann+ & prioritiz+ 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/ruct1 & 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$uce ov]weight & obesity1 musculoskeletal diseases1 respiratory conditions1 infecti\s diseases1 d5tal1 oral1 & m5tal heal? conditions1 pov]ty1 & relat$ 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 inequities 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 inequities 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$uc+ inequities 9 ! social det]m9ants ( heal? = racial & e?nic populations4 7ii7 ,demon/ration projects ,n lat] ?an #b ye>s aft] ! date ( enactm5t ( ?is ,act1 ! ,director %all implem5t at lea/ #ab demon/ration projects1 includ+ at lea/ "o project = ea* major racial & e?nic m9ority gr\p1 ea* ( :i* is unique to ! cultural & l+ui/ic ne$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 7,,vi7 ,middle ,ea/]n & ,nor!rn ,african communities4 7iii7 ,report to ,congress ,no lat] ?an #b ye>s aft] ! implem5tation ( ! initial demon/ration projects "u ?is p>agraph1 ! ,director %all submit to ,congress a report t 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? inequities bas$ on _! race1 e?nicity1 g5d]1 or sexual ori5tation4 7,,ii7 ,promot+ ! collaboration betwe5 prim>y & specialty c>e heal? c>e provid]s & pati5ts1 to ensure pati5ts impact$ by heal? inequities bas$ on race1 e?nicity1 g5d]1 or sexual ori5tation are receiv+ compreh5sive & organiz$ treatm5t & c>e4 7,,iii7 ,educat+ heal? c>e pr(essionals on ! causes & effects ( inequities 9 ! social det]m9ants ( heal? 9 relation 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 inequities 9 ! social det]m9ants ( heal? 9 relation 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> #bjbc2 & 7#b7 su* sums z may be necess>y = fiscal ye>s #bjbd ?r\gh #bjbf4 #ajjje4 ,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 & ! ,adm9i/rator 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>iation 9 ! heal? ( resid5ts by-- 7,i7 location 7su* z inn] cities1 inn] suburbs1 out] suburbs1 res]vations1 & rural areas72 & 7,,ii7 population subgr\p 7includ+ *ildr51 "y adults1 ! 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 #ajjjf4 ,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 ! effects 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 & publi%$ 9 ! ,f$]al ,regi/] on ,may #i1 #bjjb 7#fg ,f$4 ,reg4 #caabi74 7ii7 ,! f9al rule ( ! ,environm5tal ,protection ,ag5cy entitl$ ,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 & publi%$ 9 ! ,f$]al ,regi/] on ,july #cj1 #bjab 7#gg ,f$4 ,reg4 #dddid74 7iii7 ,! f9al rule entitl$ ,)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 & publi%$ 9 ! ,f$]al ,regi/] on ,m>* #ai1 #bjjc 7#fh ,f$4 ,reg4 #acfjh74 7iv7 ,! f9al rule ( ! ,environm5tal ,protection ,ag5cy entitl$ ,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$ge or ,fill ,programs2 & ,,caa ,prev5tion ( ,significant ,det]ioration & publi%$ 9 ! ,f$]al ,regi/] on ,may #ai1 #aihj 7#de ,f$4 ,reg4 #ccbij71 ) respect to ! def9ition ( ! wat]s ( ! ,unit$ ,/ates4 7v7 ,! f9al rule ( ! ,corps ( ,eng9e]s & ! ,environm5tal ,protection ,ag5cy entitl$ ,def9ition ( ,wat]s ( ! ,unit$ ,/ates--,recodification ( ,pre-,exi/+ ,rules & publi%$ 9 ! ,f$]al ,regi/] on ,octob] #bb1 #bjai 7#hd ,f$4 ,reg4 #effbf74 7vi7 ,! f9al rule ( ! ,corps ( ,eng9e]s & ! ,environm5tal ,protection ,ag5cy entitl$ ,! ,navigable ,wat]s ,protection ,rule3 ,def9ition ( ,wat]s ( ! ,unit$ ,/ates & publi%$ 9 ! ,f$]al ,regi/] on ,april #ba1 #bjbj 7#he ,f$4 ,reg4 #bbbej74 7,b7 ,=e/s & l& managem5t 7i7 ,! ,heal?y ,=e/s ,re/oration ,act ( #bjjc 7#af ,u4,s4,c4 #feja et seq474 7ii7 ,! application ( section #eec7;e7 ( title #e1 ,unit$ ,/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 #baafb7 & ,national ,=e/ ,sy/em ,l& ,managem5t ,plann+ 7#ha ,f$4 ,reg4 #ijgbc71 publi%$ on ,april #ai1 #bjac1 & ,decemb] #ae1 #bjaf1 respectively4 7iv7 ,! f9al rule entitl$ ,oil ,%ale ,managem5t--,g5]al & publi%$ on ,janu>y #ae1 #bjji 7#gc ,f$4 ,reg4 #fidad74 7v7 ,! record ( decision describ$ 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 & publi%$ on ,april #a1 #bjac 7#gh ,f$4 ,reg4 #aieah74 7,c7 ,sci5tific review ,! f9al rule entitl$ ,int]ag5cy ,coop]ation ,"u ! ,endang]$ ,species ,act 7,decemb] #af1 #bjjh7 7#gc ,f$4 ,reg4 #gfbgb71 z am5d$ by ! f9al rule entitl$ ,endang]$ & ,?reat5$ ,wildlife & ,plants2 ,regulations = ,int]ag5cy ,coop]ation 7,augu/ #bg1 #bjai7 7#hd ,f$4 ,reg4 #ddigf74 7#b7 ,me?od ,9 conduct+ ! /udy "u p>agraph 7#a71 ! ,national ,academy ( ,sci5ces may use & comp>e exi/+ sci5tific /udies reg>d+ ! regulations1 laws1 & o!r ag5cy decisions describ$ 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 ( ! effects ( 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 #ajjjg4 ,,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 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 #ajjjh4 ,e/abli% an int]ag5cy c\nsel & grant programs on social det]m9ants ( heal? 7a7 ,f9d+s2 purposes 7#a7 ,f9d+s ,congress f9ds z foll[s3 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$icaid program "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 & o!r social s]vices programs because ( ! fragm5t$ & 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$icaid4 7,d7 ,to develop /rategies to improve heal? & social outcomes )\t d5y+ s]vices to1 or re/rict+ ! eligibility (1 vuln]able populations4 7b7 ,social det]m9ants accel]ator c\ncil 7#a7 ,e/abli%m5t ,! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ 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 describ$ 9 clause 7ii7 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 conduct 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 subp>agraph 7,b77ii74 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$1 & to make in=mation on su* au?orities & opportunities publicly available2 7,c7 to provide t>get$ 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 subsection 7c72 & 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 7c71 & ! 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 7c7 ,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 & ,tribal gov]nm5ts1 academic in/itutions1 nonpr(it organizations1 community-bas$ organizations1 & o!r public & 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 & ,tribal gov]nm5ts1 academic in/itutions1 nonpr(it organizations1 or any o!r public or 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 7d7 ,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 #ajjji4 ,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 ,act or ! ,,*ange ,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 ,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-- 7,a7 is unlawfully pres5t 9 ! ,unit$ ,/ates2 or 7,b7 lacks a lawful immigration /atus 9 ! ,unit$ ,/ates4 #ajjaj4 ,&rew ,ke>se ,acc\ntability = ,d5ial ( ,m$ical ,c>e 7a7 ,9 g5]al ,*apt] #ac ( title #ah1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+3 #bej4 ,m$ical att5tion = individuals 9 ,f$]al cu/ody display+ m$ical di/ress 7a7 ,def9itions ,9 ?is section-- 7#a7 ! t]m appropriate ,inspector ,g5]al1 ) respect to a cov]$ (ficial1 means-- 7,a7 ! ,inspector ,g5]al ( ! ,f$]al ag5cy t employs ! cov]$ (ficial2 or 7,b7 9 ! case ( a cov]$ (ficial employ$ by a ,f$]al ag5cy t does n h an ,inspector ,g5]al1 ! ,inspector ,g5]al ( ! ,dep>tm5t ( ,ju/ice2 7#b7 ! t]m cov]$ (ficial means-- 7,a7 a ,f$]al law en=cem5t (fic] 7z def9$ 9 section #aae72 7,b7 an (fic] or employee ( ! ,bureau ( ,prisons2 or 7,c7 an (fic] or employee ( ! ,unit$ ,/ates ,m>%als ,s]vice2 & 7#c7 ! t]m m$ical di/ress includes brea?