,,ii #aahth ,,congress #b;d ,session ,s4 #djfe ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #bb1 #bjbd,mr4 ,padilla 7for himself and ,mr4 ,booker7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to prohibit discrimination in health care and require the provision of equitable health care1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,equal ,health ,care for ,all ,act4 #b4 ,findings ,congress finds the following3 7#a7 ,in #aiff1 ,dr4 ,martin ,luther ,king1 ,jr41 said ,of all the forms of inequality1 injustice in health care is the most shocking and inhuman because it often results in physical death44 7#b7 ,inequity in health care remains a persistent and devastating reality for many communities1 and1 in particular1 communities of color4 7#c7 ,the inequitable provision of health care has complex causes1 many stemming from systemic inequality in access to health care1 housing1 nutrition1 economic opportunity1 education1 and other factors4 7#d7 ,health care outcomes for ,black communities in particular lag far behind those of the population as a whole4 7#e7 ,dr4 ,anthony ,fauci1 former ,director of the ,national ,institute of ,allergy and ,infectious ,diseases1 said on ,april #g1 #bjbj1 the coronavirus outbreak is shining a bright light on unacceptable health disparities in the ,black community4 7#f7 ,a contributing factor in health disparities is explicit and implicit bias in the delivery of health care1 resulting in inferior care and poorer outcomes for some patients on the basis of factors that include race1 national origin1 sex 7including sexual orientation or gender identity71 disability1 age1 and religion4 7#g7 ,the ,national ,academy of ,medicine 7formerly known as the ,institute of ,medicine7 issued a report in #bjjb titled ,unequal ,treatment1 finding that racial and ethnic minorities receive lower-quality health care than ,whites do1 even when insurance status1 income1 age1 and severity of condition is comparable4 7#h7 ,just as ,congress has sought to eliminate bias1 both explicit and implicit1 in employment1 housing1 and other parts of our society1 the elimination of bias and the legacy of structural racism in health care is of paramount importance4 #c4 ,data collection and reporting 7a7 ,required reporting 7#a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary71 in consultation with the ,director for ,civil ,rights and ,health ,equity1 the ,director of the ,national ,institutes of ,health1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,deputy ,assistant ,secretary for ,minority ,health1 and the ,director of the ,centers for ,disease ,control and ,prevention1 shall by regulation require all health care providers and facilities that are required under other provisions of law to report data on specific health outcomes to the ,department of ,health and ,human ,services in aggregate form1 to disaggregate such data by demographic characteristics1 including by race1 national origin1 sex 7including sexual orientation and gender identity71 disability1 and age1 as well as any other factor that the ,secretary determines would be useful for determining a pattern of inequitable provision of health care4 7#b7 ,proposed regulations ,not later than #ij days after the date of enactment of this ,act1 the ,secretary shall issue proposed regulations to carry out paragraph 7#a74 7b7 ,repository ,the ,secretary shall-- 7#a7 not later than #a year after the date of enactment of this ,act1 establish a repository of the disaggregated data reported pursuant to subsection 7a72 and 7#b7 ensure that such repository does not contain any data that is individually identifiable4 #d4 ,requiring equitable health care in the hospital value-based purchasing program 7a7 ,equitable health care as value measurement ,section #ahhf7;b77#c77;,b77viii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77;,b77viii77 is amended by adding at the end the following new subclause3 7,,xiii7 7aa7 ,effective for payments beginning with fiscal year #bjbe1 in expanding the number of measures under subclause 7,,iii71 the ,secretary shall adopt measures that relate to equitable health care furnished by hospitals in inpatient settings4 7bb7 ,in carrying out this subclause1 the ,secretary shall solicit input and recommendations from individuals and groups representing communities of color and other protected classes and ensure measures adopted pursuant to this subclause account for social determinants of health1 as defined in section #g7;e77#aj7 of the ,equal ,health ,care for ,all ,act1 such that the social determinants of health do not adversely affect hospitals if the inequitable outcomes are not caused by that hospital's provision of care4 7cc7 ,for purposes of this subclause1 the term equitable health care refers to the principle that high-quality care should be provided to all individuals and health care treatment and services should not vary on account of the real or perceived race1 national origin1 