,,ii #aahth ,,congress #b;d ,session ,s4 #dggc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #be1 #bjbd,ms4 ,hirono 7for herself1 ,mr4 ,padilla1 ,mr4 ,booker1 ,ms4 ,warren1 ,ms4 ,duckworth1 ,mr4 ,warnock1 ,mr4 ,cardin1 ,mr4 ,welch1 and ,mr4 ,blumenthal7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to improve the health of minority individuals1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,health ,equity and ,accountability ,act of #bjbd4 #b4 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title4,sec4 #b4 ,table of contents4,,title ,i--,data collection and reporting,sec4 #ajja4 ,strengthening data collection1 improving data analysis1 and expanding data reporting4,sec4 #ajjb4 ,elimination of prerequisite of direct appropriations for data collection and analysis4,sec4 #ajjc4 ,collection of data for the ,medicare program4,sec4 #ajjd4 ,revision of ,,hipaa claims standards4,sec4 #ajje4 ,national ,center for ,health ,statistics4,sec4 #ajjf4 ,disparities data collected by the ,federal ,government4,sec4 #ajjg4 ,data collection and analysis grants to minority-serving institutions4,sec4 #ajjh4 ,safety and effectiveness of drugs with respect to racial and ethnic background4,sec4 #ajji4 ,improving health data regarding ,native ,hawaiians and ,pacific ,islanders4,sec4 #ajaj4 ,clarification of simplified administrative reporting requirement4,sec4 #ajaa4 ,data collection regarding pandemic preparedness1 testing1 infections1 and deaths4,sec4 #ajab4 ,commission on ,ensuring ,data for ,health ,equity4,sec4 #ajac4 ,task ,force on ,preventing ,bias in ,,ai and ,algorithms4,sec4 #ajad4 ,report on the health of the ,middle ,eastern and ,north ,african population4,,title ,,ii--,culturally and linguistically appropriate health and health care,sec4 #bjja4 ,definitions4,sec4 #bjjb4 ,improving access to services for individuals with limited ,english proficiency4,sec4 #bjjc4 ,ensuring standards for culturally and linguistically appropriate services in health care4,sec4 #bjjd4 ,culturally and linguistically appropriate health care in the ,public ,health ,service ,act4,sec4 #bjje4 ,pilot program for improvement and development of ,state medical interpreting services4,sec4 #bjjf4 ,training tomorrow's doctors for culturally and linguistically appropriate care3 graduate medical education4,sec4 #bjjg4 ,federal reimbursement for culturally and linguistically appropriate services under the ,medicare1 ,medicaid1 and ,state ,children's ,health ,insurance ,programs4,sec4 #bjjh4 ,increasing understanding of and improving health literacy4,sec4 #bjji4 ,requirements for health programs or activities receiving ,federal funds4,sec4 #bjaj4 ,report on ,federal efforts to provide culturally and linguistically appropriate health care services4,sec4 #bjaa4 ,english instruction for individuals with limited ,english proficiency4,sec4 #bjab4 ,implementation4,sec4 #bjac4 ,language access services4,sec4 #bjad4 ,medically underserved populations4,,title ,,iii--,health workforce diversity,sec4 #cjja4 ,amendment to the ,public ,health ,service ,act4,sec4 #cjjb4 ,hispanic-serving institutions1 historically ,black colleges and universities1 historically ,black professional or graduate institutions1 ,asian ,american and ,native ,american ,pacific ,islander-serving institutions1 ,tribal ,colleges1 regional community-based organizations1 and national minority medical associations4,sec4 #cjjc4 ,loan repayment program of ,centers for ,disease ,control and ,prevention4,sec4 #cjjd4 ,cooperative agreements for online degree programs at schools of public health and schools of allied health4,sec4 #cjje4 ,national ,health ,care ,workforce ,commission4,sec4 #cjjf4 ,scholarship and fellowship programs4,sec4 #cjjg4 ,mc,nair ,postbaccalaureate ,achievement ,program4,sec4 #cjjh4 ,rules for determination of full-time equivalent residents for cost-reporting periods4,sec4 #cjji4 ,developing and implementing strategies for local health equity4,sec4 #cjaj4 ,health ,professions ,workforce ,fund4,sec4 #cjaa4 ,future advancement of academic nursing4,sec4 #cjab4 ,sense of ,congress relating to graduate medical education4,sec4 #cjac4 ,career support for skilled1 internationally educated health professionals4,sec4 #cjad4 ,study and report on strategies for increasing diversity4,sec4 #cjae4 ,conrad ,state #cj program2 physician retention4,sec4 #cjaf4 ,grants for schools of medicine and schools of osteopathic medicine in underserved areas4,,title ,,iv--,improving ,health ,care ,access and ,quality,sec4 #djjj4 ,definition4,subtitle ,a--,reducing ,barriers to ,accessing ,care,sec4 #djja4 ,protecting protected areas4,sec4 #djjb4 ,repeal of requirement for documentation evidencing citizenship or nationality under the ,medicaid program4,sec4 #djjc4 ,,lift the ,,bar ,act4,sec4 #djjd4 ,improve affordability and reduce premium costs of health insurance for consumers4,sec4 #djje4 ,removing citizenship and immigration barriers to access to affordable health care under the ,,aca4,sec4 #djjf4 ,,heal for ,immigrant ,families ,act4,sec4 #djjg4 ,study on the uninsured4,sec4 #djjh4 ,medicaid fallback coverage program for low-income adults in non-expansion ,states4,sec4 #djji4 ,increase and extension of temporary enhanced ,,fmap for ,states which begin to expend amounts for certain mandatory individuals4,subtitle ,b--,improvement of ,coverage,sec4 #daja4 ,medicaid in the territories4,sec4 #dajb4 ,extension of the ,supplemental ,security ,income ,program to ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 and ,american ,samoa4,sec4 #dajc4 ,extension of ,medicare secondary payer4,sec4 #dajd4 ,indian defined in title ,i of the ,patient ,protection and ,affordable ,care ,act4,sec4 #daje4 ,removing ,medicare barrier to health care4,sec4 #dajf4 ,lowering ,medicare premiums and prescription drug costs4,sec4 #dajg4 ,reducing cost-sharing1 aligning income and resource eligibility tests1 simplifying enrollment1 and other program improvements for low-income beneficiaries4,sec4 #dajh4 #ajj percent ,,fmap for medical assistance provided by urban ,indian organizations4,sec4 #daji4 #ajj percent ,,fmap for medical assistance provided to a ,native ,hawaiian through a federally qualified health center or a ,native ,hawaiian health care system under the ,medicaid program4,sec4 #daaj4 ,repeal of requirement for estate recovery under the ,medicaid program4,sec4 #daaa4 ,allow for suspension of ,medicare benefits and premium liability for individuals who are incarcerated and provide a special enrollment period around the date of release4,sec4 #daab4 ,federal employee health benefits plans4,sec4 #daac4 ,continuation of ,medicaid income eligibility standard for pregnant individuals and infants4,subtitle ,c--,expansion of ,access ,part #a--;,general ,provisions,sec4 #dbja4 ,amendment to the ,public ,health ,service ,act4,sec4 #dbjb4 ,border health grants4,sec4 #dbjc4 ,critical access hospital improvements4,sec4 #dbjd4 ,medicare remote monitoring pilot projects4,sec4 #dbje4 ,community health center collaborative access expansion4,sec4 #dbjf4 ,facilitating the provision of telehealth services across ,state lines4,sec4 #dbjg4 ,scoring of preventive health savings4,sec4 #dbjh4 ,sense of ,congress on maintenance of effort provisions regarding children's health4,sec4 #dbji4 ,protection of the ,,hhs ,offices of ,minority ,health4,sec4 #dbaj4 ,office of ,minority ,health in ,veterans ,health ,administration of ,department of ,veterans ,affairs4,sec4 #dbaa4 ,study of ,,dsh payments to ensure hospital access for low-income patients4,sec4 #dbab4 ,reauthorization of programs under the ,native ,hawaiian ,health ,care ,improvement ,act4,part #b--,rural,sec4 #dbba4 ,establishment of ,rural ,community ,hospital 7,,rch7 ,program4,sec4 #dbbb4 ,rural ,health ,quality ,advisory ,commission and demonstration projects4,sec4 #dbbc4 ,rural health care services4,part #c--;,indian ,communities,sec4 #dbca4 ,assistant ,secretary of the ,indian ,health ,service4,sec4 #dbcb4 ,extension of full ,federal medical assistance percentage to ,indian health care providers4,sec4 #dbcc4 ,conferring with urban ,indian organizations4,part #d--,providers,sec4 #dbda4 ,availability of non-,english language speaking providers4,sec4 #dbdb4 ,access to essential community providers4,sec4 #dbdc4 ,provider network adequacy in communities of color4,part #e--;,dental,sec4 #dbea4 ,improving access to dental care4,sec4 #dbeb4 ,oral health literacy and awareness campaign4,sec4 #dbec4 ,ensuring ,kids ,have ,access to ,medically ,necessary ,dental ,care ,act4,subtitle ,d--,advancing ,health ,equity ,through ,payment and ,delivery ,reform ,sec4 #dcja4 ,centers for ,medicare ,medicaid ,services reporting and value-based programs4,sec4 #dcjb4 ,development and testing of disparity reducing delivery and payment models4,sec4 #dcjc4 ,diversity in ,centers for ,medicare and ,medicaid consultation4,sec4 #dcjd4 ,supporting safety net and community-based providers to compete in value-based payment systems4,sec4 #dcje4 ,improving access to care for ,medicare and ,medicaid beneficiaries4,subtitle ,e--,health ,empowerment ,zones ,sec4 #ddja4 ,designation of health empowerment zones4,sec4 #ddjb4 ,assistance to those seeking designation4,sec4 #ddjc4 ,benefits of designation4,sec4 #ddjd4 ,definition of ,secretary4,sec4 #ddje4 ,authorization of appropriations4,subtitle ,f--,equitable ,health ,care for ,all,sec4 #deja4 ,data collection and reporting4,sec4 #dejb4 ,requiring equitable health care in the hospital value-based purchasing program4,sec4 #dejc4 ,provision of inequitable health care as a basis for permissive exclusion from ,medicare and ,state health care programs4,sec4 #dejd4 ,office for ,civil ,rights and ,health ,equity of the ,department of ,health and ,human ,services4,sec4 #deje4 ,prohibiting discrimination in health care4,sec4 #dejf4 ,federal ,health ,equity ,commission4,sec4 #dejg4 ,grants for hospitals to promote equitable health care and outcomes4,subtitle ,g--,investing in ,equity,sec4 #dfja4 ,definitions4,sec4 #dfjb4 ,strategy to incentivize health equity4,sec4 #dfjc4 ,pay for ,equity ,advisory ,council4,,title ,v--,improving health outcomes for women1 gender-diverse people1 children1 and families,subtitle ,a--,underserved communities,sec4 #ejja4 ,grants to promote health for underserved communities4,subtitle ,b--,pregnancy screening,sec4 #eaja4 ,pregnancy intention screening initiative demonstration program4,sec4 #eajb4 ,birth defects prevention1 risk reduction1 and awareness4,subtitle ,c--,pregnancy-,related care,sec4 #ebja4 ,community access1 resources1 and empowerment for moms4,sec4 #ebjb4 ,,mommies4,sec4 #ebjc4 ,social determinants for moms4,sec4 #ebjd4 ,kira ,johnson ,act4,sec4 #ebje4 ,perinatal workforce4,sec4 #ebjf4 ,data to ,save ,moms ,act4,sec4 #ebjg4 ,moms matter4,sec4 #ebjh4 ,justice for ,incarcerated ,moms4,sec4 #ebji4 ,tech to save moms4,sec4 #ebaj4 ,,impact ,to ,save ,moms ,act4,sec4 #ebaa4 ,protecting moms and babies against climate change4,sec4 #ebab4 ,protect moms from domestic violence4,sec4 #ebac4 ,midwives schools and programs expansion4,sec4 #ebad4 ,gestational diabetes4,sec4 #ebae4 ,consumer education campaign4,sec4 #ebaf4 ,bibliographic database of systematic reviews for care of childbearing individuals and newborns4,sec4 #ebag4 ,development of interprofessional maternity care educational models and tools4,sec4 #ebah4 ,dissemination of the quality family planning guidelines4,subtitle ,d--,federal agency coordination on maternal health,sec4 #ecja4 ,interagency ,coordinating ,committee on the ,promotion of ,optimal ,maternity ,outcomes4,sec4 #ecjb4 ,expansion of ,,cdc ,prevention ,research ,centers ,program to include ,centers on ,optimal ,maternity ,outcomes4,sec4 #ecjc4 ,expanding models to be tested by ,center for ,medicare and ,medicaid ,innovation to explicitly include maternity care and children's health models4,sec4 #ecjd4 ,interagency update to the quality family planning guidelines4,subtitle ,e--,reproductive and ,sexual ,health,sec4 #edja4 ,sense of ,congress on urgent issues concerning barriers to abortion access and vital solutions4,sec4 #edjb4 ,emergency contraception education and information programs4,sec4 #edjc4 ,duties of pharmacies to ensure provision of ,,fda-approved contraception4,sec4 #edjd4 ,real ,education and ,access for ,healthy ,youth ,act4,sec4 #edje4 ,compassionate assistance for rape emergencies4,sec4 #edjf4 ,menstrual ,equity for ,all ,act of #bjbd4,sec4 #edjg4 ,additional focus area for the ,office on ,women's ,health4,sec4 #edjh4 ,including services furnished by certain students1 interns1 and residents supervised by certified nurse midwives or certified midwives within inpatient hospital services under ,medicare4,sec4 #edji4 ,grants to professional organizations and minority-serving institutions to increase diversity in maternal1 reproductive1 and sexual health professionals4,subtitle ,f--,children's ,health,sec4 #eeja4 ,,caring for ,kids ,act4,sec4 #eejb4 ,end ,diaper ,need ,act of #bjbd4,sec4 #eejc4 ,decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood4,subtitle ,g--,elder ,care,sec4 #efja4 ,expenses for household and elder care services necessary for gainful employment4,subtitle ,h--,miscellaneous provisions,sec4 #egja4 ,clarification supporting permissible use of funds for stillbirth prevention activities4,,title ,,vi--,mental health and substance use disorders,sec4 #fjja4 ,sense of ,congress4,subtitle ,a--,access to care and funding streams,sec4 #faja4 ,coverage of substance use disorder counselor services and peer support specialist services under part ,b of the ,medicare program4,sec4 #fajb4 ,reauthorization of ,minority ,fellowship ,program4,sec4 #fajc4 ,additional funds for ,national ,institutes of ,health4,sec4 #fajd4 ,additional funds for ,national ,institute on ,minority ,health and ,health ,disparities4,sec4 #faje4 ,grants for increasing racial and ethnic minority access to high-quality trauma support services and mental health care4,subtitle ,b--,interprofessional care ,sec4 #fbja4 ,health professions competencies to address racial and ethnic mental health inequities4,sec4 #fbjb4 ,interprofessional health care teams for behavioral health care4,sec4 #fbjc4 ,integrated ,health ,care ,demonstration ,program4,subtitle ,c--,workforce development,sec4 #fcja4 ,building an effective workforce in mental health4,sec4 #fcjb4 ,demonstration program to increase language access at eligible health centers4,sec4 #fcjc4 ,health professions competencies to address racial and ethnic minority mental health disparities4,subtitle ,d--,children's mental health,sec4 #fdja4 ,grant programs to support pediatric behavioral health care4,sec4 #fdjb4 ,increasing ,federal investment in pediatric behavioral health services4,sec4 #fdjc4 ,mental health in schools4,sec4 #fdjd4 ,additional support for youth and young adult mental health service provision4,sec4 #fdje4 ,early intervention and prevention programs for transition-age youth4,sec4 #fdjf4 ,strategies to increase access to telehealth under ,medicaid and ,children's ,health ,insurance ,program4,sec4 #fdjg4 ,youth and young adult mental health promotion1 prevention1 intervention1 and treatment4,subtitle ,e--,community-,based care,sec4 #feja4 ,mental health at the border4,sec4 #fejb4 ,asian ,american1 ,african ,american1 ,native ,hawaiian1 ,pacific ,islander1 ,indigenous1 ,middle ,eastern and ,north ,african1 and ,hispanic and ,latino behavioral health outreach and education strategy4,subtitle ,f--,reports,sec4 #ffja4 ,addressing racial and ethnic minority mental health disparities research gaps4,sec4 #ffjb4 ,research on adverse health effects associated with interactions with law enforcement4,sec4 #ffjc4 ,geo,access study4,sec4 #ffjd4 ,co-occurring conditions4,sec4 #ffje4 ,study and report on the ,,aanhpi youth mental health crisis4,sec4 #ffjf4 ,study and report on strategies on the ,,aanhpi behavioral health workforce shortage4,subtitle ,g--,miscellaneous provisions,sec4 #fgja4 ,strengthening mental health supports for ,,bipoc communities4,sec4 #fgjb4 ,,strong support for children4,sec4 #fgjc4 ,improving access to mental health4,sec4 #fgjd4 ,program to establish public-private contributions to increase the available workforce of school-based mental health service providers4,sec4 #fgje4 ,school social workers improving student success4,sec4 #fgjf4 ,opioid grants to support caregivers1 kinship care families1 and kinship caregivers4,sec4 #fgjg4 ,substance ,use and ,mental ,health ,services ,administration and subagencies4,,title ,,vii--,addressing high-impact minority diseases,subtitle ,a--,cancer,sec4 #gjja4 ,lung cancer mortality reduction4,sec4 #gjjb4 ,expansion of prostate cancer research1 outreach1 screening1 testing1 access1 and treatment effectiveness4,sec4 #gjjc4 ,prostate research1 imaging1 and men's education4,sec4 #gjjd4 ,prostate cancer detection research and education4,sec4 #gjje4 ,national ,prostate ,cancer ,council4,sec4 #gjjf4 ,improved ,medicaid coverage for certain breast and cervical cancer patients in the territories4,sec4 #gjjg4 ,cancer prevention and treatment demonstration for ethnic and racial minorities4,sec4 #gjjh4 ,reducing cancer disparities within ,medicare4,subtitle ,b--,viral hepatitis and liver cancer control and prevention,sec4 #gaja4 ,biennial assessment of ,,hhs hepatitis ,b and hepatitis ,c prevention1 education1 research1 and medical management plan4,sec4 #gajb4 ,liver cancer and disease prevention1 awareness1 and patient tracking grants4,subtitle ,c--,acquired bone marrow failure diseases,sec4 #gbja4 ,acquired bone marrow failure diseases4,subtitle ,d--,cardiovascular disease1 chronic disease1 obesity1 and other disease issues,sec4 #gcja4 ,guidelines for disease screening for minority patients4,sec4 #gcjb4 ,,cdc ,wisewoman ,screening ,program4,sec4 #gcjc4 ,report on cardiovascular care for women and minorities4,sec4 #gcjd4 ,,gao report on structural and systemic factors that perpetuate cardiovascular disparities4,sec4 #gcje4 ,coverage of comprehensive tobacco cessation services in ,medicaid1 ,,chip1 and private health insurance4,sec4 #gcjf4 ,clinical research funding for oral health4,sec4 #gcjg4 ,guide on evidence-based strategies for public health department obesity prevention programs4,sec4 #gcjh4 ,stephanie ,tubbs ,jones ,uterine ,fibroid ,research and ,education ,act4,subtitle ,e--,,hiv_/,a,i,d,s,sec4 #gdja4 ,statement of policy4,sec4 #gdjb4 ,additional funding for ,,aids drug assistance program treatments4,sec4 #gdjc4 ,enhancing the national ,,hiv surveillance system4,sec4 #gdjd4 ,evidence-based strategies for improving linkage to1 and retention in1 appropriate care4,sec4 #gdje4 ,improving entry into1 and retention in1 care and antiretroviral adherence for persons with ,,hiv4,sec4 #gdjf4 ,services to reduce ,,hiv_/,,aids in racial and ethnic minority communities4,sec4 #gdjg4 ,minority ,,aids initiative4,sec4 #gdjh4 ,health care professionals treating individuals with ,,hiv4,sec4 #gdji4 ,,hiv_/,,aids provider loan repayment program4,sec4 #gdaj4 ,dental education loan repayment program4,sec4 #gdaa4 ,reducing new ,,hiv infections among injecting drug users4,sec4 #gdab4 ,report on impact of ,,hiv_/,,aids in vulnerable populations4,sec4 #gdac4 ,national ,,hiv_/,,aids observance days4,sec4 #gdad4 ,review of all ,federal and ,state laws1 policies1 and regulations regarding the criminal prosecution of individuals for ,,hiv-related offenses4,sec4 #gdae4 ,expanding support for condoms in prisons4,sec4 #gdaf4 ,automatic reinstatement or enrollment in ,medicaid for people who test positive for ,,hiv before reentering communities4,sec4 #gdag4 ,stop ,,hiv in prison4,sec4 #gdah4 ,transfer of funds for implementation of ,ending the ,,hiv ,epidemic3 ,a ,plan for ,america4,sec4 #gdai4 ,pr,e,p access and coverage4,subtitle ,f--,diabetes,sec4 #geja4 ,research1 treatment1 and education4,sec4 #gejb4 ,research1 education1 and other activities4,sec4 #gejc4 ,programs to educate health providers on the causes and effects of diabetes in minority populations4,sec4 #gejd4 ,research1 education1 and other activities regarding diabetes in ,american ,indian populations4,sec4 #geje4 ,updated report on health disparities4,subtitle ,g--,lung disease ,sec4 #gfja4 ,asthma-related activities of the ,centers for ,disease ,control and ,prevention4,sec4 #gfjb4 ,influenza and pneumonia vaccination campaign4,sec4 #gfjc4 ,chronic obstructive pulmonary disease4,subtitle ,h--,tuberculosis,sec4 #ggja4 ,united ,states ,government assistance to combat tuberculosis4,subtitle ,i--,osteoarthritis and ,musculoskeletal ,diseases,sec4 #ghja4 ,osteoarthritis and other musculoskeletal health-related activities of the ,centers for ,disease ,control and ,prevention4,sec4 #ghjb4 ,grants for comprehensive osteoarthritis and musculoskeletal disease health education within health professions schools4,subtitle ,j--,sleep and circadian rhythm disorders,sec4 #gija4 ,sleep and circadian rhythm disorders research activities of the ,national ,institutes of ,health4,sec4 #gijb4 ,sleep and circadian rhythm health disparities-related activities of the ,centers for ,disease ,control and ,prevention4,sec4 #gijc4 ,grants for comprehensive sleep and circadian health education within health professions schools4,sec4 #gijd4 ,report on impact of sleep and circadian health disorders in vulnerable and racial_/ethnic populations4,subtitle ,k--,kidney disease research1 surveillance1 prevention1 and treatment,sec4 #gija;,a4 ,kidney disease research in minority populations4,sec4 #gija;,a-#a4 ,kidney disease action plan4,sec4 #gija;,a-#b4 ,providing for staff-assisted home dialysis for certain hemodialysis and peritoneal dialysis patients4,sec4 #gija;,a-#c4 ,increasing kidney transplants in minority populations4,sec4 #gija;,a-#d4 ,environmental and occupational health programs4,sec4 #gija;,a-#e4 ,understanding the treatment patterns associated with providing care and treatment of kidney failure in minority populations4,sec4 #gija;,a-#f4 ,encouraging kidney care workforce in underserved areas4,sec4 #gija;,a-#g4 ,the ,jack ,reynolds ,memorial ,medigap ,expansion ,act2 ,medigap coverage for beneficiaries with end-stage renal disease4,subtitle ,l--,diversity in clinical trials,sec4 #gija;,b4 ,,fda review of clinical trial best practices4,sec4 #gija;,b-#a4 ,diversifying ,investigations ,via ,equitable ,research ,studies for ,everyone ,trials ,act4,sec4 #gija;,b-#b4 ,clinical trial diversity4,sec4 #gija;,b-#c4 ,patient experience data4,subtitle ,m--,additional provisions addressing high-,impact minority diseases,sec4 #gija;,c4 ,medicare coverage of multi-cancer early detection screening tests4,sec4 #gija;,c-#a4 ,amputation ,reduction and ,compassion ,act4,sec4 #gija;,c-#b4 ,eliminating the coinsurance requirement for certain colorectal cancer screening tests furnished under the ,medicare program4,sec4 #gija;,c-#c4 ,expanding the availability of medical nutrition therapy services under the ,medicare program4,sec4 #gija;,c-#d4 ,encouraging the development and use of ,,disarm antimicrobial drugs4,sec4 #gija;,c-#e4 ,treat and ,reduce ,obesity ,act4,sec4 #gija;,c-#f4 ,incentives1 improvements1 and outreach to increase diversity in ,alzheimer's disease research4,,title ,,viii--,health ,information ,technology,sec4 #hjja4 ,definitions4,subtitle ,a--,reducing ,health ,disparities ,through ,health ,i,t,sec4 #haja4 ,,hrsa assistance to health centers for promotion of ,health ,,it4,sec4 #hajb4 ,assessment of impact of ,health ,,it on racial and ethnic minority communities2 outreach and adoption of ,health ,,it in such communities4,sec4 #hajc4 ,nondiscrimination and health equity in health information technology4,sec4 #hajd4 ,language access in health information technology4,subtitle ,b--,modifications ,to ,achieve ,parity in ,existing ,programs,sec4 #hbja4 ,extending funding to strengthen the ,health ,,it infrastructure in racial and ethnic minority communities4,sec4 #hbjb4 ,extending competitive grants for the development of loan programs to facilitate adoption of certified ,,ehr technology by providers serving racial and ethnic minority groups4,sec4 #hbjc4 ,authorization of appropriations4,subtitle ,c--,additional ,research and ,studies ,sec4 #hcja4 ,data collection and assessments conducted in coordination with minority-serving institutions4,sec4 #hcjb4 ,study of health information technology in medically underserved communities4,sec4 #hcjc4 ,assessment of use and misuse of de-identified health data4,subtitle ,d--,closing ,gaps in ,funding ,to ,adopt ,certified ,e,h,rs,sec4 #hdja4 ,extending ,medicaid ,,ehr incentive payments to rehabilitation facilities1 long-term care facilities1 and home health agencies4,sec4 #hdjb4 ,extending physician assistant eligibility for ,medicaid electronic health record incentive payments4,subtitle ,e--,expanding ,access to ,telehealth ,services,sec4 #heja4 ,removing geographic requirements for telehealth services4,sec4 #hejb4 ,expanding originating sites4,,title ,,ix--,accountability and ,evaluation,sec4 #ijja4 ,prohibition on discrimination in ,federal assisted health care services and research on the basis of sex 7including sexual orientation1 gender identity1 and pregnancy1 including termination of pregnancy71 race1 color1 national origin1 marital status1 familial status1 or disability status4,sec4 #ijjb4 ,treatment of ,medicare payments under title ,,vi of the ,civil ,rights ,act of #aifd4,sec4 #ijjc4 ,accountability and transparency within the ,department of ,health and ,human ,services4,sec4 #ijjd4 ,united ,states ,commission on ,civil ,rights4,sec4 #ijje4 ,sense of ,congress concerning full funding of activities to eliminate racial and ethnic health disparities4,sec4 #ijjf4 ,,gao and ,,nih reports4,sec4 #ijjg4 ,investigative and enforcement actions4,sec4 #ijjh4 ,federal ,health ,equity ,commission4,,title ,x--,addressing ,social ,determinants and ,improving ,environmental ,justice,subtitle ,a--,in ,general,sec4 #ajjja4 ,definitions4,sec4 #ajjjb4 ,health impact assessments4,sec4 #ajjjc4 ,grant program to conduct environmental health improvement activities and to improve social determinants of health4,sec4 #ajjjd4 ,additional research on the relationship between the built environment and the health of community residents4,sec4 #ajjje4 ,environment and public health restoration4,sec4 #ajjjf4 ,,gao report on health effects of ,deepwater ,horizon oil rig explosion in the ,gulf ,coast4,sec4 #ajjjg4 ,establish an interagency council and grant programs on social determinants of health4,sec4 #ajjjh4 ,correcting ,hurtful and ,alienating ,names in ,government ,expression 7,,change74,sec4 #ajjji4 ,andrew ,kearse ,accountability for ,denial of ,medical ,care4,sec4 #ajjaj4 ,investing in community healing4,sec4 #ajjaa4 ,environmental justice mapping and data collection4,sec4 #ajjab4 ,antiracism in public health4,sec4 #ajjac4 ,,lgbtq essential data4,sec4 #ajjad4 ,social determinants accelerator4,sec4 #ajjae4 ,improving social determinants of health4,sec4 #ajjaf4 ,notification regarding ,,snap for students receiving ,federal work-study assistance4,subtitle ,b--,gun ,violence,sec4 #ajaja4 ,reaffirming research authority of the ,centers for ,disease ,control and ,prevention4,sec4 #ajajb4 ,national ,violent ,death ,reporting ,system4,sec4 #ajajc4 ,report on effects of gun violence on public health4,sec4 #ajajd4 ,report on effects of gun violence on mental health in minority communities4,subtitle ,c--,nutrition for women1 children1 families,chapter #a--,senior hunger prevention,sec4 #ajbja4 ,short title4,sec4 #ajbjb4 ,improving ,,snap efficacy4,sec4 #ajbjc4 ,streamlining nutrition access for older adults and adults with disabilities4,sec4 #ajbjd4 ,enrollment and outreach pilot program for older adults1 kinship families1 and adults with disabilities4,sec4 #ajbje4 ,food delivery under supplemental nutrition assistance program4,sec4 #ajbjf4 ,commodity supplemental food program4,sec4 #ajbjg4 ,seniors farmers' market nutrition program4,sec4 #ajbjh4 ,infrastructure funding for farmers' markets2 local procurement pilot program4,chapter #b--;,closing the meal gap,sec4 #ajbaa4 ,elimination of time limit4,sec4 #ajbab4 ,inclusion of ,puerto ,rico in supplemental nutritional assistance program4,subtitle ,d--,universal school meals,sec4 #ajcja4 ,short title4,sec4 #ajcjb4 ,effective date4,chapter #a--,school breakfast program,sec4 #ajcaa4 ,free school breakfast program4,chapter #b--,school lunch program,sec4 #ajcba4 ,apportionment to ,states4,sec4 #ajcbb4 ,nutritional and other program requirements4,sec4 #ajcbc4 ,special assistance program4,sec4 #ajcbd4 ,price for paid lunch4,sec4 #ajcbe4 ,summer food service program for children4,sec4 #ajcbf4 ,summer electronic benefit transfer for children program4,sec4 #ajcbg4 ,child and adult care food program4,sec4 #ajcbh4 ,meals and supplements for children in afterschool care4,sec4 #ajcbi4 ,pilot projects4,sec4 #ajccj4 ,fresh fruit and vegetable program4,sec4 #ajcca4 ,training1 technical assistance1 and ,food ,service ,management ,institute4,sec4 #ajccb4 ,reimbursement of school meal delinquent debt program4,sec4 #ajccc4 ,conforming amendments4,chapter #c--;,elementary and secondary education data,sec4 #ajcda4 ,measure of poverty4,chapter #d--;,amendments to other programs and laws,sec4 #ajcea4 ,supplemental nutrition assistance program4,sec4 #ajceb4 ,higher ,education ,act of #aife4,sec4 #ajcec4 ,elementary and ,secondary ,education ,act of #aife4,sec4 #ajced4 ,america ,,competes ,act4,sec4 #ajcee4 ,workforce ,innovation and ,opportunity ,act4,sec4 #ajcef4 ,national ,science ,foundation ,authorization ,act of #bjjb4,sec4 #ajceg4 ,child care and development block grant4,sec4 #ajceh4 ,children's ,health ,act of #bjjj4,sec4 #ajcei4 ,juvenile justice and delinquency prevention4 ,i ,data collection and reporting #ajja4 ,strengthening data collection1 improving data analysis1 and expanding data reporting 7a7 ,amendments to the ,public ,health ,service ,act 7#a7 ,purpose ,the purpose of the amendments made by this subsection is to promote culturally and linguistically appropriate data collection1 analysis1 and reporting by race1 ethnicity1 sex1 primary language1 sexual orientation1 disability status1 gender identity1 age1 and socioeconomic status in federally supported health programs4 7#b7 ,,ahrq general authorities ,section #ijb7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bii;a7a77 is amended-- 7,a7 in paragraph 7#h71 by striking and at the end2 7,b7 in paragraph 7#i71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following3 7#aj7 cultural and linguistic competence of health care services and of data collection activities described under section #caja4 4 7#c7 ,definition of racial and ethnic minority group 7,a7 ,in general ,section #agjg7;g77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a77 is amended to read as follows3 7#a7 7,a7 ,the term racial and ethnic minority group means a group of individuals who are any of the following3 7i7 ,american ,indian or ,alaska ,native4 7ii7 ,asian4 7iii7 ,black or ,african ,american4 7iv7 ,hispanic or ,latino4 7v7 ,middle ,eastern or ,north ,african4 7vi7 ,native ,hawaiian or ,pacific ,islander4 7,b7 ,the terms listed in clauses 7i7 through 7vi7 of subparagraph 7,a7 shall have the meanings given such terms for purposes of the ,revisions to ,,omb's ,statistical ,policy ,directive ,no4 #ae3 ,standards for ,maintaining1 ,collecting1 and ,presenting ,federal ,data on ,race and ,ethnicity 7#hi ,fed4 ,reg4 #bbahb2 ,march #bi1 #bjbd74 4 7,b7 ,references ,except as otherwise specified1 any reference to the term racial and ethnic minority group in any ,federal regulation1 guidance1 order1 or document for establishment or implementation of any federally conducted or supported health care or public health program1 activity1 or survey shall be treated as having the definition given to such term in section #agjg7;g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g774 7,c7 ,similar terminology ,not later than #b years after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall-- 7i7 identify all regulations1 guidance1 orders1 and documents of the ,department of ,health and ,human ,services for establishment or implementation of a health care or public health program1 activity1 or survey that use1 without a definition1 terminology that is similar to the term racial and ethnic minority group2 and 7ii7 take such actions as may be necessary to clarify whether the definition of the term racial and ethnic minority group in section #agjg7;g77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a771 as amended by subparagraph 7,a71 applies to such terminology4 7#d7 ,office of ,minority ,health duties ,section #agjg7;b77#f7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;b77#f77 is amended by inserting and1 to the extent practicable1 subgroups of racial and ethnic minority groups after the health status of each minority group4 7#e7 ,office of the ,national ,coordinator for ,health ,information ,technology ,section #cjja of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#aa7 is amended-- 7,a7 in subsection 7b7-- 7i7 in paragraph 7#aj71 by striking and at the end2 7ii7 in paragraph 7#aa71 by striking the period at the end and inserting 2 and2 and 7iii7 by adding at the end the following3 7#ab7 ensures the interoperability of health information systems among federally conducted or supported health care or public health programs1 ,state health agencies1 and social service agencies4 2 and 7,b7 by amending clause 7vii7 in subsection 7c77#c77;,a7 to read as follows3 7vii7 ,strategies to enhance the use of health information technology in improving the quality of health care2 reducing medical errors2 reducing health disparities and ensuring the provision of equitable health services2 improving public health2 increasing prevention and coordination with community resources2 ensuring interoperability among federally conducted or supported health care or public health programs1 ,state health agencies1 and social service agencies2 and improving the continuity of care among health care settings4 4 7#f7 ,data collection1 analysis1 and quality ,section #caja of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjkk7 is amended-- 7,a7 in subsections 7a77#a77;,a71 7a77#a77;,c71 7a77#b77;,b71 and 7a77#b77;,e71 by striking and disability status and inserting sexual orientation1 gender identity1 age1 disability status1 and socioeconomic status2 7,b7 in subsection 7a77#a71 by amending subparagraph 7,d7 to read as follows3 7,d7 data for additional population groups if such groups can be aggregated into the data collection standards described under paragraph 7#b74 2 7,c7 in subsection 7a77#b7-- 7i7 in subparagraph 7,c7-- 7,i7 in clause 7i71 by striking and at the end2 7,,ii7 in clause 7ii7-- 7aa7 by striking is a minor or legally incapacitated and inserting is a minor1 requires assistance with communication in speech or writing1 or is legally incapacitated2 and 7bb7 by striking the semicolon at the end and inserting 2 and2 and 7,,iii7 by adding at the end the following3 7iii7 collects data in a manner that is culturally and linguistically appropriate and does not include questions unrelated to1 or that could potentially deter1 care1 such as questions related to immigration status2 2 7ii7 in subparagraph 7,d77iii71 by striking and at the end2 7iii7 in subparagraph 7,e71 by striking the period at the end and inserting 2 and2 and 7iv7 by adding at the end the following3 7,f7 use1 where practicable1 the standards developed by the ,health and ,medicine ,division of the ,national ,academies of ,sciences1 ,engineering1 and ,medicine 7formerly known as the ,institute of ,medicine7 in the #bjji publication titled ,race1 ,ethnicity1 and ,language ,data3 ,standardization for ,health ,care ,quality ,improvement4 2 and 7,d7 in subsection 7a77#c71 by amending subparagraph 7,b7 to read as follows3 7,b7 develop interoperability and security systems for data management among federally conducted or supported health care or public health programs1 ,state health agencies1 and social service agencies4 4 7b7 ,corollary provisions 7#a7 ,recommendations by the ,data ,council ,the ,data ,council of the ,department of ,health and ,human ,services1 in consultation with the ,director of the ,national ,center for ,health ,statistics1 the ,deputy ,assistant ,secretary for ,minority ,health1 the ,deputy ,assistant ,secretary for ,women's ,health1 the ,administrator of the ,centers for ,medicare ,medicaid1 the ,national ,coordinator for ,health ,information ,technology1 and other appropriate public and private entities and officials1 shall make recommendations to the ,secretary of ,health and ,human ,services concerning how to-- 7,a7 implement the amendments made by this section1 while minimizing the cost and administrative burdens of data collection and reporting on all parties1 including patients and providers2 7,b7 expand awareness among ,federal agencies1 ,states1 territories1 ,indian ,tribes1 counties1 municipalities1 health providers1 health plans1 and the general public that data collection1 analysis1 and reporting by race1 ethnicity1 sex1 primary language1 sexual orientation1 gender identity1 age1 socioeconomic status1 and disability status is legal and necessary to ensure equity and nondiscrimination in the quality of health care services2 7,c7 ensure that future patient record systems follow ,federal standards promulgated under the ,,hitech ,act 7#db ,u4,s4,c4 #bja note7 for the collection and meaningful use of electronic health data on race1 ethnicity1 sex1 primary language1 sexual orientation1 gender identity1 age1 socioeconomic status1 and disability status2 7,d7 improve health and health care data collection and analysis for more population groups if such groups can be aggregated into minimum race and ethnicity categories1 including exploring the feasibility of enhancing collection efforts in ,states1 counties1 and municipalities for racial and ethnic groups that comprise a significant proportion of the population of the ,state1 county1 or municipality2 7,e7 provide researchers with greater access to racial1 ethnic1 primary language1 sex1 sexual orientation1 gender identity1 age1 socioeconomic status1 and disability status data1 subject to all applicable privacy and confidentiality requirements1 including ,,hipaa privacy and security law as defined in section #cjji7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ai7;a772 7,f7 ensure the cultural and linguistic competence of entities that receive ,federal support to collect and report data pursuant to the amendments made by subsection 7a72 and 7,g7 safeguard and prevent the misuse of data collected under section #caja of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjkk71 as amended by subsection 7a77#f74 7#b7 ,rules of construction ,nothing in this section shall be construed to-- 7,a7 permit the use of information collected under this section or any provision amended by this section in a manner that would adversely affect any individual providing any such information2 or 7,b7 diminish any requirements on health care providers to collect data1 including such requirements in effect on or after the date of enactment of this ,act4 7#c7 ,technical assistance for the analysis of health disparity data ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality1 and in coordination with the ,assistant ,secretary for ,planning and ,evaluation1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 the ,director of the ,national ,center for ,health ,statistics1 the ,director of the ,national ,institutes of ,health1 and the ,national ,coordinator for ,health ,information ,technology1 shall provide technical assistance to agencies of the ,department of ,health and ,human ,services in meeting ,federal standards for health disparity data collection and for analysis of racial1 ethnic1 and other disparities in health and health care in programs conducted or supported by such agencies by-- 7,a7 identifying appropriate quality assurance mechanisms to monitor for health disparities2 7,b7 specifying the clinical1 diagnostic1 or therapeutic measures which should be monitored2 7,c7 developing new quality measures relating to racial and ethnic disparities and their overlap with other disparity factors in health and health care2 7,d7 identifying the level at which data analysis should be conducted2 7,e7 sharing data with external organizations for research and quality improvement purposes2 and 7,f7 identifying and addressing issues relating to the interoperability of ,federal- and ,state-level health information systems which undermine the ability of health-related programs collecting data under this section to achieve the purpose described in subsection 7a77#a74 7#d7 ,authorization of appropriations ,to carry out this subsection1 subsection 7a71 and the amendments made by subsection 7a71 there are authorized to be appropriated such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 7c7 ,additional amendments to the ,public ,health ,service ,act ,title ,,xxxiv of the ,public ,health ,service ,act1 as added by titles ,,ii and ,,iii of this ,act1 is further amended by inserting after subtitle ,b the following3 ,c ,strengthening data collection1 improving data analysis1 and expanding data reporting #cdca4 ,establishing grants for data collection improvement activities 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality and in consultation with the ,deputy ,assistant ,secretary for ,minority ,health1 the ,director of the ,national ,institutes of ,health1 the ,assistant ,secretary for ,planning and ,evaluation1 the ,national ,coordinator for ,health ,information ,technology1 and the ,director of the ,national ,center for ,health ,statistics1 shall establish a technical assistance program under which the ,secretary provides grants to eligible entities to assist such entities in complying with section #caja4 7b7 ,types of assistance ,a grant provided under this section may be used to-- 7#a7 enhance or upgrade computer technology that will facilitate collection1 analysis1 and reporting of racial1 ethnic1 primary language1 sexual orientation1 sex1 gender identity1 socioeconomic status1 and disability status data2 7#b7 improve methods for health data collection and analysis1 including additional population groups if such groups can be aggregated into the race and ethnicity categories outlined by standards developed under section #caja2 7#c7 develop mechanisms for submitting collected data subject to any applicable privacy and confidentiality regulations2 7#d7 develop educational programs to inform health plans1 health providers1 health-related agencies1 and the general public that data collection and reporting by race1 ethnicity1 primary language1 sexual orientation1 sex1 gender identity1 disability status1 and socioeconomic status are legal and essential for eliminating health and health care disparities2 and 7#e7 develop educational programs to train health providers1 health care organizations1 health plans1 health-related agencies1 and frontline health care workers on how to collect and report disaggregated data in a culturally and linguistically appropriate manner4 7c7 ,eligible entity ,to be eligible for grants under this section1 an entity shall be a ,state1 territory1 ,indian ,tribe1 municipality1 county1 health provider1 health care organization1 or health plan making a demonstrated effort to bring data collections into compliance with section #caja4 7d7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #cdcb4 ,oversampling of underrepresented groups in ,federal health surveys 7a7 ,national strategy 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,national ,center for ,health ,statistics1 and other officials within the ,department of ,health and ,human ,services as the ,secretary determines appropriate1 shall develop and implement a sustainable national strategy for oversampling underrepresented populations within the categories of race1 ethnicity1 sex1 primary language1 sexual orientation1 disability status1 gender identity1 and socioeconomic status as determined appropriate by the ,secretary in ,federal health surveys and program data collections4 ,such national strategy shall include a strategy for oversampling of ,middle ,easterners and ,north ,africans1 ,asian ,americans1 ,native ,hawaiians1 and ,pacific ,islanders4 7#b7 ,consultation ,in developing and implementing a national strategy1 as described in paragraph 7#a71 not later than #ahj days after the date of the enactment of this section1 the ,secretary shall-- 7,a7 consult with representatives of community groups1 nonprofit organizations1 nongovernmental organizations1 and government agencies working with underrepresented populations2 7,b7 solicit the participation of representatives from other ,federal departments and agencies1 including subagencies of the ,department of ,health and ,human ,services2 and 7,c7 consult on1 and use as models1 the #bjad ,national ,health ,interview ,survey oversample of ,native ,hawaiian and ,pacific ,islander populations1 the #bjaf ,behavioral ,risk ,factor ,survey of ,health ,risk ,behaviors ,among ,arab ,adults ,within the ,state of ,michigan1 and the #bjag ,behavioral ,risk ,factor ,surveillance ,system oversample of ,american ,indian and ,alaska ,native communities4 7b7 ,progress report ,not later than #b years after the date of enactment of this section1 the ,secretary shall submit to the ,congress a progress report1 which shall include the national strategy required by subsection 7a77#a74 7c7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 4 7d7 ,report to ,congress ,not later than #b years after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall submit a report to ,congress on the implementation of this section1 including the amendments made by this section4 #ajjb4 ,elimination of prerequisite of direct appropriations for data collection and analysis ,section #caja of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjkk71 as amended by section #ajja7;a71 is further amended-- 7#a7 by striking subsection 7h72 and 7#b7 by redesignating subsection 7i7 as subsection 7h74 #ajjc4 ,collection of data for the ,medicare program ,part ,a of title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq47 is amended by adding at the end the following3 #aaej;,d4 ,collection of data for the ,medicare program 7a7 ,requirement 7#a7 ,in general ,the ,commissioner of ,social ,security 7in this section referred to as the ,commissioner71 in consultation with the ,administrator of the ,centers for ,medicare ,medicaid ,services 7in this section referred to as the ,administrator71 shall collect data on the race1 ethnicity1 sex1 primary language1 sexual orientation1 gender identity1 socioeconomic status1 and disability status of all applicants for social security benefits under title ,,ii or ,medicare benefits under title ,,xviii4 7#b7 ,data collection standards 7,a7 ,in general ,in collecting data under paragraph 7#a71 the ,commissioner shall at least use the standards for data collection developed under section #caja of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjkk7 or the standards developed by the ,office of ,management and ,budget1 whichever is more disaggregated4 7,b7 ,no standards available ,in the event there are no standards for the demographic groups listed under paragraph 7#a71 the ,commissioner shall consult with stakeholder groups representing the various identities as well as with the ,office of ,minority ,health within the ,centers for ,medicare ,medicaid ,services to develop appropriate standards4 7#c7 ,data for additional population groups ,where practicable1 the data collected by the ,commissioner under paragraph 7#a7 shall include data for additional population groups if such groups can be aggregated into the race and ethnicity categories outlined by the data collection standards described in paragraph 7#b77;,a74 7#d7 ,collection of data for minors and legally incapacitated individuals ,with respect to the collection of the data described in paragraph 7#a7 of applicants who are under #ah years of age or otherwise legally incapacitated1 the ,commissioner shall require that-- 7,a7 such data be collected from the parent or legal guardian of such an applicant2 and 7,b7 the primary language of the parent or legal guardian of such an applicant or recipient be used in collecting the data4 7#e7 ,quality of data ,the ,commissioner shall periodically review the quality and completeness of the data collected under paragraph 7#a7 and make adjustments as necessary to improve both4 7#f7 ,transmission of data ,upon enrollment for ,medicare benefits under title ,,xviii1 the ,commissioner shall transmit the demographic data of an individual as collected under paragraph 7#a7 to the ,centers for ,medicare ,medicaid ,services4 7#g7 ,analysis and reporting of data ,with respect to the data transmitted under paragraph 7#f71 the ,administrator1 in consultation with the ,commissioner1 shall-- 7,a7 require that such data be uniformly analyzed and that such analysis be reported at least annually to ,congress2 7,b7 incorporate such data in other analysis and reporting on health disparities and the provision of inequitable health care services by a health care provider1 as appropriate2 7,c7 make such data available to researchers1 under the protections outlined in paragraph 7#h72 7,d7 provide opportunities to individuals enrolled for ,medicare benefits under title ,,xviii to submit updated data2 and 7,e7 ensure that the provision of assistance or benefits to an applicant is not denied or otherwise adversely affected because of the failure of the applicant to provide any of the data collected under paragraph 7#a74 7#h7 ,protection of data ,the ,commissioner shall ensure 7through the promulgation of regulations or otherwise7 that all data collected pursuant to paragraph 7#a7 is protected-- 7,a7 under the same privacy protections as the ,secretary applies to health data under the regulations promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7relating to the privacy of individually identifiable health information and other protections72 and 7,b7 from all inappropriate internal use by any entity that collects1 stores1 or receives the data1 including use of such data in determinations of eligibility 7or continued eligibility7 in health plans1 and from other inappropriate uses1 as defined by the ,secretary4 7b7 ,rule of construction ,nothing in this section shall be construed to permit the use of information collected under this section in a manner that would adversely affect any individual providing any such information4 7c7 ,technical assistance ,the ,secretary may1 either directly or by grant or contract1 provide technical assistance to enable any entity to comply with the requirements of this section or with regulations implementing this section4 7d7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #ejj1jjj1jjj for fiscal year #bjbe and #ajj1jjj1jjj for each fiscal year thereafter4 4 #ajjd4 ,revision of ,,hipaa claims standards 7a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall revise the regulations promulgated under part ,c of title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;d et seq47 7relating to the collection of data on demographics in a health-related transaction7 to require-- 7#a7 the use1 at a minimum1 of standards for data collection on race1 ethnicity1 sex1 primary language1 sexual orientation1 gender identity1 age1 disability status1 and socioeconomic status developed under section #caja of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjkk71 as amended by section #ajja7;a77#f72 and 7#b7 in consultation with the ,office of the ,national ,coordinator for ,health ,information ,technology1 the designation of the appropriate racial1 ethnic1 primary language1 disability1 sex1 and other code sets as required for claims and enrollment data4 7b7 ,dissemination ,the ,secretary of ,health and ,human ,services shall disseminate the new standards developed under subsection 7a7 to all entities that are subject to the regulations described in such subsection and provide technical assistance with respect to the collection of the data involved4 7c7 ,compliance ,the ,secretary of ,health and ,human ,services shall require that entities comply with the new standards developed under subsection 7a7 not later than #b years after the final promulgation of such standards4 #ajje4 ,national ,center for ,health ,statistics ,section #cjf7n7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdbk7n77 is amended-- 7#a7 in paragraph 7#a71 by striking #bjjc and inserting #bjbe2 7#b7 in paragraph 7#b71 in the first sentence1 by striking #bjjc and inserting #bjbe2 and 7#c7 in paragraph 7#c71 by striking #bjjb and inserting #bjbe4 #ajjf4 ,disparities data collected by the ,federal ,government 7a7 ,repository of ,government data ,the ,secretary of ,health and ,human ,services1 in coordination with the officials referenced in subsection 7b71 shall establish a centralized electronic repository of ,federal ,government data on factors related to the health and well-being of the population of the ,united ,states4 7b7 ,collection2 submission ,not later than #ahj days after the date of enactment of this ,act1 and ,january #ca of each year thereafter1 each department1 agency1 and office of the ,federal ,government that has collected data on race1 ethnicity1 sex1 primary language1 sexual orientation1 gender identity1 age1 disability status1 or socioeconomic status during the preceding calendar year shall submit such data to the repository of ,federal ,government data established under subsection 7a74 7c7 ,analysis2 public availability2 reporting ,not later than ,april #cj1 #bjbd1 and ,april #cj of each year thereafter1 the ,secretary of ,health and ,human ,services1 acting through the ,assistant ,secretary for ,planning and ,evaluation1 the ,assistant ,secretary for ,health1 the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,director of the ,national ,center for ,health ,statistics1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities1 and the ,deputy ,assistant ,secretary for ,minority ,health1 shall-- 7#a7 prepare and make available datasets for public use that relate to disparities in health status1 health care access1 health care quality1 health outcomes1 public health1 the provision of equitable health services1 and other areas of health and well-being by factors that include race1 ethnicity1 sex1 primary language1 sexual orientation1 gender identity1 disability status1 age1 and socioeconomic status2 7#b7 ensure that these datasets are publicly identified on the repository established under subsection 7a7 as disparities data2 and 7#c7 submit a report to the ,congress on the availability and use of such data by public stakeholders4 #ajjg4 ,data collection and analysis grants to minority-serving institutions 7a7 ,authority ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities and the ,deputy ,assistant ,secretary for ,minority ,health1 shall award grants to eligible entities to access and analyze racial and ethnic data on disparities in health and health care1 and where possible other data on disparities in health and health care1 to monitor and report on progress to reduce and eliminate disparities in health and health care4 7b7 ,eligible entity ,in this section1 the term eligible entity means an entity that has an accredited public health1 health policy1 or health services research program and is any of the following3 7#a7 ,a part ,b institution1 as defined in section #cbb of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajfa74 7#b7 ,a ,hispanic-serving institution1 as defined in section #ejb of such ,act 7#bj ,u4,s4,c4 #aaja;a74 7#c7 ,a ,tribal ,college or ,university1 as defined in section #caf of such ,act 7#bj ,u4,s4,c4 #ajei;c74 7#d7 ,an ,asian ,american and ,native ,american ,pacific ,islander-serving institution1 as defined in section #cga7;c7 of such ,act 7#bj ,u4,s4,c4 #ajfgq7c774 7c7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #ajjh4 ,safety and effectiveness of drugs with respect to racial and ethnic background 7a7 ,in general ,chapter ,v of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cea et seq47 is amended by inserting after section #eje;,g 7#ba ,u4,s4,c4 #cee;h7 the following3 #eje;,h4 ,safety and effectiveness of drugs with respect to racial and ethnic background 7a7 ,preapproval studies ,if there is evidence of a racial or ethnic disparity in safety or effectiveness with respect to a drug or biological product1 then-- 7#a7 7,a7 in the case of a drug1 the investigations required under section #eje7;b77#a77;,a7 shall include adequate and well-controlled investigations of the disparity2 or 7,b7 in the case of a biological product1 the evidence required under section #cea7;a7 of the ,public ,health ,service ,act for approval of a biologics license application for the biological product shall include adequate and well-controlled investigations of the disparity2 and 7#b7 if the investigations described in subparagraph 7,a7 or 7,b7 of paragraph 7#a7 confirm that there is such a disparity1 the labeling of the drug or biological product shall include appropriate information about the disparity4 7b7 ,postmarket studies 7#a7 ,in general ,if there is evidence of a racial or ethnic disparity in safety or effectiveness with respect to a drug for which there is an approved application under section #eje of this ,act or of a biological product for which there is an approved license under section #cea of the ,public ,health ,service ,act1 the ,secretary may by order require the holder of the approved application or license to conduct1 by a date specified by the ,secretary1 postmarket studies to investigate the disparity4 7#b7 ,labeling ,if the ,secretary determines that the postmarket studies confirm that there is a disparity described in paragraph 7#a71 the labeling of the drug or biological product shall include appropriate information about the disparity4 7#c7 ,study design ,the ,secretary may1 in an order under paragraph 7#a71 specify all aspects of the design of the postmarket studies required under such paragraph for a drug or biological product1 including the number of studies and study participants1 and the other demographic characteristics of the study participants4 7#d7 ,modifications of study design ,the ,secretary may1 by order and as necessary1 modify any aspect of the design of a postmarket study required in an order under paragraph 7#a7 after issuing such order4 7#e7 ,study results ,the results from a study required under paragraph 7#a7 shall be submitted to the ,secretary as a supplement to the drug application or biologics license application4 7c7 ,applications under section #eje7;j7 7#a7 ,in general ,a drug for which an application has been submitted or approved under section #eje7;j7 shall not be considered ineligible for approval under that section or misbranded under section #ejb on the basis that the labeling of the drug omits information relating to a disparity on the basis of racial or ethnic background as to the safety or effectiveness of the drug1 whether derived from investigations or studies required under this section or derived from other sources1 when the omitted information is protected by patent or by exclusivity under section #eje7;j77#e77;,f74 7#b7 ,labeling ,notwithstanding paragraph 7#a71 the ,secretary may require that the labeling of a drug approved under section #eje7;j7 that omits information relating to a disparity on the basis of racial or ethnic background as to the safety or effectiveness of the drug include a statement of any appropriate contraindications1 warnings1 or precautions related to the disparity that the ,secretary considers necessary4 7d7 ,definition ,in this section1 the term evidence of a racial or ethnic disparity in safety or effectiveness1 with respect to a drug or biological product1 includes-- 7#a7 evidence that there is a disparity on the basis of racial or ethnic background as to safety or effectiveness of a drug or biological product in the same chemical class as the drug or biological product2 7#b7 evidence that there is a disparity on the basis of racial or ethnic background in the way the drug or biological product is metabolized2 and 7#c7 other evidence as the ,secretary may determine appropriate4 4 7b7 ,enforcement ,section #ejb of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #ceb7 is amended by adding at the end the following3 7hh7 ,if it is a drug and the holder of the approved application under section #eje or license under section #cea of the ,public ,health ,service ,act for the drug has failed to complete the investigations or studies required under section #eje;,h1 or comply with any other requirement of such section #eje;,h4 4 7c7 ,drug fees ,section #gcf7;a77#a77;,a77ii7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cgi;h7a77#a77;,a77ii77 is amended by inserting after are not required the following3 1 including postmarket studies required under section #eje;,h14 #ajji4 ,improving health data regarding ,native ,hawaiians and ,pacific ,islanders ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq47 is amended by inserting after section #cag,v 7#db ,u4,s4,c4 #bdg;b-#bd7 the following3 #cag,w4 ,native ,hawaiian and ,pacific ,islander health data 7a7 ,definitions ,in this section3 7#a7 ,insular area ,the term insular area means ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 ,american ,samoa1 the ,united ,states ,virgin ,islands1 the ,federated ,states of ,micronesia1 the ,republic of ,palau1 or the ,republic of the ,marshall ,islands4 7#b7 ,native ,hawaiians and ,pacific ,islanders 7,,nhpi7 ,the term ,native ,hawaiians and ,pacific ,islanders or ,,nhpi means people having origins in any of the original peoples of ,american ,samoa1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,federated ,states of ,micronesia1 ,guam1 ,hawaii1 the ,republic of the ,marshall ,islands1 the ,republic of ,palau1 or any other ,pacific ,island4 7#c7 ,,nhpi stakeholder groups ,the term ,,nhpi stakeholder group includes each of the following3 7,a7 ,community group ,a group of ,,nhpi who are organized at the community level1 and may include a church group1 social service group1 national advocacy organization1 or cultural group4 7,b7 ,nonprofit1 nongovernmental organization ,a group of ,,nhpi with a demonstrated history of addressing ,,nhpi issues1 including a ,,nhpi coalition4 7,c7 ,designated organization ,an entity established to represent ,,nhpi populations and which has statutory responsibilities to provide1 or has community support for providing1 health care4 7,d7 ,government representatives of ,,nhpi populations ,representatives from ,hawaii1 ,american ,samoa1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,federated ,states of ,micronesia1 ,guam1 the ,republic of ,palau1 and the ,republic of the ,marshall ,islands4 7b7 ,preliminary health survey 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,national ,center for ,health ,statistics of the ,centers for ,disease ,control and ,prevention 7referred to in this section as ,,nchs71 shall conduct a preliminary health survey in order to identify the major areas and regions in the continental ,united ,states1 ,hawaii1 ,american ,samoa1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,federated ,states of ,micronesia1 ,guam1 the ,republic of ,palau1 and the ,republic of the ,marshall ,islands in which ,,nhpi people reside4 7#b7 ,contents ,the health survey described in paragraph 7#a7 shall include health data and any other data the ,secretary determines to be-- 7,a7 useful in determining health status and health care needs of ,,nhpi populations2 or 7,b7 required for developing or implementing the national strategy under subsection 7c74 7#c7 ,methodology ,methodology for the health survey described in paragraph 7#a71 including plans for designing questions1 implementation1 sampling1 and analysis1 shall be developed in consultation with ,,nhpi stakeholder groups4 7#d7 ,timeframe ,the survey required under this subsection shall be completed not later than #ah months after the date of enactment of the ,health ,equity and ,accountability ,act of #bjbd4 7c7 ,national strategy 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,,nchs and other agencies within the ,department of ,health and ,human ,services as the ,secretary determines appropriate1 shall develop and implement a sustainable national strategy for identifying and evaluating the health status and health care needs of ,,nhpi populations living in the continental ,united ,states1 ,hawaii1 ,american ,samoa1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,federated ,states of ,micronesia1 ,guam1 the ,republic of ,palau1 and the ,republic of the ,marshall ,islands4 7#b7 ,consultation ,in developing and implementing a national strategy1 as described in paragraph 7#a71 not later than #ahj days after the date of enactment of the ,health ,equity and ,accountability ,act of #bjbd1 the ,secretary-- 7,a7 shall consult with representatives of ,,nhpi stakeholder groups2 and 7,b7 may solicit the participation of representatives from other ,federal agencies4 7d7 ,progress report ,not later than #b years after the date of enactment of the ,health ,equity and ,accountability ,act of #bjbd1 the ,secretary shall submit to ,congress a progress report1 which shall include the national strategy described in subsection 7c77#a74 7e7 ,study and report by the ,health and ,medicine ,division 7#a7 ,in general ,the ,secretary shall seek to enter into an agreement with the ,health and ,medicine ,division of the ,national ,academies of ,sciences1 ,engineering1 and ,medicine to conduct a study1 with input from stakeholders in insular areas1 on each of the following3 7,a7 ,the standards and definitions of health care applied to health care systems in insular areas and the appropriateness of such standards and definitions4 7,b7 ,the status and performance of health care systems in insular areas1 evaluated based upon standards and definitions1 as the ,secretary determines appropriate4 7,c7 ,the effectiveness of donor aid in addressing health care needs and priorities in insular areas4 7,d7 ,the progress toward implementation of recommendations of the ,committee on ,health ,care ,services in the ,united ,states--,associated ,pacific ,basin that are set forth in the #aiih report entitled ,pacific ,partnerships for ,health3 ,charting a ,new ,course4 7#b7 ,report ,an agreement described in paragraph 7#a7 shall require the ,health and ,medicine ,division to submit to the ,secretary and to ,congress1 not later than #b years after the date of the enactment of the ,health ,equity and ,accountability ,act of #bjbd1 a report containing a description of the results of the study conducted under paragraph 7#a71 including the conclusions and recommendations of the ,health and ,medicine ,division for each of the items described in subparagraphs 7,a7 through 7,d7 of such paragraph4 7f7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjbe through #bjbi4 4 #ajaj4 ,clarification of simplified administrative reporting requirement ,section #aa7;a7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjbj7;a77 is amended by adding at the end the following3 7#e7 ,simplified administrative reporting requirement ,with respect to any obligation of a ,state agency to comply with the notification requirement under paragraph 7#b7 of section #dba7;e7 of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afca7;e771 notwithstanding the requirement to include in that notification the names of the sponsor and the sponsored alien involved1 the ,state agency shall be considered to have complied with the notification requirement if the ,state agency submits to the ,attorney ,general a report that includes the aggregate number of exceptions granted by the ,state agency under paragraph 7#a7 of that section4 4 #ajaa4 ,data collection regarding pandemic preparedness1 testing1 infections1 and deaths 7a7 ,skilled nursing ,facilities ,quality ,reporting ,section #ahai of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#c7 is amended by adding at the end the following new subsection3 7l7 ,requirements relating to reporting during public health emergencies ,during a public health emergency declared by the ,secretary pursuant to section #cai of the ,public ,health ,service ,act1 a skilled nursing facility shall1 not later than #a year after the first day of such declaration1 and monthly thereafter during the application of such declaration1 submit to the ,secretary the following information1 with respect to such facility and the residents of such facility3 7#a7 ,information described in section #dhc4hj7;g77#a7 of title #db1 ,code of ,federal ,regulations4 7#b7 ,the age1 race1 ethnicity1 sex1 sexual orientation1 gender identity1 socioeconomic status1 disability status1 and preferred language of the residents of such skilled nursing facility4 4 7b7 ,transparency of demographic information in certain settings 7#a7 ,demographic information ,the ,secretary of ,health and ,human ,services shall post the following information with respect to skilled nursing facilities 7as defined in section #ahai7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#c7;a7771 congregate care settings 7including skilled nursing facilities1 assisted living facilities1 prisons and jails1 residential behavioral health care and psychiatric facilities1 and facilities providing services for aging adults and people with disabilities71 and nursing facilities 7as defined in section #aiai7;a7 of such ,act 7#db ,u4,s4,c4 #acifr7a777 on the ,nursing ,home ,compare website 7as described in section #ahai7;i7 of such ,act 7#db ,u4,s4,c4 #acie;i-#c7;i7771 or a successor website1 aggregated by ,state3 7,a7 ,the age1 race1 ethnicity1 sex1 sexual orientation1 gender identity1 socioeconomic status1 disability status1 and preferred language of the residents of such skilled nursing facilities1 congregate care settings 7including skilled nursing facilities1 assisted living facilities1 prisons and jails1 residential behavioral health care and psychiatric facilities1 and facilities providing services for aging adults and people with disabilities71 and nursing facilities with suspected or confirmed infections1 including residents previously treated for ,,covid-#ai4 7,b7 ,the age1 race1 ethnicity1 sex1 sexual orientation1 gender identity1 socioeconomic status1 disability status1 and preferred language relating to total deaths and public health emergency-related deaths among residents of such skilled nursing facilities1 congregate settings 7including skilled nursing facilities1 assisted living facilities1 prisons and jails1 residential behavioral health care and psychiatric facilities1 and facilities providing services for aging adults and people with disabilities71 and nursing facilities4 7#b7 ,confidentiality ,any information reported under this subsection that is made available to the public shall be made so available in a manner that protects the identity of residents of skilled nursing facilities1 congregate care settings 7including skilled nursing facilities1 assisted living facilities1 prisons and jails1 residential behavioral health care and psychiatric facilities1 and facilities providing services for aging adults and people with disabilities71 and nursing facilities4 7#c7 ,implementation ,notwithstanding any other provision of law1 the ,secretary of ,health and ,human ,services may implement the provisions of this subsection by program instruction or otherwise4 7c7 ,equitable data collection and disclosure regarding pandemics ,part ,a of title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq47 as amended by section #ajjc1 is further amended by adding at the end the following new section3 #aaej;,e4 ,equitable data collection and disclosure regarding pandemics 7a7 ,in general ,not later than #fj days after the ,secretary submits to ,congress written notification of the determination that a disease or disorder presents a public health emergency or that a public health emergency otherwise exists1 subject to subsections 7b7 and 7c71 the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention and the ,administrator of the ,centers for ,medicare ,medicaid ,services and in consultation with the ,director of the ,indian ,health ,service1 shall collect and make publicly available on the website of the ,centers for ,disease ,control and ,prevention and the ,centers for ,medicare ,medicaid ,services1 and update every day during a pandemic1 data collected across all surveillance systems relating to a public health emergency declared under section #cai of the ,public ,health ,service ,act that is caused by a disease 7as determined by the ,secretary71 disaggregated by race1 ethnicity1 sex1 sexual orientation1 gender identity1 age1 preferred language1 socioeconomic status1 disability status1 and county4 ,such data shall include the following3 7#a7 ,data relating to all testing for the pathogen or pathogens causing the pandemic1 including the number of individuals tested and the number of tests that were positive4 7#b7 ,data relating to treatment for the pathogen causing the pandemic1 including hospitalizations and intensive care unit admissions4 7#c7 ,data relating to pandemic outcomes1 including total fatalities and case fatality rates 7expressed as the proportion of individuals who were infected with the pathogen causing the pandemic and died from the pathogen74 7#d7 ,in the case a vaccine is developed in response to a pandemic1 data relating to such vaccination1 including-- 7,a7 the number of vaccines administered2 7,b7 the number of vaccinations offered1 accepted1 and refused2 7,c7 the most common reasons for refusal2 and 7,d7 the percentage of vaccine doses allocated and administered to each priority group4 7b7 ,application of certain standards with respect to data collection ,to the extent practicable1 data collected under subsection 7a7 shall follow standards developed by the ,department of ,health and ,human ,services ,office of ,minority ,health and be collected1 analyzed1 and reported in accordance with the standards promulgated by the ,assistant ,secretary for ,planning and ,evaluation under title ,,xxxi of the ,public ,health ,service ,act4 7c7 ,privacy ,in publishing data pursuant to subsection 7a71 the ,secretary shall take all necessary steps to protect the privacy of individuals whose information is included in such data1 including-- 7#a7 complying with privacy protections provided under the regulations promulgated under section #bfd7;c7 of the ,health ,insurance and ,accountability ,act of #aiif2 and 7#b7 protections from all inappropriate internal use by an entity that collects1 stores1 or receives the data1 including use of such data in determinations of eligibility 7or continued eligibility7 in health plans1 and from inappropriate uses4 4 7d7 ,report requirements following public health emergencies 7#a7 ,publicly available summary ,not later than #fj days after the date on which the ,secretary of ,health and ,human ,services certifies that a public health emergency declared under section #cai of the ,public ,health ,service ,act has ended1 the ,secretary shall make publicly available on the website of the ,department of ,health and ,human ,services a summary of the final statistics related to such emergency4 7#b7 ,report to ,congress ,not later than #fj days after the date on which the ,secretary of ,health and ,human ,services certifies that a public health emergency declared under section #cai of the ,public ,health ,service ,act has ended1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions and the ,committee on ,finance of the ,senate and the ,committee on ,energy and ,commerce and the ,committee on ,ways and ,means of the ,house of ,representatives a report-- 7,a7 describing the testing1 hospitalization1 mortality rates1 vaccination rates1 and preferred language of patients associated with the pandemic by race and ethnicity1 rural and urban areas 7as defined in section #ahhf7;d77#b77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#b77;,d7771 and congregate care settings 7including skilled nursing facilities1 assisted living facilities1 prisons and jails1 residential behavioral health care and psychiatric facilities1 and facilities providing services for aging adults and people with disabilities7 and noncongregate care settings 7as such terms are defined by the ,secretary72 and 7,b7 proposing evidenced-based response strategies to safeguard the health of these communities in future pandemics4 #ajab4 ,commission on ,ensuring ,data for ,health ,equity 7a7 ,in general ,not later than #cj days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall establish a commission1 to be known as the ,commission on ,ensuring ,data for ,health ,equity 7referred to in this section as the ,commission7 to provide clear and robust guidance to improve the collection1 analysis1 and use of demographic data in responding to future public health emergencies4 7b7 ,membership and ,chairperson 7#a7 ,membership ,the ,commission shall be composed of-- 7,a7 the ,assistant ,secretary for ,preparedness and ,response2 7,b7 the ,director of the ,centers for ,disease ,control and ,prevention2 7,c7 the ,director of the ,national ,institutes of ,health2 7,d7 the ,commissioner of ,food and ,drugs2 7,e7 the ,administrator of the ,federal ,emergency ,management ,agency2 7,f7 the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities2 7,g7 the ,director of the ,indian ,health ,service2 7,h7 the ,administrator of the ,centers for ,medicare ,medicaid ,services2 7,i7 the ,director of the ,agency for ,healthcare ,research and ,quality2 7,j7 the ,surgeon ,general2 7,k7 the ,administrator of the ,health ,resources and ,services ,administration2 7,l7 the ,director of the ,office of ,minority ,health2 7,m7 the ,director of the ,office on ,women's ,health2 7,n7 the ,chairperson of the ,national ,council on ,disability2 7,o7 at least #d ,state1 local1 territorial1 and ,tribal public health officials representing departments of public health1 or an ,urban ,indian health representative1 who shall represent jurisdictions from different regions of the ,united ,states with relatively high concentrations of historically marginalized populations and rural populations1 to be appointed by the ,secretary2 7,p7 the ,national ,coordinator for ,health ,information ,technology2 7,q7 at least #c independent individuals with expertise on racially and ethnically diverse representation with knowledge or field experience with community-based participatory research on racial and ethnic disparities in public health1 to be appointed by the ,secretary2 and 7,r7 at least #d individuals with expertise on health equity and demographic data disparities with knowledge of1 or field experience in1 language1 disability status1 sex1 sexual orientation1 gender identity1 or socioeconomic status4 7#b7 ,chairperson ,the ,assistant ,secretary for ,preparedness and ,response shall serve as the ,chairperson of the ,commission4 7c7 ,duties ,the ,commission shall-- 7#a7 examine barriers to collecting1 analyzing1 and using demographic data in public health2 7#b7 determine how to best use such data to promote health equity across the ,united ,states and reduce racial1 ,tribal1 and other demographic disparities in health outcomes2 7#c7 7,a7 gather available data related to treatment of individuals with disabilities during the ,,covid-#ai pandemic and other public health emergencies1 including access to vaccinations1 denial of treatment for preexisting conditions1 removal or denial of disability related equipment 7including ventilators and continuous positive airway pressure 7commonly referred to as ,,cpap7 machines71 and data on completion of do-not-resuscitate orders2 and 7,b7 identify barriers to obtaining accurate and timely data related to treatment of such individuals2 7#d7 solicit input from public health officials1 community-connected organizations1 health care providers1 ,state and local agency officials1 ,tribal officials1 and other experts on barriers to1 and best practices for1 collecting demographic data2 and 7#e7 recommend policy changes that the data indicates are necessary to reduce demographic disparities in health outcomes4 7d7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,commission shall submit to ,congress1 and publish on the website of the ,department of ,health and ,human ,services1 a report containing-- 7#a7 the findings of the ,commission pursuant to subsection 7c72 7#b7 to the extent possible1 an analysis of-- 7,a7 racial and other demographic disparities in ,,covid-#ai mortality1 including an analysis of comorbidities and case fatality rates2 7,b7 sex1 sexual orientation1 and gender identity disparities in ,,covid-#ai treatment and mortality2 and 7,c7 ,federal ,government policies that disparately exacerbate the ,,covid-#ai impact1 and recommendations to improve racial and other demographic disparities in health outcomes2 7#c7 an analysis of ,,covid-#ai treatment of individuals with disabilities1 including equity of access to treatment and equipment and intersections of disability status with other demographic factors1 including race2 7#d7 an analysis of what demographic data is currently being collected1 the accuracy of that data and any gaps1 how this data is currently being used to inform efforts to combat ,,covid-#ai1 and what resources are needed to supplement existing public health data collection2 and 7#e7 the ,commission's recommendations with respect to-- 7,a7 how to enhance ,state1 local1 territorial1 and ,tribal capacity to conduct public health research on ,,covid-#ai and in future public health emergencies1 with a focus on expanded capacity to analyze data on disparities correlated with race1 ethnicity1 income1 sex1 sexual orientation1 gender identity1 age1 disability status1 specific geographic areas1 and other relevant demographic characteristics2 7,b7 how to collect1 process1 and disclose to the public the data described in subparagraph 7,a7 in a way that maintains individual privacy while helping direct the ,state1 local1 and ,tribal response to public health emergencies2 7,c7 how to improve demographic data collection related to ,,covid-#ai and other public health emergencies in the short-term and long-term1 including how to continue to grow and value the ,tribal sovereignty of data and information concerning urban and rural ,tribal communities2 7,d7 how to improve transparency and equity of treatment for individuals with disabilities during the ,,covid-#ai public health emergency and future public health emergencies2 and 7,e7 how to support ,state1 local1 and ,tribal capacity to eliminate barriers to vaccinations1 testing1 and treatment during the ,,covid-#ai public health emergency and future public health emergencies4 7e7 ,staff of commission 7#a7 ,additional staff ,the ,chairperson of the ,commission may appoint and fix the pay of additional staff to the ,commission as the ,chairperson considers appropriate4 7#b7 ,applicability of certain civil service laws ,the staff of the ,commission may be appointed without regard to the provisions of title #e1 ,united ,states ,code1 governing appointments in the competitive service1 and may be paid without regard to the provisions of chapter #ea and subchapter ,,iii of chapter #ec of that title relating to classification and ,general ,schedule pay rates4 7#c7 ,detailees ,any ,federal ,government employee may be detailed to the ,commission without reimbursement from the ,commission1 and the detailee shall retain the rights1 status1 and privileges of his or her regular employment without interruption4 7f7 ,coordination with other efforts ,the ,secretary shall1 in establishing the ,commission under this section1 take such steps as may be necessary to ensure that the work of the ,commission does not overlap with1 or otherwise duplicate1 other ,federal ,government efforts with respect to ensuring health equity in data collection in public health emergencies4 7g7 ,authorization of appropriations ,there are authorized to be appropriated such sums as may be necessary to carry out this section4 #ajac4 ,task ,force on ,preventing ,bias in ,,ai and ,algorithms 7a7 ,in general ,not later than #cj days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall establish a ,task ,force to be known as the ,task ,force on ,preventing ,,ai and ,algorithmic ,bias in ,health ,care 7referred to in this section as the ,task ,force7 to provide clear and robust guidance on how to ensure that the development and integration of artificial intelligence and algorithmic technologies within the health care service delivery process does not exacerbate health disparities and inequities1 expands access to health care services1 and improves health care delivery4 7b7 ,membership and ,chairperson 7#a7 ,membership ,the ,task ,force shall be composed of-- 7,a7 the ,chief ,information ,officer of the ,department of ,health and ,human ,services2 7,b7 the ,director of the ,centers for ,disease ,control and ,prevention2 7,c7 the ,director of the ,national ,institutes of ,health2 7,d7 the ,commissioner of ,food and ,drugs2 7,e7 the ,administrator of the ,federal ,emergency ,management ,agency2 7,f7 the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities2 7,g7 the ,director of the ,indian ,health ,service2 7,h7 the ,administrator of the ,centers for ,medicare ,medicaid ,services2 7,i7 the ,director of the ,agency for ,healthcare ,research and ,quality2 7,j7 the ,surgeon ,general2 7,k7 the ,administrator of the ,health ,resources and ,services ,administration2 7,l7 the ,director of the ,office of ,minority ,health2 7,m7 the ,director of the ,office on ,women's ,health2 7,n7 the ,chairperson of the ,national ,council on ,disability2 7,o7 the ,national ,coordinator for ,health ,information ,technology2 7,p7 at least #d ,state1 local1 territorial1 and ,tribal public health officials representing departments of public health1 or an ,urban ,indian health representative1 who shall represent jurisdictions from different regions of the ,united ,states with relatively high concentrations of historically marginalized populations1 to be appointed by the ,secretary2 7,q7 at least #c independent individuals with expertise on racially and ethnically diverse representation with knowledge or field experience with community-based participatory research on racial and ethnic disparities in public health1 to be appointed by the ,secretary2 and 7,r7 at least #d individuals with expertise on health equity and demographic data disparities with knowledge of1 or field experience in1 language1 disability status1 sex1 sexual orientation1 gender identity1 or socioeconomic status4 7#b7 ,chairperson ,the ,chief ,information ,officer of the ,department of ,health and ,human ,services 7or the ,chief ,information ,officer's designee7 shall serve as the ,chairperson of the ,task ,force4 7c7 ,duties ,the ,task ,force shall-- 7#a7 examine artificial intelligence and algorithms in the health care service sector1 including the health care delivery process relative to the use of autonomous human decision makers2 7#b7 identify the risks of health care system utilization of artificial intelligence and algorithms in terms of civil rights1 civil liberties1 and discriminatory bias in health care access1 quality1 and outcomes2 and 7#c7 prepare and submit the report under subsection 7d74 7d7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,task ,force shall-- 7#a7 submit a written report of the findings of the examination under subsection 7c77#a7 and recommendations to ,congress with respect to implementation of artificial intelligence and algorithms in health care delivery and mitigation of the risks associated with that implementation2 and 7#b7 publish such report on the website of the ,department of ,health and ,human ,services4 7e7 ,public comment ,not later than #fj days after the date of the enactment of this ,act1 the ,task ,force shall publish in the ,federal ,register a notice providing for a public comment period on the duties and activities of the ,task ,force of not less than #ij days1 beginning on the date of that publication4 7f7 ,staff of commission 7#a7 ,additional staff ,the ,chairperson of the ,task ,force may appoint and fix the pay of additional staff to the ,task ,force as the ,chairperson considers appropriate4 7#b7 ,applicability of certain civil service laws ,the staff of the ,task ,force may be appointed without regard to the provisions of title #e1 ,united ,states ,code1 governing appointments in the competitive service1 and may be paid without regard to the provisions of chapter #ea and subchapter ,,iii of chapter #ec of that title relating to classification and ,general ,schedule pay rates4 7#c7 ,detailees ,any ,federal ,government employee may be detailed to the ,task ,force without reimbursement from the ,task ,force1 and the detailee shall retain the rights1 status1 and privileges of his or her regular employment without interruption4 #ajad4 ,report on the health of the ,middle ,eastern and ,north ,african population 7a7 ,study required ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall conduct or support a comprehensive study regarding the unique health patterns and outcomes of ,middle ,eastern and ,north ,african 7referred to in this section as ,,mena7 populations4 7b7 ,requirements for study ,the comprehensive study under subsection 7a7 shall include an enumeration of ,,mena populations across the ,united ,states1 disaggregated by subpopulation1 and with respect to each such population and subpopulation-- 7#a7 the rates of-- 7,a7 obesity1 diabetes1 sickle cell anemia1 stroke1 asthma1 pneumonia1 lung cancer1 ,,hiv_/,,aids1 ,,hpv1 high cholesterol1 high blood pressure1 and chronic heart1 lung1 and kidney disease2 7,b7 morbidity and mortality1 including the rates of morbidity and mortality associated with the health conditions listed in subparagraph 7,a72 7,c7 mental health and substance use disorders2 and 7,d7 domestic violence1 dating violence1 sexual assault1 sexual harassment1 and stalking2 7#b7 analysis of-- 7,a7 the rates described in paragraph 7#a72 7,b7 the leading causes of pregnancy-associated morbidity and mortality2 and 7,c7 access to health care facilities and the associated outcomes of care2 7#c7 analysis1 enumeration1 or quantification of any other health or health-related parameters the ,secretary may determine necessary2 and 7#d7 analysis of the relationship between the health factors1 outcomes1 and conditions described in paragraphs 7#a7 through 7#c7 and the implementation of ,federal health programs4 7c7 ,consultation ,the ,secretary shall-- 7#a7 carry out this section in consultation1 as appropriate1 with the ,director of the ,census ,bureau1 the ,director of the ,centers for ,disease ,control and ,prevention1 the ,director of the ,national ,institutes of ,health1 the ,assistant ,secretary for ,mental ,health and ,substance ,use1 and other stakeholders 7including community-based organizations72 and 7#b7 determine through such consultation the subpopulations to be used for purposes of disaggregation of data pursuant to subsection 7b74 7d7 ,online portal ,upon conclusion of the comprehensive study under this section1 the ,secretary shall establish a public online portal to catalogue the results of the study1 its underlying data1 and information in the report submitted pursuant to subsection 7e74 7e7 ,reporting 7#a7 ,interim report ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a report outlining the challenges associated with1 and progress towards implementing health data collection for ,,mena populations as a distinct category and the plan for completing a comprehensive study regarding the unique health patterns and outcomes of ,,mena populations4 7#b7 ,final report ,not later than #cj days after the conclusion of the comprehensive study under this section1 the ,secretary shall submit to ,congress a report describing-- 7,a7 the results of the study conducted under this section2 and 7,b7 the rulemakings and other actions the agencies described in subsection 7c77#a7 can undertake to more equitably include ,,mena individuals in their programs4 7f7 ,privacy ,the ,secretary shall not include any personally identifiable information on the online portal under subsection 7d7 or in a report under subsection 7e74 7g7 ,definition of ,middle ,eastern and ,north ,african2 ,,mena ,in this section1 the terms ,middle ,eastern and ,north ,african or ,,mena1 with respect to individuals or populations1 includes individuals and populations who identify with or belong to one or more nationalities or ethnic groups originating in a country 7or portion thereof7 in the ,middle ,eastern and ,north ,african region 7such as ,lebanese1 ,iranians1 ,egyptians1 ,moroccans1 ,yemenis1 ,chaldeans1 ,imazighen1 ,kurds1 ,palestinians1 and ,yazidis74 ,,ii ,culturally and linguistically appropriate health and health care #bjja4 ,definitions ,in this title1 the definitions in section #cdjj of the ,public ,health ,service ,act1 as added by section #bjjd1 shall apply4 #bjjb4 ,improving access to services for individuals with limited ,english proficiency 7a7 ,purpose ,consistent with the goals provided in ,executive ,order #acaff 7#db ,u4,s4,c4 #bjjj;d-#a note2 relating to improving access to services for persons with limited ,english proficiency71 it is the purpose of this section-- 7#a7 to improve ,federal agency performance regarding access to federally conducted and federally assisted programs and activities for individuals with limited ,english proficiency2 7#b7 to require each ,federal agency to examine the services it provides and develop and implement a system by which individuals with limited ,english proficiency can obtain culturally competent services and meaningful access to those services consistent with1 and without substantially burdening1 the fundamental mission of the agency2 7#c7 to require each ,federal agency to translate any ,english language written material prepared for the general public into the top #ae non-,english languages in the ,united ,states 7according to the most recent data from the ,american ,community ,survey or its replacement7 within established timelines described in subsection 7b77#b77;,c77v72 7#d7 to require each ,federal agency to ensure that recipients of ,federal financial assistance provide culturally competent services and meaningful access to applicants and beneficiaries who are individuals with limited ,english proficiency2 7#e7 to ensure that recipients of ,federal financial assistance take reasonable steps1 consistent with the guidelines set forth in the ,guidance to ,federal ,financial ,assistance ,recipients ,regarding ,title ,,vi ,prohibition ,against ,national ,origin ,discrimination ,affecting ,limited ,english ,proficient ,persons 7#fg ,fed4 ,reg4 #dadee 7,june #ah1 #bjjb771 to ensure culturally and linguistically appropriate access to their programs and activities by individuals with limited ,english proficiency2 and 7#f7 to ensure compliance with title ,,vi of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;d et seq47 and section #aeeg of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahaaf7 7prohibiting health care providers and organizations from discriminating in the provision of services74 7b7 ,federally ,conducted programs and activities 7#a7 ,in general ,not later than #abj days after the date of enactment of this ,act1 each ,federal agency providing financial assistance to1 or administering1 a health program or activity described in section #bjjc7;a7 shall prepare a plan or update a plan to improve culturally and linguistically appropriate access to such program or activity with respect to individuals with limited ,english proficiency4 ,not later than #a year after the date of enactment of this ,act1 each such ,federal agency shall ensure that such plan is fully implemented4 7#b7 ,plan requirement ,each plan under paragraph 7#a7 shall include-- 7,a7 the steps the agency will take to ensure that individuals with limited ,english proficiency have access to each health program or activity supported or administered by the agency2 7,b7 the policies and procedures for identifying1 assessing1 and meeting the culturally and linguistically appropriate language needs of its beneficiaries that are individuals with limited ,english proficiency served by such program or activity2 7,c7 the steps the agency will take for such program or activity to be culturally and linguistically appropriate by-- 7i7 providing a range of language assistance options2 7ii7 giving notice to individuals with limited ,english proficiency of the right to competent language services2 7iii7 training staff 7at least annually72 7iv7 monitoring and assessing the quality of the language services 7at least annually72 and 7v7 translating any ,english language written material prepared for the general public into the top #ae non-,english languages in the ,united ,states 7according to the most recent data from the ,american ,community ,survey or its replacement7 within established timelines that ensure that high-quality1 culturally competent translated material is provided promptly within not more than #ae calendar days in general and within not more than #g calendar days in the case of any national emergency or ,state disaster declaration2 7,d7 the steps the agency will take for such program or activity to provide reasonable accommodations necessary for individuals with limited ,english proficiency1 including those individuals with a communication disability1 to understand communications from the agency2 7,e7 the steps the agency will take to ensure that applications1 forms1 and other significant documents for such program or activity are competently translated into the primary language of a client that is an individual with limited ,english proficiency where such materials are needed to improve access of such client to such program or activity2 7,f7 the resources the agency will provide to improve cultural and linguistic appropriateness to assist recipients of ,federal funds to improve access to health care-related programs and activities for individuals with limited ,english proficiency2 7,g7 the resources the agency will provide to ensure that competent language assistance is provided to patients that are individuals with limited ,english proficiency by interpreters or trained bilingual staff2 7,h7 the resources the agency will provide to ensure that family1 particularly minor children1 and friends are not used to provide interpretation services1 except as permitted under section #aeeg of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahaaf72 and 7,i7 the steps the agency will take and resources the agency will provide to ensure that individuals know their rights1 including the ability to file a complaint4 7#c7 ,submission of plan to ,,doj ,each agency that is required to prepare a plan under paragraph 7#a7 shall-- 7,a7 consult with populations who are directly impacted by policies in the plan and their representatives in the development of the plan2 and 7,b7 when the plan is finalized1 send a copy of such plan to the ,attorney ,general1 to serve as the central repository of all such plans4 #bjjc4 ,ensuring standards for culturally and linguistically appropriate services in health care 7a7 ,applicability ,this section shall apply to any health program or activity-- 7#a7 of which any part is receiving ,federal financial assistance1 including credits1 subsidies1 or contracts of insurance2 or 7#b7 that is carried out 7including indirectly through contracts1 subcontracts1 or other support7 by an executive agency or any entity established under title ,i of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjja et seq47 7or amendments made thereby74 7b7 ,standards ,each program or activity described