+ difficulties4 7b7 ,requirem5t 7#a7 ,(f5se ,x %all be unlawful = a cov]$ (ficial to neglig5tly fail to obta9 or provide imm$iate m$ical att5tion to an individual 9 ,f$]al cu/ody :o displays m$ical di/ress 9 ! pres5ce ( ! cov]$ (ficial if ! individual suff]s unnecess>y pa91 injury1 or dea? z a result ( t failure4 7#b7 ,p5alty ,a cov]$ (ficial :o violates p>agraph 7#a7 %all be f9$ "u ?is title1 imprison$ = n m ?an #a ye>1 or bo?4 7#c7 ,/ate civil en=cem5t ,:5ev] an attorney g5]al ( a ,/ate has reasonable cause to believe t a resid5t ( ! ,/ate has be5 aggriev$ by a violation ( p>agraph 7#a7 by a cov]$ (ficial1 ! attorney g5]al1 or ano!r (ficial1 ag5cy1 or entity designat$ by ! ,/ate1 may br+ a civil action 9 any appropriate di/rict c\rt ( ! ,unit$ ,/ates to obta9 appropriate equitable & decl>atory relief4 7c7 ,inspector ,g5]al inve/igation 7#a7 ,9 g5]al ,! appropriate ,inspector ,g5]al %all inve/igate any in/ance 9 :i*-- 7,a7 a cov]$ (ficial fails to obta9 or provide imm$iate m$ical att5tion to an individual 9 ,f$]al cu/ody :o displays m$ical di/ress 9 ! pres5ce ( ! cov]$ (ficial2 & 7,b7 ! individual suff]s unnecess>y pa91 injury1 or dea? z a result ( ! failure to obta9 or provide imm$iate m$ical att5tion4 7#b7 ,ref]ral = prosecution ,if an appropriate ,inspector ,g5]al1 9 conduct+ an inve/igation "u p>agraph 7#a71 concludes t ! cov]$ (ficial act$ neglig5tly 9 fail+ to obta9 or provide imm$iate m$ical att5tion to ! individual 9 ,f$]al cu/ody1 ! appropriate ,inspector ,g5]al %all ref] ! case to ! ,attorney ,g5]al = prosecution "u ?is section4 7#c7 ,confid5tial compla9t process ,! ,inspector ,g5]al ( a ,f$]al ag5cy t employs cov]$ (ficials %all e/abli% a process "u :i* an individual may confid5tially submit a compla9t to ! ,inspector ,g5]al reg>d+ an incid5t describ$ 9 p>agraph 7#a7 involv+ a cov]$ (ficial employ$ by ! ,f$]al ag5cy 7or1 9 ! case ( ! ,inspector ,g5]al ( ! ,dep>tm5t ( ,ju/ice1 involv+ a cov]$ (ficial employ$ by a ,f$]al ag5cy t does n h an ,inspector ,g5]al74 7d7 ,tra9+ ,! head ( an ag5cy t employs cov]$ (ficials %all provide tra9+ to ea* su* cov]$ (ficial on obta9+ or provid+ m$ical assi/ance to individuals 9 m$ical di/ress4 4 7b7 ,te*nical & con=m+ am5dm5t ,! table ( sections = *apt] #ac ( title #ah1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+3 #bej4 ,m$ical att5tion = individuals 9 ,f$]al cu/ody display+ m$ical di/ress4 4 #ajjaa4 ,inve/+ 9 community heal+ 7a7 ,f9d+s ,congress f9ds z foll[s3 7#a7 ,accord+ to ! ,bureau ( ,ju/ice ,/ati/ics1 ,african ,am]icans are m likely to h face-to-face contact ) law en=cem5t & are #b4e times m likely to exp]i5ce a ?reat or use ( nonfatal =ce by police4 7#b7 ,rese>* %[s t "y m5 :o h exp]i5c$ ^! law en=cem5t practices display high] levels ( /ress1 anxiety1 & trauma associat$ ) ! int]action4 7#c7 ,witness+ or exp]i5c+ invasive enc\nt]s ) law en=cem5t c also be an ev]yday /ressor = racial & e?nic m9orities1 lead+ to physiological & psy*ological /ra94 7#d7 ,racial & e?nic m9orities face inequities 9 access+ m5tal heal? s]vices4 7#e7 ,address+ ! /igma 9 "s communities ( color associat$ ) receiv+ m5tal heal? s]vices & in=m+ individuals ab\t available treatm5t c enc\rage bett] utilization ( ^! s]vices4 7b7 ,s5se ( ,congress ,x is ! s5se ( ,congress t x is imp]ative t a compreh5sive public heal? approa* to address+ trauma & m5tal heal? c>e be focus$ on c>e deliv]y t is culturally s5sitive & compet5t4 7c7 ,rese>* on adv]se heal? effects associat$ ) int]actions ) law en=cem5t 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,director ( ! ,(fice ( ,m9ority ,heal? ( ! ,c5t]s = ,disease ,control & ,prev5tion 7e/abli%$ pursuant to section #agjg;,a ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjju-#f;a771 %all conduct rese>* on ! adv]se heal? effects associat$ ) int]actions ) law en=cem5t4 7#b7 ,effects among racial & e?nic m9orities ,! rese>* "u p>agraph 7#a7 %all include rese>* on-- 7,a7 ! heal? consequ5ces1 bo? individual & community-wide1 ( trauma relat$ to viol5ce committ$ by law en=cem5t among racial & e?nic m9orities2 & 7,b7 ! disproportionate burd5 ( morbidity & mortality associat$ ) su* trauma4 7#c7 ,report ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all-- 7,a7 complete ! rese>* "u ?is subsection2 & 7,b7 submit to ,congress a report on ! f9d+s1 conclusions1 & recomm5dations result+ f su* rese>*4 7d7 ,grants = increas+ racial & e?nic m9ority access to high-,quality trauma support s]vices & m5tal heal? c>e 7#a7 ,9 g5]al ,! ,secret>y1 act+ ?r\gh ! ,assi/ant ,secret>y = ,m5tal ,heal? & ,sub/ance ,use1 %all aw>d grants to eligible entities to e/abli% or exp& programs = ! purpose ( increas+ racial & e?nic m9ority access to high-quality trauma support s]vices & m5tal heal? c>e4 7#b7 ,eligible entities ,to seek a grant "u ?is subsection1 an entity %all be a community-bas$ program or organization t-- 7,a7 provides culturally compet5t programs & res\rces t are align$ ) evid5ce-bas$ practices = trauma-in=m$ c>e2 & 7,b7 has demon/rat$ exp]tise 9 s]v+ communities ( color or c p>tn] ) a program t has su* demon/rat$ exp]tise4 7#c7 ,use ( funds ,z a condition on receipt ( a grant "u ?is subsection1 a grantee %all agree to use ! grant to increase racial & e?nic m9ority access to high-quality trauma support s]vices & m5tal heal? c>e1 su* z by-- 7,a7 e/abli%+ & ma9ta9+ community-bas$ programs provid+ evid5ce-bas$ s]vices 9 trauma-in=m$ c>e & culturally specific s]vices & o!r res\rces2 7,b7 develop+ innovative culturally specific /rategies & projects to enhance access to trauma-in=m$ c>e & res\rces = racial & e?nic m9orities :o face ob/acles to us+ m traditional s]vices & res\rces 7su* z ob/acles 9 geographic access to provid]s1 insurance cov]age1 & access to audio & video te*nologies72 7,c7 work+ ) ,/ate & local gov]nm5ts & social s]vice ag5cies to develop & enhance effective /rategies to provide culturally specific s]vices to racial & e?nic m9orities2 7,d7 increas+ communities' capacity to provide culturally specific res\rces & support = communities ( color2 7,e7 work+ 9 coop]ation ) ! community to develop education & prev5tion /rategies highlight+ culturally specific issues & res\rces reg>d+ racial & e?nic m9orities2 7,f7 provid+ culturally specific programs = racial & e?nic m9orities expos$ to law en=cem5t viol5ce2 & 7,g7 exam9+ ! dynamics ( culture & its impact on victimization & heal+4 7#d7 ,priority ,9 aw>d+ grants "u ?is subsection1 ! ,secret>y %all give priority to eligible entities propos+ to s]ve communities t h fac$ high rates ( community trauma1 includ+ f exposure to law en=cem5t viol5ce1 int]g5]ational pov]ty1 civil unre/1 discrim9ation1 or oppression4 7#e7 ,grant p]iod ,! p]iod ( a grant "u ?is subsection %all be #d ye>s4 7#f7 ,evaluation ,n lat] ?an #f mon?s aft] ! end ( ! p]iod ( all grants "u ?is subsection1 ! ,secret>y %all-- 7,a7 conduct an evaluation ( ! programs fund$ by a grant "u ?is subsection2 7,b7 include 9 su* evaluation an assessm5t ( ! outcomes ( ea* su* program2 & 7,c7 submit a report on ! results ( su* evaluation to ,congress4 7#g7 ,au?orization ( appropriations ,to c>ry out ?is subsection1 !re is au?oriz$ to be appropriat$ #bj1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbg4 7e7 ,behavioral & m5tal heal? outrea* education /rategy 7#a7 ,9 g5]al ,! ,secret>y1 9 coord9ation ) advocacy & behavioral & m5tal heal? organizations s]v+ racial & e?nic m9ority gr\ps1 %all develop & implem5t an outrea* & education /rategy to promote behavioral & m5tal heal?1 & r$uce /igma associat$ ) m5tal heal? conditions1 among racial & e?nic m9orities4 7#b7 ,design ,! /rategy "u ?is subsection %all be design$ to-- 7,a7 meet ! div]se cultural & language ne$s ( racial & e?nic m9ority gr\ps2 7,b7 provide in=mation on evid5ce-bas$1 culturally & l+ui/ically appropriate & adapt$ int]v5tions & treatm5ts2 7,c7 increase aw>5ess ( symptoms ( m5tal illness among racial & e?nic m9ority gr\ps2 & 7,d7 ensure full p>ticipation (1 & engage1 bo? consum]s & community memb]s 9 ! developm5t & implem5tation ( mat]ials4 7#c7 ,report ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all submit to ,congress1 & make publicly available1 a report detail+ ! outrea* & education /rategy t is develop$ & implem5t$ "u ?is subsection & ! results ( su* implem5tation4 #ajjab4 ,environm5tal ju/ice mapp+ & data collection 7a7 ,f9d+s ,congress f9ds t-- 7#a7 environm5tal haz>ds caus+ adv]se heal? outcomes h disproportionately affect$ environm5tal ju/ice communities z a result ( sy/emic inju/ices relat+ to factors t include race & income2 7#b7 environm5tal ju/ice communities h increas$ vuln]ability to ! adv]se effects ( climate *ange & ne$ significant inve/m5t to face curr5t & future environm5tal haz>ds2 7#c7 ! ,f$]al ,gov]nm5t has lack$ a cohesive & consi/5t /rategy to c>ry out ! responsibilities ( ,f$]al ag5cies describ$ 9 ,executive ,ord] #abhih 7#db ,u4,s4,c4 #dcba note2 relat+ to ,f$]al actions to address environm5tal ju/ice 9 m9ority populations & l[-income populations72 7#d7 x is necess>y t ! ,f$]al ,gov]nm5t mean+fully engage environm5tal ju/ice communities 9 ! process ( develop+ a robu/ /rategy to address environm5tal ju/ice1 includ+ high levels ( review1 input1 & cons5t2 7#e7 !re is a lack ( nationwide high-quality data relat+ to environm5tal ju/ice conc]ns1 su* z socioeconomic factors1 air pollution1 wat] pollution1 soil pollution1 & public heal?1 & a failure to update ! exi/+ data ) adequate frequ5cy2 7#f7 !re is no nationally consi/5t me?od to id5tify environm5tal ju/ice communities bas$ on ! cumulative effects ( socioeconomic factors1 pollution