sex 7including sexual orientation and gender identity71 disability1 or age of an individual1 as well as any other factor that the ,secretary determines would be useful for determining a pattern of inequitable provision of health care4 4 7b7 ,inclusion of equitable health care measures ,section #ahhf7o77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7o77#b77;,b77 is amended by adding at the end the following new clause3 7iv7 ,inclusion of equitable health care measures ,beginning in fiscal year #bjbe1 measures selected under subparagraph 7,a7 shall include the equitable health care measures described in subsection 7b77#c77;,b77viii77,,xiii74 4 #e4 ,inequitable provision of health care as a basis for permissive exclusion from ,medicare and other ,federal health care programs ,section #aabh7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g7;b77 is amended by adding at the end the following new paragraph3 7#ah7 ,inequitable provision of health care 7,a7 ,in general ,subject to subparagraph 7,b71 any health care provider that the ,secretary determines1 under section #g7;b77#b7 of the ,equal ,health ,care for ,all ,act1 has engaged in a pattern of inequitable provision of health care 7as defined in subsection 7e77#g7 of that ,act7 on the basis of race1 national origin1 sex 7including sexual orientation and gender identity71 disability1 or age of an individual4 7,b7 ,exception ,for purposes of carrying out subparagraph 7,a71 the ,secretary shall not exclude any health care provider from participation in the ,medicare program under title ,,xviii of the ,social ,security ,act or the ,medicaid program under title ,,xix of such ,act if the exclusion of such health care provider would result in increased difficulty in access to health care services for underserved or low-income communities4 4 #f4 ,office for ,civil ,rights and ,health ,equity of the ,department of ,health and ,human ,services 7a7 ,name of office ,beginning on the date of enactment of this ,act1 the ,office for ,civil ,rights of the ,department of ,health and ,human ,services shall be known as the ,office for ,civil ,rights and ,health ,equity of the ,department of ,health and ,human ,services4 ,any reference to the ,office for ,civil ,rights of the ,department of ,health and ,human ,services in any law1 regulation1 map1 document1 record1 or other paper of the ,united ,states shall be deemed to be a reference to the ,office for ,civil ,rights and ,health ,equity4 7b7 ,head of office ,the head of the ,office for ,civil ,rights and ,health ,equity shall be the ,director for ,civil ,rights and ,health ,equity1 to be appointed by the ,president4 ,any reference to the ,director of the ,office for ,civil ,rights of the ,department of ,health and ,human ,services in any law1 regulation1 map1 document1 record1 or other paper of the ,united ,states shall be deemed to be a reference to the ,director for ,civil ,rights and ,health ,equity4 #g4 ,prohibiting discrimination in health care 7a7 ,prohibiting discrimination 7#a7 ,in general ,no health care provider may1 on the basis1 in whole or in part1 of race1 sex 7including sexual orientation and gender identity71 disability1 age1 or religion1 subject an individual to the inequitable provision of health care4 7#b7 ,notice of patient rights ,the ,secretary shall provide to each patient a notice of a patient's rights under this section4 7b7 ,administrative complaint and conciliation process 7#a7 ,complaints and answers 7,a7 ,in general ,an aggrieved person may1 not later than #a year after an alleged violation of subsection 7a7 has occurred or concluded1 file a complaint with the ,director alleging inequitable provision of health care by a provider described in subsection 7a74 7,b7 ,complaint ,a complaint submitted pursuant to subparagraph 7,a7 shall be in writing and shall contain such information and be in such form as the ,director requires4 7,c7 ,oath or affirmation ,the complaint and any answer made under this subsection shall be made under oath or affirmation1 and may be reasonably and fairly modified at any time4 7#b7 ,response to complaints 7,a7 ,in general ,upon the filing of a complaint under this subsection1 the following procedures shall apply3 7i7 ,complainant notice ,the ,director shall serve notice upon the complainant acknowledging receipt of such filing and advising the complainant of the time limits and procedures provided under this section4 7ii7 ,respondent notice ,the ,director shall1 not later than #cj days after receipt of such filing-- 7,i7 serve on the respondent a notice of the complaint1 together with a copy of the original complaint2 and 7,,ii7 advise the respondent of the procedural rights and obligations of respondents under this section4 7iii7 ,answer ,the respondent may file1 not later than #fj days after receipt of the notice from the ,director1 an answer to such complaint4 7iv7 ,investigative duties ,the ,director shall-- 7,i7 make an investigation of the