in subsection 7a7-- 7#a7 shall implement strategies to recruit1 retain1 and promote individuals at all levels to maintain a diverse staff and leadership that can provide culturally and linguistically appropriate health care to patient populations of the service area of the program or activity2 7#b7 shall educate and train governance1 leadership1 and workforce at all levels and across all disciplines of the program or activity in culturally and linguistically appropriate policies and practices on an ongoing basis at least yearly2 7#c7 shall offer and provide language assistance1 including trained and competent bilingual staff and interpreter services1 to individuals with limited ,english proficiency or who have other communication needs1 at no cost to the individual at all points of contact1 and during all hours of operation1 to facilitate timely access to health care services and health care-related services2 7#d7 shall for each language group consisting of individuals with limited ,english proficiency that constitutes #e percent or #ejj individuals1 whichever is less1 of the population of persons eligible to be served or likely to be affected or encountered in the service area of the program or activity1 make available at a fifth grade reading level-- 7,a7 easily understood patient-related materials1 including print and multimedia materials1 in the language of such language group2 7,b7 information or notices about termination of benefits in such language2 7,c7 signage2 and 7,d7 any other documents or types of documents designated by the ,secretary2 7#e7 shall develop and implement clear goals1 policies1 operational plans1 and management1 accountability1 and oversight mechanisms to provide culturally and linguistically appropriate services and infuse them throughout the planning and operations of the program or activity2 7#f7 shall conduct initial and ongoing1 at least annually1 organizational assessments of culturally and linguistically appropriate services-related activities and integrate valid linguistic1 competence-related ,national ,standards for ,culturally and ,linguistically ,appropriate ,services 7,,clas7 measures into the internal audits1 performance improvement programs1 patient satisfaction assessments1 continuous quality improvement activities1 and outcomes-based evaluations of the program or activity and develop ways to standardize assessments2 7#g7 shall ensure that1 consistent with the privacy protections provided for under the regulations promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acbj;d-#b note2 ,public ,law #ajd-aia71 data on an individual required to be collected pursuant to section #caja of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjkk71 including the individual's alternative format preferences and policy modification needs1 are-- 7,a7 collected in health records2 7,b7 integrated into the management information systems of the program or activity2 7,c7 reported in such a way as to be interoperable with health information systems at the ,federal and ,state levels2 and 7,d7 periodically updated2 7#h7 shall maintain a current demographic1 cultural1 and epidemiological profile of the community1 conduct regular assessments of community health assets and needs1 and use the results of such assessments to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area of the program or activity2 7#i7 shall develop participatory1 collaborative partnerships with community-based organizations and utilize a variety of formal and informal mechanisms to facilitate community and patient involvement in designing1 implementing1 and evaluating policies and practices to ensure culturally and linguistically appropriate service-related activities2 7#aj7 shall ensure that conflict and grievance resolution processes are culturally and linguistically appropriate and capable of identifying1 preventing1 and resolving cross-cultural conflicts or complaints by patients2 7#aa7 shall annually-- 7,a7 make available to the public-- 7i7 information about the progress and successful innovations of the program or activity in implementing the standards under this section2 and 7ii7 translated materials of such information that is culturally and linguistically appropriate to the communities served under this section2 and 7,b7 provide public notice in such communities about the availability of such information2 and 7#ab7 shall1 if requested1 regularly make available to the head of each ,federal entity from which ,federal funds are provided1 information about the progress and successful innovations of the program or activity in implementing the standards under this section as required by the head of such entity4 7c7 ,comments accepted through notice and comment rulemaking ,an executive agency carrying out a program or activity described in subsection 7a7-- 7#a7 shall ensure that comments with respect to such program or activity that are accepted through notice and comment rulemaking are accepted in all languages2 7#b7 may not require such comments to be submitted only in ,english2 and 7#c7 shall ensure that any such comments that are not submitted in ,english are considered1 during the agency's review of such comments1 equally as such comments that are submitted in ,english4 #bjjd4 ,culturally and linguistically appropriate health care in the ,public ,health ,service ,act ,the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bja et seq47 is amended by adding at the end the following3 ,,xxxiv ,culturally and ,linguistically ,appropriate ,health ,care #cdjj4 ,definitions 7a7 ,in general ,in this title3 7#a7 ,bilingual ,the term bilingual1 with respect to an individual1 means an individual who has a sufficient degree of proficiency in #b languages4 7#b7 ,community health worker ,the term community health worker means a frontline health worker who is a trusted member of the community in which the worker serves or who has an unusually close understanding of the community served that enables the worker to build trusted relationships1 serve as a liaison between health and social services and the community1 facilitate access to services1 and improve the quality and cultural competence of service delivery4 7#c7 ,cultural ,the term cultural means relating to integrated patterns of human behavior that include the language1 thoughts1 communications1 actions1 customs1 beliefs1 values1 age1 and institutions of racial1 ethnic1 religious1 or social groups1 including lesbian1 gay1 bisexual1 transgender1 queer1 and questioning individuals1 and individuals with physical and mental disabilities4 7#d7 ,culturally and linguistically appropriate ,the term culturally and linguistically appropriate means being respectful of and responsive to the cultural and linguistic needs of all individuals4 7#e7 ,effective communication ,the term effective communication means an exchange of information between the provider of health care or health care-related services and the recipient of such services who is limited in ,english proficiency1 or has a communication impairment such as a hearing1 vision1 speaking1 or cognitive disability1 that enables access to1 understanding of1 and benefit from health care or health care-related services1 and full participation in the development of the treatment plan of the recipient4 7#f7 ,grievance resolution process ,the term grievance resolution process means all aspects of dispute resolution including filing complaints1 grievance and appeal procedures1 and court action4 7#g7 ,health care group ,the term health care group means a group of physicians organized1 at least in part1 for the purposes of providing physician services under the ,medicaid program under title ,,xix of the ,social ,security ,act1 the ,state ,children's ,health ,insurance ,program under title ,,xxi of such ,act1 or the ,medicare program under title ,,xviii of such ,act1 including a provider of services under part ,b of such title ,,xviii1 and may include a hospital1 a hospice provider1 a palliative care provider1 and any other individual or entity furnishing services covered under any such program that is affiliated with the health care group4 7#h7 ,health care ,the term health care includes all health care needed throughout the life cycle and the end of life4 7#i7 ,health care services ,the term health care services means services that address physical and mental health conditions1 as well as conditions impacted by social determinants of health1 in all care settings throughout the life cycle and the end of life4 7#aj7 ,health care-related services ,the term health care-related services means human or social services programs or activities that provide access1 referrals1 or links to health care services4 7#aa7 ,health educator ,the term health educator includes a professional with a baccalaureate degree who is responsible for designing1 implementing1 and evaluating individual and population health promotion1 health education 7including education on end-of-life care options71 end-of-life care1 or chronic disease prevention programs4 7#ab7 ,indian2 ,indian ,tribe ,the terms ,indian and ,indian ,tribe have the meanings given such terms in section #d of the ,indian ,self-,determination and ,education ,assistance ,act4 7#ac7 ,individual with a disability ,the term individual with a disability means any individual who has a disability as defined for the purpose of section #ejd of the ,rehabilitation ,act of #aigc4 7#ad7 ,individual with limited ,english proficiency ,the term individual with limited ,english proficiency means an individual who self-identifies on the ,census as speaking ,english less than very well4 7#ae7 ,integrated health care delivery system ,the term integrated health care delivery system means an interdisciplinary system that brings together providers from the primary health1 mental health1 substance use disorder1 hospice and palliative care1 and related disciplines to improve the health outcomes of an individual and the community4 ,such providers may include hospitals1 health1 mental health1 or substance use prevention and treatment clinics and providers1 home health agencies1 home- and community-based services providers1 congregate settings 7including any skilled nursing facilities1 assisted living facilities1 prisons and jails1 residential behavioral health care and psychiatric facilities1 and facilities providing services for aging adults and individuals with disabilities71 ambulatory surgery centers1 rehabilitation centers1 employed1 independent1 or contracted physicians1 and oral health care providers4 7#af7 ,interpreting2 interpretation ,the terms interpreting and interpretation mean the transmission of a spoken1 written1 or signed message from one language or format into another1 faithfully1 accurately1 and objectively4 7#ag7 ,language access ,the term language access means the provision of language services to an individual with limited ,english proficiency or an individual with communication disabilities designed to enhance that individual's access to1 understanding of1 or benefit from health care services or health care-related services4 7#ah7 ,language assistance services ,the term language assistance services includes-- 7,a7 oral language assistance1 including interpretation in non-,english languages provided in person or remotely by a qualified interpreter for an individual with limited ,english proficiency1 and the use of qualified bilingual or multilingual staff to communicate directly with individuals with limited ,english proficiency2 7,b7 written translation1 performed by a qualified translator1 of written content in paper or electronic form into languages other than ,english2 and 7,c7 taglines4 7#ai7 ,minority populations ,the term minority populations means individuals of racial and ethnic minority groups1 individuals of sexual and gender minority groups1 and individuals with a disability4 7#bj7 ,onsite interpretation ,the term onsite interpretation means a method of interpreting or interpretation for which the interpreter is in the physical presence of the provider of health care services or health care-related services and the recipient of such services who is limited in ,english proficiency or has a communication impairment such as an impairment in hearing1 vision1 or learning4 7#ba7 ,qualified individual with a disability ,the term qualified individual with a disability means1 with respect to a health program or activity1 an individual with a disability who1 with or without reasonable modifications to policies1 practices1 or procedures1 the removal of architectural1 communication1 or transportation barriers1 or the provision of auxiliary aids and services1 meets the essential eligibility requirements for the receipt of aids1 benefits1 or services offered or provided by the health program or activity4 7#bb7 ,qualified interpreter for an individual with a disability ,the term qualified interpreter for an individual with a disability1 with respect to an individual with a disability-- 7,a7 means an interpreter for such individual who by means of a remote interpreting service or an onsite appearance-- 7i7 adheres to generally accepted interpreter ethics principles1 including client confidentiality2 and 7ii7 is able to interpret effectively1 accurately1 and impartially1 both receptively and expressively1 using any necessary specialized vocabulary1 terminology1 and phraseology2 and 7,b7 may include-- 7i7 sign language interpreters2 7ii7 oral transliterators1 which are individuals who represent or spell in the characters of another alphabet2 and 7iii7 cued language transliterators1 which are individuals who represent or spell by using a small number of handshapes4 7#bc7 ,qualified interpreter for an individual with limited ,english proficiency ,the term qualified interpreter for an individual with limited ,english proficiency means an interpreter who by means of a remote interpreting service or an onsite appearance-- 7,a7 adheres to generally accepted interpreter ethics principles1 including client confidentiality2 7,b7 has demonstrated proficiency in speaking and understanding both spoken ,english and one or more other spoken languages2 and 7,c7 is able to interpret effectively1 accurately1 and impartially1 both receptively and expressly1 to and from such languages and ,english1 using any necessary specialized vocabulary1 terminology1 and phraseology4 7#bd7 ,qualified translator ,the term qualified translator means a translator who-- 7,a7 adheres to generally accepted translator ethics principles1 including client confidentiality2 7,b7 has demonstrated proficiency in writing and understanding both written ,english and one or more other written non-,english languages2 and 7,c7 is able to translate effectively1 accurately1 and impartially to and from such languages and ,english1 using any necessary specialized vocabulary1 terminology1 and phraseology4 7#be7 ,racial and ethnic minority group ,the term racial and ethnic minority group has the meaning given such term in section #agjg7;g74 7#bf7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality4 7#bg7 ,sexual and gender minority group ,the term sexual and gender minority group includes lesbian1 gay1 bisexual1 and transgender populations1 as well as those whose sexual orientation1 gender identity and expression1 or reproductive development varies from traditional1 societal1 cultural1 or physiological norms4 7#bh7 ,sight translation ,the term sight translation means the transmission of a written message in one language into a spoken or signed message in another language1 or an alternative format in ,english or another language4 7#bi7 ,state ,notwithstanding section #b1 the term ,state means each of the several ,states1 the ,district of ,columbia1 the ,commonwealth of ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 ,american ,samoa1 and the ,commonwealth of the ,northern ,mariana ,islands4 7#cj7 ,telephonic interpretation ,the term telephonic interpretation 7also known as over the phone interpretation or ,,opi7 means1 with respect to interpretation for an individual with limited ,english proficiency1 a method of interpretation in which the interpreter is not in the physical presence of the provider of health care services or health care-related services and such individual receiving such services1 but the interpreter is connected via telephone4 7#ca7 ,translation ,the term translation means the transmission of a written message in one language into a written or signed message in another language1 and includes translation into another language or alternative format1 such as large print font1 ,braille1 audio recording1 or ,,cd4 7#cb7 ,underserved communities ,the term underserved communities means populations sharing particular characteristics1 or geographic communities1 who have been systematically denied a full opportunity to participate in aspects of economic1 social1 and civic life1 such as-- 7,a7 ,black1 ,latino1 ,indigenous1 and ,native ,american persons1 ,asian ,americans1 ,native ,hawaiians and ,pacific ,islanders1 ,middle ,easterners and ,north ,africans1 and other persons of color2 7,b7 members of religious minorities2 7,c7 lesbian1 gay1 bisexual1 transgender1 and queer persons2 7,d7 individuals with a disability2 7,e7 persons who live in rural areas2 and 7,f7 persons otherwise adversely affected by persistent poverty or inequality4 7#cc7 ,video remote interpreting services ,the term video remote interpreting services means the provision1 in health care services or health care-related services1 through a qualified interpreter for an individual with limited ,english proficiency1 of video remote interpreting services that are-- 7,a7 in real-time1 full-motion video1 and audio over a dedicated high-speed1 wide-bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags1 choppy1 blurry1 or grainy images1 or irregular pauses in communication2 and 7,b7 in a sharply delineated image that is large enough to display4 7#cd7 ,vital document ,the term vital document includes applications for government programs that provide health care services1 medical or financial consent forms1 financial assistance documents1 letters containing important information regarding patient instructions 7such as prescriptions1 referrals to other providers1 and discharge plans7 and participation in a program 7such as a ,medicaid managed care program71 notices pertaining to the reduction1 denial1 or termination of services or benefits1 notices of the right to appeal such actions1 and notices advising individuals with limited ,english proficiency with communication disabilities of the availability of free language services1 alternative formats1 and other outreach materials4 7b7 ,reference ,in any reference in this title to a regulatory provision applicable to a handicapped individual1 the term handicapped individual in such provision shall have the same meaning as the term individual with a disability as defined in subsection 7a74 ,a ,resources and innovation for culturally and linguistically appropriate health care #cdja4 ,robert ,t4 ,matsui ,center for ,culturally and ,linguistically ,appropriate ,health ,care 7a7 ,establishment ,the ,secretary shall establish and support a center to be known as the ,robert ,t4 ,matsui ,center for ,culturally and ,linguistically ,appropriate ,health ,care 7referred to in this section as the ,center7 to carry out each of the following activities3 7#a7 ,interpretation services 7,a7 ,in general ,the ,center shall provide resources via the internet to identify and link health care providers to competent and qualified interpreter and translation services4 7,b7 ,training ,for purposes of providing the services described in subparagraph 7,a71 the ,center shall adopt a language access plan that includes training requirements for ,center staff to provide such services4 7#b7 ,translation of written material 7,a7 ,vital documents ,the ,center shall provide1 directly or through contract1 to providers of health care services and health care-related services1 at no cost to such providers and in a timely and reasonable manner1 vital documents-- 7i7 which may be submitted by an entity described in subparagraph 7,c7 for translation into non-,english languages1 or alternative formats1 at a fifth-grade reading level2 and 7ii7 from competent translation services1 the quality of which shall be monitored and reported publicly4 7,b7 ,forms ,for each form developed or revised by the ,secretary that will be used by individuals with limited ,english proficiency in health care or health care-related settings1 the ,center shall1 not later than #de calendar days of the ,secretary receiving final approval of the form from the ,office of ,management and ,budget-- 7i7 translate the form1 at a minimum1 into the top #ae non-,english languages in the ,united ,states according to the most recent data from the ,american ,community ,survey or its replacement2 and 7ii7 post all translated forms on the ,center's website4 7,c7 ,entities 7i7 ,in general ,an entity described in this subparagraph is-- 7,i7 an entity that operates a health program or activity1 any part of which receives ,federal financial assistance2 7,,ii7 an entity established under title ,i of the ,patient ,protection and ,affordable ,care ,act that administers a health program or activity2 or 7,,iii7 the ,department of ,health and ,human ,services4 7ii7 ,health program or activity ,for purposes of clause 7i71 the term health program or activity has the meaning given such term in section #ib4d of title #de1 ,code of ,federal ,regulations1 as in effect on ,july #e1 #bjbd4 7#c7 ,toll-free customer service telephone number ,the ,center shall provide1 through a toll-free number1 a customer service line for individuals with limited ,english proficiency that is linked to the toll-free telephone number #a-hjj-,,medicare and a toll-free telephone hotline provided for pursuant to section #acaa7;d77#d77;,b7 of the ,patient ,protection and ,affordable ,care ,act by an ,exchange established under title ,i of such ,act-- 7,a7 to obtain information about federally conducted or funded health programs1 including the ,medicare program under title ,,xviii of the ,social ,security ,act1 the ,medicaid program under title ,,xix of such ,act1 and the ,state ,children's ,health ,insurance ,program under title ,,xxi of such ,act1 and coverage available through an ,exchange established under title ,i of the ,patient ,protection and ,affordable ,care ,act1 and other sources of free or reduced care including federally qualified health centers1 entities receiving assistance under title ,x1 and public health departments2 7,b7 to obtain assistance with applying for or accessing these programs and understanding ,federal notices written in ,english2 and 7,c7 to learn how to access language services4 7#d7 ,health information clearinghouse 7,a7 ,in general ,the ,center shall develop and maintain1 and make available on the internet and in print1 an information clearinghouse that includes the information described in subparagraphs 7,b7 through 7,g7-- 7i7 to facilitate the provision of language services by providers of health care services and health care-related services to reduce medical errors2 7ii7 to improve medical outcomes1 improve cultural competence1 reduce health care costs caused by miscommunication with individuals with limited ,english proficiency2 and 7iii7 to reduce or eliminate the duplication of efforts to translate materials4 7,b7 ,document templates ,the ,center shall collect and evaluate for accuracy1 develop1 and make available templates for standard documents that are necessary for patients and consumers to access and make educated decisions about their health care1 including templates for each of the following3 7i7 ,administrative and legal documents1 including-- 7,i7 intake forms2 7,,ii7 forms related to the ,medicare program under title ,,xviii of the ,social ,security ,act1 the ,medicaid program under title ,,xix of such ,act1 and the ,state ,children's ,health ,insurance ,program under title ,,xxi of such ,act1 including eligibility information for such programs2 7,,iii7 forms informing patients of the compliance and consent requirements pursuant to the regulations under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif2 and 7,,iv7 documents concerning informed consent1 advanced directives1 and waivers of rights4 7ii7 ,clinical information1 such as how to take medications1 how to prevent transmission of a contagious disease1 and other prevention and treatment instructions4 7iii7 ,public health1 patient education1 and outreach materials1 such as immunization notices1 health warnings1 or screening notices4 7iv7 ,additional health or health care-related materials as determined appropriate by the ,director of the ,center4 7,c7 ,structure of forms ,in operating the clearinghouse1 the ,center shall-- 7i7 ensure that the documents posted in ,english and non-,english languages are culturally and linguistically appropriate2 7ii7 allow public review of the documents before dissemination in order to ensure that the documents are understandable and culturally and linguistically appropriate for the target populations2 7iii7 allow health care providers to customize the documents for their use2 7iv7 facilitate access to such documents2 7v7 provide technical assistance with respect to the access and use of such information2 and 7vi7 carry out any other activities the ,secretary determines to be useful to fulfill the purposes of the clearinghouse4 7,d7 ,language assistance programs ,the ,center shall provide for the collection and dissemination of information on current examples of language assistance programs and strategies to improve language services for individuals with limited ,english proficiency1 including case studies using de-identified patient information1 program summaries1 and program evaluations4 7,e7 ,culturally and linguistically appropriate materials ,the ,center shall provide1 at no cost1 to all health care providers and all providers of health care-related services1 information relating to culturally and linguistically appropriate health care for minority populations residing in the ,united ,states1 including-- 7i7 tenets of culturally and linguistically appropriate care2 7ii7 culturally and linguistically appropriate self-assessment tools2 7iii7 culturally and linguistically appropriate training tools2 7iv7 strategic plans to increase cultural and linguistic appropriateness in different types of providers of health care services and health care-related services1 including regional collaborations among health care organizations for health care services and health care-related services2 and 7v7 culturally and linguistically appropriate information for educators1 practitioners1 students1 and researchers4 7,f7 ,translation ,glossaries ,the ,center shall-- 7i7 develop and publish on its website translation glossaries that provide standardized translations of commonly used terms and phrases utilized in documents translated by the ,center2 and 7ii7 make such glossaries available-- 7,i7 free of charge2 7,,ii7 in each language in which the ,center translates forms under paragraph 7#b77;,b72 7,,iii7 in alternative formats in accordance with the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abaja et seq472 and 7,,iv7 in paper format upon request4 7,g7 ,information about progress ,the ,center shall-- 7i7 regularly collect and make publicly available information about the progress of entities receiving grants under section #cdjb regarding successful innovations in implementing the requirements of this subsection2 and 7ii7 provide public notice in the entities' communities about the availability of such information4 7b7 ,director ,the ,center shall be headed by a ,director who shall be appointed by1 and who shall report to1 the ,director of the ,agency for ,healthcare ,research and ,quality4 7c7 ,availability of language access ,the ,director of the ,center shall collaborate with the ,deputy ,assistant ,secretary for ,minority ,health1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 and the ,administrator of the ,health ,resources and ,services ,administration to notify health care providers and health care organizations about the availability of language access services by the ,center4 7d7 ,education ,the ,secretary1 directly or through contract1 shall undertake a national education campaign to inform providers1 individuals with limited ,english proficiency1 individuals with hearing or vision impairments1 health professionals1 graduate schools1 community health centers1 social service providers1 and community-based organizations about-- 7#a7 ,federal and ,state laws and guidelines governing access to language services2 7#b7 the value of using trained and competent interpreters and the risks associated with using family members1 friends1 minors1 and untrained bilingual staff2 7#c7 funding sources for developing and implementing language services2 and 7#d7 promising practices to effectively provide language services4 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #e1jjj1jjj for each of fiscal years #bjbe through #bjbi4 #cdjb4 ,innovations in culturally and linguistically appropriate health care grants 7a7 ,in general 7#a7 ,grants ,the ,secretary shall award grants to eligible entities to enable such entities to design1 implement1 and evaluate innovative1 cost-effective programs to improve culturally and linguistically appropriate access to health care services for individuals with limited ,english proficiency and communication disabilities4 7#b7 ,coordination ,in making grants under this section1 and in the design and implementation of the program established under this section1 the ,secretary shall coordinate with1 and ensure the participation of1 other agencies including the ,health ,resources and ,services ,administration1 the ,national ,institute on ,minority ,health and ,health ,disparities at the ,national ,institutes of ,health1 and the ,office of ,minority ,health4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall be-- 7#a7 a city1 county1 ,indian ,tribe1 ,state1 or subdivision thereof2 7#b7 an organization described in section #eja7;c77#c7 of the ,internal ,revenue ,code of #aihf and exempt from tax under section #eja7;a7 of such ,code2 7#c7 a community health1 mental health1 or substance use disorder center or clinic2 7#d7 a solo or group physician practice2 7#e7 an integrated health care delivery system2 7#f7 a public hospital2 7#g7 a health care group1 university1 or college2 or 7#h7 any other entity designated by the ,secretary4 7c7 ,application ,an eligible entity seeking a grant under this section shall prepare and submit to the ,secretary an application1 at such time1 in such manner1 and containing such additional information as the ,secretary may reasonably require4 7d7 ,use of funds ,an entity shall use funds received through a grant under this section to-- 7#a7 develop1 implement1 and evaluate models of providing competent interpretation services through onsite interpretation1 telephonic interpretation1 or video remote interpreting services2 7#b7 implement strategies to recruit1 retain1 and promote individuals at all levels of the organization to maintain a diverse staff and leadership that can promote and provide language services to patient populations of the service area of the entity2 7#c7 develop and maintain a needs assessment that identifies the current demographic1 cultural1 and epidemiological profile of the community to accurately plan for and implement language services needed in the service area of the entity2 7#d7 develop a strategic plan to implement language services2 7#e7 develop participatory1 collaborative partnerships with communities encompassing the patient populations of individuals with limited ,english proficiency served by the grant to gain input in designing and implementing language services2 7#f7 develop and implement grievance resolution processes that are culturally and linguistically appropriate and capable of identifying1 preventing1 and resolving complaints by individuals with limited ,english proficiency2 7#g7 develop short-term medical and mental health interpretation training courses and incentives for bilingual health care staff who are asked to provide interpretation services in the workplace2 7#h7 develop formal training programs1 including continued professional development and education programs as well as supervision1 for individuals interested in becoming dedicated health care interpreters and culturally and linguistically appropriate providers2 7#i7 provide staff language training instruction1 which shall include information on the practical limitations of such instruction for nonnative speakers2 7#aj7 develop policies that address compensation in salary for staff who receive training to become either a staff interpreter or bilingual provider2 7#aa7 develop other language assistance services as determined appropriate by the ,secretary2 7#ab7 develop1 implement1 and evaluate models of improving cultural competence1 including cultural competence programs for community health workers2 7#ac7 ensure that1 consistent with the privacy protections provided for under the regulations promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif and any applicable ,state privacy laws1 data on the individual patient or recipient's race1 ethnicity1 and primary language are collected 7and periodically updated7 in health records and integrated into the organization's information management systems or any similar system used to store and retrieve data2 and 7#ad7 ensure that culturally competent care and language assistance are available to individuals with limited ,english proficiency4 7e7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to entities that primarily engage in providing direct care and that have developed partnerships with community organizations or with agencies with experience in improving language access4 7f7 ,evaluation 7#a7 ,by grantees ,an entity that receives a grant under this section shall submit to the ,secretary an evaluation that describes1 in the manner and to the extent required by the ,secretary1 the activities carried out with funds received under the grant1 and how such activities improved access to health care services and health care-related services and the quality of health care for individuals with limited ,english proficiency4 ,such evaluation shall be collected and disseminated through the ,robert ,t4 ,matsui ,center for ,culturally and ,linguistically ,appropriate ,health ,care established under section #cdja4 ,the ,director of the ,agency for ,healthcare ,research and ,quality shall notify grantees of the availability of technical assistance for the evaluation and provide such assistance upon request4 7#b7 ,by ,secretary ,the ,director of the ,agency for ,healthcare ,research and ,quality shall evaluate or arrange with other individuals or organizations to evaluate projects funded under this section4 7g7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #e1jjj1jjj for each of fiscal years #bjbe through #bjbi4 #cdjc4 ,research on cultural and language competence 7a7 ,in general ,the ,secretary shall expand research concerning language access in the provision of health care services4 7b7 ,eligibility ,the ,secretary may conduct the research described in subsection 7a7 or enter into contracts with other individuals or organizations to conduct such research4 7c7 ,use of funds ,research conducted under this section shall be designed to do one or more of the following3 7#a7 ,to identify the barriers to mental and behavioral services that are faced by individuals with limited ,english proficiency4 7#b7 ,to identify health care providers' and health administrators' knowledge and awareness of the barriers to quality health care services that are faced by individuals with limited ,english proficiency and communication disabilities4 7#c7 ,to identify optimal approaches for delivering language access4 7#d7 ,to identify best practices for data collection1 including-- 7,a7 the collection by providers of health care services and health care-related services of data on the race1 ethnicity1 and primary language of recipients of such services1 taking into account existing research conducted by the ,government or private sector2 7,b7 the development and implementation of data collection and reporting systems2 and 7,c7 effective privacy safeguards for collected data4 7#e7 ,to develop a minimum data collection set for primary language4 7#f7 ,to evaluate the most effective ways in which the ,secretary can create or coordinate1 and subsidize or otherwise fund1 telephonic interpretation services for health care providers1 taking into consideration1 among other factors1 the flexibility necessary for such a system to accommodate variations in-- 7,a7 provider type2 7,b7 languages needed and their frequency of use2 7,c7 type of encounter2 7,d7 time of encounter1 including whether the encounter occurs during regular business hours and after hours2 and 7,e7 location of encounter4 7d7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #e1jjj1jjj for each of fiscal years #bjbe through #bjbi4 4 #bjje4 ,pilot program for improvement and development of ,state medical interpreting services 7a7 ,grants authorized ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall award #a grant in accordance with this section to each of #c ,states 7to be selected by the ,secretary7 to assist each such ,state in designing1 implementing1 and evaluating a statewide program to provide onsite interpreter services under the ,state ,medicaid plan4 7b7 ,grant period ,a grant awarded under this section is authorized for the period of #c fiscal years beginning on ,october #a1 #bjbd1 and ending on ,september #cj1 #bjbg4 7c7 ,preference ,in awarding a grant under this section1 the ,secretary shall give preference to a ,state-- 7#a7 that has a high proportion of qualified ,,lep enrollees1 as determined by the ,secretary2 7#b7 that has a large number of qualified ,,lep enrollees1 as determined by the ,secretary2 7#c7 that has a high growth rate of the population of individuals with limited ,english proficiency1 as determined by the ,secretary2 and 7#d7 that has a population of qualified ,,lep enrollees that is linguistically diverse1 requiring interpreter services in at least #bjj non-,english languages4 7d7 ,use of funds ,a ,state receiving a grant under this section shall use the grant funds to-- 7#a7 ensure that all health care providers in the ,state participating in the ,state ,medicaid plan have access to onsite interpreter services1 for the purpose of enabling effective communication between such providers and qualified ,,lep enrollees during the furnishing of items and services and administrative interactions2 7#b7 establish1 expand1 procure1 or contract for-- 7,a7 a statewide health care information technology system that is designed to achieve efficiencies and economies of scale with respect to onsite interpreter services provided to health care providers in the ,state participating in the ,state ,medicaid plan2 and 7,b7 an entity to administer such system1 the duties of which shall include-- 7i7 procuring and scheduling interpreter services for qualified ,,lep enrollees2 7ii7 procuring and scheduling interpreter services for individuals with limited ,english proficiency seeking to enroll in the ,state ,medicaid plan2 7iii7 ensuring that interpreters receive payment for interpreter services rendered under the system2 and 7iv7 consulting regularly with organizations representing ,,lep consumers1 interpreters1 and health care providers2 and 7#c7 develop mechanisms to establish1 improve1 and strengthen the competency of the medical interpretation workforce that serves qualified ,,lep enrollees in the ,state1 including a national certification process that is valid1 credible1 and vendor-neutral4 7e7 ,application ,to receive a grant under this section1 a ,state shall submit an application at such time and containing such information as the ,secretary may require1 which shall include the following3 7#a7 ,a description of the language access needs of individuals in the ,state enrolled in the ,state ,medicaid plan4 7#b7 ,a description of the extent to which the program will-- 7,a7 use the grant funds for the purposes described in subsection 7d72 7,b7 meet the health care needs of rural populations of the ,state2 and 7,c7 collect information that accurately tracks the language services requested by consumers as compared to the language services provided by health care providers in the ,state participating in the ,state ,medicaid plan4 7#c7 ,a description of how the program will be evaluated1 including a proposal for collaboration with organizations representing interpreters1 consumers1 and individuals with limited ,english proficiency4 7f7 ,definitions ,in this section3 7#a7 ,qualified ,,lep enrollee ,the term qualified ,,lep enrollee means an individual-- 7,a7 who is limited ,english proficient2 and 7,b7 who is enrolled in a ,state ,medicaid plan4 7#b7 ,state ,the term ,state has the meaning given the term in section #aaja7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acja7;a77#a771 for purposes of title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq474 7#c7 ,state ,medicaid plan ,the term ,state ,medicaid plan means a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 or a waiver of such a plan4 7#d7 ,united ,states ,the term ,united ,states has the meaning given the term in section #aaja7;a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acja7;a77#b771 for purposes of title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq474 7g7 ,continuation past demonstration ,any ,state receiving a grant under this section must agree to directly pay for language services in ,medicaid for all ,medicaid providers by the end of the grant period4 7h7 ,funding 7#a7 ,authorization of appropriations ,there is authorized to be appropriated #e1jjj1jjj to carry out this section4 7#b7 ,availability of funds ,amounts appropriated pursuant to the authorization in paragraph 7#a7 are authorized to remain available without fiscal year limitation4 7#c7 ,increased ,federal financial participation ,section #aijc7;a77#b77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#b77;,e77 is amended by inserting 7or1 in the case of a ,state that was awarded a grant under section #bjje of the ,health ,equity and ,accountability ,act of #bjbd1 #ajj percent for each quarter occurring during the grant period specified in subsection 7b7 of such section7 after #ge percent4 7i7 ,limitation ,no ,federal funds awarded under this section may be used to provide interpreter services from a location outside the ,united ,states4 #bjjf4 ,training tomorrow's doctors for culturally and linguistically appropriate care3 graduate medical education 7a7 ,direct graduate medical education ,section #ahhf7;h77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77#d77 is amended by adding at the end the following new subparagraph3 7,l7 ,treatment of culturally and linguistically appropriate training ,in determining a hospital's number of full-time equivalent residents for purposes of this subsection1 all the time that is spent by an intern or resident in an approved medical residency training program for education and training in culturally and linguistically appropriate service delivery1 which shall include all medically underserved populations 7as defined in section #ccj7;b77#c7 of the ,public ,health ,service ,act71 shall be counted toward the determination of full-time equivalency4 4 7b7 ,indirect medical education ,section #ahhf7;d77#e77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77 is amended by adding at the end the following new clause3 7xiv7 ,the provisions of subparagraph 7,l7 of subsection 7h77#d7 shall apply under this subparagraph in the same manner as they apply under such subsection4 4 7c7 ,effective date ,the amendments made by subsections 7a7 and 7b7 shall apply with respect to payments made to hospitals on or after the date that is #a year after the date of the enactment of this ,act4 #bjjg4 ,federal reimbursement for culturally and linguistically appropriate services under the ,medicare1 ,medicaid1 and ,state ,children's ,health ,insurance ,programs 7a7 ,language ,access grants for ,medicare ,providers 7#a7 ,establishment 7,a7 ,in general ,not later than #f months after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary71 acting through the ,centers for ,medicare ,medicaid ,services and in consultation with the ,center for ,medicare and ,medicaid ,innovation 7as referred to in section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a771 shall establish a demonstration program under which the ,secretary shall award grants to eligible ,medicare service providers to provide culturally and linguistically appropriate services to ,medicare beneficiaries who are limited ,english proficient1 including beneficiaries who live in diverse and underserved communities4 7,b7 ,application of innovation rules ,the demonstration project under subparagraph 7,a7 shall be conducted in a manner that is consistent with the applicable provisions of subsections 7b71 7c71 and 7d7 of section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a74 7,c7 ,number of grants ,to the extent practicable1 the ,secretary shall award not less than #bd grants under this subsection4 7,d7 ,grant period ,except as provided in paragraph 7#b77;,d71 each grant awarded under this subsection shall be for a #c-year period4 7#b7 ,eligibility requirements ,to be eligible for a grant under this subsection1 an entity must meet the following requirements3 7,a7 ,medicare provider ,the entity must be-- 7i7 a provider of services under part ,a of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq472 7ii7 a provider of services under part ,b of such title 7#db ,u4,s4,c4 #acie;j et seq472 7iii7 a ,medicare ,advantage organization offering a ,medicare ,advantage plan under part ,c of such title 7#db ,u4,s4,c4 #aciew-#ba et seq472 or 7iv7 a ,,pdp sponsor offering a prescription drug plan under part ,d of such title 7#db ,u4,s4,c4 #aciew-#aja et seq474 7,b7 ,underserved communities ,the entity must serve a community that1 with respect to necessary language services for improving access and utilization of health care among individuals who are limited ,english proficient1 is disproportionally underserved4 7,c7 ,application ,the entity must prepare and submit to the ,secretary an application1 at such time1 in such manner1 and accompanied by such additional information as the ,secretary may require4 7,d7 ,reporting ,in the case of a grantee that received a grant under this subsection in a previous year1 such grantee is only eligible for continued payments under a grant under this subsection if the grantee met the reporting requirements under paragraph 7#i7 for such year4 ,if a grantee fails to meet the requirements of such paragraph for the first year of a grant1 the ,secretary may terminate the grant and solicit applications from new grantees to participate in the demonstration program4 7#c7 ,distribution ,to the extent feasible1 the ,secretary shall award-- 7,a7 at least #aj grants to providers of services described in paragraph 7#b77;,a77i72 7,b7 at least #aj grants to service providers described in paragraph 7#b77;,a77ii72 7,c7 at least #aj grants to organizations described in paragraph 7#b77;,a77iii72 and 7,d7 at least #aj grants to sponsors described in paragraph 7#b77;,a77iv74 7#d7 ,considerations in awarding grants 7,a7 ,variation among grantees ,in awarding grants under this subsection1 the ,secretary shall select grantees to ensure the following3 7i7 ,the grantees provide many different types of language services4 7ii7 ,the grantees serve ,medicare beneficiaries who speak different languages1 and who1 as a population1 have differing needs for language services4 7iii7 ,the grantees serve ,medicare beneficiaries in both urban and rural settings4 7iv7 ,the grantees represent each ,centers for ,medicare ,medicaid ,services region1 as defined by the ,secretary4 7v7 ,the grantees serve ,medicare beneficiaries in at least #b large metropolitan statistical areas with diverse populations1 including diversity in race1 ethnicity1 sexual orientation1 gender identity1 disability status1 and socioeconomic status4 7,b7 ,priority for partnerships with community organizations and agencies ,in awarding grants under this subsection1 the ,secretary shall give priority to eligible entities that have a partnership with #a or more of the following entities that have experience in providing language services3 7i7 ,a community organization4 7ii7 ,a consortium of community organizations1 ,state agencies1 and local agencies4 7#e7 ,use of funds for competent language services 7,a7 ,in general ,subject to subparagraph 7,e71 a grantee may only use grant funds received under this subsection to pay for the provision of competent language services to ,medicare beneficiaries who are individuals who are limited ,english proficient to supplement existing ,medicare requirements4 7,b7 ,competent language services defined ,for purposes of this subsection1 the term competent language services means-- 7i7 interpreter and translation services that-- 7,i7 subject to the exceptions under subparagraph 7,c7-- 7aa7 if the grantee operates in a ,state that has statewide health care interpreter standards1 meet the ,state standards currently in effect2 or 7bb7 if the grantee operates in a ,state that does not have statewide health care interpreter standards1 utilize competent interpreters who follow the ,national ,council on ,interpreting in ,health ,care's ,code of ,ethics and ,standards of ,practice and comply with the requirements of section #aeeg of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahaaf7 as published in the ,federal ,register on ,may #ah1 #bjaf1 #ha ,fed4 ,reg4 #cacge2 and 7,,ii7 in the case of interpreter services1 are provided through-- 7aa7 onsite interpretation2 7bb7 telephonic interpretation2 or 7cc7 video interpretation2 and 7ii7 the direct provision of health care or health care-related services by a competent bilingual health care provider4 7,c7 ,exceptions 7i7 ,in general ,the requirements of subparagraph 7,b77i77,i7 do not apply1 with respect to interpreter and translation services and a grantee-- 7,i7 in the case of a ,medicare beneficiary who is limited ,english proficient1 if-- 7aa7 such beneficiary has been informed1 in the beneficiary's primary language1 of the availability of free interpreter and translation services and the beneficiary instead requests that a family member1 friend1 or other person provide such services2 and 7bb7 the grantee documents such request in the beneficiary's medical record2 or 7,,ii7 subject to clause 7ii71 in the case of a medical emergency where the delay directly associated with obtaining a competent interpreter or translation services would jeopardize the health of the patient4 7ii7 ,clarification ,clause 7i77,,ii7 shall not be construed to exempt emergency rooms or similar entities that regularly provide health care services in medical emergencies to patients who are individuals who are limited ,english proficient from any applicable legal or regulatory requirements related to providing competent interpreter and translation services without undue delay4 7,d7 ,medicare ,advantage organizations and ,,pdp sponsors ,a grantee that is a ,medicare ,advantage organization or a prescription drug plan sponsor must provide at least #ej percent of the grant funds that the grantee receives under this subsection directly to the entity's network providers 7including all health providers and pharmacists7 for the purpose of providing support for such providers to provide competent language services to ,medicare beneficiaries who are individuals who are limited ,english proficient4 7,e7 ,administrative and reporting costs ,a grantee may use up to #aj percent of the grant funds to pay for administrative costs associated with the provision of competent language services and for reporting required under paragraph 7#i74 7#f7 ,determination of amount of grant payments 7,a7 ,in general ,payments to grantees under this subsection shall be calculated based on the estimated numbers of ,medicare beneficiaries who are limited ,english proficient in a grantee's service area utilizing-- 7i7 data on the numbers of ,english learners who speak ,english less than very well from the most recently available data from the ,bureau of the ,census or other ,state-based study the ,secretary determines is likely to yield accurate data regarding the number of such individuals in such service area2 or 7ii7 data provided by the grantee1 if the grantee routinely collects data on the primary language of the ,medicare beneficiaries that the grantee serves and the ,secretary determines that the data is accurate and shows a greater number of individuals who are limited ,english proficient than would be estimated using the data under clause 7i74 7,b7 ,discretion of ,secretary ,subject to subparagraph 7,c71 the amount of payment made to a grantee under this subsection may be modified annually at the discretion of the ,secretary1 based on changes in the data under subparagraph 7,a7 with respect to the service area of a grantee for the year4 7,c7 ,limitation on amount ,the amount of a grant made under this subsection to a grantee may not exceed #ejj1jjj for the period under paragraph 7#a77;,d74 7#g7 ,assurances ,grantees under this subsection shall1 as a condition of receiving a grant under this subsection-- 7,a7 ensure that clinical and support staff receive appropriate ongoing education and training in linguistically appropriate service delivery2 7,b7 ensure the linguistic competence of bilingual providers2 7,c7 offer and provide appropriate language services at no additional charge to each patient who is limited ,english proficient for all points of contact between the patient and the grantee1 in a timely manner during all hours of operation2 7,d7 notify ,medicare beneficiaries of their right to receive language services in their primary language at least annually2 7,e7 post signage in the primary languages commonly used by the patient population in the service area of the organization2 and 7,f7 ensure that-- 7i7 primary language data are collected for recipients of language services and such data are consistent with standards developed under title ,,xxxiv of the ,public ,health ,service ,act1 as added by section #bjjb of this ,act1 to the extent such standards are available upon the initiation of the demonstration program2 and 7ii7 consistent with the privacy protections provided under the regulations promulgated pursuant to section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acbj;d-#b note71 if the recipient of language services is a minor or is incapacitated1 primary language data must also be collected on the parent or legal guardian of such recipient4 7#h7 ,no ,cost ,sharing ,medicare beneficiaries who are limited ,english proficient shall not have to pay cost sharing or co-payments for competent language services provided under this demonstration program4 7#i7 ,reporting ,requirements for grantees ,not later than the end of each calendar year1 a grantee that receives funds under this subsection in such year shall submit to the ,secretary a report that includes the following information3 7,a7 ,the number of ,medicare beneficiaries to whom competent language services are provided1 disaggregated by age and entitlement basis 7on the basis of age1 disability1 or determination of end stage renal disease74 7,b7 ,the primary languages of those ,medicare beneficiaries4 7,c7 ,the types of language services provided to such beneficiaries4 7,d7 ,whether such language services were provided by employees of the grantee or through a contract with external contractors or agencies4 7,e7 ,the types of interpretation services provided to such beneficiaries1 and the approximate length of time such service is provided to such beneficiaries4 7,f7 ,the costs of providing competent language services4 7,g7 ,an account of the training or accreditation of bilingual staff1 interpreters1 and translators providing services funded by the grant under this subsection4 7#aj7 ,evaluation and report to ,congress ,not later than #a year after the completion of a #c-year grant under this subsection1 the ,secretary shall conduct an evaluation of the demonstration program under this subsection and shall submit to the ,congress a report that includes the following3 7,a7 ,an analysis of the patient outcomes and the costs of furnishing care to the ,medicare beneficiaries who are individuals who are limited ,english proficient participating in the project as compared to such outcomes and costs for such ,medicare beneficiaries not participating1 based on the data provided under paragraph 7#i7 and any other information available to the ,secretary4 7,b7 ,the effect of delivering language services on-- 7i7 ,medicare beneficiary access to care and utilization of services2 7ii7 the efficiency and cost-effectiveness of health care delivery2 7iii7 patient satisfaction with respect to both health service delivery and language assistance2 7iv7 health outcomes2 and 7v7 the provision of culturally appropriate services provided to such beneficiaries4 7,c7 ,the extent to which bilingual staff1 interpreters1 and translators providing services under such demonstration were trained or accredited and the nature of accreditation or training needed by type of provider1 service1 or other category as determined by the ,secretary to ensure the provision of high-quality interpretation1 translation1 or other language services to ,medicare beneficiaries if such services are expanded pursuant to section #aaae;,a7c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7c774 7,d7 ,recommendations1 if any1 regarding the extension of such project to the entire ,medicare ,program1 subject to the provisions of such section #aaae;,a7c74 7#aa7 ,appropriations ,there is appropriated to carry out this subsection1 in equal parts from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i7 and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda of such ,act 7#db ,u4,s4,c4 #aciet71 #af1jjj1jjj for each fiscal year of the demonstration program4 7#ab7 ,limited ,english proficient defined ,in this subsection1 the term limited ,english proficient means individuals who self-identify on the ,census as speaking ,english less than very well4 7b7 ,language assistance services under the ,medicare program 7#a7 ,inclusion as rural health clinic services ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended-- 7,a7 in subsection 7aa77#a7-- 7i7 in subparagraph 7,c71 by striking and at the end2 7ii7 in subparagraph 7,d71 by inserting and after the comma at the end2 and 7iii7 by inserting after subparagraph 7,d7 the following new subparagraph3 7,e7 language assistance services as defined in subsection 7nnn71 2 and 7,b7 by adding at the end the following new subsection3 7nnn7 ,language assistance services and related terms ,the term language assistance services means language access or language assistance services 7as those terms are defined in section #cdjj of the ,public ,health ,service ,act7 furnished by a qualified interpreter for an individual with limited ,english proficiency or a qualified translator 7as those terms are defined in such section #cdjj7 to an individual with limited ,english proficiency 7as defined in such section #cdjj74 4 7#b7 ,coverage ,section #ahcb7;a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciek7a77#b77 is amended-- 7,a7 in subparagraph 7,i71 by striking and at the end2 7,b7 in subparagraph 7,j71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,k7 language assistance services 7as defined in section #ahfa7nnn774 4 7#c7 ,payment ,section #ahcc7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77 is amended-- 7,a7 in paragraph 7#i71 by striking and at the end2 7,b7 in paragraph 7#aj71 by striking the period at the end and inserting 2 and2 and 7,c7 by inserting after paragraph 7#aj7 the following new paragraph3 7#aa7 in the case of language assistance services 7as defined in section #ahfa7nnn771 #ajj percent of the reasonable charges for such services1 as determined in consultation with the ,medicare ,payment ,advisory ,commission4 4 7#d7 ,waiver of budget neutrality ,for the #c-year period beginning on the date of enactment of this section1 the budget neutrality provision of section #ahdh7;c77#b77;,b77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77;,b77ii77 shall not apply with respect to language assistance services 7as defined in section #ahfa7nnn7 of such ,act74 7c7 ,medicare parts ,c and ,d2 ,medicare ,advantage plans and prescription drug plans reporting requirement ,section #aheg7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;e77 is amended by adding at the end the following new paragraph3 7#f7 ,reporting requirements relating to effective language services ,a contract under this part shall require a ,medicare ,advantage organization 7and1 through application of section #ahfj;,d-#ab7;b77#c77;,d71 a contract under section #ahfj;,d-#ab shall require a ,,pdp sponsor7 to annually submit 7for each year of the contract7 a report that contains information on the internal policies and procedures of the organization 7or sponsor7 related to recruitment and retention efforts directed to workforce diversity and linguistically and culturally appropriate provision of services in each of the following contexts3 7,a7 ,the collection of data in a manner that meets the requirements of title ,i of the ,health ,equity and ,accountability ,act of #bjbd1 regarding the enrollee population4 7,b7 ,education of staff and contractors who have routine contact with enrollees regarding the various needs of the diverse enrollee population4 7,c7 ,evaluation of the language services programs and services offered by the organization 7or sponsor7 with respect to the enrollee population1 such as through analysis of complaints or satisfaction survey results4 7,d7 ,methods by which the plan provides to the ,secretary information regarding the ethnic diversity of the enrollee population4 7,e7 ,the periodic provision of educational information to plan enrollees on the language services and programs offered by the organization 7or sponsor74 4 7d7 ,improving language services in ,medicaid and ,,chip 7#a7 ,payments to ,states ,section #aijc7;a77#b77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#b77;,e771 as amended by section #bjje7;h77#c71 is further amended by-- 7,a7 striking #ge and inserting #ie2 7,b7 striking translation or interpretation services and inserting language assistance services2 and 7,c7 striking children of families and inserting individuals4 7#b7 ,state plan requirements ,section #aijb7;a77#aj77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 is amended by striking and 7#cj7 and inserting 7#cj71 and 7#cb74 7#c7 ,definition of medical assistance ,section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is amended-- 7,a7 in paragraph 7#ca71 by striking and at the end2 7,b7 by redesignating paragraph 7#cb7 as paragraph 7#cc72 and 7,c7 by inserting after paragraph 7#ca7 the following new paragraph3 7#cb7 language assistance services1 as such term is defined in section #ahfa7nnn71 provided in a timely manner to individuals with limited ,english proficiency as defined in section #cdjj of the ,public ,health ,service ,act2 and 4 7#d7 ,use of deductions and cost sharing ,subsections 7a77#b7 and 7b77#b7 of section #aiaf of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo7 are each amended-- 7,a7 in subparagraph 7,i71 by striking or at the end2 7,b7 in subparagraph 7,j71 by striking 2 and and inserting 1 or2 and 7,c7 by adding at the end the following new subparagraph3 7,k7 language assistance services described in section #aije7;a77#cb72 and 4 7#e7 ,,chip coverage requirements ,section #bajc of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7 is amended-- 7,a7 in subsection 7a71 in the matter before paragraph 7#a71 by striking 7#e71 7#f71 7#g7 and 7#h7 and inserting 7#e7 through 7#ac72 7,b7 in subsection 7c71 by adding at the end the following new paragraph3 7#ac7 ,language assistance services ,the child health assistance provided to a targeted low-income child shall include coverage of language assistance services1 as such term is defined in section #ahfa7nnn71 provided in a timely manner to individuals with limited ,english proficiency 7as defined in section #cdjj of the ,public ,health ,service ,act74 2 and 7,c7 in subsection 7e77#b7-- 7i7 in the heading1 by striking preventive and inserting certain2 and 7ii7 by inserting language assistance services described in subsection 7c77#ab71 before or for pregnancy-related assistance4 7#f7 ,definition of child health assistance ,section #baaj7;a77#bg7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;jj7a77#bg77 is amended by striking transportation1 translation1 and outreach services and inserting transportation services1 language assistance services as described in section #bajc7;c77#ac71 and outreach services4 7#g7 ,state data collection ,pursuant to the reporting requirement described in section #bajg7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7b77#a771 the ,secretary of ,health and ,human ,services shall require that ,states collect data on-- 7,a7 the primary language of individuals receiving child health assistance under title ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq472 and 7,b7 in the case of such individuals who are minors or incapacitated1 the primary language of the individual's parent or guardian4 7#h7 ,,chip payments to ,states ,section #baje of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7 is amended-- 7,a7 in subsection 7a77#a7-- 7i7 in the matter preceding subparagraph 7,a71 by striking #ge and inserting #ie2 and 7ii7 in subparagraph 7,d77iv71 by striking translation or interpretation services and inserting language assistance services2 and 7,b7 in subsection 7c77#b77;,a71 by inserting before the period at the end the following3 1 except that expenditures pursuant to clause 7iv7 of subparagraph 7,d7 of such paragraph shall not count towards this total4 7e7 ,funding language assistance services furnished by providers of health care and health care-,related services that serve high rates of uninsured ,,lep individuals 7#a7 ,payment of costs 7,a7 ,in general ,subject to subparagraph 7,b71 the ,secretary of ,health and ,human ,services 7referred to in this subsection as the ,secretary7 shall make payments 7on a quarterly basis7 directly to eligible entities to support the provision of language assistance services to individuals with limited ,english proficiency in an amount equal to an eligible entity's eligible costs for providing such services for the quarter4 7,b7 ,funding ,out of any funds in the ,treasury not otherwise appropriated1 there are appropriated to the ,secretary such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 7,c7 ,relation to ,medicaid ,,dsh ,payments under this subsection shall not offset or reduce payments under section #aibc of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d71 nor shall payments under such section be considered when determining uncompensated costs associated with the provision of language assistance services for the purposes of this subsection4 7#b7 ,methodology for payment of claims 7,a7 ,in general ,the ,secretary shall establish a methodology to determine the average per person cost of language assistance services4 7,b7 ,different entities ,in establishing such methodology1 the ,secretary may establish different methodologies for different types of eligible entities4 7,c7 ,no individual claims ,the ,secretary may not require eligible entities to submit individual claims for language assistance services for individual patients as a requirement for payment under this subsection4 7#c7 ,data collection instrument ,for purposes of this subsection1 the ,secretary shall create a standard data collection instrument that is consistent with any existing reporting requirements by the ,secretary or relevant accrediting organizations regarding the number of individuals to whom language access is provided4 7#d7 ,guidelines ,not later than #f months after the date of enactment of this ,act1 the ,secretary shall establish and distribute guidelines concerning the implementation of this subsection4 7#e7 ,reporting requirements 7,a7 ,report to ,secretary ,entities receiving payment under this subsection shall provide the ,secretary with a quarterly report on how the entity used such funds4 ,such report shall contain aggregate 7and may not contain individualized7 data collected using the instrument under paragraph 7#c7 and shall otherwise be in a form and manner determined by the ,secretary4 7,b7 ,report to ,congress ,not later than #b years after the date of enactment of this ,act1 and every #b years thereafter1 the ,secretary shall submit a report to ,congress concerning the implementation of this subsection4 7#f7 ,definitions ,in this subsection3 7,a7 ,eligible costs ,the term eligible costs means1 with respect to an eligible entity that provides language assistance services to limited ,english proficient individuals1 the product of-- 7i7 the average per person cost of language assistance services1 determined according to the methodology devised under paragraph 7#b72 and 7ii7 the number of individuals with limited ,english proficiency who are provided language assistance services by the entity and for whom no reimbursement is available for such services under the amendments made by subsection 7a71 7b71 7c71 or 7d71 or by private health insurance4 7,b7 ,eligible entity ,the term eligible entity means an entity that-- 7i7 is a ,medicaid provider that is-- 7,i7 a physician2 7,,ii7 a hospital with a low-income utilization rate 7as defined in section #aibc7;b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;b77#c777 of greater than #be percent2 7,,iii7 a ,federally qualified health center 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7772 7,,iv7 a hospice provider2 or 7,v7 a palliative care provider2 7ii7 not later than #f months after the date of the enactment of this ,act1 provides language assistance services to not less than #h percent of the entity's total number of patients2 and 7iii7 prepares and submits an application to the ,secretary1 at such time1 in such manner1 and accompanied by such information as the ,secretary may require1 to ascertain the entity's eligibility for funding under this subsection4 7,c7 ,language assistance services ,the term language assistance services has the meaning given such term in section #ahfa7nnn7 of the ,social ,security ,act1 as added by subsection 7b74 7f7 ,application of ,civil ,rights ,act of #aifd1 section #aeeg of the ,affordable ,care ,act1 and other laws ,nothing in this section shall be construed to limit otherwise existing obligations of recipients of ,federal financial assistance under title ,,vi of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;d et seq471 section #aeeg of the ,affordable ,care ,act 7#db ,u4,s4,c4 #ahaaf71 or other laws that protect the civil rights of individuals4 7g7 ,effective date 7#a7 ,in general ,except as otherwise provided and subject to paragraph 7#b71 the amendments made by this section shall take effect on ,january #a1 #bjbe4 7#b7 ,exception if ,state legislation required ,in the case of a ,state plan for medical assistance under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 or a ,state plan for child health assistance under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;aa et seq47 which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirement imposed by the amendments made by this section1 such ,state plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of the enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4 #bjjh4 ,increasing understanding of and improving health literacy 7a7 ,in general ,the ,secretary1 in consultation with the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities and the ,deputy ,assistant ,secretary for ,minority ,health1 shall award grants to eligible entities to improve health care for patient populations that have low health literacy4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall-- 7#a7 be a hospital1 health center or clinic1 health plan1 or other health entity 7including a nonprofit minority health organization or association72 and 7#b7 prepare and submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may reasonably require4 7c7 ,use of funds 7#a7 ,agency for ,healthcare ,research and ,quality ,a grant under subsection 7a7 that is awarded through the ,director of the ,agency for ,healthcare ,research and ,quality shall be used-- 7,a7 to define and increase the understanding of health literacy across all areas of health care1 including end of life care2 7,b7 to investigate the correlation between low health literacy and health and health care2 7,c7 to clarify which aspects of health literacy have an effect on health outcomes2 and 7,d7 for any other activity determined appropriate by the ,director4 7#b7 ,health ,resources and ,services ,administration ,a grant under subsection 7a7 that is awarded through the ,administrator of the ,health ,resources and ,services ,administration shall be used to conduct demonstration projects for interventions for patients with low health literacy that may include-- 7,a7 the development of new disease management and end of life care programs for patients with low health literacy2 7,b7 the tailoring of disease management programs and end of life care addressing mental1 physical1 oral1 and behavioral health conditions for patients with low health literacy2 7,c7 the translation of written health materials for patients with low health literacy2 7,d7 the identification1 implementation1 and testing of low health literacy screening tools2 7,e7 the conduct of educational campaigns for patients and providers about low health literacy2 7,f7 the conduct of educational campaigns concerning health directed specifically at patients with mental disabilities1 including those with cognitive and intellectual disabilities1 designed to reduce the incidence of low health literacy among these populations1 which shall have instructional materials in the plain language standards promulgated under the ,plain ,writing ,act of #bjaj 7#e ,u4,s4,c4 #cja note7 for ,federal agencies2 and 7,g7 other activities determined appropriate by the ,administrator4 7d7 ,definitions ,in this section3 7#a7 ,low health literacy ,the term low health literacy means the inability of an individual to obtain1 process1 and understand basic health information and services needed to make appropriate health decisions4 7#b7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services-- 7,a7 acting through the ,director of the ,agency for ,healthcare ,research and ,quality1 with respect to grants under subsection 7c77#a72 and 7,b7 acting through the ,administrator of the ,health ,resources and ,services ,administration with respect to grants under subsection 7c77#b74 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #bjji4 ,requirements for health programs or activities receiving ,federal funds 7a7 ,covered entity2 health program or activity ,in this section3 7#a7 ,covered entity ,the term covered entity means an entity described in clause 7i7 of section #cdja7;a77#b77;,c7 of the ,public ,health ,service ,act1 as added by section #bjjd4 7#b7 ,health program or activity ,the term health program or activity has the meaning given such term in clause 7ii7 of such section #cdja7;a77#b77;,c74 7b7 ,requirements ,a covered entity1 in order to ensure the right of individuals with limited ,english proficiency to receive access to high-quality health care through the health program or activity1 shall-- 7#a7 ensure that appropriate clinical and support staff receive ongoing education and training in culturally and linguistically appropriate service delivery at least annually2 7#b7 offer and provide appropriate language assistance services at no additional charge to each patient that is an individual with limited ,english proficiency at all points of contact1 in a timely manner during all hours of operation2 7#c7 notify patients of their right to receive language services in their primary language2 and 7#d7 utilize only qualified interpreters for an individual with limited ,english proficiency or qualified translators1 except as provided in subsection 7c74 7c7 ,exemptions ,the requirements of subsection 7b77#d7 shall not apply as follows3 7#a7 ,when a patient requests the use of family1 friends1 or other persons untrained in interpretation or translation if each of the following conditions are met3 7,a7 ,the interpreter requested by the patient is over the age of #ah4 7,b7 ,the covered entity informs the patient in the primary language of the patient that he or she has the option of having the entity provide to the patient an interpreter and translation services without charge4 7,c7 ,the covered entity informs the patient that the entity may not require an individual with a limited ,english proficiency to use a family member or friend as an interpreter4 7,d7 ,the covered entity evaluates whether the person the patient wishes to use as an interpreter is competent4 ,if the covered entity has reason to believe that such person is not competent as an interpreter1 the entity provides its own interpreter to protect the covered entity from liability if the patient's interpreter is later found not competent4 7,e7 ,if the covered entity has reason to believe that there is a conflict of interest between the interpreter and patient1 the covered entity may not use the patient's interpreter4 7,f7 ,the covered entity has the patient sign a waiver1 witnessed by at least #a individual not related to the patient1 that includes the information stated in subparagraphs 7,a7 through 7,e7 and is translated into the patient's primary language4 7#b7 ,when a medical emergency exists and the delay directly associated with obtaining competent interpreter or translation services would jeopardize the health of the patient1 but only until a competent interpreter or translation service is available4 7d7 ,rule of construction ,subsection 7c77#b7 shall not be construed to mean that emergency rooms or similar entities that regularly provide health care services in medical emergencies are exempt from legal or regulatory requirements related to competent interpreter services4 #bjaj4 ,report on ,federal efforts to provide culturally and linguistically appropriate health care services 7a7 ,report ,not later than #a year after the date of enactment of this ,act1 and annually thereafter1 the ,secretary of ,health and ,human ,services shall seek to enter into a contract with the ,national ,academy of ,medicine for the preparation and publication of a report that describes ,federal efforts to ensure that all individuals with limited ,english proficiency have meaningful access to health care services and health care-related services that are culturally and linguistically appropriate4 ,such report shall include-- 7#a7 a description and evaluation of the activities carried out under this ,act2 7#b7 a description and analysis of best practices1 model programs1 guidelines1 and other effective strategies for providing access to culturally and linguistically appropriate health care services2 7#c7 recommendations on the development and implementation of policies and practices by providers of health care services and health care-related services for individuals with limited ,english proficiency1 including people with cognitive1 hearing1 vision1 or print impairments2 7#d7 recommend guidelines or standards for health literacy and plain language1 informed consent1 discharge instructions1 and written communications1 and for improvement of health care access2 7#e7 a description of the effect of providing language services on quality of health care and access to care2 and 7#f7 a description of the costs associated with or savings related to the provision of language services4 7b7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #bjaa4 ,english instruction for individuals with limited ,english proficiency 7a7 ,grants authorized ,the ,secretary of ,education is authorized to provide grants to eligible entities for the provision of ,english as a second language 7in this section referred to as ,,esl7 instruction to individuals with limited ,english proficiency1 including health care-related ,english instruction1 and shall determine1 after consultation with appropriate stakeholders1 the mechanism for administering and distributing such grants4 7b7 ,eligible entity ,in this section1 the term eligible entity means-- 7#a7 a ,state2 or 7#b7 a community-based organization that predominantly employs and serves racial and ethnic minority groups 7as defined in section #agjg7;g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g774 7c7 ,application ,an eligible entity that desires to receive a grant under this section shall apply by submitting to the ,secretary of ,education an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7d7 ,use of grant ,an eligible entity shall use grant funds provided under this section to-- 7#a7 develop and implement a plan for assuring the availability of ,,esl instruction1 free of charge1 to the community served by the eligible entity1 that effectively integrates information about the nature of the ,united ,states health care system1 how to access care1 and any special language skills that may be required for individuals with limited ,english proficiency to access and regularly negotiate the health care system effectively2 7#b7 develop a plan for making ,,esl instruction available free to charge to individuals with limited ,english proficiency in the community served by the eligible entity who are seeking instruction1 including1 where appropriate1 through the use of public-private partnerships2 and 7#c7 provide ,,esl instruction to individuals with limited ,english proficiency in the community served by the eligible entity4 7e7 ,supplement1 not supplant ,an eligible entity awarded a grant under this section shall use funds made available under this section to supplement1 and not supplant1 other ,federal1 ,state1 and local funds that would otherwise be expended to carry out activities under this section4 7f7 ,duties of the ,secretary ,the ,secretary of ,education shall-- 7#a7 collect and make publicly available annual data on how much ,federal1 ,state1 and local governments spend annually on ,,esl instruction2 7#b7 collect data from eligible entities awarded a grant under this section to identify the unmet needs of individuals with limited ,english proficiency for appropriate ,,esl instruction1 including-- 7,a7 the preferred written and spoken language of such individuals2 7,b7 the availability of enrollment in ,,esl instruction programs in the communities served by each eligible entity awarded a grant under this section1 including the extent of waiting lists for ,,esl instruction1 how many programs maintain waiting lists1 and1 for programs that do not have waiting lists1 the reasons why such a list is unnecessary or otherwise not maintained2 7,c7 the availability of programs to geographically isolated communities2 7,d7 the impact of course enrollment policies1 including open enrollment1 on the availability of ,,esl instruction2 7,e7 the number of individuals with limited ,english proficiency and the number of individuals enrolled in ,,esl instruction programs in the communities served by each eligible entity awarded a grant under this section2 7,f7 the effectiveness of the ,,esl instruction provided through grants awarded under this section in meeting the needs of individuals receiving such instruction2 and 7,g7 an assessment of the need for programs that integrate job training and ,,esl instruction1 to assist individuals with limited ,english proficiency in obtaining better jobs2 7#c7 determine the cost and most appropriate methods of making ,,esl instruction available to all individuals with limited ,english proficiency in the ,united ,states who are seeking instruction2 and 7#d7 not later than #a year after the date of enactment of this ,act1 issue a report to ,congress that-- 7,a7 assesses the information collected in paragraphs 7#a71 7#b71 and 7#c7 and makes recommendations on steps that should be taken to realize the goal of making ,,esl instruction available to all individuals with limited ,english proficiency in the ,united ,states who are seeking instruction2 and 7,b7 evaluates the impact of the grant program authorized under this section on the accessibility of1 and ability to effectively negotiate1 the health care system for individuals with limited ,english proficiency who have received ,,esl instruction funded by a grant under this section4 7g7 ,authorization of ,appropriations ,there are authorized to be appropriated to the ,secretary of ,education #bej1jjj1jjj for each of fiscal years #bjbe through #bjbi to carry out this section4 #bjab4 ,implementation 7a7 ,general provisions 7#a7 ,immunity ,a person injured by a violation of this title 7including an amendment made by this title7 by a ,state may bring a civil action in the appropriate ,federal court for such injury in accordance with this section4 7#b7 ,remedies ,in a civil action under this section for a violation of this title1 such remedies shall be available as would be available in a civil action for such violation against any party other than a ,state4 7b7 ,rule of construction ,nothing in this title may be construed to limit otherwise existing obligations of recipients of ,federal financial assistance under title ,,vi of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;d et seq47 or any other ,federal statute4 #bjac4 ,language access services 7a7 ,essential benefits ,section #acjb7;b77#a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;b77#a77 is amended by adding at the end the following3 7,k7 ,language access services1 including oral interpretation and written translations4 4 7b7 ,employer-,sponsored minimum essential coverage 7#a7 ,in general ,section #cf;,b7c77#b77;,c7 of the ,internal ,revenue ,code of #aihf is amended by redesignating clauses 7iii7 and 7iv7 as clauses 7iv7 and 7v71 respectively1 and by inserting after clause 7ii7 the following new clause3 7iii7 ,coverage must include language access and services ,except as provided in clause 7iv71 an employee shall not be treated as eligible for minimum essential coverage if such coverage consists of an eligible employer-sponsored plan 7as defined in section #ejjj;,a7f77#b77 and the plan does not provide coverage for language access services1 including oral interpretation and written translations4 4 7#b7 ,conforming amendments 7,a7 ,section #cf;,b7c77#b77;,c7 of such ,code is amended by striking clause 7iii7 each place it appears in clauses 7i7 and 7ii7 and inserting clause 7iv74 7,b7 ,section #cf;,b7c77#b77;,c77iv7 of such ,code1 as redesignated by this subsection1 is amended by striking 7i7 and 7ii7 and inserting 7i71 7ii71 and 7iii74 7c7 ,quality ,reporting ,section #bgag7;a77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ag7;a77#a77 is amended-- 7#a7 by striking and at the end of subparagraph 7,c72 7#b7 by striking the period at the end of subparagraph 7,d7 and inserting 2 and2 and 7#c7 by adding at the end the following new subparagraph3 7,e7 reduce health disparities through the provision of language access services1 including oral interpretation and written translations4 4 7d7 ,regulations regarding internal claims and appeals and external review processes for health plans and health insurance issuers ,the ,secretary of the ,treasury1 the ,secretary of ,labor1 and the ,secretary of ,health and ,human ,services shall amend the regulations in section #ed4ihae-bgai7;e7 of title #bf1 ,code of ,federal ,regulations 7or successor regulations71 section #beij4gae-bgai7;e7 of title #bi1 ,code of ,federal ,regulations 7or successor regulations71 and section #adg4acf7;e7 of title #de1 ,code of ,federal ,regulations 7or successor regulations71 respectively1 to require group health plans and health insurance issuers offering group or individual health insurance coverage to which such sections apply-- 7#a7 to provide oral interpretation services without any threshold requirements2 7#b7 to provide in the ,english versions of all notices a statement prominently displayed in not less than #ae non-,english languages clearly indicating how to access the language services provided by the plan or issuer2 and 7#c7 with respect to the requirements for providing relevant notices in a culturally and linguistically appropriate manner in the applicable non-,english languages1 to apply a threshold that #e percent of the population1 or not less than #ejj individuals1 in the county is literate only in the same non-,english language in order for the language to be considered an applicable non-,english language4 7e7 ,data collection and reporting ,the ,secretary of ,health and ,human ,services shall-- 7#a7 amend the single streamlined application form developed pursuant to section #adac of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjhc7 to collect the preferred spoken and written language for each household member applying for coverage under a qualified health plan through an ,exchange under title ,i of such ,act 7#db ,u4,s4,c4 #ahjja et seq472 7#b7 require navigators1 certified application counselors1 and other individuals assisting with enrollment to collect and report requests for language assistance2 and 7#c7 require the toll-free telephone hotlines established pursuant to section #acaa7;d77#d77;,b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;d77#d77;,b77 to submit an annual report documenting the number of language assistance requests1 the types of languages requested1 the range and average wait time for a consumer to speak with an interpreter1 the number of complaints and any steps the hotline1 and any entity contracting with the ,secretary to provide language services1 have taken to actively address some of the consumer complaints4 7f7 ,effective date ,the amendments made by this section shall not apply to plans beginning prior to the date of the enactment of this ,act4 #bjad4 ,medically underserved populations ,section #ccj7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c77 is amended to read as follows3 7#c7 ,medically underserved population ,the term medically underserved population means-- 7,a7 the population of an urban or rural area designated by the ,secretary as-- 7i7 an area with a shortage of personal health services2 or 7ii7 a population group having a shortage of such services2 or 7,b7 a population of individuals1 not confined to a particular urban or rural area1 who are designated by the ,secretary as having a shortage of personal health services due to a specific demographic trait4 4 ,,iii ,health workforce diversity #cjja4 ,amendment to the ,public ,health ,service ,act ,title ,,xxxiv of the ,public ,health ,service ,act1 as added by section #bjjd1 is amended by adding at the end the following3 ,b ,diversifying the ,health ,care ,workplace #cdaa4 ,national ,working ,group on ,workforce ,diversity 7a7 ,in general ,the ,secretary1 acting through the ,bureau of ,health ,workforce of the ,health ,resources and ,services ,administration1 shall award a grant to an entity determined appropriate by the ,secretary for the establishment of a national working group on workforce diversity4 7b7 ,representation ,in establishing the national working group under subsection 7a73 7#a7 ,the grantee shall ensure that the group has representatives of each of the following3 7,a7 ,the ,health ,resources and ,services ,administration4 7,b7 ,the ,department of ,health and ,human ,services ,data ,council4 7,c7 ,the ,office of ,minority ,health of the ,department of ,health and ,human ,services4 7,d7 ,the ,substance ,abuse and ,mental ,health ,services ,administration4 7,e7 ,the ,bureau of ,labor ,statistics of the ,department of ,labor4 7,f7 ,the ,national ,institute on ,minority ,health and ,health ,disparities4 7,g7 ,the ,agency for ,healthcare ,research and ,quality4 7,h7 ,the ,national ,academy of ,medicine4 7,i7 ,the ,indian ,health ,service4 7,j7 ,the ,centers for ,medicare ,medicaid ,services4 7,k7 ,the ,department of ,education4 7,l7 ,institutions described in section #cga7;a7 of the ,higher ,education ,act of #aife4 7,m7 ,consumer organizations4 7,n7 ,health professional associations1 including those that represent underrepresented minority populations4 7,o7 ,researchers in the area of health workforce4 7,p7 ,health workforce accreditation entities4 7,q7 ,private 7including nonprofit7 foundations that have sponsored workforce diversity initiatives4 7,r7 ,local and ,state health departments4 7,s7 ,representatives of community members to be included on admissions committees for health profession schools pursuant to subsection 7c77#i74 7,t7 ,national community-based organizations that serve as a national intermediary to their rural or urban affiliate members and have demonstrated capacity to train health care professionals4 7,u7 ,the ,veterans ,health ,administration4 7,v7 ,other entities determined appropriate by the ,secretary4 7#b7 ,the grantee shall ensure that1 in addition to the representatives under paragraph 7#a71 the working group has not less than #e health professions students representing various health profession fields and levels of training4 7c7 ,activities ,the working group established under subsection 7a7 shall convene at least twice each year to complete the following activities3 7#a7 ,review public and private health workforce diversity initiatives4 7#b7 ,identify successful health workforce diversity programs and practices4 7#c7 ,examine challenges relating to the development and implementation of health workforce diversity initiatives4 7#d7 ,draft a national strategic work plan for health workforce diversity1 including recommendations for public and private sector initiatives4 7#e7 ,develop a framework and methods for the evaluation of current and future health workforce diversity initiatives4 7#f7 ,develop recommended standards for workforce diversity that could be applicable to all health professions programs and programs funded under this ,act4 7#g7 ,develop guidelines to train health professionals to care for a diverse population4 7#h7 ,develop a workforce data collection or tracking system to identify where health professionals of racial and ethnic minority groups practice4 7#i7 ,develop a strategy for the inclusion of community members on admissions committees for health profession schools4 7#aj7 ,help with monitoring of standards for diversity1 equity1 and inclusion4 7#aa7 ,other activities determined appropriate by the ,secretary4 7d7 ,annual report ,not later than #a year after the establishment of the working group under subsection 7a71 and annually thereafter1 the working group shall prepare and make available to the general public for comment1 an annual report on the activities of the working group4 ,such report shall include the recommendations of the working group for improving health workforce diversity4 7e7 ,coordination with other efforts ,in providing for the establishment of the working group under subsection 7a71 the ,secretary shall take such steps as may be necessary to ensure that the work of the working group does not overlap with1 or otherwise duplicate1 other ,federal ,government efforts with respect to ensuring health equity in data collection in public health emergencies4 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #cdab4 ,technical ,clearinghouse for health workforce diversity 7a7 ,in general ,the ,secretary1 acting through the ,deputy ,assistant ,secretary for ,minority ,health1 and in collaboration with the ,bureau of ,health ,workforce within the ,health ,resources and ,services ,administration and the ,national ,institute on ,minority ,health and ,health ,disparities1 shall establish a technical clearinghouse on health workforce diversity within the ,office of ,minority ,health and coordinate current and future clearinghouses related to health workforce diversity4 7b7 ,information and services ,the clearinghouse established under subsection 7a7 shall offer the following information and services3 7#a7 ,information on the importance of health workforce diversity4 7#b7 ,statistical information relating to representation of underrepresented minority populations in health and allied health professions and occupations4 7#c7 ,model health workforce diversity practices and programs1 including integrated models of care4 7#d7 ,admissions policies that promote health workforce diversity and are in compliance with ,federal and ,state laws4 7#e7 ,retainment policies that promote completion of health profession degrees for underserved populations4 7#f7 ,lists of scholarship1 loan repayment1 and loan cancellation grants as well as fellowship information for underserved populations for health professions schools4 7#g7 ,foundation and other large organizational initiatives relating to health workforce diversity4 7c7 ,consultation ,in carrying out this section1 the ,secretary shall consult with non-,federal entities which may include health professional associations representing minority populations and sections of major health professional associations representing minority populations to ensure the adequacy and accuracy of information4 7d7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #cdac4 ,support for institutions committed to workforce diversity1 equity1 and inclusion 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration and the ,director of the ,centers for ,disease ,control and ,prevention1 shall award grants to eligible entities that demonstrate a commitment to health workforce diversity4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall-- 7#a7 be an educational institution or entity that historically produces or trains meaningful numbers of underrepresented health professionals of minority populations1 including-- 7,a7 part ,b institutions1 as defined in section #cbb of the ,higher ,education ,act of #aife2 7,b7 historically ,black professional or graduate institutions eligible for grants under section #cbf of such ,act2 7,c7 ,hispanic-serving health professions schools2 7,d7 ,hispanic-serving institutions1 as defined in section #ejb of such ,act2 7,e7 ,tribal ,colleges or ,universities1 as defined in section #caf of such ,act2 7,f7 ,asian ,american and ,native ,american ,pacific ,islander-serving institutions1 as defined in section #cga7;c7 of such ,act2 7,g7 institutions that have programs to recruit and retain underrepresented health professionals of minority populations1 in which a significant number of the enrolled participants are from minority populations2 7,h7 health professional associations1 which may include health professional associations representing underrepresented minority populations2 and 7,i7 institutions1 including national and regional community-based organizations with demonstrated commitment to a diversified workforce-- 7i7 located in communities with predominantly underrepresented minority populations2 7ii7 with whom partnerships have been formed for the purpose of increasing workforce diversity2 and 7iii7 in which at least #bj percent of the enrolled participants are from underrepresented minority populations2 and 7#b7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,amounts received under a grant under subsection 7a7 shall be used to expand existing workforce diversity programs1 implement new workforce diversity programs1 or evaluate existing or new workforce diversity programs1 including with respect