burd51 & public heal?2 7#g7 a me?od describ$ 9 p>agraph 7#f7 is ne$$ to correct = raci/ & unju/ practices lead+ to hi/orical & curr5t environm5tal inju/ices ?r\gh ! t>get$ inve/m5t 9 environm5tal ju/ice communities ( at lea/ #dj p]c5t ( ! funds provid$ = a clean en]gy transition & o!r relat$ inve/m5ts1 includ+ transportation infra/ructure1 h\s+ infra/ructure1 & wat] quality infra/ructure2 7#h7 funds t>get$ = environm5tal ju/ice communities %\ld include set-asides = te*nical assi/ance & capacity build+ = environm5tal ju/ice communities to access ! funds2 7#i7 p>ticul> ov]sight & c>e are necess>y :5 inve/+ 9 environm5tal ju/ice communities to ensure t exi/+ issues are n exac]bat$ & new issues are n creat$1 p>ticul>ly issues relat+ to pollution burd5 & ! displacem5t ( resid5ts2 7#aj7 sev]al ,/ates1 academic in/itutions1 & nonpr(it organizations h engag$ 9 cumulative impact environm5tal ju/ice mapp+ ef=ts t c s]ve z ref]5ces = a ,f$]al mapp+ ef=t2 7#aa7 _m environm5tal ju/ice communities1 su* z communities 9 ,canc] ,alley 9 ! ,/ate ( ,l\isiana1 h be5 cle>ly affect$ by extreme environm5tal haz>ds su* t ! communities-- 7,a7 are id5tifiable be=e ! e/abli%m5t ( ! tool "u p>agraph 7#b7 ( subsection 7d7 & ! completion ( ! data gap audit "u p>agraph 7#d7 ( t subsection2 & 7,b7 %\ld be eligible = programs t>get$ t[>d environm5tal ju/ice communities t h fac$ extreme environm5tal haz>ds be=e ! e/abli%m5t ( t tool & ! completion ( t audit2 7#ab7 9 addition to inve/m5t 9 environm5tal ju/ice communities1 pollution r$uction is ess5tial to a*iev+ equitable access to a heal?y & clean environm5t & an equitable en]gy sy/em2 & 7#ac7 specific policy & p]mitt+ decisions & inve/m5ts may rely on diff]5t comb9ations ( data sets & indicators relat+ to environm5tal ju/ice1 & race alone may be consid]$ a crit]ion :5 assess+ ! susceptibility ( a community to environm5tal inju/ice4 7b7 ,def9itions ,9 ?is section3 7#a7 ,advisory c\ncil ,! t]m advisory c\ncil means ! advisory c\ncil e/abli%$ "u subsection 7c77#d77;,b77i74 7#b7 ,committee ,! t]m ,committee means ! ,environm5tal ,ju/ice ,mapp+ ,committee e/abli%$ by subsection 7c77#a74 7#c7 ,environm5tal ju/ice ,! t]m environm5tal ju/ice means ! fair treatm5t & mean+ful involvem5t ( all p reg>dless ( race1 color1 culture1 national orig91 or income1 ) respect to ! developm5t1 implem5tation1 & en=cem5t ( environm5tal laws1 regulations1 & policies to ensure t ea* p]son enjoys-- 7,a7 ! same degree ( protection f environm5tal & heal? haz>ds2 & 7,b7 equal access to any ,f$]al ag5cy action relat+ to ! developm5t1 implem5tation1 & en=cem5t ( environm5tal laws1 regulations1 & policies = ! purpose ( hav+ a heal?y environm5t 9 :i* to live1 le>n1 "w1 & recreate4 7#d7 ,environm5tal ju/ice community ,! t]m environm5tal ju/ice community means a community ) significant repres5tation ( communities ( color1 l[-income communities1 or ,tribal & indig5\s communities1 t exp]i5ces1 or is at risk ( exp]i5c+1 high] or m adv]se human heal? or environm5tal effects1 z comp>$ to o!r communities4 7#e7 ,gr\nd-tru?+ ,! t]m gr\nd-tru?+ means a community fact-f9d+ process by :i* resid5ts ( a community supplem5t te*nical in=mation ) local k = ! purpose ( bett] in=m+ policy & project decisions4 7#f7 ,relevant /akehold] ,! t]m relevant /akehold] means-- 7,a7 a repres5tative ( a regional1 ,/ate1 ,tribal1 or local gov]nm5t ag5cy2 7,b7 a repres5tative ( a nongov]nm5tal organization ) exp]i5ce 9 areas t may include ,tribal relations1 environm5tal cons]vation1 city & regional plann+1 & public heal?2 7,c7 a repres5tative ( a labor union2 7,d7 a repres5tative or memb] (-- 7i7 an environm5tal ju/ice community2 or 7ii7 a community-bas$ organization = an environm5tal ju/ice community2 7,e7 an individual ) exp]tise 9 cumulative impacts1 geospatial data1 & environm5tal ju/ice1 p>ticul>ly su* an individual f an academic or rese>* in/itution2 & 7,f7 an advocate ) exp]i5ce 9 environm5tal ju/ice :o repres5ts an environm5tal ju/ice community4 7c7 ,e/abli%m5t ( ,committee 7#a7 ,9 g5]al ,!re is e/abli%$ a committee1 to be kn[n z ! ,environm5tal ,ju/ice ,mapp+ ,committee4 7#b7 ,memb]%ip 7,a7 ,9 g5]al ,! ,committee %all be compos$ ( n few] ?an #a repres5tative ( ea* ( ! foll[+3 7i7 ,( ! ,environm5tal ,protection ,ag5cy-- 7,i7 ! ,(fice ( ,air & ,radiation2 7,,ii7 ! ,(fice ( ,*emical ,safety & ,pollution ,prev5tion2 7,,iii7 ! ,(fice ( ,int]national & ,tribal ,affairs2 7,,iv7 ! ,(fice ( ,l& & ,em]g5cy ,managem5t2 7,v7 ! ,(fice ( ,wat]2 7,,vi7 ! ,(fice ( ,environm5tal ,ju/ice2 7,,vii7 ! ,(fice ( ,rese>* & ,developm5t2 & 7,,viii7 ! ,(fice ( ,public ,engagem5t & ,environm5tal ,education4 7ii7 ,! ,c\ncil on ,environm5tal ,quality4 7iii7 ,( ! ,dep>tm5t ( ,comm]ce-- 7,i7 ! ,(fice ( ,oceanic & ,atmosph]ic ,rese>*1 includ+ n few] ?an #a repres5tative ( ! ,climate ,program ,(fice2 7,,ii7 ! ,economics & ,/ati/ics ,adm9i/ration1 includ+ n few] ?an #a repres5tative ( ! ,bureau ( ,economic ,analysis2 & 7,,iii7 ! ,national ,in/itute ( ,/&>ds & ,te*nology4 7iv7 ,( ! ,dep>tm5t ( ,heal? & ,human ,s]vices-- 7,i7 ! ,c5t]s = ,disease ,control & ,prev5tion1 n includ+ ! ,ag5cy = ,toxic ,sub/ances & ,disease ,regi/ry2 7,,ii7 ! ,ag5cy = ,toxic ,sub/ances & ,disease ,regi/ry2 7,,iii7 ! ,adm9i/ration = ,*ildr5 & ,families2 7,,iv7 ( ! ,national ,in/itutes ( ,heal?-- 7aa7 ! ,national ,in/itute ( ,environm5tal ,heal? ,sci5ces2 7bb7 ! ,national ,in/itute ( ,m5tal ,heal?2 & 7cc7 ! ,national ,in/itute on ,m9ority ,heal? & ,heal? ,disp>ities2 & 7,v7 ! ,(fice = ,civil ,rights4 7v7 ,( ! ,dep>tm5t ( ! ,int]ior-- 7,i7 ! ,bureau ( ,indian ,affairs2 7,,ii7 ! ,(fice ( ,civil ,rights2 & 7,,iii7 ! ,unit$ ,/ates ,geological ,survey4 7vi7 ,! ,=e/ ,s]vice4 7vii7 ,! ,dep>tm5t ( ,h\s+ & ,urban ,developm5t4 7viii7 ,! ,dep>tm5t ( ,en]gy4 7ix7 ,! ,dep>tm5t ( ,transportation4 7x7 ,! ,dep>tm5t ( ,ju/ice4 7xi7 ,! ,f$]al ,en]gy ,regulatory ,commission4 7xii7 ,! ,dep>tm5t ( ! ,treasury4 7xiii7 ,su* o!r ,f$]al dep>tm5ts1 ag5cies1 & (fices z ! ,adm9i/rator det]m9es to be appropriate1 p>ticul>ly (fices relat+ to public engagem5t4 7,b7 ,selection ( repres5tatives ,! head ( a dep>tm5t or ag5cy describ$ 9 subp>agraph 7,a7 %all1 9 appo9t+ to ! ,committee a repres5tative ( ! dep>tm5t or ag5cy1 select a repres5tative-- 7i7 ( a compon5t ( ! dep>tm5t or ag5cy t is among ! compon5ts t are ! mo/ relevant to ! responsibilities ( ! ,committee2 or 7ii7 :o has exp]tise 9 areas relevant to ^? responsibilities1 su* z demographic indicators relat+ to socioeconomic h>d%ip1 environm5tal ju/ice1 public engagem5t1 public heal?1 exposure to pollution1 future climate & extreme wea!r mapp+1 af=dable en]gy1 su/a9able transportation1 & access to wat]1 food1 & gre5 space4 7,c7 ,co-*airs 7i7 ,9 g5]al ,! memb]s ( ! ,committee %all select #c memb]s to s]ve z co-*airs ( ! ,committee-- 7,i7 #a ( :om %all be a repres5tative ( ! ,environm5tal ,protection ,ag5cy2 7,,ii7 #a ( :om %all be a repres5tative ( ! ,c\ncil on ,environm5tal ,quality2 & 7,,iii7 #a ( :om %all h sub/antial exp]i5ce 9 public engagem5t4 7ii7 ,t]ms ,ea* co-*air %all s]ve = a t]m ( n m ?an #c ye>s4 7iii7 ,responsibilities ( co-*airs ,! co-*airs ( ! ,committee %all-- 7,i7 det]m9e ! ag5da ( ! ,committee1 9 consultation ) o!r memb]s ( ! ,committee2 7,,ii7 direct ! "w ( ! ,committee1 includ+ ! ov]sight ( a mean+ful public engagem5t process2 & 7,,iii7 conv5e meet+s ( ! ,committee n less frequ5tly ?an once ea* fiscal qu>t]4 7#c7 ,adm9i/rative support 7,a7 ,9 g5]al ,! ,adm9i/rator %all provide te*nical & adm9i/rative support to ! ,committee4 7,b7 ,fund+ ,! ,adm9i/rator may c>ry out subp>agraph 7,a7 us+1 9 addition to any am\nts made available "u subsection 7f71 am\nts au?oriz$ to be appropriat$ to ! ,adm9i/rator be=e ! date ( enactm5t ( ?is ,act & available = obligation z ( t date ( enactm5t4 7#d7 ,consultation 7,a7 ,9 g5]al ,9 c>ry+ out ! duties ( ! ,committee1 ! ,committee %all consult ) relevant /akehold]s4 7,b7 ,advisory c\ncil 7i7 ,9 g5]al ,! ,committee %all e/abli% an advisory c\ncil compos$ ( a balanc$ proportion ( relevant /akehold]s1 at lea/ ( :om %all repres5t environm5tal ju/ice communities4 7ii7 ,*air ,! advisory c\ncil %all be *air$ by an environm5tal ju/ice advocate or o!r relevant /akehold] ) sub/antial exp]i5ce 9 environm5tal ju/ice4 7iii7 ,requirem5ts ,consultation describ$ 9 subp>agraph 7,a7 %all include-- 7,i7 e>ly & regul> engagem5t ) ! advisory c\ncil1 includ+ 9 c>ry+ out public engagem5t "u subp>agraph 7,c72 & 7,,ii7 consid]ation ( ! recomm5dations ( ! advisory c\ncil4 7iv7 ,recomm5dations n us$ ,if ! ,committee does n use a recomm5dation ( ! advisory