alleged inequitable provision of health care2 and 7,,ii7 complete such investigation within #ahj days 7unless it is impracticable to complete such investigation within #ahj days7 after the filing of the complaint4 7,b7 ,investigations 7i7 ,pattern or practice ,in the course of investigating the complaint1 the ,director may seek records of care provided to patients other than the complainant if necessary to demonstrate or disprove an allegation of inequitable provision of health care or to determine whether there is a pattern or practice of such care4 7ii7 ,accounting for social determinants of health ,in investigating the complaint and reaching a determination on the validity of the complaint1 the ,director shall account for social determinants of health and the effect of such social determinants on health care outcomes1 so that the health care provider named in the complaint is not held accountable for a factor outside of the control of the provider's provision of health care4 7iii7 ,inability to complete investigation ,if the ,director is unable to complete 7or finds it is impracticable to complete7 the investigation within #ahj days after the filing of the complaint 7or1 if the ,secretary takes further action under paragraph 7#f77;,b7 with respect to a complaint1 within #ahj days after the commencement of such further action71 the ,director shall notify the complainant and respondent in writing of the reasons involved4 7iv7 ,report to state licensing authorities ,on concluding each investigation under this subparagraph1 the ,director shall provide to each ,state licensing authority that is responsible for the licensing of the health care provider under investigation1 information specifying the results of the investigation4 7,c7 ,report 7i7 ,final report ,on completing each investigation under this paragraph1 the ,director shall prepare a final investigative report4 7ii7 ,modification of report ,a final report under this subparagraph may be modified if additional evidence is later discovered4 7#c7 ,conciliation 7,a7 ,in general ,during the period beginning on the date on which a complaint is filed under this subsection and ending on the date of final disposition of such complaint 7including during an investigation under paragraph 7#b77;,b771 the ,director shall1 to the extent feasible1 engage in conciliation with respect to such complaint4 7,b7 ,conciliation agreement ,a conciliation agreement arising out of such conciliation shall be an agreement between the respondent and the complainant1 and shall be subject to approval by the ,director4 7,c7 ,rights protected ,the ,director shall approve a conciliation agreement only if the agreement protects the rights of the complainant and other persons similarly situated4 7,d7 ,reporting of agreement 7i7 ,in general ,subject to clause 7ii71 the ,secretary shall make available to the ,state licensing authority described in paragraph 7#b77;,b77iv7 a copy of a conciliation agreement entered into pursuant to this subsection unless the complainant and respondent otherwise agree1 and the ,secretary determines1 that disclosure is not required to further the purposes of this subsection4 7ii7 ,limitation ,a conciliation agreement that is made available to the ,state licensing authority pursuant to clause 7i7 may not disclose individually identifiable health information4 7#d7 ,failure to comply with conciliation agreement ,whenever the ,director has reasonable cause to believe that a respondent has breached a conciliation agreement1 the ,director shall refer the matter to the ,attorney ,general to consider filing a civil action to enforce such agreement4 7#e7 ,written consent for disclosure of information ,nothing said or done in the course of conciliation under this subsection may be made public1 or used as evidence in a subsequent proceeding under this subsection1 without the written consent of the parties to the conciliation4 7#f7 ,prompt judicial action 7,a7 ,in general ,if the ,director determines at any time following the filing of a complaint under this subsection that prompt judicial action is necessary to carry out the purposes of this subsection1 the ,director may recommend that the ,attorney ,general promptly commence a civil action under subsection 7d74 7,b7 ,immediate suit ,if the ,director determines at any time following the filing of a complaint under this subsection that the public interest would be served by allowing the complainant to bring a civil action under subsection 7c7 in a ,state or ,federal court immediately1 the ,director shall certify that the administrative process has concluded and that the complainant may file such a suit immediately4 7#g7 ,annual report ,not later than #a year after the date of enactment of this ,act1 and annually thereafter1 the ,director shall make publicly available a report detailing the activities of the ,office for ,civil ,rights and ,health ,equity under this subsection1 including-- 7,a7 the number