to mental health care professions4 ,such programs shall enhance diversity by considering status as a member of a minority population as part of an individualized consideration of qualifications4 ,possible activities may include-- 7#a7 educational outreach programs relating to opportunities in the health professions2 7#b7 scholarship1 fellowship1 grant1 loan repayment1 and loan cancellation programs2 7#c7 postbaccalaureate programs2 7#d7 academic enrichment programs1 particularly targeting those who would not be competitive for health professions schools2 7#e7 supporting workforce diversity in kindergarten through #abth grade and other health pipeline programs2 7#f7 mentoring programs2 7#g7 internship or rotation programs involving hospitals1 health systems1 health plans1 and other health entities2 7#h7 community partnership development for purposes relating to workforce diversity2 or 7#i7 leadership training4 7d7 ,reports ,not later than #a year after receiving a grant under this section1 and annually for the term of the grant1 a grantee shall submit to the ,secretary a report that summarizes and evaluates all activities conducted under the grant4 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #cdad4 ,career development for scientists and researchers 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,national ,institutes of ,health1 the ,director of the ,centers for ,disease ,control and ,prevention1 the ,commissioner of ,food and ,drugs1 the ,director of the ,agency for ,healthcare ,research and ,quality1 and the ,administrator of the ,health ,resources and ,services ,administration1 shall award grants that expand existing opportunities for scientists and researchers and promote the inclusion of underrepresented minority populations in the health professions4 7b7 ,research funding ,the head of each agency listed in subsection 7a7 shall establish or expand existing programs to provide research funding to scientists and researchers in training4 ,under such programs1 the head of each such entity shall give priority in allocating research funding to support health research in traditionally underserved communities1 including underrepresented minority populations1 and research classified as community or participatory4 7c7 ,data collection ,the head of each agency listed in subsection 7a7 shall collect data on the number 7expressed as an absolute number and a percentage7 of underrepresented applicants from minority populations1 and applicants from populations that are not minority populations1 who receive and are denied agency funding at every stage of review4 ,such data shall be reported annually to the ,secretary and the appropriate committees of ,congress4 7d7 ,student loan reimbursement ,the ,secretary shall establish a student loan reimbursement program to provide student loan reimbursement assistance to researchers who focus on racial and ethnic disparities in health4 ,the ,secretary shall promulgate regulations to define the scope and procedures for the program under this subsection4 7e7 ,student loan cancellation ,the ,secretary shall establish a student loan cancellation program to provide student loan cancellation assistance to researchers who focus on racial and ethnic disparities in health4 ,students participating in the program shall make a minimum #e-year commitment to work at an accredited health professions school4 ,the ,secretary shall promulgate additional regulations to define the scope and procedures for the program under this subsection4 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #cdae4 ,career support for nonresearch health professionals 7a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 the ,assistant ,secretary for ,mental ,health and ,substance ,use1 the ,administrator of the ,health ,resources and ,services ,administration1 and the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall establish a program to award grants to universities and other institutions to enter into agreements with eligible individuals under which-- 7#a7 the university or institution supports the eligible individual's career in a nonresearch-related health and wellness profession2 and 7#b7 the eligible individual commits to performing a period of obligated service in such a career to serve1 or to work on health issues affecting1 underserved communities1 such as communities of racial and ethnic minority groups4 7b7 ,eligible individuals ,to be an eligible individual for purposes of subsection 7a71 an individual shall be a student in a health professions school1 a graduate of such a school who is working in a health profession1 an individual working in a health or wellness profession 7including mental and behavioral health71 or a faculty member of such a school4 7c7 ,application ,to seek a grant under this section1 a university or other institution shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7d7 ,use of funds ,a university or other institution receiving a grant under this section shall use the grant for agreements described in subsection 7a74 ,such agreements may-- 7#a7 support an eligible individual's health activities or projects that involve underserved communities1 including communities of racial and ethnic minority groups2 7#b7 support an eligible individual's health-related career advancement activities2 7#c7 pay1 or reimburse for payment of1 student loans or training or credentialing costs for eligible individuals who are health professionals and are focused on health issues affecting underserved communities1 including communities of racial and ethnic minority groups2 and 7#d7 establish and promote leadership training programs for eligible individuals to decrease health disparities and to increase cultural competence with the goal of increasing diversity in leadership positions4 7e7 ,definition ,in this section1 the term career in a nonresearch-related health and wellness profession means employment or intended employment in the field of public health1 health policy1 health management1 health administration1 medicine1 nursing1 pharmacy1 psychology1 social work1 psychiatry1 other mental and behavioral health1 allied health1 community health1 social work1 or other fields determined appropriate by the ,secretary1 other than in a position that involves research4 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #cdaf4 ,research on the effect of workforce diversity on quality 7a7 ,in general ,the ,director of the ,agency for ,healthcare ,research and ,quality 7in this section referred to as the ,director71 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health and the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities1 shall award grants to eligible entities to expand research on the link between health workforce diversity and quality health care4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall-- 7#a7 be a clinical1 public health1 or health services research entity or other entity determined appropriate by the ,director2 and 7#b7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,amounts received under a grant awarded under subsection 7a7 shall be used to support research that investigates the effect of health workforce diversity on-- 7#a7 language access2 7#b7 cultural competence2 7#c7 patient satisfaction2 7#d7 timeliness of care2 7#e7 safety of care2 7#f7 effectiveness of care2 7#g7 efficiency of care2 7#h7 patient outcomes2 7#i7 community engagement2 7#aj7 resource allocation2 7#aa7 organizational structure2 7#ab7 compliance of care2 or 7#ac7 other topics determined appropriate by the ,director4 7d7 ,priority ,in awarding grants under subsection 7a71 the ,director shall give individualized consideration to all relevant aspects of the applicant's background4 ,consideration of prior research experience involving the health of underserved communities shall be such a relevant aspect4 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #cdag4 ,health disparities education program 7a7 ,establishment ,the ,secretary1 acting through the ,office of ,minority ,health1 in collaboration with the ,national ,institute on ,minority ,health and ,health ,disparities1 the ,office for ,civil ,rights1 the ,centers for ,disease ,control and ,prevention1 the ,centers for ,medicare ,medicaid ,services1 the ,health ,resources and ,services ,administration1 and other appropriate public and private entities1 shall establish and coordinate a health and health care disparities education program to support1 develop1 and implement educational initiatives and outreach strategies that inform health care professionals and the public about the existence of and methods to reduce racial and ethnic disparities in health and health care4 7b7 ,activities ,the ,secretary1 through the education program established under subsection 7a71 shall1 through the use of public awareness and outreach campaigns targeting the general public and the medical community at large-- 7#a7 disseminate scientific evidence for the existence and extent of racial and ethnic disparities in health care1 including disparities that are not otherwise attributable to known factors such as access to care1 patient preferences1 or appropriateness of intervention1 as described in the #bjjb report of the ,national ,academy of ,medicine 7formerly the ,institute of ,medicine7 entitled ,unequal ,treatment3 ,confronting ,racial and ,ethnic ,disparities in ,health ,care1 as well as the impact of disparities related to age1 disability status1 socioeconomic status1 sex1 gender identity1 and sexual orientation on racial and ethnic minority groups2 7#b7 disseminate new research findings to health care providers and patients to assist them in understanding1 reducing1 and eliminating health and health care disparities2 7#c7 disseminate information about the impact of linguistic and cultural barriers on health care quality and the obligation of health providers who receive ,federal financial assistance to ensure that individuals with limited ,english proficiency have access to language access services2 7#d7 disseminate information about the importance and legality of racial1 ethnic1 disability status1 socioeconomic status1 sex1 gender identity1 and sexual orientation1 and primary language data collection1 analysis1 and reporting2 7#e7 design and implement specific educational initiatives to health care providers relating to health and health care disparities2 7#f7 assess the impact of the programs established under this section in raising awareness of health and health care disparities and providing information on available resources2 and 7#g7 design and implement specific educational initiatives to educate the health care workforce relating to unconscious bias4 7c7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 4 #cjjb4 ,hispanic-serving institutions1 historically ,black colleges and universities1 historically ,black professional or graduate institutions1 ,asian ,american and ,native ,american ,pacific ,islander-serving institutions1 ,tribal ,colleges1 regional community-based organizations1 and national minority medical associations ,part ,b of title ,,vii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bic et seq47 is amended by adding at the end the following3 #gdb4 ,hispanic-serving institutions1 historically ,black colleges and universities1 historically ,black professional or graduate institutions1 ,asian ,american and ,native ,american ,pacific ,islander-serving institutions1 and ,tribal ,colleges 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration and in consultation with the ,secretary of ,education1 shall award grants to ,hispanic-serving institutions1 historically ,black colleges and universities1 historically ,black professional or graduate institutions eligible for grants under section #cbf of the ,higher ,education ,act of #aife1 ,asian ,american and ,native ,american ,pacific ,islander-serving institutions1 ,tribal ,colleges or ,universities1 regional community-based organizations1 and national minority medical associations1 for counseling1 mentoring1 and providing information on financial assistance to prepare underrepresented minority individuals to enroll in and graduate from health professional schools and to increase services for underrepresented minority students including-- 7#a7 mentoring with underrepresented health professionals2 7#b7 providing financial assistance information for continued education and applications to health professional schools2 and 7#c7 retaining existing enrolled underrepresented minority students in a health professions school4 7b7 ,definitions ,in this section3 7#a7 ,asian ,american and ,native ,american ,pacific ,islander-serving institution ,the term ,asian ,american and ,native ,american ,pacific ,islander-serving institution has the meaning given such term in section #cbj7;b7 of the ,higher ,education ,act of #aife4 7#b7 ,hispanic-serving institution ,the term ,hispanic-serving institution means an entity that-- 7,a7 is a school or program for which there is a definition under section #gii;,b2 7,b7 has an enrollment of full-time equivalent students that is made up of at least #i percent ,hispanic students2 7,c7 has been effective in carrying out programs to recruit ,hispanic individuals to enroll in and graduate from the school2 7,d7 has been effective in recruiting and retaining ,hispanic faculty members2 7,e7 has a significant number of graduates who are providing health services to medically underserved populations or to individuals in health professional shortage areas2 and 7,f7 is a ,hispanic ,center of ,excellence in ,health ,professions ,education designated under section #gcf7;d77#b74 7#c7 ,historically ,black college and university ,the term historically ,black college and university has the meaning given the term part ,b institution as defined in section #cbb of the ,higher ,education ,act of #aife4 7#d7 ,tribal college or university ,the term ,tribal ,college or ,university has the meaning given such term in section #caf7;b7 of the ,higher ,education ,act of #aife4 7c7 ,certain loan repayment programs ,in carrying out the ,national ,health ,service ,corps ,loan ,repayment ,program established under subpart ,,iii of part ,d of title ,,iii and the loan repayment program under section #cag;,f1 the ,secretary shall ensure1 notwithstanding such subpart or section1 that loan repayments of not less than #ej1jjj per year per person are awarded for repayment of loans incurred for enrollment or participation of underrepresented minority individuals in health professional schools and other health programs described in this section4 7d7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 4 #cjjc4 ,loan repayment program of ,centers for ,disease ,control and ,prevention ,section #cag;,f7c77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#g7;c77#a77 is amended by striking #ejj1jjj for fiscal year #aiid1 and such sums as may be necessary for each of the fiscal years #aiie through #bjjb and inserting such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #cjjd4 ,cooperative agreements for online degree programs at schools of public health and schools of allied health ,part ,d of title ,,vii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bid et seq47 is amended by inserting after section #gee of such ,act 7#db ,u4,s4,c4 #bid;e7 the following3 #gee;,a4 ,cooperative agreements for online degree programs 7a7 ,cooperative agreements ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 in consultation with the ,director of the ,centers for ,disease ,control and ,prevention1 the ,director of the ,agency for ,healthcare ,research and ,quality1 and the ,deputy ,assistant ,secretary for ,minority ,health1 shall enter into cooperative agreements with schools of public health and schools of allied health to design and implement online degree programs4 7b7 ,priority ,in entering into cooperative agreements under this section1 the ,secretary shall give priority to any school of public health or school of allied health that has an established track record of serving medically underserved communities4 7c7 ,requirements ,as a condition of entering into a cooperative agreement with the ,secretary under this section1 a school of public health or school of allied health shall agree to design and implement an online degree program that meets the following restrictions3 7#a7 ,enrollment of individuals who have obtained a secondary school diploma or its recognized equivalent4 7#b7 ,maintaining a significant enrollment of underrepresented minority or disadvantaged students4 7#c7 ,achieving a high completion rate of enrolled underrepresented minority or disadvantaged students4 7d7 ,period of cooperative agreements ,the period during which payments are made through a cooperative agreement entered into under this section may not exceed #c years4 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 4 #cjje4 ,national ,health ,care ,workforce ,commission 7a7 ,sense of ,congress ,it is the sense of ,congress that the ,national ,health ,care ,workforce ,commission established by section #eaja of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #bidq7 should1 in carrying out its assigned duties under that section1 give attention to the needs of racial and ethnic minority groups1 individuals with lower socioeconomic status1 individuals with mental1 developmental1 and physical disabilities1 lesbian1 gay1 bisexual1 transgender1 queer1 and questioning populations1 and individuals who are members of multiple minority or special population groups4 7b7 ,reauthorization ,section #eaja7;h77#b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #bidq7h77#b77 is amended by striking such sums as may be necessary and inserting #c1jjj1jjj for each of fiscal years #bjbe through #bjbg4 #cjjf4 ,scholarship and fellowship programs ,subtitle ,b of title ,,xxxiv of the ,public ,health ,service ,act1 as added by section #cjja1 is further amended by inserting after section #cdag the following3 #cdah4 ,david ,satcher ,public ,health and ,health ,services ,corps 7a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention1 in collaboration with the ,administrator of the ,health ,resources and ,services ,administration and the ,deputy ,assistant ,secretary for ,minority ,health1 shall award grants to eligible entities to increase awareness among secondary and postsecondary students of career opportunities in the health professions4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall-- 7#a7 be a clinical1 public health1 or health services organization1 community-based or nonprofit entity1 or other entity determined appropriate by the ,director of the ,centers for ,disease ,control and ,prevention2 7#b7 serve a health professional shortage area1 as determined by the ,secretary2 7#c7 work with students1 including those from racial and ethnic minority groups1 that have expressed an interest in the health professions2 and 7#d7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,grant awards under subsection 7a7 shall be used to support internships that will increase awareness among students of non-research-based1 career opportunities in the following health professions3 7#a7 ,medicine4 7#b7 ,nursing4 7#c7 ,public health4 7#d7 ,pharmacy4 7#e7 ,health administration and management4 7#f7 ,health policy4 7#g7 ,psychology4 7#h7 ,dentistry4 7#i7 ,international health4 7#aj7 ,social work4 7#aa7 ,allied health4 7#ab7 ,psychiatry4 7#ac7 ,hospice care4 7#ad7 ,community health1 patient navigation1 and peer support4 7#ae7 ,other professions determined appropriate by the ,director of the ,centers for ,disease ,control and ,prevention4 7d7 ,priority ,in awarding grants under subsection 7a71 the ,director of the ,centers for ,disease ,control and ,prevention shall give priority to those entities that-- 7#a7 serve a high proportion of individuals from disadvantaged backgrounds2 7#b7 have experience in health disparity elimination programs2 7#c7 facilitate the entry of disadvantaged individuals into institutions of higher education2 and 7#d7 provide counseling or other services designed to assist disadvantaged individuals in successfully completing their education at the postsecondary level4 7e7 ,stipends 7#a7 ,in general ,subject to paragraph 7#b71 an entity receiving a grant under this section may use the funds made available through such grant to award stipends for educational and living expenses to students participating in the internship supported by the grant4 7#b7 ,limitations ,a stipend awarded under paragraph 7#a7 to an individual-- 7,a7 may not be provided for a period that exceeds #f months2 and 7,b7 may not exceed #bj per day for an individual 7notwithstanding any other provision of law regarding the amount of a stipend74 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #cdai4 ,louis ,stokes ,public ,health ,scholars ,program 7a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health1 shall award scholarships to eligible individuals under subsection 7b7 who seek a career in public health4 7b7 ,eligibility ,to be eligible to receive a scholarship under subsection 7a71 an individual shall-- 7#a7 have interest1 knowledge1 or skill in public health research or public health practice1 or other health professions as determined appropriate by the ,director of the ,centers for ,disease ,control and ,prevention2 7#b7 reside in a health professional shortage area as determined by the ,secretary2 7#c7 demonstrate promise for becoming a leader in public health2 7#d7 secure admission to a #d-year institution of higher education2 and 7#e7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,amounts received under an award under subsection 7a7 shall be used to support opportunities for students to become public health professionals4 7d7 ,priority ,in awarding grants under subsection 7a71 the ,director shall give priority to those students that-- 7#a7 are from disadvantaged backgrounds2 7#b7 have secured admissions to an institution described in section #cga7;a7 of the ,higher ,education ,act of #aife2 and 7#c7 have identified a health professional as a mentor at their institution described in subsection 7b77#d7 and an academic advisor to assist in the completion of their baccalaureate degree4 7e7 ,scholarships ,the ,secretary may approve payment of scholarships under this section for such individuals for any period of education in student undergraduate tenure1 except that such a scholarship may not be provided to an individual for more than #d years1 and such a scholarship may not exceed #aj1jjj per academic year for an individual 7notwithstanding any other provision of law regarding the amount of a scholarship74 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #cdbj4 ,patsy ,mink ,health and ,gender ,research ,fellowship ,program 7a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health1 the ,assistant ,secretary for ,mental ,health and ,substance ,use1 and the ,director of the ,indian ,health ,service1 shall award research fellowships to eligible individuals under subsection 7b7 to conduct research that will examine gender and health disparities and to pursue a career in the health professions4 7b7 ,eligibility ,to be eligible to receive a fellowship under subsection 7a71 an individual shall-- 7#a7 have experience in health research or public health practice2 7#b7 reside in a health professional shortage area designated by the ,secretary under section #ccb2 7#c7 have expressed an interest in the health professions2 7#d7 demonstrate promise for becoming a leader in the field of women's sexual and reproductive health1 including family planning2 7#e7 secure admission to a health professions school or graduate program with an emphasis in gender studies2 and 7#f7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,a fellowship awarded under subsection 7a7 to an eligible individual under subsection 7b7 shall be used to support an opportunity for the individual to become a researcher and advance the research base on the intersection between gender and health4 7d7 ,priority ,in awarding fellowships under subsection 7a71 the ,director of the ,centers for ,disease ,control and ,prevention shall give priority to those applicants that-- 7#a7 are from disadvantaged backgrounds2 and 7#b7 have identified a mentor and academic advisor who will assist in the completion of their graduate or professional degree and have secured a research assistant position with a researcher working in the area of gender and health4 7e7 ,fellowships ,the ,director of the ,centers for ,disease ,control and ,prevention may approve fellowships for individuals under this section for any period of education in the student's graduate or health profession tenure1 except that such a fellowship may not be provided to an individual for more than #c years1 and such a fellowship may not exceed #ah1jjj per academic year for an individual 7notwithstanding any other provision of law regarding the amount of a fellowship74 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #cdba4 ,paul ,david ,wellstone ,international ,health ,fellowship ,program 7a7 ,in general ,the ,director of the ,agency for ,healthcare ,research and ,quality1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health1 shall award research fellowships to eligible individuals under subsection 7b7 to advance their understanding of international health4 7b7 ,eligibility ,to be eligible to receive a fellowship under subsection 7a71 an individual shall-- 7#a7 have educational experience in the field of international health2 7#b7 reside in a health professional shortage area as determined by the ,secretary2 7#c7 demonstrate promise for becoming a leader in the field of international health2 7#d7 be in the fourth year of a #d-year institution of higher education or a recent graduate of a #d-year institution of higher education2 and 7#e7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,a fellowship awarded under subsection 7a7 to an eligible individual under subsection 7b7 shall be used to support an opportunity for the individual to become a health professional and to advance the knowledge of the individual about international issues relating to health care access and quality4 7d7 ,priority ,in awarding fellowships under subsection 7a71 the ,director of the ,agency for ,healthcare ,research and ,quality shall give priority to eligible individuals under subsection 7b7 that-- 7#a7 are from a disadvantaged background2 and 7#b7 have identified a mentor at a health professions school or institution1 an academic advisor to assist in the completion of their graduate or professional degree1 and an advisor from an international health non-governmental organization1 private volunteer organization1 or other international institution or program that focuses on increasing health care access and quality for residents in developing countries4 7e7 ,fellowships ,a fellowship awarded under this section may not-- 7#a7 be provided to an eligible individual for more than a period of #f months2 7#b7 be awarded to a graduate of a #d-year institution of higher education that has not been enrolled in such institution for more than #a year2 or 7#c7 exceed #d1jjj per academic year 7notwithstanding any other provision of law regarding the amount of a fellowship74 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #cdbb4 ,edward ,r4 ,roybal ,health ,scholar ,program 7a7 ,in general ,the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 and the ,administrator of the ,health ,resources and ,services ,administration1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health1 shall award grants to eligible entities under subsection 7b7 to expose entering graduate students to the health professions4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall-- 7#a7 be a clinical1 public health1 or health services organization1 community-based1 academic1 or nonprofit entity1 or other entity determined appropriate by the ,director of the ,agency for ,healthcare ,research and ,quality2 7#b7 serve in a health professional shortage area designated by the ,secretary under section #ccb2 7#c7 work with students obtaining a degree in the health professions2 and 7#d7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,use of funds ,amounts received under a grant awarded under subsection 7a7 shall be used to support opportunities that expose students to non-research-based health professions1 including-- 7#a7 public health policy2 7#b7 health care and pharmaceutical policy2 7#c7 health care administration and management2 7#d7 health economics2 and 7#e7 other professions determined appropriate by the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 or the ,administrator of the ,health ,resources and ,services ,administration4 7d7 ,priority ,in awarding grants under subsection 7a71 the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 and the ,administrator of the ,health ,resources and ,services ,administration1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health1 shall give priority to entities that-- 7#a7 have experience with health disparity elimination programs2 7#b7 facilitate training in the fields described in subsection 7c72 and 7#c7 provide counseling or other services designed to assist students in successfully completing their education at the postsecondary level4 7e7 ,stipends 7#a7 ,in general ,subject to paragraph 7#b71 an entity receiving a grant under this section may use the funds made available through such grant to award stipends for educational and living expenses to students participating in the opportunities supported by the grant4 7#b7 ,limitations ,a stipend awarded under paragraph 7#a7 to an individual-- 7,a7 may not be provided for a period that exceeds #b months2 and 7,b7 may not exceed #ajj per day 7notwithstanding any other provision of law regarding the amount of a stipend74 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #cdbc4 ,leadership fellowship programs 7a7 ,in general ,the ,secretary shall award grants to national minority medical or health professional associations to develop leadership fellowship programs for underrepresented health professionals in order to-- 7#a7 assist such professionals in becoming future leaders in public health and health care delivery institutions2 and 7#b7 increase diversity in decision-making positions that can improve the health of underserved communities4 7b7 ,use of funds ,a leadership fellowship program supported under this section shall-- 7#a7 focus on training mid-career physicians and health care executives who have documented leadership experience and a commitment to public health services in underserved communities2 and 7#b7 support ,federal public health policy and budget programs1 and priorities that impact health equity1 through activities such as didactic lectures and leader site visits4 7c7 ,period of grants ,the period during which payments are made under a grant awarded under subsection 7a7 may not exceed #c years4 7d7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 4 #cjjg4 ,mc,nair ,postbaccalaureate ,achievement ,program ,section #djb;,e of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajgj;a-#ae7 is amended by striking subsection 7g7 and inserting the following3 7g7 ,collaboration in health profession diversity training programs ,the ,secretary shall coordinate with the ,secretary of ,health and ,human ,services to ensure that there is collaboration between the goals of the program under this section and programs of the ,health ,resources and ,services ,administration that promote health workforce diversity4 ,the ,secretary of ,education shall take such measures as may be necessary to encourage students participating in projects assisted under this section to consider health profession careers4 7h7 ,funding ,from amounts appropriated pursuant to the authority of section #djb;,a7g71 the ,secretary shall1 to the extent practicable1 allocate funds for projects authorized by this section in an amount that is not less than #ca1jjj1jjj for each of the fiscal years #bjbe through #bjbi4 4 #cjjh4 ,rules for determination of full-time equivalent residents for cost-reporting periods 7a7 ,,dgme determinations ,section #ahhf7;h77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77#d771 as amended by section #bjjf7;a71 is amended-- 7#a7 in subparagraph 7,e71 by striking ,subject to subparagraphs 7,j7 and 7,k71 such rules and inserting ,subject to subparagraphs 7,j71 7,k71 and 7,m71 such rules2 7#b7 in subparagraph 7,j71 by striking ,such rules and inserting ,subject to subparagraph 7,m71 such rules2 7#c7 in subparagraph 7,k71 by striking ,in determining and inserting ,subject to subparagraph 7,m71 in determining2 and 7#d7 by adding at the end the following new subparagraph3 7,m7 ,treatment of certain residents and interns ,for purposes of cost-reporting periods beginning on or after ,october #a1 #bjbe1 in determining the hospital's number of full-time equivalent residents for purposes of this paragraph1 all time spent by an intern or resident in an approved medical residency training program shall be counted toward the determination of full-time equivalency if the hospital-- 7i7 is recognized as a subsection 7d7 hospital2 7ii7 is recognized as a subsection 7d7 ,puerto ,rico hospital2 7iii7 is reimbursed under a reimbursement system authorized under section #ahad7;b77#c72 or 7iv7 is a provider-based hospital outpatient department4 4 7b7 ,,ime determinations ,section #ahhf7;d77#e77;,b77xi7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77xi77 is amended-- 7#a7 in subclause 7,,ii71 by striking ,in determining and inserting ,subject to subclause 7,,iv71 in determining2 7#b7 in subclause 7,,iii71 by striking ,in determining and inserting ,subject to subclause 7,,iv71 in determining2 and 7#c7 by inserting after subclause 7,,iii7 the following new subclause3 7,,iv7 ,for purposes of cost-reporting periods beginning on or after ,october #a1 #bjbe1 the provisions of subparagraph 7,m7 of subsection 7h77#d7 shall apply under this subparagraph in the same manner as they apply under such subsection4 4 #cjji4 ,developing and implementing strategies for local health equity 7a7 ,grants ,the ,secretary of ,health and ,human ,services1 acting jointly with the ,secretary of ,education and the ,secretary of ,labor1 shall make grants to eligible institutions of higher educations for the purposes of-- 7#a7 in accordance with subsection 7b71 developing capacity-- 7,a7 to build an evidence base for successful strategies for increasing local health equity2 and 7,b7 to serve as national models of driving local health equity2 and 7#b7 in accordance with subsection 7c71 developing a strategic partnership with the community in which the institution is located4 7b7 ,developing capacity for increasing local health equity ,as a condition of receipt of a grant under subsection 7a71 an institution of higher education shall agree to use such grant to build an evidence base for successful strategies for increasing local health equity1 and to serve as a national model of driving local health equity1 by supporting-- 7#a7 resources to strengthen institutional metrics and capacity to execute institution-wide health workforce goals that can serve as models for increasing health equity in communities across the ,united ,states2 7#b7 collaborations among a cohort of institutions in implementing systemic change1 partnership development1 and programmatic efforts supportive of health equity goals across disciplines and populations2 and 7#c7 enhanced or newly developed data systems and research infrastructure capable of informing current and future workforce efforts and building a foundation for a broader research agenda targeting urban health disparities4 7c7 ,strategic partnerships ,as a condition of receipt of a grant under subsection 7a71 an institution of higher education shall agree to use the grant to develop a strategic partnership with the community in which such institution is located for the purposes of-- 7#a7 strengthening connections between such institution and the community-- 7,a7 to improve evaluation of1 and address1 the health and health workforce needs of such community2 and 7,b7 to engage such community in health workforce development2 7#b7 developing1 enhancing1 or accelerating innovative undergraduate and graduate programs in the biomedical sciences and health professions2 and 7#c7 strengthening pipeline programs in the biomedical sciences and health professions1 including by developing partnerships between institutions of higher education and elementary schools and secondary schools to recruit the next generation of health professionals earlier in the pipeline to a health care career4 7d7 ,definition of eligible institution of higher education ,for purposes of this section1 the term eligible institution of higher education includes-- 7#a7 a program authorized under section #cag7;a7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;d7a772 and 7#b7 a professional or graduate institution described in section #cbf of such ,act 7#bj ,u4,s4,c4 #ajfc;b74 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #cjaj4 ,health ,professions ,workforce ,fund 7a7 ,establishment ,there is established in the ,health ,resources and ,services ,administration of the ,department of ,health and ,human ,services a ,health ,professions ,workforce ,fund to provide for expanded and sustained national investment in the health professions and nursing workforce development programs under titles ,,vii and title ,,viii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bib et seq42 #db ,u4,s4,c4 #bif et seq474 7b7 ,funding 7#a7 ,in general ,there is authorized to be appropriated1 and there is appropriated1 out of any monies in the ,treasury not otherwise appropriated1 to the ,health ,professions ,workforce ,fund-- 7,a7 #cib1jjj1jjj for fiscal year #bjbe2 7,b7 #dab1jjj1jjj for fiscal year #bjbf2 7,c7 #dcb1jjj1jjj for fiscal year #bjbg2 7,d7 #ded1jjj1jjj for fiscal year #bjbh2 7,e7 #dgf1jjj1jjj for fiscal year #bjbi2 7,f7 #ejj1jjj1jjj for fiscal year #bjcj2 7,g7 #ebe1jjj1jjj for fiscal year #bjca2 and 7,h7 #eeb1jjj1jjj for fiscal year #bjcb4 7#b7 ,health professions education programs ,for the purpose of carrying out health professions education programs authorized under title ,,vii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bib et seq471 in addition to any other amounts authorized to be appropriated for such purpose1 there is authorized to be appropriated out of any monies in the ,health ,professions ,workforce ,fund1 the following3 7,a7 #bfe1jjj1jjj for fiscal year #bjbe4 7,b7 #bgh1jjj1jjj for fiscal year #bjbf4 7,c7 #bib1jjj1jjj for fiscal year #bjbg4 7,d7 #cjg1jjj1jjj for fiscal year #bjbh4 7,e7 #cbb1jjj1jjj for fiscal year #bjbi4 7,f7 #cch1jjj1jjj for fiscal year #bjcj4 7,g7 #cee1jjj1jjj for fiscal year #bjca4 7,h7 #cgc1jjj1jjj for fiscal year #bjcb4 7#c7 ,nursing workforce development programs ,for the purpose of carrying out nursing workforce development programs authorized under title ,,viii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bif et seq471 in addition to any other amounts authorized to be appropriated for such purpose1 there is authorized to be appropriated out of any monies in the ,health ,professions ,workforce ,fund1 the following3 7,a7 #abg1jjj1jjj for fiscal year #bjbe4 7,b7 #acd1jjj1jjj for fiscal year #bjbf4 7,c7 #adj1jjj1jjj for fiscal year #bjbg4 7,d7 #adg1jjj1jjj for fiscal year #bjbh4 7,e7 #aed1jjj1jjj for fiscal year #bjbi4 7,f7 #afb1jjj1jjj for fiscal year #bjcj4 7,g7 #agj1jjj1jjj for fiscal year #bjca4 7,h7 #agi1jjj1jjj for fiscal year #bjcb4 #cjaa4 ,future advancement of academic nursing 7a7 ,support for nursing education and the future nursing workforce ,part ,d of title ,,viii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bifp et seq47 is amended by adding at the end the following3 #hcb4 ,nursing education enhancement and modernization grants in underserved areas 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 may award grants to schools of nursing for-- 7#a7 increasing the number of faculty and students at such schools in order to enhance the preparedness of the ,united ,states for1 and the ability of the ,united ,states to address and quickly respond to1 public health emergencies declared under section #cai and pandemics2 or 7#b7 the enhancement and modernization of nursing education programs4 7b7 ,priority ,in selecting grant recipients under this section1 the ,secretary shall give priority to schools of nursing that-- 7#a7 are located in a medically underserved community2 7#b7 are located in a health professional shortage area as defined under section #ccb7;a72 or 7#c7 are institutions of higher education listed under section #cga7;a7 of the ,higher ,education ,act of #aife4 7c7 ,consideration ,in awarding grants under this section1 the ,secretary1 to the extent practicable1 may ensure equitable distribution of awards among the geographic regions of the ,united ,states4 7d7 ,use of funds ,a school of nursing that receives a grant under this section may use the funds awarded through such grant for activities that include-- 7#a7 enhancing enrollment and retention of students at such school1 with a priority for students from disadvantaged backgrounds 7including racial or ethnic groups underrepresented in the nursing workforce71 individuals from rural and underserved areas1 low-income individuals1 and first generation college students 7as defined in section #djb;,a7h77#c7 of the ,higher ,education ,act of #aife72 7#b7 creating1 supporting1 or modernizing educational programs and curriculum at such school2 7#c7 retaining current faculty1 and hiring new faculty1 with an emphasis on faculty from racial or ethnic groups who are underrepresented in the nursing workforce2 7#d7 modernizing infrastructure at such school1 including audiovisual or other equipment1 personal protective equipment1 simulation and augmented reality resources1 telehealth technologies1 and virtual and physical laboratories2 7#e7 partnering with a health care facility1 nurse-managed health clinic1 community health center1 or other facility that provides health care in order to provide educational opportunities for the purpose of establishing or expanding clinical education2 7#f7 enhancing and expanding nursing programs that prepare nurse researchers and scientists2 7#g7 establishing nurse-led intradisciplinary and interprofessional educational partnerships2 and 7#h7 other activities that the ,secretary determines further the development1 improvement1 and expansion of schools of nursing4 7e7 ,reports from entities ,each school of nursing awarded a grant under this section shall submit an annual report to the ,secretary on the activities conducted under such grant1 and other information as the ,secretary may require4 7f7 ,report to ,congress ,not later than #e years after the date of the enactment of this section1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives a report that provides a summary of the activities and outcomes associated with grants made under this section4 ,such report shall include-- 7#a7 a list of schools of nursing receiving grants under this section1 including the primary geographic location of any school of nursing that was improved or expanded through such a grant2 7#b7 the total number of students who are enrolled at or who have graduated from any school of nursing that was improved or expanded through a grant under this section1 which such statistic shall-- 7,a7 to the extent such information is available1 be deidentified and disaggregated by race1 ethnicity1 age1 sex1 geographic region1 disability status1 and other relevant factors2 and 7,b7 include an indication of the number of such students who are from racial or ethnic groups underrepresented in the nursing workforce1 such students who are from rural or underserved areas1 such students who are low-income students1 and such students who are first generation college students 7as defined in section #djb;,a7h77#c7 of the ,higher ,education ,act of #aife72 7#c7 to the extent such information is available1 the effects of the grants awarded under this section on retaining and hiring of faculty1 including any increase in diverse faculty1 the number of clinical education partnerships1 the modernization of nursing education infrastructure1 and other ways this section helps address and quickly respond to public health emergencies and pandemics2 7#d7 recommendations for improving the grants awarded under this section2 and 7#e7 any other considerations as the ,secretary determines appropriate4 7g7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #a1jjj1jjj1jjj1 to remain available until expended4 4 7b7 ,strengthening nurse education ,the heading of part ,d of title ,,viii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bifp et seq47 is amended by striking ,basic4 #cjab4 ,sense of ,congress relating to graduate medical education ,it is the sense of ,congress that eliminating the limit of the number of residency positions that receive some level of ,medicare support under section #ahhf7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h771 also referred to as the ,medical graduate medical education cap1 is critical to-- 7#a7 ensuring an appropriate supply of physicians to meet the health care needs in the ,united ,states2 7#b7 facilitating equitable access for all who seek health care2 7#c7 increasing the racial and ethnic diversity of physicians in the ,united ,states2 and 7#d7 mitigating disparities in health and health care4 #cjac4 ,career support for skilled1 internationally educated health professionals 7a7 ,grants to eligible entities 7#a7 ,authority to provide grants ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary71 acting through the ,bureau of ,health ,workforce within the ,health ,resources and ,services ,administration1 the ,national ,institute on ,minority ,health and ,health ,disparities1 or the ,office of ,minority ,health1 may award grants to eligible entities under paragraph 7#b7 to carry out activities described in subsection 7b74 7#b7 ,eligibility ,to be eligible to receive a grant under this section1 an entity shall-- 7,a7 be a clinical1 public health1 or health services organization1 a community-based or nonprofit entity1 an academic institution1 a faith-based organization1 a ,state1 county1 or local government1 an area health education center1 or another entity determined appropriate by the ,secretary2 and 7,b7 submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7b7 ,authorized activities ,a grant awarded under this section shall be used-- 7#a7 to provide services to assist unemployed and underemployed skilled immigrants1 residing in the ,united ,states1 who have legal1 permanent work authorization and who are internationally educated health professionals1 enter into the health workforce of the ,united ,states with employment matching their health professional skills and education1 and advance in employment to positions that better match their health professional education and expertise2 7#b7 to provide training opportunities to reduce barriers to entry and advancement in the health workforce for skilled1 internationally educated immigrants2 7#c7 to educate employers regarding the abilities and capacities of internationally educated health professionals2 7#d7 to assist in the evaluation of foreign credentials2 7#e7 to support preceptorships for international medical graduates in hospital primary care training2 and 7#f7 to facilitate access to contextualized and accelerated courses on ,english as a second language4 #cjad4 ,study and report on strategies for increasing diversity 7a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study on strategies for increasing the diversity of the health professional workforce4 ,such study shall include an analysis of strategies for increasing the number of health professionals from rural1 lower income1 and underrepresented minority communities1 including which strategies are most effective for achieving such goal4 7b7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report on the study conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 #cjae4 ,conrad ,state #cj program2 physician retention 7a7 ,conrad ,state #cj program extension 7#a7 ,in general ,section #bbj7;c7 of the ,immigration and ,nationality ,technical ,corrections ,act of #aiid 7,public ,law #ajc-daf2 #h ,u4,s4,c4 #aahb note7 is amended by striking ,september #cj1 #bjae and inserting the date that is #c years after the date of the enactment of the ,health ,equity and ,accountability ,act of #bjbd4 7#b7 ,effective date ,the amendment made by paragraph 7#a7 shall take effect as if enacted on ,september #cj1 #bjah4 7b7 ,retaining physicians who have practiced in medically underserved communities ,section #bja7;b77#a7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaea7;b77#a77 is amended by adding at the end the following3 7,f7 7i7 ,alien physicians who have completed service requirements of a waiver requested under section #bjc7;b77#b77;,b77ii71 including-- 7,i7 alien physicians who completed such service before the date of the enactment of the ,health ,equity and ,accountability ,act of #bjbd2 and 7,,ii7 the spouse or children of an alien physician described in subclause 7,i74 7ii7 ,nothing in this subparagraph may be construed-- 7,i7 to prevent the filing of a petition with the ,secretary of ,homeland ,security for classification under section #bjd7;a7 or the filing of an application for adjustment of status under section #bde by an alien physician described in clause 7i77,i7 before the date on which such alien physician completed the service described in section #bad7l7 or worked full-time as a physician for an aggregate of #e years at the location identified in the section #bad7l7 waiver or in an area or areas designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals2 or 7,,ii7 to permit the ,secretary of ,homeland ,security to grant a petition or application described in subclause 7,i7 until the alien has satisfied all of the requirements of the waiver received under section #bad7l74 4 7c7 ,employment protections for physicians 7#a7 ,exceptions to #b-year foreign residency requirement ,section #bad7l77#a7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahd7l77#a77 is amended-- 7,a7 in the matter preceding subparagraph 7,a71 by striking ,attorney ,general and inserting ,secretary of ,homeland ,security2 7,b7 in subparagraph 7,a71 by striking ,director of the ,united ,states ,information ,agency and inserting ,secretary of ,state2 7,c7 in subparagraph 7,b71 by inserting 1 except as provided in paragraphs 7#g7 and 7#h7 before the semicolon at the end2 7,d7 in subparagraph 7,c71 by amending clauses 7i7 and 7ii7 to read as follows3 7i7 the alien demonstrates a bona fide offer of full-time employment at a health facility or health care organization1 which employment has been determined by the ,secretary of ,homeland ,security to be in the public interest2 and 7ii7 the alien-- 7,i7 has accepted employment with the health facility or health care organization in a geographic area or areas which are designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals2 7,,ii7 begins employment by the later of the date that is-- 7aa7 #abj days after receiving such waiver2 7bb7 #abj days after completing graduate medical education or training under a program approved pursuant to section #bab7;j77#a72 or 7cc7 #abj days after receiving nonimmigrant status or employment authorization1 if the alien or the alien's employer petitions for such nonimmigrant status or employment authorization not later than #abj days after the date on which the alien completes his or her graduate medical education or training under a program approved pursuant to section #bab7;j77#a72 and 7,,iii7 agrees to continue to work for a total of not less than #c years in the status authorized for such employment under this subsection1 except as provided in paragraph 7#h72 and 2 and 7,e7 in subparagraph 7,d71 in the matter preceding clause 7i71 by inserting except as provided in paragraph 7#h71 before in the case4 7#b7 ,allowable visa status for physicians fulfilling waiver requirements in medically underserved areas ,section #bad7l77#b77;,a7 of such ,act 7#h ,u4,s4,c4 #aahd7l77#b77;,a77 is amended to read as follows3 7,a7 ,upon the request of an interested ,federal agency or an interested ,state agency for recommendation of a waiver under this section by a physician who is maintaining valid nonimmigrant status under section #aja7;a77#ae77;,j7 and received a favorable recommendation by the ,secretary of ,state1 the ,secretary of ,homeland ,security may adjust the status of such physician to any status authorized for employment under this ,act4 ,the numerical limitations set forth in subsection 7g77#a77;,a7 shall not apply to any alien whose status is adjusted pursuant to this subparagraph4 4 7#c7 ,violation of agreements ,section #bad7l77#c77;,a7 of such ,act 7#h ,u4,s4,c4 #aahd7l77#c77;,a77 is amended by inserting substantial requirement of an before agreement entered into4 7#d7 ,physician employment in underserved areas ,section #bad7l7 of such ,act1 as amended by this subsection1 is further amended by adding at the end the following3 7#d7 7,a7 ,if an interested ,state agency denies an application for a waiver under paragraph 7#a77;,b7 from a physician pursuing graduate medical education or training pursuant to section #aja7;a77#ae77;,j7 because the ,state has requested the maximum number of waivers permitted for that fiscal year1 the physician's nonimmigrant status shall be extended for up to #f months if the physician agrees to seek a waiver under this subsection 7except for paragraph 7#a77;,d77ii77 to work for an employer described in paragraph 7#a77;,c7 in a ,state that has not yet requested the maximum number of waivers4 7,b7 ,such physician shall be authorized to work only for the employer referred to in subparagraph 7,a7 during the period beginning on the date on which a new waiver application is filed with such ,state and ending on the earlier of-- 7i7 the date on which the ,secretary of ,homeland ,security denies such waiver2 or 7ii7 the date on which the ,secretary approves an application for adjustment of status under paragraph 7#b77;,a7 pursuant to the approval of such waiver4 4 7#e7 ,contract requirements ,section #bad7l7 of such ,act1 as amended by this subsection1 is further amended by adding at the end the following3 7#e7 ,an alien granted a waiver under paragraph 7#a77;,c7 shall enter into an employment agreement with the contracting health facility or health care organization that-- 7,a7 specifies-- 7i7 the maximum number of on-call hours per week 7which may be a monthly average7 that the alien will be expected to be available2 and 7ii7 the compensation the alien will receive for on-call time2 7,b7 specifies-- 7i7 whether the contracting facility or organization-- 7,i7 has secured medical malpractice liability protection for the alien under section #bbd7;g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bcc7;g72 or 7,,ii7 will pay the alien's malpractice insurance premiums2 and 7ii7 the amount of such liability protection that will be provided2 7,c7 describes all of the work locations that the alien will work and includes a statement that the contracting facility or organization will not add additional work locations without the approval of the ,federal agency or ,state agency that requested the waiver2 and 7,d7 does not include a non-compete provision4 7#f7 ,an alien granted a waiver under this subsection whose employment relationship with a health facility or health care organization terminates under paragraph 7#a77;,c77ii7 during the #c-year service period required under paragraph 7#a7 shall be considered to be maintaining lawful status in an authorized period of stay during the #abj-;day period referred to in items 7aa7 and 7bb7 of subclause 7,,iii7 of paragraph 7#a77;,c77ii7 or the #de-;day period referred to in subclause 7,,iii77cc7 of such paragraph4 4 7#f7 ,recapturing waiver slots lost to other ,states ,section #bad7l7 of such ,act1 as amended by this subsection1 is further amended by adding at the end the following3 7#g7 ,if a recipient of a waiver under this subsection terminates the recipient's employment with a health facility or health care organization pursuant to paragraph 7#a77;,c77ii71 including termination of employment because of circumstances described in paragraph 7#a77;,c77ii77,,iii71 and accepts new employment with such a facility or organization in a different ,state1 the ,state from which the alien is departing may be granted an additional waiver by the ,secretary of ,state for use in the fiscal year in which the alien's employment was terminated4 4 7#g7 ,exception ,to #c-year work requirement ,section #bad7l7 of such ,act1 as amended by this subsection1 is further amended by adding at the end the following3 7#h7 ,the #c-year work requirement set forth in subparagraphs 7,c7 and 7,d7 of paragraph 7#a7 shall not apply if-- 7,a7 7i7 the ,secretary of ,homeland ,security determines the existence of extenuating circumstances1 including violations by the employer of the employment agreement with the alien or of labor and employment laws1 which justify a lesser period of employment at such facility or organization2 and 7ii7 the alien demonstrates1 not later than #abj days after the employment termination date 7unless the ,secretary determines that extenuating circumstances would justify an extension71 another bona fide offer of employment at a health facility or health care organization in a geographic area or areas designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals1 for the remainder of such #c-year period2 7,b7 7i7 the interested ,state agency that requested the waiver attests to the existence of extenuating circumstances1 including violations by the employer of the employment agreement with the alien or of labor and employment laws1 which justify a lesser period of employment at such facility or organization2 and 7ii7 the alien demonstrates1 not later than #abj days after the employment termination date 7unless the ,secretary determines that extenuating circumstances would justify an extension71 another bona fide offer of employment at a health facility or health care organization in a geographic area or areas designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals1 for the remainder of such #c-year period2 or 7,c7 the alien-- 7i7 elects not to pursue a determination of extenuating circumstances pursuant to subparagraph 7,a7 or 7,b72 7ii7 terminates the alien's employment relationship with the health facility or health care organization at which the alien was employed2 7iii7 demonstrates1 not later than #de days after the employment termination date1 another bona fide offer of employment at a health facility or health care organization in a geographic area or areas1 in the ,state that requested the alien's waiver1 which are designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals2 and 7iv7 agrees to be employed for the remainder of such #c-year period1 and #a additional year for each termination under clause 7ii74 4 7d7 ,allotment of ,conrad ,state #cj waivers 7#a7 ,in general ,section #bad7l7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahd7l771 as amended by subsection 7c71 is further amended by adding at the end the following3 7#i7 7,a7 7i7 ,all ,states shall be allotted a total of #ce waivers under paragraph 7#a77;,b7 for a fiscal year if #ij percent of the waivers available to the ,states receiving at least #e waivers were used in the previous fiscal year4 7ii7 ,when an allotment occurs under clause 7i71 all ,states shall be allotted an additional #e waivers under paragraph 7#a77;,b7 for each subsequent fiscal year if #ij percent of the waivers available to the ,states receiving at least #e waivers were used in the previous fiscal year4 ,if the ,states are allotted #de or more waivers for a fiscal year1 the ,states will only receive an additional increase of #e waivers the following fiscal year if #ie percent of the waivers available to the ,states receiving at least #a waiver were used in the previous fiscal year4 7,b7 ,any increase in allotments under subparagraph 7,a7 shall be maintained indefinitely1 unless in a fiscal year the total number of such waivers granted is #e percent lower than in the last year in which there was an increase in the number of waivers allotted pursuant to this paragraph1 in which case-- 7i7 the number of waivers allotted shall be decreased by #e for all ,states beginning in the next fiscal year2 and 7ii7 each additional #e percent decrease in such waivers granted from the last year in which there was an increase in the allotment1 shall result in an additional decrease of #e waivers allotted for all ,states1 provided that the number of waivers allotted for all ,states shall not drop below #cj4 4 7#b7 ,academic medical centers ,section #bad7l77#a77;,d7 of such ,act1 as amended by subsection 7c77#a77;,e71 is further amended-- 7,a7 in clause 7ii71 by striking and at the end2 7,b7 in clause 7iii71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following3 7iv7 in the case of a request by an interested ,state agency-- 7,i7 the head of such agency determines that the alien is to practice medicine in1 or be on the faculty of a residency program at1 an academic medical center 7as defined in section #daa4cee7;e77#b7 of title #db1 ,code of ,federal ,regulations1 or a similar successor regulation71 without regard to whether such facility is located within an area designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals2 and 7,,ii7 the head of such agency determines that-- 7aa7 the alien physician's work is in the public interest2 and 7bb7 the grant of such waiver would not cause the number of the waivers granted on behalf of aliens for such ,state for a fiscal year to exceed #c 7within the limitation in subparagraph 7,b7 and subject to paragraph 7#f771 in accordance with the conditions of this clause4 4 7e7 ,amendments to the procedures1 definitions1 and other provisions related to physician immigration 7#a7 ,dual intent for physicians seeking graduate medical training ,section #bad7;b7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahd7;b77 is amended by striking and other than a nonimmigrant described in any provision of section #aja7;a77#ae77;,h77i7 except subclause 7b#a7 of such section7 and inserting a nonimmigrant described in any provision of section #aja7;a77#ae77;,h77i7 7except subclause 7b#a7 of such section71 and an alien coming to the ,united ,states to receive graduate medical education or training as described in section #bab7;j7 or to take examinations required to receive graduate medical education or training as described in section #bab7;j774 7#b7 ,physician national interest waiver clarifications 7,a7 ,practice and geographic area ,section #bjc7;b77#b77;,b77ii77,i7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaec7;b77#b77;,b77ii77,i77 is amended by striking items 7aa7 and 7bb7 and inserting the following3 7aa7 the alien physician agrees to work on a full-time basis practicing primary care1 specialty medicine1 or a combination thereof1 in an area or areas designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals1 or at a health care facility under the jurisdiction of the ,secretary of ,veterans ,affairs2 or 7bb7 the alien physician is pursuing such waiver based upon service at a facility or facilities that serve patients who reside in a geographic area or areas designated by the ,secretary of ,health and ,human ,services as having a shortage of health care professionals 7without regard to whether such facility or facilities are located within such an area7 and a ,federal agency1 or a local1 county1 regional1 or ,state department of public health determines the alien physician's work was or will be in the public interest4 4 7,b7 ,five-year service requirement ,section #bjc7;b77#b77;,b77ii7 of such ,act1 as amended by subparagraph 7,a71 is further amended-- 7i7 by moving subclauses 7,,ii71 7,,iii71 and 7,,iv7 #d ems to the left2 and 7ii7 in subclause 7,,ii7-- 7,i7 by inserting 7aa7 after 7,,ii72 and 7,,ii7 by adding at the end the following3 7bb7 ,the #e-year service requirement described in item 7aa7 shall begin on the date on which the alien physician begins work in the shortage area in any legal status and not on the date on which an immigrant visa petition is filed or approved4 ,such service shall be aggregated without regard to when such service began and without regard to whether such service began during or in conjunction with a course of graduate medical education4 7cc7 ,an alien physician shall not be required to submit an employment contract with a term exceeding the balance of the #e-year commitment yet to be served or an employment contract dated within a minimum time period before filing a visa petition under this subsection4 7dd7 ,an alien physician shall not be required to file additional immigrant visa petitions upon a change of work location from the location approved in the original national interest immigrant petition4 4 7#c7 ,technical clarification regarding advanced degree for physicians ,section #bjc7;b77#b77;,a7 of such ,act is amended by adding at the end the following3 ,an alien physician holding a foreign medical degree that has been deemed sufficient for acceptance by an accredited ,united ,states medical residency or fellowship program is a member of the professions holding an advanced degree or its equivalent44 7#d7 ,short-,term work authorization for physicians completing their residencies 7,a7 ,in general ,a physician completing graduate medical education or training described in section #bab7;j7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahb7;j77 as a nonimmigrant described in section #aja7;a77#ae77;,h77i7 of such ,act 7#h ,u4,s4,c4 #aaja7;a77#ae77;,h77i77-- 7i7 shall have such nonimmigrant status automatically extended until ,october #a of the fiscal year for which a petition for a continuation of such nonimmigrant status has been submitted in a timely manner and the employment start date for the beneficiary of such petition is ,october #a of that fiscal year2 and 7ii7 shall be authorized to be employed incident to status during the period between the filing of such petition and ,october #a of such fiscal year4 7,b7 ,termination ,the physician's status and employment authorization shall terminate on the date that is #cj days after the date on which a petition described in clause 7i77,i7 is rejected1 denied1 or revoked4 7,c7 ,automatic extension ,a physician's status and employment authorization will automatically extend to ,october #a of the next fiscal year if all of the visas described in section #aja7;a77#ae77;,h77i7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaja7;a77#ae77;,h77i77 that were authorized to be issued for the fiscal year have been issued4 7#e7 ,applicability of section #bab7;e7 to spouses and children of ,j-#a exchange visitors ,a spouse or child of an exchange visitor described in section #aja7;a77#ae77;,j7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaja7;a77#ae77;,j77 shall not be subject to the requirements under section #bab7;e7 of such ,act 7#h ,u4,s4,c4 #aahb7;e774 7f7 ,annual ,conrad ,state #cj ,j-#a ,visa ,waiver ,program statistical report ,the ,director of ,u4,s4 ,citizenship and ,immigration ,service shall submit an annual report to ,congress and to the ,secretary of ,health and ,human ,services that identifies the number of aliens admitted during the most recently concluded fiscal year as a result of the ,conrad ,state #cj ,j-#a ,visa ,waiver ,program established under sections #bab7;e7 and #bad7l7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahb7;e7 and #aahd7l771 broken down by ,state4 #cjaf4 ,grants for schools of medicine and schools of osteopathic medicine in underserved areas ,subpart ,,ii of part ,c of title ,,vii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bicm et seq47 is amended by adding at the end the following3 #gdi;,c4 ,grants for schools of medicine and schools of osteopathic medicine in underserved areas 7a7 ,in general ,the ,secretary may award grants to institutions of higher education 7including consortiums of such institutions7 for the establishment1 improvement1 or expansion of a school of medicine or osteopathic medicine1 or a branch campus of a school of medicine or osteopathic medicine4 7b7 ,priority ,in selecting grant recipients under this section1 the ,secretary shall give priority to any institution of higher education 7or consortium of such institutions7 that-- 7#a7 proposes to use the grant for the establishment of a school of medicine or osteopathic medicine1 or a branch campus of a school of medicine or osteopathic medicine1 in an area-- 7,a7 in which-- 7i7 no other such school is based2 or 7ii7 in the case in which the school of medicine or osteopathic medicine proposed to be established would be a minority-serving institution1 no other minority-serving institution that includes a school of medicine or osteopathic medicine is based2 and 7,b7 that is a medically underserved community or a health professional shortage area2 or 7#b7 is a minority-serving institution described in section #cga7;a7 of the ,higher ,education ,act of #aife or an institution or program described in section #cbf7;e7 of such ,act4 7c7 ,considerations ,in awarding grants under this section1 the ,secretary1 to the extent practicable1 may ensure equitable distribution of awards among the geographical regions of the ,united ,states4 7d7 ,use of funds ,an institution of higher education 7or a consortium of such institutions7-- 7#a7 shall use grant amounts received under this section to-- 7,a7 recruit1 enroll1 and retain medical students who are pursuing a degree of doctor of medicine or doctor of osteopathy1 including individuals who are from disadvantaged backgrounds 7including racial and ethnic groups underrepresented among medical students and health professions71 individuals from rural and underserved areas1 low-income individuals1 and first generation college students1 at a school of medicine or osteopathic medicine or a branch campus of a school of medicine or osteopathic medicine2 and 7,b7 develop1 implement1 and expand curriculum that emphasizes care for rural and underserved populations1 including accessible and culturally and linguistically appropriate care and services1 at such school or branch campus2 and 7#b7 may use grant amounts received under this section to-- 7,a7 plan and construct-- 7i7 a school of medicine or osteopathic medicine1 or a branch campus of a school of medicine or osteopathic medicine1 in an area in which no other such school is based2 or 7ii7 a school of medicine or osteopathic medicine1 or a branch campus of a school of medicine or osteopathic medicine1 that will be a minority-serving institution1 in an area in which no other such school that is a minority-serving institution is based2 7,b7 plan1 develop1 and meet criteria for accreditation for a school of medicine or osteopathic medicine or a branch campus of a school of medicine or osteopathic medicine2 7,c7 hire faculty1 including faculty from racial and ethnic groups who are underrepresented among the medical and other health professions1 and other staff to serve at such a school or branch campus2 7,d7 support educational programs at such a school or branch campus2 7,e7 modernize and expand infrastructure at such a school or branch campus2 and 7,f7 support other activities that the ,secretary determines further the establishment1 improvement1 or expansion of a school of medicine or osteopathic medicine or a branch campus of a school of medicine or osteopathic medicine4 7e7 ,application ,to be eligible to receive a grant under subsection 7a71 an institution of higher education 7or a consortium of such institutions71 shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require1 including a description of the institution's or consortium's planned activities described in subsection 7d74 7f7 ,reporting 7#a7 ,reports from entities ,each institution of higher education1 or consortium of such institutions1 awarded a grant under this section shall submit an annual report to the ,secretary on the activities conducted under such grant1 and other information as the ,secretary may require4 7#b7 ,report to ,congress ,not later than #e years after the date of enactment of this section and every #e years thereafter1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives a report that provides a summary of the activities and outcomes associated with grants made under this section4 ,such reports shall include-- 7,a7 a list of awardees1 including their primary geographic location1 and location of any school of medicine or osteopathic medicine1 or a branch campus of a school of medicine or osteopathic medicine that was established1 improved1 or expanded under this program2 7,b7 the total number of students 7including the number of students from racial and ethnic groups underrepresented among medical students and health professions1 low-income students1 and first generation college students7 who-- 7i7 are enrolled at or who have graduated from any school of medicine or osteopathic medicine1 or a branch campus of a school of medicine or osteopathic medicine1 that was established1 improved1 or expanded under this program1 deidentified and disaggregated by race1 ethnicity1 age1 sex1 geographic region1 disability status1 and other relevant factors1 to the extent such information is available2 and 7ii7 who subsequently participate in an accredited internship or medical residency program upon graduation from any school of medicine or osteopathic medicine1 or a branch campus of a school of medicine or osteopathic medicine1 that was established1 improved1 or expanded under this program1 deidentified and disaggregated by race1 ethnicity1 age1 sex1 geographic region1 disability status1 medical specialty pursued1 and other relevant factors1 to the extent such information is available2 7,c7 the effects of such program on the health care provider workforce1 including any impact on demographic representation disaggregated by race1 ethnicity1 and sex1 and the fields or specialties pursued by students who have graduated from any school of medicine or osteopathic medicine1 or a branch campus of a school of medicine or osteopathic medicine1 that was established1 improved1 or expanded under this program2 7,d7 the effects of such program on health care access in underserved areas1 including medically underserved communities and health professional shortage areas2 and 7,e7 recommendations for improving the program described in this section1 and any other considerations as the ,secretary determines appropriate4 7#c7 ,public availability ,the ,secretary shall make reports submitted under paragraph 7#b7 publicly available on the website of the ,department of ,health and ,human ,services4 7g7 ,definitions ,in this section3 7#a7 ,branch campus 7,a7 ,in general ,the term branch campus1 with respect to a school of medicine or osteopathic medicine1 means an additional location of such school that is geographically apart and independent of the main campus1 at which the school offers at least #ej percent of the program leading to a degree of doctor of medicine or doctor of osteopathy that is offered at the main campus4 7,b7 ,independence from main campus ,for purposes of subparagraph 7,a71 the location of a school described in such subparagraph shall be considered to be independent of the main campus described in such subparagraph if the location-- 7i7 is permanent in nature2 7ii7 offers courses in educational programs leading to a degree1 certificate1 or other recognized educational credential2 7iii7 has its own faculty and administrative or supervisory organization2 and 7iv7 has its own budgetary and hiring authority4 7#b7 ,first generation college student ,the term first generation college student has the meaning given such term in section #djb;,a7h77#c7 of the ,higher ,education ,act of #aife4 7#c7 ,health professional shortage area ,the term health professional shortage area has the meaning given such term in section #ccb7;a74 7#d7 ,institution of higher education ,the term institution of higher education has the meaning given such term in section #aja of the ,higher ,education ,act of #aife4 7#e7 ,medically underserved community ,the term medically underserved community has the meaning given such term in section #gii;,b7#f74 7h7 ,authorization of appropriations ,there is authorized to be appropriated such sums as may be necessary to carry out this section4 4 ,,iv ,improving ,health ,care ,access and ,quality #djjj4 ,definition ,in this title and the amendments made by this title1 the term health care includes all health care needed throughout the life cycle and the end of life4 ,a ,reducing ,barriers to ,accessing ,care #djja4 ,protecting protected areas ,section #bhg of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aceg7 is amended-- 7#a7 by striking the ,service each place such term appears and inserting the ,department of ,homeland ,security2 7#b7 by striking ,attorney ,general each place such term appears and inserting ,secretary of ,homeland ,security2 7#c7 in subsection 7f77#a71 by striking ,commissioner and inserting ,director of ,u4,s4 ,citizenship and ,immigration ,services2 7#d7 in subsection 7h7-- 7,a7 by striking of the ,immigration and ,nationality ,act2 and 7,b7 by striking of such ,act2 and 7#e7 by adding at the end the following3 7i7 7#a7 ,in this subsection3 7,a7 ,the term appropriate congressional committees means-- 7i7 the ,committee on ,homeland ,security and ,governmental ,affairs of the ,senate2 7ii7 the ,committee on the ,judiciary of the ,senate2 7iii7 the ,committee on ,homeland ,security of the ,house of ,representatives2 and 7iv7 the ,committee on the ,judiciary of the ,house of ,representatives4 7,b7 ,the term enforcement action-- 7i7 means an apprehension1 arrest1 inspection interview1 request for identification1 search1 seizure1 service of charging documents or subpoenas1 or surveillance for the purposes of immigration enforcement2 and 7ii7 includes an enforcement action at1 or focused on1 a protected area that is part of a joint case led by another law enforcement agency4 7,c7 ,the term exigent circumstances means a situation involving-- 7i7 the imminent risk of death1 violence1 or physical harm to any person or property1 including a situation implicating terrorism or the national security of the ,united ,states2 7ii7 the immediate arrest or pursuit of a dangerous felon1 terrorist suspect1 or other individual presenting an imminent danger2 or 7iii7 the imminent risk of destruction of evidence that is material to an ongoing criminal case4 7,d7 ,the term prior approval means-- 7i7 in the case of officers and agents of ,u4,s4 ,immigration and ,customs ,enforcement1 prior written approval to carry out an enforcement action involving a specific individual or individuals authorized by-- 7,i7 the ,assistant ,director of ,operations1 ,homeland ,security ,investigations2 7,,ii7 the ,executive ,associate ,director1 ,homeland ,security ,investigations2 7,,iii7 the ,assistant ,director for ,field ,operations1 ,enforcement and ,removal ,operations2 or 7,,iv7 the ,executive ,associate ,director for ,field ,operations1 ,enforcement and ,removal ,operations2 7ii7 in the case of officers and agents of ,u4,s4 ,customs and ,border ,protection1 prior written approval to carry out an enforcement action involving a specific individual or individuals authorized by-- 7,i7 a ,chief ,patrol ,agent2 7,,ii7 the ,director of ,field ,operations2 7,,iii7 the ,director of ,air and ,marine ,operations2 or 7,,iv7 the ,internal ,affairs ,special ,agent in ,charge2 and 7iii7 in the case of other ,federal1 ,state1 or local law enforcement officers1 to carry out an enforcement action involving a specific individual or individuals authorized by-- 7,i7 the head of the ,federal agency carrying out the enforcement action2 or 7,,ii7 the head of the ,state or local law enforcement agency carrying out the enforcement action4 7,e7 ,the term protected area includes all of the physical space located within #a1jjj feet of-- 7i7 any medical treatment or mental health care facility1 including any hospital1 doctor's office1 health clinic1 alcohol or drug prevention1 counseling1 or treatment facilities1 syringe exchange services1 vaccination1 treatment1 or testing sites1 emergent or urgent care facility1 sites that serve pregnant individuals1 or community health centers2 7ii7 any public or private school1 including any known and licensed day care facility1 preschool1 sites of early childhood programs1 primary school1 secondary school1 postsecondary school 7including colleges and universities71 or other institution of learning 7including vocational or trade schools72 7iii7 any scholastic or education-related activity or event or before or after school program1 including field trips and interscholastic events2 7iv7 any school bus or school bus stop2 7v7 any place where children gather1 such as a playground1 a recreation center1 a library1 a foster care facility1 or a group home for children2 7vi7 any physical structure of an organization or subdivision of government that-- 7,i7 assists children1 pregnant women1 victims of crime or abuse1 or individuals with significant mental or physical disabilities2 7,,ii7 provides social services and assistance1 including homeless shelters1 community-based organizations1 facilities that serve disabled persons1 drug or alcohol counseling and treatment facilities1 food banks or food pantries1 and other places providing emergency and disaster services or assistance with food and nutrition1 housing affordability and income or other services funded by ,state or local government1 charitable giving1 the ,special ,supplemental ,nutrition ,program for ,women1 ,infants1 and ,children 7,,wic71 ,supplemental ,nutrition ,assistance ,program 7,,snap71 ,temporary ,assistance for ,needy ,families 7,,tanf71 ,social ,security1 or the ,united ,states ,housing ,act2 or 7,,iii7 provides hospice1 palliative1 or other available end-of-life care services to terminally ill persons2 7vii7 any church1 synagogue1 mosque1 or other place of worship or religious study1 including buildings rented for the purpose of religious services1 retreats1 counseling1 workshops1 instruction1 and education2 7viii7 any ,federal1 ,state1 or local courthouse1 including the office of an individual's legal counsel or representative1 and a probation1 parole1 or supervised release office2 7ix7 the site of a funeral1 grave-side ceremony1 rosary1 wedding1 or other religious ceremony or observance2 7x7 any public demonstration1 such as a march1 a rally1 or a parade2 7xi7 any domestic violence shelter1 rape crisis center1 child advocacy center1 supervised visitation center1 family justice center1 or victim services provider2 7xii7 any congressional district office2 7xiii7 indoor and outdoor premises of a ,state department of motor vehicles2 7xiv7 a place where disaster or emergency response and relief is provided1 including evacuation routes1 places where shelter or emergency supplies1 food1 or water are distributed1 or places where registration for disaster-relief assistance or family reunification is underway2 or 7xv7 any other location specified by the ,secretary of ,homeland ,security for purposes of this subsection4 7#b7 7,a7 ,an enforcement action may not take place at1 or be focused on1 a protected area unless-- 7i7 the action involves exigent circumstances2 and 7ii7 prior approval for the enforcement action was obtained4 7,b7 ,if an enforcement action is initiated pursuant to subparagraph 7,a7 and the exigent circumstances permitting the enforcement action cease1 the enforcement action shall be discontinued until such exigent circumstances reemerge4 7,c7 ,if an enforcement action is carried out in violation of this subsection-- 7i7 no information resulting from the enforcement action may be entered into the record or received into evidence in a removal proceeding resulting from the enforcement action2 and 7ii7 the noncitizen who is the subject of such removal proceeding may file a motion for the immediate termination of the removal proceeding4 7#c7 7,a7 ,this subsection shall apply to any enforcement action by officers or agents of the ,department of ,homeland ,security1 including-- 7i7 officers or agents of ,u4,s4 ,immigration and ,customs ,enforcement2 7ii7 officers or agents of ,u4,s4 ,customs and ,border ,protection2 and 7iii7 any individual designated to perform immigration enforcement functions pursuant to subsection 7g74 7,b7 ,while carrying out an enforcement action within a protected area1 officers and agents referred to in subparagraph 7,a7 shall make every effort-- 7i7 to limit the time spent in the protected area2 7ii7 to limit the enforcement action in the protected area to the person or persons for whom prior approval was obtained2 and 7iii7 to conduct themselves discreetly4 7,c7 ,if1 while carrying out an enforcement action that is not initiated in or focused on a protected area1 officers or agents are led into a protected area1 and no exigent circumstance and prior approval with respect to the protected area1 such officers or agents shall-- 7i7 cease before taking any further enforcement action2 7ii7 conduct themselves in a discreet manner2 7iii7 maintain surveillance on an individual2 and 7iv7 immediately consult their supervisor in order to determine whether such enforcement action should be discontinued4 7,d7 ,the limitations under this paragraph shall not apply to the transportation of an individual apprehended at or near a land or sea border to a hospital or health care provider for the purpose of providing medical care to such individual4 7#d7 7,a7 ,each official specified in subparagraph 7,b7 shall ensure that the employees under his or her supervision receive annual training regarding compliance with-- 7i7 the requirements under this subsection with respect to enforcement actions at or focused on protected areas and enforcement actions that lead officers or agents to a protected area2 and 7ii7 the requirements under section #bci of this ,act and section #chd of the ,illegal ,immigration ,reform and ,immigrant ,responsibility ,act of #aiif 7#h ,u4,s4,c4 #acfg74 7,b7 ,the officials specified in this subparagraph are-- 7i7 the ,chief ,counsel of each ,field ,office of ,u4,s4 ,immigration and ,customs ,enforcement2 7ii7 each ,field ,office ,director of ,u4,s4 ,immigration and ,customs ,enforcement2 7iii7 each ,special ,agent in ,charge of ,u4,s4 ,immigration and ,customs ,enforcement2 7iv7 each ,chief ,patrol ,agent of ,u4,s4 ,customs and ,border ,protection2 7v7 the ,director of ,field ,operations of ,u4,s4 ,customs and ,border ,protection2 7vi7 the ,director of ,air and ,marine ,operations of ,u4,s4 ,customs and ,border ,protection2 7vii7 the ,internal ,affairs ,special ,agent in ,charge of ,u4,s4 ,customs and ,border ,protection2 and 7viii7 the chief law enforcement officer of each ,state or local law enforcement agency that enters into a written agreement with the ,department of ,homeland ,security pursuant to subsection 7g74 7#e7 ,not later than #ahj days after the date of the enactment of the ,health ,equity and ,accountability ,act of #bjbd1 the ,secretary of ,homeland ,security shall modify the ,notice to ,appear form 7,form ,i-#hfb7-- 7,a7 to provide the subject of an enforcement action with information1 written in plain language1 summarizing the restrictions against enforcement actions at protected areas 7as described in this subsection7 and the remedies available to the individual if such action violates such restrictions2 7,b7 to ensure that the information provided pursuant to subparagraph 7,a7 is accessible to an individual with limited ,english proficiency2 and 7,c7 to ensure that the subject of an enforcement action is not permitted to verify that the officers or agents that carried out such action complied with the restrictions set forth in this subsection4 7#f7 7,a7 ,the ,director of ,u4,s4 ,immigration and ,customs ,enforcement and the ,commissioner of ,u4,s4 ,customs and ,border ,protection shall each submit an annual report to the appropriate congressional committees that includes the information set forth in subparagraph 7,b7 with respect to the respective agency4 7,b7 ,each report submitted pursuant to subparagraph 7,a7 shall include1 with respect to the submitting agency during the reporting period-- 7i7 the number of enforcement actions that were carried out at1 or focused on1 a protected area2 7ii7 the number of enforcement actions in which officers or agents were subsequently led to a protected area2 and 7iii7 for each enforcement action described in clause 7i7 or 7ii7-- 7,i7 the date on which such action occurred2 7,,ii7 the specific site1 city1 county1 and ,state in which such action occurred2 7,,iii7 if the site of the enforcement action was in a protected area-- 7aa7 the identification of the protected area2 7bb7 the reasons such action was taken in such area2 7cc7 if such action was taken without prior approval1 certification that notification to headquarters of a submitting agency was provided after such action took place2 and 7dd7 a report describing what occurred during and immediately after such action2 7,,iv7 the components of the agency involved in the enforcement action2 7,v7 a description of the enforcement action1 including the nature of the criminal activity of its intended target2 7,,vi7 the number of individuals1 if any1 arrested or taken into custody2 7,,vii7 the number of collateral arrests1 if any1 and the reasons for each such arrest2 7,,viii7 a certification whether the location administrator of a protected area was contacted before1 during1 or after the enforcement action2 and 7,,ix7 the percentage of all of the staff members and supervisors reporting to the officials listed in paragraph 7#d77;,b7 who completed the training required under paragraph 7#d77;,a74 7#g7 ,nothing in the subsection may be construed-- 7,a7 to affect the authority of ,federal1 ,state1 or local law enforcement agencies-- 7i7 to enforce generally applicable ,federal or ,state criminal laws unrelated to immigration2 or 7ii7 to protect residents from imminent threats to public safety2 or 7,b7 to limit or override the protections provided in-- 7i7 section #bci2 or 7ii7 section #chd of the ,illegal ,immigration ,reform and ,immigrant ,responsibility ,act of #aiif 7#h ,u4,s4,c4 #acfg74 4 #djjb4 ,repeal of requirement for documentation evidencing citizenship or nationality under the ,medicaid program 7a7 ,repeal ,subsections 7i77#bb7 and 7x7 of section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 are each repealed4 7b7 ,conforming amendments 7#a7 ,state payments for medical assistance ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended-- 7,a7 by amending paragraph 7#df7 of subsection 7a7 to read as follows3 7#df7 provide that information is requested and exchanged for purposes of income and eligibility verification in accordance with a ,state system which meets the requirements of section #aacg of this ,act2 2 7,b7 in subsection 7e77#ac77;,a77i7-- 7i7 in the matter preceding subclause 7,i71 by striking sections #aijb7;a77#df77;,b7 and #aacg7;d7 and inserting section #aacg7;d72 and 7ii7 in subclause 7,,iv71 by striking #aijb7;a77#df77;,b7 or2 and 7,c7 by striking subsection 7ee74 7#b7 ,repeal ,subsection 7c7 of section #fjcf of the ,deficit ,reduction ,act of #bjje 7#db ,u4,s4,c4 #acif;b note7 is repealed4 7c7 ,effective date ,the amendments made by this section shall take effect on the date of enactment of this ,act4 #djjc4 ,,lift the ,,bar ,act 7a7 ,elimination of arbitrary eligibility restrictions 7#a7 ,in general ,sections #djb1 #djc1 #daa1 #dab1 #dba1 and #dbb of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afab1 #afac1 #afba1 #afbb1 #afca1 and #afcb7 are repealed4 7#b7 ,conforming amendments ,title ,,iv of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afja et seq47 is amended-- 7,a7 in section #dja7;b77#e7 7#h ,u4,s4,c4 #afaa7;b77#e771 by striking the program defined in section #djb7;a77#c77;,a7 7relating to the supplemental security income program7 and inserting the ,supplemental ,security ,income ,program under title ,,xvi of the ,social ,security ,act 7#db ,u4,s4,c4 #acha et seq472 7,b7 in section #djd7;a7 7#h ,u4,s4,c4 #afad7;a771 by striking 1 #djb1 or #djc2 7,c7 in section #dac 7#h ,u4,s4,c4 #afbe7-- 7i7 by striking ,a ,state and inserting the following3 7a7 ,state or local public benefit defined ,in this section1 the term ,state or local public benefit-- 7#a7 except as provided in paragraphs 7#b7 and 7#c71 means-- 7,a7 any grant1 contract1 loan1 professional license1 or commercial license provided by an agency of a ,state or local government or by appropriated funds of a ,state or local government2 and 7,b7 any retirement1 welfare1 health1 disability1 public or assisted housing1 postsecondary education1 food assistance1 unemployment benefit1 or any other similar benefit for which payments or assistance are provided to an individual1 household1 or family eligibility unit by an agency of a ,state or local government or by appropriated funds of a ,state or local government2 7#b7 does not apply-- 7,a7 to any contract1 professional license1 or commercial license for a nonimmigrant whose visa for entry is related to such employment in the ,united ,states1 or to a citizen of a freely associated state1 if section #ada of the applicable compact of free association approved in ,public ,law #ii-bci or #ii-feh 7or a successor provision7 is in effect2 7,b7 with respect to benefits for an alien who as a work authorized nonimmigrant or as an alien lawfully admitted for permanent residence under the ,immigration and ,nationality ,act qualified for such benefits and for whom the ,united ,states under reciprocal treaty agreements is required to pay benefits1 as determined by the ,secretary of ,state1 after consultation with the ,attorney ,general2 or 7,c7 to the issuance of a professional license to1 or the renewal of a professional license by1 a foreign national not physically present in the ,united ,states2 and 7#c7 does not include any ,federal public benefit4 7b7 ,proof of eligibility requirement ,a ,state 2 and 7ii7 in subsection 7b71 as redesignated1 by striking 7as defined in section #daa7;c772 7,d7 in section #dcb7;d7 7#h ,u4,s4,c4 #afdb7;d771 by striking 7as defined in section #daa7;c77 and inserting 7as defined in section #dac7;a772 7,e7 in section #dce 7#h ,u4,s4,c4 #afde71 by striking 7as provided under section #djc72 and 7,f7 in section #dcf 7#h ,u4,s4,c4 #afdf7-- 7i7 by striking the food stamp program 7as defined in section #djb7;a77#c77;,b77 and inserting the supplemental nutrition assistance program established under the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjaa et seq472 and 7ii7 by striking the supplemental security income program 7as defined in section #djb7;a77#c77;,a77 and inserting the ,supplemental ,security ,income ,program under title ,,xvi of the ,social ,security ,act 7#db ,u4,s4,c4 #acha et seq474 7b7 ,qualified noncitizens ,title ,,iv of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afja et seq47 is amended-- 7#a7 in the title header1 by striking ,aliens and inserting ,noncitizens2 7#b7 in the header of section #dja 7#h ,u4,s4,c4 #afaa71 by striking ,aliens who are not qualified aliens and inserting ,noncitizens who are not qualified noncitizens2 7#c7 by striking qualified alien each place such term appears and inserting qualified noncitizen2 7#d7 by striking qualified aliens each place such term appears and inserting qualified noncitizens2 7#e7 by striking qualified alien's each place such term appears and inserting qualified noncitizen's2 7#f7 by striking an alien each place such term appears and inserting a noncitizen2 7#g7 by striking alien each place such term appears and inserting noncitizen2 7#h7 by striking aliens each place such term appears and inserting noncitizens2 and 7#i7 by striking alien's each place such term appears and inserting noncitizen's4 7c7 ,access to basic services for lawfully residing noncitizens ,section #dca of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afda7 is amended-- 7#a7 by striking subsection 7b7 and inserting the following3 7b7 ,qualified noncitizen ,for purposes of this title1 the term qualified noncitizen means a noncitizen who1 at the time the noncitizen applies for1 receives1 or attempts to receive a ,federal public benefit1 is lawfully present in the ,united ,states4 2 7#b7 in subsection 7c7-- 7,a7 in the header1 by striking qualified aliens and inserting qualified noncitizens2 7,b7 in paragraph 7#c71 by striking or at the end2 7,c7 in paragraph 7#d71 by striking the period at the end and inserting 2 or2 and 7,d7 by inserting after paragraph 7#d7 the following3 7#e7 a noncitizen-- 7,a7 in a category that was treated as lawfully present for purposes of section #aaja of the ,patient ,protection and ,affordable ,care ,act of #bjaj 7#db ,u4,s4,c4 #ahjja72 7,b7 who met the requirements of section #djb7;a77#b77;,d7 of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afab7;a77#b77;,d77 on or before ,january #a1 #bjba2 7,c7 who is granted special immigrant juvenile status as described by section #aja7;a77#bg77;,j7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaja7;a77#bg77;,j772 7,d7 who has a pending1 bona fide application for nonimmigrant status under section #aja7;a77#ae77,u7 of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aaja7a77ae77,u772 7,e7 who was granted relief under the ,deferred ,action for ,childhood ,arrivals program2 or 7,f7 who is not described in subparagraphs 7,a7 through 7,e71 is not a citizen of the ,united ,states1 resides in a ,state or territory of the ,united ,states1 and is authorized by ,federal law to be present in the ,united ,states4 2 and 7#c7 by adding at the end the following3 7d7 ,noncitizen ,in this title1 the term noncitizen means any individual who is not a citizen of the ,united ,states4 4 7d7 ,child nutrition programs ,section #gdb of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afae7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in the header by striking ,school lunch and breakfast programs and inserting ,child nutrition programs2 7,b7 by striking the school lunch program and inserting any program2 and 7,c7 by striking the school breakfast program under section #d of the and inserting any program under2 and 7#b7 in subsection 7b71 by amending paragraph 7#a7 to read as follows3 7#a7 ,in general ,a ,state may not deny benefits under programs established under the provisions of law described in paragraph 7#b7 on the basis of an individual's citizenship or immigration status4 4 7e7 ,exclusion of medical assistance expenditures for citizens of ,freely ,associated ,states ,section #aajh7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7;h77 is amended-- 7#a7 by striking ,expenditures and inserting3 7#a7 ,in general ,expenditures 2 and 7#b7 by adding at the end the following3 7#b7 ,exception ,with respect to eligibility for benefits under a ,state plan approved under title ,,xix 7other than medical assistance described in section #dja7;b77#a77;,a7 of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afaa7;b77#a77;,a7771 paragraph 7#a7 shall not apply to any individual who lawfully resides in #a of the #ej ,states or in the ,district of ,columbia in accordance with the ,compacts of ,free ,association between the ,government of the ,united ,states and the ,governments of the ,federated ,states of ,micronesia1 the ,republic of the ,marshall ,islands1 and the ,republic of ,palau and shall not apply1 at the option of the ,governor of ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa as communicated to the ,secretary of ,health and ,human ,services in writing1 to any individual who lawfully resides in the respective territory in accordance with such ,compacts4 4 7f7 ,children's ,health ,insurance ,program ,effective ,january #a1 #bjbe1 section #bajg7;e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77 is amended-- 7#a7 by striking subparagraph 7,p72 and 7#b7 by redesignating subparagraphs 7,q71 7,r71 7,s71 7,t71 and 7,u7 as subparagraphs 7,p71 7,q71 7,r71 7,s71 and 7,t71 respectively4 7g7 ,conforming amendments 7#a7 ,supplemental food assistance program ,the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjaa et seq47 is amended-- 7,a7 in section #e 7#g ,u4,s4,c4 #bjad7-- 7i7 in subsection 7d77#aj71 by striking 7k7 and inserting 7j72 7ii7 by striking subsection 7i72 and 7iii7 by redesignating subsections 7j71 7k71 7l71 7m71 and 7n7 as subsections 7i71 7j71 7k71 7l71 and 7m71 respectively2 7,b7 in section #f 7#g ,u4,s4,c4 #bjae7-- 7i7 in subsection 7f71 by striking an alien lawfully admitted for permanent and all that follows through the end of the subsection and inserting a noncitizen who is lawfully present in the ,united ,states42 and 7ii7 in subsection 7s77#b71 by striking 7i71 7k71 7l71 7m71 and 7n7 and inserting 7j71 7k71 7l71 and 7m72 and 7,c7 in section #aa7;e77#b77;,b77v77,,ii7 7#g ,u4,s4,c4 #bjbj7;e77#b77;,b77v77,,ii77 by striking aliens and inserting noncitizens4 7#b7 ,medicaid ,section #aijc7v7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7v77 is amended-- 7,a7 in paragraph 7#a71 by striking admitted for and all that follows and inserting present in the ,united ,states42 and 7,b7 by striking paragraph 7#d74 7#c7 ,housing assistance ,section #bad7;a7 of the ,housing and ,community ,development ,act of #aihj 7#db ,u4,s4,c4 #adcf;a7a77 is amended-- 7,a7 by redesignating paragraphs 7#f7 and 7#g7 as paragraphs 7#g7 and 7#h71 respectively2 and 7,b7 by inserting after paragraph 7#e7 the following3 7#f7 a qualified noncitizen 7as defined in section #dca of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afda772 4 7#d7 ,assistance not treated as debt absent fraud ,section #bac;,a of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aahc;a7 is amended-- 7,a7 in subsection 7a77#c7-- 7i7 in subparagraph 7,a71 by striking 7as provided under section #djc of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif72 and 7ii7 in subparagraph 7,b71 in the undesignated matter following clause 7ii71 by striking 7as provided under section #djc of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif72 and 7,b7 in subsection 7b77#a77;,a7 is amended by striking benefit1 and inserting benefit by fraud14 7h7 ,federal agency guidance ,not later than #ahj days after the date of the enactment of this ,act1 each ,federal agency affected by any of the amendments made by this section shall issue guidance with respect to the implementation of such amendments4 7i7 ,effective date ,except as otherwise provided in this section1 the amendments made by this section-- 7#a7 shall take effect on the date of the enactment of this ,act2 and 7#b7 shall apply to services furnished on or after the date that is #ahj days after the date on which any guidance is issued pursuant to subsection 7h74 #djjd4 ,improve affordability and reduce premium costs of health insurance for consumers 7a7 ,in general ,section #cf;,b7b77#c77;,a7 of the ,internal ,revenue ,code of #aihf is amended to read as follows3 7,a7 ,applicable percentage ,the applicable percentage for any taxable year shall be the percentage such that the applicable percentage for any taxpayer whose household income is within an income tier specified in the following table shall increase1 on a sliding scale in a linear manner1 from the initial premium percentage to the final premium percentage specified in such table for such income tier3 ,in the case of household income 7expressed as a percent of poverty line7 within the following income tier3,the initial premium percentage is--,the final premium percentage is--,up to #aej percent#j4jj4jaej percent up to #bjj percent#j4jc4jbjj percent up to #bej percent#c4jd4jbej percent up to #cjj percent#d4jf4jcjj percent up to #djj percent#f4jh4edjj percent and higher#h4eh4e4 4 7b7 ,conforming amendments ,section #cf;,b7c77#a7 of the ,internal ,revenue ,code of #aihf is amended-- 7#a7 by striking but does not exceed #djj percent in subparagraph 7,a71 and 7#b7 by striking subparagraph 7,e74 7c7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after ,december #ca1 #bjbc4 #djje4 ,removing citizenship and immigration barriers to access to affordable health care under the ,,aca 7a7 ,in general 7#a7 ,premium tax credits ,section #cf;,b of the ,internal ,revenue ,code of #aihf is amended-- 7,a7 in subsection 7c77#a71 by amending subparagraph 7,b7 to read as follows3 7,b7 ,special rule for certain individuals ineligible for ,medicaid due to status ,if-- 7i7 a taxpayer has a household income which is not greater than #ajj percent of an amount equal to the poverty line for a family of the size involved1 7ii7 the taxpayer is a noncitizen who is not eligible for the ,medicaid program under title ,,xix of the ,social ,security ,act by reason of the individual's immigration status1 7iii7 the taxpayer is ineligible for minimum essential coverage under section #ejjj;,a7f77#a77;,a77ii71 and 7iv7 under the ,medicaid eligibility criteria for noncitizens in effect on ,december #bf1 #bjbj1 the taxpayer would be ineligible for such minimum essential coverage by reason of the taxpayer's immigration status1 the taxpayer shall1 for purposes of the credit under this section1 be treated as an applicable taxpayer with a household income which is equal to #ajj percent of the poverty line for a family of the size involved4 4 7,b7 by striking subsection 7e74 7#b7 ,cost-sharing reductions ,section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7 is amended-- 7,a7 by striking subsection 7e72 and 7,b7 by redesignating subsections 7f7 and 7g7 as subsections 7e7 and 7f71 respectively4 7#c7 ,basic health program eligibility ,section #acca7;e77#a77;,b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjea7;e77#a77;,b77 is amended by striking lawfully present in the ,united ,states14 7#d7 ,restrictions on ,federal payments ,section #adab of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjhb7 is amended-- 7,a7 by striking subsection 7d72 and 7,b7 by redesignating subsection 7e7 as subsection 7d74 7#e7 ,requirement to maintain minimum essential coverage ,section #ejjj;,a7d7 of the ,internal ,revenue ,code of #aihf is amended-- 7,a7 by striking paragraph 7#c72 and 7,b7 by redesignating paragraph 7#d7 as paragraph 7#c74 7b7 ,conforming amendments 7#a7 ,establishment of program ,section #adaa7;a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjha7;a77 is amended-- 7,a7 by striking paragraph 7#a72 and 7,b7 by redesignating paragraphs 7#b71 7#c71 and 7#d7 as paragraphs 7#a71 7#b71 and 7#c71 respectively4 7#b7 ,qualified individuals ,section #acab7;f7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjcb7;f77 is amended-- 7,a7 in the heading1 by striking 2 access limited to citizens and lawful residents2 and 7,b7 by striking paragraph 7#c74 7c7 ,effective date ,the amendments made by this section shall apply to years1 plan years1 and taxable years1 as applicable1 beginning after ,december #ca1 #bjbd4 #djjf4 ,,heal for ,immigrant ,families ,act 7a7 ,consistency in health insurance coverage for individuals with federally authorized presence1 including deferred action 7#a7 ,in general ,for purposes of eligibility under any of the provisions described in paragraph 7#b71 all individuals granted federally authorized presence in the ,united ,states shall be considered to be lawfully present in the ,united ,states4 7#b7 ,provisions described ,the provisions described in this paragraph are the following3 7,a7 ,exchange eligibility ,section #adaa of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca74 7,b7 ,reduced cost-sharing eligibility ,section #adjb of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga74 7,c7 ,premium subsidy eligibility ,section #cf;,b of the ,internal ,revenue ,code of #aihf 7#bf ,u4,s4,c4 #cf;,b74 7,d7 ,medicaid and chip eligibility ,titles ,,xix and ,,xxi of the ,social ,security ,act1 including under section #aijc7v7 of such ,act 7#db ,u4,s4,c4 #acif;b7v774 7#c7 ,effective date 7,a7 ,in general ,paragraph 7#a7 shall take effect on the date of enactment of this ,act4 7,b7 ,transition through special enrollment period ,in the case of an individual described in paragraph 7#a7 who1 before the first day of the first annual open enrollment period under subparagraph 7,b7 of section #acaa7;c77#f7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77#f77 beginning after the date of enactment of this ,act1 is granted federally authorized presence in the ,united ,states and who1 as a result of such subsection1 qualifies for a subsidy under a provision described in subparagraph 7,b7 or 7,c7 of paragraph 7#b71 the ,secretary of ,health and ,human ,services shall establish a special enrollment period under subparagraph 7,c7 of such section #acaa7;c77#f7 during which such individual may enroll in qualified health plans through ,exchanges under title ,i of the ,patient ,protection and ,affordable ,care ,act and qualify for such a subsidy4 ,for such an individual who has been granted federally authorized presence in the ,united ,states as of the date of enactment of this ,act1 such special enrollment period shall begin not later than #ij days after such date of enactment4 ,nothing in this paragraph shall be construed as affecting the authority of the ,secretary to establish additional special enrollment periods under such subparagraph 7,c74 7b7 ,state option ,to expand ,medicaid and ,,chip to individuals without lawful presence 7#a7 ,medicaid 7,a7 ,in general ,section #aijb7;a77#aj77;,a77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77ii77 is amended-- 7i7 in subclause 7,,xxii71 by striking or at the end2 7ii7 in subclause 7,,xxiii71 by striking the semicolon and inserting 2 or2 and 7iii7 by adding at the end the following new subclause3 7,,xxiv7 who would be eligible under the ,state plan 7or waiver of such plan7 under this title if they were citizens of the ,united ,states2 4 7,b7 ,conforming amendment ,section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is amended1 in the matter preceding paragraph 7#a7-- 7i7 in the matter designated as clause 7xvi71 by striking or at the end2 7ii7 in the matter designated as clause 7xvii71 by adding or at the end2 and 7iii7 by inserting after the matter designated as clause 7xvii7 the following3 7xviii7 individuals described in section #aijb7;a77#aj77;,a77ii77,,xxiv71 4 7#b7 ,,chip ,title ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq47 is amended by inserting after section #baab the following new section3 #baab;,a4 ,state option to provide coverage for individuals without lawful presence ,a ,state may elect through an amendment to its ,state child health plan under section #bajb to treat an individual as a targeted low-income child or a targeted low-income pregnant woman for purposes of this title if such individual would otherwise be included as such a child or such a pregnant woman 7as applicable7 under such plan if the individual were a citizen of the ,united ,states4 4 7#c7 ,nonapplication of eligibility prohibition ,section #dja7;a7 of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#db ,u4,s4,c4 #afaa7;a77 is amended by adding at the end the following new sentence3 ,the preceding sentence shall not apply with respect to a noncitizen's eligibility under a ,state plan 7or waiver of such plan7 under title ,,xix of the ,social ,security ,act or under a ,state child health plan 7or waiver of such plan7 under title ,,xxi of such ,act to the extent that such ,state has elected to make such individual so eligible pursuant to section #aijb7;a77#aj77;,a77ii77,,xxiv7 or #baab;,a of such ,act1 respectively44 7c7 ,preserving access to coverage 7#a7 ,in general ,nothing in this section1 including the amendments made by this section1 shall prevent lawfully present noncitizens who are ineligible for full benefits under the ,medicaid program under title ,,xix of the ,social ,security ,act from securing a credit for which such lawfully present noncitizens would be eligible under section #cf;,b7c77#a77;,b7 of the ,internal ,revenue ,code of #aihf and under the ,medicaid provisions for lawfully present noncitizens1 as in effect on the date prior to the date of enactment of this ,act4 7#b7 ,definition ,for purposes of paragraph 7#a71 the term full benefits means1 with respect to an individual and ,state1 medical assistance for all services covered under the ,state plan under title ,,xix of the ,social ,security ,act that is not less in amount1 duration1 or scope1 or is determined by the ,secretary of ,health and ,human ,services to be substantially equivalent to the medical assistance available for an individual described in section #aijb7;a77#aj77;,a77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77i774 #djjg4 ,study on the uninsured 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall-- 7#a7 conduct a study1 in accordance with the standards under section #caja of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjkk71 on the demographic characteristics of the population of individuals who do not have health insurance or oral health coverage2 and 7#b7 predict1 based on such study1 the demographic characteristics of the population of individuals who would remain without health insurance after the end of any annual open enrollment or any special enrollment period or upon enactment and implementation of any legislative changes to the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 that affect the number of persons eligible for health insurance4 7b7 ,reporting requirements 7#a7 ,in general ,not later than #ab months after the date of the enactment of this ,act1 the ,secretary shall submit to the ,congress the results of the study under subsection 7a77#a7 and the prediction made under subsection 7a77#b74 7#b7 ,reporting of demographic characteristics ,the ,secretary shall-- 7,a7 report the demographic characteristics under paragraphs 7#a7 and 7#b7 of subsection 7a7 on the basis of racial and ethnic minority group 7as defined in section #agjg7;g77#a7 of the ,public ,health ,service ,act71 and stratify the reporting on each racial and ethnic minority group by other demographic characteristics that can impact access to health insurance1 such as sexual orientation1 gender identity1 primary language1 disability status1 sex1 socioeconomic status1 age group1 citizenship1 and immigration status1 in a manner consistent with title ,i of this ,act1 including the amendments made by such title2 and 7,b7 not use such report1 or any information gathered in preparing such report-- 7i7 to engage in or anticipate any deportation or immigration related enforcement action by any entity1 including the ,department of ,homeland ,security2 or 7ii7 for the exploitation of1 or discrimination against1 communities of color or the ,,lgbtq population4 #djjh4 ,medicaid fallback coverage program for low-income adults in non-expansion ,states 7a7 ,in general ,as soon as possible after the date of enactment of this ,act the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall-- 7#a7 directly or by contract1 establish a program that offers eligible individuals the opportunity to enroll in health benefits coverage that meets the requirements described in subsection 7c7 and any requirements applicable to such coverage pursuant to subsection 7d72 and 7#b7 ensure that such program is administered consistent with the requirements of section #dca4aj7;c77#b7 of title #db1 ,code of ,federal ,regulations4 7b7 ,definition of eligible individual ,in this section1 the term eligible individual means an individual who-- 7#a7 is described in section #aijb7;a77#aj77;,a77i77,,viii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77i77,,viii772 7#b7 resides in a ,state that-- 7,a7 does not expend amounts for medical assistance under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 for all individuals described in such section2 and 7,b7 did not expend amounts for medical assistance under such title for all such individuals as of the date of enactment of this ,act2 and 7#c7 would not be eligible for medical assistance under such ,state's plan for medical assistance under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 or a waiver of such plan1 as such plan or waiver was in effect on such date4 7c7 ,health benefits coverage requirements ,the requirements described in this subsection with respect to health benefits coverage are the following3 7#a7 ,essential health benefits ,at a minimum1 the coverage meets the minimum standards required under paragraph 7#e7 of section #aicg7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#g7;b77 for benchmark coverage described in paragraph 7#a7 of such section or benchmark equivalent coverage described in paragraph 7#b7 of such section4 7#b7 ,premiums and cost-sharing ,no premiums are imposed for the coverage1 and deductibles1 cost-sharing1 or similar charges may only be imposed in accordance with the requirements imposed on ,state ,medicaid plans under section #aiaf of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo74 7d7 ,application of requirements and provisions of title ,,xix of the ,social ,security ,act ,the ,secretary shall specify that-- 7#a7 any requirement applicable to the furnishing of medical assistance under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 by ,states that have elected to make medical assistance available to individuals described in section #aijb7;a77#aj77;,a77i77,,viii7 of such title 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77i77,,viii77 that does not conflict with the requirements specified in subsection 7c7 applies to the program established under this section2 and 7#b7 other provisions of such title apply to such program4 7e7 ,no ,state mandate ,nothing in this section shall be construed as requiring a ,state to make expenditures related to the program established under this section and the ,secretary shall not impose any such requirement4 7f7 ,funding ,there are appropriated to the ,secretary for each fiscal year beginning with fiscal year #bjbe from any funds in the ,treasury not otherwise appropriated1 such sums as are necessary to carry out this section4 #djji4 ,increase and extension of temporary enhanced ,,fmap for ,states which begin to expend amounts for certain mandatory individuals 7a7 ,in general ,section #aije7;ii77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7ii77#a77 is amended-- 7#a7 by striking #h-quarter period and inserting #dj-quarter period2 and 7#b7 by striking #e percentage points and inserting #aj percentage points4 7b7 ,effective date ,the amendments made by this section shall take effect as if included in the enactment of section #ihad of the ,american ,rescue ,plan ,act of #bjba 7,public ,law #aag-b74 ,b ,improvement of ,coverage #daja4 ,medicaid in the territories 7a7 ,elimination of general ,medicaid funding limitations 7,,cap7 for territories 7#a7 ,in general ,section #aajh of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7 is amended-- 7,a7 in subsection 7f71 in the matter preceding paragraph 7#a71 by striking subsections 7g7 and 7h7 and inserting subsections 7g71 7h71 and 7j72 7,b7 in subsection 7g77#b71 in the matter preceding subparagraph 7,a71 by inserting subsection 7j7 and after subject to2 7,c7 in subsection 7i71 by striking paragraph 7#d72 and 7,d7 by adding at the end the following new subsection3 7j7 ,sunset of medicaid funding limitations for puerto rico1 the virgin islands1 guam1 the northern mariana islands1 and american samoa ,subsections 7f7 and 7g7 shall not apply to ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa beginning with fiscal year #bjbe4 4 7#b7 ,conforming amendments 7,a7 ,section #aijb7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7j77 is amended by striking 1 the limitation in section #aajh7;f7114 7,b7 ,section #aijc7u7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7u77 is amended by striking paragraph 7#d74 7#c7 ,effective date ,the amendments made by this subsection shall apply beginning with fiscal year #bjbe4 7b7 ,elimination of specific ,federal medical assistance percentage 7,,fmap7 limitation for ,puerto ,rico ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in subsection 7b71 in the first sentence1 by inserting for fiscal years before fiscal year #bjbf after ,american ,samoa2 and 7#b7 in subsection 7ff77#b71 by striking #bjbg and inserting #bjbe4 7c7 ,permitting medicaid ,,dsh allotments for territories ,section #aibc7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;f77 is amended-- 7#a7 in paragraph 7#f71 by adding at the end the following new subparagraph3 7,c7 ,territories 7i7 ,fiscal year #bjbe ,for fiscal year #bjbe1 the ,,dsh allotment for ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa shall bear the same ratio to #cjj1jjj1jjj as the ratio of the number of individuals who are low-income or uninsured and residing in such respective territory 7as estimated from time to time by the ,secretary7 bears to the sums of the number of such individuals residing in all of the territories4 7ii7 ,subsequent fiscal year ,for each subsequent fiscal year1 the ,,dsh allotment for each such territory is subject to an increase in accordance with paragraph 7#c74 2 and 7#b7 in paragraph 7#i71 by inserting before the period at the end the following3 1 and includes1 beginning with fiscal year #bjbe1 ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa4 #dajb4 ,extension of the ,supplemental ,security ,income ,program to ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 and ,american ,samoa 7a7 ,in general ,section #cjc of the ,social ,security ,amendments of #aigb 7#hf ,stat4 #adhd7 is amended by striking subsection 7b74 7b7 ,conforming amendments 7#a7 ,definition of state ,section #aaja7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acja7;a77#a77 is amended by striking the #eth sentence and inserting the following3 ,such term when used in title ,,xvi includes ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 and ,american ,samoa44 7#b7 ,elimination of limit on total payments to the territories ,section #aajh of such ,act 7#db ,u4,s4,c4 #acjh7 is amended-- 7,a7 in the section heading1 by striking 2 limitation on total payments2 7,b7 by striking subsection 7a72 and 7,c7 in subsection 7c71 by striking paragraphs 7#b7 and 7#d7 and redesignating paragraphs 7#c7 and 7#e7 as paragraphs 7#b7 and 7#d71 respectively4 7#c7 ,united ,states nationals treated the same as citizens ,section #afad7;a77#a77;,b7 of such ,act 7#db ,u4,s4,c4 #achb;c7a77#a77;,b77 is amended-- 7,a7 in clause 7i77,i71 by inserting or national1 after citizen2 7,b7 in clause 7i77,,ii71 by adding 2 or at the end2 and 7,c7 in clause 7ii71 by inserting or national after citizen4 7#d7 ,territories included in geographic meaning of ,united ,states ,section #afad7;e7 of such ,act 7#db ,u4,s4,c4 #achb;c7e77 is amended by striking and the ,district of ,columbia and inserting 1 the ,district of ,columbia1 ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 and ,american ,samoa4 7c7 ,waiver authority ,the ,commissioner of ,social ,security may waive or modify any statutory requirement relating to the provision of benefits under the ,supplemental ,security ,income ,program under title ,,xvi of the ,social ,security ,act in ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 or ,american ,samoa1 to the extent that the ,commissioner deems it necessary in order to adapt the program to the needs of the territory involved4 7d7 ,effective date ,this section and the amendments made by this section shall take effect on the #ast day of the #ast ,federal fiscal year that begins #a year or more after the date of the enactment of this ,act4 #dajc4 ,extension of ,medicare secondary payer 7a7 ,in general ,section #ahfb7;b77#a77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7b77#a77;,c77 is amended-- 7#a7 in the last sentence1 by inserting 1 and before ,january #a1 #bjbe after prior to such date72 and 7#b7 by adding at the end the following new sentence3 ,effective for items and services furnished on or after ,january #a1 #bjbe 7with respect to periods beginning on or after the date that is #db months prior to such date71 clauses 7i7 and 7ii7 shall be applied by substituting #db-month for #ab-month each place it appears44 7b7 ,effective date ,the amendments made by this section shall take effect on the date of enactment of this ,act4 ,for purposes of determining an individual's status under section #ahfb7;b77#a77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7b77#a77;,c771 as amended by subsection 7a71 an individual who is within the coordinating period as of the date of enactment of this ,act shall have that period extended to the full #db months described in the last sentence of such section1 as added by the amendment made by subsection 7a77#b74 #dajd4 ,indian defined in title ,i of the ,patient ,protection and ,affordable ,care ,act 7a7 ,definition of ,indian ,section #acjd of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbd7 is amended by adding at the end the following3 7f7 ,indian ,in this title3 7#a7 ,in general ,the term ,indian means-- 7,a7 an ,indian1 a ,california ,indian1 or an ,urban ,indian 7as those terms are defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc772 or 7,b7 an individual who is of ,indian descent and a member of an ,indian community served by a local facility or program of the ,indian ,health ,service4 7#b7 ,inclusions ,the term ,indian includes the following individuals3 7,a7 ,a member of a federally recognized ,indian ,tribe4 7,b7 ,a resident of an urban center who meets #a or more of the following criteria3 7i7 ,a member of a ,tribe1 band1 or other organized group of ,indians1 including those ,tribes1 bands1 or groups terminated since #aidj and those recognized as of the date of enactment of the ,health ,equity and ,accountability ,act of #bjbd or later by the ,state in which they reside1 or being a descendant1 in the first or second degree1 of any such member4 7ii7 ,an ,eskimo or ,aleut or other ,alaska ,native4 7iii7 ,an individual who is determined to be an ,indian under regulations promulgated by the ,secretary4 7,c7 ,an individual who is considered by the ,secretary of the ,interior to be an ,indian for any purpose4 7,d7 ,an individual who is considered by the ,secretary to be an ,indian for purposes of eligibility for services provided by the ,indian ,health ,service1 including as a ,california ,indian1 ,eskimo1 ,aleut1 or other ,alaska ,native4 4 7b7 ,conforming amendments 7#a7 ,affordable choices of health benefit plans ,section #acaa7;c77#f77;,d7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77#f77;,d77 is amended by striking 7as defined in section #d of the ,indian ,health ,care ,improvement ,act74 7#b7 ,reduced cost-sharing for individuals enrolling in qualified health plans ,section #adjb7;d7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjga7;d77 is amended-- 7,a7 in paragraph 7#a71 in the matter preceding subparagraph 7,a71 by striking 7as defined in section #d7;d7 of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej;b7d7772 and 7,b7 in paragraph 7#b71 in the matter preceding subparagraph 7,a71 by striking 7as so defined74 7#c7 ,exemption from penalty for not maintaining minimum essential coverage ,section #ejjj;,a7e7 of the ,internal ,revenue ,code of #aihf is amended by striking paragraph 7#c7 and inserting the following3 7#c7 ,indians ,any applicable individual who is an ,indian 7as defined in section #acjd7;f7 of the ,patient ,protection and ,affordable ,care ,act74 4 7c7 ,effective date of ,,irc amendment ,the amendment made by subsection 7b77#c7 shall apply to taxable years beginning after the date of the enactment of this ,act4 #daje4 ,removing ,medicare barrier to health care 7a7 ,part ,a ,section #ahah7;a77#c77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#b7;a77#c77;,b77 is amended by striking an alien and all that follows through under this section and inserting an individual who is lawfully present in the ,united ,states4 7b7 ,part ,b ,section #ahcf7;a77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieo7a77#b77;,b77 is amended by striking an alien and all that follows through under this part and inserting an individual who is lawfully present in the ,united ,states4 #dajf4 ,lowering ,medicare premiums and prescription drug costs 7a7 ,medicare ,cost ,assistance ,program 7#a7 ,in general ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is amended by adding at the end the following new section3 #ahii;,c4 ,medicare ,cost ,assistance ,program 7a7 ,in general ,effective beginning ,january #a1 #bjbe1 in the case of a ,medicare ,cost ,assistance ,program eligible individual 7as defined in subsection 7b77#a771 the ,secretary shall provide ,medicare cost assistance for the following costs incurred with respect to the individual3 7#a7 ,premiums under section #ahah4 7#b7 ,premiums under section #ahci4 7#c7 ,coinsurance under this title 7including coinsurance described in section #ahac74 7#d7 ,deductibles established under this title 7including those described in section #ahac and section #ahcc7;b774 7#e7 ,the difference between the amount that is paid under section #ahcc7;a7 and the amount that would be paid under such section if any reference to a percent less than #ajj percent therein were deemed a reference to #ajj percent4 7b7 ,determination of eligibility 7#a7 ,medicare ,cost ,assistance ,program eligible individual defined ,the term ,medicare ,cost ,assistance ,program eligible individual means an individual who-- 7,a7 is eligible for1 and is receiving1 medical assistance for the payment of medicare cost-sharing under a ,state ,medicaid program pursuant to clause 7i71 7iii71 or 7iv7 of section #aijb7;a77#aj77;,e7 as of ,december #ca1 #bjbd2 or 7,b7 7i7 is entitled to hospital insurance benefits under part ,a 7including an individual entitled to such benefits pursuant to an enrollment under section #ahah72 and 7ii7 has income at or below #bjj percent of the poverty line applicable to a family of the size involved4 7#b7 ,joint determination by ,commissioner of ,social ,security for ,,lis and ,medicare cost assistance 7,a7 ,in general ,the determination of whether an individual is a ,medicare ,cost ,assistance ,program eligible individual shall be determined by the ,commissioner of ,social ,security 7referred to in this section as the ,commissioner7 jointly with the determination of whether an individual is a subsidy eligible individual described in section #ahfj;,d-#ad7;a77#c74 ,such determination shall be made with respect to eligibility for ,medicare cost assistance under this section and premium and cost-sharing subsidies under section #ahfj;,d-#ad upon application of an individual for a determination with respect to eligibility for either such assistance or such subsidies4 ,there are authorized to be appropriated to the ,social ,security ,administration such sums as may be necessary for the determination of eligibility under this paragraph4 7,b7 ,effective period ,determinations under this paragraph with respect to eligibility for each of such assistance or such subsidies shall be effective beginning with the month in which the individual applies for a determination described in subparagraph 7,a7 and shall remain in effect until such time as the ,secretary determines the individual is no longer eligible as determined under subparagraph 7,c77ii74 7,c7 ,redeterminations ,with respect to eligibility determinations under this paragraph-- 7i7 redeterminations shall be made at the same time with respect to eligibility for ,medicare cost assistance under this section and cost-sharing subsidies under section #ahfj;,d-#ad1 but not more frequently than once every #ab months2 7ii7 a redetermination shall automatically determine that an individual remains eligible for such assistance or subsidies unless-- 7,i7 the ,commissioner has information indicating that the individual's circumstances have changed such that the individual is no longer eligible for such assistance or subsidies2 7,,ii7 the ,commissioner sends notice to the individual regarding such information that requests a response either confirming or correcting such information2 and 7,,iii7 the individual either confirms such information or fails to provide documentation indicating that such circumstances have not changed within #fj days of receiving the notice described in subclause 7,,ii72 7iii7 the ,commissioner shall establish procedures for appeals of such determinations that are similar to the procedures described in the third sentence of section #afca7;c77#a77;,a72 and 7iv7 judicial review of the final decision of the ,commissioner made after a hearing shall be available to the same extent1 and with the same limitations1 as provided in subsections 7g7 and 7h7 of section #bje4 7,d7 ,treatment of medicaid beneficiaries ,the ,secretary shall provide that individuals who are full-benefit dual eligible individuals 7as defined in section #aice7;c77#f77 or who are recipients of supplemental security income benefits under title ,,xvi shall be treated as a ,medicare ,cost ,assistance ,program eligible individual and1 in the case of such individual who is a part ,d eligible individual1 a subsidy eligible individual described in section #ahfj;,d-#ad7;a77#c74 7,e7 ,simplified application form 7i7 ,in general ,the ,secretary shall develop and distribute a simplified application form for use by individuals in applying for ,medicare cost assistance under this section and premium and cost-sharing subsidies under section #ahfj;,d-#ad4 ,such form shall be easily readable based on culturally fluid language for all demographics beyond just the various languages offered4 ,an audio version1 digital version1 and photo-voice option should also be provided for all learners4 ,the ,secretary shall provide for the translation of such application form into at least the #aj languages 7other than ,english7 that are most often used by individuals applying for hospital insurance benefits under section #bbf or #bbf;,a and shall make the translated forms available to the ,commissioner of ,social ,security4 7ii7 ,consultation ,in developing the form under clause 7i71 the ,secretary shall consult with beneficiary groups4 7#c7 ,income determinations ,for purposes of applying this section-- 7,a7 in the case of an individual who is not treated as a ,medicare ,cost ,assistance ,program eligible individual or a subsidy eligible individual under paragraph 7#b77;,d71 income shall be determined in the manner described under section #afab for purposes of the supplemental security income program1 except that support and maintenance furnished in kind shall not be counted as income2 and 7,b7 the term poverty line has the meaning given such term in section #fgc7b7 of the ,community ,services ,block ,grant ,act 7#db ,u4,s4,c4 #iijb7b771 including any revision required by such section4 7c7 ,beneficiary protections 7#a7 ,in general ,in the case in which the payment for ,medicare cost assistance for a ,medicare ,cost ,assistance ,program eligible individual with respect to an item or service is reduced or eliminated1 the individual shall not have any legal liability to make payment to a provider of services 7as defined in section #ahfa7u771 a supplier 7as defined in section #ahfa7;d771 or to an organization described in section #aijc7m77#a77;,a7 for the service1 and any lawful sanction that may be imposed upon a provider of services1 a supplier1 or such an organization for excess charges under this title or title ,,xix shall apply to the imposition of any charge imposed upon the individual in such case4 7#b7 ,clarification ,this paragraph shall not be construed as preventing payment of any medicare cost assistance by a medicare supplemental policy or an employer retiree health plan on behalf of an individual4 7d7 ,administration 7#a7 ,in general ,the ,secretary shall establish procedures for the administration of the program under this section4 7#b7 ,funding ,for purposes of carrying out this section1 the ,secretary shall make payments from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda1 in such proportion as the ,secretary determines appropriate1 of such amounts as the ,secretary determines necessary to provide ,medicare cost assistance under this section4 7e7 ,references to medicare cost-,sharing ,effective beginning ,january #a1 #bjbe1 any reference to medicare cost-sharing described in section #aije7p7 shall be deemed a reference to ,medicare cost assistance under this section4 7f7 ,outreach efforts ,for provisions relating to outreach efforts to increase awareness of the availability of ,medicare cost assistance1 see section #aadd4 4 7#b7 ,special enrollment period 7,a7 ,no premium penalty ,section #ahci7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7b77 is amended1 in the last sentence1 by inserting the following before the period3 or1 effective beginning ,january #a1 #bjbe1 for individuals who are ,medicare ,cost ,assistance ,program eligible individuals 7as defined in section #ahii;,c7b77#a7744 7,b7 ,special enrollment period ,section #ahcg of the ,social ,security ,act 7#db ,u4,s4,c4 #aciep7 is amended by adding at the end the following new subsection3 7p7 ,special enrollment period for ,medicare ,cost ,assistance ,program eligible individual 7#a7 ,in general ,effective beginning ,january #a1 #bjbe1 the ,secretary shall establish special enrollment periods for ,medicare ,cost ,assistance ,program eligible individuals 7as defined in section #ahii;,c7b77#a774 7#b7 ,coverage period ,in the case of an individual who enrolls during the special enrollment period provided under paragraph 7#a71 the coverage period under this part shall-- 7,a7 begin on the first day of the first month in which the individual applies for a determination under section #ahii;,c7b77#b77;,a72 and 7,b7 remain in effect until such time as the ,secretary determines the individual is no longer eligible as determined under section #ahii;,c7b77#b77;,c77ii74 4 7,c7 ,conforming sunset of ,state agreements relating to enrollment of qualified medicare beneficiaries 7i7 ,part ,a ,section #ahah7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#b7;g77 is amended by adding at the end the following new paragraph3 7#c7 ,sunset ,this subsection shall not apply on or after ,january #a1 #bjbe4 4 7ii7 ,part ,b ,section #ahdc7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciev7h77 is amended by adding at the end the following new paragraph3 7#d7 ,sunset with respect to qualified medicare beneficiaries ,this subsection shall not apply with respect to qualified medicare beneficiaries on or after ,january #a1 #bjbe4 4 7#c7 ,public awareness campaign ,section #aadd of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#ad7 is amended by adding at the end the following new subsection3 7d7 ,public awareness campaign 7#a7 ,in general ,the ,commissioner shall conduct a public awareness campaign to educate ,medicare beneficiaries on the availability of ,medicare cost assistance for low-income individuals under section #ahii;,c4 7#b7 ,coordination ,in carrying out the public awareness campaign under paragraph 7#a71 the ,commissioner shall coordinate with ,state health insurance assistance programs described in subsection 7a77#a77;,a7 of section #aai of the ,medicare ,improvements for ,patients and ,providers ,act of #bjjh 7#db ,u4,s4,c4 #acie;b-#c note71 the ,administrator of the ,administration for ,community ,living1 and the ,administrator of the ,centers for ,medicare ,medicaid ,services4 7#c7 ,funding ,there is appropriated to the ,commissioner1 out of any funds in the ,treasury not otherwise appropriated1 #aj1jjj1jjj for each of fiscal years #bjbe through #bjbi1 to provide grants to ,state health insurance assistance programs to carry out outreach and education activities under the public awareness campaign pursuant to this subsection4 4 7b7 ,moving ,medicare cost-,sharing benefits from ,medicaid to ,medicare 7#a7 ,ending most ,medicare cost-,sharing benefits under ,medicaid ,section #aijb7;a77#aj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77 is amended-- 7,a7 by inserting for calendar quarters beginning before ,january #a1 #bjbe1 before for making each place it appears in clauses 7i71 7iii71 and 7iv7 of subparagraph 7,e72 and 7,b7 in the matter following subparagraph 7,g7-- 7i7 by inserting furnished during calendar quarters beginning before ,january #a1 #bjbe after 7described in section #aije7p77#c772 7ii7 by striking 7,,xv7 and inserting 1 7,,xv72 7iii7 by striking and 7,,xviii7 and inserting 1 7,,xviii72 7iv7 by striking and 7,,xix7 and inserting 7,,xix72 and 7v7 by inserting 1 and 7,,xx7 no medical assistance for medicare cost-sharing1 other than medical assistance for medicare cost-sharing for qualified disabled and working individuals described in section #aije7s71 shall be made available after ,january #a1 #bjbe before the semicolon at the end4 7#b7 ,conforming amendments 7,a7 ,title ,,xix 7i7 ,section #aijc7;i7 of such ,act 7#db ,u4,s4,c4 #acif;b7i771 as amended by section #djjb1 is amended-- 7,i7 in paragraph 7#bf71 by striking or at the end2 7,,ii7 in paragraph 7#bg71 by striking the period at the end and inserting 2 or2 and 7,,iii7 by inserting after paragraph 7#bg7 the following new paragraph3 7#bh7 with respect to any amount expended for medical assistance for medicare cost-sharing 7other than medical assistance for medicare cost-sharing for qualified disabled and working individuals described in section #aije7s77 furnished during calendar quarters beginning on or after ,january #a1 #bjbe4 4 7ii7 ,section #aije7;a7 of such ,act 7#db ,u4,s4,c4 #acif;d7a77 is amended1 in the first sentence1 by inserting furnished during calendar quarters beginning before ,january #a1 #bjbe after medicare cost-sharing4 7iii7 ,section #aicc7;g7 of such ,act 7#db ,u4,s4,c4 #acifu-#c7;g77 is amended-- 7,i7 in paragraph 7#b77,q71 by striking paragraph 7#d71 for each subsequent year and inserting paragraphs 7#d7 and 7#e71 for each subsequent year before #bjbe2 and 7,,ii7 by adding at the end the following3 7#e7 ,sunset ,no individual shall be selected to be a qualifying individual for any calendar year or period under this section beginning on or after ,january #a1 #bjbe1 and no ,state allocation shall be made for any fiscal year or period under this section beginning on or after ,january #a1 #bjbe4 4 7iv7 ,section #aice7;a7 of such ,act 7#db ,u4,s4,c4 #acifu-#e7;a77 is amended-- 7,i7 in paragraph 7#b77;,a71 by striking make determinations and inserting prior to ,january #a1 #bjbe1 make determinations2 and 7,,ii7 in paragraph 7#c71 by inserting prior to ,january #a1 #bjbe1 before the ,state shall4 7c7 ,enhancing prescription drug affordability by expanding access to assistance with out-of-,pocket costs under ,medicare part ,d for low-,income seniors and individuals with disabilities 7#a7 ,expanding access ,section #ahfj;,d-#ad of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7 is amended-- 7,a7 in subsection 7a7-- 7i7 in paragraph 7#a71 in the matter preceding subparagraph 7,a7-- 7,i7 by striking #aej percent and inserting #bjj percent2 and 7,,ii7 by striking and who meets the resources requirement described in paragraph 7#c77;,d7 7or1 with respect to a plan year beginning on or after ,january #a1 #bjbe1 paragraph 7#c77;,e77 or who is covered under this paragraph under paragraph 7#c77;,b77i72 7ii7 by striking paragraph 7#b72 7iii7 in paragraph 7#c7-- 7,i7 in subparagraph 7,a7-- 7aa7 in clause 7i71 by adding and at the end2 7bb7 in clause 7ii7-- 7,,aa7 by striking #aej percent and inserting #bjj percent2 and 7,,bb7 by striking 2 and at the end and inserting a period2 and 7cc7 by striking clause 7iii72 7,,ii7 by striking subparagraphs 7,b7 and 7,c7 and inserting the following3 7,b7 ,determinations ,for provisions relating to joint determinations with respect to eligibility for ,medicare cost assistance under section #ahii;,c and premium and cost-sharing subsidies under this section1 see section #ahii;,c7b77#b74 7,c7 ,income determinations ,for purposes of applying this section-- 7i7 in the case of an individual who is not treated as a ,medicare cost-sharing assistance eligible individual and a subsidy eligible individual under section #ahii;,c7b77#b77;,d71 income shall be determined in the manner described under section #afab for purposes of the supplemental security income program1 except that support and maintenance furnished in kind shall not be counted as income2 and 7ii7 the term poverty line has the meaning given such term in section #fgc7b7 of the ,community ,services ,block ,grant ,act 7#db ,u4,s4,c4 #iijb7b771 including any revision required by such section4 2 and 7,,iii7 by striking subparagraphs 7,d71 7,e71 and 7,g72 and 7iv7 in paragraph 7#d7-- 7,i7 in subparagraph 7,a7-- 7aa7 by striking 7,a7 ,copayment for lowest income dual eligible individuals4--2 7bb7 by redesignating clauses 7i7 and 7ii7 as subparagraphs 7,a7 and 7,b71 respectively and indenting appropriately2 and 7cc7 by moving the flush text at the end #b ems to the left2 and 7,,ii7 by striking subparagraph 7,b72 and 7,b7 in subsection 7c77#a71 in the second sentence1 by striking subsections 7a77#a77;,d7 and 7a77#b77;,e7 and inserting subsection 7a77#a77;,d74 7#b7 ,treatment of reduction of cost-sharing for individuals receiving home and community-based services ,section #ahfj;,d-#ad7;a77#a77;,d77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#a77;,d77i77 is amended-- 7,a7 by striking who would be such an institutionalized individual or couple1 if the full-benefit dual eligible individual were not2 and 7,b7 by striking or subsection 7c7 or 7d7 of section #aiae or under a ,state plan amendment under subsection 7i7 of such section and inserting 1 section #aaae;,a1 section #aiae1 or under a ,state plan amendment4 7#c7 ,effective date ,the amendments made by this subsection shall apply to plan year #bjbe and subsequent plan years4 #dajg4 ,reducing cost-sharing1 aligning income and resource eligibility tests1 simplifying enrollment1 and other program improvements for low-income beneficiaries 7a7 ,increase in income eligibility to #ace percent of ,,fpl for qualified ,medicare beneficiaries 7#a7 ,in general ,section #aije7p77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77#b77;,a77 is amended by striking shall be at least the percent provided under subparagraph 7,b7 7but not more than #ajj percent7 of the official poverty line and all that follows through the period at the end and inserting the following3 shall be-- 7i7 before ,january #a1 #bjbe1 at least the percent provided under subparagraph 7,b7 7but not more than #ajj percent7 of the official poverty line 7as defined by the ,office of ,management and ,budget1 and revised annually in accordance with section #fgc7b7 of the ,community ,services ,block ,grant ,act 7#db ,u4,s4,c4 #iijb7b77 applicable to a family of the size involved2 and 7ii7 on or after ,january #a1 #bjbe1 equal to #ace percent of the official poverty line 7as so defined and revised7 applicable to a family of the size involved4 4 7#b7 ,not counting in-kind support and maintenance as income ,section #aije7p77#b77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77#b77;,d77 is amended by adding at the end the following new clause3 7iii7 ,in determining income under this subsection1 support and maintenance furnished in kind shall not be counted as income4 4 7b7 ,increase in income eligibility to #bjj percent of ,,fpl for specified low-,income ,medicare beneficiaries 7#a7 ,eligibility of individuals with incomes below #aej percent of ,,fpl ,section #aijb7;a77#aj77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,e77 is amended-- 7,a7 by adding and at the end of clause 7ii72 7,b7 in clause 7iii7-- 7i7 by striking and #abj percent in #aiie and years thereafter and inserting #abj percent in #aiie and years thereafter before #bjbe1 and #bjj percent in #bjbe and years thereafter2 and 7ii7 by striking and at the end2 and 7,c7 by striking clause 7iv74 7#b7 ,references ,section #aije7p77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77#a77 is amended by adding at and below subparagraph 7,c7 the following flush sentence3 ,the term specified low-income medicare beneficiary means an individual described in section #aijb7;a77#aj77;,e77iii74 4 7#c7 ,conforming amendments 7,a7 ,the first sentence of section #aije7;b7 of such ,act 7#db ,u4,s4,c4 #acif;d7b77 is amended by striking 8and section #aicc7;d704 7,b7 ,section #aicc of such ,act 7#db ,u4,s4,c4 #acifu-#c7 is repealed4 7c7 #ajj percent ,,fmap ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in subsection 7b71 by striking and 7ii7 and inserting 7ii71 and 7kk72 and 7#b7 amended by adding at the end the following new subsection3 7kk7 ,increased ,,fmap for expanded medicare cost-,sharing populations 7#a7 ,in general ,notwithstanding subsection 7b71 with respect to expenditures described in paragraph 7#b7 the ,federal medical assistance percentage shall be equal to #ajj percent4 7#b7 ,expenditures described ,the expenditures described in this paragraph are expenditures made on or after ,january #a1 #bjbe1 for medical assistance for medicare cost-sharing provided to any individual under clause 7i71 7ii71 or 7iii7 of section #aijb7;a77#aj77;,e7 who would not have been eligible for medicare cost-sharing under any such clause under the income or resource eligibility standards in effect on ,october #a1 #bjah4 4 7d7 ,consolidation of low-,income subsidy resource eligibility tests 7#a7 ,in general ,section #ahfj;,d-#ad7;a77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#c77 is amended-- 7,a7 by striking subparagraph 7,d72 7,b7 by redesignating subparagraphs 7,e7 through 7,g7 as subparagraphs 7,d7 through 7,f71 respectively2 and 7,c7 in the heading of subparagraph 7,d71 as so redesignated1 by striking ,alternative resource and inserting ,resource4 7#b7 ,clarification of certain rules relating to income and resource determinations ,section #ahfj;,d-#ad7;a77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#c771 as amended by paragraph 7#a71 is amended by striking subparagraph 7,f7 and inserting the following new subparagraphs3 7,f7 ,resource exclusions ,in determining the resources of an individual 7and the eligible spouse of the individual1 if any7 under section #afac for purposes of subparagraph 7,d7-- 7i7 no part of the value of any life insurance policy shall be taken into account2 7ii7 no part of the value of any vehicle shall be taken into account2 7iii7 there shall be excluded an amount equal to #a1ejj each with respect to any individual or eligible spouse of an individual who attests that some of the resources of such individual or spouse will be used to meet the burial and related expenses of such individual or spouse2 and 7iv7 no balance in1 or benefits received under1 an employee pension benefit plan 7as defined in section #c of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #ajjb77 shall be taken into account4 7,g7 ,family size ,in determining the size of the family of an individual for purposes of determining the income eligibility of such individual under this section1 an individual's family shall consist of-- 7i7 the individual2 7ii7 the individual's spouse who lives in the same household as the individual 7if any72 and 7iii7 any other individuals who-- 7,i7 are related to the individual whose income eligibility is in question or such individual's spouse who lives in the same household2 7,,ii7 are living in the same household as such individual2 and 7,,iii7 are dependent on such individual or such individual's spouse who is living in the same household for at least one-half of their financial support4 4 7#c7 ,conforming amendments ,section #ahfj;,d-#ad7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77 is amended-- 7,a7 in paragraph 7#a71 in the matter preceding subparagraph 7,a71 by inserting 7as determined under paragraph 7#c77;,g77 after family of the size involved2 and 7,b7 in paragraph 7#c71 as amended by paragraphs 7#a7 and 7#b7-- 7i7 in subparagraph 7,a71 in the matter preceding clause 7i71 by striking subparagraph 7,f7 and inserting subparagraph 7,e72 7ii7 in subparagraph 7,a77ii71 by inserting 7as determined under subparagraph 7,g77 after family of the size involved2 7iii7 in subparagraph 7,a77iii71 by striking or 7,e72 7iv7 in subparagraph 7,b77v71 in the matter preceding subclause 7,i71 by striking subparagraph 7,f7 and inserting subparagraph 7,e72 and 7v7 in subparagraph 7,d77i71 in the matter preceding subclause 7,i71 by striking subject to the life insurance policy exclusion provided under subparagraph 7,g7 and inserting subject to the resource exclusions provided under subparagraph 7,f74 7e7 ,alignment of low-,income subsidy and medicare savings program income and resource eligibility tests 7#a7 ,application of ,medicaid spousal impoverishment resource allowance to ,,msp and ,,lis resource eligibility ,section #aije7p77#a77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77#a77;,c77 is amended to read as follows3 7,c7 whose resources 7as determined under section #afac for purposes of the supplemental security income program subject to the resource exclusions under subparagraph 7,f7 of section #ahfj;,d-#ad7;a77#c77 do not exceed-- 7i7 in the case of an individual with a spouse1 an amount equal to the sum of the first amount specified in subsection 7f77#b77;,a77i7 of section #aibd 7as adjusted under subsection 7g7 of such section7 and the amount specified in subsection 7f77#b77;,a77ii77,,ii7 of such section 7as so adjusted72 or 7ii7 in the case of an individual who does not have a spouse1 an amount equal to of the amount described in clause 7i74 4 7#b7 ,application to ,q,d,w,is ,section #aije7s77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7s77#c77 is amended to read as follows3 7#c7 whose resources 7as determined under section #afac for purposes of the supplemental security income program subject to the resource exclusions under subparagraph 7,f7 of section #ahfj;,d-#ad7;a77#c77 do not exceed-- 7,a7 in the case of an individual with a spouse1 the amount in effect for the year under clause 7i7 of subsection 7p77#a77;,c72 and 7,b7 in the case of an individual who does not have a spouse1 the amount in effect for the year under clause 7ii7 of subsection 7p77#a77;,c72 and 4 7#c7 ,application to ,,lis ,clause 7i7 of section #ahfj;,d-#ad7;a77#c77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#c77;,d771 as redesignated and amended by subsection 7d77#a71 is amended to read as follows3 7i7 ,in general ,the resources requirement of this subparagraph is that an individual's resources 7as determined under section #afac for purposes of the supplemental security income program subject to the resource exclusions provided under subparagraph 7,f77 do not exceed the amount in effect for the year under section #aije7p77#a77;,c77ii74 4 7f7 ,enrollment simplifications 7#a7 ,application of #c-month retroactive eligibility to ,q,m,bs 7,a7 ,in general ,section #aijb7;e77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#h77 is amended by striking after the end of the month in which the determination first occurs and inserting in or after the third month before the month in which the individual makes application for assistance4 7,b7 ,process for submitting claims during retroactive eligibility period ,section #aijb7;e77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#h77 is further amended by adding at the end the following3 ,the ,secretary shall provide for a process under which claims for medical assistance under the ,state plan may be submitted for services furnished to such an individual during such #c-month period before the month in which the individual made application for assistance44 7,c7 ,conforming amendment ,section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is amended1 in the matter preceding paragraph 7#a71 by striking or1 in the case of medicare cost-sharing with respect to a qualified medicare beneficiary described in subsection 7p77#a71 if provided after the month in which the individual becomes such a beneficiary4 7#b7 ,state option for #ab-month continuous eligibility for ,s,l,m,bs and ,q,w,d,is ,section #aijb7;e77#ab7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#ab77 is amended-- 7,a7 by redesignating subparagraphs 7,a7 and 7,b7 as clauses 7i7 and 7ii71 respectively2 7,b7 by inserting 7,a7 after 7#ab72 and 7,c7 by adding at the end the following3 7,b7 ,at the option of the ,state1 the plan may provide that an individual who is determined to be eligible for benefits under a ,state plan approved under this title under any of the following eligibility categories1 or who is redetermined to be eligible for such benefits under any of such categories1 shall be considered to meet the eligibility requirements met on the date of application and shall remain eligible for those benefits until the end of the #ab-month period following the date of the determination or redetermination of eligibility1 except that a ,state may provide for such determinations more frequently1 but not more frequently than once every #f months for an individual3 7i7 ,a specified low-income medicare beneficiary described in subsection 7a77#aj77;,e77iii7 of this section who is determined eligible for medicare cost-sharing described in section #aije7p77#c77;,a77ii74 7ii7 ,a qualified disabled and working individual described in section #aije7s7 who is determined eligible for medicare cost-sharing described in section #aije7p77#c77;,a77i74 4 7#c7 ,state option to use ,express ,lane eligibility for the ,medicare ,savings ,program ,section #aijb7;e77#ac77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#ac77;,a77 is amended by adding at the end the following new clause3 7iii7 ,state option to extend express lane eligibility to other populations 7,i7 ,in general ,at the option of the ,state1 the ,state may apply the provisions of this paragraph with respect to determining eligibility under this title for an eligible individual 7as defined in subclause 7,,ii774 ,in applying this paragraph in the case of a ,state making such an option1 any reference in this paragraph to a child with respect to this title 7other than a reference to child health assistance7 shall be deemed to be a reference to an eligible individual4 7,,ii7 ,eligible individual defined ,in this clause1 the term eligible individual means any of the following3 7aa7 ,a qualified medicare beneficiary described in section #aije7p77#a7 for purposes of determining eligibility for medicare cost-sharing 7as defined in section #aije7p77#c774 7bb7 ,a specified low-income medicare beneficiary described in subsection 7a77#aj77;,e77iii7 of this section for purposes of determining eligibility for medicare cost-sharing described in section #aije7p77#c77;,a77ii74 7cc7 ,a qualified disabled and working individual described in section #aije7s7 for purposes of determining eligibility for medicare cost-sharing described in section #aije7p77#c77;,a77i74 4 7g7 ,medicaid treatment of certain ,medicare providers ,section #aijb7n7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7n77 is amended by adding at the end the following new paragraph3 7#d7 ,a ,state plan shall not deny a claim from a provider or supplier with respect to medicare cost-sharing described in subparagraph 7,b71 7,c71 or 7,d7 of section #aije7p77#c7 for an item or service which is eligible for payment under title ,,xviii on the basis that the provider or supplier does not have a provider agreement in effect under this title or does not otherwise serve all individuals entitled to medical assistance under this title4 ,the ,state shall create a mechanism through which providers or suppliers that do not otherwise have provider agreements with the ,state can bill the ,state for medicare cost-sharing for qualified medicare beneficiaries4 4 7h7 ,eligibility for other programs ,section #aije7p7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77 is amended by adding at the end the following new paragraph3 7#g7 ,notwithstanding any other provision of law1 any medical assistance for some or all medicare cost-sharing under this title shall not be considered income or resources in determining eligibility for1 or the amount of assistance or benefits provided under1 any other public benefit provided under ,federal law or the law of any ,state or political subdivision thereof4 4 7i7 ,treatment of qualified ,medicare beneficiaries1 specified low-,income ,medicare beneficiaries1 and other dual eligibles as medicare beneficiaries ,section #ahfb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7 is amended by adding at the end the following new subsection3 7p7 ,treatment of ,qualified ,medicare ,beneficiaries 7,q,m,bs71 ,specified ,low-,income ,medicare ,beneficiaries 7,s,l,m,bs71 and ,other ,dual ,eligibles ,nothing in this title shall be construed as authorizing a provider of services or supplier to discriminate 7through a private contractual arrangement or otherwise7 against an individual who is otherwise entitled to services under this title on the basis that the individual is a qualified medicare beneficiary 7as defined in section #aije7p77#a771 a specified low-income medicare beneficiary1 or is otherwise eligible for medical assistance for medicare cost-sharing or other benefits under title ,,xix4 4 7j7 ,additional ,funding for ,state ,health ,insurance ,assistance ,programs 7#a7 ,grants 7,a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall use amounts made available under subparagraph 7,b7 to make grants to ,states for ,state health insurance assistance programs receiving assistance under section #dcfj of the ,omnibus ,budget ,reconciliation ,act of #aiij 7#db ,u4,s4,c4 #acie;b-#d74 7,b7 ,funding ,for purposes of making grants under this subsection1 the ,secretary shall provide for the transfer1 from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i7 and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda of such ,act 7#db ,u4,s4,c4 #aciet71 in the same proportion as the ,secretary determines under section #ahec7;f7 of such ,act 7#db ,u4,s4,c4 #aciew-#bc7;f771 of #ej1jjj1jjj to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account for each of the fiscal years #bjbe through #bjbi1 to remain available until expended4 7#b7 ,amount of grants ,the amount of a grant to a ,state under this subsection from the total amount made available under paragraph 7#a7 shall be equal to the sum of the amount allocated to the ,state under paragraph 7#c77;,a7 and the amount allocated to the ,state under subparagraph 7#c77;,b74 7#c7 ,allocation to ,states 7,a7 ,allocation based on percentage of low-income beneficiaries ,the amount allocated to a ,state under this subparagraph from #b_/c of the total amount made available under paragraph 7#a7 shall be based on the number of individuals who meet the requirement under subsection 7a77#c77;,a77ii7 of section #ahfj;,d-#ad of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7 but who have not enrolled to receive a subsidy under such section #ahfj;,d-#ad relative to the total number of individuals who meet the requirement under such subsection 7a77#c77;,a77ii7 in each ,state1 as estimated by the ,secretary4 7,b7 ,allocation based on percentage of rural beneficiaries ,the amount allocated to a ,state under this subparagraph from #a_/c of the total amount made available under paragraph 7#a7 shall be based on the number of part ,d eligible individuals 7as defined in section #ahfj;,d-#a7;a77#c77;,a7 of such ,act 7#db ,u4,s4,c4 #aciew-#aja7;a77#c77;,a777 residing in a rural area relative to the total number of such individuals in each ,state1 as estimated by the ,secretary4 7#d7 ,portion of grant based on percentage of low-income beneficiaries to be used to provide outreach to individuals who may be subsidy eligible individuals or eligible for the ,medicare ,savings ,program ,each grant awarded under this subsection with respect to amounts allocated under paragraph 7#c77;,a7 shall be used to provide outreach to individuals who may be subsidy eligible individuals 7as defined in section #ahfj;,d-#ad7;a77#c77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#c77;,a777 or eligible for the program of medical assistance for payment of the cost of medicare cost-sharing under the ,medicaid program pursuant to sections #aijb7;a77#aj77;,e7 and #aicc of such ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,e71 #acifu-#c74 7k7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendments and repeal made by this section take effect on ,january #a1 #bjbe1 and1 with respect to title ,,xix of the ,social ,security ,act1 apply to calendar quarters beginning on or after ,january #a1 #bjbe4 7#b7 ,exception for ,state legislation ,in the case of a ,state plan for medical assistance under title ,,xix of the ,social ,security ,act which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirements imposed by the amendments and repeal made by this section1 the ,state plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of the enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4 #dajh4 #ajj percent ,,fmap for medical assistance provided by urban ,indian organizations 7a7 ,in general ,the third sentence of section #aije7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b77 is amended by striking for the #h fiscal year quarters beginning with the first fiscal year quarter beginning after the date of the enactment of the ,american ,rescue ,plan ,act of #bjba1 and inserting and4 7b7 ,effective date ,the amendment made by this section shall apply to medical assistance provided on or after the date of enactment of this ,act4 #daji4 #ajj percent ,,fmap for medical assistance provided to a ,native ,hawaiian through a federally qualified health center or a ,native ,hawaiian health care system under the ,medicaid program 7a7 ,in general ,the third sentence of section #aije7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b77 is amended by striking 1 for such #h fiscal year quarters4 7b7 ,effective date ,the amendment made by this section shall apply to medical assistance provided on or after the date of enactment of this ,act4 #daaj4 ,repeal of requirement for estate recovery under the ,medicaid program ,section #aiag of the ,social ,security ,act 7#db ,u4,s4,c4 #acifp7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by amending paragraph 7#a7 to read as follows3 7#a7 ,no lien may be imposed against the property of any individual prior to his death on account of medical assistance paid or to be paid on his behalf under the ,state plan1 except pursuant to the judgment of a court on account of benefits incorrectly paid on behalf of such individual4 2 7,b7 by striking paragraph 7#b72 7,c7 in paragraph 7#c71 by striking 7#a77;,b7 and inserting 7#a72 and 7,d7 by redesignating paragraph 7#c7 as paragraph 7#b72 and 7#b7 by amending subsection 7b7 to read as follows3 7b7 ,adjustment or recovery of medical assistance correctly paid under a ,state plan ,no adjustment or recovery of any medical assistance correctly paid on behalf of an individual under the ,state plan may be made4 4 #daaa4 ,allow for suspension of ,medicare benefits and premium liability for individuals who are incarcerated and provide a special enrollment period around the date of release 7a7 ,special enrollment period for individuals incarcerated at time of ,medicare eligibility ,section #ahcg7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciep7i77 is amended by adding at the end the following new paragraph3 7#e7 7,a7 ,in the case of an individual who-- 7i7 at the time the individual first satisfies paragraph 7#a7 or 7#b7 of section #ahcf7;a71 is incarcerated2 or 7ii7 has elected not to enroll 7or to be deemed enrolled7 under this section during the individual's initial enrollment period2 there shall be a special enrollment period described in subparagraph 7,b74 7,b7 ,the special enrollment period referred to in subparagraph 7,a7 is the #f-month period beginning on the first day after which the individual is no longer incarcerated4 4 7b7 ,premium amount ,section #ahci7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7a77 is amended-- 7#a7 in paragraph 7#a71 in the second sentence1 by striking and 7#g71 and inserting 7#g71 and 7#h712 and 7#b7 by adding at the end the following new paragraph3 7#h7 ,in the case of an individual whose coverage period includes months in which by reason of custody under penal authority coverage is excluded pursuant to section #ahfb7;a77#c71 the premium amount for such months such individual is in custody under penal authority shall be zero4 4 7c7 ,conforming amendment ,section #ahah7;d77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#b7;d77#e77 is amended by adding at the end the following3 7,d7 ,in the case of an individual who is a person who is excluded from coverage pursuant to section #ahfb7;a77#c7 by reason of custody under penal authority1 the amount of the monthly premium for such individual shall be zero for any month in which such individual is in custody under penal authority4 4 #daab4 ,federal employee health benefits plans 7a7 ,coverage of pregnancy ,the ,director of the ,office of ,personnel ,management shall issue such regulations as are necessary to ensure that pregnancy is considered a change in family status and a qualifying life event for an individual who is eligible to enroll1 but is not enrolled1 in a health benefits plan under chapter #hi of title #e1 ,united ,states ,code4 7b7 ,effective date ,the requirement in paragraph 7#a7 shall apply with respect to any contract entered into under section #hijb of title #e1 ,united ,states ,code1 on or after the date that is #a year after the date of enactment of this ,act4 #daac4 ,continuation of ,medicaid income eligibility standard for pregnant individuals and infants ,section #aijb7l77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7l77#b77;,a77 is amended-- 7#a7 in clause 7i71 by striking and not more than #ahe percent2 7#b7 in clause 7ii7-- 7,a7 in subclause 7,i71 by striking and after the comma2 7,b7 in subclause 7,,ii71 by striking the period at the end and inserting 1 and2 and 7,c7 by adding at the end the following3 7,,iii7 ,january #a1 #bjbe1 is the percentage provided under clause 7v74 2 and 7#c7 by adding at the end the following new clause3 7v7 ,the percentage provided under clause 7ii7 for medical assistance provided on or after ,january #a1 #bjbe1 with respect to individuals described in subparagraph 7,a7 or 7,b7 of paragraph 7#a7 shall not be less than-- 7,i7 the percentage specified for such individuals by the ,state in an amendment to its ,state plan 7whether approved or not7 as of ,january #a1 #bjad2 or 7,,ii7 if no such percentage is specified as of ,january #a1 #bjad1 the percentage established for such individuals under the ,state's authorizing legislation or provided for under the ,state's appropriations as of that date4 4 ,c ,expansion of ,access #a ,general ,provisions #dbja4 ,amendment to the ,public ,health ,service ,act ,title ,,xxxiv of the ,public ,health ,service ,act1 as amended by titles ,i1 ,,ii1 and ,,iii of this ,act1 is further amended by inserting after subtitle ,c the following3 ,d ,reconstruction and ,improvement ,grants for ,public ,health ,care ,facilities ,serving ,pacific ,islanders and the ,insular ,areas #cdda4 ,grant support for quality improvement initiatives 7a7 ,in general ,the ,secretary1 in collaboration with the ,administrator of the ,health ,resources and ,services ,administration1 the ,director of the ,agency for ,healthcare ,research and ,quality1 and the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall award grants to eligible entities for the conduct of demonstration projects to improve the quality of and access to health care4 7b7 ,eligibility ,to be eligible to receive a grant under subsection 7a71 an entity shall-- 7#a7 be a health center1 hospital1 health plan1 health system1 community clinic1 hospice or palliative care provider1 or other health entity determined appropriate by the ,secretary-- 7,a7 that1 by legal mandate or explicitly adopted mission1 provides patients with access to services regardless of their ability to pay2 7,b7 that provides care or treatment for a substantial number of patients who are uninsured1 are receiving assistance under a ,state plan under title ,,xix of the ,social ,security ,act 7or under a waiver of such plan71 or are members of vulnerable populations1 as determined by the ,secretary2 and 7,c7 7i7 with respect to which1 not less than #ej percent of the entity's patient population is made up of racial and ethnic minority groups2 or 7ii7 that-- 7,i7 serves a disproportionate percentage of local patients who are from a racial and ethnic minority group1 or has a patient population at least #ej percent of which is composed of individuals with limited ,english proficiency2 and 7,,ii7 provides an assurance that amounts received under the grant will be used only to support quality improvement activities in the racial and ethnic minority group served2 and 7#b7 prepare and submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7c7 ,priority ,in awarding grants under subsection 7a71 the ,secretary shall give priority to eligible entities that-- 7#a7 demonstrate an intent to operate as part of a health care partnership1 network1 collaborative1 coalition1 or alliance where each member entity contributes to the design1 implementation1 and evaluation of the proposed intervention2 or 7#b7 intend to use funds to carry out systemwide changes with respect to health care quality improvement1 including-- 7,a7 improved systems for data collection and reporting2 7,b7 innovative collaborative or similar processes2 7,c7 group programs with behavioral or self-management interventions2 7,d7 case management services2 7,e7 physician or patient reminder systems2 7,f7 educational interventions2 7,g7 comprehensive and patient-centric health care2 7,h7 creation and distribution of education materials on available health care options2 or 7,i7 other activities determined appropriate by the ,secretary4 7d7 ,use of funds ,an entity shall use amounts received under a grant under subsection 7a7 to support the implementation and evaluation of health care quality improvement activities or minority health and health care disparity reduction activities that include-- 7#a7 with respect to health care systems1 activities relating to improving-- 7,a7 patient safety2 7,b7 timeliness of care2 7,c7 effectiveness of care2 7,d7 efficiency of care2 7,e7 patient centeredness2 7,f7 health information technology2 7,g7 accessibility and availability of information on health care2 7,h7 comprehensiveness of health care2 and 7,i7 patient involvement and choice in health care2 and 7#b7 with respect to patients1 activities relating to-- 7,a7 staying healthy2 7,b7 getting well1 mentally and physically2 7,c7 living effectively with illness or disability2 7,d7 preparing for end of life and ensuring that end-of-life care is accessible and available1 as well as coping with end-of-life issues2 and 7,e7 shared decision making4 7e7 ,common data systems ,the ,secretary shall provide financial and other technical assistance to grantees under this section for the development of common data systems4 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjcb4 #cddb4 ,centers of excellence 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall designate centers of excellence at public hospitals1 and other health systems serving large numbers of patients from minority populations1 that-- 7#a7 meet the requirements of section #cdda7;b77#a72 7#b7 demonstrate excellence in providing care to minority populations2 and 7#c7 demonstrate excellence in reducing disparities in health and health care4 7b7 ,requirements ,a hospital or health system that serves as a center of excellence under subsection 7a7 shall-- 7#a7 design1 implement1 and evaluate programs and policies relating to the delivery of care in racially1 ethnically1 and linguistically diverse populations2 7#b7 provide training and technical assistance to other hospitals and health systems relating to the provision of high-quality health care to minority populations2 and 7#c7 develop activities for graduate or continuing medical education that institutionalize a focus on cultural competence training for health care providers4 7c7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section1 such sums as may be necessary for each of fiscal years #bjbe through #bjcb4 #cddc4 ,reconstruction and improvement grants for public health care facilities serving pacific islanders and the insular areas 7a7 ,in general ,the ,secretary shall provide direct financial assistance to designated health care providers and community health centers in ,american ,samoa1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,united ,states ,virgin ,islands1 ,puerto ,rico1 and ,hawaii for the purposes of reconstructing and improving health care facilities and services in a culturally competent and sustainable manner4 7b7 ,eligibility ,to be eligible to receive direct financial assistance under subsection 7a71 an entity shall be a public health facility or community health center located in ,american ,samoa1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,united ,states ,virgin ,islands1 ,puerto ,rico1 or ,hawaii that-- 7#a7 is owned or operated by-- 7,a7 the ,government of ,american ,samoa1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,united ,states ,virgin ,islands1 ,puerto ,rico1 or ,hawaii or a unit of local government2 or 7,b7 a nonprofit organization2 and 7#b7 7,a7 provides care or treatment for a substantial number of patients who are uninsured1 are receiving assistance under title ,,xviii of the ,social ,security ,act or under a ,state plan under title ,,xix of such ,act 7or under a waiver of such plan71 or are members of a vulnerable population1 as determined by the ,secretary2 or 7,b7 serves a disproportionate percentage of local patients that are from a racial and ethnic minority group4 7c7 ,report ,not later than #ahj days after the date of enactment of this title and annually thereafter1 the ,secretary shall submit to the ,congress and the ,president a report that includes an assessment of health resources and facilities serving populations in ,american ,samoa1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,united ,states ,virgin ,islands1 ,puerto ,rico1 and ,hawaii4 ,in preparing such report1 the ,secretary shall-- 7#a7 consult with and obtain information on all health care facilities needs from the entities receiving direct financial assistance under subsection 7a72 7#b7 include all amounts of ,federal assistance received by each such entity in the preceding fiscal year2 7#c7 review the total unmet needs of health care facilities serving ,american ,samoa1 ,guam1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,united ,states ,virgin ,islands1 ,puerto ,rico1 and ,hawaii1 including needs for renovation and expansion of existing facilities2 7#d7 include a strategic plan for addressing the needs of each such population identified in the report2 and 7#e7 evaluate the effectiveness of the care provided by measuring patient outcomes and cost measures4 7d7 ,authorization of appropriations ,there are authorized to be appropriated such sums as necessary to carry out this section4 4 #dbjb4 ,border health grants 7a7 ,definitions ,in this section3 7#a7 ,border area ,the term border area means the ,united ,states-,mexico ,border ,area1 as defined in section #h of the ,united ,states-,mexico ,border ,health ,commission ,act 7#bb ,u4,s4,c4 #bijn-#f74 7#b7 ,eligible entity ,the term eligible entity means an entity that is located in the border area and is any of the following3 7,a7 ,a ,state1 local government1 or ,tribal government4 7,b7 ,a public institution of higher education4 7,c7 ,a nonprofit health organization4 7,d7 ,a community health center4 7,e7 ,a community clinic that is a health center receiving assistance under section #ccj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b74 7,f7 ,a nonprofit organization serving immigrants4 7b7 ,authorization ,from funds appropriated pursuant to subsection 7f71 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary71 acting through the ,united ,states members of the ,united ,states-,mexico ,border ,health ,commission1 shall award grants to eligible entities to address priorities and recommendations to improve the health of border area residents that are established by-- 7#a7 the ,united ,states members of the ,united ,states-,mexico ,border ,health ,commission2 7#b7 the ,state border health offices2 and 7#c7 the ,secretary4 7c7 ,application ,an eligible entity that desires a grant under subsection 7b7 shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require and demonstrating the entity's capacity to provide culturally and linguistically appropriate services to border area residents4 7d7 ,use of funds ,an eligible entity that receives a grant under subsection 7b7 shall use the grant funds for-- 7#a7 programs relating to-- 7,a7 maternal and child health2 7,b7 primary care and preventative health2 7,c7 public health and public health infrastructure2 7,d7 musculoskeletal health and obesity2 7,e7 health education and promotion2 7,f7 oral health2 7,g7 mental and behavioral health2 7,h7 substance use disorders2 7,i7 health conditions that have a high prevalence in the border area2 7,j7 medical and health services research2 7,k7 workforce training and development2 7,l7 community health workers1 patient navigators1 and promotores2 7,m7 health care infrastructure problems in the border area 7including planning and construction grants72 7,n7 health disparities in the border area2 7,o7 environmental health2 7,p7 outreach and enrollment services with respect to ,federal programs 7including programs authorized under titles ,,xix and ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq42 #db ,u4,s4,c4 #acig;aa et seq4772 7,q7 end-of-life care2 and 7,r7 addressing social determinants of health2 and 7#b7 other programs determined appropriate by the ,secretary4 7e7 ,supplement1 not supplant ,amounts provided to an eligible entity awarded a grant under subsection 7b7 shall be used to supplement and not supplant other funds available to the eligible entity to carry out the activities described in subsection 7d74 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section1 #bjj1jjj1jjj for fiscal year #bjbe1 and such sums as may be necessary for each succeeding fiscal year4 #dbjc4 ,critical access hospital improvements 7a7 ,elimination of isolation test for cost-,based ambulance reimbursement 7#a7 ,in general ,section #ahcd7l77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77#h77 is amended-- 7,a7 in subparagraph 7,b7-- 7i7 by striking owned and2 and 7ii7 by inserting 7including when such services are provided by the entity under an arrangement with the hospital7 after hospital2 and 7,b7 by striking the comma at the end of subparagraph 7,b7 and all that follows and inserting a period4 7#b7 ,effective date ,the amendments made by this subsection shall apply to services furnished on or after ,january #a1 #bjbe4 7b7 ,provision of a more flexible alternative to the ,,cah designation #be inpatient bed limit requirement 7#a7 ,in general ,section #ahbj7;c77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#d7;c77#b77 is amended-- 7,a7 in subparagraph 7,b77iii71 by striking provides not more than and inserting subject to subparagraph 7,f71 provides not more than2 and 7,b7 by adding at the end the following new subparagraph3 7,f7 ,alternative to #be inpatient bed limit requirement 7i7 ,in general ,a ,state may elect to treat a facility1 with respect to the designation of the facility for a cost reporting period1 as satisfying the requirement of subparagraph 7,b77iii7 relating to a maximum number of acute care inpatient beds if the facility elects1 in accordance with a method specified by the ,secretary and before the beginning of the cost reporting period1 to meet the requirement under clause 7ii74 7ii7 ,alternate requirement ,the requirement under this clause1 with respect to a facility and a cost reporting period1 is that the total number of inpatient bed days described in subparagraph 7,b77iii7 during such period will not exceed #g1cjj4 ,for purposes of this subparagraph1 an individual who is an inpatient in a bed in the facility for a single day shall be counted as one inpatient bed day4 7iii7 ,withdrawal of election ,the option described in clause 7i7 shall not apply to a facility for a cost reporting period if the facility 7for any two consecutive cost reporting periods during the previous #e cost-reporting periods7 was treated under such option and had a total number of inpatient bed days for each of such two cost reporting periods that exceeded the number specified in such clause4 4 7#b7 ,effective date ,the amendments made by paragraph 7#a7 shall apply to cost reporting periods beginning on or after the date of the enactment of this ,act4 #dbjd4 ,medicare remote monitoring pilot projects 7a7 ,pilot projects 7#a7 ,in general ,not later than #i months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall conduct pilot projects under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 for the purpose of providing incentives to home health agencies to utilize home monitoring and communications technologies that-- 7,a7 enhance health and health care outcomes for ,medicare beneficiaries2 and 7,b7 reduce expenditures under such title4 7#b7 ,site requirements 7,a7 ,urban and ,rural ,the ,secretary shall conduct the pilot projects under this section in both urban and rural areas4 7,b7 ,site in a small ,state ,the ,secretary shall conduct at least #c of the pilot projects in a ,state with a population of less than #a1jjj1jjj4 7#c7 ,definition of home health agency ,in this section1 the term home health agency has the meaning given that term in section #ahfa7o7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7o774 7b7 ,medicare beneficiaries within the scope of projects ,the ,secretary shall specify the criteria for identifying those ,medicare beneficiaries who shall be considered within the scope of the pilot projects under this section for purposes of the application of subsection 7c7 and for the assessment of the effectiveness of the home health agency in achieving the objectives of this section4 ,such criteria may provide for the inclusion in the projects of ,medicare beneficiaries who begin receiving home health services under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 after the date of the implementation of the projects4 7c7 ,incentives 7#a7 ,performance targets ,the ,secretary shall establish for each home health agency participating in a pilot project under this section a performance target using one of the following methodologies1 as determined appropriate by the ,secretary3 7,a7 ,adjusted historical performance target ,the ,secretary shall establish for the agency-- 7i7 a base expenditure amount equal to the average total payments made to the agency under parts ,a and ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 for ,medicare beneficiaries determined to be within the scope of the pilot project in a base period determined by the ,secretary2 and 7ii7 an annual per capita expenditure target for such beneficiaries1 reflecting the base expenditure amount adjusted for risk and adjusted growth rates4 7,b7 ,comparative performance target ,the ,secretary shall establish for the agency a comparative performance target equal to the average total payments under such parts ,a and ,b during the pilot project for comparable individuals in the same geographic area that are not determined to be within the scope of the pilot project4 7#b7 ,incentive ,subject to paragraph 7#c71 the ,secretary shall pay to each participating home care agency an incentive payment for each year under the pilot project equal to a portion of the ,medicare savings realized for such year relative to the performance target under paragraph 7#a74 7#c7 ,limitation on expenditures ,the ,secretary shall limit incentive payments under this section in order to ensure that the aggregate expenditures under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 7including incentive payments under this subsection7 do not exceed the amount that the ,secretary estimates would have been expended if the pilot projects under this section had not been implemented4 7d7 ,waiver authority ,the ,secretary may waive such provisions of titles ,,xi and ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq42 #db ,u4,s4,c4 #acie et seq47 as the ,secretary determines to be appropriate for the conduct of the pilot projects under this section4 7e7 ,report to ,congress ,not later than #e years after the date that the first pilot project under this section is implemented1 the ,secretary shall submit to ,congress a report on the pilot projects4 ,such report shall contain a detailed description of issues related to the expansion of the projects under subsection 7f7 and recommendations for such legislation and administrative actions as the ,secretary considers appropriate4 7f7 ,expansion ,if the ,secretary determines that any of the pilot projects under this section enhance health outcomes for ,medicare beneficiaries and reduce expenditures under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 the ,secretary may initiate comparable projects in additional areas4 7g7 ,incentive payments have no effect on other ,medicare payments to agencies ,an incentive payment under this section-- 7#a7 shall be in addition to the payments that a home health agency would otherwise receive under title ,,xviii of the ,social ,security ,act for the provision of home health services2 and 7#b7 shall have no effect on the amount of such payments4 #dbje4 ,community health center collaborative access expansion ,section #ccj7r77#d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7r77#d77 is amended-- 7#a7 in subparagraph 7,a71 by striking primary health care services each place it appears and inserting primary health care and other mental1 dental1 and physical health services2 and 7#b7 in subparagraph 7,b7-- 7,a7 in clause 7i71 by striking and at the end2 7,b7 in clause 7ii71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following3 7iii7 in the case of a rural health clinic described in such subparagraph-- 7,i7 that such clinic provides1 to the extent possible1 enabling services1 such as transportation and language assistance 7including translation and interpretation72 and 7,,ii7 that the primary health care and other services described in such subparagraph are subject to full reimbursement according to the prospective payment system for ,federally qualified health center services under section #ahcd7o7 of the ,social ,security ,act4 4 #dbjf4 ,facilitating the provision of telehealth services across ,state lines 7a7 ,in general ,for purposes of expediting the provision of telehealth services1 for which payment is made under the ,medicare ,program established under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 across ,state lines1 the ,secretary of ,health and ,human ,services shall1 in consultation with representatives of ,states1 physicians1 health care practitioners1 and patient advocates1 encourage and facilitate the adoption of provisions allowing for multistate practitioner practice across ,state lines4 7b7 ,definitions ,in subsection 7a73 7#a7 ,telehealth service ,the term telehealth service has the meaning given that term in subparagraph 7,f7 of section #ahcd7m77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d774 7#b7 ,physician1 practitioner ,the terms physician and practitioner have the meaning given those terms in subparagraphs 7,d7 and 7,e71 respectively1 of section #ahcd7m77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d774 7#c7 ,medicare program ,the term ,medicare ,program means the program of health insurance administered by the ,secretary of ,health and ,human ,services under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 #dbjg4 ,scoring of preventive health savings ,section #bjb of the ,congressional ,budget and ,impoundment ,control ,act of #aigd 7#b ,u4,s4,c4 #fjb7 is amended by adding at the end the following3 7h7 ,scoring of preventive health savings 7#a7 ,determination by the ,director ,upon a request by the chairman or ranking minority member of the ,committee on the ,budget of the ,senate1 or by the chairman or ranking minority member of the ,committee on the ,budget of the ,house of ,representatives1 the ,director shall determine if a proposed measure would result in reductions in budget outlays in budgetary outyears through the use of preventive health and preventive health services4 7#b7 ,projections ,if the ,director determines that a measure would result in substantial reductions in budget outlays as described in paragraph 7#a71 the ,director-- 7,a7 shall include1 in any projection prepared by the ,director1 a description and estimate of the reductions in budget outlays in the budgetary outyears and a description of the basis for such conclusions2 and 7,b7 may prepare a budget projection that includes some or all of the budgetary outyears1 notwithstanding the time periods for projections described in subsection 7e7 and sections #cjh1 #djb1 and #dbd4 7#c7 ,definitions ,as used in this subsection-- 7,a7 the term budgetary outyears means the #b consecutive #aj-;fiscal-year periods beginning with the first fiscal year that is #aj years after the budget year provided for in the most recently agreed to concurrent resolution on the budget2 and 7,b7 the term preventive health means an action that focuses on the health of the public1 individuals1 and defined populations in order to protect1 promote1 and maintain health1 wellness1 and functional ability1 and prevent disease1 disability1 and premature death that is demonstrated by credible and publicly available epidemiological projection models1 incorporating clinical trials or observational studies in humans1 to avoid future health care costs4 4 #dbjh4 ,sense of ,congress on maintenance of effort provisions regarding children's health ,it is the sense of the ,congress that-- 7#a7 the maintenance of effort provisions added to sections #aijb and #baje7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a2 #db ,u4,s4,c4 #acig;ee7d77 by sections #bjja7;b7 and #baja7;b7 of the ,patient ,protection and ,affordable ,care ,act were intended to maintain the eligibility standards for the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 and ,children's ,health ,insurance ,program under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;aa et seq47 to protect vulnerable and disabled adults1 children1 and senior citizens1 many of whom are also members of communities of color2 7#b7 the maintenance of effort provisions for children's coverage have been extended by the ,congress through ,september #cj1 #bjbi2 7#c7 the maintenance of effort provisions ensure the continued success of the ,medicaid program and ,children's ,health ,insurance ,program and were intended to specifically protect vulnerable and disabled children1 many of whom are also members of communities of color2 and 7#d7 the maintenance of effort provisions must be strictly enforced and proposals to weaken or waive the maintenance of effort provisions must not be considered4 #dbji4 ,protection of the ,,hhs ,offices of ,minority ,health 7a7 ,in general ,pursuant to section #agjg;,a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f;a71 the ,offices of ,minority ,health established within the ,centers for ,disease ,control and ,prevention1 the ,health ,resources and ,services ,administration1 the ,substance ,abuse and ,mental ,health ,services ,administration1 the ,agency for ,healthcare ,research and ,quality1 the ,food and ,drug ,administration1 and the ,centers for ,medicare ,medicaid ,services1 are offices that1 regardless of change in the structure of the ,department of ,health and ,human ,services1 shall report to the ,secretary of ,health and ,human ,services4 7b7 ,sense of ,congress ,it is the sense of the ,congress that the ,offices of ,minority ,health referred to in subsection 7a7 play a critical role in addressing health disparities and should be adequately funded and given a prominent role in evaluating and establishing health policies and programs4 #dbaj4 ,office of ,minority ,health in ,veterans ,health ,administration of ,department of ,veterans ,affairs 7a7 ,establishment and functions ,subchapter ,i of chapter #gc of title #ch1 ,united ,states ,code1 is amended by inserting after section #gcjh the following new section3 #gcjh;,a4 ,office of ,minority ,health 7a7 ,establishment ,there is established in the ,department within the ,office of the ,under ,secretary for ,health an office to be known as the ,office of ,minority ,health 7in this section referred to as the ,office74 7b7 ,head ,the ,director of the ,office of ,minority ,health shall be the head of the ,office4 ,the ,director of the ,office of ,minority ,health shall be appointed by the ,under ,secretary for ,health from among individuals qualified to perform the duties of the position4 7c7 ,functions ,the functions of the ,office are as follows3 7#a7 ,to establish short-range and long-range goals and objectives and coordinate all other activities within the ,veterans ,health ,administration that relate to disease prevention1 health promotion1 health care services delivery1 health and health care education1 health care quality1 and health care research concerning veterans who are members of a racial or ethnic minority group4 7#b7 ,to support research1 demonstrations1 and evaluations to test new and innovative models for the discharge of activities described in paragraph 7#a74 7#c7 ,to increase knowledge and understanding of health risk factors for veterans who are members of a racial or ethnic minority group4 7#d7 ,to develop mechanisms that support better health care information dissemination1 education1 prevention1 and services delivery to veterans from disadvantaged backgrounds1 including veterans who are members of a racial or ethnic minority group4 7#e7 ,to enter into contracts or agreements with appropriate public and nonprofit private entities to develop and carry out programs to provide bilingual or interpretive services to assist veterans who are members of a racial or ethnic minority group and who lack proficiency in speaking the ,english language in accessing and receiving health care services through the ,veterans ,health ,administration4 7#f7 ,to carry out programs to improve access to health care services through the ,veterans ,health ,administration for veterans with limited proficiency in speaking the ,english language1 including the development and evaluation of demonstration and pilot projects for that purpose4 7#g7 ,to advise the ,under ,secretary for ,health on matters relating to the development1 implementation1 and evaluation of health professions education in decreasing disparities in health care outcomes between veterans who are members of a racial or ethnic minority group and other veterans1 including cultural competency as a method of eliminating such health disparities4 7#h7 ,to perform such other functions and duties as the ,secretary or the ,under ,secretary for ,health considers appropriate4 7d7 ,definitions ,in this section3 7#a7 ,the term racial or ethnic minority group means any of the following3 7,a7 ,american ,indians 7including ,alaska ,natives1 ,eskimos1 and ,aleuts74 7,b7 ,asian ,americans4 7,c7 ,native ,hawaiians and ,pacific ,islanders4 7,d7 ,blacks4 7,e7 ,hispanics4 7#b7 ,the term ,hispanic means individuals whose origin is from ,mexico1 ,puerto ,rico1 ,cuba1 ,central or ,south ,america1 or any other ,spanish-speaking country4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such subchapter is amended by inserting after the item relating to section #gcjh the following new item3 #gcjh;,a4 ,office of ,minority ,health4 4 #dbaa4 ,study of ,,dsh payments to ensure hospital access for low-income patients 7a7 ,in general ,not later than ,january #a1 #bjbe1 the ,comptroller ,general of the ,united ,states shall conduct a study on how amendments made by the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 and the ,health ,care and ,education ,reconciliation ,act of #bjaj 7,public ,law #aaa-aeb7 to titles ,,xviii and ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq42 #db ,u4,s4,c4 #acif et seq47 relating to disproportionate share hospital adjustment payments under ,medicare and ,medicaid 7and subsequent amendments made with respect to such payments7 affect the timely access to health care services for low-income patients4 ,such study shall-- 7#a7 evaluate and examine whether ,states electing to make medical assistance available under section #aijb7;a77#aj77;,a77i77,,viii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77i77,,viii77 7including ,states making such an election through a waiver of the ,state plan7 to individuals described in such section mitigate the need for payments to disproportionate share hospitals under section #ahhf7;d77#e77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,f77 and section #aibc of such ,act 7#db ,u4,s4,c4 #acifr-#d71 including the impact of such ,states electing to make medical assistance available to such individuals on-- 7,a7 the number of individuals in the ,united ,states who are without health insurance and the distribution of such individuals in relation to areas primarily served by disproportionate share hospitals2 and 7,b7 the low-income utilization rate of such hospitals and the resulting fiscal sustainability of such hospitals2 7#b7 evaluate the appropriate level and distribution of such payments among such disproportionate share hospitals for purposes of-- 7,a7 sufficiently accounting for the level of uncompensated care provided by such hospitals to low-income patients2 and 7,b7 providing timely access to health care services for individuals in medically underserved areas2 and 7#c7 assess1 with respect to such disproportionate share hospitals-- 7,a7 the role played by such hospitals in providing critical access to emergency1 inpatient1 and outpatient health services1 including end-of-life services1 as well as the location of such hospitals in relation to medically underserved areas2 and 7,b7 the extent to which such hospitals satisfy the requirements established for charitable hospital organizations under section #eja7r7 of the ,internal ,revenue ,code of #aihf with respect to community health needs assessments1 financial assistance policy requirements1 limitations on charges1 and billing and collection requirements4 7b7 ,reports 7#a7 ,report to ,congress ,not later than #ahj days after the date on which the study under subsection 7a7 is completed1 the ,comptroller ,general of the ,united ,states shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,finance of the ,senate a report that contains-- 7,a7 the results of the study2 7,b7 recommendations to ,congress for any legislative changes to the payments to disproportionate share hospitals under section #ahhf7;d77#e77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,f77 and section #aibc of such ,act 7#db ,u4,s4,c4 #acifr-#d7 that are needed to ensure access to health services for low-income patients that-- 7i7 are based on the number of individuals without health insurance1 the amount of uncompensated care provided by such hospitals1 and the impact of reduced payment levels on low-income communities2 and 7ii7 takes into account any reports submitted by the ,secretary of the ,treasury1 in consultation with the ,secretary of ,health and ,human ,services1 to congressional committees regarding the costs incurred by charitable hospital organizations for charity care1 bad debt1 nonreimbursed expenses for services provided to individuals under the ,medicare program under title ,,xviii of the ,social ,security ,act and the ,medicaid program under title ,,xix of such ,act1 and any community benefit activities provided by such organizations4 7#b7 ,report to the ,secretary of ,health and ,human ,services ,not later than #ahj days after the date on which the study under subsection 7a7 is completed1 the ,comptroller ,general of the ,united ,states shall submit to the ,secretary of ,health and ,human ,services a report that contains-- 7,a7 the results of the study2 and 7,b7 any recommendations for purposes of assisting in the development of the methodology for the adjustment of payments to disproportionate share hospitals1 as required under section #ahhf7r7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7r77 and the reduction of such payments under section #aibc7;f77#g7 of such ,act 7#db ,u4,s4,c4 #acifr-#d7;f77#g771 taking into account the reports referred to in paragraph 7#a77;,b77ii74 #dbab4 ,reauthorization of programs under the ,native ,hawaiian ,health ,care ,improvement ,act 7a7 ,native ,hawaiian health care systems ,section #f7;h77#a7 of the ,native ,hawaiian ,health ,care ,improvement ,act 7#db ,u4,s4,c4 #aagje7;h77#a77 is amended by striking may be necessary for fiscal years #aiic through #bjai and inserting are necessary4 7b7 ,administrative grant for ,papa ,ola ,lokahi ,section #g7;b7 of the ,native ,hawaiian ,health ,care ,improvement ,act 7#db ,u4,s4,c4 #aagjf7;b77 is amended by striking may be necessary for fiscal years #aiic through #bjai and inserting are necessary4 7c7 ,native ,hawaiian health scholarships ,section #aj7;c7 of the ,native ,hawaiian ,health ,care ,improvement ,act 7#db ,u4,s4,c4 #aagji7;c77 is amended by striking may be necessary for fiscal years #aiic through #bjai and inserting are necessary4 #b ,rural #dbba4 ,establishment of ,rural ,community ,hospital 7,,rch7 ,program 7a7 ,in general ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 as amended by section #bjjg7;b77#a71 is amended by adding at the end of the following new subsection3 7ooo7 ,rural ,community ,hospital2 ,rural ,community ,hospital ,services 7#a7 ,the term rural community hospital means a hospital 7as defined in subsection 7e77 that-- 7,a7 is located in a rural area 7as defined in section #ahhf7;d77#b77;,d77 or treated as being so located pursuant to section #ahhf7;d77#h77;,e72 7,b7 subject to paragraph 7#b71 has less than #ea acute care inpatient beds1 as reported in its most recent cost report2 7,c7 makes available #bd-;hour emergency care services2 7,d7 subject to paragraph 7#c71 has a provider agreement in effect with the ,secretary and is open to the public as of ,january #a1 #bjaj2 and 7,e7 applies to the ,secretary for such designation4 7#b7 ,for purposes of paragraph 7#a77;,b71 beds in a psychiatric or rehabilitation unit of the hospital which is a distinct part of the hospital shall not be counted4 7#c7 ,paragraph 7#a77;,d7 shall not be construed to prohibit any of the following from qualifying as a rural community hospital3 7,a7 ,a replacement facility 7as defined by the ,secretary in regulations in effect on ,january #a1 #bjab7 with the same service area 7as defined by the ,secretary in regulations in effect on such date74 7,b7 ,a facility obtaining a new provider number pursuant to a change of ownership4 7,c7 ,a facility which has a binding written agreement with an outside1 unrelated party for the construction1 reconstruction1 lease1 rental1 or financing of a building as of ,january #a1 #bjab4 7#d7 ,nothing in this subsection shall be construed as prohibiting a critical access hospital from qualifying as a rural community hospital if the critical access hospital meets the conditions otherwise applicable to hospitals under subsection 7e7 and section #ahff4 7#e7 ,nothing in this subsection shall be construed as prohibiting a rural community hospital participating in the demonstration program under section #daj;,a of the ,medicare ,prescription ,drug1 ,improvement1 and ,modernization ,act of #bjjc 7#db ,u4,s4,c4 #acieww note2 ,public ,law #ajh-agc7 from qualifying as a rural community hospital if the rural community hospital meets the conditions otherwise applicable to hospitals under subsection 7e7 and section #ahff4 4 7b7 ,payment 7#a7 ,inpatient hospital services ,section #ahad of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7 is amended by adding at the end the following new subsection3 7m7 ,payment for ,inpatient ,services ,furnished in ,rural ,community ,hospitals ,the amount of payment under this part for inpatient hospital services furnished in a rural community hospital1 other than such services furnished in a psychiatric or rehabilitation unit of the hospital which is a distinct part1 is1 at the election of the hospital in the application referred to in section #ahfa7ooo77#a77;,e7-- 7#a7 #aja percent of the reasonable costs of providing such services1 without regard to the amount of the customary or other charge1 or 7#b7 the amount of payment provided for under the prospective payment system for inpatient hospital services under section #ahhf7;d74 4 7#b7 ,outpatient services ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7aa7 ,payment for outpatient services furnished in rural community hospitals ,the amount of payment under this part for outpatient services furnished in a rural community hospital is1 at the election of the hospital in the application referred to in section #ahfa7ooo77#a77;,e7-- 7#a7 #aja percent of the reasonable costs of providing such services1 without regard to the amount of the customary or other charge and any limitation under section #ahfa7v77#a77,u71 or 7#b7 the amount of payment provided for under the prospective payment system for covered ,,opd services under section #ahcc7t74 4 7#c7 ,exemption from #cj-percent reduction in reimbursement for bad debt ,section #ahfa7v77#a77,t7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7v77#a77,t77 is amended in the matter preceding clause 7i7 by inserting 7other than for a rural community hospital7 after ,in determining such reasonable costs for hospitals4 7c7 ,beneficiary cost-,sharing for outpatient services ,section #ahcd7;aa7 of the ,social ,security ,act 7as added by subsection 7b77#b77 is amended-- 7#a7 by redesignating paragraphs 7#a7 and 7#b7 as subparagraphs 7,a7 and 7,b71 respectively2 7#b7 by inserting 7#a7 after 7aa72 and 7#c7 by adding at the end the following3 7#b7 ,the amounts of beneficiary cost-sharing for outpatient services furnished in a rural community hospital under this part shall be as follows3 7,a7 ,for items and services that would have been paid under section #ahcc7t7 if furnished by a hospital1 the amount of cost-sharing determined under paragraph 7#h7 of such section4 7,b7 ,for items and services that would have been paid under section #ahcc7;h7 if furnished by a provider of services or supplier1 no cost-sharing shall apply4 7,c7 ,for all other items and services1 the amount of cost-sharing that would apply to the item or service under the methodology that would be used to determine payment for such item or service if provided by a physician1 provider of services1 or supplier1 as the case may be4 4 7d7 ,conforming amendments 7#a7 ,part ,a payment ,section #ahad7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7b77 is amended in the matter preceding paragraph 7#a7 by inserting other than inpatient hospital services furnished by a rural community hospital1 after critical access hospital services14 7#b7 ,part ,b payment ,section #ahcc7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a771 as amended by section #bbjg7;b77#c71 is amended-- 7,a7 by striking and at the end of paragraph 7#aj72 7,b7 by striking the period at the end of paragraph 7#aa7 and inserting 2 and2 and 7,c7 by adding at the end the following3 7#ab7 in the case of outpatient services furnished by a rural community hospital1 the amounts described in section #ahcd7;aa74 4 7#c7 ,technical amendments 7,a7 ,consultation with ,state agencies ,section #ahfc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciez7 is amended by striking and 7dd77#b7 and inserting 7dd77#b71 and 7ooo77#a74 7,b7 ,provider agreements ,section #ahff7;a77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#b77;,a77 is amended by inserting section #ahcd7;aa77#b71 after section #ahcc7;b714 7e7 ,effective ,date ,the amendments made by this section shall apply to items and services furnished on or after the date that is #cj days after the date of the enactment of this ,act4 #dbbb4 ,rural ,health ,quality ,advisory ,commission and demonstration projects 7a7 ,rural ,health ,quality ,advisory ,commission 7#a7 ,establishment ,not later than #f months after the date of the enactment of this section1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall establish a commission to be known as the ,rural ,health ,quality ,advisory ,commission 7in this section referred to as the ,commission74 7#b7 ,duties of commission 7,a7 ,national plan ,the ,commission shall develop1 coordinate1 and facilitate implementation of a national plan for rural health quality improvement4 ,the national plan shall-- 7i7 identify objectives for rural health quality improvement2 7ii7 identify strategies to eliminate known gaps in rural health system capacity and improve rural health quality2 and 7iii7 provide recommendations for ,federal programs to identify opportunities for strengthening and aligning policies and programs to improve rural health quality4 7,b7 ,demonstration projects ,the ,commission shall design demonstration projects to recommend to the ,secretary to test alternative models for rural health quality improvement1 including with respect to both personal and population health4 7,c7 ,monitoring ,the ,commission shall monitor progress toward the objectives identified pursuant to subparagraph 7,a77i74 7#c7 ,membership 7,a7 ,number ,the ,commission shall be composed of #aa members appointed by the ,secretary4 7,b7 ,selection ,the ,secretary shall select the members of the ,commission from among individuals with significant rural health care and health care quality expertise1 including expertise in clinical health care1 health care quality research1 end-of-life care1 population or public health1 or purchaser organizations4 7#d7 ,contracting authority ,subject to the availability of funds1 the ,commission may enter into contracts and make other arrangements1 as may be necessary to carry out the duties described in paragraph 7#b74 7#e7 ,staff ,upon the request of the ,commission1 the ,secretary may detail1 on a reimbursable basis1 any of the personnel of the ,office of ,rural ,health ,policy of the ,health ,resources and ,services ,administration1 the ,agency for ,healthcare ,research and ,quality1 or the ,centers for ,medicare ,medicaid ,services to the ,commission to assist in carrying out this subsection4 7#f7 ,reports to congress ,not later than #a year after the establishment of the ,commission1 and annually thereafter1 the ,commission shall submit a report to the ,congress on rural health quality4 ,each such report shall include the following3 7,a7 ,an inventory of relevant programs and recommendations for improved coordination and integration of policy and programs4 7,b7 ,an assessment of achievement of the objectives identified in the national plan developed under paragraph 7#b7 and recommendations for realizing such objectives4 7,c7 ,recommendations on ,federal legislation1 regulations1 or administrative policies to enhance rural health quality and outcomes4 7b7 ,rural ,health ,quality ,demonstration ,projects 7#a7 ,in general ,not later than #bgj days after the date of the enactment of this section1 the ,secretary1 in consultation with the ,rural ,health ,quality ,advisory ,commission1 the ,office of ,rural ,health ,policy of the ,health ,resources and ,services ,administration1 the ,agency for ,healthcare ,research and ,quality1 and the ,centers for ,medicare ,medicaid ,services1 shall make grants to eligible entities for a total of #e demonstration projects to implement and evaluate methods for improving the quality of health care in rural communities4 ,each such demonstration project shall include-- 7,a7 alternative community models that-- 7i7 will achieve greater integration of personal and population health services2 and 7ii7 address safety1 effectiveness1 patient- or community-centeredness1 timeliness1 efficiency1 and equity 7the #f aims identified by the ,national ,academy of ,medicine 7formerly known as the ,institute of ,medicine7 in its report entitled ,crossing the ,quality ,chasm3 ,a ,new ,health ,system for the #bast ,century released on ,march #a1 #bjja72 7,b7 innovative approaches to the financing and delivery of health care services to achieve rural health quality and accessibility goals for patients2 and 7,c7 development of quality improvement support structures to assist rural health systems and professionals in the provision of health care 7such as workforce support structures1 quality monitoring and reporting1 clinical care protocols1 and information technology applications74 7#b7 ,eligible entities ,in this subsection1 the term eligible entity means a consortium that-- 7,a7 shall include-- 7i7 at least one health care provider or health care delivery system located in a rural area2 and 7ii7 at least one organization representing multiple community stakeholders2 and 7,b7 may include other partners such as rural research centers4 7#c7 ,consultation ,in developing the program for awarding grants under this subsection1 the ,secretary shall consult with the ,administrator of the ,agency for ,healthcare ,research and ,quality1 rural health care providers1 rural health care researchers1 and private and nonprofit groups 7including national associations7 which are undertaking similar efforts4 7#d7 ,expedited waivers ,the ,secretary shall expedite the processing of any waiver that-- 7,a7 is authorized under title ,,xviii or ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq42 #db ,u4,s4,c4 #acif et seq472 and 7,b7 is necessary to carry out a demonstration project under this subsection4 7#e7 ,demonstration project sites ,the ,secretary shall ensure that the #e demonstration projects funded under this subsection are conducted at a variety of sites representing the diversity of rural communities in the ,united ,states4 7#f7 ,duration ,each demonstration project under this subsection shall be for a period of #d years4 7#g7 ,independent evaluation ,the ,secretary shall enter into an arrangement with an entity that has experience working directly with rural health systems for the conduct of an independent evaluation of the program carried out under this subsection4 7#h7 ,report ,not later than #a year after the conclusion of all of the demonstration projects funded under this subsection1 the ,secretary shall submit a report to the ,congress on the results of such projects4 ,the report shall include-- 7,a7 an evaluation of patient access to care1 patient outcomes1 and an analysis of the cost-effectiveness of each such project2 and 7,b7 recommendations on ,federal legislation1 regulations1 or administrative policies to enhance rural health quality and outcomes4 7c7 ,appropriations 7#a7 ,in general ,out of funds in the ,treasury not otherwise appropriated1 there are appropriated to the ,secretary to carry out this section #cj1jjj1jjj for the period of fiscal years #bjbe through #bjbi4 7#b7 ,availability 7,a7 ,in general ,except as provided in subparagraph 7,b71 funds appropriated under paragraph 7#a7 shall remain available for expenditure through fiscal year #bjbh4 7,b7 ,report ,for purposes of carrying out subsection 7b77#h71 funds appropriated under paragraph 7#a7 shall remain available for expenditure through fiscal year #bjbi4 7#c7 ,reservation ,of the amount appropriated under paragraph 7#a71 the ,secretary shall reserve-- 7,a7 #e1jjj1jjj to carry out subsection 7a72 and 7,b7 #be1jjj1jjj to carry out subsection 7b71 of which-- 7i7 #b percent shall be for the provision of technical assistance to grant recipients2 and 7ii7 #e percent shall be for the independent evaluation under subsection 7b77#g74 #dbbc4 ,rural health care services ,section #ccj;,a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c7 is amended to read as follows3 #ccj;,a4 ,rural health care services outreach1 rural health network development1 ,delta rural disparities and health systems development1 and small rural health care provider quality improvement grant programs 7a7 ,purpose ,the purpose of this section is to provide for grants-- 7#a7 under subsection 7b71 to promote rural health care services outreach2 7#b7 under subsection 7c71 to provide for the planning and implementation of integrated health care networks in rural areas2 7#c7 under subsection 7d71 to assist rural communities in the ,delta ,region to reduce health disparities and to promote and enhance health system development2 and 7#d7 under subsection 7e71 to provide for the planning and implementation of small rural health care provider quality improvement activities4 7b7 ,rural health care services outreach grants 7#a7 ,grants ,the ,director of the ,office of ,rural ,health ,policy of the ,health ,resources and ,services ,administration 7referred to in this section as the ,director7 may award grants to eligible entities to promote rural health care services outreach by expanding the delivery of health care services to include new and enhanced services in rural areas4 ,the ,director may award the grants for periods of not more than #c years4 7#b7 ,eligibility ,to be eligible to receive a grant under this subsection for a project1 an entity-- 7,a7 shall be a rural public or rural nonprofit private entity1 a facility that qualifies as a rural health clinic under title ,,xviii of the ,social ,security ,act1 a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas1 or a ,tribal government whose grant-funded activities will be conducted within federally recognized ,tribal areas2 7,b7 shall represent a consortium composed of members-- 7i7 that include #c or more independently owned health care entities2 and 7ii7 that may be nonprofit or for-profit entities2 and 7,c7 shall not previously have received a grant under this subsection for the same or a similar project1 unless the entity is proposing to expand the scope of the project or the area that will be served through the project4 7#c7 ,applications ,to be eligible to receive a grant under this subsection1 an eligible entity shall prepare and submit to the ,director an application at such time1 in such manner1 and containing such information as the ,director may require1 including-- 7,a7 a description of the project that the eligible entity will carry out using the funds provided under the grant2 7,b7 a description of the manner in which the project funded under the grant will meet the health care needs of rural populations in the local community or region to be served2 7,c7 a plan for quantifying how health care needs will be met through identification of the target population and benchmarks of service delivery or health status1 such as-- 7i7 quantifiable measurements of health and health care status improvement for projects focusing on health promotion2 or 7ii7 benchmarks of increased access to primary and end-of-life care1 including tracking factors such as the number and type of primary and end-of-life care visits1 identification of a medical home1 or other general measures of such access2 7,d7 a description of how the local community or region to be served will be involved in the development and ongoing operations of the project2 7,e7 a plan for sustaining the project after ,federal support for the project has ended2 7,f7 a description of how the project will be evaluated2 7,g7 the administrative capacity to submit annual performance data electronically as specified by the ,director2 and 7,h7 other such information as the ,director determines to be appropriate4 7c7 ,rural health network development grants 7#a7 ,grants 7,a7 ,in general ,the ,director may award rural health network development grants to eligible entities to promote1 through planning and implementation1 the development of integrated health care networks that have combined the functions of the entities participating in the networks in order to-- 7i7 achieve efficiencies and economies of scale2 7ii7 expand access to1 coordinate1 and improve the quality of the health care delivery system through development of organizational efficiencies2 7iii7 implement health information technology to achieve efficiencies1 reduce medical errors1 and improve quality2 7iv7 coordinate care and manage chronic and terminal illness2 and 7v7 strengthen the rural health care system as a whole and across all facets of the health care delivery system1 including end-of-life care1 in such a manner as to show a quantifiable return on investment to the participants in the network4 7,b7 ,grant periods ,the ,director may award such a rural health network development grant-- 7i7 for a period of #c years for implementation activities2 or 7ii7 for a period of #a year for planning activities to assist in the initial development of an integrated health care network1 if the proposed participants in the network do not have a history of collaborative efforts and a #c-year grant would be inappropriate4 7#b7 ,eligibility ,to be eligible to receive a grant under this subsection1 an entity-- 7,a7 shall be a rural public or rural nonprofit private entity1 a facility that qualifies as a rural health clinic under title ,,xviii of the ,social ,security ,act1 a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas1 or a ,tribal government whose grant-funded activities will be conducted within federally recognized ,tribal areas2 7,b7 shall represent a network composed of participants-- 7i7 that include #c or more independently owned health care entities2 and 7ii7 that may be nonprofit or for-profit entities2 and 7,c7 shall not previously have received a grant under this subsection 7other than a #a-year grant for planning activities7 for the same or a similar project4 7#c7 ,applications ,to be eligible to receive a grant under this subsection1 an eligible entity1 in consultation with the appropriate ,state office of rural health or another appropriate ,state entity1 shall prepare and submit to the ,director an application at such time1 in such manner1 and containing such information as the ,director may require1 including-- 7,a7 a description of the project that the eligible entity will carry out using the funds provided under the grant2 7,b7 an explanation of the reasons why ,federal assistance is required to carry out the project2 7,c7 a description of-- 7i7 the history of collaborative activities carried out by the participants in the network2 7ii7 the degree to which the participants are ready to integrate their functions2 and 7iii7 how the local community or region to be served will benefit from and be involved in the activities carried out by the network2 7,d7 a description of how the local community or region to be served will experience increased access to quality health care services across the continuum of care as a result of the integration activities carried out by the network1 including a description of-- 7i7 return on investment for the community and the network members2 and 7ii7 other quantifiable performance measures that show the benefit of the network activities2 7,e7 a plan for sustaining the project after ,federal support for the project has ended2 7,f7 a description of how the project will be evaluated2 7,g7 the administrative capacity to submit annual performance data electronically as specified by the ,director2 and 7,h7 other such information as the ,director determines to be appropriate4 7d7 ,delta rural disparities and health systems development grants 7#a7 ,grants ,the ,director may award grants to eligible entities to support reduction of health disparities1 improve access to health care1 and enhance rural health system development in the ,delta ,region4 7#b7 ,eligibility ,to be eligible to receive a grant under this subsection1 an entity shall be a rural public or rural nonprofit private entity1 a facility that qualifies as a rural health clinic under title ,,xviii of the ,social ,security ,act1 a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas1 or a ,tribal government whose grant-funded activities will be conducted within federally recognized ,tribal areas4 7#c7 ,applications ,to be eligible to receive a grant under this subsection1 an eligible entity shall prepare and submit to the ,director an application at such time1 in such manner1 and containing such information as the ,director may require1 including-- 7,a7 a description of the project that the eligible entity will carry out using the funds provided under the grant2 7,b7 an explanation of the reasons why ,federal assistance is required to carry out the project2 7,c7 a description of the manner in which the project funded under the grant will meet the health care needs of the ,delta ,region2 7,d7 a description of how the local community or region to be served will experience increased access to quality health care services as a result of the activities carried out by the entity2 7,e7 a description of how health disparities will be reduced or the health system will be improved2 7,f7 a plan for sustaining the project after ,federal support for the project has ended2 7,g7 a description of how the project will be evaluated including process and outcome measures related to the quality of care provided or how the health care system improves its performance2 7,h7 a description of how the grantee will develop an advisory group made up of representatives of the communities to be served to provide guidance to the grantee to best meet community need2 and 7,i7 other such information as the ,director determines to be appropriate4 7e7 ,small rural health care provider quality improvement grants 7#a7 ,grants ,the ,director may award grants to provide for the planning and implementation of small rural health care provider quality improvement activities4 ,the ,director may award the grants for periods of #a to #c years4 7#b7 ,eligibility ,to be eligible for a grant under this subsection1 an entity-- 7,a7 shall be-- 7i7 a rural public or rural nonprofit private health care provider or provider of health care services1 such as a rural health clinic2 or 7ii7 another rural provider or network of small rural providers identified by the ,director as a key source of local care2 and 7,b7 shall not previously have received a grant under this subsection for the same or a similar project4 7#c7 ,preference ,in awarding grants under this subsection1 the ,director shall give preference to facilities that qualify as rural health clinics under title ,,xviii of the ,social ,security ,act4 7#d7 ,applications ,to be eligible to receive a grant under this subsection1 an eligible entity shall prepare and submit to the ,director an application at such time1 in such manner1 and containing such information as the ,director may require1 including-- 7,a7 a description of the project that the eligible entity will carry out using the funds provided under the grant2 7,b7 an explanation of the reasons why ,federal assistance is required to carry out the project2 7,c7 a description of the manner in which the project funded under the grant will assure continuous quality improvement in the provision of services by the entity2 7,d7 a description of how the local community or region to be served will experience increased access to quality health care services as a result of the activities carried out by the entity2 7,e7 a plan for sustaining the project after ,federal support for the project has ended2 7,f7 a description of how the project will be evaluated including process and outcome measures related to the quality of care provided2 and 7,g7 other such information as the ,director determines to be appropriate4 7f7 ,general requirements 7#a7 ,prohibited uses of funds ,an entity that receives a grant under this section may not use funds provided through the grant-- 7,a7 to build or acquire real property2 or 7,b7 for construction4 7#b7 ,coordination with other agencies ,the ,director shall coordinate activities carried out under grant programs described in this section1 to the extent practicable1 with ,federal and ,state agencies and nonprofit organizations that are operating similar grant programs1 to maximize the effect of public dollars in funding meritorious proposals4 7g7 ,report ,not later than ,september #cj1 #bjbe1 the ,secretary shall prepare and submit to the appropriate committees of ,congress a report on the progress and accomplishments of the grant programs described in subsections 7b71 7c71 7d71 and 7e74 7h7 ,definition of ,delta ,region ,in this section1 the term ,delta ,region has the meaning given to the term region in section #chb;,a of the ,consolidated ,farm and ,rural ,development ,act 7#g ,u4,s4,c4 #bjji;aa74 7i7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbh4 4 #c ,indian ,communities #dbca4 ,assistant ,secretary of the ,indian ,health ,service 7a7 ,references ,any reference in a law1 regulation1 document1 paper1 or other record of the ,united ,states to the ,director of the ,indian ,health ,service shall be deemed to be a reference to the ,assistant ,secretary of the ,indian ,health ,service4 7b7 ,executive ,schedule ,section #ecae of title #e1 ,united ,states ,code1 is amended1 in the matter relating to the ,assistant ,secretaries of ,health and ,human ,services1 by striking 7#f7 and inserting 7#g71 #a of whom shall be the ,assistant ,secretary of the ,indian ,health ,service4 7c7 ,conforming amendment ,section #ecaf of title #e1 ,united ,states ,code1 is amended by striking ,director1 ,indian ,health ,service1 ,department of ,health and ,human ,services44 #dbcb4 ,extension of full ,federal medical assistance percentage to ,indian health care providers ,section #aije7;a77#i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#i77 is amended to read as follows3 7#i7 clinic services furnished by or under the direction of a physician1 without regard to whether the clinic itself is administered by a physician1 including-- 7,a7 such services furnished outside the clinic by clinic personnel to an eligible individual who does not reside in a permanent dwelling or does not have a fixed home or mailing address2 and 7,b7 such services furnished outside the clinic by any ,indian ,health ,service facility1 a health program or facility operated by a tribe or tribal organization under the ,indian ,self-,determination ,act 7,public ,law #ic-fch71 or an urban ,indian organization receiving funds under title ,v of the ,indian ,health ,care ,improvement ,act2 4 #dbcc4 ,conferring with urban ,indian organizations ,section #ead of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #affj;d7 is amended by striking subsection 7b7 and inserting the following3 7b7 ,requirement ,the ,secretary shall ensure that the ,service and other agencies and offices of the ,department and the ,department of ,veterans ,affairs confer1 to the maximum extent practicable1 with urban ,indian organizations in carrying out-- 7#a7 this ,act2 and 7#b7 other provisions of law relating to ,indian health care4 4 #d ,providers #dbda4 ,availability of non-,english language speaking providers 7a7 ,in general ,section #acaa7;c77#a77;,b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77#a77;,b77 is amended by inserting before the semicolon the following3 and the ability of such provider to provide care in a language other than ,english either through the provider speaking such language or by the provider having a qualified interpreter for an individual with limited ,english proficiency 7as defined in section #cdjj of such ,act7 who speaks such language available during office hours4 7b7 ,effective date ,the amendment made by subsection 7a7 shall not apply to any plan beginning on or prior to the date that is #a year after the date of the enactment of this ,act4 #dbdb4 ,access to essential community providers 7a7 ,essential community providers ,section #acaa7;c77#a77;,c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77#a77;,c77 is amended-- 7#a7 by inserting 7i7 after 7,c72 and 7#b7 by adding at the end the following new clauses3 7ii7 not later than ,january #a1 #bjbe1 increase the percentage of essential community providers as described in clause 7i7 included in its network by #aj percent annually 7based on the level in the plan for #bjbc7 until #ij percent of all federally qualified health centers and #ge percent of all other such essential community providers in the contract service area are in-network2 and 7iii7 include at least one essential community provider in each of the essential community provider categories described in section #aef4bce7;a77#b77;ii77,b7 of title #de1 ,code of ,federal ,regulations 7as in effect on the date of enactment of the ,health ,equity and ,accountability ,act of #bjbd71 in each county in the service area1 where available2 4 7b7 ,reporting requirements ,section #acaa7;e77#c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;e77#c77 is amended by adding at the end the following new subparagraph3 7,e7 ,data on essential community providers ,the ,secretary shall require qualified health plans to submit annually to the ,secretary data on the percentage of essential community providers as described in clause 7ii7 of subsection 7c77#a77;,c71 by county1 that contract with each qualified health plan offered in that county and the percentage of such essential community providers1 by category as described in clause 7iii7 of such subsection1 that contract with each qualified health plan offered in that county4 ,such data shall be made available to the general public4 4 7c7 ,essential ,community ,provider provisions applied under ,medicare and ,medicaid 7#a7 ,medicare ,section #aheb7;d77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;d77#a77 is amended-- 7,a7 by striking and at the end of subparagraph 7,d72 7,b7 by striking the period at the end of subparagraph 7,e7 and inserting 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,f7 the plan meets the requirements of clauses 7ii7 and 7iii7 of section #acaa7;c77#a77;,c7 of the ,patient ,protection and ,affordable ,care ,act 7relating to inclusion in networks of essential community providers74 4 7#b7 ,medicaid ,section #aicb7;b77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;b77#e77 is amended-- 7,a7 by striking and at the end of subparagraph 7,a72 7,b7 by striking the period at the end of subparagraph 7,b7 and inserting 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,c7 meets the requirements of clauses 7ii7 and 7iii7 of section #acaa7;c77#a77;,c7 of the ,patient ,protection and ,affordable ,care ,act 7relating to inclusion in networks of essential community providers7 with respect to services offered in the service area involved4 4 #dbdc4 ,provider network adequacy in communities of color 7a7 ,in general ,section #acaa7;c77#a77;,b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77#a77;,b771 as amended by section #dbda7;a71 is further amended-- 7#a7 by inserting 7i7 after 7,b72 and 7#b7 by adding at the end the following new clauses3 7ii7 meet such network adequacy standards as the ,secretary may establish with regard to-- 7,i7 appointment wait time2 7,,ii7 travel time and distance to health care provider facilities and providers by public and private transit2 7,,iii7 hours of operation to accommodate individuals who cannot come to provider appointments during standard business hours2 7,,iv7 availability of health care options for patients2 and 7,v7 other network adequacy standards to ensure that care through these plans is accessible to diverse communities1 including individuals with limited ,english proficiency as defined in section #cdjj of such ,act2 and 7iii7 provide coverage for services for enrollees through out-of-network providers at no additional cost to the enrollees in cases where in-network providers are unable to comply with the standards established under subclause 7,,iii7 or 7,,iv7 of clause 7ii7 for such services and the out-of-network providers can deliver such services in compliance with such standards2 4 7b7 ,effective date ,the amendments made by subsection 7a7 shall not apply to plans beginning on or prior to the date that is #a year after the date of the enactment of the ,health ,equity and ,accountability ,act of #bjbd4 #e ,dental #dbea4 ,improving access to dental care 7a7 ,reports to ,congress 7#a7 ,,gao reports ,not later than #a year after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress-- 7,a7 a report on the ,alaska ,dental ,health ,aide ,therapists program and the ,dental ,therapist and ,advanced ,dental ,therapist programs in ,minnesota1 to assess the effectiveness of dental therapists in-- 7i7 improving access to timely dental care among communities of color2 7ii7 providing high-quality care2 7iii7 providing culturally competent care2 and 7iv7 providing accessible care to people with disabilities2 7,b7 a report on ,state variations in the use of dental hygienists and the effectiveness of expanding the scope of practice for dental hygienists in-- 7i7 improving access to timely dental care among communities of color2 7ii7 providing high-quality care2 7iii7 providing culturally competent care2 and 7iv7 providing accessible care to people with disabilities2 and 7,c7 a report on the use of telehealth services to enhance services provided by dental hygienists and therapists1 including recommendations for any modifications to the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 and the ,medicaid program under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq47 to better provide for telehealth consultations in conjunction with therapists' and hygienists' care4 7#b7 ,,hrsa report on dental shortage areas ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall submit to ,congress a report which details geographic dental access shortages and the preparedness of dental providers to offer culturally and linguistically appropriate1 affordable1 accessible1 and timely services4 7b7 ,expansion of dental health aid therapists in ,tribal and urban ,indian communities ,section #aai of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afafl7 is amended-- 7#a7 in subsection 7d7-- 7,a7 by striking paragraph 7#b7 and inserting the following3 7#b7 ,requirements2 exclusion ,subject to paragraphs 7#c7 and 7#d71 in establishing a national program under paragraph 7#a71 the ,secretary-- 7,a7 shall not reduce the amounts provided for the ,community ,health ,aide ,program described in subsections 7a7 and 7b72 7,b7 shall exclude dental health aide therapist services from services covered under that ,program2 and 7,c7 shall include urban ,indian organizations4 2 and 7,b7 in paragraph 7#c7-- 7i7 in the paragraph heading1 by striking or tribal organization and inserting 1 tribal organization1 or urban ,indian organization2 and 7ii7 in each of subparagraphs 7,a7 and 7,b71 by striking or tribal organization and inserting 1 tribal organization1 or urban ,indian organization2 and 7#b7 in subsection 7e71 by striking or a tribal organization and inserting a tribal organization1 or an urban ,indian organization4 7c7 ,coverage of dental services under the ,medicare program 7#a7 ,coverage ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is amended-- 7,a7 in subparagraph 7,,jj71 by inserting and at the end2 and 7,b7 by adding at the end the following new subparagraph3 7,,kk7 dental and oral health services 7as defined in subsection 7ppp772 4 7#b7 ,dental and oral health services defined ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 as amended by sections #bjjg7;b7 and #dbba7;a71 is amended by adding at the end the following new subsection3 7ppp7 ,dental and oral health services 7#a7 ,the term dental and oral health services means services 7as defined by the ,secretary7 that are necessary to prevent disease and promote oral health1 restore oral structures to health and function1 and treat emergency conditions1 including-- 7,a7 routine diagnostic and preventive care such as dental cleanings1 exams1 and x-rays2 7,b7 basic dental services such as fillings and extractions2 7,c7 major dental services such as root canals1 crowns1 and dentures2 7,d7 emergency dental care2 and 7,e7 other necessary services related to dental and oral health 7as defined by the ,secretary74 7#b7 ,for purposes of paragraph 7#a71 such term shall include mobile and portable oral health services 7as defined by the ,secretary7 that-- 7,a7 are provided for the purpose of overcoming mobility1 transportation1 and access barriers for individuals2 and 7,b7 satisfy the standards and certification requirements established under section #aijb7;a77#hb7 for the ,state in which the services are provided4 4 7#c7 ,payment and coinsurance ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7,a7 by striking and before 7,,hh72 and 7,b7 by inserting before the semicolon at the end the following3 and 7,,ii7 with respect to dental and oral health services 7as defined in section #ahfa7ppp771 the amount paid shall be 7i7 in the case of such services that are preventive1 #ajj percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section #ahdh1 and 7ii7 in the case of all other such services1 #hj percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section #ahdh4 7#d7 ,payment under physician fee schedule ,section #ahdh7;j77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c77 is amended by inserting 1 7#b77,,kk71 after 7including administration of the health risk assessment74 7#e7 ,dentures ,section #ahfa7s77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#h77 is amended-- 7,a7 by striking 7other than dental7 and inserting 7including dentures72 and 7,b7 by striking internal body4 7#f7 ,repeal of ground for exclusion ,section #ahfb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7 is amended by striking paragraph 7#ab74 7#g7 ,effective date ,the amendments made by this section shall apply to services furnished on or after ,january #a1 #bjbf4 7d7 ,requiring ,medicaid coverage of dental and oral health services for adults 7#a7 ,in general 7,a7 ,mandatory coverage 7i7 ,in general 7,i7 ,requirement ,section #aijb7;a77#aj77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77 is amended by inserting 7#aj71 before 7#ac77;,b714 7,,ii7 ,medically needy 7aa7 ,in general ,section #aijb7;a77#aj77;,c77iv7 of such ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,c77iv77 is amended by inserting 7#aj71 before 7#ac77;,b74 7bb7 ,rule of construction ,nothing in this section or the amendments made by this section shall be construed to limit the access of an individual residing in an institutional setting to dental and oral health services 7as such term is defined in section #aije7ll7 of the ,social ,security ,act1 as added by paragraph 7#b77;,b774 7,,iii7 ,effective date ,the amendments made by clauses 7i7 and 7ii7 shall apply with respect to expenditures for medical assistance in calendar quarters beginning on or after ,january #a1 #bjbf4 7ii7 ,benchmark coverage ,section #aicg7;b77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#g7;b77#e77 is amended by striking the period and inserting 1 and1 beginning ,january #a1 #bjbf1 coverage of dental and oral health services 7as such term is defined in section #aije7ll7744 7iii7 ,optional application to territories ,section #aijb7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7j77 is amended-- 7,i7 by striking this title1 the ,secretary and inserting 8this title-- 7#a7 in the case of a ,state other than the #ej ,states and the ,district of ,columbia the requirement under subsection 7a77#aj77;,a7 to provide the care and services listed in paragraph 7#aj7 of section #aije7;a7 shall be optional2 and 7#b7 the ,secretary 2 and 7,,ii7 by striking the second comma after section #aajh7;f74 7,b7 ,definition of dental and oral health services ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 as amended by section #dajg7;c71 is amended-- 7i7 in subsection 7a77#aj71 by inserting and dental and oral health services 7as defined in subsection 7ll77 after dental services2 and 7ii7 by adding at the end the following new subsection3 7ll7 ,dental and oral health services ,for purposes of subsection 7a77#aj71 the term dental and oral health services means dentures and denture services1 implants and implant services1 and services necessary to prevent oral disease and promote oral health1 restore oral structures to health and function1 reduce oral pain1 and treat emergency oral conditions1 that are furnished by a provider who is legally authorized to furnish such items and services under ,state law 7or the ,state regulatory mechanism provided by ,state law74 4 7,c7 ,conforming amendment 7i7 ,in general ,section #aije7;a77#aj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#aj771 as amended by paragraph 7#b71 is amended by striking dental services and4 7ii7 ,effective date ,the amendment made by subparagraph 7,a7 shall take effect on ,january #a1 #bjbf4 7#b7 ,state option for additional dental and oral health benefits ,section #aije7;a77#ac7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#ac77 is amended by inserting the following new subparagraph after subparagraph 7,c73 7,d7 at ,state option1 such items and services related to dental and oral health services 7as defined in subsection 7ll77 that are in addition to those identified in such subsection 7ll7 as the ,state may specify2 4 7#c7 ,increased ,,fmap 7,a7 ,medicaid ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 as amended by paragraph 7#a71 is further amended-- 7i7 in subsection 7b71 by striking and 7kk7 and inserting 7kk71 and 7mm72 7ii7 in subsection 7ff71 by striking and 7ii7 and inserting 1 7ii71 and 7mm72 and 7iii7 by adding at the end the following new subsection3 7mm7 ,increased ,,fmap for expenditures related to dental and oral health services 7#a7 ,in general 7,a7 #ej ,states and ,,dc ,notwithstanding subsection 7b71 in the case of a ,state that is #a of the #ej ,states or the ,district of ,columbia1 during the #ab-quarter period that begins on ,january #a1 #bjbf1 the ,federal medical assistance percentage shall be equal to #ajj percent with respect to amounts expended by the ,state for medical assistance for dental and oral health services authorized under paragraph 7#aj7 of subsection 7a74 ,in no case may the application of this subparagraph result in the ,federal medical assistance percentage determined for a ,state with respect to expenditures described in this subparagraph exceeding #ajj percent4 7,b7 ,territories 7i7 ,in general ,notwithstanding subsection 7b71 in the case of a ,state that is ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa1 during a period described in clause 7ii71 the ,federal medical assistance percentage shall be equal to #ajj percent with respect to amounts expended by the ,state for medical assistance for any item or service that is included in dental and oral health services authorized under paragraph 7#aj7 of subsection 7a74 ,in no case may the application of this clause result in the ,federal medical assistance percentage determined for a ,state with respect to expenditures described in this clause exceeding #ajj percent4 7ii7 ,period described ,a period described in this clause is1 with respect to an item or service described in clause 7i7 and a ,state described in such clause1 the #ab-quarter period that begins with the first quarter beginning on or after ,january #a1 #bjbf1 in which such item or service is first covered under the ,state plan or under a waiver of such plan4 7#b7 ,exclusions ,the ,federal medical assistance percentage specified in paragraph 7#a7 shall not apply to amounts expended for medical assistance during any period for-- 7,a7 additional items and services authorized under paragraph 7#ac77;,d7 of subsection 7a72 or 7,b7 items and services furnished to an individual if1 as of the date of enactment of this subsection1 medical assistance was available to such individual for such items and services or medicare cost-sharing under the ,state plan or a waiver of such plan4 4 7,b7 ,exclusion of amounts attributable to increased ,,fmap from territorial caps ,section #aajh of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh71 as amended by section #daja1 is amended-- 7i7 in subsection 7f71 in the matter preceding paragraph 7#a71 by striking 7h71 and 7j7 and inserting 7h71 7j71 and 7k72 and 7ii7 by adding at the end the following3 7k7 ,exclusion from caps of amounts attributable to increased ,,fmap for coverage of dental and oral health services ,any additional amount paid to ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 and ,american ,samoa for expenditures for medical assistance that is attributable to an increase in the ,federal medical assistance percentage applicable to such expenditures under section #aije7mm7 shall not be taken into account for purposes of applying payment limits under subsections 7f7 and 7g74 4 7e7 ,oral health services as an essential health benefit ,section #acjb7;b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbb7;b771 as amended by section #bjac7;a71 is further amended-- 7#a7 in paragraph 7#a7-- 7,a7 in subparagraph 7,j71 by striking oral and2 and 7,b7 by adding at the end the following3 7,l7 ,oral health services for children and adults4 2 and 7#b7 by adding at the end the following3 7#f7 ,oral health services ,for purposes of paragraph 7#a77,l71 the term oral health services means services 7as defined by the ,secretary7 that are necessary to prevent any oral disease and promote oral health1 restore oral structures to health and function1 and treat emergency oral conditions4 4 7f7 ,demonstration program on training and employment of alternative dental health care providers for dental health care services for veterans in rural and other underserved communities 7#a7 ,demonstration program authorized ,the ,secretary of ,veterans ,affairs may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to increase access to dental health care services for veterans who are entitled to such services from the ,department of ,veterans ,affairs and reside in rural and other underserved communities4 7#b7 ,telehealth ,for purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care1 dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible4 7#c7 ,alternative dental health care providers defined ,in this subsection1 the term alternative dental health care providers has the meaning given that term in section #cdj;,g-#a7;a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;g-#a7;a77#b774 7#d7 ,authorization of appropriations ,there are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection4 7g7 ,demonstration program on training and employment of alternative dental health care providers for dental health care services for members of the ,armed ,forces and dependents lacking ready access to such services 7#a7 ,demonstration program authorized ,the ,secretary of ,defense may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to increase access to dental health care services for members of the ,armed ,forces and their dependents who lack ready access to such services1 including the following individuals3 7,a7 ,members and dependents who reside in rural areas or areas otherwise underserved by dental health care providers4 7,b7 ,members of a reserve component of the ,armed ,forces in active status who are potentially deployable4 7#b7 ,telehealth ,for purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care1 dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible4 7#c7 ,definitions ,in this subsection3 7,a7 ,active status ,the term active status has the meaning given that term in section #aja7;d7 of title #aj1 ,united ,states ,code4 7,b7 ,alternative dental health care providers ,the term alternative dental health care providers has the meaning given that term in section #cdj;,g-#a7;a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;g-#a7;a77#b774 7#d7 ,authorization of appropriations ,there are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection4 7h7 ,demonstration program on training and employment of alternative dental health care providers for dental health care services for prisoners within the custody of the bureau of prisons 7#a7 ,demonstration program authorized ,the ,attorney ,general1 acting through the ,director of the ,bureau of ,prisons1 may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to increase access to dental health services for prisoners within the custody of the ,bureau of ,prisons4 7#b7 ,telehealth ,for purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care1 dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible4 7#c7 ,alternative dental health care providers defined ,in this subsection1 the term alternative dental health care providers has the meaning given that term in section #cdj;,g-#a7;a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;g-#a7;a77#b774 7#d7 ,authorization of appropriations ,there are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection4 7i7 ,demonstration program on training and employment of alternative dental health care providers for dental health care services under the ,indian ,health ,service 7#a7 ,demonstration program authorized ,the ,secretary of ,health and ,human ,services1 acting through the ,indian ,health ,service1 may carry out a demonstration program to establish programs to train and employ alternative dental health care providers in order to help eliminate oral health disparities and increase access to dental services through health programs operated by the ,indian ,health ,service1 ,indian tribes1 tribal organizations1 and ,urban ,indian organizations4 7#b7 ,telehealth ,for purposes of alternative dental health care providers and other dental care providers who are licensed to provide clinical care1 dental services provided under the demonstration program under this subsection may be administered by such providers through telehealth-enabled collaboration and supervision when appropriate and feasible4 7#c7 ,definitions ,in this subsection3 7,a7 ,alternative dental health care providers defined ,the term alternative dental health care providers has the meaning given that term in section #cdj;,g-#a7;a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;g-#a7;a77#b774 7,b7 ,indian ,health ,care ,improvement ,act ,the terms ,indian tribe1 tribal organization1 and ,urban ,indian organization have the meaning given the terms in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc74 7#d7 ,authorization of appropriations ,there are authorized to be appropriated such sums as are necessary to carry out the demonstration program under this subsection4 #dbeb4 ,oral health literacy and awareness campaign ,the ,public ,health ,service ,act is amended by inserting after section #cdj;,g-#a of such ,act 7#db ,u4,s4,c4 #bef;g-#a7 the following3 #cdj;,g-#b4 ,oral health literacy and awareness 7a7 ,campaign ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall establish a public education campaign 7referred to in this subsection as the campaign7 across all relevant programs of the ,health ,resources and ,services ,administration 7including the health center program1 oral health workforce programs1 maternal and child health programs1 the ,ryan ,white ,,hiv_/,,aids ,program1 and rural health programs7 to increase oral health literacy and awareness4 7b7 ,strategies ,in carrying out the campaign1 the ,secretary shall identify oral health literacy and awareness strategies that are evidence based and focused on oral health care education1 including education on prevention of oral disease such as early childhood and other caries1 periodontal disease1 and oral cancer4 7c7 ,focus ,the ,secretary shall design the campaign to communicate directly with specific populations1 including children1 pregnant women1 parents1 the elderly1 individuals with disabilities1 and ethnic and racial minority populations1 including ,indians1 ,alaska ,natives1 and ,native ,hawaiians1 in a culturally and linguistically appropriate manner4 7d7 ,outcomes ,in carrying out the campaign1 the ,secretary shall include a process for measuring outcomes and effectiveness4 7e7 ,report to ,congress ,not later than #c years after the date of enactment of this section1 the ,secretary shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate a report on the outcomes and effectiveness of the campaign4 7f7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #gej1jjj for each of fiscal years #bjbe through #bjbi4 4 #dbec4 ,ensuring ,kids ,have ,access to ,medically ,necessary ,dental ,care ,act 7a7 ,prohibition of lifetime or annual limits on dental benefits under the ,children's ,health ,insurance ,program 7#a7 ,in general ,section #bajc7;c77#f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7c77#f77 is amended-- 7,a7 in subparagraph 7,a71 by inserting 1 subject to subparagraph 7,d71 after shall include2 7,b7 in subparagraph 7,b71 by striking ,a ,state and inserting ,subject to subparagraph 7,d71 a ,state2 and 7,c7 by adding at the end the following new subparagraph3 7,d7 ,no lifetime or annual limits on dental benefits ,a ,state shall not establish lifetime or annual limits on the dollar value of benefits for dental services provided under the ,state child health plan to a targeted low-income child1 and1 in the case that the ,state elects to provide pregnancy-related assistance pursuant to section #baab1 to a targeted low-income pregnant woman 7as defined in section #baab7;d771 including benefits for such services that are provided through dental coverage that is otherwise equivalent to a benchmark dental package described in subparagraph 7,c74 4 7#b7 ,effective date ,the amendments made by this subsection shall take effect on the date that is #f months after the date of enactment of this ,act4 7b7 ,requiring wraparound coverage of dental services for certain children under ,,chip 7#a7 ,in general ,section #baaj7;b77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;jj7b77#e77 is amended-- 7,a7 in the paragraph header1 by striking ,option and inserting ,requirement2 7,b7 in subparagraph 7,a71 by striking may waive and inserting shall waive2 and 7,c7 in subparagraph 7,c7-- 7i7 in the subparagraph header1 by striking ,conditions and inserting ,requirements2 and 7ii7 by striking may not offer dental-only supplemental coverage under this paragraph unless the ,state satisfies the following conditions and inserting shall offer dental-only supplemental coverage under this paragraph in accordance with the following requirements4 7#b7 ,effective date ,the amendments made by this subsection shall take effect on the date that is #f months after the date of enactment of this ,act4 ,d ,advancing ,health ,equity ,through ,payment and ,delivery ,reform #dcja4 ,centers for ,medicare ,medicaid ,services reporting and value-based programs 7a7 ,advancing ,health ,equity in ,reporting and ,value-,based ,payment ,programs 7#a7 ,in general ,the ,administrator of the ,centers for ,medicare ,medicaid ,services 7in this section referred to as the ,administrator7 shall require that a clinician or other professional participating in any pay-for-reporting or value-based payment program stratify clinical quality measures by disparity variables1 including race1 ethnicity1 sex1 primary language1 disability status1 sexual orientation1 gender identity1 and socioeconomic status4 ,a clinician or other professional may use existing demographic data collection fields in certified electronic health record technology 7as defined in section #ahdh7o77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#d777 to carry out such data stratification under the preceding sentence4 ,such stratified data will assist clinicians and other professionals in the identification of disparities obscured in aggregated data and assist with the provision of interventions that target reducing those disparities4 7#b7 ,clinician ,in assessing performance in any value-based payment program1 the ,administrator shall incorporate a clinician or other professional's performance in reducing disparities across race1 ethnicity1 sex1 primary language1 disability status1 sexual orientation1 gender identity1 and socioeconomic status4 ,linking performance payments to the reduction of health care disparities across such variables will assist in holding clinicians and other professionals accountable for providing quality care that can lead to decreased health inequities4 7#c7 ,requirement of adoption of cert ,all entities1 clinicians1 or other professionals participating in the ,quality ,payment ,program of the ,centers for ,medicare ,medicaid ,services shall be required to adopt #bjae certified electronic health record technology 7as so defined7 as a condition of participating in such program4 7b7 ,quality improvement activities ,the ,administrator1 upon yearly review of the ,quality ,payment ,program1 shall add quality improvement activities that implement the ,culturally and ,linguistically ,accessible ,standards 7,,clas7 as ,improvement ,activities under the ,quality ,payment ,program4 #dcjb4 ,development and testing of disparity reducing delivery and payment models 7a7 ,in general ,the ,center for ,medicare and ,medicaid ,innovation established under section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7 7in this section referred to as the ,,cmi7 shall establish a dedicated fund to identify1 test1 evaluate1 and scale delivery and payment models under the applicable titles 7as defined in subsection 7a77#d77;,b7 of such section7 that target health disparities among racial and ethnic minorities1 including models that support high-value nonmedical services that address socially determined barriers to health in all stages of the life cycle through end-of-life1 including ,english proficiency status1 low health and health care literacy1 lack of access to health care planning1 including end-of-life care planning1 case management1 transportation1 enrollment assistance needs1 stable and affordable housing1 utility assistance1 employment and career development1 and nutrition and food security which will help to reduce disparities and impact the overall cost of care4 7b7 ,amendment to ,social ,security ,act ,the second sentence of section #aaae;,a7a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7a77#a77 is amended by inserting and improve health equity after expenditures4 7c7 ,pilot programs ,the ,,cmi shall prioritize the testing of models under such section #aaae;,a that include partnerships with entities1 including community-based organizations or other nonprofit entities1 to help address socially determined barriers to health and health care4 7d7 ,alternatives ,any model tested by the ,,cmi under such #aaae;,a shall include measures to assess and track the impact of the model on health disparities1 using existing measures such as the ,healthcare ,disparities and ,cultural ,competency ,measures endorsed by the entity with a contract under section #ahij7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7a771 and stratified by race1 ethnicity1 ,english proficiency1 gender identity1 sexual orientation1 and disability status4 #dcjc4 ,diversity in ,centers for ,medicare and ,medicaid consultation 7a7 ,in general ,in carrying out the duties under this subtitle1 the ,,cmi shall consult clinical and analytical experts with expertise in medicine and health care management1 specifically such experts with expertise in-- 7#a7 the health care needs of minority1 rural1 and underserved populations2 and 7#b7 the financial needs of safety net1 community-based1 rural1 and critical access providers1 including federally qualified health centers4 7b7 ,open door forums ,the ,,cmi shall use open door forums or other mechanisms to seek external feedback from interested parties and incorporate that feedback into the development of models4 #dcjd4 ,supporting safety net and community-based providers to compete in value-based payment systems 7a7 ,in general ,any pay-for-performance or alternative payment model that is developed and tested by the ,center for ,medicare and ,medicaid ,innovation established under section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a71 or any other agency of the ,department of ,health and ,human ,services with respect to the programs under titles ,,xviii1 ,,xix1 or ,,xxi of such ,act1 shall be assessed for potential impact on safety net1 community-based1 and critical access providers1 including ,federally qualified health centers4 7b7 ,new models ,the rollout of any such models shall include training and additional up front resources for community-based and safety net providers to enable those providers to participate in the model4 #dcje4 ,improving access to care for ,medicare and ,medicaid beneficiaries ,section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in the last sentence of paragraph 7#a71 by inserting advance health equity and before improve the coordination2 and 7,b7 in the first sentence of paragraph 7#c7-- 7i7 by inserting 7including the ,office of ,minority ,health of the ,centers for ,medicare ,medicaid ,services1 the ,office of ,rural ,health ,policy of the ,health ,resources and ,services ,administration1 and the ,office on ,women's ,health of the ,department of ,health and ,human ,services7 after relevant ,federal agencies2 and 7ii7 by striking experts with expertise in medicine and inserting experts with expertise in medicine1 the causes of health disparities and the social determinants of health1 and2 7#b7 in subsection 7b7-- 7,a7 in paragraph 7#b7-- 7i7 in subparagraph 7,a7-- 7,i7 by inserting the following after the first sentence3 ,prior to selecting a model under this paragraph1 the ,secretary shall consult with the ,office of ,minority ,health of the ,centers for ,medicare ,medicaid ,services1 the ,office of ,rural ,health ,policy of the ,health ,resources and ,services ,administration1 and the ,office on ,women's ,health of the ,department of ,health and ,human ,services to ensure that models under consideration address health disparities and social determinants of health as appropriate for populations to be cared for under the model42 7,,ii7 by inserting and1 for models for which testing begins on or after ,january #a1 #bjbe1 address health equity as well as improving access to care received by individuals receiving benefits under such title after applicable title2 and 7,,iii7 by adding at the end the following3 ,the models selected under this subparagraph shall include the social determinants of health payment model described in subsection 7h71 the testing of which shall begin not later than ,december #ca1 #bjbe42 and 7ii7 in subparagraph 7,c71 by adding at the end the following new clauses3 7ix7 ,whether the model will affect access to care from providers and suppliers caring for high risk patients or operating in underserved areas4 7x7 ,whether the model has the potential to reduce health disparities1 including minority and rural health disparities4 2 7,b7 in paragraph 7#c77;,b7-- 7i7 in clause 7i71 by inserting or health equity after quality of care2 7ii7 in clause 7ii71 by inserting or increasing health inequities after quality of care2 and 7iii7 in clause 7iii71 by inserting or health equity after quality of care2 and 7,c7 in paragraph 7#d77;,a7-- 7i7 in clause 7i71 by striking 2 and and inserting a semicolon2 7ii7 in clause 7ii71 by striking the period and inserting 2 and2 and 7iii7 by adding at the end the following new clause3 7iii7 for models for which testing begins on or after ,january #a1 #bjbe1 the extent to which the model improves health equity4 2 7#c7 in subsection 7c7-- 7,a7 in paragraph 7#a7-- 7i7 in subparagraph 7,a71 by inserting or1 beginning on or after ,january #a1 #bjbe1 increasing health inequities before the semicolon2 and 7ii7 in subparagraph 7,b71 by inserting or1 beginning on or after ,january #a1 #bjbe1 health equity after patient care2 and 7,b7 in paragraph 7#c71 by inserting or increase health disparities experienced by beneficiaries1 including low-income1 minority1 or rural beneficiaries1 or that such expansion would improve health equity before the period2 7#d7 in subsection 7g71 by adding at the end the following3 ,for reports submitted after the date of enactment of the ,health ,equity and ,accountability ,act of #bjbd1 each such report shall include information on the following3 7#a7 ,the interventions that address social determinants of health1 health disparities1 or health equity in payment models selected by the ,,cmi for testing under this section4 7#b7 ,estimated ,federal savings achieved through reducing disparities1 including rural and minority health disparities1 improving health equity1 or addressing social determinants of health4 7#c7 ,the effectiveness of interventions in mitigating negative health outcomes and higher costs associated with social determinants of health within models selected by the ,center for ,medicare and ,medicaid ,innovation for testing4 7#d7 ,other areas determined appropriate by the ,secretary4 2 and 7#e7 by adding at the end the following new subsection3 7h7 ,social determinants of health payment model 7#a7 ,in general ,the social determinants of health payment model described in this subsection is a payment model that tests each of the payment and service delivery innovations described in paragraph 7#b7 in a region determined appropriate by the ,secretary4 7#b7 ,payment and service delivery innovations described ,for purposes of paragraph 7#a71 the payment and service delivery innovations described in this clause are the following3 7,a7 ,payment and service delivery innovations for behavioral health services1 focusing on gathering actionable data to address the higher costs associated with beneficiaries with diagnosed behavioral conditions4 7,b7 ,payment and service delivery innovations targeting conditions or comorbidities of individuals entitled or enrolled under the ,medicare program under title ,,xviii and enrolled under a ,state plan under the ,medicaid program under title ,,xix to increase capacity in underserved areas4 7,c7 ,payment and service delivery innovations targeting conditions or comorbidities of applicable individuals to increase capacity in underserved areas4 7,d7 ,payment and service delivery innovations targeted on ,medicaid eligible pregnant and postpartum women1 up to one year after delivery4 4 ,e ,health ,empowerment ,zones #ddja4 ,designation of health empowerment zones 7a7 ,in general ,the ,secretary may1 at the request of an eligible community partnership described in subsection 7b77#a71 designate an eligible area described in subsection 7b77#b7 as a health empowerment zone for the purpose of eligibility for a grant under section #ddjb4 7b7 ,eligibility criteria 7#a7 ,eligible community partnership ,a community partnership is eligible to submit a request under this section if the partnership-- 7,a7 demonstrates widespread public support from key individuals and entities in the eligible area1 including members of the target community1 ,state and local governments1 nonprofit organizations including national and regional intermediaries with demonstrated capacity to serve low-income urban communities1 and community and industry leaders1 for designation of the eligible area as a health empowerment zone2 and 7,b7 includes representatives of-- 7i7 a broad cross-section of stakeholders and residents from communities in the eligible area experiencing disproportionate disparities in health status and health care2 and 7ii7 organizations1 facilities1 and institutions that have a history of working within and serving such communities4 7#b7 ,eligible area ,an area is eligible to be designated as a health empowerment zone under this section if one or more communities in the area experience disproportionate disparities in health status and health care4 ,in determining whether a community experiences such disparities1 the ,secretary shall consider data collected by the ,department of ,health and ,human ,services focusing on the following areas3 7,a7 ,access to affordable1 high-quality health care services4 7,b7 ,the prevalence of disproportionate rates of certain illnesses or diseases including the following3 7i7 ,arthritis1 osteoporosis1 chronic back conditions1 and other musculoskeletal diseases4 7ii7 ,cancer4 7iii7 ,chronic kidney disease4 7iv7 ,diabetes4 7v7 ,injury 7intentional and unintentional74 7vi7 ,violence 7intimate and nonintimate74 7vii7 ,maternal and paternal illnesses and diseases4 7viii7 ,infant mortality4 7ix7 ,mental illness and other disabilities4 7x7 ,substance use disorder treatment and prevention1 including underage drinking4 7xi7 ,nutrition1 obesity1 and overweight conditions4 7xii7 ,heart disease4 7xiii7 ,hypertension4 7xiv7 ,cerebrovascular disease or stroke4 7xv7 ,tuberculosis4 7xvi7 ,,hiv_/,,aids and other sexually transmitted infections4 7xvii7 ,viral hepatitis4 7xviii7 ,asthma4 7xix7 ,tooth decay and other oral health issues4 7,c7 ,within the community1 the historical and persistent presence of conditions that have been found to contribute to health disparities including any such conditions respecting any of the following3 7i7 ,poverty4 7ii7 ,educational status and the quality of community schools4 7iii7 ,income4 7iv7 ,access to high-quality affordable health care4 7v7 ,work and work environment4 7vi7 ,environmental conditions in the community1 including with respect to clean water1 clean air1 and the presence or absence of pollutants4 7vii7 ,language and ,english proficiency4 7viii7 ,access to affordable healthy food4 7ix7 ,access to ethnically and culturally diverse health and human service providers and practitioners4 7x7 ,access to culturally and linguistically competent health and human services and health and human service providers4 7xi7 ,health-supporting infrastructure4 7xii7 ,health insurance that is adequate and affordable4 7xiii7 ,race1 racism1 and bigotry 7conscious and unconscious74 7xiv7 ,sexual orientation4 7xv7 ,health and health care literacy4 7xvi7 ,place of residence 7such as urban areas1 rural areas1 and reservations of ,indian ,tribes74 7xvii7 ,stress4 7c7 ,procedure 7#a7 ,request ,a request under subsection 7a7 shall-- 7,a7 describe the bounds of the area to be designated as a health empowerment zone and the process used to select those bounds2 7,b7 demonstrate that the partnership submitting the request is an eligible community partnership described in subsection 7b77#a72 7,c7 demonstrate that the area is an eligible area described in subsection 7b77#b72 7,d7 include a comprehensive assessment of disparities in health status and health care experience by one or more communities in the area2 7,e7 set forth-- 7i7 a vision and a set of values for the area2 and 7ii7 a comprehensive and holistic set of goals to be achieved in the area through designation as a health empowerment zone2 and 7,f7 include a strategic plan and an action plan for achieving the goals described in subparagraph 7,e77ii74 7#b7 ,approval ,not later than #fj days after the receipt of a request for designation of an area as a health empowerment zone under this section1 the ,secretary shall approve or disapprove the request4 7d7 ,minimum number ,the ,secretary-- 7#a7 shall designate not more than #aaj health empowerment zones under this section2 and 7#b7 of such zones designated under paragraph 7#a71 shall designate at least one health empowerment zone in each of the several ,states1 the ,district of ,columbia1 and each territory or possession of the ,united ,states4 #ddjb4 ,assistance to those seeking designation ,at the request of any organization or entity seeking to submit a request under section #ddja7;a71 the ,secretary shall provide technical assistance1 and may award a grant1 to assist such organization or entity-- 7#a7 to form an eligible community partnership described in section #ddja7;b77#a72 7#b7 to complete a health assessment1 including an assessment of health disparities under section #ddja7;c77#a77;,d72 or 7#c7 to prepare and submit a request1 including a strategic plan1 in accordance with section #ddja4 #ddjc4 ,benefits of designation 7a7 ,priority ,in awarding a grant under subsection 7b71 a ,federal official shall give priority to any applicant that-- 7#a7 meets the eligibility criteria for the grant2 7#b7 proposes to use the grant for activities in a health empowerment zone2 and 7#c7 demonstrates that such activities will directly and significantly further the goals of the strategic plan approved for such zone under section #ddja4 7b7 ,grants for initial implementation of strategic plan 7#a7 ,in general ,upon designating an eligible area as a health empowerment zone at the request of an eligible community partnership1 the ,secretary shall1 subject to the availability of appropriations1 make a grant to the community partnership for implementation of the strategic plan for such zone4 7#b7 ,grant period ,a grant under paragraph 7#a7 for a health empowerment zone shall be for a period of #b years and may be renewed1 except that the total period of grants under paragraph 7#a7 for such zone may not exceed #aj years4 7#c7 ,limitation ,in awarding grants under this subsection1 the ,secretary shall not give less priority to an applicant or reduce the amount of a grant because the ,secretary rendered technical assistance or made a grant to the same applicant under section #ddja4 7#d7 ,reporting ,the ,secretary shall establish metrics for measuring the progress of grantees under this subsection and1 based on such metrics1 require each such grantee to report to the ,secretary not less than every #f months on the progress in implementing the strategic plan for the health empowerment zone4 #ddjd4 ,definition of ,secretary ,in this subtitle1 the term ,secretary means the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,health ,resources and ,services ,administration and the ,deputy ,assistant ,secretary for ,minority ,health1 and in cooperation with the ,director of the ,office of ,community ,services and the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities4 #ddje4 ,authorization of appropriations ,to carry out this subtitle1 there is authorized to be appropriated #ajj1jjj1jjj for fiscal year #bjbe4 ,f ,equitable ,health ,care for ,all #deja4 ,data collection and reporting 7a7 ,required reporting 7#a7 ,in general ,the ,secretary of ,health and ,human ,services1 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 of ,health and ,human ,services determines would be useful for determining a pattern of provision of inequitable health care4 7#b7 ,proposed regulations ,not later than #ij days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall issue proposed regulations to carry out paragraph 7#a74 7b7 ,repository ,the ,secretary of ,health and ,human ,services 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 7#b7 subject to paragraph 7#c71 make the data in such repository publicly available2 and 7#c7 ensure that such repository does not contain any data that is individually identifiable4 #dejb4 ,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 #deje7;e77#aj7 of the ,health ,equity and ,accountability ,act of #bjbd4 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 provision of inequitable 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 #dejc4 ,provision of inequitable health care as a basis for permissive exclusion from ,medicare and ,state 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 ,provision of inequitable health care 7,a7 ,in general ,subject to subparagraph 7,b71 any health care provider that the ,secretary determines has engaged in a pattern of providing inequitable health care 7as defined in section #deje7;e77#g7 of the ,health ,equity and ,accountability ,act of #bjbd7 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 #dejd4 ,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 #deje4 ,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 provision of inequitable 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 provision of inequitable 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 provision of inequitable 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 provision of inequitable 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 outcomes4 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 the appropriate ,state licensing authorities 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 ,publicly available agreement 7i7 ,in general ,subject to clause 7ii71 the ,secretary shall make available to the public 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 public 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 ,provision of inequitable health care ,the term provision of inequitable 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 #dejf4 ,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 listed 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 appointed under paragraph 7#b77;,b7 of the ,commission 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 #dejg4 ,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 #bjbc4 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 #dejb7;a74 7g7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 ,g ,investing in ,equity #dfja4 ,definitions ,in this subtitle3 7#a7 ,advisory ,council ,the term ,advisory ,council means the ,pay for ,equity ,council convened under section #dfjc4 7#b7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#c7 ,strategy ,the term ,strategy means the ,pay for ,equity ,strategy set forth under section #dfjb4 #dfjb4 ,strategy to incentivize health equity 7a7 ,in general ,the ,secretary1 in consultation with the heads of other appropriate ,federal agencies1 shall develop jointly with the ,advisory ,council and submit to the ,committee on ,finance of the ,senate and the ,committee on ,energy and ,commerce and the ,committee on ,ways and ,means of the ,house of ,representatives1 and make publicly available on the internet website of the ,department of ,health and ,human ,services1 a ,pay for ,equity ,strategy4 7b7 ,contents ,the ,strategy shall establish goals for ,federal programs1 including those authorized under titles ,,xviii and ,,xix of the ,social ,security ,act1 to incentivize health equity1 which may include at least-- 7#a7 incorporating measures of equity into all payment models by #bjbf2 7#b7 tying a percentage of reimbursement in value-based payment models to equity measure performance by #bjbi2 and 7#c7 increasing the number of safety net providers participating in value-based payment by a set percentage by #bjca4 7c7 ,duties of the ,secretary ,the ,secretary1 in carrying out subsection 7a71 shall oversee the following3 7#a7 ,collecting and making publicly available information submitted by the ,advisory ,council4 7#b7 ,coordinating and assessing existing ,federal ,government programs and activities to assess capacity to meet equity goals4 7#c7 ,providing technical assistance1 as appropriate1 such as disseminating identified best practices and information sharing based on reports developed as a result of this subtitle4 7d7 ,initial strategy2 updates ,the ,secretary shall-- 7#a7 not later than #ah months after the date of enactment of this ,act1 develop1 publish1 and submit to the ,committee on ,finance of the ,senate and the ,committee on ,energy and ,commerce and the ,committee on ,ways and ,means of the ,house of ,representatives the strategy outlined in subsection 7a72 and 7#b7 biennially update1 publish1 and submit to ,congress an updated strategy to-- 7,a7 reflect new developments1 challenges1 opportunities1 and solutions2 and 7,b7 review progress and1 based on the results of such review1 recommend priority actions for improving the implementation of such recommendations1 as appropriate4 7e7 ,process for public input ,the ,secretary shall establish a process for public input to inform the development of1 and updates to1 the ,strategy1 including a process for the public to submit recommendations to the ,advisory ,council and an opportunity for public comment on the proposed ,strategy4 #dfjc4 ,pay for ,equity ,advisory ,council 7a7 ,convening ,the ,secretary shall convene a ,pay for ,equity ,advisory ,council to advise and provide recommendations1 including identified best practices1 to the ,secretary on the ,pay for ,equity ,strategy4 7b7 ,membership 7#a7 ,in general ,the members of the ,advisory ,council shall consist of-- 7,a7 the appointed members under paragraph 7#b72 and 7,b7 the ,federal members under paragraph 7#c74 7#b7 ,appointed members ,in addition to the ,federal members under paragraph 7#c71 the ,secretary shall appoint not more than #ae voting members of the ,advisory ,council who are not representatives of ,federal departments or agencies and who shall include at least #a representative of each of the following3 7,a7 ,beneficiaries of ,medicare and ,medicaid4 7,b7 ,safety net health care providers4 7,c7 ,value-based payment experts4 7,d7 ,other members with expertise and lived experience the ,secretary deems appropriate4 7#c7 ,federal members ,the ,federal members of the ,advisory ,council1 who shall be nonvoting members1 shall consist of the following3 7,a7 ,the ,administrator of the ,centers for ,medicare ,medicaid ,services 7or the ,administrator's designee74 7,b7 ,the ,administrator of the ,health ,resources and ,services ,administration4 7#d7 ,diverse representation ,the ,secretary shall ensure that the membership of the ,advisory ,council reflects the diversity of individuals impacted by ,federal health payment programs4 7c7 ,meetings ,the ,advisory ,council shall meet quarterly during the #a-year period beginning on the date of enactment of this ,act and at least #c times during each year thereafter4 ,meetings of the ,advisory ,council shall be open to the public4 ,v ,improving health outcomes for women1 gender-diverse people1 children1 and families ,a ,underserved communities #ejja4 ,grants to promote health for underserved communities ,part ,q of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;h et seq47 is amended by adding at the end the following3 #cii,z-#c4 ,grants to promote health for underserved communities 7a7 ,grants ,authorized ,the ,secretary1 in collaboration with the ,administrator of the ,health ,resources and ,services ,administration and other ,federal officials determined appropriate by the ,secretary1 may award grants to eligible entities-- 7#a7 to promote health for medically underserved communities1 such as racial and ethnic minority women1 racial and ethnic minority children1 adolescents1 and lesbian1 gay1 bisexual1 transgender1 queer1 nonbinary1 gender-nonconforming1 or questioning communities2 and 7#b7 to strengthen health outreach initiatives in medically underserved communities1 including linguistically isolated populations4 7b7 ,use of ,funds ,grants awarded pursuant to subsection 7a7 may be used to support the activities of community health workers1 including such activities-- 7#a7 to provide education and outreach regarding enrollment in health insurance including the ,state ,children's ,health ,insurance ,program under title ,,xxi of the ,social ,security ,act1 ,medicare under title ,,xviii of such ,act1 and ,medicaid under title ,,xix of such ,act2 7#b7 to provide education and outreach in a community setting regarding health problems prevalent among medically underserved communities1 and especially among racial and ethnic minority women1 racial and ethnic minority children1 adolescents1 and lesbian1 gay1 bisexual1 transgender1 queer1 nonbinary1 gender-nonconforming1 or questioning communities2 7#c7 to provide education and experiential learning opportunities and target risk factors and healthy behaviors that impede or contribute to achieving positive health outcomes1 including-- 7,a7 healthy nutrition2 7,b7 physical activity2 7,c7 overweight or obesity2 7,d7 tobacco use1 including the use of e-cigarettes and vaping2 7,e7 alcohol and substance use2 7,f7 injury and violence2 7,g7 sexual health2 7,h7 mental health2 7,i7 musculoskeletal health and arthritis2 7,j7 prenatal and postnatal care2 7,k7 dental and oral health2 7,l7 understanding informed consent2 7,m7 stigma2 and 7,n7 environmental hazards2 7#d7 to promote community wellness and awareness2 and 7#e7 to provide education and refer target populations to appropriate health care agencies and community-based programs and organizations in order to increase access to quality health care services1 including preventive health services4 7c7 ,application 7#a7 ,in general ,each eligible entity that desires to receive a grant under subsection 7a7 shall submit an application to the ,secretary at such time1 in such manner1 and accompanied by such additional information as the ,secretary may require4 7#b7 ,contents ,each application submitted pursuant to paragraph 7#a7 shall-- 7,a7 describe the activities for which assistance under this section is sought2 7,b7 contain an assurance that1 with respect to each community health worker program receiving funds under the grant awarded1 such program provides in-language training and supervision to community health workers to enable such workers to provide authorized program activities in 7at least7 the most commonly used languages within a particular geographic region2 7,c7 contain an assurance that the applicant will evaluate the effectiveness of community health worker programs receiving funds under the grant2 7,d7 contain an assurance that each community health worker program receiving funds under the grant will provide culturally competent services in the linguistic context most appropriate for the individuals served by the program2 7,e7 contain a plan to document and disseminate project descriptions and results to other ,states and organizations as identified by the ,secretary2 and 7,f7 describe plans to enhance the capacity of individuals to utilize health services and health-related social services under ,federal1 ,state1 and local programs by-- 7i7 assisting individuals in establishing eligibility under the programs and in receiving the services or other benefits of the programs2 and 7ii7 providing other services1 as the ,secretary determines to be appropriate1 which may include transportation and translation services4 7d7 ,priority ,in awarding grants under subsection 7a71 the ,secretary shall give priority to those applicants-- 7#a7 who propose to target geographic areas that-- 7,a7 7i7 have a high percentage of residents who are uninsured or underinsured 7if the targeted geographic area is located in a ,state that has elected to make medical assistance available under section #aijb7;a77#aj77;,a77i77,,viii7 of the ,social ,security ,act to individuals described in such section72 7ii7 have a high percentage of underinsured residents in a particular geographic area 7if the targeted geographic area is located in a ,state that has not so elected72 or 7iii7 have a high number of households experiencing extreme poverty2 and 7,b7 have a high percentage of families for whom ,english is not their primary language or including smaller limited ,english-proficient communities within the region that are not otherwise reached by linguistically appropriate health services2 7#b7 with experience in providing health or health-related social services to individuals who are underserved with respect to such services2 and 7#c7 with documented community activity and experience with community health workers4 7e7 ,collaboration with academic institutions ,the ,secretary shall encourage community health worker programs receiving funds under this section to collaborate with academic institutions1 including minority-serving institutions4 ,nothing in this section shall be construed to require such collaboration4 7f7 ,quality assurance and cost-,effectiveness ,the ,secretary shall establish guidelines for ensuring the quality of the training and supervision of community health workers under the programs funded under this section and for ensuring the cost-effectiveness of such programs4 7g7 ,monitoring ,the ,secretary shall monitor community health worker programs identified in approved applications and shall determine whether such programs are in compliance with the guidelines established under subsection 7f74 7h7 ,technical assistance ,the ,secretary may provide technical assistance to community health worker programs identified in approved applications with respect to planning1 developing1 and operating programs under the grant4 7i7 ,report to ,congress 7#a7 ,in general ,not later than #d years after the date on which the ,secretary first awards grants under subsection 7a71 the ,secretary shall submit to ,congress a report regarding the grant project4 7#b7 ,contents ,the report required under paragraph 7#a7 shall include the following3 7,a7 ,a description of the programs for which grant funds were used4 7,b7 ,the number of individuals served4 7,c7 ,an evaluation of-- 7i7 the effectiveness of these programs2 7ii7 the cost of these programs2 and 7iii7 the impact of these programs on the health outcomes of the community residents4 7,d7 ,recommendations for sustaining the community health worker programs developed or assisted under this section4 7,e7 ,recommendations regarding training to enhance career opportunities for community health workers4 7j7 ,definitions ,in this section3 7#a7 ,community health worker ,the term community health worker means an individual who promotes health or nutrition within the community in which the individual resides-- 7,a7 by serving as a liaison between communities and health care agencies2 7,b7 by providing guidance and social assistance to community residents2 7,c7 by enhancing community residents' ability to effectively communicate with health care providers2 7,d7 by providing culturally and linguistically appropriate health or nutrition education2 7,e7 by advocating for individual and community health1 including dental1 oral1 mental1 and environmental health1 or nutrition needs2 7,f7 by taking into consideration the needs of the communities served1 including the prevalence rates of risk factors that impede achieving positive healthy outcomes among pregnant1 birthing1 and postpartum people and children1 especially among racial and ethnic minority pregnant1 birthing1 and postpartum people and children2 or 7,g7 by providing referral and followup services4 7#b7 ,community setting ,the term community setting means a home or a community organization that serves a population4 7#c7 ,eligible entity ,the term eligible entity means-- 7,a7 a unit of ,state1 territorial1 local1 or ,tribal government 7including a federally recognized ,tribe or ,alaska ,native village72 or 7,b7 a community-based organization4 7#d7 ,medically underserved community ,the term medically underserved community means a community-- 7,a7 that has a substantial number of individuals who are members of a medically underserved population1 as defined by section #ccj7;b77#c72 7,b7 a significant portion of which is a health professional shortage area as designated under section #ccb2 and 7,c7 that includes populations that are linguistically isolated1 such as geographic areas with a shortage of health professionals able to provide linguistically appropriate services4 7#e7 ,support ,the term support means the provision of training1 supervision1 and materials needed to effectively deliver the services described in subsection 7b71 