c\ncil1 n lat] ?an #fj days aft] ! date on :i* ! ,committee receives notice ( ! recomm5dation1 ! ,committee %all-- 7,i7 make available to ! public on an int]net website ( ! ,environm5tal ,protection ,ag5cy a writt5 report describ+ ! rationale ( ! ,committee = n us+ ! recomm5dation2 & 7,,ii7 submit ! report describ$ 9 subclause 7,i7 to ! ,committee on ,environm5t & ,public ,works ( ! ,s5ate & ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives4 7v7 ,outrea* ,! advisory c\ncil may c>ry out public outrea* activities us+ am\nts made available "u subsection 7f7 to supplem5t public engagem5t c>ri$ out by ! ,committee "u subp>agraph 7,c74 7,c7 ,public engagem5t 7i7 ,9 g5]al ,! ,committee %all1 ?r\gh\t ! process ( c>ry+ out ! duties ( ! ,committee describ$ 9 subsection 7d7-- 7,i7 mean+fully engage ) relevant /akehold]s1 p>ticul>ly-- 7aa7 memb]s & repres5tatives ( environm5tal ju/ice communities2 7bb7 environm5tal ju/ice advocates2 & 7cc7 individuals ) exp]tise 9 cumulative impacts & geospatial data2 & 7,,ii7 ensure t ! input ( ! /akehold]s describ$ 9 subclause 7,i7 is c5tral to ! activities ( ! ,committee4 7ii7 ,plan 7,i7 ,9 g5]al ,9 c>ry+ out clause 7i71 ! ,committee %all develop a plan1 9 consultation ) ! advisory c\ncil1 = compreh5sive public engagem5t )1 & incorporation ( fe$back f1 environm5tal ju/ice advocates & memb]s ( environm5tal ju/ice communities4 7,,ii7 ,/rategies to ov]come b>ri]s to public engagem5t ,! plan develop$ "u subclause 7,i7 %all include /rategies to ov]come b>ri]s to public engagem5t1 includ+-- 7aa7 language b>ri]s2 7bb7 transportation b>ri]s2 7cc7 economic b>ri]s2 & 7dd7 lack ( int]net access4 7,,iii7 ,consid]ation ,9 develop+ ! plan "u subclause 7,i71 ! ,committee %all consid] ! div]se & v>i$ exp]i5ces ( environm5tal ju/ice communities relat+ to ! scope & types ( environm5tal haz>ds & socioeconomic inju/ices4 7iii7 ,consultation & solicitation ( public comm5t 7,i7 ,9 g5]al ,9 c>ry+ out clause 7i71 n less frequ5tly ?an once ea* fiscal qu>t]1 ! ,committee %all consult ) ! advisory c\ncil & solicit mean+ful public comm5t1 p>ticul>ly f relevant /akehold]s1 on ! activities ( ! ,committee4 7,,ii7 ,requirem5ts ,! ,committee %all c>ry out subclause 7,i7 ?r\gh means includ+-- 7aa7 public notice ( a meet+ ( ! ,committee occurr+ dur+ ! applicable fiscal qu>t]1 :i* %all include-- 7,,aa7 notice 9 publications relevant to environm5tal ju/ice communities2 7,,bb7 notification to environm5tal ju/ice communities ?r\gh direct means1 su* z community c5t]s & s*ools2 & 7,,cc7 direct outrea* to kn[n environm5tal ju/ice gr\ps2 7bb7 public broadca/ ( t meet+1 includ+ solicit+ & receiv+ comm5ts by virtual means2 & 7cc7 public availability ( a transcript ( t meet+ ?r\gh publication on an accessible website4 7,,iii7 ,languages ,! ,committee %all provide ea* notice1 notification1 direct outrea*1 broadca/1 & transcript describ$ 9 subclause 7,,ii7 9 ea* language commonly us$ 9 ! applicable environm5tal ju/ice community1 includ+ ?r\gh oral int]pretation1 if applicable4 7iv7 ,fund+ ,( am\nts made available "u subsection 7f71 ! ,adm9i/rator %all make available to ! ,committee su* sums z are necess>y = p>ticipation by relevant /akehold]s 9 public engagem5t "u ?is p>agraph1 z det]m9$ by ! ,adm9i/rator1 9 consultation ) ! advisory c\ncil4 7d7 ,duties ( ,committee 7#a7 ,9 g5]al ,! ,committee %all-- 7,a7 e/abli% a tool describ$ 9 p>agraph 7#b7 to id5tify environm5tal ju/ice communities1 includ+ ! id5tification (-- 7i7 crit]ia to be us$ 9 ! tool2 & 7ii7 a me?odology to det]m9e ! cumulative impacts ( ^? crit]ia2 7,b7 assess & address data gaps 9 accordance ) p>agraph 7#d72 & 7,c7 collect data = ! environm5tal ju/ice data repository e/abli%$ "u subsection 7e74 7#b7 ,e/abli%m5t ( tool 7,a7 ,9 g5]al ,! ,committee1 9 consultation ) relevant /akehold]s & ! advisory c\ncil1 %all e/abli% an int]active1 transp>5t1 integrat$1 & ,f$]al ,gov]nm5t-wide tool = assess+ & mapp+ environm5tal ju/ice communities bas$ on ! cumulative impacts ( all indicators select$ by ! ,committee to be integrat$ into ! tool4 7,b7 ,requirem5ts ,9 e/abli%+ ! tool "u subp>agraph 7,a71 ! ,committee %all-- 7i7 integrate into ! tool multiple data lay]s ( indicators t fall into categories includ+-- 7,i7 demographics1 p>ticul>ly relat+ to socioeconomic h>d%ip & social /ressors1 su* z-- 7aa7 race & e?nicity2 7bb7 l[ income2 7cc7 high unemploym5t2 7dd7 l[ levels ( home own]%ip2 7ee7 high r5t burd52 7ff7 high transportation burd52 7gg7 l[ levels ( educational atta9m5t2 7hh7 l+ui/ic isolation2 7ii7 en]gy insecurity or high utility rate burd52 7jj7 food insecurity2 7kk7 heal? insurance /atus & access to heal? c>e2 & 7ll7 memb]%ip 9 an ,indian ,tribe2 7,,ii7 public heal?1 p>ticul>ly data t are indicative ( s5sitive populations1 su* z-- 7aa7 rates ( a/hma2 7bb7 rates ( c>diovascul> disease2 7cc7 *ildhood leukemia or o!r canc]s t correlate ) environm5tal haz>ds2 7dd7 l[ bir? weight2 7ee7 mat]nal mortality2 7ff7 rates ( lead poison+2 & 7gg7 rates ( diabetes2 7,,iii7 pollution burd5s1 su* z pollution burd5s creat$ by-- 7aa7 toxic *emicals2 7bb7 air pollutants2 7cc7 wat] pollutants2 7dd7 soil contam9ants2 & 7ee7 p]fluoroalkyl & polyfluoroalkyl sub/ances2 & 7,,iv7 environm5tal effects1 su* z effects creat$ by proximity to-- 7aa7 risk managem5t plan sites2 7bb7 haz>d\s wa/e facilities2 7cc7 sites on ! ,national ,priorities ,li/ develop$ by ! ,presid5t 9 accordance ) section #aje7;a77#h77;,b7 ( ! ,compreh5sive ,environm5tal ,response1 ,comp5sation1 & ,liability ,act ( #aihj 7#db ,u4,s4,c4 #ifje7;a77#h77;,b772 & 7dd7 fossil fuel infra/ructure2 7ii7 inve/igate h[ fur!r indicators ( vuln]ability to ! impacts ( climate *ange 7includ+ proximity & exposure to sea level rise1 wildfire smoke1 flood+1 dr\ght1 ris+ av]age temp]atures1 extreme /orms1 & extreme heat1 & f9ancial burd5s f flood & fire insurance7 %\ld be incorporat$ into ! tool z an additional set ( lay]s2 7iii7 id5tify & consid] ! effects ( o!r indicators relat+ to environm5tal ju/ice = integration into ! tool z lay]s1 includ+-- 7,i7 safe1 suffici5t1 & af=dable dr9k+ wat]1 sanitation1 & /ormwat] s]vices2 7,,ii7 access to & ! quality (-- 7aa7 gre5 space & tree canopy cov]2 7bb7 heal?y food2 7cc7 af=dable en]gy & wat]2 7dd7 transportation2 7ee7 reliable communication sy/ems1 su* z broadb& int]net2 7ff7 *ild c>e2 7gg7 high-quality public s*ools1 e>ly *ildhood education1 & *ild c>e2 & 7hh7 heal? c>e facilities2 7,,iii7 l5g? ( commute2 7,,iv7 indoor air quality 9 multiunit dwell+s2 7,v7 m5tal heal?2 7,,vi7 labor m>ket categories1 p>ticul>ly relat+ to ess5tial work]s2 & 7,,vii7 ea* type ( utility exp5se2 7iv7 consid] ! implem5tation ( specific regional indicators1 ) ! pot5tial-- 7,i7 to create regionally & locally d[nscal$ maps 9 addition to a national map2 7,,ii7 to provide inc5tives = ,/ates to collect data & conduct additional analyses to capture conditions specific to _! localities2 7,,iii7 to provide res\rces = & engage 9 gr\nd-tru?+ to id5tify & v]ify important data ) community memb]s2 & 7,,iv7 to develop companion res\rces =1 & provide te*nical support to1 regional1 ,/ate1 local1 or ,tribal gov]nm5ts to create _! own maps & environm5tal ju/ice scores ) relevant regional1 ,/ate1 local1 & ,tribal data2 7v7 id5tify a me?odology to acc\nt = ! cumulative impacts ( all indicators select$ by ! ,committee "u clause 7i71 9 addition to o!r indicators z ! ,committee det]m9es to be necess>y1 to provide relative environm5tal ju/ice scores = regions t are-- 7,i7 z small z practicable to id5tify communities2 & 7,,ii7 n l>g] ?an a c5sus tract2 7vi7 ensure t ! tool is capable ( provid+ maps ( environm5tal ju/ice communities bas$ on environm5tal ju/ice scores describ$ 9 clause 7v72 7vii7 ensure t us]s ( ! tool are able to map available lay]s toge!r or indep5d5tly z desir$2 7viii7 implem5t a me?od = us]s ( ! tool to g5]ate a map & environm5tal ju/ice score bas$ on a subset ( indicators1 p>ticul>ly = ! purpose ( us+ ! tool 9 address+ v>i\s policy ne$s1 p]mitt+ processes1 & inve/m5t goals2 7ix7 make ! tool cu/omizable to address specific policy ne$s1 p]mitt+ processes1 & inve/m5t goals2 7x7 acc\nt = conditions t are n captur$ by ! quantitative data us$ to develop ! #a or m maps & environm5tal ju/ice scores compris+ ! tool1 by-- 7,i7 develop+ & execut+ a plan to p]=m outrea* to relevant communities2 & 7,,ii7 e/abli%+ a me*anism by :i* communities c self-id5tify z environm5tal ju/ice communities to be includ$ 9 ! tool1 :i* may include cit+ qualitative data on conditions = :i* quantitative data are lack+1 su* z cultural loss 9 ,tribal