of complaints filed and the basis on which the complaints were filed2 7,b7 the number of investigations undertaken as a result of such complaints2 and 7,c7 the disposition of all such investigations4 7c7 ,enforcement by private persons 7#a7 ,in general 7,a7 ,civil action 7i7 ,in suit ,a complainant under subsection 7b7 may commence a civil action to obtain appropriate relief with respect to an alleged violation of subsection 7a71 or for breach of a conciliation agreement under subsection 7b71 in an appropriate district court of the ,united ,states or ,state court-- 7,i7 not sooner than the earliest of-- 7aa7 the date a conciliation agreement is reached under subsection 7b72 7bb7 the date of a final disposition of a complaint under subsection 7b72 or 7cc7 #ahj days after the first day of the alleged violation2 and 7,,ii7 not later than #b years after the final day of the alleged violation4 7ii7 ,statute of limitations ,the computation of such #b-year period shall not include any time during which an administrative proceeding 7including investigation or conciliation7 under subsection 7b7 was pending with respect to a complaint under such subsection4 7,b7 ,barring suit ,if the ,director has obtained a conciliation agreement under subsection 7b7 regarding an alleged violation of subsection 7a71 no action may be filed under this paragraph by the complainant involved with respect to the alleged violation except for the purpose of enforcing the terms of such an agreement4 7#b7 ,relief which may be granted 7,a7 ,in general ,in a civil action under paragraph 7#a71 if the court finds that a violation of subsection 7a7 or breach of a conciliation agreement has occurred1 the court may award to the plaintiff actual and punitive damages1 and may grant as relief1 as the court determines to be appropriate1 any permanent or temporary injunction1 temporary restraining order1 or other order 7including an order enjoining the defendant from engaging in a practice violating subsection 7a7 or ordering such affirmative action as may be appropriate74 7,b7 ,fees and costs ,in a civil action under paragraph 7#a71 the court1 in its discretion1 may allow the prevailing party1 other than the ,united ,states1 a reasonable attorney's fee and costs4 ,the ,united ,states shall be liable for such fees and costs to the same extent as a private person4 7#c7 ,intervention by ,attorney ,general ,upon timely application1 the ,attorney ,general may intervene in a civil action under paragraph 7#a71 if the ,attorney ,general certifies that the case is of general public importance4 7d7 ,enforcement by the ,attorney ,general 7#a7 ,commencement of actions 7,a7 ,pattern or practice cases ,the ,attorney ,general may commence a civil action in any appropriate district court of the ,united ,states if the ,attorney ,general has reasonable cause to believe that any health care provider covered by subsection 7a7-- 7i7 is engaged in a pattern or practice that violates such subsection2 or 7ii7 is engaged in a violation of such subsection that raises an issue of significant public importance4 7,b7 ,cases by referral ,the ,director may determine1 based on a pattern of complaints1 a pattern of violations1 a review of data reported by a health care provider covered by subsection 7a71 or any other means1 that there is reasonable cause to believe a health care provider is engaged in a pattern or practice that violates subsection 7a74 ,if the ,director makes such a determination1 the ,director shall refer the related findings to the ,attorney ,general4 ,if the ,attorney ,general finds that such reasonable cause exists1 the ,attorney ,general may commence a civil action in any appropriate district court of the ,united ,states4 7#b7 ,enforcement of subpoenas ,the ,attorney ,general1 on behalf of the ,director1 or another party at whose request a subpoena is issued under this subsection1 may enforce such subpoena in appropriate proceedings in the district court of the ,united ,states for the district in which the person to whom the subpoena was addressed resides1 was served1 or transacts business4 7#c7 ,relief which may be granted in civil actions 7,a7 ,in general ,in a civil action under paragraph 7#a71 the court-- 7i7 may award such preventive relief1 including a permanent or temporary injunction1 temporary restraining order1 or other order against the person responsible for a violation of subsection 7a7 as is necessary to assure the full enjoyment of the rights granted by this subsection2 7ii7 may award such other relief as the court determines to be appropriate1 including monetary damages1 to aggrieved persons2 and 7iii7 may1 to vindicate the public interest1 assess punitive damages against the respondent-- 7,i7 in an amount not exceeding #ejj1jjj1 for a first violation2 and 7,,ii7 in an amount not exceeding #a1jjj1jjj1 for any subsequent violation4 7,b7 ,fees and costs ,in a civil action under this subsection1 the court1 in its discretion1 may