reimbursement for services1 and other benefits4 7k7 ,authorization of ,appropriations ,there are authorized to be appropriated to carry out this section #ae1jjj1jjj for each of fiscal years #bjbe through #bjbi4 4 ,b ,pregnancy screening #eaja4 ,pregnancy intention screening initiative demonstration program ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq47 is amended by adding at the end the following3 #cii,v-#h4 ,pregnancy intention screening initiative demonstration program 7a7 ,program establishment ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall establish a demonstration program to facilitate the clinical adoption of pregnancy intention screening initiatives by health care and social services providers4 7b7 ,grants ,the ,secretary may carry out the demonstration program through awarding grants to eligible entities to implement pregnancy intention screening initiatives1 collect data1 and evaluate such initiatives4 7c7 ,eligible entities ,to be eligible for a grant under this section1 an entity shall-- 7#a7 provide non-directive1 comprehensive1 medically accurate information2 and 7#b7 be a community-based organization1 voluntary health organization1 public health department1 community health center1 or other interested public or private primary1 behavioral1 or other health care or social service provider or organization4 7d7 ,pregnancy intention screening initiative ,for purposes of this section1 the term pregnancy intention screening initiative means any initiative by an eligible entity to routinely screen people with respect to their pregnancy intentions and goals to either prevent unintended pregnancies or improve the likelihood of healthy pregnancies1 in order to better provide health care that meets the contraceptive or pre-pregnancy needs and goals of such people4 7e7 ,evaluation 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall1 by grant or contract1 and after consultation as described in paragraph 7#b71 conduct an evaluation of the demonstration program1 with respect to pregnancy intention screening initiatives1 conducted under this section4 ,such evaluation shall include3 7,a7 ,assessment of the implementation of pregnancy intention screening protocols among a diverse group of patients and providers1 including collecting data on the experiences and outcomes for diverse patient populations in a variety of clinical settings4 7,b7 ,analysis of outcome measures that will facilitate effective and widespread adoption of such protocols by health care providers for inquiring about and responding to pregnancy goals of people with both contraceptive and pre-pregnancy care4 7,c7 ,consideration of health inequities among the population served4 7,d7 ,assessment of the equitable and voluntary application of such initiatives to minority and medically underserved communities4 7,e7 ,assessment of the training1 capacity1 and ongoing technical assistance needed for providers to effectively implement such pregnancy intention screening protocols4 7,f7 ,assessment of whether referral systems for selected protocols follow evidence-based standards that ensure access to comprehensive health services and appropriate follow-up care4 7,g7 ,measuring through rigorous methods the effect of such initiatives on key health outcomes4 7#b7 ,consultation with independent1 expert advisory panel ,in conducting the evaluation under paragraph 7#a71 the ,director of the ,centers for ,disease ,control and ,prevention shall consult with physicians1 physician assistants1 advanced practice registered nurses1 nurse midwives1 and other health care providers who specialize in women's health1 and other experts in public health1 clinical practice1 program evaluation1 and research4 7#c7 ,report ,not later than one year after the last day of the demonstration program under this section1 the ,director of the ,centers for ,disease ,control and ,prevention shall-- 7,a7 submit to ,congress a report on the results of the evaluation conducted under paragraph 7#a72 and 7,b7 make the report publicly available4 7f7 ,funding 7#a7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #aj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7#b7 ,limitation ,not more than #bj percent of funds appropriated to carry out this section pursuant to paragraph 7#a7 for a fiscal year may be used for purposes of the evaluation under subsection 7e74 4 #eajb4 ,birth defects prevention1 risk reduction1 and awareness 7a7 ,in general ,the ,secretary shall establish and implement a birth defects prevention and public awareness program1 consisting of the activities described in subsections 7b7 and 7c74 7b7 ,nationwide media campaign ,in carrying out subsection 7a71 the ,secretary shall conduct or support a nationwide media campaign to increase awareness among health care providers and at-risk populations about pregnancy and breastfeeding information services4 7c7 ,grants for pregnancy and breastfeeding information services 7#a7 ,in general ,in carrying out subsection 7a71 the ,secretary shall award grants to ,state or regional agencies or organizations for any of the following3 7,a7 ,information services ,the provision of1 or campaigns to increase awareness about1 pregnancy and breastfeeding information services4 7,b7 ,surveillance and research ,the conduct or support of-- 7i7 surveillance of or research on-- 7,i7 maternal exposures and maternal health conditions that may influence the risk of birth defects1 prematurity1 or other adverse pregnancy outcomes2 and 7,,ii7 maternal exposures that may influence health risks to a breastfed infant2 or 7ii7 networking to facilitate surveillance or research described in this subparagraph4 7#b7 ,preference for certain ,states ,the ,secretary1 in making any grant under this subsection1 shall give preference to ,states1 otherwise equally qualified1 that have pregnancy and breastfeeding information services in place4 7#c7 ,matching funds ,the ,secretary may only award a grant under this subsection to a ,state or regional agency or organization that agrees1 with respect to the costs to be incurred in carrying out the grant activities1 to make available 7directly or through donations from public or private entities7 non-,federal funds toward such costs in an amount equal to not less than #be percent of the amount of the grant4 7#d7 ,coordination ,the ,secretary shall ensure that activities funded through a grant under this subsection are coordinated1 to the maximum extent practicable1 with other birth defects prevention and environmental health activities of the ,federal ,government1 including with respect to pediatric environmental health specialty units and children's environmental health centers4 7d7 ,evaluation ,the ,secretary shall provide for an evaluation of pregnancy and breastfeeding information services carried out by ,states to identify efficient and effective models of-- 7#a7 providing information2 7#b7 raising awareness and increasing knowledge about birth defects prevention measures and targeting education to at-risk groups2 7#c7 modifying risk behaviors2 or 7#d7 other outcome measures as determined appropriate by the ,secretary4 7e7 ,definitions ,in this section3 7#a7 ,maternal ,the term maternal refers to people who are pregnant or breastfeeding4 7#b7 ,pregnancy and breastfeeding information services ,the term pregnancy and breastfeeding information services includes only-- 7,a7 information services to provide accurate1 evidence-based1 clinical information regarding maternal exposures during pregnancy or breastfeeding that may be associated with birth defects1 health risks to a breastfed infant1 or other health risks1 such as exposures to medications1 chemicals1 infections1 foodborne pathogens1 illnesses1 nutrition1 lifestyle1 or climate- and weather-related factors2 7,b7 the provision of accurate1 evidence-based information weighing risks of exposures during breastfeeding against the benefits of breastfeeding2 and 7,c7 the provision of information described in subparagraph 7,a7 or 7,b7 through counselors1 websites1 fact sheets1 telephonic or electronic communication1 community outreach efforts1 or other appropriate means4 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention4 7f7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated-- 7#a7 #e1jjj1jjj for fiscal year #bjbe2 7#b7 #f1jjj1jjj for fiscal year #bjbf2 7#c7 #g1jjj1jjj for fiscal year #bjbg2 7#d7 #h1jjj1jjj for fiscal year #bjbh2 and 7#e7 #i1jjj1jjj for fiscal year #bjbi4 ,c ,pregnancy-related care #ebja4 ,community access1 resources1 and empowerment for moms 7a7 ,short title ,this section may be cited as the ,community ,access1 ,resources1 and ,empowerment for ,moms ,act or the ,,care for ,moms ,act4 7b7 ,improving ,federal efforts with respect to prevention of maternal mortality 7#a7 ,funding for ,state-based perinatal quality collaboratives development and sustainability 7,a7 ,in general ,not later than one year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services1 acting through the ,division of ,reproductive ,health of the ,centers for ,disease ,control and ,prevention 7referred to in this paragraph as the ,secretary71 shall establish a grant program to be known as the ,state-,based ,perinatal ,quality ,collaborative ,grant ,program1 under which the ,secretary shall award grants to eligible entities for the purpose of development and sustainability of ,state-based perinatal quality collaboratives in every ,state1 the ,district of ,columbia1 and eligible territories1 in order to measurably improve perinatal care and perinatal health outcomes for pregnant and postpartum women and their infants4 7,b7 ,grant amounts ,grants awarded under this paragraph shall be in amounts not to exceed #bej1jjj per year1 for the duration of the grant period4 7,c7 ,state-based perinatal quality collaborative defined ,for purposes of this paragraph1 the term ,state-based perinatal quality collaborative means a network of teams that-- 7i7 is multidisciplinary in nature and includes the full range of perinatal and maternity care providers2 7ii7 works to improve measurable outcomes for maternal and infant health by advancing evidence-informed clinical practices using quality improvement principles2 7iii7 works with hospital-based or outpatient facility-based clinical teams1 experts1 and stakeholders1 including patients and families1 to spread best practices and optimize resources to improve perinatal care and outcomes2 7iv7 employs strategies that include the use of the collaborative learning model to provide opportunities for hospitals and clinical teams to collaborate on improvement strategies1 rapid-response data to provide timely feedback to hospital and other clinical teams to track progress1 and quality improvement science to provide support and coaching to hospital and clinical teams2 7v7 has the goal of improving population-level outcomes in maternal and infant health2 and 7vi7 has the goal of improving outcomes of all birthing people1 through the coordination1 integration1 and collaboration across birth settings4 7,d7 ,authorization of appropriations ,for purposes of carrying out this paragraph1 there is authorized to be appropriated #ce1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7#b7 ,expansion of ,medicaid and ,,chip coverage for pregnant and postpartum women 7,a7 ,requiring coverage of oral health services for pregnant and postpartum women 7i7 ,medicaid ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 as amended by section #dbea7;d77#c77;,a71 is amended-- 7,i7 in subsection 7a77#d7-- 7aa7 by striking 2 and 7,d7 and inserting 2 7,d72 7bb7 by striking 2 and 7,e7 and inserting 2 7,e72 7cc7 by striking 2 and 7,f7 and inserting 2 7,f72 and 7dd7 by striking the semicolon at the end and inserting 2 and 7,g7 oral health services for pregnant and postpartum women 7as defined in subsection 7nn7722 and 7,,ii7 by adding at the end the following new subsection3 7nn7 ,oral health services for pregnant and postpartum women 7#a7 ,in general ,for purposes of this title1 the term oral health services for pregnant and postpartum women means dental services necessary to prevent disease and promote oral health1 restore oral structures to health and function1 and treat emergency conditions that are furnished to a woman during pregnancy 7or during the #a-year period beginning on the last day of the pregnancy74 7#b7 ,coverage requirements ,to satisfy the requirement to provide oral health services for pregnant and postpartum women1 a ,state shall1 at a minimum1 provide coverage for preventive1 diagnostic1 periodontal1 and restorative care consistent with recommendations for perinatal oral health care and dental care during pregnancy from the ,american ,academy of ,pediatric ,dentistry and the ,american ,college of ,obstetricians and ,gynecologists4 4 7ii7 ,,chip ,section #bajc7;c77#f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7c77#f77 is amended-- 7,i7 in subparagraph 7,a7-- 7aa7 by inserting or a targeted low-income pregnant woman after targeted low-income child2 and 7bb7 by inserting 1 and1 in the case of a targeted low-income child who is pregnant or a targeted low-income pregnant woman1 satisfy the coverage requirements specified in section #aije7nn7 after emergency conditions2 and 7,,ii7 in subparagraph 7,b71 by inserting 7but only if1 in the case of a targeted low-income child who is pregnant or a targeted low-income pregnant woman1 the benchmark dental benefit package satisfies the coverage requirements specified in section #aije7nn77 after subparagraph 7,c74 7,b7 ,requiring #ab-month continuous coverage of full benefits for pregnant and postpartum individuals under ,medicaid and ,,chip 7i7 ,medicaid ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended-- 7,i7 in subsection 7a7-- 7aa7 in paragraph 7#hf71 by striking and at the end2 7bb7 in paragraph 7#hg71 by striking the period at the end and inserting 2 and2 and 7cc7 by inserting after paragraph 7#hg7 the following new paragraph3 7#hh7 provide that the ,state plan is in compliance with subsection 7e77#af74 2 and 7,,ii7 in subsection 7e77#af7-- 7aa7 in subparagraph 7,a71 by striking ,at the option of the ,state1 the ,state plan 7or waiver of such ,state plan7 may provide and inserting ,a ,state plan 7or waiver of such ,state plan7 shall provide2 7bb7 in subparagraph 7,b71 in the matter preceding clause 7i71 by striking by a ,state making an election under this paragraph and inserting under a ,state plan 7or a waiver of such ,state plan72 and 7cc7 by striking subparagraph 7,c74 7ii7 ,,chip 7,i7 ,in general ,section #bajg7;e77#a77;,j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77;,j771 as inserted by section #ihbb of the ,american ,rescue ,plan ,act of #bjba 7,public ,law #aag-b71 is amended to read as follows3 7,j7 ,paragraphs 7#e7 and 7#af7 of section #aijb7;e7 7relating to the requirement to provide medical assistance under the ,state plan or waiver consisting of full benefits during pregnancy and throughout the #ab-month postpartum period under title ,,xix74 4 7,,ii7 ,conforming ,section #baab7;d77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acigll7d77#b77;,a77 is amended by striking the month in which the #fj-;day period and all that follows through pursuant to section #bajg7;e77#a714 7,c7 ,maintenance of effort 7i7 ,medicaid ,section #aijb7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7l77 is amended by adding at the end the following new paragraph3 7#e7 ,during the period that begins on the date of enactment of this paragraph and ends on the date that is #e years after such date of enactment1 as a condition for receiving any ,federal payments under section #aijc7;a7 for calendar quarters occurring during such period1 a ,state shall not have in effect1 with respect to women who are eligible for medical assistance under the ,state plan or under a waiver of such plan on the basis of being pregnant or having been pregnant1 eligibility standards1 methodologies1 or procedures under the ,state plan or waiver that are more restrictive than the eligibility standards1 methodologies1 or procedures1 respectively1 under such plan or waiver that are in effect on the date of enactment of this paragraph4 4 7ii7 ,,chip ,section #baje7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7d77 is amended by adding at the end the following new paragraph3 7#d7 ,in eligibility standards for targeted low-income pregnant women ,during the period that begins on the date of enactment of this paragraph and ends on the date that is #e years after such date of enactment1 as a condition of receiving payments under subsection 7a7 and section #aijc7;a71 a ,state that elects to provide assistance to women on the basis of being pregnant 7including pregnancy-related assistance provided to targeted low-income pregnant women 7as defined in section #baab7;d771 pregnancy-related assistance provided to women who are eligible for such assistance through application of section #aijb7v77#d77;,a77i7 under section #bajg7;e77#a71 or any other assistance under the ,state child health plan 7or a waiver of such plan7 which is provided to women on the basis of being pregnant7 shall not have in effect1 with respect to such women1 eligibility standards1 methodologies1 or procedures under such plan 7or waiver7 that are more restrictive than the eligibility standards1 methodologies1 or procedures1 respectively1 under such plan 7or waiver7 that are in effect on the date of enactment of this paragraph4 4 7,d7 ,information on benefits ,the ,secretary of ,health and ,human ,services shall make publicly available on the internet website of the ,department of ,health and ,human ,services1 information regarding benefits available to pregnant and postpartum women and under the ,medicaid program and the ,children's ,health ,insurance ,program1 including information on-- 7i7 benefits that ,states are required to provide to pregnant and postpartum women under such programs2 7ii7 optional benefits that ,states may provide to pregnant and postpartum women under such programs2 and 7iii7 the availability of different kinds of benefits for pregnant and postpartum women1 including oral health and mental health benefits and breastfeeding services and supplies1 under such programs4 7,e7 ,federal funding for cost of extended ,medicaid and ,,chip coverage for postpartum women 7i7 ,medicaid ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 as amended by title ,,iv and subparagraph 7,a77i77,,ii71 is further amended-- 7,i7 in subsection 7b71 by striking and 7mm7 and inserting 7mm71 and 7oo72 and 7,,ii7 by adding at the end the following3 7oo7 ,increased ,,fmap for extended medical assistance for postpartum individuals 7#a7 ,in general ,notwithstanding subsection 7b71 the ,federal medical assistance percentage for a ,state1 with respect to amounts expended by such ,state for medical assistance for an individual who is eligible for such assistance on the basis of being pregnant or having been pregnant that is provided during the #cje-;day period that begins on the #fjth day after the last day of the individual's pregnancy 7including any such assistance provided during the month in which such period ends71 shall be equal to-- 7,a7 during the first #bj-quarter period for which this subsection is in effect with respect to a ,state1 #ajj percent2 and 7,b7 with respect to a ,state1 during each quarter thereafter1 #ij percent4 7#b7 ,exclusion from territorial caps ,any payment made to a territory for expenditures for medical assistance for an individual described in paragraph 7#a7 that is subject to the ,federal medical assistance percentage specified under paragraph 7#a7 shall not be taken into account for purposes of applying payment limits under subsections 7f7 and 7g7 of section #aajh4 4 7ii7 ,,chip ,section #baje7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7c77 is amended by adding at the end the following new paragraph3 7#ac7 ,enhanced payment for extended assistance provided to pregnant women ,notwithstanding subsection 7b71 the enhanced ,,fmap1 with respect to payments under subsection 7a7 for expenditures under the ,state child health plan 7or a waiver of such plan7 for assistance provided under the plan 7or waiver7 to a woman who is eligible for such assistance on the basis of being pregnant 7including pregnancy-related assistance provided to a targeted low-income pregnant woman 7as defined in section #baab7;d771 pregnancy-related assistance provided to a woman who is eligible for such assistance through application of section #aijb7v77#d77;,a77i7 under section #bajg7;e77#a71 or any other assistance under the plan 7or waiver7 provided to a woman who is eligible for such assistance on the basis of being pregnant7 during the #cje-;day period that begins on the #fjth day after the last day of her pregnancy 7including any such assistance provided during the month in which such period ends71 shall be equal to-- 7,a7 during the first #bj-quarter period for which this subsection is in effect with respect to a ,state1 #ajj percent2 and 7,b7 with respect to a ,state1 during each quarter thereafter1 #ij percent4 4 7,f7 ,guidance on ,state options for ,medicaid coverage of doula services ,not later than #a year after the date of the enactment of this section1 the ,secretary of ,health and ,human ,services shall issue guidance for the ,states concerning options for ,medicaid coverage and payment for support services provided by doulas4 7,g7 ,enhanced ,,fmap for rural obstetric and gynecological services ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 as amended by title ,,iv and subparagraphs 7,a7 and 7,e71 is further amended-- 7i7 in subsection 7b71 by striking and 7oo7 and inserting 7oo71 and 7pp72 and 7ii7 by adding at the end the following new subsection3 7pp7 ,increased ,,fmap for medical assistance for obstetric and gynecological services furnished at rural hospitals 7#a7 ,in general ,notwithstanding subsection 7b71 the ,federal medical assistance percentage for a ,state1 with respect to amounts expended by such ,state for medical assistance for obstetric or gynecological services that are furnished in a hospital that is located in a rural area 7as defined for purposes of section #ahhf7 shall be equal to #ij percent for each calendar quarter beginning with the first calendar quarter during which this subsection is in effect4 7#b7 ,exclusion from territorial caps ,any payment made to a territory for expenditures for medical assistance described in paragraph 7#a7 that is subject to the ,federal medical assistance percentage specified under paragraph 7#a7 shall not be taken into account for purposes of applying payment limits under subsections 7f7 and 7g7 of section #aajh4 4 7,h7 ,effective dates 7i7 ,in general ,subject to clauses 7ii7 and 7iii7-- 7,i7 the amendments made by subparagraphs 7,a71 7,b71 and 7,e7 shall take effect on the first day of the first calendar quarter that begins on or after the date that is #a year after the date of enactment of this section2 7,,ii7 the amendments made by subparagraph 7,c7 shall take effect on the date of enactment of this section2 and 7,,iii7 the amendments made by subparagraph 7,g7 shall take effect on the first day of the first calendar quarter that begins on or after the date of enactment of this section4 7ii7 ,exception for ,state legislation ,in the case of a ,state plan under title ,,xix of the ,social ,security ,act or a ,state child health plan under title ,,xxi of such ,act that the ,secretary of ,health and ,human ,services determines requires ,state legislation in order for the respective plan to meet any requirement imposed by amendments made by this paragraph1 the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of enactment of this section4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session shall be considered to be a separate regular session of the ,state legislature4 7iii7 ,state option for earlier effective date ,a ,state may elect to have subsection 7e77#af7 of section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 and subparagraph 7,j7 of section #bajg7;e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a771 as amended by subparagraph 7,b71 and subsection 7oo7 of section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 and paragraph 7#ac7 of section #baje7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7c771 as added by subparagraph 7,e71 take effect with respect to the ,state on the first day of any fiscal quarter that begins before the date described in clause 7i7 and apply to amounts payable to the ,state for expenditures for medical assistance1 child health assistance1 or pregnancy-related assistance to pregnant or postpartum individuals furnished on or after such day4 7#c7 ,regional centers of excellence ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq47 7as amended by section #eaja7 is amended by adding at the end the following3 #cii,v-#i4 ,regional centers of excellence addressing implicit bias and cultural competency in patient-provider interactions education 7a7 ,in general ,not later than one year after the date of enactment of this section1 the ,secretary1 in consultation with such other agency heads as the ,secretary determines appropriate1 shall award cooperative agreements for the establishment or support of regional centers of excellence addressing implicit bias1 cultural competency1 and respectful care practices in patient-provider interactions education for the purpose of enhancing and improving how health care professionals are educated in implicit bias and delivering culturally competent health care4 7b7 ,eligibility ,to be eligible to receive a cooperative agreement under subsection 7a71 an entity shall-- 7#a7 be a public or other nonprofit entity specified by the ,secretary that provides educational and training opportunities for students and health care professionals1 which may be a health system1 teaching hospital1 community health center1 medical school1 school of public health1 school of nursing1 dental school1 social work school1 school of professional psychology1 or any other health professional school or program at an institution of higher education 7as defined in section #aja of the ,higher ,education ,act of #aife7 focused on the prevention1 treatment1 or recovery of health conditions that contribute to maternal mortality and the prevention of maternal mortality and severe maternal morbidity2 7#b7 demonstrate community engagement and participation1 such as through partnerships with home visiting and case management programs and community-based organizations serving minority populations2 7#c7 demonstrate engagement with groups engaged in the implementation of health care professional training in implicit bias and delivering culturally competent care1 such as departments of public health1 perinatal quality collaboratives1 hospital systems1 and health care professional groups1 in order to obtain input on resources needed for effective implementation strategies2 and 7#d7 provide to the ,secretary such information1 at such time and in such manner1 as the ,secretary may require4 7c7 ,diversity ,in awarding a cooperative agreement under subsection 7a71 the ,secretary shall take into account any regional differences among eligible entities and make an effort to ensure geographic diversity among award recipients4 7d7 ,dissemination of information 7#a7 ,public availability ,the ,secretary shall make publicly available on the internet website of the ,department of ,health and ,human ,services information submitted to the ,secretary under subsection 7b77#d74 7#b7 ,evaluation ,the ,secretary shall evaluate each regional center of excellence established or supported pursuant to subsection 7a7 and disseminate the findings resulting from each such evaluation to the appropriate public and private entities4 7#c7 ,distribution ,the ,secretary shall share evaluations and overall findings with ,state departments of health and other relevant ,state level offices to inform ,state and local best practices4 7e7 ,maternal mortality defined ,in this section1 the term maternal mortality means death of a woman that occurs during pregnancy or within the one-year period following the end of such pregnancy4 7f7 ,authorization of appropriations ,for purposes of carrying out this section1 there is authorized to be appropriated #e1jjj1jjj for each of fiscal years #bjbe through #bjbi4 4 7#d7 ,special supplemental nutrition program for women1 infants1 and children ,section #ag7;d77#c77;,a77ii7 of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aghf7;d77#c77;,a77ii77 is amended-- 7,a7 by striking the clause designation and heading and all that follows through ,a ,state and inserting the following3 7ii7 ,women 7,i7 ,breastfeeding women ,a ,state 2 7,b7 in subclause 7,i7 7as so designated71 by striking #a year and all that follows through earlier and inserting #b years postpartum2 and 7,c7 by adding at the end the following3 7,,ii7 ,postpartum women ,a ,state may elect to certify a postpartum woman for a period of #b years4 4 7c7 ,full spectrum doula workforce 7#a7 ,in general ,the ,secretary of ,health and ,human ,services shall establish and implement a program to award grants or contracts to health professions schools1 schools of public health1 academic health centers1 ,state or local governments1 territories1 ,indian ,tribes and ,tribal organizations1 ,urban ,indian organizations1 ,native ,hawaiian organizations1 or other appropriate public or private nonprofit entities or community-based organizations 7or consortia of any such entities1 including entities promoting multidisciplinary approaches71 to establish or expand programs to grow and diversify the doula workforce1 including through improving the capacity and supply of health care providers4 7#b7 ,use of funds ,amounts made available by paragraph 7#a7 shall be used for the following activities3 7,a7 ,establishing programs that provide education and training to individuals seeking appropriate training or certification as full spectrum doulas4 7,b7 ,expanding the capacity of existing programs described in subparagraph 7,a71 for the purpose of increasing the number of students enrolled in such programs1 including by awarding scholarships for students who agree to work in underserved communities after receiving such education and training4 7,c7 ,developing and implementing strategies to recruit and retain students from underserved communities1 particularly from demographic groups experiencing high rates of maternal mortality and severe maternal morbidity1 including racial and ethnic minority groups1 into programs described in subparagraphs 7,a7 and 7,b74 7#c7 ,funding ,in addition to amounts otherwise available1 there is appropriated to the ,secretary of ,health and ,human ,services for fiscal year #bjbe1 out of any money in the ,treasury not otherwise appropriated1 #ej1jjj1jjj1 to remain available until expended1 for carrying out this subsection4 7d7 ,grants for rural obstetric mobile health units ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq47 is amended by adding at the end the following3 #cbj;,c4 ,grants for rural obstetric mobile health units 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration 7referred to in this section as the ,secretary71 shall establish a pilot program under which the ,secretary shall make grants to ,states-- 7#a7 to purchase and equip rural mobile health units for the purpose of providing pre-conception1 pregnancy1 postpartum1 and obstetric emergency services in rural and underserved communities2 7#b7 to train providers including obstetrician-gynecologists1 certified nurse-midwives1 nurse practitioners1 nurses1 and midwives to operate and provide obstetric services1 including training and planning for obstetric emergencies1 in such mobile health units2 and 7#c7 to address access issues1 including social determinants of health and wrap-around clinical and community services including nutrition1 housing1 lactation services1 and transportation support and referrals4 7b7 ,no sharing of data with law enforcement ,as a condition of receiving a grant under this section1 a ,state shall submit to the ,secretary an assurance that the ,state will not make available to ,federal or ,state law enforcement any personally identifiable information regarding any pregnant or postpartum individual collected pursuant to such grant4 7c7 ,grant duration ,the period of a grant under this section shall not exceed #e years4 7d7 ,implementing and reporting 7#a7 ,in general ,states that receive pilot grants under this section shall-- 7,a7 implement the program funded by the pilot grants2 and 7,b7 not later than #c years after the date of enactment of this section1 and not later than #f years after such date of enactment1 submit to the ,secretary a report that describes the results of such program1 including-- 7i7 relevant information and relevant quantitative indicators of the programs' success in improving the standard of care and maternal health outcomes for individuals in rural and underserved communities seen for pre-conception1 pregnancy1 or postpartum visits in the rural mobile health units1 stratified by the categories of data specified in paragraph 7#b72 7ii7 relevant qualitative evaluations from individuals receiving pre-conception1 pregnant1 or postpartum care from rural mobile health units1 including measures of patient-reported experience of care and measures of patient-reported issues with access to care without the rural mobile health unit pilot2 and 7iii7 strategies to sustain such programs beyond the duration of the grant and expand such programs to other rural and underserved communities4 7#b7 ,categories of data ,the categories of data specified in this paragraph are the following3 7,a7 ,race1 ethnicity1 sex1 gender1 gender identity1 primary language1 age1 geography1 insurance status1 disability status4 7,b7 ,number of visits provided for preconception1 prenatal1 or postpartum care4 7,c7 ,number of repeat visits provided for preconception1 prenatal1 or postpartum care4 7,d7 ,number of screenings or tests provided for smoking1 substance use1 hypertension1 sexually-transmitted diseases1 diabetes1 ,,hiv1 depression1 intimate partner violence1 pap smears1 and pregnancy4 7#c7 ,data privacy protection ,the reports referred to in paragraph 7#a77;,b7 shall not contain any personally identifiable information regarding any pregnant or postpartum individual4 7e7 ,evaluation ,the ,secretary shall conduct an evaluation of the pilot program under this section to determine the impact of the pilot program with respect to-- 7#a7 the effectiveness of the grants awarded under this section to improve maternal health outcomes in rural and underserved communities1 with data stratified by race1 ethnicity1 primary language1 socioeconomic status1 geography1 insurance type1 and other factors as the ,secretary determines appropriate2 7#b7 spending on maternity care by ,states participating in the pilot program2 7#c7 to the extent practicable1 qualitative and quantitative measures of patient experience2 and 7#d7 any other areas of assessment that the ,secretary determines relevant4 7f7 ,report ,not later than one year after the completion of the pilot program under this section1 the ,secretary shall submit to ,congress1 and make publicly available1 a report that describes-- 7#a7 the results of the evaluation conducted under subsection 7e72 and 7#b7 a recommendation regarding whether the pilot program should be continued after fiscal year #bjbi and expanded on a national basis4 7g7 ,authorization of appropriations ,there is authorized to be appropriated to the ,secretary to carry out this section #aj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 4 7e7 ,requiring notification of impending hospital obstetric unit closure ,section #ahff7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77 is amended-- 7#a7 in subparagraph 7,x71 by striking and at the end2 7#b7 in subparagraph 7,y77ii77,v71 by striking the period and inserting 1 and2 and 7#c7 by inserting after subparagraph 7,y7 the following new subparagraph3 7,z7 beginning #ahj days after the date of the enactment of this subparagraph1 in the case of a hospital1 not less than #ij days prior to the closure of any obstetric unit of the hospital1 to submit to the ,secretary a notification which shall include-- 7i7 a report analyzing the impact the closure will have on the community2 7ii7 steps the hospital will take to identify other health care providers that can alleviate any service gaps as a result of the closure2 and 7iii7 any additional information as may be required by the ,secretary4 4 7f7 ,evaluation and report on maternal health needs 7#a7 ,in general ,not later than #b years after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall conduct1 and submit to ,congress a report that describes the results of1 an evaluation of-- 7,a7 where the maternal health needs are greatest in the ,united ,states2 and 7,b7 the ,federal expenditures made to address such needs4 7#b7 ,period covered ,the evaluation under paragraph 7#a7 shall cover the period of calendar years #bjjj through #bjbc4 7#c7 ,analysis ,the evaluation under paragraph 7#a7 shall include analysis of the following3 7,a7 ,how ,federal funds provided to ,states for maternal health were distributed across regions1 ,states1 and localities or counties4 7,b7 ,barriers to applying for and receiving ,federal funds for maternal health1 including1 with respect to initial applications-- 7i7 requirements for submission in partnership with other entities2 and 7ii7 stringent network requirements4 7,c7 ,why applicants did not receive funding1 including limited availability of funds1 the strength of the respective applications1 and failure to adhere to requirements4 7#d7 ,disaggregation of data ,the report under paragraph 7#a7 shall disaggregate data on mothers served by race1 ethnicity1 insurance status1 and language spoken4 7g7 ,increasing excise taxes on cigarettes and establishing excise tax equity among all tobacco product tax rates 7#a7 ,tax parity for ,roll-,your-,own tobacco ,section #egja7;g7 of the ,internal ,revenue ,code of #aihf is amended by striking #bd4gh and inserting #di4ef4 7#b7 ,tax parity for pipe tobacco ,section #egja7;f7 of the ,internal ,revenue ,code of #aihf is amended by striking #b4hcaa cents and inserting #di4ef4 7#c7 ,tax parity for smokeless tobacco 7,a7 ,section #egja7;e7 of the ,internal ,revenue ,code of #aihf is amended-- 7i7 in paragraph 7#a71 by striking #a4ea and inserting #bf4hd2 7ii7 in paragraph 7#b71 by striking #ej4cc cents and inserting #aj4gd2 and 7iii7 by adding at the end the following3 7#c7 ,smokeless tobacco sold in discrete single-use units ,on discrete single-use units1 #ajj4ff per thousand4 4 7,b7 ,section #egjb7m7 of such ,code is amended-- 7i7 in paragraph 7#a71 by striking or chewing tobacco and inserting 1 chewing tobacco1 or discrete single-use unit2 7ii7 in paragraphs 7#b7 and 7#c71 by inserting that is not a discrete single-use unit before the period in each such paragraph2 and 7iii7 by adding at the end the following3 7#d7 ,discrete single-use unit ,the term discrete single-use unit means any product containing1 made from1 or derived from tobacco or nicotine that-- 7,a7 is not intended to be smoked2 and 7,b7 is in the form of a lozenge1 tablet1 pill1 pouch1 dissolvable strip1 or other discrete single-use or single-dose unit4 4 7#d7 ,tax parity for small cigars ,paragraph 7#a7 of section #egja7;a7 of the ,internal ,revenue ,code of #aihf is amended by striking #ej4cc and inserting #ajj4ff4 7#e7 ,tax parity for large cigars 7,a7 ,in general ,paragraph 7#b7 of section #egja7;a7 of the ,internal ,revenue ,code of #aihf is amended by striking #eb4ge percent and all that follows through the period and inserting the following3 #di4ef per pound and a proportionate tax at the like rate on all fractional parts of a pound but not less than #aj4jff cents per cigar44 7,b7 ,guidance ,the ,secretary of the ,treasury1 or the ,secretary's delegate1 may issue guidance regarding the appropriate method for determining the weight of large cigars for purposes of calculating the applicable tax under section #egja7;a77#b7 of the ,internal ,revenue ,code of #aihf4 7,c7 ,conforming amendment ,section #egjb of such ,code is amended by striking subsection 7l74 7#f7 ,tax parity for ,roll-,your-,own tobacco and certain processed tobacco ,subsection 7o7 of section #egjb of the ,internal ,revenue ,code of #aihf is amended by inserting 1 and includes processed tobacco that is removed for delivery or delivered to a person other than a person with a permit provided under section #egac1 but does not include removals of processed tobacco for exportation after wrappers thereof4 7#g7 ,clarifying tax rate for other tobacco products 7,a7 ,in general ,section #egja of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new subsection3 7i7 ,other tobacco products ,any product not otherwise described under this section that has been determined to be a tobacco product by the ,food and ,drug ,administration through its authorities under the ,family ,smoking ,prevention and ,tobacco ,control ,act shall be taxed at a level of tax equivalent to the tax rate for cigarettes on an estimated per use basis as determined by the ,secretary4 4 7,b7 ,establishing per use basis ,for purposes of section #egja7;i7 of the ,internal ,revenue ,code of #aihf1 not later than #ab months after the later of the date of the enactment of this ,act or the date that a product has been determined to be a tobacco product by the ,food and ,drug ,administration1 the ,secretary of the ,treasury 7or the ,secretary of the ,treasury's delegate7 shall issue final regulations establishing the level of tax for such product that is equivalent to the tax rate for cigarettes on an estimated per use basis4 7#h7 ,clarifying definition of tobacco products 7,a7 ,in general ,subsection 7c7 of section #egjb of the ,internal ,revenue ,code of #aihf is amended to read as follows3 7c7 ,tobacco products ,the term tobacco products means-- 7#a7 cigars1 cigarettes1 smokeless tobacco1 pipe tobacco1 and roll-your-own tobacco1 and 7#b7 any other product subject to tax pursuant to section #egja7;i74 4 7,b7 ,conforming amendments ,subsection 7d7 of section #egjb of such ,code is amended by striking cigars1 cigarettes1 smokeless tobacco1 pipe tobacco1 or roll-your-own tobacco each place it appears and inserting tobacco products4 7#i7 ,increasing tax on cigarettes 7,a7 ,small cigarettes ,section #egja7;b77#a7 of such ,code is amended by striking #ej4cc and inserting #ajj4ff4 7,b7 ,large cigarettes ,section #egja7;b77#b7 of such ,code is amended by striking #aje4fi and inserting #baa4ch4 7#aj7 ,tax rates adjusted for inflation ,section #egja of such ,code1 as amended by paragraph 7#g71 is amended by adding at the end the following new subsection3 7j7 ,inflation adjustment 7#a7 ,in general ,in the case of any calendar year beginning after #bjbd1 the dollar amounts provided under this chapter shall each be increased by an amount equal to-- 7,a7 such dollar amount1 multiplied by 7,b7 the cost-of-living adjustment determined under section #a7;f77#c7 for the calendar year1 determined by substituting #8calendar year #bjbc' for #8calendar year #bjaf' in subparagraph 7,a77ii7 thereof4 7#b7 ,rounding ,if any amount as adjusted under paragraph 7#a7 is not a multiple of #j4ja1 such amount shall be rounded to the next highest multiple of #j4ja4 4 7#aa7 ,floor ,stocks ,taxes 7,a7 ,imposition of tax ,on tobacco products manufactured in or imported into the ,united ,states which are removed before any tax increase date and held on such date for sale by any person1 there is hereby imposed a tax in an amount equal to the excess of-- 7i7 the tax which would be imposed under section #egja of the ,internal ,revenue ,code of #aihf on the article if the article had been removed on such date1 over 7ii7 the prior tax 7if any7 imposed under section #egja of such ,code on such article4 7,b7 ,credit against tax ,each person shall be allowed as a credit against the taxes imposed by subparagraph 7,a7 an amount equal to the lesser of #a1jjj or the amount of such taxes4 ,for purposes of the preceding sentence1 all persons treated as a single employer under subsection 7b71 7c71 7m71 or 7o7 of section #dad of the ,internal ,revenue ,code of #aihf shall be treated as #a person for purposes of this subparagraph4 7,c7 ,liability for tax and method of payment 7i7 ,liability for tax ,a person holding tobacco products on any tax increase date to which any tax imposed by subparagraph 7,a7 applies shall be liable for such tax4 7ii7 ,method of payment ,the tax imposed by subparagraph 7,a7 shall be paid in such manner as the ,secretary shall prescribe by regulations4 7iii7 ,time for payment ,the tax imposed by subparagraph 7,a7 shall be paid on or before the date that is #abj days after the effective date of the tax rate increase4 7,d7 ,articles in foreign trade zones ,notwithstanding the ,act of ,june #ah1 #aicd 7commonly known as the ,foreign ,trade ,zone ,act1 #dh ,stat4 #iih1 #ai ,u4,s4,c4 #ha;a et seq471 or any other provision of law1 any article which is located in a foreign trade zone on any tax increase date shall be subject to the tax imposed by subparagraph 7,a7 if-- 7i7 internal revenue taxes have been determined1 or customs duties liquidated1 with respect to such article before such date pursuant to a request made under the first proviso of section #c7;a7 of such ,act1 or 7ii7 such article is held on such date under the supervision of an officer of the ,united ,states ,customs and ,border ,protection of the ,department of ,homeland ,security pursuant to the second proviso of such section #c7;a74 7,e7 ,definitions ,for purposes of this paragraph-- 7i7 ,in general ,any term used in this paragraph which is also used in section #egjb of such ,code shall have the same meaning as such term has in such section4 7ii7 ,tax increase date ,the term tax increase date means the effective date of any increase in any tobacco product excise tax rate pursuant to the amendments made by this subsection 7other than paragraph 7#aj7 thereof74 7iii7 ,secretary ,the term ,secretary means the ,secretary of the ,treasury or the ,secretary's delegate4 7,f7 ,controlled groups ,rules similar to the rules of section #ejfa7;e77#c7 of such ,code shall apply for purposes of this paragraph4 7,g7 ,other laws applicable ,all provisions of law1 including penalties1 applicable with respect to the taxes imposed by section #egja of such ,code shall1 insofar as applicable and not inconsistent with the provisions of this paragraph1 apply to the floor stocks taxes imposed by subparagraph 7,a71 to the same extent as if such taxes were imposed by such section #egja4 ,the ,secretary may treat any person who bore the ultimate burden of the tax imposed by subparagraph 7,a7 as the person to whom a credit or refund under such provisions may be allowed or made4 7#ab7 ,effective dates 7,a7 ,in general ,except as provided in subparagraphs 7,b7 and 7,c71 the amendments made by this subsection shall apply to articles removed 7as defined in section #egjb7;j7 of the ,internal ,revenue ,code of #aihf7 after the last day of the month which includes the date of the enactment of this ,act4 7,b7 ,discrete single-use units1 large cigars1 and processed tobacco ,the amendments made by paragraphs 7#c77;,a77iii71 7#c77;,b71 7#e71 and 7#f7 shall apply to articles removed 7as defined in section #egjb7;j7 of the ,internal ,revenue ,code of #aihf7 after the date that is #f months after the date of the enactment of this ,act4 7,c7 ,other tobacco products ,the amendments made by paragraph 7#g77;,a7 shall apply to products removed after the last day of the month which includes the date that the ,secretary of the ,treasury 7or the ,secretary of the ,treasury's delegate7 issues final regulations establishing the level of tax for such product4 #ebjb4 ,,mommies 7a7 ,,gao study and report 7#a7 ,in general ,not later than #a year after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report on the gaps in coverage with respect to-- 7,a7 pregnant individuals enrolled under a ,state plan 7or waiver of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 and the ,children's ,health ,insurance ,program under title ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq472 and 7,b7 postpartum individuals enrolled under a ,state plan 7or waiver of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 and the ,children's ,health ,insurance ,program under title ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq47 who received assistance under either such program during their pregnancy4 7#b7 ,content of report ,the report required under this paragraph shall include the following3 7,a7 ,information about the abilities and successes of ,state ,medicaid agencies in determining whether pregnant and postpartum individuals are eligible under another insurance affordability program1 and in transitioning any such individuals who are so eligible to coverage under such a program at the end of their period of eligibility for medical assistance1 pursuant to section #dce4abjj of the title #db1 ,code of ,federal ,regulations 7as in effect on ,september #a1 #bjah74 7,b7 ,information on factors contributing to gaps in coverage that disproportionately impact underserved populations1 including low-income individuals1 ,black1 ,indigenous1 and other individuals of color1 individuals who reside in a health professional shortage area 7as defined in section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7a77#a77;,a777 or individuals who are members of a medically underserved population 7as defined by section #ccj7;b77#c7 of such ,act 7#db ,u4,s4,c4 #bed;b7b77#c77;,a7774 7,c7 ,recommendations for addressing and reducing such gaps in coverage4 7,d7 ,such other information as the ,comptroller ,general deems necessary4 7#c7 ,data disaggregation ,to the greatest extent possible1 the ,comptroller ,general shall disaggregate data presented in the report1 including by age1 gender identity1 race1 ethnicity1 income level1 and other demographic factors4 7b7 ,maternity care home demonstration project ,title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is amended by inserting the following new section after section #aidg3 #aidh4 ,maternity ,care ,home ,demonstration ,project 7a7 ,in general ,not later than #a year after the date of the enactment of this section1 the ,secretary shall establish a demonstration project 7in this section referred to as the demonstration project7 under which the ,secretary shall provide grants to ,states to enter into arrangements with eligible entities to implement or expand a maternity care home model for eligible individuals4 7b7 ,goals of demonstration project ,the goals of the demonstration project are the following3 7#a7 ,to improve-- 7,a7 maternity and infant care outcomes2 7,b7 birth equity2 7,c7 health equity for-- 7i7 ,black1 ,indigenous1 and other people of color2 7ii7 lesbian1 gay1 bisexual1 transgender1 queer1 non-binary1 and gender nonconfirming individuals2 7iii7 people with disabilities2 and 7iv7 other underserved populations2 7,d7 communication by maternity1 infant care1 and social services providers2 7,e7 integration of perinatal support services1 including community health workers1 doulas1 social workers1 public health nurses1 peer lactation counselors1 lactation consultants1 childbirth educators1 peer mental health workers1 and others1 into health care entities and organizations2 7,f7 care coordination between maternity1 infant care1 oral health services1 and social services providers within the community2 7,g7 the quality and safety of maternity and infant care2 7,h7 the experience of individuals receiving maternity care1 including by increasing the ability of an individual to develop and follow their own birthing plans2 and 7,i7 access to adequate prenatal and postpartum care1 including-- 7i7 prenatal care that is initiated in a timely manner2 7ii7 not fewer than #e post-pregnancy visits to a maternity care provider2 and 7iii7 interpregnancy care4 7#b7 ,to provide coordinated1 evidence-based1 respectful1 culturally and linguistically appropriate1 and person-centered maternity care management4 7#c7 ,to decrease-- 7,a7 severe and preventable maternal morbidity and maternal mortality2 7,b7 overall health care spending2 7,c7 unnecessary emergency department visits2 7,d7 inequities in maternal and infant care outcomes1 including racial1 economic1 disability1 gender-based1 and geographical inequities2 7,e7 racial1 gender1 economic1 and other discrimination among health care professionals2 7,f7 racism1 discrimination1 disrespect1 and abuse in maternity care settings2 7,g7 the rate of cesarean deliveries for low-risk pregnancies2 7,h7 the rate of pre-term births and infants born with low birth weight2 and 7,i7 the rate of avoidable maternal and newborn hospitalizations and admissions to intensive care units4 7c7 ,consultation ,in designing and implementing the demonstration project the ,secretary shall consult with stakeholders1 including-- 7#a7 ,states2 7#b7 organizations representing relevant health care professionals1 including oral health services professionals2 7#c7 organizations1 particularly reproductive justice and birth justice organizations led by people of color1 that represent consumers of maternal health care1 including consumers of maternal health care who are disproportionately impacted by poor maternal health outcomes2 7#d7 representatives with experience implementing other maternity care home models1 including representatives from the ,center for ,medicare and ,medicaid ,innovation2 7#e7 community-based health care professionals1 including doulas1 lactation consultants1 and other stakeholders2 7#f7 experts in promoting health equity and combating racial bias in health care settings2 and 7#g7 ,black1 ,indigenous1 and other maternal health care consumers of color who have experienced severe maternal morbidity4 7d7 ,application and selection of ,states 7#a7 ,in general ,a ,state seeking to participate in the demonstration project shall submit an application to the ,secretary at such time and in such manner as the ,secretary shall require4 7#b7 ,selection of ,states 7,a7 ,in general ,the ,secretary shall select at least #aj ,states to participate in the demonstration project4 7,b7 ,selection requirements ,in selecting ,states to participate in the demonstration project1 the ,secretary shall-- 7i7 ensure that there is geographic and regional diversity in the areas in which activities will be carried out under the project2 7ii7 ensure that ,states with significant inequities in maternal and infant health outcomes1 including severe maternal morbidity1 and other inequities based on race1 income1 or access to maternity care1 are included2 and 7iii7 ensure that at least #a territory is included4 7e7 ,grants 7#a7 ,in general ,from amounts appropriated under subsection 7l71 the ,secretary shall award #a grant for each year of the demonstration project to each ,state that is selected to participate in the demonstration project4 7#b7 ,use of grant funds ,a ,state may use funds received under this section to-- 7,a7 award grants or make payments to eligible entities as part of an arrangement described in subsection 7f77#b72 7,b7 provide financial incentives to health care professionals1 including community-based health care workers and community-based doulas1 who participate in the ,state's maternity care home model2 7,c7 provide adequate training for health care professionals1 including community-based health care workers1 doulas1 and care coordinators1 who participate in the ,state's maternity care home model1 which may include training for cultural humility and antiracism1 racial bias1 health equity1 reproductive and birth justice1 trauma-informed care1 home visiting skills1 and respectful communication and listening skills1 particularly in regards to maternal health2 7,d7 pay for personnel and administrative expenses associated with designing1 implementing1 and operating the ,state's maternity care home model2 7,e7 pay for items and services that are furnished under the ,state's maternity care home model and for which payment is otherwise unavailable under this title2 7,f7 pay for services and materials to ensure culturally and linguistically appropriate communication1 including-- 7i7 language services such as interpreters and translation of written materials2 and 7ii7 development of culturally and linguistically appropriate materials2 and auxiliary aids and services2 and 7,g7 pay for other costs related to the ,state's maternity care home model1 as determined by the ,secretary4 7#c7 ,grant for national independent evaluator 7,a7 ,in general ,from the amounts appropriated under subsection 7l71 prior to awarding any grants under paragraph 7#a71 the ,secretary shall enter into a contract with a national external entity to create a single1 uniform process to-- 7i7 ensure that ,states that receive grants under paragraph 7#a7 comply with the requirements of this section2 and 7ii7 evaluate the outcomes of the demonstration project in each participating ,state4 7,b7 ,annual report ,the contract described in subparagraph 7,a7 shall require the national external entity to submit to the ,secretary-- 7i7 a yearly evaluation report for each year of the demonstration project2 and 7ii7 a final impact report after the demonstration project has concluded4 7,c7 ,secretary's authority ,nothing in this paragraph shall prevent the ,secretary from making a determination that a ,state is not in compliance with the requirements of this section without the national external entity making such a determination4 7f7 ,partnership with eligible entities 7#a7 ,in general ,as a condition of receiving a grant under this section1 a ,state shall enter into an arrangement with one or more eligible entities that meets the requirements of paragraph 7#b74 7#b7 ,arrangements with eligible entities ,under an arrangement between a ,state and an eligible entity under this subsection1 the eligible entity shall perform the following functions1 with respect to eligible individuals enrolled with the entity under the ,state's maternity care home model-- 7,a7 provide culturally and linguistically appropriate congruent care1 which may include prenatal care1 family planning services1 medical care1 mental and behavioral care1 postpartum care1 and oral health services to such eligible individuals through a team of health care professionals1 which may include obstetrician-gynecologists1 maternal-fetal medicine specialists1 family physicians1 primary care providers1 oral health providers1 physician assistants1 advanced practice registered nurses such as nurse practitioners and certified nurse midwives1 certified midwives1 certified professional midwives1 physical therapists1 social workers1 traditional and community-based doulas1 lactation consultants1 childbirth educators1 community health workers1 peer mental health supporters1 and other health care professionals2 7,b7 conduct a risk assessment of each such eligible individual to determine if their pregnancy is high or low risk1 and establish a tailored pregnancy care plan1 which takes into consideration the individual's own preferences and pregnancy care and birthing plans and determines the appropriate support services to reduce the individual's medical1 social1 and environmental risk factors1 for each such eligible individual based on the results of such risk assessment2 7,c7 assign each such eligible individual to a culturally and linguistically appropriate care coordinator1 which may be a nurse1 social worker1 traditional or community-based doula1 community health worker1 midwife1 or other health care provider1 who is responsible for ensuring that such eligible individual receives the necessary medical care and connections to essential support services2 7,d7 provide1 or arrange for the provision of1 essential support services1 such as services that address-- 7i7 food access1 nutrition1 and exercise2 7ii7 smoking cessation2 7iii7 substance use disorder and addiction treatment2 7iv7 anxiety1 depression1 trauma1 and other mental and behavioral health issues2 7v7 breastfeeding1 chestfeeding1 or other infant feeding options supports1 initiation1 continuation1 and duration2 7vi7 stable1 affordable1 safe1 and healthy housing2 7vii7 transportation2 7viii7 intimate partner violence2 7ix7 community and police violence2 7x7 home visiting services2 7xi7 childbirth and newborn care education2 7xii7 oral health education2 7xiii7 continuous labor support2 7xiv7 group prenatal care2 7xv7 family planning and contraceptive care and supplies2 and 7xvi7 affordable child care2 7,e7 as appropriate1 facilitate connections to a usual primary care provider1 which may be a reproductive health care provider2 7,f7 refer to guidelines and opinions of medical associations when determining whether an elective delivery should be performed on an eligible individual before #ci weeks of gestation2 7,g7 provide such eligible individual with evidence-based and culturally and linguistically appropriate education and resources to identify potential warning signs of pregnancy and postpartum complications and when and how to obtain medical attention2 7,h7 provide1 or arrange for the provision of1 culturally and linguistically appropriate pregnancy and postpartum health services1 including family planning counseling and services1 to eligible individuals2 7,i7 track and report postpartum health and birth outcomes of such eligible individuals and their children2 7,j7 ensure that care is person-centered1 culturally and linguistically appropriate1 and patient-led1 including by engaging eligible individuals in their own care1 including through communication and education2 and 7,k7 ensure adequate training for appropriately serving the population of individuals eligible for medical assistance under the ,state plan 7or waiver of such plan71 including through reproductive justice1 birth justice1 birth equity1 and anti-racist frameworks1 home visiting skills1 and knowledge of social services4 7g7 ,term of demonstration project ,the ,secretary shall conduct the demonstration project for a period of #e years4 7h7 ,report ,not later than #ah months after the date of the enactment of this section and annually thereafter for each year of the demonstration project term1 the ,secretary shall submit a report to ,congress on the results of the demonstration project1 including-- 7#a7 the results of the final report of the national external entity required under subsection 7e77#c77;,b77ii72 and 7#b7 recommendations on whether the model studied in the demonstration project should be continued or more widely adopted1 including by private health plans4 7i7 ,waiver authority ,to the extent that the ,secretary determines necessary in order to carry out the demonstration project1 the ,secretary may waive section #aijb7;a77#a7 7relating to statewideness7 and section #aijb7;a77#aj77;,b7 7relating to comparability74 7j7 ,technical assistance ,the ,secretary shall establish a process to provide technical assistance to ,states that are awarded grants under this section and to eligible entities and other providers participating in a ,state maternity care home model funded by such a grant4 7k7 ,definitions ,in this section3 7#a7 ,eligible entity ,the term eligible entity means an entity or organization that provides medically accurate1 comprehensive maternity services to individuals who are eligible for medical assistance under a ,state plan under this title or a waiver of such a plan1 and may include3 7,a7 ,a freestanding birth center4 7,b7 ,an entity or organization receiving assistance under section #ccj of the ,public ,health ,service ,act4 7,c7 ,a federally qualified health center4 7,d7 ,a rural health clinic4 7,e7 ,a health facility operated by an ,indian tribe or tribal organization 7as those terms are defined in section #d of the ,indian ,health ,care ,improvement ,act74 7#b7 ,eligible individual ,the term eligible individual means a pregnant individual or a formerly pregnant individual during the #a-year period beginning on the last day of the pregnancy1 or such longer period beginning on such day as a ,state may elect1 who is-- 7,a7 enrolled in a ,state plan under this title1 a waiver of such a plan1 or a ,state child health plan under title ,,xxi2 and 7,b7 a patient of an eligible entity which has entered into an arrangement with a ,state under subsection 7g74 7l7 ,authorization of appropriations ,there are authorized to be appropriated to the ,secretary1 for each of fiscal years #bjbe through #bjcb1 such sums as may be necessary to carry out this section4 4 7c7 ,reapplication of ,medicare payment rate floor to primary care services furnished under ,medicaid and inclusion of additional providers 7#a7 ,reapplication of payment floor2 additional providers 7,a7 ,in general ,section #aijb7;a77#ac7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#ac77 is amended-- 7i7 in subparagraph 7,b71 by striking 2 and and inserting a semicolon2 7ii7 in subparagraph 7,c71 by striking the semicolon and inserting 2 and2 and 7iii7 by adding at the end the following new subparagraph3 7,d7 payment for primary care services 7as defined in subsection 7jj77#a77 furnished in the period that begins on the first day of the first month that begins after the date of enactment of this subparagraph by a provider described in subsection 7jj77#b7-- 7i7 at a rate that is not less than #ajj percent of the payment rate that applies to such services and the provider of such services under part ,b of title ,,xviii 7or1 if greater1 the payment rate that would be applicable under such part if the conversion factor under section #ahdh7;d7 for the year were the conversion factor under such section for #bjji72 7ii7 in the case of items and services that are not items and services provided under such part1 at a rate to be established by the ,secretary2 and 7iii7 in the case of items and services that are furnished in rural areas 7as defined in section #ahhf7;d77#b77;,d771 health professional shortage areas 7as defined in section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e7a77#a77;,a7771 or medically underserved areas 7according to a designation under section #ccj7;b77#c77;,a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c77;,a7771 at the rate otherwise applicable to such items or services under clause 7i7 or 7ii7 increased1 at the ,secretary's discretion1 by not more than #be percent2 4 7,b7 ,conforming amendments 7i7 ,section #aijb7;a77#ac77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#ac77;,c77 is amended by striking subsection 7jj7 and inserting subsection 7jj77#a74 7ii7 ,section #aije7;dd7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7dd77 is amended-- 7,i7 by striking ,notwithstanding and inserting the following3 7#a7 ,in general ,notwithstanding 2 7,,ii7 by striking section #aijb7;a77#ac77;,c7 and inserting subparagraph 7,c7 of section #aijb7;a77#ac72 7,,iii7 by inserting or for services described in subparagraph 7,d7 of section #aijb7;a77#ac7 furnished during an additional period specified in paragraph 7#b71 after #bjae12 7,,iv7 by striking under such section and inserting under subparagraph 7,c7 or 7,d7 of section #aijb7;a77#ac71 as applicable2 and 7,v7 by adding at the end the following3 7#b7 ,additional periods ,for purposes of paragraph 7#a71 the following are additional periods3 7,a7 ,the period that begins on the first day of the first month that begins after the date of enactment of this paragraph4 4 7#b7 ,improved targeting of primary care ,section #aijb7;jj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7jj77 is amended-- 7,a7 by redesignating paragraphs 7#a7 and 7#b7 as clauses 7i7 and 7ii71 respectively1 and realigning the left margins accordingly2 7,b7 by striking ,for purposes of subsection 7a77#ac77;,c7 and inserting the following3 7#a7 ,in general 7,a7 ,definition ,for purposes of subparagraphs 7,c7 and 7,d7 of subsection 7a77#ac7 2 and 7,c7 by inserting after clause 7ii7 7as so redesignated7 the following3 7,b7 ,exclusions ,such term does not include any services described in subparagraph 7,a7 or 7,b7 of paragraph 7#a7 if such services are provided in an emergency department of a hospital4 7#b7 ,additional providers ,for purposes of subparagraph 7,d7 of subsection 7a77#ac71 a provider described in this paragraph is any of the following3 7,a7 ,a physician with a primary specialty designation of family medicine1 general internal medicine1 or pediatric medicine1 or obstetrics and gynecology4 7,b7 ,an advanced practice clinician1 as defined by the ,secretary1 that works under the supervision of-- 7i7 a physician that satisfies the criteria specified in subparagraph 7,a72 7ii7 a nurse practitioner or a physician assistant 7as such terms are defined in section #ahfa7;aa77#e77;,a77 who is working in accordance with ,state law2 or 7iii7 or a certified nurse-midwife 7as defined in section #ahfa7;gg77 or a certified professional midwife who is working in accordance with ,state law4 7,c7 ,a rural health clinic1 federally qualified health center1 health center that receives funding under title ,x of the ,public ,health ,service ,act1 or other health clinic that receives reimbursement on a fee schedule applicable to a physician4 7,d7 ,an advanced practice clinician supervised by a physician described in subparagraph 7,a71 another advanced practice clinician1 or a certified nurse-midwife4 7,e7 ,a midwife who is working in accordance with ,state law4 4 7#c7 ,ensuring payment by managed care entities 7,a7 ,in general ,section #aijc7m77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7m77#b77;,a77 is amended-- 7i7 in clause 7xii71 by striking and after the semicolon2 7ii7 by realigning the left margin of clause 7xiii7 so as to align with the left margin of clause 7xii7 and by striking the period at the end of clause 7xiii7 and inserting 2 and2 and 7iii7 by inserting after clause 7xiii7 the following3 7xiv7 such contract provides that 7,i7 payments to providers specified in section #aijb7;a77#ac77;,d7 for primary care services 7as defined in section #aijb7;jj77 that are furnished during a year or period 7as specified in section #aijb7;a77#ac77;,d7 and section #aije7;dd77 are at least equal to the amounts set forth and required by the ,secretary by regulation2 7,,ii7 the entity shall1 upon request1 provide documentation to the ,state1 sufficient to enable the ,state and the ,secretary to ensure compliance with subclause 7,i72 and 7,,iii7 the ,secretary shall approve payments described in subclause 7,i7 that are furnished through an agreed upon capitation1 partial capitation1 or other value-based payment arrangement if the capitation1 partial capitation1 or other value-based payment arrangement is based on a reasonable methodology and the entity provides documentation to the ,state sufficient to enable the ,state and the ,secretary to ensure compliance with subclause 7,i74 4 7,b7 ,conforming amendment ,section #aicb7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;f77 is amended-- 7i7 by striking section #aijb7;a77#ac77;,c7 and inserting subsections 7,c7 and 7,d7 of section #aijb7;a77#ac72 and 7ii7 by inserting 1 and clause 7xiv7 of section #aijc7m77#b77;,a7 before the period4 7d7 ,,macpac report and ,,cms guidance on increasing access to doula services for ,medicaid beneficiaries 7#a7 ,,macpac ,report 7,a7 ,in general ,not later than #a year after the date of the enactment of this ,act1 the ,medicaid and ,,chip ,payment and ,access ,commission 7referred to in this subsection as ,,macpac7 shall publish a report on the coverage of doula services under ,state ,medicaid programs1 which shall at a minimum include the following3 7i7 ,information about coverage for doula services under ,state ,medicaid programs that currently provide coverage for such care1 including the type of doula services offered 7such as prenatal1 labor and delivery1 postpartum support1 and also community-based and traditional doula services74 7ii7 ,an analysis of barriers to covering doula services under ,state ,medicaid programs4 7iii7 ,an identification of effective strategies to increase the use of doula services in order to provide better care and achieve better maternal and infant health outcomes1 including strategies that ,states may use to recruit1 train1 and certify a diverse doula workforce1 particularly from underserved communities1 communities of color1 and communities facing linguistic or cultural barriers4 7iv7 ,recommendations for legislative and administrative actions to increase access to doula services in ,state ,medicaid programs1 including actions that ensure doulas may earn a living wage that accounts for their time and costs associated with providing care and community-based doula program administration and operation4 7,b7 ,stakeholder consultation ,in developing the report required under subparagraph 7,a71 ,,macpac shall consult with relevant stakeholders1 including-- 7i7 ,states2 7ii7 organizations1 especially reproductive justice and birth justice organizations led by people of color1 representing consumers of maternal health care1 including those that are disproportionately impacted by poor maternal health outcomes2 7iii7 organizations and individuals representing doulas1 including community-based doula programs and those who serve underserved communities1 including communities of color1 and communities facing linguistic or cultural barriers2 7iv7 organizations representing health care providers2 and 7v7 ,black1 ,indigenous1 and other maternal health care consumers of color who have experienced severe maternal morbidity4 7#b7 ,,cms guidance 7,a7 ,in general ,not later than #a year after the date that ,,macpac publishes the report required under paragraph 7#a77;,a71 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall issue guidance to ,states on increasing access to doula services under ,medicaid4 ,such guidance shall at a minimum include-- 7i7 options for ,states to provide medical assistance for doula services under ,state ,medicaid programs2 7ii7 best practices for ensuring that doulas1 including community-based doulas1 receive reimbursement for doula services provided under a ,state ,medicaid program1 at a level that allows doulas to earn a living wage that accounts for their time and costs associated with providing care and community-based doula program administration2 and 7iii7 best practices for increasing access to doula services1 including services provided by community-based doulas1 under ,state ,medicaid programs4 7,b7 ,stakeholder consultation ,in developing the guidance required under subparagraph 7,a71 the ,administrator of the ,centers for ,medicare ,medicaid ,services shall consult with ,,macpac and other relevant stakeholders1 including-- 7i7 ,state ,medicaid officials2 7ii7 organizations representing consumers of maternal health care1 including those that are disproportionately impacted by poor maternal health outcomes2 7iii7 organizations representing doulas1 including community-based doulas and those who serve underserved communities1 such as communities of color and communities facing linguistic or cultural barriers2 and 7iv7 organizations representing medical professionals4 7e7 ,,gao report on ,state ,medicaid programs' use of telehealth ,to increase access to maternity care ,not later than #a year after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit a report to ,congress on ,state ,medicaid programs' use of telehealth to increase access to maternity care4 ,such report shall include the following3 7#a7 ,the number of ,state ,medicaid programs that utilize telehealth that increases access to maternity care4 7#b7 ,with respect to ,state ,medicaid programs that utilize telehealth that increases access to maternity care1 information about-- 7,a7 common characteristics of such programs' approaches to utilizing telehealth that increases access to maternity care2 7,b7 differences in ,states' approaches to utilizing telehealth to improve access to maternity care1 and the resulting differences in ,state maternal health outcomes1 as determined by factors described in subsection 7,c72 and 7,c7 when compared to patients who receive maternity care in person1 what is known about-- 7i7 the demographic characteristics1 such as race1 ethnicity1 sex1 sexual orientation1 gender identity1 disability status1 age1 and preferred language of the individuals enrolled in such programs who use telehealth to access maternity care2 7ii7 health outcomes for such individuals1 including frequency of mortality and severe morbidity1 as compared to individuals with similar characteristics who did not use telehealth to access maternity care2 7iii7 the services provided to individuals through telehealth1 including family planning services1 mental health care services1 and oral health services2 7iv7 the devices and equipment provided to individuals for remote patient monitoring and telehealth1 including blood pressure monitors and blood glucose monitors2 7v7 the quality of maternity care provided through telehealth1 including whether maternity care provided through telehealth is culturally and linguistically appropriate2 7vi7 the level of patient satisfaction with maternity care provided through telehealth to individuals enrolled in ,state ,medicaid programs2 7vii7 the impact of utilizing telehealth to increase access to maternity care on spending1 cost savings1 access to care1 and utilization of care under ,state ,medicaid programs2 and 7viii7 the accessibility and effectiveness of telehealth for maternity care during the ,,covid-#ai pandemic4 7#c7 ,an identification and analysis of the barriers to using telehealth to increase access to maternity care under ,state ,medicaid programs4 7#d7 ,recommendations for such legislative and administrative actions related to increasing access to telehealth maternity services under ,medicaid as the ,comptroller ,general deems appropriate4 #ebjc4 ,social determinants for moms 7a7 ,task force to develop a strategy to address social determinants of maternal health 7#a7 ,in general ,the ,secretary of ,health and ,human ,services shall convene a task force 7in this subsection referred to as the ,task ,force7 to develop a strategy to coordinate efforts between ,federal agencies to address social determinants of maternal health with respect to pregnant and postpartum individuals4 7#b7 ,ex officio members ,the ex officio members of the ,task ,force shall consist of the following3 7,a7 ,the ,secretary of ,health and ,human ,services 7or a designee thereof74 7,b7 ,the ,secretary of ,housing and ,urban ,development 7or a designee thereof74 7,c7 ,the ,secretary of ,transportation 7or a designee thereof74 7,d7 ,the ,secretary of ,agriculture 7or a designee thereof74 7,e7 ,the ,secretary of ,labor 7or a designee thereof74 7,f7 ,the ,administrator of the ,environmental ,protection ,agency 7or a designee thereof74 7,g7 ,the ,assistant ,secretary for the ,administration for ,children and ,families 7or a designee thereof74 7,h7 ,the ,administrator of the ,centers for ,medicare ,medicaid ,services 7or a designee thereof74 7,i7 ,the ,director of the ,indian ,health ,service 7or a designee thereof74 7,j7 ,the ,director of the ,national ,institutes of ,health 7or a designee thereof74 7,k7 ,the ,administrator of the ,health ,resources and ,services ,administration 7or a designee thereof74 7,l7 ,the ,deputy ,assistant ,secretary for ,minority ,health of the ,department of ,health and ,human ,services 7or a designee thereof74 7,m7 ,the ,deputy ,assistant ,secretary for ,women's ,health of the ,department of ,health and ,human ,services 7or a designee thereof74 7,n7 ,the ,director of the ,centers for ,disease ,control and ,prevention 7or a designee thereof74 7,o7 ,the ,director of the ,office on ,violence ,against ,women of the ,department of ,justice 7or a designee thereof74 7#c7 ,appointed members ,in addition to the ex officio members of the ,task ,force1 the ,secretary of ,health and ,human ,services shall appoint the following members of the ,task ,force3 7,a7 ,at least two representatives of patients1 to include-- 7i7 a representative of patients who have suffered from severe maternal morbidity2 or 7ii7 a representative of patients who is a family member of an individual who suffered a pregnancy-related death4 7,b7 ,at least two leaders of community-based organizations that address maternal mortality and severe maternal morbidity with a specific focus on racial and ethnic inequities4 ,in appointing such leaders under this subparagraph1 the ,secretary of ,health and ,human ,services shall give priority to individuals who are leaders of organizations led by individuals from racial and ethnic minority groups4 7,c7 ,at least two perinatal health workers4 7,d7 ,a professionally diverse panel of maternity care providers4 7#d7 ,chair ,the ,secretary of ,health and ,human ,services shall select the chair of the ,task ,force from among the members of the ,task ,force4 7#e7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,task ,force shall submit to ,congress a report on-- 7,a7 the strategy developed under paragraph 7#a72 7,b7 recommendations on funding amounts with respect to implementing such strategy2 and 7,c7 recommendations for how to expand coverage of social services to address social determinants of maternal health under ,medicaid managed care organizations and ,state ,medicaid programs4 7#f7 ,termination ,section #ajac of title #e1 ,united ,states ,code1 shall not apply to the ,task ,force with respect to termination4 7b7 ,housing for ,moms grant program 7#a7 ,definitions ,in this subsection3 7,a7 ,eligible entity ,the term eligible entity means-- 7i7 a community-based organization2 7ii7 a ,state or local governmental entity1 including a ,state or local public health department2 7iii7 an ,indian tribe or ,tribal organization 7as such terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd772 or 7iv7 an ,urban ,indian organization 7as such term is defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc774 7,b7 ,secretary ,the term ,secretary means the ,secretary of ,housing and ,urban ,development4 7#b7 ,establishment ,the ,secretary shall establish a ,housing for ,moms grant program to make grants to eligible entities to increase access to safe1 stable1 affordable1 and adequate housing for pregnant and postpartum individuals and their families4 7#c7 ,application ,to be eligible to receive a grant under this subsection1 an eligible entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may provide4 7#d7 ,priority ,in awarding grants under this subsection1 the ,secretary shall give priority to an eligible entity that-- 7,a7 is a community-based organization or will partner with a community-based organization to implement initiatives to increase access to safe1 stable1 affordable1 and adequate housing for pregnant and postpartum individuals and their families2 7,b7 is operating in an area with high rates of adverse maternal health outcomes or significant racial or ethnic inequities in maternal health outcomes1 to the extent such data are available2 and 7,c7 is operating in an area with a high poverty rate or a significant number of individuals who lack consistent access to safe1 stable1 affordable1 and adequate housing4 7#e7 ,use of funds ,an eligible entity that receives a grant under this subsection shall use funds from the grant for the purposes of-- 7,a7 identifying and conducting outreach to pregnant and postpartum individuals who are low-income and lack consistent access to safe1 stable1 affordable1 and adequate housing2 7,b7 providing safe1 stable1 affordable1 and adequate housing options to such individuals2 7,c7 connecting such individuals with local organizations offering safe1 stable1 affordable1 and adequate housing options2 7,d7 providing application assistance to such individuals seeking to enroll in programs offering safe1 stable1 affordable1 and adequate housing options2 7,e7 providing direct financial assistance to such individuals for the purposes of maintaining safe1 stable1 and adequate housing for the duration of the individual's pregnancy and postpartum periods2 and 7,f7 working with relevant stakeholders to ensure that local housing and homeless shelter infrastructure is supportive to pregnant and postpartum individuals1 including through-- 7i7 health-promoting housing codes2 7ii7 enforcement of housing codes2 7iii7 proactive rental inspection programs2 7iv7 code enforcement officer training2 and 7v7 partnerships between regional offices of the ,department of ,housing and ,urban ,development and community-based organizations to ensure housing laws are understood and violations are discovered4 7#f7 ,reporting 7,a7 ,eligible entities ,the ,secretary shall require each eligible entity receiving a grant under this subsection to annually submit to the ,secretary and make publicly available a report on the status of activities conducted using the grant4 7,b7 ,secretary ,not later than the end of each fiscal year in which grants are made under this subsection1 the ,secretary shall submit to ,congress and make publicly available a report that-- 7i7 summarizes the reports received under subparagraph 7,a72 7ii7 evaluates the effectiveness of grants awarded under this subsection in increasing access to safe1 stable1 affordable1 and adequate housing for pregnant and postpartum individuals and their families2 and 7iii7 makes recommendations with respect to ensuring activities described in paragraph 7#e7 continue after grant amounts made available under this subsection are expended4 7#g7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this subsection #aj1jjj1jjj for fiscal year #bjbe1 which shall remain available until expended4 7c7 ,department of ,transportation 7#a7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,transportation shall submit to ,congress and make publicly available a report containing-- 7,a7 an assessment of transportation barriers preventing individuals from attending prenatal and postpartum appointments1 accessing maternal health care services1 or accessing services and resources related to social determinants of maternal health2 7,b7 recommendations on how to overcome the barriers assessed under subparagraph 7,a72 and 7,c7 an assessment of transportation safety risks for pregnant individuals and recommendations on how to mitigate those risks4 7#b7 ,considerations ,in carrying out paragraph 7#a71 the ,secretary of ,transportation shall give special consideration to solutions for-- 7,a7 pregnant and postpartum individuals living in a health professional shortage area designated under section #ccb of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e72 7,b7 pregnant and postpartum individuals living in areas with high maternal mortality or severe morbidity rates or significant racial or ethnic inequities in maternal health outcomes2 and 7,c7 pregnant and postpartum individuals with a disability that impacts mobility4 7d7 ,department of ,agriculture 7#a7 ,special supplemental nutrition program for women1 infants1 and children 7,a7 ,extension of postpartum period ,section #ag7;b77#aj7 of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aghf7;b77#aj77 is amended by striking six and inserting #bd4 7,b7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a report that evaluates the effect of the amendment made by subparagraph 7,a7 on-- 7i7 maternal and infant health outcomes1 including racial and ethnic inequities with respect to those outcomes2 7ii7 breastfeeding rates among postpartum individuals2 7iii7 qualitative evaluations of family experiences under the special supplemental nutrition program for women1 infants1 and children established under section #ag of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aghf72 and 7iv7 other relevant information as determined by the ,secretary4 7#b7 ,grant program for healthy food and clean water for pregnant and postpartum individuals 7,a7 ,in general ,the ,secretary shall establish a program 7referred to in this paragraph as the program7 to award grants1 on a competitive basis1 to eligible entities to carry out the activities described in subparagraph 7,d74 7,b7 ,application ,to be eligible for a grant under the program1 an eligible entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary determines appropriate4 7,c7 ,priority ,in awarding grants under the program1 the ,secretary shall give priority to an eligible entity that-- 7i7 is1 or will partner with1 an eligible entity described in paragraph 7#c77;,a77i72 and 7ii7 is operating in an area with a high rate of-- 7,i7 adverse maternal health outcomes2 or 7,,ii7 significant racial or ethnic inequities in maternal health outcomes4 7,d7 ,use of funds ,an eligible entity shall use a grant awarded under the program to deliver healthy food1 infant formula1 clean water1 or diapers to pregnant and postpartum individuals located in areas that are food deserts1 as determined by the ,secretary using data from the ,food ,access ,research ,atlas of the ,department of ,agriculture4 7,e7 ,reports 7i7 ,eligible entities ,not later than #a year after the date on which an eligible entity receives a grant under the program1 and annually thereafter1 the eligible entity shall submit to the ,secretary a report on the status of activities conducted using the grant1 which shall contain such information as the ,secretary may require4 7ii7 ,secretary 7,i7 ,in general ,not later than #b years after the date on which the first grant is awarded under the program1 the ,secretary shall submit to ,congress a report that includes-- 7aa7 a summary of the reports submitted by eligible entities under clause 7i72 7bb7 an assessment of the extent to which food distributed using grants awarded under the program was purchased from local and regional food systems2 7cc7 an evaluation of the effect of the program on maternal and infant health outcomes1 including racial and ethnic inequities with respect to those outcomes2 and 7dd7 recommendations with respect to ensuring the activities described in subparagraph 7,d7 continue after the grant period funding those activities expires4 7,,ii7 ,publication ,the ,secretary shall make the report submitted under subclause 7,i7 publicly available on the website of the ,department of ,agriculture4 7,f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out the program #e1jjj1jjj for the period of fiscal years #bjbe through #bjbg4 7#c7 ,definitions ,in this subsection3 7,a7 ,eligible entity ,the term eligible entity means-- 7i7 a community-based organization2 7ii7 a ,state or local governmental entity1 including a ,state or local public health department2 7iii7 an ,indian ,tribe or ,tribal organization 7as those terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd772 and 7iv7 an ,urban ,indian organization 7as defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc774 7,b7 ,secretary ,the term ,secretary means the ,secretary of ,agriculture4 7e7 ,environmental study through ,national ,academies 7#a7 ,in general ,not later than #fj days after the date of enactment of this ,act1 the ,administrator of the ,environmental ,protection ,agency shall seek to enter into an agreement with the ,national ,academies of ,sciences1 ,engineering1 and ,medicine 7referred to in this subsection as the ,national ,academies7 under which the ,national ,academies agree to conduct a study on the impacts of1 with respect to maternal and infant health incomes1 water and air quality1 exposure to extreme temperatures1 environmental chemicals1 environmental risks in the workplace and the home1 and pollution levels4 7#b7 ,study requirements ,the agreement under paragraph 7#a7 shall direct the ,national ,academies to make recommendations for-- 7,a7 improving environmental conditions to improve maternal and infant health outcomes2 and 7,b7 reducing or eliminating racial and ethnic inequities in those outcomes4 7#c7 ,report ,the agreement under paragraph 7#a7 shall direct the ,national ,academies to complete the study under this subsection1 and submit to ,congress and make publicly available a report on the results of the study1 not later than #a year after the date of enactment of this ,act4 7f7 ,child care access 7#a7 ,grant program ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall award grants to eligible organizations to carry out programs to provide pregnant and postpartum individuals with free and accessible drop-in child care services during prenatal and postpartum appointments4 7#b7 ,application ,to be eligible to receive a grant under this subsection1 an eligible entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7#c7 ,eligible organizations 7,a7 ,eligibility ,to be eligible to receive a grant under this subsection1 an organization shall be an organization that-- 7i7 provides child care services2 and 7ii7 can carry out a program providing pregnant and postpartum individuals with free and accessible drop-in child care services during prenatal and postpartum appointments4 7,b7 ,prioritization ,in selecting grant recipients under this subsection1 the ,secretary shall give priority to eligible organizations that operate in an area that has1 to the extent data with respect to such an area are available-- 7i7 high rates of adverse maternal health outcomes2 or 7ii7 significant racial or ethnic inequities in maternal health outcomes4 7#d7 ,timing ,the ,secretary shall commence the grant program under paragraph 7#a7 not later than #a year after the date of enactment of this ,act4 7#e7 ,reporting 7,a7 ,grantees ,each recipient of a grant under this subsection shall annually submit to the ,secretary and make publicly available a report on the status of activities conducted using the grant4 ,each such report shall include-- 7i7 an analysis of the effect of the funded program on prenatal and postpartum appointment attendance rates2 7ii7 summaries of qualitative assessments of the funded program from-- 7,i7 pregnant and postpartum individuals participating in the program2 and 7,,ii7 the families of such individuals2 and 7iii7 such additional information as the ,secretary may require4 7,b7 ,secretary ,not later than the end of fiscal year #bjbg1 the ,secretary shall submit to the ,congress1 and make publicly available1 a report containing each of the following3 7i7 ,a summary of the reports received under subparagraph 7,a74 7ii7 ,an assessment of the effects1 if any1 of the funded programs on maternal health outcomes1 with a specific focus on racial and ethnic inequities in such outcomes4 7iii7 ,a description of actions the ,secretary can take to ensure that pregnant and postpartum individuals eligible for medical assistance under a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #aicf et seq47 have access to free and accessible drop-in child care services during prenatal and postpartum appointments1 including identification of the funding necessary to carry out such actions4 7#f7 ,drop-,in child care services defined ,in this subsection1 the term drop-in child care services means child care 7including early childhood education7 services that are-- 7,a7 delivered at a facility that meets the requirements of all applicable laws and regulations of the ,state or local government in which it is located1 including the requirements for licensing of the facility as a child care facility2 and 7,b7 provided in single encounters without requiring full-time enrollment of a person in a child care program4 7#g7 ,authorization of appropriations ,to carry out this subsection1 there is authorized to be appropriated #e1jjj1jjj for the period of fiscal years #bjbe through #bjbg4 7g7 ,grants to local entities addressing social determinants of maternal health 7#a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall award grants to eligible entities to-- 7,a7 address social determinants of maternal health for pregnant and postpartum individuals2 and 7,b7 eliminate racial and ethnic inequities in maternal health outcomes4 7#b7 ,application ,to be eligible to receive a grant under this subsection an eligible entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may provide4 7#c7 ,prioritization ,in awarding grants under paragraph 7#a71 the ,secretary shall give priority to an eligible entity that-- 7,a7 is a community-based organization1 or will partner with a community-based organization to carry out the activities under paragraph 7#d72 7,b7 is operating in an area with high rates of adverse maternal health outcomes or significant racial or ethnic inequities in maternal health outcomes2 and 7,c7 is operating in an area with a high poverty rate4 7#d7 ,activities ,an eligible entity that receives a grant under this subsection may use funds received through the grant to-- 7,a7 hire and retain staff2 7,b7 develop and distribute a list of available resources with respect to social service programs in a community2 7,c7 establish a resource center that provides multiple social service programs in a single location2 7,d7 offer programs and resources in the communities in which the respective eligible entities are located to address social determinants of health for pregnant and postpartum individuals2 and 7,e7 consult with such pregnant and postpartum individuals to conduct an assessment of the activities under this paragraph4 7#e7 ,technical assistance ,the ,secretary shall provide to grant recipients under this subsection technical assistance to plan for sustaining programs to address social determinants of maternal health among pregnant and postpartum individuals after the period of the grant4 7#f7 ,reporting 7,a7 ,grantees ,not later than #a year after the date on which an eligible entity first receives a grant under this subsection1 and annually thereafter1 an eligible entity shall submit to the ,secretary1 and make publicly available1 a report on the status of activities conducted using the grant4 ,each such report shall include data on the effects of such activities1 disaggregated by race1 ethnicity1 gender1 and other relevant factors4 7,b7 ,secretary ,not later than the end of fiscal year #bjbi1 the ,secretary shall submit to ,congress a report that includes-- 7i7 a summary of the reports received under subparagraph 7,a72 and 7ii7 recommendations for-- 7,i7 improving maternal health outcomes2 and 7,,ii7 reducing or eliminating racial and ethnic inequities in maternal health outcomes4 7#g7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this subsection #ae1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7h7 ,definitions ,in this section3 7#a7 ,culturally congruent ,the term culturally congruent1 with respect to care or maternity care provided to a health care consumer1 means care that is in agreement with the preferred cultural values1 beliefs1 worldview1 language1 and practices of the health care consumer and other relevant stakeholders4 7#b7 ,maternity care provider ,the term maternity care provider means a health care provider who-- 7,a7 is a physician1 physician assistant1 midwife who meets at a minimum the international definition of the midwife and global standards for midwifery education as established by the ,international ,confederation of ,midwives1 nurse practitioner1 or clinical nurse specialist2 and 7,b7 has a focus on maternal or perinatal health4 7#c7 ,maternal mortality ,the term maternal mortality means a death occurring during or within a one-year period after pregnancy1 caused by pregnancy-related or childbirth complications1 including a suicide1 overdose1 or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy-related or childbirth complications4 7#d7 ,perinatal health worker ,the term perinatal health worker means a doula1 community health worker1 peer supporter1 breastfeeding and lactation educator or counselor1 nutritionist or dietitian1 childbirth educator1 social worker1 home