communities2 7xi7 consid] t ! tool-- 7,i7 w be us$ across ! ,f$]al ,gov]nm5t 9 scre5+ ,f$]al policies1 p]mitt+ processes1 & inve/m5ts = environm5tal & climate ju/ice impacts2 & 7,,ii7 may be us$ to assess communities = pollution r$uction programs2 & 7xii7 c>ry out su* o!r activities z ! ,committee det]m9es to be appropriate4 7#c7 ,transp>5cy & updates 7,a7 ,9 g5]al 7i7 ,notice & comm5t ,! ,committee %all e/abli% ! tool describ$ 9 p>agraph 7#b7 aft] provid+ notice & an opportunity = public comm5t4 7ii7 ,he>+s ,9 c>ry+ out clause 7i71 ! ,committee %all hold he>+s1 :i* %all be "t & language appropriate1 9 communities affect$ by environm5tal ju/ice issues 9 geographically disp>ate ,/ates & ,tribal areas4 7,b7 ,updates 7i7 ,annual updates ,! ,committee %all update ! tool describ$ 9 p>agraph 7#b7 n less frequ5tly ?an annually to acc\nt = data sets t are updat$ annually4 7ii7 ,o!r updates ,n less frequ5tly ?an once e #c ye>s1 ! ,committee %all-- 7,i7 update ! indicators1 me?odology1 or bo? = ! tool describ$ 9 p>agraph 7#b72 & 7,,ii7 reevaluate data submitt$ by ,f$]al dep>tm5ts & ag5cies t is us$ = ! tool4 7iii7 ,reports ,aft] ! initial e/abli%m5t ( ! tool describ$ 9 p>agraph 7#b7 & ea* update "u clause 7i7 or 7ii71 ! ,committee %all publi% a report describ+-- 7,i7 ! process = id5tify+ indicators relat+ to environm5tal ju/ice 9 ! developm5t ( ! tool2 7,,ii7 ! me?odology describ$ 9 p>agraph 7#b77;,b77v72 & 7,,iii7 ! use ( public input & community engagem5t 9 t process4 7,c7 ,tra9+ tutorials & sessions 7i7 ,9 g5]al ,! ,committee %all-- 7,i7 develop virtual tra9+ tutorials & sessions = environm5tal ju/ice communities = ! use ( ! tool describ$ 9 p>agraph 7#b72 & 7,,ii7 :]e practicable1 provide 9-p]son tra9+ sessions = environm5tal ju/ice communities = ! use ( t tool4 7ii7 ,languages ,! tutorials & sessions "u clause 7i7 %all be made available 9 ea* language commonly us$ 9 ! applicable environm5tal ju/ice community4 7,d7 ,public availability 7i7 ,9 g5]al ,! ,committee %all make available to ! public on an int]net website ( ! ,environm5tal ,protection ,ag5cy-- 7,i7 ! tool describ$ 9 p>agraph 7#b72 7,,ii7 ea* update "u clauses 7i7 & 7ii7 ( subp>agraph 7,b72 7,,iii7 ea* report "u subp>agraph 7,b77iii72 & 7,,iv7 ! tra9+ tutorials & sessions develop$ "u subp>agraph 7,c77i77,i74 7ii7 ,accessibility ,! ,committee %all make ! tool1 updates1 & reports describ$ 9 clause 7i7 accessible to ! public by publication 9 relevant languages & ) accessibility functions1 z appropriate4 7iii7 ,requirem5t ,9 c>ry+ out clause 7i77,i71 ! ,committee %all take measures to prev5t ! tool f be+ misus$ to discrim9ate aga9/ environm5tal ju/ice communities1 su* z by provid+ safegu>ds aga9/ ! use ( d[nscal$ data t may enable ! id5tification ( individuals4 7#d7 ,data gap audit 7,a7 ,9 g5]al ,9 e/abli%+ ! tool describ$ 9 p>agraph 7#b71 ! ,committee %all direct relevant ,f$]al dep>tm5ts & ag5cies to conduct an audit ( data collect$ by ! dep>tm5t or ag5cy to id5tify any data t are relevant to environm5tal ju/ice conc]ns1 includ+ data relat+ to-- 7i7 public heal? metrics2 7ii7 toxic *emicals2 7iii7 socioeconomic demographics2 7iv7 air quality2 7v7 wat] quality2 & 7vi7 kill+s ( individuals by law en=cem5t (fic]s4 7,b7 ,requirem5ts ,an audit describ$ 9 subp>agraph 7,a7 %all-- 7i7 exam9e ! granul>ity & accessibility ( ! data2 7ii7 address ! ne$ = improv$ air quality monitor+2 & 7iii7 include recomm5dations to o!r ,f$]al dep>tm5ts & ag5cies on means to improve ! quality1 granul>ity1 & transp>5cy (1 & public involvem5t 91 data collection & dissem9ation4 7,c7 ,improvem5ts ,! ,committee %all direct a ,f$]al dep>tm5t or ag5cy1 9 conduct+ an audit "u subp>agraph 7,a71 to address gaps 9 exi/+ data collection t w assi/ ! ,committee 9 e/abli%+ & op]at+ ! tool describ$ 9 p>agraph 7#b71 includ+ by provid+ to ! dep>tm5t or ag5cy-- 7i7 b5*m>ks to meet 9 address+ ! gaps2 7ii7 in/ructions = consi/5cy 9 data =matt+ t w all[ = inclusion ( data 9 ! environm5tal ju/ice data repository describ$ 9 subsection 7e72 & 7iii7 be/ practices = collect+ data 9 collaboration ) local organizations & p>tn]s1 su* z engag+ 9 gr\nd-tru?+4 7,d7 ,reports ,n lat] ?an #ahj days aft] a ,f$]al dep>tm5t or ag5cy has conduct$ an audit "u subp>agraph 7,a71 ! ,committee %all-- 7i7 make available to ! public on an int]net website ( ! ,environm5tal ,protection ,ag5cy a report describ+ ! f9d+s & conclusions ( ! audit1 includ+ ! progress made by ! ,f$]al dep>tm5t or ag5cy 9 address+ environm5tal ju/ice data gaps2 & 7ii7 submit ! report describ$ 9 clause 7i7 to-- 7,i7 ! ,committee on ,environm5t & ,public ,works ( ! ,s5ate2 7,,ii7 ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate2 7,,iii7 ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives2 & 7,,iv7 ! ,committee on ,education & ,labor ( ! ,h\se ( ,repres5tatives4 7e7 ,environm5tal ju/ice data repository 7#a7 ,9 g5]al ,! ,adm9i/rator %all e/abli% an environm5tal ju/ice data repository to ma9ta9-- 7,a7 ! data collect$ by ! ,committee ?r\gh ! e/abli%m5t ( ! tool describ$ 9 subsection 7d77#b7 & ! audits conduct$ "u subsection 7d77#d77;,a72 & 7,b7 any subnational data collect$ "u p>agraph 7#c77;,b74 7#b7 ,updates ,! ,adm9i/rator %all update ! data 9 ! data repository describ$ 9 p>agraph 7#a7 z frequ5tly z practicable1 includ+ e ye> if practicable1 b n less frequ5tly ?an once e #c ye>s4 7#c7 ,availability2 inclusion ( subnational data ,! ,adm9i/rator-- 7,a7 %all make ! data repository describ$ 9 p>agraph 7#a7 available to regional1 ,/ate1 local1 & ,tribal gov]nm5ts2 & 7,b7 may collaborate ) ! gov]nm5ts describ$ 9 subp>agraph 7,a7 to include )9 t data repository subnational data 9 exi/5ce be=e ! e/abli%m5t ( ! tool describ$ 9 subsection 7d77#b7 & ! completion ( ! audits "u subsection 7d77#d77;,a74 7#d7 ,requirem5t ,! ,adm9i/rator %all take measures to prev5t ! data 9 ! data repository describ$ 9 p>agraph 7#a7 f be+ misus$ to discrim9ate aga9/ environm5tal ju/ice communities1 su* z by provid+ safegu>ds aga9/ ! use ( d[nscal$ data t may enable ! id5tification ( individuals4 7f7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to ! ,adm9i/rator to c>ry out ?is section1 includ+ any necess>y adm9i/rative co/s ( ! ,committee-- 7#a7 #bj1jjj1jjj = ea* ( fiscal ye>s #bjbc & #bjbd2 & 7#b7 #ah1jjj1jjj = ea* ( fiscal ye>s #bjbe ?r\gh #bjbg4 7g7 ,effect ,no?+ 9 any provision ( ?is section relat+ to ! tool describ$ 9 subsection 7d77#b7 prohibits a ,/ate f develop+ a map relat+ to environm5tal ju/ice or pollution burd5 t relies on diff]5t data1 or analyzes data diff]5tly1 ?an t tool4 #ajjac4 ,antiracism 9 public heal? 7a7 ,f9d+s ,congress f9ds z foll[s3 7#a7 ,= c5turies1 /ructural racism1 def9$ by ! ,national ,museum ( ,african ,am]ican ,hi/ory & ,culture z an ov]>*+ sy/em ( racial bias across in/itutions & society1 9 ! ,unit$ ,/ates has negatively affect$ communities ( color1 especially ,black1 ,lat9x1 ,asian ,am]ican1 ,pacific ,isl&]1 & ,am]ican ,indian & ,alaska ,native p1 to exp& & re9=ce ,:ite supremacy4 7#b7 ,/ructural racism det]m9es ! conditions 9 :i* p are born1 gr[1 "w1 live1 & age & det]m9e p's access to quality h\s+1 education1 food1 transportation1 & political p[]1 & o!r social det]m9ants ( heal?4 7#c7 ,/ructural racism s]ves z a major b>ri] to a*iev+ heal? equity & elim9at+ racial & e?nic inequities 9 heal? outcomes t exi/ at al>m+ rates & are det]m9$ by a wid] set ( =ces & sy/ems4 7#d7 ,due to /ructural racism 9 ! ,unit$ ,/ates1 p ( color are m likely to suff] f *ronic heal? conditions 7su* z he>t disease1 diabetes1 a/hma1 hepatitis1 & hyp]t5sion7 & infecti\s diseases 7su* z ,,hiv_/,,aids1 & ,,covid-#ai7 comp>$ to _! ,:ite c\nt]p>ts4 7#e7 ,due to /ructural racism 9 mat]nal heal? c>e 9 ! ,unit$ ,/ates1 ,black & ,am]ican ,indian & ,alaska ,native infants are m ?an twice z likely to die ?an ,:ite infants1 ,black wom5 are #c to #d times m likely to die f pregnancy-relat$ causes ?an ,:ite wom51 & ,am]ican ,indian & ,alaska ,native wom5 are #e times m likely to die f pregnancy-relat$ causes ?an ,:ite wom54 ,?is tr5d p]si/s ev5 :5 adju/+ = income & education4 7#f7 ,due to /ructural racism 9 ! ,unit$ ,/ates1 ,non-,hispanic ,black wom5 h ! highe/ rates = #bb ( #be sev]e morbidity indicators us$ by ! ,c5t] = ,disease ,control & ,prev5tion4 7#g7 ,due to /ructural racism 9 ! ,unit$ ,/ates1 p ( color comprise a disproportionate p]c5tage ( p]sons ) disabilities 9 ! ,unit$ ,/ates4 7#h7 ,due to /ructural racism 9 ! ,unit$ ,/ates1 ,black m5 are up to #c times z likely to be kill$ by police z ,:ite m51 & #a 9 e #a1jjj ,black m5 w die z a result ( police