allow the prevailing party1 other than the ,united ,states1 a reasonable attorney's fee and costs4 ,the ,united ,states shall be liable for such fees and costs to the extent provided by section #bdab of title #bh1 ,united ,states ,code4 7#d7 ,intervention in civil actions ,upon timely application1 any person may intervene in a civil action commenced by the ,attorney ,general under paragraphs 7#a7 and 7#b7 if the action involves an alleged violation of subsection 7a7 with respect to which such person is an aggrieved person 7including a person who is a complainant under subsection 7b77 or a conciliation agreement to which such person is a party4 7e7 ,definitions ,in this section3 7#a7 ,aggrieved person ,the term aggrieved person means-- 7,a7 a person who believes that the person was or will be injured in violation of subsection 7a72 or 7,b7 the personal representative or estate of a deceased person who was injured in violation of subsection 7a74 7#b7 ,director ,the term ,director means the ,director for ,civil ,rights and ,health ,equity of the ,department of ,health and ,human ,services4 7#c7 ,disability ,the term disability has the meaning given such term in section #c of the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abajb74 7#d7 ,conciliation ,the term conciliation means the attempted resolution of issues raised by a complaint1 or by the investigation of such complaint1 through informal negotiations involving the complainant1 the respondent1 and the ,secretary4 7#e7 ,conciliation agreement ,the term conciliation agreement means a written agreement setting forth the resolution of the issues in conciliation4 7#f7 ,individually identifiable health information ,the term individually identifiable health information means any information1 including demographic information collected from an individual-- 7,a7 that is created or received by a health care provider covered by subsection 7a71 health plan1 employer1 or health care clearinghouse2 7,b7 that relates to the past1 present1 or future physical or mental health or condition of1 the provision of health care to1 or the past1 present1 or future payment for the provision of health care to1 the individual2 and 7,c7 7i7 that identifies the individual2 or 7ii7 with respect to which there is a reasonable basis to believe that the information can be used to identify the individual4 7#g7 ,inequitable provision of health care ,the term inequitable provision of health care means the provision of any health care service1 by a health care provider in a manner that-- 7,a7 fails to meet a high-quality care standard1 meaning the health care provider fails to-- 7i7 avoid harm to patients as a result of the health services that are intended to help the patient2 7ii7 provide health services based on scientific knowledge to all and to all patients who benefit2 7iii7 refrain from providing services to patients not likely to benefit2 7iv7 provide care that is responsive to patient preferences1 needs1 and values2 and 7v7 avoids waits or delays in care2 and 7,b7 is discriminatory in intent or effect based at least in part on a basis specified in subsection 7a74 7#h7 ,respondent ,the term respondent means the person or other entity accused in a complaint of a violation of subsection 7a74 7#i7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#aj7 ,social determinants of health ,the term social determinants of health means conditions in the environments in which individuals live1 work1 attend school1 and worship1 that affect a wide range of health1 functioning1 and quality-of-life outcomes and risks4 7f7 ,rule of construction ,nothing in this section shall be construed as repealing or limiting the effect of title ,,vi of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;d et seq471 section #aeeg of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahaaf71 section #ejd of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gid71 or the ,age ,discrimination ,act of #aige 7#db ,u4,s4,c4 #faja et seq474 #h4 ,federal ,health ,equity ,commission 7a7 ,establishment of ,commission 7#a7 ,in general ,there is established the ,federal ,health ,equity ,commission 7in this section referred to as the ,commission74 7#b7 ,membership 7,a7 ,in general ,the ,commission shall be composed of-- 7i7 #h voting members appointed under subparagraph 7,b72 and 7ii7 the nonvoting1 ex officio members described in subparagraph 7,c74 7,b7 ,voting members ,not more than #d of the members described in subparagraph 7,a77i7 shall at any one time be of the same political party4 ,such members shall have recognized expertise in and personal experience with racial and ethnic health inequities1 health care needs of vulnerable and marginalized populations1 and health equity as a vehicle for improving health status and health outcomes4 ,such members shall be appointed to the ,commission as follows3 7i7 #d members of the ,commission shall be appointed by the ,president4 7ii7 #b members of the ,commission shall be appointed by the ,president pro tempore of the ,senate1 upon the recommendations of the majority leader and the minority leader of the ,senate4 ,each member appointed to the ,commission under this clause shall be appointed from a different political party4 7iii7 #b members of the ,commission shall be appointed by the ,speaker of the ,house of ,representatives upon the recommendations of the majority leader and the minority leader of the ,house of ,representatives4 ,each member appointed to the ,commission under this clause shall be appointed from a different political party4 7,c7 ,ex officio member ,the ,commission shall have the following nonvoting1 ex officio members3 7i7 ,the ,director for ,civil ,rights and ,health ,equity of the ,department of ,health and ,human ,services4 7ii7 ,the ,deputy ,assistant ,secretary for ,minority ,health of the ,department of ,health and ,human ,services4 7iii7 ,the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities4 7iv7 ,the ,chairperson of the ,advisory ,committee on ,minority ,health established under section #agjg7;c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;c774 7#c7 ,terms ,the term of office of each member of the ,commission appointed under paragraph 7#b77;,b7 shall be #f years4 7#d7 ,chairperson2 ,vice ,chairperson 7,a7 ,chairperson ,the ,president shall1 with the concurrence of a majority of the members of the ,commission appointed under paragraph 7#b77;,b71 designate a ,chairperson from among the members of the ,commission appointed under such paragraph4 7,b7 ,vice ,chairperson 7i7 ,designation ,the ,speaker of the ,house of ,representatives shall1 in consultation with the majority leaders and the minority leaders of the ,senate and the ,house of ,representatives and with the concurrence of a majority of the members of the ,commission appointed under paragraph 7#b77;,b71 designate a ,vice ,chairperson from among the members of the ,commission appointed under such paragraph4 ,the ,vice ,chairperson may not be a member of the same political party as the ,chairperson4 7ii7 ,duty ,the ,vice ,chairperson shall act in place of the ,chairperson in the absence of the ,chairperson4 7#e7 ,removal of members ,the ,president may remove a member of the ,commission only for neglect of duty or malfeasance in office4 7#f7 ,quorum ,a majority of members of the ,commission appointed under paragraph 7#b77;,b7 shall constitute a quorum of the ,commission1 but a lesser number of members may hold hearings4 7b7 ,duties of the ,commission 7#a7 ,in general ,the ,commission shall-- 7,a7 monitor and report on the implementation of this ,act2 and 7,b7 investigate1 monitor1 and report on progress towards health equity and the elimination of health disparities4 7#b7 ,annual report ,the ,commission shall-- 7,a7 submit to the ,president and ,congress at least one report annually on health equity and health disparities2 and 7,b7 include in such report-- 7i7 a description of actions taken by the ,department of ,health and ,human ,services and any other ,federal agency related to health equity or health disparities2 and 7ii7 recommendations on ensuring equitable health care and eliminating health disparities4 7c7 ,powers 7#a7 ,hearings 7,a7 ,in general ,the ,commission or1 at the direction of the ,commission1 any subcommittee or member of the ,commission1 may1 for the purpose of carrying out this section1 as the ,commission or the subcommittee or member considers advisable-- 7i7 hold such hearings1 meet and act at such times and places1 take such testimony1 receive such evidence1 and administer such oaths2 and 7ii7 require1 by subpoena or otherwise1 the attendance and testimony of such witnesses and the production of such books1 records1 correspondence1 memoranda1 papers1 documents1 tapes1 and materials4 7,b7 ,limitation on hearings ,the ,commission may hold a hearing under subparagraph 7,a77i7 only if the hearing is approved-- 7i7 by a majority of the members of the ,commission appointed under subsection 7a77#b77;,b72 or 7ii7 by a majority of such members present at a meeting when a quorum is present4 7#b7 ,issuance and enforcement of subpoenas 7,a7 ,issuance ,a subpoena issued under paragraph 7#a7 shall-- 7i7 bear the signature of the ,chairperson of the ,commission2 and 7ii7 be served by any person or class of persons designated by the ,chairperson for that purpose4 7,b7 ,enforcement ,in the case of contumacy or failure to obey a subpoena issued under paragraph 7#a71 the ,united ,states district court for the district in which the subpoenaed person resides1 is served1 or may be found may issue an order requiring the person to appear at any designated place to testify or to produce documentary or other evidence4 7,c7 ,noncompliance ,any failure to obey the order of the court may be punished by the court as a contempt of court4 7#c7 ,witness allowances and fees 7,a7 ,in general ,section #ahba of title #bh1 ,united ,states ,code1 shall apply