visitor1 language interpreter1 or navigator4 7#e7 ,postpartum and postpartum period ,the terms postpartum and postpartum period refer to the #a-year period beginning on the last day of the pregnancy of an individual4 7#f7 ,racial and ethnic minority group ,the term racial and ethnic minority group has the meaning given such term in section #agjg7;g77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a774 7#g7 ,severe maternal morbidity ,the term severe maternal morbidity means a health condition1 including mental health conditions and substance use disorders1 attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant4 7#h7 ,social determinants of maternal health defined ,the term social determinants of maternal health means non-clinical factors that impact maternal health outcomes1 including-- 7,a7 economic factors1 which may include poverty1 employment1 food security1 support for and access to lactation and other infant feeding options1 housing stability1 and related factors2 7,b7 neighborhood factors1 which may include quality of housing1 access to transportation1 access to child care1 availability of healthy foods and nutrition counseling1 availability of clean water1 air and water quality1 ambient temperatures1 neighborhood crime and violence1 access to broadband1 and related factors2 7,c7 social and community factors1 which may include systemic racism1 gender discrimination or discrimination based on other protected classes1 workplace conditions1 incarceration1 and related factors2 7,d7 household factors1 which may include ability to conduct lead testing and abatement1 car seat installation1 indoor air temperatures1 and related factors2 7,e7 education access and quality factors1 which may include educational attainment1 language and literacy1 and related factors2 and 7,f7 health care access factors1 including health insurance coverage1 access to culturally congruent health care services1 providers1 and non-clinical support1 access to home visiting services1 access to wellness and stress management programs1 health literacy1 access to telehealth and items required to receive telehealth services1 and related factors4 #ebjd4 ,kira ,johnson ,act 7a7 ,investments in community-,based organizations ,to improve ,black maternal health outcomes 7#a7 ,awards ,following the #a-year period described in paragraph 7#c71 the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall award grants to eligible entities to establish or expand programs to prevent maternal mortality and severe maternal morbidity among ,black pregnant and postpartum individuals4 7#b7 ,eligibility ,to be eligible to seek a grant under this subsection1 an entity shall be a community-based organization offering programs and resources aligned with evidence-based practices for improving maternal health outcomes for ,black pregnant and postpartum individuals4 7#c7 ,outreach and technical assistance period ,during the #a-year period beginning on the date of enactment of this ,act1 the ,secretary shall-- 7,a7 conduct outreach to encourage eligible entities to apply for grants under this subsection2 and 7,b7 provide technical assistance to eligible entities on best practices for applying for grants under this subsection4 7#d7 ,special consideration 7,a7 ,outreach ,in conducting outreach under paragraph 7#c71 the ,secretary shall give special consideration to eligible entities that-- 7i7 are based in1 and provide support for1 communities with high rates of adverse maternal health outcomes or significant racial and ethnic inequities in maternal health outcomes1 to the extent such data are available2 7ii7 are led by ,black people2 and 7iii7 offer programs and resources that are aligned with evidence-based practices for improving maternal health outcomes for ,black pregnant and postpartum individuals4 7,b7 ,awards ,in awarding grants under this subsection1 the ,secretary shall give special consideration to eligible entities that-- 7i7 are described in clauses 7i71 7ii71 and 7iii7 of subparagraph 7,a72 7ii7 offer programs and resources designed in consultation with and intended for ,black pregnant and postpartum individuals2 and 7iii7 offer programs and resources in the communities in which the respective eligible entities are located that-- 7,i7 promote maternal mental health and maternal substance use disorder treatments and supports that are aligned with evidence-based practices for improving maternal mental and behavioral health outcomes for ,black pregnant and postpartum individuals2 7,,ii7 address social determinants of maternal health for pregnant and postpartum individuals2 7,,iii7 promote evidence-based health literacy and pregnancy1 childbirth1 and parenting education for pregnant and postpartum individuals2 7,,iv7 provide support from perinatal health workers to pregnant and postpartum individuals2 7,v7 provide culturally congruent training to perinatal health workers2 7,,vi7 conduct or support research on maternal health issues disproportionately impacting ,black pregnant and postpartum individuals2 7,,vii7 provide support to family members of individuals who suffered a pregnancy-associated death or pregnancy-related death2 7,,viii7 operate midwifery practices that provide culturally congruent maternal health care and support1 including for the purposes of-- 7aa7 supporting additional education1 training1 and certification programs1 including support for distance learning2 7bb7 providing financial support to current and future midwives to address education costs1 debts1 and other needs2 7cc7 clinical site investments2 7dd7 supporting preceptor development trainings2 7ee7 expanding the midwifery practice2 or 7ff7 related needs identified by the midwifery practice and described in the practice's application2 or 7,,ix7 have developed other programs and resources that address community-specific needs for pregnant and postpartum individuals and are aligned with evidence-based practices for improving maternal health outcomes for ,black pregnant and postpartum individuals4 7#e7 ,technical assistance ,the ,secretary shall provide to grant recipients under this subsection technical assistance on-- 7,a7 capacity building to establish or expand programs to prevent adverse maternal health outcomes among ,black pregnant and postpartum individuals2 7,b7 best practices in data collection1 measurement1 evaluation1 and reporting2 and 7,c7 planning for sustaining programs to prevent maternal mortality and severe maternal morbidity among ,black pregnant and postpartum individuals after the period of the grant4 7#f7 ,evaluation ,not later than the end of fiscal year #bjbi1 the ,secretary shall submit to the ,congress an evaluation of the grant program under this subsection that-- 7,a7 assesses the effectiveness of outreach efforts during the application process in diversifying the pool of grant recipients2 7,b7 makes recommendations for future outreach efforts to diversify the pool of grant recipients for ,department of ,health and ,human ,services grant programs and funding opportunities related to maternal health2 7,c7 assesses the effectiveness of programs funded by grants under this subsection in improving maternal health outcomes for ,black pregnant and postpartum individuals1 to the extent practicable2 and 7,d7 makes recommendations for future ,department of ,health and ,human ,services grant programs and funding opportunities that deliver funding to community-based organizations that provide programs and resources that are aligned with evidence-based practices for improving maternal health outcomes for ,black pregnant and postpartum individuals4 7#g7 ,authorization of appropriations ,to carry out this subsection1 there is authorized to be appropriated #aj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7b7 ,investments in community-,based organizations ,to improve maternal health outcomes in underserved communities 7#a7 ,awards ,following the #a-year period described in paragraph 7#c71 the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall award grants to eligible entities to establish or expand programs to prevent maternal mortality and severe maternal morbidity among underserved groups4 7#b7 ,eligibility ,to be eligible to seek a grant under this subsection1 an entity shall be a community-based organization offering programs and resources aligned with evidence-based practices for improving maternal health outcomes for pregnant and postpartum individuals4 7#c7 ,outreach and technical assistance period ,during the #a-year period beginning on the date of enactment of this ,act1 the ,secretary shall-- 7,a7 conduct outreach to encourage eligible entities to apply for grants under this subsection2 and 7,b7 provide technical assistance to eligible entities on best practices for applying for grants under this subsection4 7#d7 ,special consideration 7,a7 ,outreach ,in conducting outreach under paragraph 7#c71 the ,secretary shall give special consideration to eligible entities that-- 7i7 are based in1 and provide support for1 communities with high rates of adverse maternal health outcomes or significant racial and ethnic inequities in maternal health outcomes1 to the extent such data are available2 7ii7 are led by individuals from racially1 ethnically1 and geographically diverse backgrounds2 and 7iii7 offer programs and resources that are aligned with evidence-based practices for improving maternal health outcomes for pregnant and postpartum individuals4 7,b7 ,awards ,in awarding grants under this subsection1 the ,secretary shall give special consideration to eligible entities that-- 7i7 are described in clauses 7i71 7ii71 and 7iii7 of subparagraph 7,a72 7ii7 offer programs and resources designed in consultation with and intended for pregnant and postpartum individuals from underserved groups2 7iii7 offer programs and resources in the communities in which the respective eligible entities are located that-- 7,i7 promote maternal mental health and maternal substance use disorder treatments and support that are aligned with evidence-based practices for improving maternal mental and behavioral health outcomes for pregnant and postpartum individuals2 7,,ii7 address social determinants of maternal health for pregnant and postpartum individuals2 7,,iii7 promote evidence-based health literacy and pregnancy1 childbirth1 and parenting education for pregnant and postpartum individuals2 7,,iv7 provide support from perinatal health workers to pregnant and postpartum individuals2 7,v7 provide culturally congruent training to perinatal health workers2 7,,vi7 conduct or support research on maternal health outcomes and inequities2 7,,vii7 provide support to family members of individuals who suffered a pregnancy-associated death or pregnancy-related death2 or 7,,viii7 operate midwifery practices that provide culturally congruent maternal health care and support1 including for the purposes of-- 7aa7 supporting additional education1 training1 and certification programs1 including support for distance learning2 7bb7 providing financial support to current and future midwives to address education costs1 debts1 and other needs2 7cc7 clinical site investments2 7dd7 supporting preceptor development trainings2 7ee7 expanding the midwifery practice2 or 7ff7 related needs identified by the midwifery practice and described in the practice's application2 or 7iv7 have developed other programs and resources that address community-specific needs for pregnant and postpartum individuals and are aligned with evidence-based practices for improving maternal health outcomes for pregnant and postpartum individuals4 7#e7 ,technical assistance ,the ,secretary shall provide to grant recipients under this subsection technical assistance on-- 7,a7 capacity building to establish or expand programs to prevent adverse maternal health outcomes among pregnant and postpartum individuals from underserved groups2 7,b7 best practices in data collection1 measurement1 evaluation1 and reporting2 and 7,c7 planning for sustaining programs to prevent maternal mortality and severe maternal morbidity among pregnant and postpartum individuals from underserved groups after the period of the grant4 7#f7 ,evaluation ,not later than the end of fiscal year #bjbi1 the ,secretary shall submit to the ,congress an evaluation of the grant program under this subsection that-- 7,a7 assesses the effectiveness of outreach efforts during the application process in diversifying the pool of grant recipients2 7,b7 makes recommendations for future outreach efforts to diversify the pool of grant recipients for ,department of ,health and ,human ,services grant programs and funding opportunities related to maternal health2 7,c7 assesses the effectiveness of programs funded by grants under this subsection in improving maternal health outcomes for pregnant and postpartum individuals from underserved groups1 to the extent practicable2 and 7,d7 makes recommendations for future ,department of ,health and ,human ,services grant programs and funding opportunities that deliver funding to community-based organizations that provide programs and resources that are aligned with evidence-based practices for improving maternal health outcomes for pregnant and postpartum individuals4 7#g7 ,definition ,in this subsection1 the term underserved groups refers to pregnant and postpartum individuals-- 7,a7 from racial and ethnic minority groups2 7,b7 whose household income is equal to or less than #aej percent of the ,federal poverty line2 7,c7 who live in health professional shortage areas 7as such term is defined in section #ccb of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e772 7,d7 who live in counties with no hospital offering obstetric care1 no birth center1 and no obstetric provider2 or 7,e7 who live in counties with a level of vulnerability of moderate-to-high or higher1 according to the ,social ,vulnerability ,index of the ,centers for ,disease ,control and ,prevention4 7#h7 ,authorization of appropriations ,to carry out this subsection1 there is authorized to be appropriated #aj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7c7 ,respectful maternity care training for all employees in maternity care settings ,part ,b of title ,,vii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bic et seq47 7as amended by section #cjjb71 is amended by adding at the end the following3 #gdc4 ,respectful maternity care training for all employees in maternity care settings 7a7 ,grants ,the ,secretary shall award grants for programs to reduce and prevent bias1 racism1 and discrimination in maternity care settings and to advance respectful1 culturally congruent1 trauma-informed care4 7b7 ,special consideration ,in awarding grants under subsection 7a71 the ,secretary shall give special consideration to applications for programs that would-- 7#a7 apply to all maternity care providers and any employees who interact with pregnant and postpartum individuals in the provider setting1 including front desk employees1 sonographers1 schedulers1 health care professionals1 hospital or health system administrators1 security staff1 and other employees2 7#b7 emphasize periodic1 as opposed to one-time1 trainings for all birthing professionals and employees described in paragraph 7#a72 7#c7 address implicit bias1 racism1 and cultural humility2 7#d7 be delivered in ongoing education settings for providers maintaining their licenses1 with a preference for trainings that provide continuing education units2 7#e7 include trauma-informed care best practices and an emphasis on shared decision making between providers and patients2 7#f7 include antiracism training and programs2 7#g7 be delivered in undergraduate programs that funnel into health professions schools2 7#h7 be delivered in settings that apply to providers of the special supplemental nutrition program for women1 infants1 and children under section #ag of the ,child ,nutrition ,act of #aiff2 7#i7 integrate bias training in obstetric emergency simulation trainings or related trainings2 7#aj7 include training for emergency department employees and emergency medical technicians on recognizing warning signs for severe pregnancy-related complications2 7#aa7 offer training to all maternity care providers on the value of racially1 ethnically1 and professionally diverse maternity care teams to provide culturally congruent care2 or 7#ab7 be based on one or more programs designed by a historically ,black college or university or other minority-serving institution4 7c7 ,application ,to seek a grant under subsection 7a71 an entity shall submit an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7d7 ,reporting to ,secretary ,each recipient of a grant under this section shall annually submit to the ,secretary a report on the status of activities conducted using the grant1 including1 as applicable1 a description of the impact of training provided through the grant on patient outcomes and patient experience for pregnant and postpartum individuals from racial and ethnic minority groups and their families4 7e7 ,dissemination of findings ,based on the annual reports submitted pursuant to subsection 7d71 the ,secretary-- 7#a7 shall produce an annual report on the findings resulting from programs funded through this section2 7#b7 shall disseminate such report to all recipients of grants under this section and to the public2 and 7#c7 may include in such report findings on best practices for improving patient outcomes and patient experience for pregnant and postpartum individuals from racial and ethnic minority groups and their families in maternity care settings4 7f7 ,definitions ,in this section3 7#a7 ,the term postpartum means the one-year period beginning on the last day of an individual's pregnancy4 7#b7 ,the term culturally congruent means in agreement with the preferred cultural values1 beliefs1 world view1 language1 and practices of the health care consumer and other stakeholders4 7#c7 ,the term maternity care provider means a health care provider who-- 7,a7 is a physician1 physician assistant1 midwife who meets at a minimum the international definition of the midwife and global standards for midwifery education as established by the ,international ,confederation of ,midwives1 nurse practitioner1 or clinical nurse specialist2 and 7,b7 has a focus on maternal or perinatal health4 7#d7 ,the term racial and ethnic minority group has the meaning given such term in section #agjg7;g77#a74 7g7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #e1jjj1jjj for each of fiscal years #bjbe through #bjbi4 4 7d7 ,study on reducing and preventing bias1 racism1 and discrimination in maternity care settings 7#a7 ,in general ,the ,secretary of ,health and ,human ,services shall seek to enter into an agreement1 not later than #ij days after the date of enactment of this ,act1 with the ,national ,academies of ,sciences1 ,engineering1 and ,medicine 7referred to in this subsection as the ,national ,academies7 under which the ,national ,academies agree to-- 7,a7 conduct a study on the design and implementation of programs to reduce and prevent bias1 racism1 and discrimination in maternity care settings and to advance respectful1 culturally congruent1 trauma-informed care2 and 7,b7 not later than #b years after the date of enactment of this ,act-- 7i7 complete the study2 and 7ii7 transmit a report on the results of the study to the ,congress4 7#b7 ,possible topics ,the agreement entered into pursuant to paragraph 7#a7 may provide for the study of any of the following3 7,a7 ,the development of a scorecard or other evaluation standards for programs designed to reduce and prevent bias1 racism1 and discrimination in maternity care settings to assess the effectiveness of such programs in improving patient outcomes and patient experience for pregnant and postpartum individuals from racial and ethnic minority groups and their families4 7,b7 ,determination of the types and frequency of training to reduce and prevent bias1 racism1 and discrimination in maternity care settings that are demonstrated to improve patient outcomes or patient experience for pregnant and postpartum individuals from racial and ethnic minority groups and their families4 7e7 ,respectful maternity care compliance program 7#a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this subsection as the ,secretary7 shall award grants to accredited hospitals1 health systems1 and other maternity care settings to establish as an integral part of quality implementation initiatives within one or more hospitals or other birth settings a respectful maternity care compliance program4 7#b7 ,program requirements ,a respectful maternity care compliance program funded through a grant under this subsection shall-- 7,a7 institutionalize mechanisms to allow patients receiving maternity care services1 the families of such patients1 or perinatal health workers supporting such patients to report instances of racism or evidence of bias on the basis of race1 ethnicity1 or another protected class2 7,b7 institutionalize response mechanisms through which representatives of the program can directly follow up with the patient1 if possible1 and the patient's family in a timely manner2 7,c7 prepare1 and make publicly available1 a hospital- or health system-wide strategy to reduce bias on the basis of race1 ethnicity1 or another protected class in the delivery of maternity care that includes-- 7i7 information on the training programs to reduce and prevent bias1 racism1 and discrimination on the basis of race1 ethnicity1 or another protected class for all employees in maternity care settings2 7ii7 information on the number of cases reported to the compliance program2 and 7iii7 the development of methods to routinely assess the extent to which bias1 racism1 or discrimination on the basis of race1 ethnicity1 or another protected class are present in the delivery of maternity care to patients from racial and ethnic minority groups2 7,d7 develop mechanisms to routinely collect and publicly report hospital-level data related to patient-reported experience of care2 and 7,e7 provide annual reports to the ,secretary with information about each case reported to the compliance program over the course of the year containing such information as the ,secretary may require1 such as-- 7i7 de-identified demographic information on the patient in the case1 such as race1 ethnicity1 gender identity1 and primary language2 7ii7 the content of the report from the patient or the family of the patient to the compliance program2 7iii7 the response from the compliance program2 and 7iv7 to the extent applicable1 institutional changes made as a result of the case4 7#c7 ,secretary requirements 7,a7 ,processes ,not later than #ahj days after the date of enactment of this ,act1 the ,secretary shall establish processes for-- 7i7 disseminating best practices for establishing and implementing a respectful maternity care compliance program within a hospital or other birth setting2 7ii7 promoting coordination and collaboration between hospitals1 health systems1 and other maternity care delivery settings on the establishment and implementation of respectful maternity care compliance programs2 and 7iii7 evaluating the effectiveness of respectful maternity care compliance programs on maternal health outcomes and patient and family experiences1 especially for patients from racial and ethnic minority groups and their families4 7,b7 ,study 7i7 ,in general ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall1 through a contract with an independent research organization1 conduct a study on strategies to address-- 7,i7 racism or bias on the basis of race1 ethnicity1 or another protected class in the delivery of maternity care services2 and 7,,ii7 successful implementation of respectful care initiatives4 7ii7 ,components of study ,the study shall include the following3 7,i7 ,an assessment of the reports submitted to the ,secretary from the respectful maternity care compliance programs pursuant to paragraph 7#b77;,e74 7,,ii7 ,based on such assessment1 recommendations for potential accountability mechanisms related to cases of racism or bias on the basis of race1 ethnicity1 or another protected class in the delivery of maternity care services at hospitals and other birth settings4 ,such recommendations shall take into consideration medical and non-medical factors that contribute to adverse patient experiences and maternal health outcomes4 7iii7 ,report ,the ,secretary shall submit to the ,congress1 and make publicly available1 a report on the results of the study under this subparagraph4 7#d7 ,authorization of appropriations ,to carry out this subsection1 there is authorized to be appropriated such sums as may be necessary for fiscal years #bjbe through #bjcj4 7f7 ,,gao report 7#a7 ,in general ,not later than #b years after the date of enactment of this ,act and annually thereafter1 the ,comptroller ,general of the ,united ,states shall submit to the ,congress1 and make publicly available1 a report on the establishment of respectful maternity care compliance programs within hospitals1 health systems1 and other maternity care settings4 7#b7 ,matters included ,the report under paragraph 7#a7 shall include the following3 7,a7 ,information regarding the extent to which hospitals1 health systems1 and other maternity care settings have elected to establish respectful maternity care compliance programs1 including-- 7i7 which hospitals and other birth settings elect to establish compliance programs and when such programs are established2 7ii7 to the extent practicable1 impacts of the establishment of such programs on maternal health outcomes and patient and family experiences in the hospitals and other birth settings that have established such programs1 especially for patients from racial and ethnic minority groups and their families2 7iii7 information on geographic areas1 and types of hospitals or other birth settings1 where respectful maternity care compliance programs are not being established and information on factors contributing to decisions to not establish such programs2 and 7iv7 recommendations for establishing respectful maternity care compliance programs in geographic areas1 and types of hospitals or other birth settings1 where such programs are not being established4 7,b7 ,whether the funding made available to carry out this subsection has been sufficient and1 if applicable1 recommendations for additional appropriations to carry out this subsection4 7,c7 ,such other information as the ,comptroller ,general determines appropriate4 7g7 ,definitions ,in this section3 7#a7 ,culturally congruent ,the term culturally congruent1 with respect to care or maternity care1 means care that is in agreement with the preferred cultural values1 beliefs1 worldview1 language1 and practices of the health care consumer and other stakeholders4 7#b7 ,maternity care provider ,the term maternity care provider means a health care provider who-- 7,a7 is a physician1 physician assistant1 midwife who meets at a minimum the international definition of the midwife and global standards for midwifery education as established by the ,international ,confederation of ,midwives1 nurse practitioner1 or clinical nurse specialist2 and 7,b7 has a focus on maternal or perinatal health4 7#c7 ,maternal mortality ,the term maternal mortality means a death occurring during or within a one-year period after pregnancy1 caused by pregnancy-related or childbirth complications1 including a suicide1 overdose1 or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy-related or childbirth complications4 7#d7 ,perinatal health worker ,the term perinatal health worker means a doula1 community health worker1 peer supporter1 breastfeeding and lactation educator or counselor1 nutritionist or dietitian1 childbirth educator1 social worker1 home visitor1 language interpreter1 or navigator4 7#e7 ,postpartum and postpartum period ,the terms postpartum and postpartum period refer to the #a-year period beginning on the last day of the pregnancy of an individual4 7#f7 ,pregnancy-associated death ,the term pregnancy-associated death means a death of a pregnant or postpartum individual1 by any cause1 that occurs during1 or within #a year following1 the individual's pregnancy1 regardless of the outcome1 duration1 or site of the pregnancy4 7#g7 ,pregnancy-related death ,the term pregnancy-related death means a death of a pregnant or postpartum individual that occurs during1 or within #a year following1 the individual's pregnancy1 from a pregnancy complication1 a chain of events initiated by pregnancy1 or the aggravation of an unrelated condition by the physiologic effects of pregnancy4 7#h7 ,racial and ethnic minority group ,the term racial and ethnic minority group has the meaning given such term in section #agjg7;g77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a774 7#i7 ,severe maternal morbidity ,the term severe maternal morbidity means a health condition1 including mental health conditions and substance use disorders1 attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant4 7#aj7 ,social determinants of maternal health defined ,the term social determinants of maternal health means non-clinical factors that impact maternal health outcomes1 including-- 7,a7 economic factors1 which may include poverty1 employment1 food security1 support for and access to lactation and other infant feeding options1 housing stability1 and related factors2 7,b7 neighborhood factors1 which may include quality of housing1 access to transportation1 access to child care1 availability of healthy foods and nutrition counseling1 availability of clean water1 air and water quality1 ambient temperatures1 neighborhood crime and violence1 access to broadband1 and related factors2 7,c7 social and community factors1 which may include systemic racism1 gender discrimination or discrimination based on other protected classes1 workplace conditions1 incarceration1 and related factors2 7,d7 household factors1 which may include ability to conduct lead testing and abatement1 car seat installation1 indoor air temperatures1 and related factors2 7,e7 education access and quality factors1 which may include educational attainment1 language and literacy1 and related factors2 and 7,f7 health care access factors1 including health insurance coverage1 access to culturally congruent health care services1 providers1 and non-clinical support1 access to home visiting services1 access to wellness and stress management programs1 health literacy1 access to telehealth and items required to receive telehealth services1 and related factors4 #ebje4 ,perinatal workforce 7a7 ,,hhs agency directives 7#a7 ,guidance to ,states 7,a7 ,in general ,not later than #b years after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall issue and disseminate guidance to ,states to educate providers1 managed care entities1 and other insurers about the value and process of delivering respectful maternal health care through diverse and multidisciplinary care provider models4 7,b7 ,contents ,the guidance required by subparagraph 7,a7 shall address how ,states can encourage and incentivize hospitals1 health systems1 midwifery practices1 freestanding birth centers1 other maternity care provider groups1 managed care entities1 and other insurers-- 7i7 to recruit and retain maternity care providers1 mental and behavioral health care providers acting in accordance with ,state law1 registered dietitians or nutrition professionals 7as such term is defined in section #ahfa7vv77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7vv77#b7771 and lactation consultants certified by the ,international ,board of ,lactation ,consultants ,examiners-- 7,i7 from racially1 ethnically1 and linguistically diverse backgrounds2 7,,ii7 with experience practicing in racially and ethnically diverse communities2 and 7,,iii7 who have undergone training on implicit bias and racism2 7ii7 to incorporate into maternity care teams-- 7,i7 midwives who meet1 at a minimum1 the international definition of the midwife and global standards for midwifery education1 as established by the ,international ,confederation of ,midwives2 and 7,,ii7 perinatal health workers2 7iii7 to provide collaborative1 culturally congruent care2 and 7iv7 to provide opportunities for individuals enrolled in accredited midwifery education programs to participate in job shadowing with maternity care teams in hospitals1 health systems1 midwifery practices1 and freestanding birth centers4 7#b7 ,study on respectful and culturally congruent maternity care 7,a7 ,study ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,national ,institutes of ,health 7in this paragraph referred to as the ,secretary71 shall conduct a study on best practices in respectful and culturally congruent maternity care4 7,b7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall-- 7i7 complete the study required by subparagraph 7,a72 7ii7 submit to the ,congress1 and make publicly available1 a report on the results of such study2 and 7iii7 include in such report-- 7,i7 a compendium of examples of hospitals1 health systems1 midwifery practices1 freestanding birth centers1 other maternity care provider groups1 managed care entities1 and other insurers that are delivering respectful and culturally congruent maternal health care2 7,,ii7 a compendium of examples of hospitals1 health systems1 midwifery practices1 freestanding birth centers1 other maternity care provider groups1 managed care entities1 and other insurers that have made progress in reducing inequities in maternal health outcomes and improving birthing experiences for pregnant and postpartum individuals from racial and ethnic minority groups2 and 7,,iii7 recommendations to hospitals1 health systems1 midwifery practices1 freestanding birth centers1 other maternity care provider groups1 managed care entities1 and other insurers1 for best practices in respectful and culturally congruent maternity care4 7b7 ,grants ,to grow and diversify the perinatal workforce ,title ,,vii of the ,public ,health ,service ,act is amended by inserting after section #geg 7#db ,u4,s4,c4 #bid;f7 the following3 #geh4 ,perinatal workforce grants 7a7 ,in general ,the ,secretary shall award grants to entities to establish or expand programs described in subsection 7b7 to grow and diversify the perinatal workforce4 7b7 ,use of funds ,recipients of grants under this section shall use the grants to grow and diversify the perinatal workforce by-- 7#a7 establishing schools or programs that provide education and training to individuals seeking appropriate licensing or certification as-- 7,a7 physician assistants who will complete clinical training in the field of maternal and perinatal health2 or 7,b7 perinatal health workers2 and 7#b7 expanding the capacity of existing schools or programs described in paragraph 7#a71 for the purposes of increasing the number of students enrolled in such schools or programs1 including by awarding scholarships for students4 7c7 ,prioritization ,in awarding grants under this section1 the ,secretary shall give priority to any entity that-- 7#a7 has demonstrated a commitment to recruiting and retaining students and faculty from racial and ethnic minority groups2 7#b7 has developed a strategy to recruit and retain a diverse pool of students into the perinatal workforce program or school supported by funds received through the grant1 particularly from racial and ethnic minority groups and other underserved populations2 7#c7 has developed a strategy to recruit and retain students who plan to practice in a health professional shortage area designated under section #ccb2 7#d7 has developed a strategy to recruit and retain students who plan to practice in an area with significant racial and ethnic inequities in maternal health outcomes1 to the extent practicable2 and 7#e7 includes in the standard curriculum for all students within the perinatal workforce program or school a bias1 racism1 or discrimination training program that includes training on implicit bias and racism4 7d7 ,reporting ,as a condition on receipt of a grant under this section for a perinatal workforce program or school1 an entity shall agree to submit to the ,secretary an annual report on the activities conducted through the grant1 including-- 7#a7 the number and demographics of students participating in the program or school2 7#b7 the extent to which students in the program or school are entering careers in-- 7,a7 health professional shortage areas designated under section #ccb2 and 7,b7 areas with significant racial and ethnic inequities in maternal health outcomes1 to the extent such data are available2 and 7#c7 whether the program or school has included in the standard curriculum for all students a bias1 racism1 or discrimination training program that includes explicit and implicit bias1 and if so the effectiveness of such training program4 7e7 ,period of grants ,the period of a grant under this section shall not exceed #e years4 7f7 ,application ,to seek a grant under this section1 an entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require1 including any information necessary for prioritization under subsection 7c74 7g7 ,technical assistance ,the ,secretary shall provide1 directly or by contract1 technical assistance to entities seeking or receiving a grant under this section on the development1 use1 evaluation1 and post-grant period sustainability of the perinatal workforce programs or schools proposed to be1 or being1 established or expanded through the grant4 7h7 ,report by the ,secretary ,not later than #d years after the date of enactment of this section1 the ,secretary shall prepare and submit to the ,congress1 and post on the internet website of the ,department of ,health and ,human ,services1 a report on the effectiveness of the grant program under this section at-- 7#a7 recruiting students from racial and ethnic minority groups2 7#b7 increasing the number of physician assistants who will complete clinical training in the field of maternal and perinatal health1 and perinatal health workers1 from racial and ethnic minority groups and other underserved populations2 7#c7 increasing the number of physician assistants who will complete clinical training in the field of maternal and perinatal health1 and perinatal health workers1 working in health professional shortage areas designated under section #ccb2 and 7#d7 increasing the number of physician assistants who will complete clinical training in the field of maternal and perinatal health1 and perinatal health workers1 working in areas with significant racial and ethnic inequities in maternal health outcomes1 to the extent such data are available4 7i7 ,definition ,in this section1 the term racial and ethnic minority group has the meaning given such term in section #agjg7;g74 7j7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #ae1jjj1jjj for each of fiscal years #bjbe through #bjbi4 4 7c7 ,grants ,to grow and diversify the nursing workforce in maternal and perinatal health ,title ,,viii of the ,public ,health ,service ,act is amended by inserting after section #haa 7#db ,u4,s4,c4 #bif;j7 the following3 #hab4 ,perinatal nursing workforce grants 7a7 ,in general ,the ,secretary shall award grants to schools of nursing to grow and diversify the perinatal nursing workforce4 7b7 ,use of funds ,recipients of grants under this section shall use the grants to grow and diversify the perinatal nursing workforce by providing scholarships to students seeking to become-- 7#a7 nurse practitioners whose education includes a focus on maternal and perinatal health2 or 7#b7 clinical nurse specialists whose education includes a focus on maternal and perinatal health4 7c7 ,prioritization ,in awarding grants under this section1 the ,secretary shall give priority to any school of nursing that-- 7#a7 has developed a strategy to recruit and retain a diverse pool of students seeking to enter careers focused on maternal and perinatal health1 particularly students from racial and ethnic minority groups and other underserved populations2 7#b7 has developed a partnership with a practice setting in a health professional shortage area designated under section #ccb for the clinical placements of the school's students2 7#c7 has developed a strategy to recruit and retain students who plan to practice in an area with significant racial and ethnic inequities in maternal health outcomes1 to the extent practicable2 and 7#d7 includes in the standard curriculum for all students seeking to enter careers focused on maternal and perinatal health a bias1 racism1 or discrimination training program that includes education on implicit bias and racism4 7d7 ,reporting ,as a condition on receipt of a grant under this section1 a school of nursing shall agree to submit to the ,secretary an annual report on the activities conducted through the grant1 including1 to the extent practicable-- 7#a7 the number and demographics of students in the school of nursing seeking to enter careers focused on maternal and perinatal health2 7#b7 the extent to which such students are preparing to enter careers in-- 7,a7 health professional shortage areas designated under section #ccb2 and 7,b7 areas with significant racial and ethnic inequities in maternal health outcomes1 to the extent such data are available2 and 7#c7 whether the standard curriculum for all students seeking to enter careers focused on maternal and perinatal health includes a bias1 racism1 or discrimination training program that includes education on implicit bias and racism4 7e7 ,period of grants ,the period of a grant under this section shall be up to #e years4 7f7 ,application ,to seek a grant under this section1 an entity shall submit to the ,secretary an application1 at such time1 in such manner1 and containing such information as the ,secretary may require1 including any information necessary for prioritization under subsection 7c74 7g7 ,technical assistance ,the ,secretary shall provide1 directly or by contract1 technical assistance to schools of nursing seeking or receiving a grant under this section on the processes of awarding and evaluating scholarships through the grant4 7h7 ,report by the ,secretary ,not later than #d years after the date of enactment of this section1 the ,secretary shall prepare and submit to the ,congress1 and post on the internet website of the ,department of ,health and ,human ,services1 a report on the effectiveness of the grant program under this section at-- 7#a7 recruiting students from racial and ethnic minority groups and other underserved populations2 7#b7 increasing the number of nurse practitioners and clinical nurse specialists entering careers focused on maternal and perinatal health from racial and ethnic minority groups and other underserved populations2 7#c7 increasing the number of nurse practitioners and clinical nurse specialists entering careers focused on maternal and perinatal health working in health professional shortage areas designated under section #ccb2 and 7#d7 increasing the number of nurse practitioners and clinical nurse specialists entering careers focused on maternal and perinatal health working in areas with significant racial and ethnic inequities in maternal health outcomes1 to the extent such data are available4 7i7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #ae1jjj1jjj for each of fiscal years #bjbe through #bjbi4 4 7d7 ,,gao report 7#a7 ,in general ,not later than #b years after the date of enactment of this ,act1 and every #e years thereafter1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report on barriers to maternal health education and access to care in the ,united ,states4 ,such report shall include the information and recommendations described in paragraph 7#b74 7#b7 ,content of report ,the report under paragraph 7#a7 shall include-- 7,a7 an assessment of current barriers to entering accredited midwifery education programs1 and recommendations for addressing such barriers1 particularly for low-income people and people from racial and ethnic minority groups2 7,b7 an assessment of current barriers to entering and successfully completing accredited education programs for other health professional careers related to maternity care1 including maternity care providers1 mental and behavioral health care providers acting in accordance with ,state law1 registered dietitians or nutrition professionals 7as such term is defined in section #ahfa7vv77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7vv77#b7771 and lactation consultants certified by the ,international ,board of ,lactation ,consultants ,examiners1 particularly for low-income people and people from racial and ethnic minority groups2 7,c7 an assessment of current barriers that prevent midwives from meeting the international definition of the midwife and global standards for midwifery education as established by the ,international ,confederation of ,midwives1 and recommendations for addressing such barriers1 particularly for low-income people and people from racial and ethnic minority groups2 7,d7 an assessment of inequities in access to maternity care providers1 mental or behavioral health care providers acting in accordance with ,state law1 registered dietitians or nutrition professionals 7as such term is defined in section #ahfa7vv77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7vv77#b7771 lactation consultants certified by the ,international ,board of ,lactation ,consultants ,examiners1 and perinatal health workers1 stratified by race1 ethnicity1 gender identity1 geographic location1 and insurance type and recommendations to promote greater access equity2 and 7,e7 recommendations to promote greater equity in compensation for perinatal health workers under public and private insurers1 particularly for such individuals from racially and ethnically diverse backgrounds4 7e7 ,definitions ,in this section3 7#a7 ,culturally congruent ,the term culturally congruent1 with respect to care or maternity care1 means care that is in agreement with the preferred cultural values1 beliefs1 worldview1 language1 and practices of the health care consumer and other stakeholders4 7#b7 ,maternity care provider ,the term maternity care provider means a health care provider who-- 7,a7 is a physician1 physician assistant1 midwife who meets at a minimum the international definition of the midwife and global standards for midwifery education as established by the ,international ,confederation of ,midwives1 nurse practitioner1 or clinical nurse specialist2 and 7,b7 has a focus on maternal or perinatal health4 7#c7 ,perinatal health worker ,the term perinatal health worker means a doula1 community health worker1 peer supporter1 breastfeeding and lactation educator or counselor1 nutritionist or dietitian1 childbirth educator1 social worker1 home visitor1 language interpreter1 or navigator4 7#d7 ,postpartum ,the terms postpartum refers to the #a-year period beginning on the last day of the pregnancy of an individual4 7#e7 ,racial and ethnic minority group ,the term racial and ethnic minority group has the meaning given such term in section #agjg7;g77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a774 #ebjf4 ,data to ,save ,moms ,act 7a7 ,short title ,this section may be cited as the ,data ,to ,save ,moms ,act4 7b7 ,funding for maternal mortality review committees ,to promote representative community engagement 7#a7 ,in general ,section #cag,k7d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;d77 is amended by adding at the end the following3 7#i7 ,grants to promote representative community engagement in maternal mortality review committees 7,a7 ,in general ,the ,secretary may1 using funds made available pursuant to subparagraph 7,c71 provide assistance to an applicable maternal mortality review committee of a ,state1 ,indian tribe1 tribal organization1 or ,urban ,indian organization 7as such terms are defined in section #d of the ,indian ,health ,care ,improvement ,act7-- 7i7 to select for inclusion in the membership of such a committee community members from the ,state1 ,indian tribe1 tribal organization1 or ,urban ,indian organization by-- 7,i7 prioritizing community members who can increase the diversity of the committee's membership with respect to race and ethnicity1 location1 and professional background1 including members with non-clinical experiences2 and 7,,ii7 to the extent applicable1 using funds reserved under subsection 7f71 to address barriers to maternal mortality review committee participation for community members1 including through providing required training1 reducing transportation barriers1 providing compensation1 and providing other supports as may be necessary2 7ii7 to establish initiatives to conduct outreach and community engagement efforts within communities throughout the ,state or ,indian tribe to seek input from community members on the work of such maternal mortality review committee1 with a particular focus on outreach to people who are members of minority groups2 and 7iii7 to release public reports assessing-- 7,i7 the pregnancy-related death and pregnancy-associated death review processes of the maternal mortality review committee1 with a particular focus on the maternal mortality review committee's sensitivity to the unique circumstances of pregnant and postpartum individuals from racial and ethnic minority groups 7as such term is defined in section #agjg7;g77#a77 who have suffered pregnancy-related deaths2 and 7,,ii7 the impact of the use of funds made available pursuant to paragraph 7,c7 on increasing the diversity of the maternal mortality review committee membership and promoting community engagement efforts throughout the ,state or ,indian tribe4 7,b7 ,technical assistance ,the ,secretary shall provide 7either directly through the ,department of ,health and ,human ,services or by contract7 technical assistance to any maternal mortality review committee receiving a grant under this paragraph on best practices for increasing the diversity of the maternal mortality review committee's membership and for conducting effective community engagement throughout the ,state or ,indian tribe4 7,c7 ,authorization of appropriations ,in addition to any funds made available under subsection 7f71 there are authorized to be appropriated to carry out this paragraph #aj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 4 7#b7 ,reservation of funds ,section #cag,k7f7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;f77 is amended by adding at the end the following3 ,of the amount made available under the preceding sentence for a fiscal year1 not less than #a1ejj1jjj shall be reserved for grants awarded under subsection 7d77#i7 to ,indian tribes1 tribal organizations1 or ,urban ,indian organizations 7as such terms are defined in section #d of the ,indian ,health ,care ,improvement ,act744 7c7 ,data collection and review ,section #cag,k7d77#c77;,a77i7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;d77#c77;,a77i77 is amended-- 7#a7 by redesignating subclauses 7,,ii7 and 7,,iii7 as subclauses 7,v7 and 7,,vi71 respectively2 and 7#b7 by inserting after subclause 7,i7 the following3 7,,ii7 to the extent practicable1 reviewing cases of severe maternal morbidity1 according to the most up-to-date indicators2 7,,iii7 to the extent practicable1 reviewing deaths during pregnancy or up to #a year after the end of a pregnancy from suicide1 overdose1 or other death from a mental health condition or substance use disorder attributed to1 or aggravated by1 pregnancy or childbirth complications2 7,,iv7 to the extent practicable1 consulting with local community-based organizations representing pregnant and postpartum individuals from demographic groups disproportionately impacted by poor maternal health outcomes to ensure that1 in addition to clinical factors1 non-clinical factors that might have contributed to a pregnancy-related death are appropriately considered2 4 7d7 ,review of maternal health data collection processes and quality measures 7#a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator for the ,centers for ,medicare ,medicaid ,services and the ,director of the ,agency for ,healthcare ,research and ,quality 7referred to in this subsection as the ,secretary71 shall consult with relevant stakeholders-- 7,a7 to review existing maternal health data collection processes and quality measures2 and 7,b7 to make recommendations to improve such processes and measures1 including topics described in paragraph 7#c74 7#b7 ,collaboration ,in carrying out this subsection1 the ,secretary shall consult with a diverse group of maternal health stakeholders1 which may include-- 7,a7 pregnant and postpartum individuals and their family members1 and nonprofit organizations representing such individuals1 with a particular focus on patients from racial and ethnic minority groups2 7,b7 community-based organizations that provide support for pregnant and postpartum individuals1 with a particular focus on patients from racial and ethnic minority groups2 7,c7 membership organizations for maternity care providers2 7,d7 organizations representing perinatal health workers2 7,e7 organizations that focus on maternal mental or behavioral health2 7,f7 organizations that focus on intimate partner violence2 7,g7 institutions of higher education1 with a particular focus on minority-serving institutions2 7,h7 licensed and accredited hospitals1 birth centers1 midwifery practices1 or other medical practices that provide maternal health care services to pregnant and postpartum patients2 7,i7 relevant ,state and local public agencies1 including ,state maternal mortality review committees2 and 7,j7 the ,national ,quality ,forum1 or such other standard-setting organizations specified by the ,secretary4 7#c7 ,topics ,the review of maternal health data collection processes and recommendations to improve such processes and measures required under paragraph 7#a7 shall assess all available relevant information1 including information from ,state-level sources1 and shall consider at least the following3 7,a7 ,current ,state and ,tribal practices for maternal health1 maternal mortality1 and severe maternal morbidity data collection and dissemination1 including consideration of-- 7i7 the timeliness of processes for amending a death certificate when new information pertaining to the death becomes available to reflect whether the death was a pregnancy-related death2 7ii7 relevant data collected with electronic health records1 including data on race1 ethnicity1 socioeconomic status1 insurance type1 and other relevant demographic information2 7iii7 maternal health data collected and publicly reported by hospitals1 health systems1 midwifery practices1 and birth centers2 7iv7 the barriers preventing ,states from correlating maternal outcome data with race and ethnicity data2 7v7 processes for determining the cause of a pregnancy-associated death in ,states that do not have a maternal mortality review committee2 7vi7 whether maternal mortality review committees include multidisciplinary and diverse membership 7as described in section #cag,k7d77#a77;,a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;d77#a77;,a7772 7vii7 whether members of maternal mortality review committees participate in trainings on bias1 racism1 or discrimination1 and the quality of such trainings2 7viii7 the extent to which ,states have implemented systematic processes of listening to the stories of pregnant and postpartum individuals and their family members1 with a particular focus on pregnant and postpartum individuals from racial and ethnic minority groups and their family members1 to fully understand the causes of1 and inform potential solutions to1 the maternal mortality and severe maternal morbidity crisis within their respective ,states2 7ix7 the extent to which maternal mortality review committees are considering social determinants of maternal health when examining the causes of pregnancy-associated and pregnancy-related deaths2 7x7 the extent to which maternal mortality review committees are making actionable recommendations based on their reviews of adverse maternal health outcomes and the extent to which such recommendations are being implemented by appropriate stakeholders2 7xi7 the legal and administrative barriers preventing the collection1 collation1 and dissemination of ,state maternity care data2 7xii7 the effectiveness of data collection and reporting processes in separating pregnancy-associated deaths from pregnancy-related deaths2 and 7xiii7 the current ,federal1 ,state1 local1 and ,tribal funding support for the activities referred to in clauses 7i7 through 7xii74 7,b7 ,whether the funding support referred to in subparagraph 7,a77xiii7 is adequate for ,states to carry out optimal data collection and dissemination processes with respect to maternal health1 maternal mortality1 and severe maternal morbidity4 7,c7 ,current quality measures for maternity care1 including prenatal measures1 labor and delivery measures1 and postpartum measures1 including topics such as-- 7i7 effective quality measures for maternity care used by hospitals1 health systems1 midwifery practices1 birth centers1 health plans1 and other relevant entities2 7ii7 the sufficiency of current outcome measures used to evaluate maternity care for driving improved care1 experiences1 and outcomes in maternity care payment and delivery system models2 7iii7 maternal health quality measures that other countries effectively use2 7iv7 validated measures that have been used for research purposes that could be tested1 refined1 and submitted for national endorsement2 7v7 barriers preventing maternity care providers and insurers from implementing quality measures that are aligned with best practices2 7vi7 the frequency with which maternity care quality measures are reviewed and revised2 7vii7 the strengths and weaknesses of the ,prenatal and ,postpartum ,care measures of the ,health ,plan ,employer ,data and ,information ,set measures established by the ,national ,committee for ,quality ,assurance2 7viii7 the strengths and weaknesses of maternity care quality measures under the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 and the ,children's ,health ,insurance ,program under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;aa et seq471 including the extent to which ,states voluntarily report relevant measures2 7ix7 the extent to which maternity care quality measures are informed by patient experiences that include measures of patient-reported experience of care2 7x7 the current processes for collecting stratified data on the race and ethnicity of pregnant and postpartum individuals in hospitals1 health systems1 midwifery practices1 and birth centers1 and for incorporating such racially and ethnically stratified data in maternity care quality measures2 7xi7 the extent to which maternity care quality measures account for the unique experiences of pregnant and postpartum individuals from racial and ethnic minority groups2 and 7xii7 the extent to which hospitals1 health systems1 midwifery practices1 and birth centers are implementing existing maternity care quality measures4 7,d7 ,recommendations on authorizing additional funds and providing additional technical assistance to improve maternal mortality review committees and ,state and ,tribal maternal health data collection and reporting processes4 7,e7 ,recommendations for new authorities that may be granted to maternal mortality review committees to be able to-- 7i7 access records from other ,federal and ,state agencies and departments that may be necessary to identify causes of pregnancy-associated and pregnancy-related deaths that are unique to pregnant and postpartum individuals from specific populations1 such as veterans and individuals who are incarcerated2 and 7ii7 work with relevant experts who are not members of the maternal mortality review committee to assist in the review of pregnancy-associated deaths of pregnant and postpartum individuals from specific populations1 such as veterans and individuals who are incarcerated4 7,f7 ,recommendations to improve and standardize current quality measures for maternity care1 with a particular focus on racial and ethnic inequities in maternal health outcomes4 7,g7 ,recommendations to improve the coordination by the ,department of ,health and ,human ,services of the efforts undertaken by the agencies and organizations within the ,department related to maternal health data and quality measures4 7#d7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall submit to ,congress1 and make publicly available1 a report on the results of the review of maternal health data collection processes and quality measures and recommendations to improve such processes and measures required under paragraph 7#a74 7#e7 ,definition of maternal mortality review committee ,in this subsection1 the term maternal mortality review committee means a maternal mortality review committee duly authorized by a ,state and receiving funding under section #cag,k7a77#b77;,d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#ab7;a77#b77;,d774 7#f7 ,authorization of appropriations ,there are authorized to be appropriated such sums as may be necessary to carry out this subsection for each of fiscal years #bjbe through #bjbi4 7e7 ,indian ,health ,service study on maternal mortality and severe maternal morbidity 7#a7 ,in general ,the ,director of the ,indian ,health ,service 7referred to in this subsection as the ,director7 shall1 in coordination with entities described in paragraph 7#b7-- 7,a7 not later than #ij days after the date of enactment of this ,act1 enter into a contract with an independent research organization or ,tribal ,epidemiology ,center to conduct a comprehensive study on maternal mortality and severe maternal morbidity in the populations of ,american ,indian and ,alaska ,native individuals2 and 7,b7 not later than #c years after the date of enactment of this ,act1 submit to ,congress a report on that study that contains recommendations for policies and practices that can be adopted to improve maternal health outcomes for pregnant and postpartum ,american ,indian and ,alaska ,native individuals4 7#b7 ,participating entities 7,a7 ,in general ,the entities referred to in paragraph 7#a7 shall consist of #ab members1 selected by the ,director from among individuals nominated by ,indian ,tribes and ,tribal organizations 7as those terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd77 and ,urban ,indian organizations 7as defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc774 7,b7 ,requirement ,in selecting members under subparagraph 7,a71 the ,director shall ensure that each of the #ab service areas of the ,indian ,health ,service are represented4 7#c7 ,contents of study ,the study conducted pursuant to paragraph 7#a77;,a7 shall-- 7,a7 examine the causes of maternal mortality and severe maternal morbidity that are unique to ,american ,indian and ,alaska ,native individuals2 7,b7 include a systematic process of listening to the stories of ,american ,indian and ,alaska ,native pregnant and postpartum individuals to fully understand the causes of1 and inform potential solutions to1 the maternal mortality and severe maternal morbidity crisis within the communities of those individuals2 7,c7 distinguish between the causes of1 landscape of maternity care at1 and recommendations to improve maternal health outcomes within the different settings in which ,american ,indian and ,alaska ,native pregnant and postpartum individuals receive maternity care1 including-- 7i7 facilities operated by the ,indian ,health ,service2 7ii7 an ,indian health program operated by an ,indian ,tribe or a ,tribal organization 7as those terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd77 pursuant to a contract1 grant1 cooperative agreement1 or compact with the ,indian ,health ,service pursuant to the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecja et seq472 and 7iii7 an ,urban ,indian health program operated by an ,urban ,indian organization 7as defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc77 pursuant to a grant or contract with the ,indian ,health ,service pursuant to title ,v of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afea et seq472 7,d7 review processes for coordinating programs of the ,indian ,health ,service with social services provided through other programs administered by the ,secretary of ,health and ,human ,services 7other than the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 the ,medicaid program under title ,,xix of that ,act 7#db ,u4,s4,c4 #acif et seq471 and the ,state ,children's ,health ,insurance ,program under title ,,xxi of that ,act 7#db ,u4,s4,c4 #acig;aa et seq4772 7,e7 review current data collection and quality measurement processes and practices2 7,f7 assess causes and frequency of maternal mental health conditions and substance use disorders2 7,g7 consider social determinants of health1 including poverty1 lack of health insurance1 unemployment1 sexual violence1 and environmental conditions in ,tribal areas2 7,h7 consider the role that historical mistreatment of ,american ,indian and ,alaska ,native people has played in causing currently high rates of maternal mortality and severe maternal morbidity2 7,i7 consider how current funding of the ,indian ,health ,service affects the ability of the ,indian ,health ,service to deliver quality maternity care2 7,j7 consider the extent to which the delivery of maternity care services is culturally appropriate for ,american ,indian and ,alaska ,native pregnant and postpartum individuals2 7,k7 make recommendations to reduce misclassification of ,american ,indian and ,alaska ,native pregnant and postpartum individuals1 including consideration of best practices in training for maternal mortality review committee members to be able to correctly classify ,american ,indian and ,alaska ,native individuals2 and 7,l7 make recommendations informed by the stories shared by ,american ,indian and ,alaska ,native pregnant and postpartum individuals pursuant to subparagraph 7,b7 to improve maternal health outcomes for those individuals4 7#d7 ,report ,the agreement entered into under paragraph 7#a77;,a7 with an independent research organization or ,tribal ,epidemiology ,center shall require that the independent research organization or ,tribal ,epidemiology ,center1 as applicable1 submit to ,congress a report on the results of the study conducted pursuant to that agreement not later than #cf months after the date of enactment of this ,act4 7#e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this subsection #b1jjj1jjj for each of fiscal years #bjbe through #bjbg4 7f7 ,grants to minority-,serving institutions to study maternal mortality1 severe maternal morbidity1 and other adverse maternal health outcomes 7#a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this subsection as the ,secretary7 shall establish a program under which the ,secretary shall award grants to research centers1 health professions schools and programs1 and other entities at minority-serving institutions to study specific aspects of the maternal health crisis among pregnant and postpartum individuals from racial and ethnic minority groups4 ,such research may-- 7,a7 include the development and implementation of systematic processes of listening to the stories of pregnant and postpartum individuals from racial and ethnic minority groups1 and perinatal health workers supporting such individuals1 to fully understand the causes of1 and inform potential solutions to1 the maternal mortality and severe maternal morbidity crisis within their respective communities2 7,b7 assess the potential causes of relatively low rates of maternal mortality among ,hispanic individuals1 including potential racial misclassification and other data collection and reporting issues that might be misrepresenting maternal mortality rates among ,hispanic individuals in the ,united ,states2 and 7,c7 assess differences in rates of adverse maternal health outcomes among subgroups identifying as ,hispanic4 7#b7 ,application ,to be eligible to receive a grant under paragraph 7#a71 an entity described in such paragraph shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7#c7 ,technical assistance ,the ,secretary may use not more than #aj percent of the funds made available under paragraph 7#g7-- 7,a7 to conduct outreach to minority-serving institutions to raise awareness of the availability of grants under paragraph 7#a72 7,b7 to provide technical assistance in the application process for such a grant2 and 7,c7 to promote capacity building1 as needed to enable entities described in such paragraph to submit such an application4 7#d7 ,reporting requirement ,each entity awarded a grant under this subsection shall periodically submit to the ,secretary a report on the status of activities conducted using the grant4 7#e7 ,evaluation ,beginning one year after the date on which the first grant is awarded under this subsection1 the ,secretary shall submit to ,congress an annual report summarizing the findings of research conducted using funds made available under this subsection4 7#f7 ,minority-,serving institutions defined ,in this subsection1 the term minority-serving institution means an eligible institution described in section #cga7;a7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajfgq7a774 7#g7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this subsection #aj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7g7 ,definitions ,in this section3 7#a7 ,culturally congruent ,the term culturally congruent1 with respect to care or maternity care1 means care that is in agreement with the preferred cultural values1 beliefs1 worldview1 language1 and practices of the health care consumer and other stakeholders4 7#b7 ,maternity care provider ,the term maternity care provider means a health care provider who-- 7,a7 is a physician1 physician assistant1 midwife who meets at a minimum the international definition of the midwife and global standards for midwifery education as established by the ,international ,confederation of ,midwives1 nurse practitioner1 or clinical nurse specialist2 and 7,b7 has a focus on maternal or perinatal health4 7#c7 ,maternal mortality ,the term maternal mortality means a death occurring during or within a one-year period after pregnancy1 caused by pregnancy-related or childbirth complications1 including a suicide1 overdose1 or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy-related or childbirth complications4 7#d7 ,perinatal health worker ,the term perinatal health worker means a doula1 community health worker1 peer supporter1 breastfeeding and lactation educator or counselor1 nutritionist or dietitian1 childbirth educator1 social worker1 home visitor1 language interpreter1 or navigator4 7#e7 ,postpartum and postpartum period ,the terms postpartum and postpartum period refer to the #a-year period beginning on the last day of the pregnancy of an individual4 7#f7 ,pregnancy-associated ,the term pregnancy-associated1 with respect to a death1 means a death of a pregnant or postpartum individual1 by any cause1 that occurs during1 or within #a year following1 the individual's pregnancy1 regardless of the outcome1 duration1 or site of the pregnancy4 7#g7 ,pregnancy-related ,the term pregnancy-related1 with respect to a death1 means a death of a pregnant or postpartum individual that occurs during1 or within #a year following1 the individual's pregnancy1 from a pregnancy complication1 a chain of events initiated by pregnancy1 or the aggravation of an unrelated condition by the physiologic effects of pregnancy4 7#h7 ,racial and ethnic minority group ,the term racial and ethnic minority group has the meaning given such term in section #agjg7;g77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a774 7#i7 ,severe maternal morbidity ,the term severe maternal morbidity means a health condition1 including mental health conditions and substance use disorders1 attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant4 7#aj7 ,social determinants of maternal health ,the term social determinants of maternal health means non-clinical factors that impact maternal health outcomes1 including-- 7,a7 economic factors1 which may include poverty1 employment1 food security1 support for and access to lactation and other infant feeding options1 housing stability1 and related factors2 7,b7 neighborhood factors1 which may include quality of housing1 access to transportation1 access to child care1 availability of healthy foods and nutrition counseling1 availability of clean water1 air and water quality1 ambient temperatures1 neighborhood crime and violence1 access to broadband1 and related factors2 7,c7 social and community factors1 which may include systemic racism1 gender discrimination or discrimination based on other protected classes1 workplace conditions1 incarceration1 and related factors2 7,d7 household factors1 which may include ability to conduct lead testing and abatement1 car seat installation1 indoor air temperatures1 and related factors2 7,e7 education access and quality factors1 which may include educational attainment1 language and literacy1 and related factors2 and 7,f7 health care access factors1 including health insurance coverage1 access to culturally congruent health care services1 providers1 and non-clinical support1 access to home visiting services1 access to wellness and stress management programs1 health literacy1 access to telehealth and items required to receive telehealth services1 and related factors4 #ebjg4 ,moms matter 7a7 ,maternal mental health equity grant program 7#a7 ,in general ,the ,secretary shall establish a program to award grants to eligible entities to address maternal mental health conditions and substance use disorders with respect to pregnant and postpartum individuals1 with a focus on racial and ethnic minority groups4 7#b7 ,application ,to be eligible to receive a grant under this subsection1 an eligible entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may provide1 including how such entity will use funds for activities described in paragraph 7#d7 that are culturally congruent4 7#c7 ,priority ,in awarding grants under this subsection1 the ,secretary shall give priority to an eligible entity that-- 7,a7 is1 or will partner with1 a community-based organization to address maternal mental health conditions and substance use disorders described in paragraph 7#a72 7,b7 is operating in an area with high rates of-- 7i7 adverse maternal health outcomes2 or 7ii7 significant racial or ethnic inequities in maternal health outcomes2 and 7,c7 is operating in a health professional shortage area designated under section #ccb of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e74 7#d7 ,use of funds ,an eligible entity that receives a grant under this subsection shall use funds for the following3 7,a7 ,establishing or expanding maternity care programs to improve the integration of maternal health and behavioral health care services into primary care settings where pregnant individuals regularly receive health care services4 7,b7 ,establishing or expanding group prenatal care programs or postpartum care programs4 7,c7 ,expanding existing programs that improve maternal mental and behavioral health during the prenatal and postpartum periods1 with a focus on individuals from racial and ethnic minority groups4 7,d7 ,providing services and support for pregnant and postpartum individuals with maternal mental health conditions and substance use disorders1 including referrals to addiction treatment centers that offer evidence-based treatment options4 7,e7 ,addressing stigma associated with maternal mental health conditions and substance use disorders1 with a focus on racial and ethnic minority groups4 7,f7 ,raising awareness of warning signs of maternal mental health conditions and substance use disorders1 with a focus on pregnant and postpartum individuals from racial and ethnic minority groups4 7,g7 ,establishing or expanding programs to prevent suicide or self-harm among pregnant and postpartum individuals4 7,h7 ,offering evidence-aligned programs at freestanding birth centers that provide maternal mental and behavioral health care education1 treatments1 and services1 and other services for individuals throughout the prenatal and postpartum period4 7,i7 ,establishing or expanding programs to provide education and training to maternity care providers with respect to-- 7i7 identifying potential warning signs for maternal mental health conditions or substance use disorders in pregnant and postpartum individuals1 with a focus on individuals from racial and ethnic minority groups2 and 7ii7 in the case where such providers identify such warning signs1 offering referrals to mental and behavioral health care professionals4 7,j7 ,developing a website1 or other source1 that includes information on health care providers who treat maternal mental health conditions and substance use disorders4 7,k7 ,establishing or expanding programs in communities to improve coordination between maternity care providers and mental and behavioral health care providers who treat maternal mental health conditions and substance use disorders1 including through the use of toll-free hotlines4 7,l7 ,carrying out other programs aligned with evidence-based practices for addressing maternal mental health conditions and substance use disorders for pregnant and postpartum individuals from racial and ethnic minority groups4 7#e7 ,reporting 7,a7 ,eligible entities ,an eligible entity that receives a grant under paragraph 7#a7 shall submit annually to the ,secretary1 and make publicly available1 a report on the activities conducted using funds received through a grant under this subsection4 ,such reports shall include quantitative and qualitative evaluations of such activities1 including the experience of individuals who received health care through such grant4 7,b7 ,secretary ,not later than the end of fiscal year #bjbf1 the ,secretary shall submit to ,congress a report that includes-- 7i7 a summary of the reports received under subparagraph 7,a72 7ii7 an evaluation of the effectiveness of grants awarded under this subsection2 7iii7 recommendations with respect to expanding coverage of evidence-based screenings and treatments for maternal mental health conditions and substance use disorders2 and 7iv7 recommendations with respect to ensuring activities described under paragraph 7#d7 continue after the end of a grant period4 7#f7 ,definitions ,in this subsection3 7,a7 ,culturally congruent ,the term culturally congruent1 with respect to care or maternity care1 means care that is in agreement with the preferred cultural values1 beliefs1 worldview1 language1 and practices of the health care consumer and other stakeholders4 7,b7 ,eligible entity ,the term eligible entity means-- 7i7 a community-based organization serving pregnant and postpartum individuals1 including such organizations serving individuals from racial and ethnic minority groups and other underserved populations2 7ii7 a nonprofit or patient advocacy organization with expertise in maternal mental and behavioral health2 7iii7 a maternity care provider2 7iv7 a mental or behavioral health care provider who treats maternal mental health conditions or substance use disorders2 7v7 a ,state or local governmental entity1 including a ,state or local public health department2 7vi7 an ,indian ,tribe or ,tribal organization 7as such terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd772 and 7vii7 an ,urban ,indian organization 7as such term is defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc774 7,c7 ,freestanding birth center ,the term freestanding birth center has the meaning given that term under section #aije7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7#a774 7,d7 ,maternity care provider ,the term maternity care provider means a health care provider who-- 7i7 is a physician1 physician assistant1 midwife who meets at a minimum the international definition of the midwife and global standards for midwifery education as established by the ,international ,confederation of ,midwives1 nurse practitioner1 or clinical nurse specialist2 and 7ii7 has a focus on maternal or perinatal health4 7,e7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services1 acting through the ,assistant ,secretary for ,mental ,health and ,substance ,use4 7#g7 ,authorization of appropriations ,to carry out this subsection1 there is authorized to be appropriated #be1jjj1jjj for each of fiscal years #bjbe through #bjbh4 7b7 ,grants ,to grow and diversify the maternal mental and behavioral health care workforce ,title ,,vii of the ,public ,health ,service ,act is amended by inserting after section #geh 7as added by section #ebje7;b77 the following3 #geh;,a4 ,maternal mental and behavioral health care workforce grants 7a7 ,in general ,the ,secretary may award grants to entities to establish or expand programs described in subsection 7b7 to grow and diversify the maternal mental and behavioral health care workforce4 7b7 ,use of funds ,recipients of grants under this section shall use the grants to grow and diversify the maternal mental and behavioral health care workforce by-- 7#a7 establishing schools or programs that provide education and training to individuals seeking appropriate licensing or certification as mental or behavioral health care providers who will specialize in maternal mental health conditions or substance use disorders2 or 7#b7 expanding the capacity of existing schools or programs described in paragraph 7#a71 for the purposes of increasing the number of students enrolled in such schools or programs1 including by awarding scholarships for students4 7c7 ,prioritization ,in awarding grants under this section1 the ,secretary shall give priority to any entity that-- 7#a7 has demonstrated a commitment to recruiting and retaining students and faculty from racial and ethnic minority groups2 7#b7 has developed a strategy to recruit and retain a diverse pool of students into the maternal mental or behavioral health care workforce program or school supported by funds received through the grant1 particularly from racial and ethnic minority groups and other underserved populations2 7#c7 has developed a strategy to recruit and retain students who plan to practice in a health professional shortage area designated under section #ccb2 7#d7 has developed a strategy to recruit and retain students who plan to practice in an area with significant racial and ethnic inequities in maternal health outcomes1 to the extent practicable2 and 7#e7 includes in the standard curriculum for all students within the maternal mental or behavioral health care workforce program or school a bias1 racism1 or discrimination training program that includes training on implicit bias and racism4 7d7 ,reporting ,as a condition on receipt of a grant under this section for a maternal mental or behavioral health care workforce program or school1 an entity shall agree to submit to the ,secretary an annual report on the activities conducted through the grant1 including-- 7#a7 the number and demographics of students participating in the program or school2 7#b7 the extent to which students in the program or school are entering careers in-- 7,a7 health professional shortage areas designated under section #ccb2 and 7,b7 areas with significant racial and ethnic inequities in maternal health outcomes1 to the extent such data are available2 and 7#c7 whether the program or school has included in the standard curriculum for all students a bias1 racism1 or discrimination training program that includes training on implicit bias and racism1 and if so the effectiveness of such training program4 7e7 ,period of grants ,the period of a grant under this section shall be up to #e years4 7f7 ,application ,to seek a grant under this section1 an entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require1 including any information necessary for prioritization under subsection 7c74 7g7 ,technical assistance ,the ,secretary shall provide1 directly or by contract1 technical assistance to entities seeking or receiving a grant under this section on the development1 use1 evaluation1 and post-grant period sustainability of the maternal mental or behavioral health care workforce programs or schools proposed to be1 or being1 established or expanded through the grant4 7h7 ,report by the ,secretary ,not later than #d years after the date of enactment of this section1 the ,secretary shall prepare and submit to the ,congress1 and post on the internet website of the ,department of ,health and ,human ,services1 a report on the effectiveness of the grant program under this section at-- 7#a7 recruiting students from racial and ethnic minority groups and other underserved populations2 7#b7 increasing the number of mental or behavioral health care providers specializing in maternal mental health conditions or substance use disorders from racial and ethnic minority groups and other underserved populations2 7#c7 increasing the number of mental or behavioral health care providers specializing in maternal mental health conditions or substance use disorders working in health professional shortage areas designated under section #ccb2 and 7#d7 increasing the number of mental or behavioral health care providers specializing in maternal mental health conditions or substance use disorders working in areas with significant racial and ethnic inequities in maternal health outcomes1 to the extent such data are available4 7i7 ,definitions ,in this section3 7#a7 ,racial and ethnic minority group ,the term racial and ethnic minority group has the meaning given such term in section #agjg7;g77#a74 7#b7 ,mental or behavioral health care provider ,the term mental or behavioral health care provider refers to a health care provider in the field of mental and behavioral health1 including substance use disorders1 acting in accordance with ,state law4 7j7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #ae1jjj1jjj for each of fiscal years #bjbe through #bjbi4 4 #ebjh4 ,justice for ,incarcerated ,moms 7a7 ,ending the shackling of pregnant individuals 7#a7 ,in general ,beginning on the date that is #f months after the date of enactment of this ,act1 and annually thereafter1 in each ,state that receives a grant under subpart #a of part ,e of title ,i of the ,omnibus ,crime ,control and ,safe ,streets ,act of #aifh 7#cd ,u4,s4,c4 #ajaea et seq47 7commonly referred to as the ,edward ,byrne ,memorial ,justice ,assistance ,grant ,program7 and that does not have in effect throughout the ,state for such fiscal year laws restricting the use of restraints on pregnant individuals in prison that are substantially similar to the rights1 procedures1 requirements1 effects1 and penalties set forth in section #dcbb of title #ah1 ,united ,states ,code1 the amount of such grant that would otherwise be allocated to such ,state under such subpart for the fiscal year shall be decreased by #be percent4 7#b7 ,reallocation ,amounts not allocated to a ,state for failure to comply with paragraph 7#a7 shall be reallocated in accordance with subpart #a of part ,e of title ,i of the ,omnibus ,crime ,control and ,safe ,streets ,act of #aifh 7#cd ,u4,s4,c4 #ajaea et seq47 to ,states that have complied with such paragraph4 7b7 ,creating model programs for the care of incarcerated individuals in the prenatal and postpartum periods 7#a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,attorney ,general1 acting through the ,director of the ,bureau of ,prisons1 shall establish1 in not fewer than #f ,bureau of ,prisons facilities1 programs to optimize maternal health outcomes for pregnant and postpartum individuals incarcerated in such facilities4 ,the ,attorney ,general shall establish such programs in consultation with stakeholders such as-- 7,a7 relevant community-based organizations1 particularly organizations that represent incarcerated and formerly incarcerated individuals and organizations that seek to improve maternal health outcomes for pregnant and postpartum individuals from demographic groups with elevated rates of maternal mortality1 severe maternal morbidity1 maternal health disparities1 or other adverse perinatal or childbirth outcomes2 7,b7 relevant organizations representing patients1 with a particular focus on patients from demographic groups with elevated rates of maternal mortality1 severe maternal morbidity1 maternal health disparities1 or other adverse perinatal or childbirth outcomes2 7,c7 organizations representing maternity care providers and maternal health care education programs2 7,d7 perinatal health workers2 and 7,e7 researchers and policy experts in fields related to maternal health care for incarcerated individuals4 7#b7 ,start date ,each selected facility shall begin facility programs not later than #ah months after the date of enactment of this ,act4 7#c7 ,facility priority ,in carrying out paragraph 7#a71 the ,director shall give priority to a facility based on-- 7,a7 the number of pregnant and postpartum individuals incarcerated in such facility and1 among such individuals1 the number of pregnant and postpartum individuals from demographic groups with elevated rates of maternal mortality1 severe maternal morbidity1 maternal health disparities1 or other adverse perinatal or childbirth outcomes2 and 7,b7 the extent to which the leaders of such facility have demonstrated a commitment to developing exemplary programs for pregnant and postpartum individuals incarcerated in such facility4 7#d7 ,program duration ,the programs established under this subsection shall be for a #e-year period4 7#e7 ,programs ,bureau of ,prisons facilities selected by the ,director shall establish programs for pregnant and postpartum incarcerated individuals1 and such programs may-- 7,a7 provide access to perinatal health workers from pregnancy through the postpartum period2 7,b7 provide access to healthy foods and counseling on nutrition1 recommended activity levels1 and safety measures throughout pregnancy2 7,c7 train correctional officers to ensure that pregnant incarcerated individuals receive safe and respectful treatment2 7,d7 train medical personnel to ensure that pregnant incarcerated individuals receive trauma-informed1 culturally and linguistically congruent care that promotes the health and safety of the pregnant individuals2 7,e7 provide counseling and treatment for individuals who have suffered from-- 7i7 diagnosed mental or behavioral health conditions1 including trauma and substance use disorders2 7ii7 trauma or violence1 including domestic violence2 7iii7 human immunodeficiency virus2 7iv7 sexual abuse2 7v7 pregnancy or infant loss2 or 7vi7 chronic conditions2 7,f7 provide evidence-based pregnancy and childbirth education1 parenting support1 and other relevant forms of health literacy2 7,g7 provide clinical education opportunities to maternity care providers in training to expand pathways into maternal health care careers serving incarcerated individuals2 7,h7 offer opportunities for postpartum individuals to maintain contact with the individual's newborn child to promote bonding1 including enhanced visitation policies1 access to prison nursery programs1 or breastfeeding support2 7,i7 provide reentry assistance1 particularly to-- 7i7 ensure access to health insurance coverage and transfer of health records to community providers if an incarcerated individual exits the criminal justice system during such individual's pregnancy or in the postpartum period2 and 7ii7 connect individuals exiting the criminal justice system during pregnancy or in the postpartum period to community-based resources1 such as referrals to health care providers1 substance use disorder treatments1 and social services that address social determinants of maternal health2 or 7,j7 establish partnerships with local public entities1 private community entities1 community-based organizations1 ,indian ,tribes and ,tribal organizations 7as such terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd771 and ,urban ,indian organizations 7as such term is defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc77 to establish or expand pretrial diversion programs as an alternative to incarceration for pregnant and postpartum individuals4 ,such programs may include-- 7i7 evidence-based childbirth education or parenting classes2 7ii7 prenatal health coordination2 7iii7 family and individual counseling2 7iv7 evidence-based screenings1 education1 and1 as needed1 treatment for mental and behavioral health conditions1 including drug and alcohol treatments2 7v7 family case management services2 7vi7 domestic violence education and prevention2 7vii7 physical and sexual abuse counseling2 and 7viii7 programs to address social determinants of health such as employment1 housing1 education1 transportation1 and nutrition4 7#f7 ,implementation and reporting ,a selected facility shall be responsible for-- 7,a7 implementing programs1 which may include the programs described in paragraph 7#e72 and 7,b7 not later than #c years after the date of enactment of this ,act1 and #f years after the date of enactment of this ,act1 reporting results of the programs to the ,director1 including information describing-- 7i7 relevant quantitative indicators of success in improving the standard of care and health outcomes for pregnant and postpartum incarcerated individuals in the facility1 including data stratified by race1 ethnicity1 sex1 gender1 primary language1 age1 geography1 disability status1 the category of the criminal charge against such individual1 rates of pregnancy-related deaths1 pregnancy-associated deaths1 cases of infant mortality and morbidity1 rates of preterm births and low-birthweight births1 cases of severe maternal morbidity1 cases of violence against pregnant or postpartum individuals1 diagnoses of maternal mental or behavioral health conditions1 and other such information as appropriate2 7ii7 relevant qualitative and quantitative evaluations from pregnant and postpartum incarcerated individuals who participated in such programs1 including measures of patient-reported experience of care2 and 7iii7 strategies to sustain such programs after fiscal year #bjbi and expand such programs to other facilities4 7#g7 ,report ,not later than #f years after the date of enactment of this ,act1 the ,director shall submit to the ,attorney ,general and to ,congress a report describing the results of the programs funded under this subsection4 7#h7 ,oversight ,not later than #a year after the date of enactment of this ,act1 the ,attorney ,general shall award a contract to an independent organization or independent organizations to conduct oversight of the programs described in paragraph 7#e74 7#i7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this subsection #aj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7c7 ,grant program ,to improve maternal health outcomes for individuals in state and local prisons and jails 7#a7 ,establishment ,not later than #a year after the date of enactment of this ,act1 the ,attorney ,general1 acting through the ,director of the ,bureau of ,justice ,assistance1 shall award ,justice for ,incarcerated ,moms grants to ,states to establish or expand programs in ,state and local prisons and jails for pregnant and postpartum incarcerated individuals4 ,the ,attorney ,general shall award such grants in consultation with stakeholders such as-- 7,a7 relevant community-based organizations1 particularly organizations that represent incarcerated and formerly incarcerated individuals and organizations that seek to improve maternal health outcomes for pregnant and postpartum individuals from demographic groups with elevated rates of maternal mortality1 severe maternal morbidity1 maternal health disparities1 or other adverse perinatal or childbirth outcomes2 7,b7 relevant organizations representing patients1 with a particular focus on patients from demographic groups with elevated rates of maternal mortality1 severe maternal morbidity1 maternal health disparities1 or other adverse perinatal or childbirth outcomes2 7,c7 organizations representing maternity care providers and maternal health care education programs2 7,d7 perinatal health workers2 and 7,e7 researchers and policy experts in fields related to maternal health care for incarcerated individuals4 7#b7 ,applications ,each applicant for a grant under this subsection shall submit to the ,director of the ,bureau of ,justice ,assistance an application at such time1 in such manner1 and containing such information as the ,director may require4 7#c7 ,use of funds ,a ,state that is awarded a grant under this subsection shall use such grant to establish or expand programs for pregnant and postpartum incarcerated individuals1 and such programs may-- 7,a7 provide access to perinatal health workers from pregnancy through the postpartum period2 7,b7 provide access to healthy foods and counseling on nutrition1 recommended activity levels1 and safety measures throughout pregnancy2 7,c7 train correctional officers to ensure that pregnant incarcerated individuals receive safe and respectful treatment2 7,d7 train medical personnel to ensure that pregnant incarcerated individuals receive trauma-informed1 culturally and linguistically congruent care that promotes the health and safety of the pregnant individuals2 7,e7 provide counseling and treatment for individuals who have suffered from-- 7i7 diagnosed mental or behavioral health conditions1 including trauma and substance use disorders2 7ii7 trauma or violence1 including domestic violence2 7iii7 human immunodeficiency virus2 7iv7 sexual abuse2 7v7 pregnancy or infant loss2 or 7vi7 chronic conditions2 7,f7 provide evidence-based pregnancy and childbirth education1 parenting support1 and other relevant forms of health literacy2 7,g7 provide clinical education opportunities to maternity care providers in training to expand pathways into maternal health care careers serving incarcerated individuals2 7,h7 offer opportunities for postpartum individuals to maintain contact with the individual's newborn child to promote bonding1 including enhanced visitation policies1 access to prison nursery programs1 or breastfeeding support2 7,i7 provide reentry assistance1 particularly to-- 7i7 ensure access to health insurance coverage and transfer of health records to community providers if an incarcerated individual exits the criminal justice system during such individual's pregnancy or in the postpartum period2 and 7ii7 connect individuals exiting the criminal justice system during pregnancy or in the postpartum period to community-based resources1 such as referrals to health care providers1 substance use disorder treatments1 and social services that address social determinants of maternal health2 or 7,j7 establish partnerships with local public entities1 private community entities1 community-based organizations1 ,indian ,tribes and ,tribal organizations 7as such terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd771 and ,urban ,indian organizations 7as such term is defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc77 to establish or expand pretrial diversion programs as an alternative to incarceration for pregnant and postpartum individuals4 ,such programs may include-- 7i7 evidence-based childbirth education or parenting classes2 7ii7 prenatal health coordination2 7iii7 family and individual counseling2 7iv7 evidence-based screenings1 education1 and1 as needed1 treatment for mental and behavioral health conditions1 including drug and alcohol treatments2 7v7 family case management services2 7vi7 domestic violence education and prevention2 7vii7 physical and sexual abuse counseling2 and 7viii7 programs to address social determinants of health such as employment1 housing1 