viol5ce4 ,polic+ has adv]se effects on m5tal heal? 9 ,black communities4 7#i7 ,due to ! conflu5ce ( /ructural racism & factors su* z g5d]1 class1 & sexual ori5tation or g5d] id5tity1 commonly ref]r$ to z int]sectionality1 ,black & ,lat9x transg5d] wom5 are m likely to die due to viol5ce & homicide ?an _! ,:ite c\nt]p>ts4 7#aj7 ,due to /ructural racism1 inequitable access to quality heal? c>e & long-t]m s]vices & supports also disproportionately burd5s communities ( color2 p ( color & immigrants are less likely to be insur$ & are m likely to live 9 m$ically und]s]v$ areas4 7#aa7 ,due to /ructural racism1 old] adults ( color are also m likely to be admitt$ to nurs+ homes & assi/$ liv+ facilities & to reside 9 ^? ( poor quality1 & :5 old] adults ( color d receive home & community-bas$ s]vices1 ,m$icaid sp5ds less money on _! s]vices & !y are m likely to be hospitaliz$ ?an old] ,:ite adults4 7#ab7 ,9 addition1 ! ,f$]al ,gov]nm5t's failure to honor ! unique political /atus ( ,am]ican ,indian & ,alaska ,native p1 to respect ! inh]5t sov]eignty ( ,tribal ,nations1 & to uphold its tru/ & treaty obligations to ,tribal ,nations & ,am]ican ,indian & ,alaska ,native p1 is an ongo+ & unju/ manife/ation ( c5turies ( oppression1 ) ! consequ5ce ( adv]se heal? outcomes = ,native peoples4 7#ac7 ,! ,,covid-#ai p&emic has expos$ ! deva/at+ impact ( /ructural racism on ! ,unit$ ,/ates ability to ensure equitable heal? outcomes = p ( color1 & made ^! communities m likely to suff] f sev]e outcomes due to ! coronavirus infection4 7#ad7 ,racial & e?nic inequity 9 public heal? is a result ( sy/ematic1 p]sonally m$iat$1 & int]naliz$ racism & raci/ public & private policies & practices1 & dismantl+ /ructural racism is integral to address+ public heal?4 7b7 ,public heal? rese>* & inve/m5t 9 dismantl+ /ructural racism ,"p ,b ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bdc et seq47 is am5d$ by add+ at ! end ! foll[+3 #cbj;,c4 ,national c5t] on ,antiracism & ,heal? 7a7 ,9 g5]al 7#a7 ,national c5t] ,!re is e/abli%$ )9 ! ,c5t]s = ,disease ,control & ,prev5tion a c5t] to be kn[n z ! ,national ,c5t] on ,antiracism & ,heal? 7ref]r$ to 9 ?is section z ! ,c5t]74 ,! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all appo9t a director to head ! ,c5t] :o has exp]i5ce liv+ 9 & work+ ) racial & e?nic m9ority communities4 ,! ,c5t] %all promote public heal? by-- 7,a7 decl>+ racism a public heal? crisis & nam+ racism z an hi/orical & pres5t ?reat to ! physical & m5tal heal? & well-be+ ( ! ,unit$ ,/ates & _w2 7,b7 aim+ to develop new k 9 ! sci5ce & practice ( antiracism1 includ+ by id5tify+ ! me*anisms by :i* racism op]ates 9 ! provision ( heal? c>e & 9 sy/ems t impact heal? & well-be+2 7,c7 transf]r+ t k into practice1 includ+ by develop+ int]v5tions t dismantle ! me*anisms ( racism & replace su* me*anisms ) equitable /ructures1 policies1 practices1 norms1 & values s t a heal?y society c be realiz$2 & 7,d7 contribut+ to a national & global conv]sation reg>d+ ! impacts ( racism on ! heal? & well-be+ ( ! ,unit$ ,/ates & _w4 7#b7 ,g5]al duties ,! ,secret>y1 act+ ?r\gh ! ,c5t]1 %all und]take activities to c>ry out ! mission ( ! ,c5t] z describ$ 9 p>agraph 7#a71 su* z ! foll[+3 7,a7 ,conduct rese>* into1 collect1 analyze & make publicly available data on1 & provide lead]%ip & coord9ation = ! sci5ce & practice ( antiracism1 ! public heal? impacts ( /ructural racism1 & ! effectiv5ess ( int]v5tion /rategies to address ^! impacts4 ,topics ( rese>* & data collection "u ?is subp>agraph may include id5tify+ & und]/&+-- 7i7 policies & practices t h a disp>ate impact on ! heal? & well-be+ ( communities ( color2 7ii7 ! public heal? impacts ( implicit racial bias1 ,:ite supremacy1 wea!r+1 x5ophobia1 discrim9ation1 & prejudice2 7iii7 ! social det]m9ants ( heal? result+ f /ructural racism1 includ+ pov]ty1 h\s+1 employm5t1 political p>ticipation1 & environm5tal factors2 & 7iv7 ! int]section ( racism & o!r sy/ems ( oppression1 includ+ z relat$ to age1 sexual ori5tation1 g5d] id5tity1 & disability /atus4 7,b7 ,aw>d noncompetitive grants & coop]ative agreem5ts to eligible public & nonpr(it private entities1 includ+ ,/ate1 local1 t]ritorial1 & ,tribal heal? ag5cies & organizations1 = ! rese>* & collection1 analysis1 & report+ ( data on ! topics describ$ 9 subp>agraph 7,a74 7,c7 ,e/abli%1 ?r\gh grants or coop]ative agreem5ts1 at lea/ #c regional c5t]s ( excell5ce1 locat$ 9 racial & e?nic m9ority communities1 9 antiracism = ! purpose ( develop+ new k 9 ! sci5ce & practice ( antiracism 9 heal? by rese>*+1 und]/&+1 & id5tify+ ! me*anisms by :i* racism op]ates 9 ! heal? space1 racial & e?nic inequities 9 heal? c>e access & outcomes1 ! hi/ory ( successful antiraci/ movem5ts 9 heal?1 & o!r antiraci/ public heal? "w4 7,d7 ,e/abli% a cle>+h\se )9 ! ,c5t]s = ,disease ,control & ,prev5tion = ! collection & /orage ( data g5]at$ "u ! programs implem5t$ "u ?is section = :i* !re is n an o!rwise exi/+ surveillance sy/em at ! ,c5t]s = ,disease ,control & ,prev5tion4 ,su* data %all-- 7i7 be compreh5sive & disaggregat$1 to ! ext5t practicable1 by includ+ racial1 e?nic1 prim>y language1 sex1 g5d] id5tity1 sexual ori5tation1 age1 socioeconomic /atus1 & disability disp>ities2 7ii7 be made publicly available2 7iii7 protect ! privacy ( individuals ^: in=mation is includ$ 9 su* data2 & 7iv7 comply ) privacy protections "u ! regulations promulgat$ "u section #bfd7;c7 ( ! ,heal? ,insurance ,portability & ,acc\ntability ,act ( #aiif4 7,e7 ,provide in=mation & education to ! public on ! public heal? impacts ( /ructural racism & on antiraci/ public heal? int]v5tions4 7,f7 ,consult ) o!r ,c5t]s & ,national ,in/itutes )9 ! ,c5t]s = ,disease ,control & ,prev5tion1 includ+ ! ,(fice ( ,m9ority ,heal? & ,heal? ,equity & ! ,c5t] = ,/ate1 ,tribal1 ,local1 & ,t]ritorial ,support1 to ensure t sci5tific & programmatic activities initiat$ by ! ag5cy consid] /ructural racism 9 _! designs1 conceptualizations1 & executions1 :i* %all include-- 7i7 putt+ measures ( racism 9 population-bas$ surveys2 7ii7 e/abli%+ a ,f$]al ,advisory ,committee on racism & heal? = ! ,c5t]s = ,disease ,control & ,prev5tion2 7iii7 develop+ tra9+ programs1 curricula1 & sem9>s = ! purposes ( tra9+ public heal? pr(essionals & rese>*]s ar\nd issues ( race1 racism1 & antiracism2 7iv7 provid+ /&>ds & be/ practices = programm+ & grant recipi5t compliance ) ,f$]al data collection /&>ds1 includ+ section #caja ( ! ,public ,heal? ,s]vice ,act2 & 7v7 e/abli%+ lead]%ip & /akehold] c\ncils ) exp]ts & lead]s 9 racism & public heal? disp>ities4 7,g7 ,coord9ate ) ! ,indian ,heal? ,s]vice & ) ! ,c5t]s = ,disease ,control & ,prev5tion's ,tribal ,advisory ,committee to ensure mean+ful ,tribal consultation1 ! ga!r+ ( in=mation f ,tribal au?orities1 & respect = ,tribal data sov]eignty4 7,h7 ,engage 9 gov]nm5t to gov]nm5t consultation ) ,indian ,tribes & ,tribal organizations4 7,i7 ,at lea/ e #b ye>s1 produce & publicly po/ on ! ,c5t]s = ,disease ,control & ,prev5tion's website a report on antiraci/ activities complet$ by ! ,c5t]1 :i* may include newly id5tifi$ antiraci/ public heal? practices4 7b7 ,def9itions ,9 ?is section3 7#a7 ,antiracism ,! t]m antiracism is a collection ( antiraci/ policies t lead to racial equity1 & are sub/antiat$ by antiraci/ ideas4 7#b7 ,antiraci/ ,! t]m antiraci/ is any measure t produces or su/a9s racial equity betwe5 racial gr\ps4 7c7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ su* sums z may be necess>y to c>ry out ?is section4 4 7c7 ,public heal? rese>* & inve/m5t 9 police viol5ce 7#a7 ,9 g5]al ,! ,secret>y %all e/abli% )9 ! ,national ,c5t] = ,injury ,prev5tion & ,control ( ! ,c5t]s = ,disease ,control & ,prev5tion 7ref]r$ to 9 ?is subsection z ! ,c5t]7 a law en=cem5t viol5ce prev5tion program4 7#b7 ,g5]al duties ,9 implem5t+ ! program "u p>agraph 7#a71 ! ,c5t] %all conduct rese>* into1 & provide lead]%ip & coord9ation =-- 7,a7 ! und]/&+ & promotion ( k ab\t ! public heal? impacts ( uses ( =ce by law en=cem5t1 includ+ police brutality & viol5ce2 7,b7 develop+ public heal? int]v5tions & p]spectives = elim9at+ dea?s1 injury1 trauma1 & negative m5tal heal? effects f police pres5ce & int]actions1 includ+ police brutality & viol5ce2 & 7,c7 ensur+ compreh5sive data collection1 analysis1 & report+ reg>d+ police viol5ce & misconduct1 9 consultation ) ! ,dep>tm5t ( ,ju/ice & indep5d5t rese>*]s4 7#c7 ,functions ,"u ! program "u p>agraph 7#a71 ! ,c5t] %all-- 7,a7 summ>ize & enhance ! k ( ! di/ribution1 /atus1 & *>act]i/ics ( law en=cem5t-relat$ dea?1 trauma1 & injury2 7,b7 conduct rese>* & prep>e1 ) ! assi/ance ( ,/ate public heal? dep>tm5ts-- 7i7 /ati/ics on law en=cem5t-relat$ dea?1 injury1 & brutality2 7ii7 /udies ( ! factors1 includ+ legal1 socioeconomic1 discrim9ation1 & o!r factors t correlate ) or influ5ce police brutality2 7iii7 public in=mation ab\t uses ( =ce by law en=cem5t1 includ+ police brutality & viol5ce1 = ! practical use ( ! public heal? community1 includ+ publications t syn!size in=mation relevant to ! national goal ( und]/&+ police viol5ce & me?ods = its control2 7iv7 in=mation to id5tify socioeconomic gr\ps1 communities1 & geographic areas 9 ne$ ( /udy1 & a /rategic plan = rese>* necess>y to compreh5d ! ext5t & nature ( police uses ( =ce by law en=cem5t1 includ+ police brutality & viol5ce1 & det]m9e :at options exi/ to r$uce or eradicate dea? & injury t result2 & 7v7 be/ practices 9 police viol5ce prev5tion 9 o!r c\ntries2 7,c7 aw>d grants1 contracts1 & coop]ative agreem5ts to provide = ! conduct ( epidemiologic rese>* on uses ( =ce by law en=cem5t1 includ+ police brutality & viol5ce1 by ,f$]al1 ,/ate1 local1 & private ag5cies1 in/itutions1 organizations1 & individuals2 7,d7 aw>d grants1 contracts1 & coop]ative agreem5ts to community gr\ps1 indep5d5t rese>* organizations1 academic in/itutions1 & o!r entities to support1 execute1 or conduct rese>* on int]v5tions to r$uce or elim9ate uses ( =ce by law en=cem5t1 includ+ police brutality & viol5ce2 7,e7 coord9ate ) ! ,dep>tm5t ( ,ju/ice1 & o!r ,f$]al1 ,/ate1 & local ag5cies on ! /&>dization ( data collection1 /orage1 & retrieval necess>y to collect1 evaluate1 analyze1 & dissem9ate in=mation ab\t ! ext5t & nature ( uses ( =ce by law en=cem5t1 includ+ police brutality & viol5ce1 z well z options = ! eradication ( su* practices2 7,f7 submit an annual report to ,congress on rese>* f9d+s ) recomm5dations to improve data collection & /&>dization & to disrupt processes 9 polic+ t pres]ve & re9=ce racism & racial disp>ities 9 public heal?2 7,g7 conduct prim>y rese>* & explore uses ( =ce by law en=cem5t1 includ+ police brutality & viol5ce1 & options = its control2 & 7,h7 /udy alt]natives to law en=cem5t response z a me?od ( r$uc+ police viol5ce4 7#d7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$1 su* sums z may be necess>y to c>ry out ?is subsection4 #ajjad4 ,,lgbtq ess5tial data 7a7 ,improv+ data collection on ! sexual ori5tation & g5d] id5tity ( deceas$ individuals ?r\gh ! ,national ,viol5t ,dea? ,report+ ,sy/em 7#a7 ,collection ( sexual ori5tation & g5d] id5tity data 7,a7 ,9 g5]al ,n lat] ?an #abj days aft] ! date ( enactm5t ( ?is ,act1 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion %all take measures to improve ! incid5ce ( ! collection ( in=mation on ! sexual ori5tation & g5d] id5tity ( deceas$ individuals ?r\gh ! ,national ,viol5t ,dea? ,report+ ,sy/em or any successor programs4 7,b7 ,confid5tiality ,any in=mation collect$ relat+ to ! sexual ori5tation or g5d] id5tity ( a dec$5t %all be ma9ta9$ 9 accordance ) ! confid5tiality & privacy /&>ds & policies = ! protection ( individuals applicable to all o!r data collect$ = purposes ( ! ,national ,viol5t ,dea? ,report+ ,sy/em4 7#b7 ,def9itions ,9 ?is subsection3 7,a7 ,g5d] id5tity ,! t]m g5d] id5tity means an individual's s5se ( be+ male1 female1 transg5d]1 or ano!r g5d]1 z di/9ct f ! individual's sex assign$ at bir?4 7,b7 ,sexual ori5tation ,! t]m sexual ori5tation means h[ a p]son id5tifies 9 t]ms ( _! emotional1 romantic1 or sexual attractions1 & includes id5tification z /raight1 het]osexual1 gay1 lesbian1 or bisexual1 among o!r t]ms4 7#c7 ,au?orization ,!re is au?oriz$ to be appropriat$ #be1jjj1jjj = fiscal ye> #bjbc to c>ry out ?is subsection4 7b7 ,s5se ( ,congress ,x is ! s5se ( ,congress t-- 7#a7 ! ,c5t]s = ,disease ,control & ,prev5tion has made significant ef=ts to enc\rage ,/ates & o!r jurisdictions to collect data on sexual ori5tation & g5d] id5tity ?r\gh ! ,national ,viol5t ,dea? ,report+ ,sy/em2 & 7#b7 jurisdictions t p>ticipate 9 ! collection ( su* data ?r\gh ! ,national ,viol5t ,dea? ,report+ ,sy/em %\ld be comm5d$ = _! p>ticipation4 #ajjae4 ,social det]m9ants accel]ator 7a7 ,f9d+s2 purposes 7#a7 ,f9d+s ,congress f9ds z foll[s3 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$icaid4 7,d7 ,to develop /rategies to improve heal? & social outcomes )\t d5y+ s]vices to1 or re/rict+ ! eligibility (1 vuln]able populations4 7b7 ,social det]m9ants accel]ator c\ncil 7#a7 ,e/abli%m5t ,! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ 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 7a77#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 describ$ 9 clause 7ii7 to s]ve z a memb] ( ! ,c\ncil4 7ii7 ,responsibilities ,an employee describ$ 9 ?is subp>agraph %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/ ?ree 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 subp>agraph 7,b77ii74 7,d7 ,,omb role ,! ,director ( ! ,(fice ( ,managem5t & ,budget %all facilitate ! timely resolution ( ,gov]nm5twide & multiag5cy issues to help ! ,c\ncil a*ieve cons5sus recomm5dations describ$ "u p>agraph 7#c77;,a74 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$icaid ag5cies2 7,,iii7 individuals f ,/ate & local gov]nm5t budget (fices2 7,,iv7 individuals f public h\s+ au?orities or ,/ate h\s+ f9ance ag5cies2 7,v7 individuals f nonpr(it organizations1 small bus9esses1 & philan?ropic organizations2 7,,vi7 advocates2 7,,vii7 rese>*]s2 & 7,,viii7 any o!r individuals ! ,*air det]m9es to be appropriate4 7#c7 ,duties ,! duties ( ! ,c\ncil are-- 7,a7 to make recomm5dations to ! ,secret>y & ! ,adm9i/rator reg>d+ ! crit]ia = mak+ aw>ds "u subsection 7c72 7,b7 to id5tify ,f$]al au?orities & opportunities = use by ,/ates or local gov]nm5ts to improve coord9ation ( fund+ & adm9i/ration ( ,f$]al programs1 ! b5efici>ies ( :om include individuals describ$ 9 subsection 7a71 & :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 subsection 7c71 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 p>agraph 7#d72 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$back f ,/ate1 local1 & ,tribal gov]nm5ts1 includ+ ?r\gh an annual survey by an indep5d5t ?ird p>ty1 on h[ to improve ! te*nical assi/ance ! ,c\ncil provides to bett] equip ,/ate1 local1 & ,tribal gov]nm5ts to coord9ate heal? & social s]vice programs2 7,g7 to solicit applications = grants "u subsection 7c72 & 7,h7 to coord9ate ) o!r cross-ag5cy initiatives focus$ 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 p>agraph 7#c71 includ+ solicitation ( applications = ! grants "u subsection 7c74 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 subsection 7c71 includ+-- 7i7 ! be/ practices & evid5ce-bas$ approa*es su* gov]nm5ts plan to employ to a*ieve ! purposes li/$ 9 subsection 7a77#b72 & 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 7c71 & ! 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 7c7 ,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 p>agraph 7#b71 = ! developm5t ( social det]m9ants accel]ator plans1 z describ$ 9 p>agraph 7#f74 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 p>agraph 7#b77;,a7 & 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 7d7 ,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 #be1jjj1jjj1 ( :i* up to #e1jjj1jjj may be us$ to c>ry out ?is section1 to rema9 available = obligation until ! date t is #e ye>s aft] ! date ( enactm5t ( ?is ,act4 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 subsection 7c7 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 7c7 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 #ajjaf4 ,improv+ social det]m9ants ( heal? 7a7 ,f9d+s ,congress f9ds z foll[s3 7#a7 ,heal?y ,p #bjcj def9es social det]m9ants ( heal? z conditions 9 ! environm5ts :]e p are born1 live1 le>n1 "w1 play1 wor%ip1 & age t affect a wide range ( heal?1 function+1 & quality-(-life outcomes & risks4 7#b7 ,"o ( ! ov]>*+ goals ( ,heal?y ,p #bjcj is to create social1 physical1 & economic environm5ts t promote atta9+ ! full pot5tial = heal? & well-be+ = all4 7#c7 ,heal?y ,p #bjcj develop$ a place-bas$ organiz+ framework1 reflect+ five key areas ( social det]m9ants ( heal? namely-- 7,a7 economic /ability2 7,b7 education access & quality2 7,c7 social & community context2 7,d7 heal? c>e access & quality2 & 7,e7 neighborhood & built environm5t4 7#d7 ,x is e/imat$ t m$ical c>e acc\nts = only #aj to #bj p]c5t ( ! modifiable contributors to heal?y outcomes = a population4 7#e7 ,! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices has indicat$ ! importance ( ! social det]m9ants 9 its "w /at+ t1 ,z we seek to fo/] innovation1 re?9k rural heal?1 f9d solutions to ! opioid epidemic1 & cont9ue to put pati5ts fir/1 we ne$ to take into acc\nt social det]m9ants ( heal? & recognize _! importance44 7#f7 ,! ,dep>tm5t ( ,heal? & ,human ,s]vices' ,public ,heal? #c4j initiative recognizes ! role ( public heal? 9 work+ across sectors on social det]m9ants ( heal?1 z well z ! role ( public heal? z *ief heal? /rategi/ 9 communities4 7#g7 ,?r\gh its ,heal? ,impact 9 #e ,ye>s initiative1 ! ,c5t]s = ,disease ,control & ,prev5tion has highlight$ noncl9ical1 community-wide approa*es t %[ positive heal? impacts1 results )9 #e ye>s1 & co/-effectiv5ess or co/-sav+s ov] ! lifetime ( ! population or e>li]4 7#h7 ,heal? dep>tm5ts & ! ,c5t]s = ,disease ,control & ,prev5tion are n fund$ = su* cross-cutt+ "w4 7b7 ,social ,det]m9ants ( ,heal? ,program 7#a7 ,program ,to ! ext5t & 9 ! am\nts made available 9 advance 9 appropriations ,acts1 ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion 79 ?is section ref]r$ to z ! ,director7 %all c>ry out a program1 to be kn[n z ! ,social ,det]m9ants ( ,heal? ,program 79 ?is section ref]r$ to z ! ,program71 to a*ieve ! foll[+ goals3 7,a7 ,improve heal? outcomes & r$uce heal? inequities by coord9at+ social det]m9ants ( heal? activities across ! ,c5t]s = ,disease ,control & ,prev5tion4 7,b7 ,improve ! capacity ( public heal? ag5cies & community organizations to address social det]m9ants ( heal? 9 communities4 7#b7 ,activities ,to a*ieve ! goals li/$ 9 p>agraph 7#a71 ! ,director %all c>ry out activities includ+ ! foll[+3 7,a7 ,coord9at+ across ! ,c5t]s = ,disease ,control & ,prev5tion to ensure t relevant programs consid] & incorporate social det]m9ants ( heal? 9 grant aw>ds & o!r activities4 7,b7 ,aw>d+ grants "u subsection 7c7 to ,/ate1 local1 t]ritorial1 & ,tribal heal? ag5cies & organizations1 & to o!r eligible entities1 to address social det]m9ants ( heal? 9 t>get communities4 7,c7 ,aw>d+ grants "u subsection 7d7 to nonpr(it organizations & public or o!r nonpr(it in/itutions ( high] education-- 7i7 to conduct rese>* on be/ practices to improve social det]m9ants ( heal?2 7ii7 to provide te*nical assi/ance1 tra9+1 & evaluation assi/ance to grantees "u subsection 7c72 & 7iii7 to dissem9ate be/ practices to grantees "u subsection 7c74 7,d7 ,coord9at+1 support+1 & align+ activities ( ! ,c5t]s = ,disease ,control & ,prev5tion relat$ to social det]m9ants ( heal? ) activities ( o!r ,f$]al ag5cies relat$ to social det]m9ants ( heal?1 includ+ su* activities ( ag5cies 9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices su* z ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 7,e7 ,collect+ & analyz+ data relat$ to ! social det]m9ants ( heal?4 7c7 ,grants ,to address social det]m9ants ( heal? 7#a7 ,9 g5]al ,! ,director1 z "p ( ! ,program1 %all aw>d grants to eligible entities to address social det]m9ants ( heal? 9 _! communities4 7#b7 ,eligibility ,to be eligible to apply = a grant "u ?is subsection1 an entity %all be-- 7,a7 a ,/ate1 local1 t]ritorial1 or ,tribal heal? ag5cy or organization2 7,b7 a qualifi$ nongov]nm5tal entity1 z def9$ by ! ,director2 or 7,c7 a consortium ( entities t includes a ,/ate1 local1 t]ritorial1 or ,tribal heal? ag5cy or organization4 7#c7 ,use ( funds 7,a7 ,9 g5]al ,a grant "u ?is subsection %all be us$ to address social det]m9ants ( heal? 9 a t>get community by design+ & implem5t+ innovative1 evid5ce-bas$1 cross-sector /rategies4 7,b7 ,t>get community ,= purposes ( ?is subsection1 a t>get community %all be a ,/ate1 c\nty1 city1 or o!r municipality4 7#d7 ,priority ,9 aw>d+ grants "u ?is subsection1 ! ,director %all prioritize applicants propos+ to s]ve t>get communities ) significant unmet heal? & social ne$s1 z def9$ by ! ,director4 7#e7 ,application ,to seek a grant "u ?is subsection1 an eligible entity %all-- 7,a7 submit an application at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,director may require2 7,b7 propose a set ( activities to address social det]m9ants ( heal? ?r\gh evid5ce-bas$1 cross-sector /rategies1 :i* activities may include-- 7i7 collect+ quantifiable data f heal? c>e1 social s]vices1 & o!r entities reg>d+ ! mo/ significant gaps 9 heal?-promot+ social1 economic1 & environm5tal ne$s2 7ii7 id5tify+ evid5ce-bas$ approa*es to meet+ ! nonm$ical1 social ne$s ( populations id5tifi$ by data collection describ$ 9 clause 7i71 su* z un/able h\s+ or food insecurity2 7iii7 develop+ scalable me?ods to meet pati5ts' social ne$s id5tifi$ 9 cl9ical sett+s or o!r sites2 7iv7 conv5+ entities su* z local & ,/ate gov]nm5tal & nongov]nm5tal organizations1 heal? sy/ems1 payors1 & community-bas$ organizations to review1 plan1 & implem5t community-wide int]v5tions & /rategies to advance heal?-promot+ social conditions2 7v7 monitor+ & evaluat+ ! impact ( activities fund$ ?r\gh ! grant on ! heal? & well-be+ ( ! resid5ts ( ! t>get community & on ! co/ ( heal? c>e2 & 7vi7 su* o!r activities z may be specifi$ by ! ,director2 7,c7 demon/rate h[ ! eligible entity w collaborate )-- 7i7 heal? sy/ems2 7ii7 payors1 includ+1 z appropriate1 ,m$icaid manag$ c>e organizations 7z def9$ 9 section #aijc7m77#a77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7m77#a77;,a7771 ,m$ic>e ,advantage plans "u "p ,c ( title ,,xviii ( su* ,act 7#db ,u4,s4,c4 #aciew-#ba et seq471 & heal? insurance issu]s & gr\p heal? plans 7z su* t]ms are def9$ 9 section #bgia ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ia772 7iii7 o!r relevant /akehold]s & initiatives 9 areas ( ne$1 su* z ! ,acc\ntable ,heal? ,communities ,model ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 heal? homes "u ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 community-bas$ organizations1 & human s]vices organizations2 7iv7 o!r non-heal? c>e sector organizations1 includ+ organizations focus+ on transportation1 h\s+1 or food access2 & 7v7 local employ]s2 & 7,d7 id5tify key heal? inequities 9 ! t>get community & demon/rate h[ ! propos$ ef=ts ( ! eligible entity w\ld address su* inequities4 7#f7 ,monitor+ & evaluation ,z a condition ( receipt ( a grant "u ?is subsection1 a grantee %all agree to submit an annual report to ! ,director describ+ ! activities c>ri$ out ?r\gh ! grant & ! outcomes ( su* activities4 7#g7 ,indep5d5t national evaluation 7,a7 ,9 g5]al ,n lat] ?an #e ye>s aft] ! fir/ grants are aw>d$ "u ?is subsection1 ! ,director %all provide = ! comm5cem5t ( an indep5d5t national evaluation ( ! program "u ?is subsection4 7,b7 ,report to ,congress ,n lat] ?an #fj days aft] receiv+ ! results ( su* indep5d5t national evaluation1 ! ,director %all report su* results to ,congress4 7d7 ,rese>* & tra9+ ,! ,director1 z "p ( ! ,program-- 7#a7 %all aw>d grants to nonpr(it organizations & public or o!r nonpr(it in/itutions ( high] education-- 7,a7 to conduct rese>* on be/ practices to improve social det]m9ants ( heal?2 7,b7 to provide te*nical assi/ance1 tra9+1 & evaluation assi/ance to grantees "u subsection 7c72 & 7,c7 to dissem9ate be/ practices to grantees "u subsection 7c72 & 7#b7 may require a grantee "u p>agraph 7#a7 to provide te*nical assi/ance & capacity build+ to entities t are eligible entities "u subsection 7c7 b n receiv+ funds ?r\gh su* section4 7e7 ,fund+ 7#a7 ,9 g5]al ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section1 #ej1jjj1jjj = ea* ( fiscal ye>s #bjbc ?r\gh #bjbh4 7#b7 ,allocation ,( ! am\nt made available to c>ry out ?is section = a fiscal ye>1 n less ?an #ge p]c5t %all be us$ = grants "u subsections 7c7 & 7d74 ,b ,gun ,viol5ce #ajaja4 ,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 #ajajb4 ,national ,viol5t ,dea? ,report+ ,sy/em ,! ,secret>y ( ,heal? & ,human ,s]vices1 act+ ?r\gh ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion1 %all improve ! ,national ,viol5t ,dea? ,report+ ,sy/em 7z au?oriz$ by sections #cja7;a7 & #cia7;a7 ( ! ,public ,s]vice ,heal? ,act 7#db ,u4,s4,c4 #bda7;a71 #bhj;b7a771 p>ticul>ly ?r\gh ! inclusion ( additional ,/ates & activities to increase ! quality1 type1 & timel9ess ( report$ data4 ,p>ticipation 9 ! ,sy/em by ! ,/ates %all be volunt>y4 #ajajc4 ,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$+ ye>1 & ! /atus ( actions tak5 to address su* effects4 #ajajd4 ,report on effects ( gun viol5ce on m5tal heal? 9 m9ority communities ,n lat] ?an "o ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,deputy ,assi/ant ,secret>y = ,m9ority ,heal? 9 ! ,(fice ( ! ,secret>y ( ,heal? & ,human ,s]vices %all submit to ,congress a report on ! effects ( gun viol5ce on public heal?1 includ+ m5tal heal?1 9 m9ority communities 9 ! ,unit$ ,/ates1 & ! /atus ( actions tak5 to address su* effects4