to a witness requested or subpoenaed to appear at a hearing of the ,commission4 7,b7 ,expenses ,the per diem and mileage allowances for a witness shall be paid from funds available to pay the expenses of the ,commission4 7#d7 ,postal services ,the ,commission may use the ,united ,states mails in the same manner and under the same conditions as other agencies of the ,federal ,government4 7#e7 ,gifts ,the ,commission may accept1 use1 and dispose of gifts or donations of services or property4 7d7 ,administrative ,provisions 7#a7 ,staff 7,a7 ,director ,there shall be a full-time staff director for the ,commission who shall-- 7i7 serve as the administrative head of the ,commission2 and 7ii7 be appointed by the ,chairperson with the concurrence of the ,vice ,chairperson4 7,b7 ,other personnel ,the ,commission may-- 7i7 appoint such other personnel as it considers advisable1 subject to the provisions of title #e1 ,united ,states ,code1 governing appointments in the competitive service1 and the provisions of chapter #ea and subchapter ,,iii of chapter #ec of that title relating to classification and ,general ,schedule pay rates2 and 7ii7 may procure temporary and intermittent services under section #caji7;b7 of title #e1 ,united ,states ,code1 at rates for individuals not in excess of the daily equivalent paid for positions at the maximum rate for ,,gs-#ae of the ,general ,schedule under section #eccb of title #e1 ,united ,states ,code4 7#b7 ,compensation of members 7,a7 ,non-,federal employees ,each member of the ,commission who is not an officer or employee of the ,federal ,government shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level ,,iv of the ,executive ,schedule under section #ecae of title #e1 ,united ,states ,code1 for each day 7including travel time7 during which the member is engaged in the performance of the duties of the ,commission4 7,b7 ,federal employees ,each member of the ,commission who is an officer or employee of the ,federal ,government shall serve without compensation in addition to the compensation received for the services of the member as an office or employee of the ,federal ,government4 7,c7 ,travel expenses ,a member of the ,commission shall be allowed travel expenses1 including per diem in lieu of subsistence1 at rates authorized for an employee of an agency under subchapter ,i of chapter #eg of title #e1 ,united ,states ,code1 while away from the home or regular place of business of the member in the performance of the duties of the ,commission4 7#c7 ,cooperation ,the ,commission may secure directly from any ,federal department or agency such information as the ,commission considers necessary to carry out this ,act4 ,upon request of the ,chairman of the ,commission1 the head of such department or agency shall furnish such information to the ,commission4 7e7 ,permanent ,commission ,section #ajac of title #e1 ,united ,states ,code1 shall not apply to the ,commission4 7f7 ,authorization of appropriations ,there are authorized to be appropriated for fiscal year #bjbe and each fiscal year thereafter such sums as may be necessary to carry out the duties of the ,commission4 #i4 ,grants for hospitals to promote equitable health care and outcomes 7a7 ,in general ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall award grants to hospitals to promote equitable health care treatment and services1 and reduce disparities in care and outcomes4 7b7 ,consultation ,in establishing the criteria for grants under this section and evaluating applications for such grants1 the ,secretary shall consult with the ,director for ,civil ,rights and ,health ,equity of the ,department of ,health and ,human ,services4 7c7 ,use of funds ,a hospital shall use funds received from a grant under this section to establish or expand programs to provide equitable health care to all patients and to ensure equitable health care outcomes4 ,such uses may include-- 7#a7 providing explicit and implicit bias training to medical providers and staff2 7#b7 providing translation or interpretation services for patients2 7#c7 recruiting and training a diverse workforce2 7#d7 tracking data related to care and outcomes2 and 7#e7 training on cultural sensitivity4 7d7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to hospitals that have received disproportionate share hospital payments under section #ahhf7r7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7r77 or section #aibc of such ,act 7#db ,u4,s4,c4 #acifr-#d7 with respect to fiscal year #bjba4 7e7 ,supplement1 not supplant ,grants awarded under this section shall be used to supplement1 not supplant1 any nongovernment efforts1 or other ,federal1 ,state1 or local funds provided to a recipient4 7f7 ,equitable health care defined ,the term equitable health care has the meaning given such term in section #ahhf7;b77#c77;,b77viii77,,xiii77cc7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77;,b77viii77,,xiii77cc771 as added by section #d7;a74