education1 transportation1 and nutrition4 7#d7 ,priority ,in awarding grants under this subsection1 the ,director of the ,bureau of ,justice ,assistance shall give priority to applicants based on-- 7,a7 the number of pregnant and postpartum individuals incarcerated in the ,state and1 among such individuals1 the number of pregnant and postpartum individuals from demographic groups with elevated rates of maternal mortality1 severe maternal morbidity1 maternal health disparities1 or other adverse perinatal or childbirth outcomes2 and 7,b7 the extent to which the ,state has demonstrated a commitment to developing exemplary programs for pregnant and postpartum individuals incarcerated in the prisons and jails in the ,state4 7#e7 ,grant duration ,a grant awarded under this subsection shall be for a #e-year period4 7#f7 ,implementing and reporting ,a ,state that receives a grant under this subsection shall be responsible for-- 7,a7 implementing the program funded by the grant2 and 7,b7 not later than #c years after the date of enactment of this ,act1 and #f years after the date of enactment of this ,act1 reporting results of such program to the ,attorney ,general1 including information describing-- 7i7 relevant quantitative indicators of the program's success in improving the standard of care and health outcomes for pregnant and postpartum incarcerated individuals in the facility1 including data stratified by race1 ethnicity1 sex1 gender1 primary language1 age1 geography1 disability status1 category of the criminal charge against such individual1 incidence rates of pregnancy-related deaths1 pregnancy-associated deaths1 cases of infant mortality and morbidity1 rates of preterm births and low-birthweight births1 cases of severe maternal morbidity1 cases of violence against pregnant or postpartum individuals1 diagnoses of maternal mental or behavioral health conditions1 and other such information as appropriate2 7ii7 relevant qualitative and quantitative evaluations from pregnant and postpartum incarcerated individuals who participated in such programs1 including measures of patient-reported experience of care2 and 7iii7 strategies to sustain such programs beyond the duration of the grant and expand such programs to other facilities4 7#g7 ,report ,not later than #f years after the date of enactment of this ,act1 the ,attorney ,general shall submit to ,congress a report describing the results of such grant programs4 7#h7 ,oversight ,not later than #a year after the date of enactment of this ,act1 the ,attorney ,general shall award a contract to an independent organization or independent organizations to conduct oversight of the programs described in paragraph 7#c74 7#i7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this subsection #aj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7d7 ,,gao report 7#a7 ,in general ,not later than #b years after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report on adverse maternal and infant health outcomes among incarcerated individuals and infants born to such individuals1 with a particular focus on racial and ethnic disparities in maternal and infant health outcomes for incarcerated individuals4 7#b7 ,contents of report ,the report described in this subsection shall include-- 7,a7 to the extent practicable-- 7i7 the number of pregnant individuals who are incarcerated in ,bureau of ,prisons facilities2 7ii7 the number of incarcerated individuals1 including those incarcerated in ,federal1 ,state1 and local correctional facilities1 who have experienced a pregnancy-related death1 pregnancy-associated death1 or the death of an infant in the most recent #aj years of available data2 7iii7 the number of cases of severe maternal morbidity among incarcerated individuals1 including those incarcerated in ,federal1 ,state1 and local detention facilities1 in the most recent #aj years of available data2 7iv7 the number of preterm and low-birthweight births of infants born to incarcerated individuals1 including those incarcerated in ,federal1 ,state1 and local correctional facilities1 in the most recent #aj years of available data2 and 7v7 statistics on the racial and ethnic disparities in maternal and infant health outcomes and severe maternal morbidity rates among incarcerated individuals1 including those incarcerated in ,federal1 ,state1 and local detention facilities2 7,b7 in the case that the ,comptroller ,general of the ,united ,states is unable determine the information required in clauses 7i7 through 7iii7 of subparagraph 7,a71 an assessment of the barriers to determining such information and recommendations for improvements in tracking maternal health outcomes among incarcerated individuals1 including those incarcerated in ,federal1 ,state1 and local detention facilities2 7,c7 the implications of pregnant and postpartum incarcerated individuals being ineligible for medical assistance under a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 including information about-- 7i7 the effects of such ineligibility on maternal health outcomes for pregnant and postpartum incarcerated individuals1 with emphasis given to such effects for pregnant and postpartum individuals from racial and ethnic minority groups2 and 7ii7 potential implications on maternal health outcomes resulting from temporarily suspending1 rather than permanently terminating1 such eligibility when a pregnant or postpartum individual is incarcerated2 7,d7 the extent to which ,federal1 ,state1 and local correctional facilities are holding pregnant and postpartum individuals who test positive for illicit drug use in detention with special conditions1 such as additional bond requirements1 due to the individual's drug use1 and the effect of such detention policies on maternal and infant health outcomes2 7,e7 causes of adverse maternal health outcomes that are unique to incarcerated individuals1 including those incarcerated in ,federal1 ,state1 and local detention facilities2 7,f7 causes of adverse maternal health outcomes and severe maternal morbidity that are unique to incarcerated individuals from racial and ethnic minority groups2 7,g7 recommendations to reduce maternal mortality and severe maternal morbidity among incarcerated individuals and to address racial and ethnic disparities in maternal health outcomes for incarcerated individuals in ,bureau of ,prisons facilities and ,state and local prisons and jails2 and 7,h7 such other information as may be appropriate to reduce the occurrence of adverse maternal health outcomes among incarcerated individuals and to address racial and ethnic disparities in maternal health outcomes for such individuals4 7e7 ,definitions ,in this section3 7#a7 ,culturally and linguistically congruent ,the term culturally and linguistically congruent1 with respect to care or maternity care1 means care that is in agreement with the preferred cultural values1 beliefs1 worldview1 language1 and practices of the health care consumer and other stakeholders4 7#b7 ,maternal mortality ,the term maternal mortality means a death occurring during or within a #a-year period after pregnancy1 caused by pregnancy-related or childbirth complications1 including a suicide1 overdose1 or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy-related or childbirth complications4 7#c7 ,maternity care provider ,the term maternity care provider means a health care provider who-- 7,a7 is a physician1 a physician assistant1 a midwife who meets1 at a minimum1 the international definition of a midwife and global standards for midwifery education as established by the ,international ,confederation of ,midwives1 an advanced practice registered nurse1 or a lactation consultant certified by the ,international ,board of ,lactation ,consultant ,examiners2 and 7,b7 has a focus on maternal or perinatal health4 7#d7 ,perinatal health worker ,the term perinatal health worker means a nonclinical health worker focused on maternal or perinatal health1 such as a doula1 community health worker1 peer supporter1 lactation educator or counselor1 nutritionist or dietitian1 childbirth educator1 social worker1 home visitor1 patient navigator or coordinator1 or language interpreter4 7#e7 ,postpartum and postpartum period ,the terms postpartum and postpartum period refer to the #a-year period beginning on the last day of the pregnancy of an individual4 7#f7 ,pregnancy-associated death ,the term pregnancy-associated death means a death of a pregnant or postpartum individual1 by any cause1 that occurs during1 or within #a year following1 the individual's pregnancy1 regardless of the outcome1 duration1 or site of the pregnancy4 7#g7 ,pregnancy-related death ,the term pregnancy-related death means a death of a pregnant or postpartum individual that occurs during1 or within #a year following1 the individual's pregnancy1 from a pregnancy complication1 a chain of events initiated by pregnancy1 or the aggravation of an unrelated condition by the physiologic effects of pregnancy4 7#h7 ,racial and ethnic minority group ,the term racial and ethnic minority group has the meaning given such term in section #agjg7;g77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a774 7#i7 ,severe maternal morbidity ,the term severe maternal morbidity means a health condition1 including mental health conditions and substance use disorders1 attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant4 7#aj7 ,social determinants of maternal health ,the term social determinants of maternal health means nonclinical factors that impact maternal health outcomes4 #ebji4 ,tech to save moms 7a7 ,definitions ,in this section3 7#a7 ,postpartum and postpartum period ,the terms postpartum and postpartum period refer to the #a-year period beginning on the last day of the pregnancy of an individual4 7#b7 ,racial and ethnic minority group ,the term racial and ethnic minority group has the meaning given such term in section #agjg7;g77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a774 7#c7 ,severe maternal morbidity ,the term severe maternal morbidity means a health condition1 including mental health conditions and substance use disorders1 attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant4 7#d7 ,social determinants of maternal health ,the term social determinants of maternal health means non-clinical factors that impact maternal health outcomes1 including-- 7,a7 economic factors1 which may include poverty1 employment1 food security1 support for and access to lactation and other infant feeding options1 housing stability1 and related factors2 7,b7 neighborhood factors1 which may include quality of housing1 access to transportation1 access to child care1 availability of healthy foods and nutrition counseling1 availability of clean water1 air and water quality1 ambient temperatures1 neighborhood crime and violence1 access to broadband1 and related factors2 7,c7 social and community factors1 which may include systemic racism1 gender discrimination or discrimination based on other protected classes1 workplace conditions1 incarceration1 and related factors2 7,d7 household factors1 which may include ability to conduct lead testing and abatement1 car seat installation1 indoor air temperatures1 and related factors2 7,e7 education access and quality factors1 which may include educational attainment1 language and literacy1 and related factors2 and 7,f7 health care access factors1 including health insurance coverage1 access to culturally congruent health care services1 providers1 and non-clinical support1 access to home visiting services1 access to wellness and stress management programs1 health literacy1 access to telehealth and items required to receive telehealth services1 and related factors4 7b7 ,integrated telehealth models in maternity care services 7#a7 ,in general ,section #aaae;,a7b77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b77 is amended by adding at the end the following3 7xxviii7 ,focusing on title ,,xix1 providing for the adoption of and use of telehealth tools that allow for screening1 monitoring1 and management of common health complications with respect to an individual receiving medical assistance during such individual's pregnancy and for not more than a #a-year period beginning on the last day of the pregnancy4 4 7#b7 ,effective date ,the amendment made by paragraph 7#a7 shall take effect #a year after the date of the enactment of this section4 7c7 ,grants ,to expand the use of technology-,enabled collaborative learning and capacity models for pregnant and postpartum individuals ,title ,,iii of the ,public ,health ,service ,act is amended by inserting after section #ccj,n 7#db ,u4,s4,c4 #bed;c-#bj7 the following3 #ccj,n-#a4 ,expanding capacity for maternal health outcomes 7a7 ,establishment ,beginning not later than #a year after the date of enactment of this section1 the ,secretary shall award grants to eligible entities to evaluate1 develop1 and expand the use of technology-enabled collaborative learning and capacity building models and improve maternal health outcomes-- 7#a7 in health professional shortage areas2 7#b7 in areas with high rates of maternal mortality and severe maternal morbidity2 7#c7 in areas with significant racial and ethnic inequities in maternal health outcomes2 and 7#d7 for medically underserved populations and ,american ,indians and ,alaska ,natives1 including ,indian ,tribes1 ,tribal organizations1 and ,urban ,indian organizations4 7b7 ,use of ,funds 7#a7 ,required uses ,recipients of grants under this section shall use the grants to-- 7,a7 train maternal health care providers1 students1 and other similar professionals through models that include-- 7i7 methods to increase safety and health care quality2 7ii7 training to increase awareness of1 and eliminate implicit bias1 racism1 and discrimination in1 the provision of health care2 7iii7 best practices in screening for and1 as needed1 evaluating and treating maternal mental health conditions and substance use disorders2 7iv7 training on best practices in maternity care for pregnant and postpartum individuals during the ,,covid-#ai public health emergency or future public health emergencies2 7v7 methods to screen for social determinants of maternal health risks in the prenatal and postpartum periods2 and 7vi7 the use of remote patient monitoring tools for pregnancy-related complications described in section #aaae;,a7b77#b77;,b77xxviii7 of the ,social ,security ,act2 7,b7 evaluate and collect information on the effect of such models on-- 7i7 access to1 and quality of1 care2 7ii7 outcomes with respect to the health of an individual2 and 7iii7 the experience of individuals who receive pregnancy-related health care2 7,c7 develop qualitative and quantitative measures to identify best practices for the expansion and use of such models2 7,d7 study the effect of such models on patient outcomes and maternity care providers2 and 7,e7 conduct any other activity1 as determined by the ,secretary4 7#b7 ,permissible uses ,recipients of grants under this section may use grants to support-- 7,a7 the use and expansion of technology-enabled collaborative learning and capacity building models1 including hardware and software that-- 7i7 enable distance learning and technical support2 and 7ii7 support the secure exchange of electronic health information2 and 7,b7 maternity care providers1 students1 and other similar professionals in the provision of maternity care through such models4 7c7 ,application 7#a7 ,in general ,an eligible entity seeking a grant under subsection 7a7 shall submit to the ,secretary an application1 at such time1 in such manner1 and containing such information as the ,secretary may require4 7#b7 ,assurance ,an application under paragraph 7#a7 shall include an assurance that such entity shall collect information on1 and assess the effect of1 the use of technology-enabled collaborative learning and capacity building models1 including with respect to-- 7,a7 maternal health outcomes2 7,b7 access to maternal health care services2 7,c7 quality of maternal health care2 and 7,d7 retention of maternity care providers serving areas and populations described in subsection 7a74 7d7 ,limitations 7#a7 ,number ,the ,secretary may not award more than #a grant under this section to an eligible entity4 7#b7 ,duration ,a grant awarded under this section shall be for a #e-year period4 7e7 ,access to broadband ,in administering grants under this section1 the ,secretary may coordinate with other agencies to ensure that funding opportunities are available to support access to reliable1 high-speed internet for grantees4 7f7 ,technical assistance ,the ,secretary shall provide 7either directly or by contract7 technical assistance to eligible entities1 including recipients of grants under subsection 7a71 on the development1 use1 and sustainability of technology-enabled collaborative learning and capacity building models to expand access to maternal health care services provided by such entities1 including-- 7#a7 in health professional shortage areas2 7#b7 in areas with high rates of maternal mortality and severe maternal morbidity or significant racial and ethnic inequities in maternal health outcomes2 and 7#c7 for medically underserved populations or ,american ,indians and ,alaska ,natives4 7g7 ,research and evaluation ,the ,secretary1 in consultation with experts1 shall develop a strategic plan to research and evaluate the evidence for such models4 7h7 ,reporting 7#a7 ,eligible entities ,an eligible entity that receives a grant under subsection 7a7 shall submit to the ,secretary a report1 at such time1 in such manner1 and containing such information as the ,secretary may require4 7#b7 ,secretary ,not later than #d years after the date of enactment of this section1 the ,secretary shall submit to the ,congress1 and make available on the website of the ,department of ,health and ,human ,services1 a report that includes-- 7,a7 a description of grants awarded under subsection 7a7 and the purpose and amounts of such grants2 7,b7 a summary of-- 7i7 the evaluations conducted under subsection 7b77#a77;,b72 7ii7 any technical assistance provided under subsection 7f72 and 7iii7 the activities conducted under subsection 7a72 and 7,c7 a description of any significant findings with respect to-- 7i7 patient outcomes2 and 7ii7 best practices for expanding1 using1 or evaluating technology-enabled collaborative learning and capacity building models4 7i7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section1 #f1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7j7 ,definitions ,in this section3 7#a7 ,eligible entity 7,a7 ,in general ,the term eligible entity means an entity that provides1 or supports the provision of1 maternal health care services or other evidence-based services for pregnant and postpartum individuals-- 7i7 in health professional shortage areas2 7ii7 in areas with high rates of adverse maternal health outcomes or significant racial and ethnic inequities in maternal health outcomes2 or 7iii7 who are-- 7,i7 members of medically underserved populations2 or 7,,ii7 ,american ,indians and ,alaska ,natives1 including ,indian ,tribes1 ,tribal organizations1 and ,urban ,indian organizations4 7,b7 ,inclusions ,an eligible entity may include entities that lead1 or are capable of leading1 a technology-enabled collaborative learning and capacity building model4 7#b7 ,health professional shortage area ,the term health professional shortage area means a health professional shortage area designated under section #ccb4 7#c7 ,indian ,tribe ,the term ,indian ,tribe has the meaning given such term in section #d of the ,indian ,self-,determination and ,education ,assistance ,act4 7#d7 ,maternal mortality ,the term maternal mortality means a death occurring during or within the #a-year period after pregnancy caused by pregnancy-related or childbirth complications1 including a suicide1 overdose1 or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy or childbirth complications4 7#e7 ,medically underserved population ,the term medically underserved population has the meaning given such term in section #ccj7;b77#c74 7#f7 ,postpartum ,the term postpartum means the #a-year period beginning on the last date of an individual's pregnancy4 7#g7 ,severe maternal morbidity ,the term severe maternal morbidity means a health condition1 including a mental health or substance use disorder1 attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the individual who was pregnant4 7#h7 ,technology-enabled collaborative learning and capacity building model ,the term technology-enabled collaborative learning and capacity building model means a distance health education model that connects health care professionals1 and other specialists1 through simultaneous interactive videoconferencing for the purpose of facilitating case-based learning1 disseminating best practices1 and evaluating outcomes in the context of maternal health care4 7#i7 ,tribal organization ,the term ,tribal organization has the meaning given such term in section #d of the ,indian ,self-,determination and ,education ,assistance ,act4 7#aj7 ,urban ,indian organization ,the term ,urban ,indian organization has the meaning given such term in section #d of the ,indian ,health ,care ,improvement ,act4 4 7d7 ,grants ,to promote equity in maternal health outcomes through digital tools 7#a7 ,in general ,beginning not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this subsection as the ,secretary7 shall make grants to eligible entities to reduce racial and ethnic inequities in maternal health outcomes by increasing access to digital tools related to maternal health care4 7#b7 ,applications ,to be eligible to receive a grant under this subsection1 an eligible entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7#c7 ,prioritization ,in awarding grants under this subsection1 the ,secretary shall prioritize an eligible entity-- 7,a7 in an area with high rates of adverse maternal health outcomes or significant racial and ethnic inequities in maternal health outcomes2 7,b7 in a health professional shortage area designated under section #ccb of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e72 and 7,c7 that promotes technology that addresses racial and ethnic inequities in maternal health outcomes4 7#d7 ,limitations 7,a7 ,number ,the ,secretary may award not more than #a grant under this subsection to an eligible entity4 7,b7 ,duration ,a grant awarded under this subsection shall be for a #e-year period4 7#e7 ,technical assistance ,the ,secretary shall provide technical assistance to an eligible entity on the development1 use1 evaluation1 and post-grant sustainability of digital tools for purposes of promoting equity in maternal health outcomes4 7#f7 ,reporting 7,a7 ,eligible entities ,an eligible entity that receives a grant under paragraph 7#a7 shall submit to the ,secretary a report1 at such time1 in such manner1 and containing such information as the ,secretary may require4 7,b7 ,secretary ,not later than #d years after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a report that includes-- 7i7 an evaluation on the effectiveness of grants awarded under this subsection to improve health outcomes for pregnant and postpartum individuals from racial and ethnic minority groups2 7ii7 recommendations on new grant programs that promote the use of technology to improve such maternal health outcomes2 and 7iii7 recommendations with respect to-- 7,i7 technology-based privacy and security safeguards in maternal health care2 7,,ii7 reimbursement rates for maternal telehealth services2 7,,iii7 the use of digital tools to analyze large data sets to identify potential pregnancy-related complications2 7,,iv7 barriers that prevent maternity care providers from providing telehealth services across ,states2 7,v7 the use of consumer digital tools such as mobile phone applications1 patient portals1 and wearable technologies to improve maternal health outcomes2 7,,vi7 barriers that prevent access to telehealth services1 including a lack of access to reliable1 high-speed internet or electronic devices2 7,,vii7 barriers to data sharing between the ,special ,supplemental ,nutrition ,program for ,women1 ,infants1 and ,children program and maternity care providers1 and recommendations for addressing such barriers2 and 7,,viii7 lessons learned from expanded access to telehealth related to maternity care during the ,,covid-#ai public health emergency4 7#g7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this subsection #f1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7e7 ,report on the use of technology in maternity care 7#a7 ,in general ,not later than #fj days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall enter into an agreement with the ,national ,academies of ,sciences1 ,engineering1 and ,medicine 7referred to in this section as the ,national ,academies7 under which the ,national ,academies shall conduct a study on the use of technology and patient monitoring devices in maternity care4 7#b7 ,content ,the agreement entered into pursuant to paragraph 7#a7 shall provide for the study of the following3 7,a7 ,the use of innovative technology 7including artificial intelligence7 in maternal health care1 including the extent to which such technology has affected racial or ethnic biases in maternal health care4 7,b7 ,the use of patient monitoring devices 7including pulse oximeter devices7 in maternal health care1 including the extent to which such devices have affected racial or ethnic biases in maternal health care4 7,c7 ,best practices for reducing and preventing racial or ethnic biases in the use of innovative technology and patient monitoring devices in maternity care4 7,d7 ,best practices in the use of innovative technology and patient monitoring devices for pregnant and postpartum individuals from racial and ethnic minority groups4 7,e7 ,best practices with respect to privacy and security safeguards in such use4 7#c7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,national ,academies shall complete the study under this subsection1 and transmit a report of the results of such study to ,congress4 #ebaj4 ,,impact ,to ,save ,moms ,act 7a7 ,perinatal ,care ,alternative ,payment ,model ,demonstration ,project 7#a7 ,in general ,for the period of fiscal years #bjbe through #bjbh1 the ,secretary of ,health and ,human ,services 7referred to in this subsection as the ,secretary71 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall establish and implement1 in accordance with the requirements of this subsection1 a demonstration project1 to be known as the ,perinatal ,care ,alternative ,payment ,model ,demonstration ,project 7referred to in this subsection as the ,demonstration ,project71 for purposes of allowing ,states to test payment models under their ,state plans under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 and ,state child health plans under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;aa et seq47 with respect to maternity care provided to pregnant and postpartum individuals enrolled in such ,state plans and ,state child health plans4 7#b7 ,coordination ,in establishing the ,demonstration ,project1 the ,secretary shall coordinate with stakeholders such as-- 7,a7 ,state ,medicaid programs2 7,b7 relevant organizations representing maternal health care providers2 7,c7 relevant organizations representing patients1 with a particular focus on individuals from demographic groups with disproportionate rates of adverse maternal health outcomes2 7,d7 relevant community-based organizations1 particularly organizations that seek to improve maternal health outcomes for individuals from demographic groups with disproportionate rates of adverse maternal health outcomes2 7,e7 non-clinical perinatal health workers such as doulas1 community health workers1 peer supporters1 certified lactation consultants1 nutritionists and dieticians1 social workers1 home visitors1 and navigators2 7,f7 relevant health insurance issuers2 7,g7 hospitals1 health systems1 freestanding birth centers 7as such term is defined in paragraph 7#c77;,b7 of section #aije7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l7771 ,federally-qualified health centers 7as such term is defined in paragraph 7#b77;,b7 of such section71 and rural health clinics 7as such term is defined in section #ahfa7;aa7 of such ,act 7#db ,u4,s4,c4 #aciex7aa7772 7,h7 researchers and policy experts in fields related to maternity care payment models2 and 7,i7 any other stakeholders as the ,secretary determines appropriate1 with a particular focus on stakeholders from demographic groups with disproportionate rates of adverse maternal health outcomes4 7#c7 ,considerations ,in establishing the ,demonstration ,project1 the ,secretary shall consider each of the following3 7,a7 ,findings from any evaluations of the ,strong ,start for ,mothers and ,newborns initiative carried out by the ,centers for ,medicare ,medicaid ,services1 the ,health ,resources and ,services ,administration1 and the ,administration on ,children and ,families4 7,b7 ,any alternative payment model that-- 7i7 is designed to improve maternal health outcomes for racial and ethnic groups with disproportionate rates of adverse maternal health outcomes2 7ii7 includes methods for stratifying patients by pregnancy risk level and1 as appropriate1 adjusting payments under such model to take into account pregnancy risk level2 7iii7 establishes evidence-based quality metrics for such payments2 7iv7 includes consideration of non-hospital birth settings such as freestanding birth centers 7as so defined72 7v7 includes consideration of social determinants of health that are relevant to maternal health outcomes such as housing1 transportation1 nutrition1 and other non-clinical factors that influence maternal health outcomes2 or 7vi7 includes diverse maternity care teams that include-- 7,i7 maternity care providers1 including obstetrician-gynecologists1 family physicians1 physician assistants1 midwives who meet1 at a minimum1 the international definition of the term midwife and global standards for midwifery education 7as established by the ,international ,confederation of ,midwives71 and nurse practitioners-- 7aa7 from racially1 ethnically1 and professionally diverse backgrounds2 7bb7 with experience practicing in racially and ethnically diverse communities2 or 7cc7 who have undergone trainings on racism1 implicit bias1 and explicit bias2 and 7,,ii7 non-clinical perinatal health workers such as doulas1 community health workers1 peer supporters1 certified lactation consultants1 nutritionists and dieticians1 social workers1 home visitors1 and navigators4 7#d7 ,eligibility ,to be eligible to participate in the ,demonstration ,project1 a ,state shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7#e7 ,evaluation ,the ,secretary shall conduct an evaluation of the ,demonstration ,project to determine the impact of the ,demonstration ,project on-- 7,a7 maternal health outcomes1 with data stratified by race1 ethnicity1 socioeconomic indicators1 and any other factors as the ,secretary determines appropriate2 7,b7 spending on maternity care by ,states participating in the ,demonstration ,project2 7,c7 to the extent practicable1 subjective measures of patient experience2 and 7,d7 any other areas of assessment that the ,secretary determines relevant4 7#f7 ,report ,not later than #a year after the completion or termination date of the ,demonstration ,project1 the ,secretary shall submit to the ,committee on ,energy and ,commerce1 the ,committee on ,ways and ,means1 and the ,committee on ,education and the ,workforce of the ,house of ,representatives and the ,committee on ,finance and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate1 and make publicly available1 a report containing-- 7,a7 the results of any evaluation conducted under paragraph 7#e72 and 7,b7 a recommendation regarding whether the ,demonstration ,project should be continued after fiscal year #bjbh and expanded on a national basis4 7#g7 ,authorization of appropriations ,there are authorized to be appropriated such sums as are necessary to carry out this subsection4 7#h7 ,definitions ,in this subsection3 7,a7 ,alternative payment model ,the term alternative payment model has the meaning given such term in section #ahcc7z77#c77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7z77#c77;,c774 7,b7 ,perinatal ,the term perinatal means the period beginning on the day a person becomes pregnant and ending on the last day of the #a-year period beginning on the last day of such person's pregnancy4 7b7 ,,macpac report 7#a7 ,in general ,not later than #b years after the date of the enactment of this section1 the ,medicaid and ,,chip ,payment and ,access ,commission shall publish a report on issues relating to the continuity of coverage under ,state plans under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 and ,state child health plans under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;aa et seq47 for pregnant and postpartum individuals4 ,such report shall1 at a minimum1 include the following3 7,a7 ,an assessment of any existing policies under such ,state plans and such ,state child health plans regarding presumptive eligibility for pregnant individuals while their application for enrollment in such a ,state plan or such a ,state child health plan is being processed4 7,b7 ,an assessment of any existing policies under such ,state plans and such ,state child health plans regarding measures to ensure continuity of coverage under such a ,state plan or such a ,state child health plan for pregnant and postpartum individuals1 including such individuals who need to change their health insurance coverage during their pregnancy or the postpartum period following their pregnancy4 7,c7 ,an assessment of any existing policies under such ,state plans and such ,state child health plans regarding measures to automatically reenroll individuals who are eligible to enroll under such a ,state plan or such a ,state child health plan as a parent4 7,d7 ,if determined appropriate by the ,commission1 any recommendations for the ,department of ,health and ,human ,services1 or such ,state plans and such ,state child health plans1 to ensure continuity of coverage under such a ,state plan or such a ,state child health plan for pregnant and postpartum people4 7#b7 ,postpartum defined ,in this subsection1 the term postpartum means the #a-year period beginning on the last day of a person's pregnancy4 #ebaa4 ,protecting moms and babies against climate change 7a7 ,grant program ,to protect vulnerable mothers and babies from climate change risks 7#a7 ,in general ,not later than #ahj days after the date of enactment of this section1 the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall establish a grant program 7in this subsection referred to as the ,program7 to protect vulnerable individuals from risks associated with climate change4 7#b7 ,grant authority ,in carrying out the ,program1 the ,secretary may award1 on a competitive basis1 grants to #aj covered entities4 7#c7 ,applications ,to be eligible for a grant under the ,program1 a covered entity shall submit to the ,secretary an application at such time1 in such form1 and containing such information as the ,secretary may require1 which shall include1 at a minimum1 a description of the following3 7,a7 ,plans for the use of grant funds awarded under the ,program and how patients and stakeholder organizations were involved in the development of such plans4 7,b7 ,how such grant funds will be targeted to geographic areas that have disproportionately high levels of risks associated with climate change for vulnerable individuals4 7,c7 ,how such grant funds will be used to address racial and ethnic inequities in-- 7i7 adverse maternal and infant health outcomes2 and 7ii7 exposure to risks associated with climate change for vulnerable individuals4 7,d7 ,strategies to prevent an initiative assisted with such grant funds from causing-- 7i7 adverse environmental impacts2 7ii7 displacement of residents and businesses2 7iii7 rent and housing price increases2 or 7iv7 disproportionate adverse impacts on racial and ethnic minority groups and other underserved populations4 7#d7 ,selection of grant recipients 7,a7 ,timing ,not later than #bgj days after the date of enactment of this ,act1 the ,secretary shall select the recipients of grants under the ,program4 7,b7 ,consultation ,in selecting covered entities for grants under the ,program1 the ,secretary shall consult with-- 7i7 representatives of stakeholder organizations2 7ii7 the ,administrator of the ,environmental ,protection ,agency2 7iii7 the ,administrator of the ,national ,oceanic and ,atmospheric ,administration2 and 7iv7 from the ,department of ,health and ,human ,services-- 7,i7 the ,deputy ,assistant ,secretary for ,minority ,health2 7,,ii7 the ,administrator of the ,centers for ,medicare ,medicaid ,services2 7,,iii7 the ,administrator of the ,health ,resources and ,services ,administration2 7,,iv7 the ,director of the ,national ,institutes of ,health2 and 7,v7 the ,director of the ,centers for ,disease ,control and ,prevention4 7,c7 ,priority ,in selecting a covered entity to be awarded a grant under the ,program1 the ,secretary shall give priority to covered entities that serve a county-- 7i7 designated1 or located in an area designated1 as a nonattainment area pursuant to section #ajg of the ,clean ,air ,act 7#db ,u4,s4,c4 #gdjg7 for any air pollutant for which air quality criteria have been issued under section #ajh7;a7 of such ,act 7#db ,u4,s4,c4 #gdjh7;a772 7ii7 with a level of vulnerability of moderate-to-high or higher1 according to the ,social ,vulnerability ,index of the ,centers for ,disease ,control and ,prevention2 or 7iii7 with temperatures that pose a risk to human health1 as determined by the ,secretary1 in consultation with the ,administrator of the ,national ,oceanic and ,atmospheric ,administration and the ,chair of the ,united ,states ,global ,change ,research ,program1 based on the best available science4 7,d7 ,limitation ,a recipient of grant funds under the ,program may not use such grant funds to serve a county that is served by any other recipient of a grant under the ,program4 7#e7 ,use of funds ,a covered entity awarded grant funds under the ,program may only use such grant funds for the following3 7,a7 ,initiatives to identify risks associated with climate change for vulnerable individuals and to provide services and support to such individuals that address such risks1 which may include-- 7i7 training for health care providers1 doulas1 and other employees in hospitals1 birth centers1 midwifery practices1 and other health care practices that provide prenatal or labor and delivery services to vulnerable individuals on the identification of1 and patient counseling relating to1 risks associated with climate change for vulnerable individuals2 7ii7 hiring1 training1 or providing resources to community health workers and perinatal health workers who can help identify risks associated with climate change for vulnerable individuals1 provide patient counseling about such risks1 and carry out the distribution of relevant services and support2 7iii7 enhancing the monitoring of risks associated with climate change for vulnerable individuals1 including by-- 7,i7 collecting data on such risks in specific census tracts1 neighborhoods1 or other geographic areas2 and 7,,ii7 sharing such data with local health care providers1 doulas1 and other employees in hospitals1 birth centers1 midwifery practices1 and other health care practices that provide prenatal or labor and delivery services to local vulnerable individuals2 and 7iv7 providing vulnerable individuals-- 7,i7 air conditioning units1 residential weatherization support1 filtration systems1 household appliances1 or related items2 7,,ii7 direct financial assistance2 and 7,,iii7 services and support1 including housing and transportation assistance1 to prepare for or recover from extreme weather events1 which may include floods1 hurricanes1 wildfires1 droughts1 and related events4 7,b7 ,initiatives to mitigate levels of and exposure to risks associated with climate change for vulnerable individuals1 which shall be based on the best available science and which may include initiatives to-- 7i7 develop1 maintain1 or expand urban or community forestry initiatives and tree canopy coverage initiatives2 7ii7 improve infrastructure1 including buildings and paved surfaces2 7iii7 develop or improve community outreach networks to provide culturally and linguistically appropriate information and notifications about risks associated with climate change for vulnerable individuals2 and 7iv7 provide enhanced services to racial and ethnic minority groups and other underserved populations4 7#f7 ,length of award ,a grant under this subsection shall be disbursed over #d fiscal years4 7#g7 ,technical assistance ,the ,secretary shall provide technical assistance to a covered entity awarded a grant under the ,program to support the development1 implementation1 and evaluation of activities funded with such grant4 7#h7 ,reports to ,secretary 7,a7 ,annual report ,for each fiscal year during which a covered entity is disbursed grant funds under the ,program1 such covered entity shall submit to the ,secretary a report that summarizes the activities carried out by such covered entity with such grant funds during such fiscal year1 which shall include a description of the following3 7i7 ,the involvement of stakeholder organizations in the implementation of initiatives assisted with such grant funds4 7ii7 ,relevant health and environmental data1 disaggregated1 to the extent practicable1 by race1 ethnicity1 gender1 and pregnancy status4 7iii7 ,qualitative feedback received from vulnerable individuals with respect to initiatives assisted with such grant funds4 7iv7 ,criteria used in selecting the geographic areas assisted with such grant funds4 7v7 ,efforts to address racial and ethnic inequities in adverse maternal and infant health outcomes and in exposure to risks associated with climate change for vulnerable individuals4 7vi7 ,any negative and unintended impacts of initiatives assisted with such grant funds1 including-- 7,i7 adverse environmental impacts2 7,,ii7 displacement of residents and businesses2 7,,iii7 rent and housing price increases2 and 7,,iv7 disproportionate adverse impacts on racial and ethnic minority groups and other underserved populations4 7vii7 ,how the covered entity will address and prevent any impacts described in clause 7vi74 7,b7 ,publication ,not later than #cj days after the date on which a report is submitted under subparagraph 7,a71 the ,secretary shall publish such report on a public website of the ,department of ,health and ,human ,services4 7#i7 ,report to ,congress ,not later than the date that is #e years after the date on which the ,program is established1 the ,secretary shall submit to ,congress and publish on a public website of the ,department of ,health and ,human ,services a report on the results of the ,program1 including the following3 7,a7 ,summaries of the annual reports submitted under paragraph 7#h74 7,b7 ,evaluations of the initiatives assisted with grant funds under the ,program4 7,c7 ,an assessment of the effectiveness of the ,program in-- 7i7 identifying risks associated with climate change for vulnerable individuals2 7ii7 providing services and support to such individuals2 7iii7 mitigating levels of and exposure to such risks2 and 7iv7 addressing racial and ethnic inequities in adverse maternal and infant health outcomes and in exposure to such risks4 7,d7 ,a description of how the ,program could be expanded1 including-- 7i7 monitoring efforts or data collection that would be required to identify areas with high levels of risks associated with climate change for vulnerable individuals2 7ii7 how such areas could be identified using the strategy developed under subsection 7d72 and 7iii7 recommendations for additional funding4 7#aj7 ,covered entity defined ,in this subsection1 the term covered entity means a consortium of organizations serving a county that-- 7,a7 shall include a community-based organization2 and 7,b7 may include-- 7i7 another stakeholder organization2 7ii7 the government of such county2 7iii7 the governments of one or more municipalities within such county2 7iv7 a ,state or local public health department or emergency management agency2 7v7 a local health care practice1 which may include a licensed and accredited hospital1 birth center1 midwifery practice1 or other health care practice that provides prenatal or labor and delivery services to vulnerable individuals2 7vi7 an ,indian tribe or tribal organization 7as such terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd772 7vii7 an ,urban ,indian organization 7as defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc772 and 7viii7 an institution of higher education4 7#aa7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this subsection #ajj1jjj1jjj for fiscal years #bjbe through #bjbh4 7b7 ,grant program for education and training at health profession schools 7#a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall establish a grant program 7in this subsection referred to as the ,program7 to provide funds to health profession schools to support the development and integration of education and training programs for identifying and addressing risks associated with climate change for vulnerable individuals4 7#b7 ,grant authority ,in carrying out the ,program1 the ,secretary may award1 on a competitive basis1 grants to health profession schools4 7#c7 ,application ,to be eligible for a grant under the ,program1 a health profession school shall submit to the ,secretary an application at such time1 in such form1 and containing such information as the ,secretary may require1 which shall include1 at a minimum1 a description of the following3 7,a7 ,how such health profession school will engage with vulnerable individuals1 and stakeholder organizations representing such individuals1 in developing and implementing the education and training programs supported by grant funds awarded under the ,program4 7,b7 ,how such health profession school will ensure that such education and training programs will address racial and ethnic inequities in exposure to1 and the effects of1 risks associated with climate change for vulnerable individuals4 7#d7 ,use of funds ,a health profession school awarded a grant under the ,program shall use the grant funds to develop1 and integrate into the curriculum and continuing education of such health profession school1 education and training on each of the following3 7,a7 ,identifying risks associated with climate change for vulnerable individuals and individuals with the intent to become pregnant4 7,b7 ,how risks associated with climate change affect vulnerable individuals and individuals with the intent to become pregnant4 7,c7 ,racial and ethnic inequities in exposure to1 and the effects of1 risks associated with climate change for vulnerable individuals and individuals with the intent to become pregnant4 7,d7 ,patient counseling and mitigation strategies relating to risks associated with climate change for vulnerable individuals4 7,e7 ,relevant services and support for vulnerable individuals relating to risks associated with climate change and strategies for ensuring vulnerable individuals have access to such services and support4 7,f7 ,implicit and explicit bias1 racism1 and discrimination4 7,g7 ,related topics identified by such health profession school based on the engagement of such health profession school with vulnerable individuals and stakeholder organizations representing such individuals4 7#e7 ,partnerships ,in carrying out activities with grant funds1 a health profession school awarded a grant under the ,program may partner with one or more of the following3 7,a7 ,a ,state or local public health department4 7,b7 ,a health care professional membership organization4 7,c7 ,a stakeholder organization4 7,d7 ,a health profession school4 7,e7 ,an institution of higher education4 7#f7 ,reports to ,secretary 7,a7 ,annual report ,for each fiscal year during which a health profession school is disbursed grant funds under the ,program1 such health profession school shall submit to the ,secretary a report that describes the activities carried out with such grant funds during such fiscal year4 7,b7 ,final report ,not later than the date that is #a year after the end of the last fiscal year during which a health profession school is disbursed grant funds under the ,program1 the health profession school shall submit to the ,secretary a final report that summarizes the activities carried out with such grant funds4 7#g7 ,report to ,congress ,not later than the date that is #f years after the date on which the ,program is established1 the ,secretary shall submit to ,congress and publish on a public website of the ,department of ,health and ,human ,services a report that includes the following3 7,a7 ,a summary of the reports submitted under paragraph 7#f74 7,b7 ,recommendations to improve education and training programs at health profession schools with respect to identifying and addressing risks associated with climate change for vulnerable individuals4 7#h7 ,health profession school defined ,in this subsection1 the term health profession school means an accredited-- 7,a7 medical school2 7,b7 school of nursing2 7,c7 midwifery program2 7,d7 physician assistant education program2 7,e7 teaching hospital2 7,f7 residency or fellowship program2 or 7,g7 other school or program determined appropriate by the ,secretary4 7#i7 ,authorization of ,appropriations ,there is authorized to be appropriated to carry out this subsection #e1jjj1jjj for fiscal years #bjbe through #bjbh4 7c7 ,,nih ,consortium on ,birth and ,climate ,change ,research 7#a7 ,establishment ,not later than #a year after the date of enactment of this ,act1 the ,director of the ,national ,institutes of ,health 7in this subsection referred to as the ,director of ,,nih7 shall establish the ,consortium on ,birth and ,climate ,change ,research 7in this subsection referred to as the ,consortium74 7#b7 ,duties 7,a7 ,in general ,the ,consortium shall coordinate1 across the institutes1 centers1 and offices of the ,national ,institutes of ,health1 research on the risks associated with climate change for vulnerable individuals4 7,b7 ,required activities ,in carrying out subparagraph 7,a71 the ,consortium shall-- 7i7 establish research priorities1 including by prioritizing research that-- 7,i7 identifies the risks associated with climate change for vulnerable individuals with a particular focus on inequities in such risks among racial and ethnic minority groups and other underserved populations2 and 7,,ii7 identifies strategies to reduce levels of1 and exposure to1 such risks1 with a particular focus on risks among racial and ethnic minority groups and other underserved populations2 7ii7 identify gaps in available data related to such risks2 7iii7 identify gaps in1 and opportunities for1 research collaborations2 7iv7 identify funding opportunities for community-based organizations and researchers from racially1 ethnically1 and geographically diverse backgrounds2 and 7v7 publish annual reports on the work and findings of the ,consortium on a public website of the ,national ,institutes of ,health4 7#c7 ,membership ,the ,director of ,,nih shall appoint to the ,consortium representatives of such institutes1 centers1 and offices of the ,national ,institutes of ,health as the ,director of ,,nih considers appropriate1 including1 at a minimum1 representatives of-- 7,a7 the ,national ,institute of ,environmental ,health ,sciences2 7,b7 the ,national ,institute on ,minority ,health and ,health ,disparities2 7,c7 the ,eunice ,kennedy ,shriver ,national ,institute of ,child ,health and ,human ,development2 7,d7 the ,national ,institute of ,nursing ,research2 and 7,e7 the ,office of ,research on ,women's ,health4 7#d7 ,chairperson ,the ,chairperson of the ,consortium shall be designated by the ,director of ,,nih and selected from among the representatives appointed under paragraph 7#c74 7#e7 ,consultation ,in carrying out the duties described in paragraph 7#b71 the ,consortium shall consult with-- 7,a7 the heads of relevant ,federal agencies1 including-- 7i7 the ,environmental ,protection ,agency2 7ii7 the ,national ,oceanic and ,atmospheric ,administration2 7iii7 the ,occupational ,safety and ,health ,administration2 and 7iv7 from the ,department of ,health and ,human ,services-- 7,i7 the ,office of ,minority ,health in the ,office of the ,secretary2 7,,ii7 the ,centers for ,medicare ,medicaid ,services2 7,,iii7 the ,health ,resources and ,services ,administration2 7,,iv7 the ,centers for ,disease ,control and ,prevention2 7,v7 the ,indian ,health ,service2 and 7,,vi7 the ,administration for ,children and ,families2 and 7,b7 representatives of-- 7i7 stakeholder organizations2 7ii7 health care providers and professional membership organizations with expertise in maternal health or environmental justice2 7iii7 ,state and local public health departments2 7iv7 licensed and accredited hospitals1 birth centers1 midwifery practices1 or other health care practices that provide prenatal or labor and delivery services to vulnerable individuals2 and 7v7 institutions of higher education1 including such institutions that are minority-serving institutions or have expertise in maternal health or environmental justice4 7d7 ,strategy for identifying climate change risk zones for vulnerable mothers and babies 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall develop a strategy 7in this subsection referred to as the ,strategy7 for designating areas that the ,secretary determines to have a high risk of adverse maternal and infant health outcomes among vulnerable individuals as a result of risks associated with climate change4 7#b7 ,strategy requirements 7,a7 ,in general ,in developing the ,strategy1 the ,secretary shall establish a process to identify areas where vulnerable individuals are exposed to a high risk of adverse maternal and infant health outcomes as a result of risks associated with climate change in conjunction with other factors that can impact such health outcomes1 including-- 7i7 the incidence of diseases associated with air pollution1 extreme heat1 and other environmental factors2 7ii7 the availability and accessibility of maternal and infant health care providers2 7iii7 ,english-language proficiency among people of reproductive age2 7iv7 the health insurance status of people of reproductive age2 7v7 the number of people of reproductive age who are members of racial or ethnic groups with disproportionately high rates of adverse maternal and infant health outcomes2 7vi7 the socioeconomic status of people of reproductive age1 including with respect to-- 7,i7 poverty2 7,,ii7 unemployment2 7,,iii7 household income2 and 7,,iv7 educational attainment2 and 7vii7 access to quality housing1 transportation1 and nutrition4 7,b7 ,resources ,in developing the ,strategy1 the ,secretary shall identify1 and incorporate a description of1 the following3 7i7 ,existing mapping tools or ,federal programs that identify-- 7,i7 risks associated with climate change for vulnerable individuals2 and 7,,ii7 other factors that can influence maternal and infant health outcomes1 including the factors described in subparagraph 7,a74 7ii7 ,environmental1 health1 socioeconomic1 and demographic data relevant to identifying risks associated with climate change for vulnerable individuals4 7iii7 ,existing monitoring networks that collect data described in clause 7ii71 and any gaps in such networks4 7iv7 ,federal1 ,state1 and local stakeholders involved in maintaining monitoring networks identified under clause 7iii71 and how such stakeholders are coordinating their monitoring efforts4 7v7 ,additional monitoring networks1 and enhancements to existing monitoring networks1 that would be required to address gaps identified under clause 7iii71 including at the subcounty and census tract level4 7vi7 ,funding amounts required to establish the monitoring networks identified under clause 7v7 and recommendations for ,federal1 ,state1 and local coordination with respect to such networks4 7vii7 ,potential uses for data collected and generated as a result of the ,strategy1 including how such data may be used in determining recipients of grants under the program established by subsection 7a7 or other similar programs4 7viii7 ,other information the ,secretary considers relevant for the development of the ,strategy4 7#c7 ,coordination and consultation ,in developing the ,strategy1 the ,secretary shall-- 7,a7 coordinate with the ,administrator of the ,environmental ,protection ,agency and the ,administrator of the ,national ,oceanic and ,atmospheric ,administration2 and 7,b7 consult with-- 7i7 stakeholder organizations2 7ii7 health care providers and professional membership organizations with expertise in maternal health or environmental justice2 7iii7 ,state and local public health departments2 7iv7 licensed and accredited hospitals1 birth centers1 midwifery practices1 or other health care providers that provide prenatal or labor and delivery services to vulnerable individuals2 and 7v7 institutions of higher education1 including such institutions that are minority-serving institutions or have expertise in maternal health or environmental justice4 7#d7 ,notice and comment ,at least #bdj days before the date on which the ,strategy is published in accordance with paragraph 7#e71 the ,secretary shall provide-- 7,a7 notice of the ,strategy on a public website of the ,department of ,health and ,human ,services2 and 7,b7 an opportunity for public comment of at least #ij days4 7#e7 ,publication ,not later than #ah months after the date of enactment of this ,act1 the ,secretary shall publish on a public website of the ,department of ,health and ,human ,services-- 7,a7 the ,strategy2 7,b7 the public comments received under paragraph 7#d72 and 7,c7 the responses of the ,secretary to such public comments4 7e7 ,definitions ,in this section1 the following definitions apply3 7#a7 ,adverse maternal and infant health outcomes ,the term adverse maternal and infant health outcomes includes the outcomes of pre-term birth1 low birth weight1 stillbirth1 infant or maternal mortality1 and severe maternal morbidity4 7#b7 ,institution of higher education ,the term institution of higher education has the meaning given such term in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja74 7#c7 ,minority-serving institution ,the term minority-serving institution means an entity specified in any of paragraphs 7#a7 through 7#g7 of section #cga7;a7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajfgq7a774 7#d7 ,racial and ethnic minority group ,the term racial and ethnic minority group has the meaning given such term in section #agjg7;g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g774 7#e7 ,risks associated with climate change ,the term risks associated with climate change includes risks associated with extreme heat1 air pollution1 extreme weather events1 and other environmental issues associated with climate change that can result in adverse maternal and infant health outcomes4 7#f7 ,stakeholder organization ,the term stakeholder organization means-- 7,a7 a community-based organization with expertise in providing assistance to vulnerable individuals2 7,b7 a nonprofit organization with expertise in maternal or infant health or environmental justice2 and 7,c7 a patient advocacy organization representing vulnerable individuals4 7#g7 ,vulnerable individual ,the term vulnerable individual means-- 7,a7 an individual who is pregnant2 7,b7 an individual who was pregnant during any portion of the preceding #a-year period2 and 7,c7 an individual under #c years of age4 #ebab4 ,protect moms from domestic violence 7a7 ,study by ,department of ,health and ,human ,services 7#a7 ,study ,the ,secretary1 in collaboration with the ,health ,resources and ,services ,administration1 the ,substance ,abuse and ,mental ,health ,services ,administration1 and the ,administration for ,children and ,families1 and in consultation with the ,attorney ,general of the ,united ,states1 the ,director of the ,indian ,health ,service1 and stakeholders 7including community-based organizations1 culturally specific organizations1 and ,tribal public health authorities71 shall conduct a study on the extent to which individuals are more at risk of maternal mortality or severe maternal morbidity as a result of being a victim of domestic violence1 dating violence1 sexual assault1 stalking1 human trafficking1 sex trafficking1 child sexual abuse1 or forced marriage4 7#b7 ,reports ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall complete the study under paragraph 7#a7 and submit a report to the ,congress on the results of such study4 ,such report shall include-- 7,a7 an analysis of the extent to which domestic violence1 dating violence1 sexual assault1 stalking1 human trafficking1 sex trafficking1 child sexual abuse1 and forced marriage contribute to1 or result in1 maternal mortality2 7,b7 an analysis of the impact of domestic violence1 dating violence1 sexual assault1 stalking1 human trafficking1 sex trafficking1 child sexual abuse1 and forced marriage on access to health care 7including mental health care7 and substance use disorder treatment and recovery support2 7,c7 a breakdown 7including by race and ethnicity7 of categories of individuals who are disproportionately victims of domestic violence1 dating violence1 sexual assault1 stalking1 human trafficking1 sex trafficking1 child sexual abuse1 or forced marriage that contributes to1 or results in1 pregnancy-related death2 7,d7 an analysis of the impact on health1 mental health1 and substance use resulting from domestic violence1 dating violence1 sexual assault1 stalking1 human trafficking1 sex trafficking1 child sexual abuse1 and forced marriage among ,alaskan ,natives1 ,native ,hawaiians1 and ,american ,indians during the prenatal and postpartum period2 7,e7 an assessment of the factors that increase or decrease risks for maternal mortality or severe maternal morbidity among victims of domestic violence1 dating violence1 sexual assault1 stalking1 human trafficking1 sex trafficking1 child sexual abuse1 or forced marriage2 7,f7 an assessment of increased risk of maternal mortality or severe maternal morbidity stemming from suicide1 substance use disorders1 or drug overdose due to domestic violence1 dating violence1 sexual assault1 stalking1 human trafficking1 sex trafficking1 child sexual abuse1 or forced marriage2 7,g7 recommendations for legislative or policy changes-- 7i7 to reduce maternal mortality rates2 and 7ii7 to address health inequities that contribute to inequities in such rates and deaths2 7,h7 best practices to reduce maternal mortality and severe maternal morbidity among victims of domestic violence1 dating violence1 sexual assault1 stalking1 human trafficking1 sex trafficking1 child sexual abuse1 and forced marriage1 including-- 7i7 reducing reproductive coercion1 mental health conditions1 and substance use coercion2 and 7ii7 routinely assessing pregnant people for domestic violence and other forms of reproductive violence2 and 7,i7 any other information on maternal mortality or severe maternal morbidity the ,secretary determines appropriate to include in the report4 7b7 ,study by ,national ,academy of medicine 7#a7 ,in general ,the ,secretary shall seek to enter into an arrangement with the ,national ,academy of ,medicine 7or1 if the ,academy declines to enter into such arrangement1 another appropriate entity7 to study-- 7,a7 the impact of domestic violence1 dating violence1 sexual assault1 stalking1 human trafficking1 sex trafficking1 child sexual abuse1 and forced marriage on an individual's health2 relative to 7,b7 maternal mortality and severe maternal morbidity4 7#b7 ,topics ,the study under paragraph 7#a7 shall-- 7,a7 examine-- 7i7 whether domestic violence1 dating violence1 sexual assault1 stalking1 human trafficking1 sex trafficking1 child sexual abuse1 or forced marriage1 or generational intimate partner violence1 trauma1 and psychiatric disorders1 increase the risk of suicide1 substance use1 and drug overdose among pregnant and postpartum persons2 and 7ii7 the intersection of domestic violence1 dating violence1 sexual assault1 stalking1 human trafficking1 sex trafficking1 child sexual abuse1 and forced marriage as a social determinant of health2 and 7,b7 give particular focus to impacts among ,african ,american1 ,american ,indian1 ,native ,hawaiian1 ,alaskan ,native1 and ,,lgbtq birthing persons4 7c7 ,grants for innovative approaches 7#a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 and in collaboration with the ,administration for ,children and ,families1 the ,indian ,health ,service1 and the ,substance ,abuse and ,mental ,health ,services ,administration1 shall award grants to eligible entities for developing and implementing innovative approaches to improve maternal and child health outcomes of victims of domestic violence1 dating violence1 sexual assault1 stalking1 human trafficking1 sex trafficking1 child sexual abuse1 or forced marriage4 7#b7 ,eligible entity ,to seek a grant under this subsection1 an entity shall be-- 7,a7 a ,state1 local1 or federally recognized ,tribal government2 7,b7 a nonprofit organization or community-based organization that provides prevention or intervention services related to domestic violence1 dating violence1 sexual assault1 stalking1 human trafficking1 sex trafficking1 child sexual abuse1 or forced marriage2 7,c7 a tribal organization or ,urban ,indian organization 7as such terms are defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc772 7,d7 an entity1 the principal purpose of which is to provide health care1 such as a hospital1 clinic1 health department1 freestanding birthing center1 perinatal health worker1 or maternity care provider2 7,e7 an institution of higher education2 or 7,f7 a comprehensive substance use disorder parenting program4 7#c7 ,priority ,in awarding grants under this subsection1 the ,secretary shall give priority to applicants proposing to address-- 7,a7 mental health and substance use disorders among pregnant persons2 or 7,b7 pregnant and postpartum persons experiencing intimate partner violence4 7#d7 ,freestanding birth center defined ,in this subsection1 the term freestanding birth center has the meaning given that term in section #aije7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l774 7#e7 ,authorization of appropriations ,to carry out this subsection1 there is authorized to be appropriated #be1jjj1jjj for the period of fiscal years #bjbe through #bjbg4 7d7 ,guidance ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall issue and disseminate guidance to ,states1 ,tribes1 territories1 maternity care providers1 and managed care entities on-- 7#a7 providing universal education on healthy relationships and intimate partner violence2 7#b7 developing protocols on-- 7,a7 routine assessment of intimate partner violence2 and 7,b7 health promotion and strategies for trauma-informed care plans2 and 7#c7 creating sustainable partnerships with community-based organizations that address domestic violence1 dating violence1 sexual assault1 stalking1 human trafficking1 sex trafficking1 child sexual abuse1 or forced marriage4 7e7 ,definitions ,in this section3 7#a7 ,the term maternal mortality-- 7,a7 means death that-- 7i7 occurs during1 or within the #a-year period after1 pregnancy2 and 7ii7 is attributed to or aggravated by pregnancy-related or childbirth complications2 and 7,b7 includes a suicide1 drug overdose death1 homicide 7including a domestic violence-related homicide71 or other death resulting from a mental health or substance use disorder attributed to or aggravated by pregnancy-related or childbirth complications4 7#b7 ,the term maternity care provider means a health care provider who-- 7,a7 is a physician1 physician assistant1 nurse1 midwife who meets at a minimum the international definition of the midwife and global standards for midwifery education as established by the ,international ,confederation of ,midwives1 nurse practitioner1 or clinical nurse specialist2 and 7,b7 has a focus on maternal or perinatal health4 7#c7 ,the term perinatal health worker means a worker who-- 7,a7 is a doula1 community health worker1 peer supporter1 breastfeeding and lactation educator or counselor1 nutritionist or dietitian1 childbirth educator1 social worker1 home visitor1 language interpreter1 or navigator2 and 7,b7 provides assistance with perinatal health4 7#d7 ,the term postpartum refers to the #ab-month period following childbirth4 7#e7 ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#f7 ,the term severe maternal morbidity means a health condition1 including a mental health condition or substance use disorder1 that-- 7,a7 is attributed to or aggravated by pregnancy or childbirth2 and 7,b7 results in significant short-term or long-term consequences to the health of the individual who was pregnant4 #ebac4 ,midwives schools and programs expansion 7a7 ,midwifery schools and programs 7#a7 ,in general ,title ,,vii of the ,public ,health ,service ,act is amended by inserting after section #gfj 7#db ,u4,s4,c4 #bidk7 the following3 #gfj;,a4 ,midwifery schools and programs 7a7 ,in general ,the ,secretary may award grants to institutions of higher education 7as defined in subsections 7a7 and 7b7 of section #aja of the ,higher ,education ,act of #aife7 for the following3 7#a7 ,direct support of students in an accredited midwifery school or program4 7#b7 ,establishment or expansion of an accredited midwifery school or program4 7#c7 ,securing1 preparing1 or providing support for increasing the number of1 qualified preceptors for training the students of an accredited midwifery school or program4 7b7 ,special considerations ,in awarding grants under subsection 7a71 the ,secretary shall give special consideration to any institution of higher education that-- 7#a7 agrees to prioritize students who plan to practice in a health professional shortage area designated under section #ccb2 and 7#b7 demonstrates a focus on increasing racial and ethnic minority representation in midwifery education4 7c7 ,restriction ,the ,secretary shall not provide any assistance under this section to be used with respect to a midwifery school or program within a school of nursing 7as defined in section #hja74 7d7 ,authorization of appropriations 7#a7 ,in general ,there is authorized to be appropriated to carry out this section #ae1jjj1jjj for the period of fiscal years #bjbe through #bjbi4 7#b7 ,allocation ,of the amounts made available to carry out this section for any fiscal year1 the ,secretary shall use-- 7,a7 #ej percent to award grants for purposes specified in subsection 7a77#a72 7,b7 #be percent to award grants for purposes specified in subsection 7a77#b72 and 7,c7 #be percent to award grants for purposes specified in subsection 7a77#c74 4 7#b7 ,definitions 7,a7 ,midwifery school or program ,section #gii;,b7#a77;,a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #biep7#a77;,a77 is amended-- 7i7 by inserting midwifery school or program1 before and school of chiropractic2 7ii7 by inserting a degree or certificate in midwifery or an equivalent degree or certificate1 before and a degree of doctor of chiropractic or an equivalent degree2 and 7iii7 by striking any such school and inserting any such school or program4 7,b7 ,accredited ,section #gii;,b7#a77;,e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #biep7#a77;,e77 is amended by inserting a midwifery school or program1 before or a graduate program in health administration4 7b7 ,nurse-,midwives ,title ,,viii of the ,public ,health ,service ,act is amended by inserting after section #hab 7as added by section #ebje7;c771 the following3 #hab;,a4 ,midwifery expansion program 7a7 ,in general ,the ,secretary may award grants to schools of nursing for the following3 7#a7 ,direct support of students in an accredited nurse-midwifery school or program4 7#b7 ,establishment or expansion of an accredited nurse-midwifery school or program4 7#c7 ,securing1 preparing1 or providing support for increasing the numbers of1 preceptors at clinical training sites to precept students training to become certified nurse-midwives4 7b7 ,special considerations ,in awarding grants under subsection 7a71 the ,secretary shall give special consideration to any school of nursing that-- 7#a7 agrees to prioritize students who choose to pursue an advanced education degree in nurse-midwifery to practice in a health professional shortage area designated under section #ccb2 and 7#b7 demonstrates a focus on increasing racial and ethnic minority representation in nurse-midwifery education4 7c7 ,authorization of appropriations 7#a7 ,in general ,to carry out this section1 there is authorized to be appropriated #bj1jjj1jjj for the period of fiscal years #bjbe through #bjbi4 7#b7 ,allocation ,of the amounts made available to carry out this section for any fiscal year1 the ,secretary shall use-- 7,a7 #ej percent to award grants for purposes specified in subsection 7a77#a72 7,b7 #be percent to award grants for purposes specified in subsection 7a77#b72 and 7,c7 #be percent to award grants for purposes specified in subsection 7a77#c74 4 #ebad4 ,gestational diabetes ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq47 is amended by adding after section #cag;,h 7#db ,u4,s4,c4 #bdg;b-#i7 the following3 #cag;,h-#a4 ,gestational diabetes 7a7 ,understanding and monitoring gestational diabetes 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 in consultation with the ,diabetes ,mellitus ,interagency ,coordinating ,committee established under section #dbi and representatives of appropriate national health organizations1 shall develop a multisite gestational diabetes research project within the diabetes program of the ,centers for ,disease ,control and ,prevention to expand and enhance surveillance data and public health research on gestational diabetes4 7#b7 ,areas to be addressed ,the research project developed under paragraph 7#a7 shall address-- 7,a7 procedures to establish accurate and efficient systems for the collection of gestational diabetes data within each ,state and commonwealth1 territory1 or possession of the ,united ,states2 7,b7 the progress of collaborative activities with the ,national ,vital ,statistics ,system1 the ,national ,center for ,health ,statistics1 and ,state health departments with respect to the standard birth certificate1 in order to improve surveillance of gestational diabetes2 7,c7 postpartum methods of tracking individuals with gestational diabetes after delivery as well as targeted interventions proven to lower the incidence of type #b diabetes in that population2 7,d7 variations in the distribution of diagnosed and undiagnosed gestational diabetes1 and of impaired fasting glucose tolerance and impaired fasting glucose1 within and among groups of pregnant individuals2 and 7,e7 factors and culturally sensitive interventions that influence risks and reduce the incidence of gestational diabetes and related complications during childbirth1 including cultural1 behavioral1 racial1 ethnic1 geographic1 demographic1 socioeconomic1 and genetic factors4 7#c7 ,report ,not later than #b years after the date of enactment of this section1 and annually thereafter1 the ,secretary shall generate a report on the findings and recommendations of the research project including prevalence of gestational diabetes in the multisite area and disseminate the report to the appropriate ,federal and non-,federal agencies4 7b7 ,expansion of gestational diabetes research 7#a7 ,in ,general ,the ,secretary shall expand and intensify public health research regarding gestational diabetes4 ,such research may include-- 7,a7 developing and testing novel approaches for improving postpartum diabetes testing or screening and for preventing type #b diabetes in individuals who can become pregnant with a history of gestational diabetes2 and 7,b7 conducting public health research to further understanding of the epidemiologic1 socioenvironmental1 behavioral1 translation1 and biomedical factors and health systems that influence the risk of gestational diabetes and the development of type #b diabetes in individuals who can become pregnant with a history of gestational diabetes4 7#b7 ,authorization of ,appropriations ,there is authorized to be appropriated to carry out this subsection #e1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7c7 ,demonstration grants ,to lower the rate of gestational diabetes 7#a7 ,in ,general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall award grants1 on a competitive basis1 to eligible entities for demonstration projects that implement evidence-based interventions to reduce the incidence of gestational diabetes1 the recurrence of gestational diabetes in subsequent pregnancies1 and the development of type #b diabetes in individuals who can become pregnant with a history of gestational diabetes4 7#b7 ,priority ,in making grants under this subsection1 the ,secretary shall give priority to projects focusing on-- 7,a7 helping individuals who can become pregnant who have #a or more risk factors for developing gestational diabetes2 7,b7 working with individuals who can become pregnant with a history of gestational diabetes during a previous pregnancy2 7,c7 providing postpartum care for individuals who can become pregnant with gestational diabetes2 7,d7 tracking cases where individuals who can become pregnant with a history of gestational diabetes developed type #b diabetes2 7,e7 educating mothers with a history of gestational diabetes about the increased risk of their child developing diabetes2 7,f7 working to prevent gestational diabetes and prevent or delay the development of type #b diabetes in individuals who can become pregnant with a history of gestational diabetes2 and 7,g7 achieving outcomes designed to assess the efficacy and cost-effectiveness of interventions that can inform decisions on long-term sustainability1 including third-party reimbursement4 7#c7 ,application ,an eligible entity desiring to receive a grant under this subsection shall submit to the ,secretary-- 7,a7 an application at such time1 in such manner1 and containing such information as the ,secretary may require2 and 7,b7 a plan to-- 7i7 lower the rate of gestational diabetes during pregnancy2 or 7ii7 develop methods of tracking individuals who can become pregnant with a history of gestational diabetes and develop effective interventions to lower the incidence of the recurrence of gestational diabetes in subsequent pregnancies and the development of type #b diabetes4 7#d7 ,uses of ,funds ,an eligible entity receiving a grant under this subsection shall use the grant funds to carry out demonstration projects described in paragraph 7#a71 including-- 7,a7 expanding community-based health promotion education1 activities1 and incentives focused on the prevention of gestational diabetes and development of type #b diabetes in individuals who can become pregnant with a history of gestational diabetes2 7,b7 aiding ,state- and ,tribal-based diabetes prevention and control programs to collect1 analyze1 disseminate1 and report surveillance data on individuals who can become pregnant with1 and at risk for1 gestational diabetes1 the recurrence of gestational diabetes in subsequent pregnancies1 and1 for individuals who can become pregnant with a history of gestational diabetes1 the development of type #b diabetes2 and 7,c7 training and encouraging health care providers-- 7i7 to promote risk assessment1 high-quality care1 and self-management for gestational diabetes and the recurrence of gestational diabetes in subsequent pregnancies2 and 7ii7 to prevent the development of type #b diabetes in individuals who can become pregnant with a history of gestational diabetes1 and its complications in the practice settings of the health care providers4 7#e7 ,report ,not later than #d years after the date of enactment of this section1 the ,secretary shall prepare and submit to the ,congress a report concerning the results of the demonstration projects conducted through the grants awarded under this subsection4 7#f7 ,definition of ,eligible ,entity ,in this subsection1 the term eligible entity means a nonprofit organization 7such as a nonprofit academic center or community health center7 or a ,state1 ,tribal1 or local health agency4 7#g7 ,authorization of ,appropriations ,there is authorized to be appropriated to carry out this subsection #e1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7d7 ,postpartum followup regarding gestational diabetes ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall work with the ,state- and ,tribal-based diabetes prevention and control programs assisted by the ,centers to encourage postpartum followup after gestational diabetes1 as medically appropriate1 for the purpose of reducing the incidence of gestational diabetes1 the recurrence of gestational diabetes in subsequent pregnancies1 the development of type #b diabetes in individuals with a history of gestational diabetes1 and related complications4 4 #ebae4 ,consumer education campaign ,section #bbi7;b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bcg;a7b77 is amended-- 7#a7 in paragraph 7#f71 by striking and at the end2 7#b7 in paragraph 7#g71 by striking the period at the end and inserting a semicolon2 and 7#c7 by adding at the end the following3 7#h7 not later than #a year after the date of enactment of this paragraph1 develop and implement a #d-year culturally and linguistically appropriate multimedia consumer education campaign that is designed to promote understanding and acceptance of evidence-based maternity practices and models of care for optimal maternity outcomes among individuals of childbearing ages and families of such individuals and that-- 7,a7 highlights the importance of protecting1 promoting1 and supporting the innate capacities of childbearing individuals and their newborns for childbirth1 breastfeeding1 and attachment2 7,b7 promotes understanding of the importance of using obstetric interventions when medically necessary and when supported by strong1 high-quality evidence2 7,c7 highlights the widespread overuse of maternity practices that have been shown to have benefit when used appropriately in situations of medical necessity1 but which can expose pregnant individuals1 infants1 or both to risk of harm if used routinely and indiscriminately2 7,d7 emphasizes the noninvasive maternity practices that have proven correlation or may be associated with improvement in outcomes with no detrimental side effects1 and are significantly underused in the ,united ,states1 including smoking cessation programs in pregnancy1 group model prenatal care1 continuous labor support1 nonsupine positions for birth1 and external version to turn breech babies at term2 7,e7 educates consumers about-- 7i7 the qualifications of licensed providers of maternity care1 including obstetrician-gynecologists1 family physicians1 certified nurse-midwives1 certified midwives1 and certified professional midwives2 and 7ii7 the best evidence about the safety1 satisfaction1 outcomes1 and costs of such providers2 7,f7 informs consumers about the best available research comparing birth center births1 planned home births1 and hospital births1 including information about each setting's safety1 satisfaction1 outcomes1 and costs2 7,g7 fosters participation in high-quality1 evidence-based childbirth education that promotes a healthy and safe approach to pregnancy1 childbirth1 and early parenting2 is taught by certified educators1 peer counselors1 and health professionals2 and promotes informed decision making by childbearing individuals2 7,h7 informs consumers about-- 7i7 the effects of systemic1 institutional1 and interpersonal racism on the health1 well-being1 and outcomes of birthing people2 7ii7 the importance of respectful1 culturally and linguistically appropriate1 and culturally congruent care2 and 7iii7 the value of community-based and community-led maternal care and support2 and 7,i7 is pilot tested for consumer comprehension1 cultural sensitivity1 and acceptance of the messages across geographically1 racially1 ethnically1 and linguistically diverse populations2 4 #ebaf4 ,bibliographic database of systematic reviews for care of childbearing individuals and newborns 7a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality1 shall-- 7#a7 make publicly available an online bibliographic database identifying systematic reviews1 including an explanation of the level and quality of evidence1 for care of childbearing individuals and newborns2 and 7#b7 initiate regular updates that incorporate newly issued and updated systematic reviews4 7b7 ,sources ,to aim for a comprehensive inventory of systematic reviews relevant to maternal and newborn care1 the database shall identify reviews from diverse sources1 including-- 7#a7 scientific peer-reviewed journals2 7#b7 databases1 including the ,cochrane ,database of ,systematic ,reviews2 and 7#c7 internet websites of agencies and organizations throughout the world that produce such systematic reviews4 7c7 ,features ,the database shall-- 7#a7 provide bibliographic citations for each record within the database1 and for each such citation include an explanation of the level and quality of evidence2 7#b7 include abstracts1 as available2 7#c7 provide reference to companion documents as may exist for each review1 such as evidence tables and guidelines or consumer educational materials developed from the review2 7#d7 provide links to the source of the full review and to any companion documents2 7#e7 provide links to the source of a previous version or update of the review2 7#f7 be searchable by intervention or other topic of the review1 reported outcomes1 author1 title1 and source2 and 7#g7 offer to users periodic electronic notification of database updates relating to users' topics of interest4 7d7 ,outreach ,not later than the first date the database is made publicly available and periodically thereafter1 the ,secretary of ,health and ,human ,services shall publicize the availability1 features1 and uses of the database under this section to the stakeholders described in subsection 7e74 7e7 ,consultation ,for purposes of developing the database under this section and maintaining and updating such database1 the ,secretary of ,health and ,human ,services shall convene and consult with an advisory committee composed of relevant stakeholders1 including-- 7#a7 ,federal ,medicaid administrators and ,state agencies administrating ,state plans under title ,,xix of the ,social ,security ,act pursuant to section #aijb7;a77#e7 of such ,act 7#db ,u4,s4,c4 #acif;a7a77#e772 7#b7 providers of maternity and newborn care from both academic and community-based settings1 including obstetrician-gynecologists1 family physicians1 certified nurse midwives1 certified midwives1 certified professional midwives1 physician assistants1 perinatal nurses1 pediatricians1 and nurse practitioners2 7#c7 maternal-fetal medicine specialists2 7#d7 neonatologists2 7#e7 childbearing individuals and advocates for such individuals1 including childbirth educators certified by a nationally accredited program1 representing communities that are diverse in terms of race1 ethnicity1 indigenous status1 and geographic area2 7#f7 employers and purchasers2 7#g7 health facility and system leaders1 including both hospital and birth center facilities2 7#h7 journalists2 and 7#i7 bibliographic informatics specialists4 7f7 ,authorization of appropriations ,there is authorized to be appropriated #b1ejj1jjj for each of fiscal years #bjbe through #bjbg for the purpose of developing the database and such sums as may be necessary for each subsequent fiscal year for updating the database and providing outreach and notification to users1 as described in this section4 #ebag4 ,development of interprofessional maternity care educational models and tools 7a7 ,in general ,not later than #ahj days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services1 acting in conjunction with the ,administrator of ,health ,resources and ,services ,administration1 shall convene1 for a #a-year period1 an ,interprofessional ,maternity ,provider ,education ,commission 7referred to in this section as the ,commission7 to discuss and make recommendations for-- 7#a7 a consensus standard physiologic maternity care curriculum that takes into account the core competencies for basic midwifery practice such as those developed by the ,american ,college of ,nurse-,midwives and the ,north ,american ,registry of ,midwives1 and the educational objectives for physicians practicing in obstetrics and gynecology as determined by the ,council on ,resident ,education in ,obstetrics and ,gynecology2 7#b7 suggestions for multidisciplinary use of the consensus physiologic curriculum2 7#c7 strategies to integrate and coordinate education across maternity care disciplines1 including recommendations to increase medical and midwifery student exposure to out-of-hospital birth2 7#d7 curriculum and strategies for continuing education of practicing perinatal professionals who have completed their undergraduate and graduate education2 and 7#e7 pilot demonstrations of interprofessional educational models4 7b7 ,participants 7#a7 ,professions ,the ,commission shall include maternity care educators1 curriculum developers1 service leaders1 certification leaders1 and accreditation leaders from the various professions that provide or support maternity care in the ,united ,states4 ,such professions shall include obstetrician gynecologists1 certified nurse midwives or certified midwives1 family practice physicians1 nurse practitioners1 physician assistants1 certified professional midwives1 perinatal nurses1 doulas1 lactation personnel1 and community health workers4 7#b7 ,consumer advocates ,the ,commission shall also include representation from maternity care consumer advocates4 7c7 ,curriculum ,the consensus standard physiologic maternity care curriculum described in subsection 7a77#a7 shall-- 7#a7 have a public health focus with a foundation in health promotion and disease prevention2 7#b7 foster physiologic childbearing and person and family centered care2 7#c7 reflect the extensive1 growing research evidence about-- 7,a7 the innate abilities and processes of the birthing person and the fetus or newborn for labor1 birth1 postpartum transition1 breastfeeding1 and attachment1 when promoted1 supported1 and protected2 and 7,b7 the effects of factors that disturb and disrupt these processes2 7#d7 integrate strategies to reduce maternal and infant morbidity and mortality2 7#e7 incorporate recommendations to ensure respectful1 safe1 and seamless consultation1 referral1 transport1 and transfer of care when necessary2 7#f7 include cultural sensitivity and strategies to decrease inequities in maternity outcomes2 and 7#g7 include implicit bias training4 7d7 ,report ,not later than #ahj days after the final meeting of the ,commission1 the ,secretary of ,health and ,human ,services shall-- 7#a7 submit to ,congress a report containing the recommendations made by the ,commission under this section2 and 7#b7 make such report publicly available4 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section-- 7#a7 #a1jjj1jjj for each of fiscal years #bjbe and #bjbf2 and 7#b7 such sums as are necessary for each of fiscal years #bjbg through #bjbi4 #ebah4 ,dissemination of the quality family planning guidelines 7a7 ,in general ,not later than #ahj days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services and the ,director of the ,centers for ,disease ,control and ,prevention shall-- 7#a7 develop a plan for outreach to publicly funded health care providers1 including federally qualified health centers 7as defined in section #ahfa7;aa77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#d777 and branches of the ,indian ,health ,service1 about the quality family planning guidelines referred to in section #ecjd2 and 7#b7 award grants to eligible entities to implement such guidelines for all patients seeking family planning services4 7b7 ,definition ,in this section1 the term eligible entity means a publicly funded health care provider that serves persons of reproductive age4 ,d ,federal agency coordination on maternal health #ecja4 ,interagency ,coordinating ,committee on the ,promotion of ,optimal ,maternity ,outcomes 7a7 ,in general ,part ,a of title ,,ii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bjb et seq47 is amended by adding at the end the following3 #bbi;,a4 ,interagency ,coordinating ,committee on the ,promotion of ,optimal ,maternity ,outcomes 7a7 ,in general ,the ,secretary1 acting through the ,deputy ,assistant ,secretary for ,women's ,health under section #bbi and in collaboration with the ,federal officials specified in subsection 7b71 shall establish the ,interagency ,coordinating ,committee on the ,promotion of ,optimal ,maternity ,outcomes 7referred to in this section as the ,,iccpom74 7b7 ,other agencies ,the officials specified in this subsection are the ,secretary of ,labor1 the ,secretary of ,defense1 the ,secretary of ,veterans ,affairs1 the ,surgeon ,general1 the ,director of the ,centers for ,disease ,control and ,prevention1 the ,administrator of the ,health ,resources and ,services ,administration1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 the ,director of the ,indian ,health ,service1 the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration1 the ,director of the ,national ,institute of ,child ,health and ,human ,development1 the ,director of the ,agency for ,healthcare ,research and ,quality1 the ,assistant ,secretary for ,children and ,families1 the ,deputy ,assistant ,secretary for ,minority ,health1 the ,director of the ,office of ,personnel ,management1 and such other ,federal officials as the ,secretary of ,health and ,human ,services determines to be appropriate4 7c7 ,chair ,the ,deputy ,assistant ,secretary for ,women's ,health shall serve as the chair of the ,,iccpom4 7d7 ,duties ,the ,,iccpom shall guide policy and program development across the ,federal ,government with respect to promotion of optimal maternity care1 provided1 however1 that nothing in this section shall be construed as transferring regulatory or program authority from an agency to the ,,iccpom4 7e7 ,consultations ,the ,,iccpom shall actively seek the input of1 and shall consult with1 all appropriate and interested stakeholders1 including ,state health departments1 public health research and interest groups1 foundations1 childbearing individuals and their advocates1 and maternity care professional associations and organizations1 reflecting racially1 ethnically1 demographically1 and geographically diverse communities4 7f7 ,annual report 7#a7 ,in general ,the ,secretary1 on behalf of the ,,iccpom1 shall annually submit to ,congress a report that summarizes-- 7,a7 all programs and policies of ,federal agencies 7including the ,medicare ,program under title ,,xviii of the ,social ,security ,act and the ,medicaid program under title ,,xix of such ,act7 designed to promote optimal maternity care1 focusing particularly on programs and policies that support the adoption of evidence-based maternity care1 as defined by timely1 scientifically sound systematic reviews2 7,b7 all programs and policies of ,federal agencies 7including the ,medicare ,program under title ,,xviii of the ,social ,security ,act and the ,medicaid program under title ,,xix of such ,act7 designed to address the problems of maternal mortality and morbidity1 infant mortality1 prematurity1 and low birth weight1 including such programs and policies designed to address racial and ethnic inequities with respect to each of such problems2 7,c7 the extent of progress in reducing maternal mortality and infant mortality1 low birth weight1 and prematurity at ,state and national levels2 and 7,d7 such other information regarding optimal maternity care 7such as quality and performance measures7 as the ,secretary determines to be appropriate4 7#b7 ,reducing inequities with respect to indigenous status ,the information specified in paragraph 7#a77;,c7 shall be included in each such report in a manner that disaggregates such information by race1 ethnicity1 and indigenous status in order to determine the extent of progress in reducing racial and ethnic inequities and inequities related to indigenous status4 7#c7 ,certain information ,each report under paragraph 7#a7 shall include information 7disaggregated by race1 ethnicity1 and indigenous status1 as applicable7 on the following rates1 trends1 and costs by ,state3 7,a7 ,the rate and trend of primary cesarean deliveries and repeat cesarean deliveries4 7,b7 ,the rate and trend of vaginal births after cesarean4 7,c7 ,the rate and trend of vaginal breech births4 7,d7 ,the rate and trend of induction of labor4 7,e7 ,the rate and trend of freestanding birth center births4 7,f7 ,the rate and trend of planned and unplanned home birth4 7,g7 ,the rate and trends of attended births by different types of maternity care providers1 including by an obstetrician-gynecologist1 family practice physician1 obstetrician-gynecologist1 physician assistant1 certified nurse-midwife1 certified midwife1 and certified professional midwife4 7,h7 ,the rate and trend of severe maternal morbidity4 7,i7 ,the rates and trends of prenatal and postpartum anxiety and depression4 7,j7 ,the rate and trend of preterm birth4 7,k7 ,the rate and trend of low birth weight4 7,l7 ,the cost of maternity care disaggregated by place of birth and provider of care1 including-- 7i7 uncomplicated vaginal birth2 7ii7 complicated vaginal birth2 7iii7 uncomplicated cesarean birth2 and 7iv7 complicated cesarean birth4 7g7 ,authorization of appropriations ,there is authorized to be appropriated1 in addition to amounts authorized to be appropriated under section #bbi7;e71 to carry out this section #a1jjj1jjj for each of the fiscal years #bjbe through #bjbi4 4 7b7 ,conforming amendments 7#a7 ,inclusion as duty of ,,hhs office on women's health ,section #bbi7;b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bcg;a7b77 7as amended by section #ebae7 is amended by adding at the end the following3 7#i7 establish the ,interagency ,coordinating ,committee on the ,promotion of ,optimal ,maternity ,outcomes in accordance with section #bbi;,a2 and 4 7#b7 ,treatment of biennial reports ,section #bbi7;d7 of such ,act 7#db ,u4,s4,c4 #bcg;a7d77 is amended by inserting 7other than under subsection 7b77#i77 after under this section4 #ecjb4 ,expansion of ,,cdc ,prevention ,research ,centers ,program to include ,centers on ,optimal ,maternity ,outcomes 7a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall support the establishment of additional ,prevention ,research ,centers under the ,prevention ,research ,center ,program administered by the ,centers for ,disease ,control and ,prevention4 ,such additional centers shall each be known as a ,center for ,excellence on ,optimal ,maternity ,outcomes4 7b7 ,research ,each ,center for ,excellence on ,optimal ,maternity ,outcomes shall-- 7#a7 conduct at least one focused program of research to improve maternity outcomes1 including the reduction of cesarean birth rates1 early elective inductions1 prematurity rates1 and low birth weight rates within an underserved population that has a disproportionately large burden of suboptimal maternity outcomes1 including maternal mortality and morbidity1 infant mortality1 prematurity1 or low birth weight1 which such program shall include developing performance and quality measures for accountability2 7#b7 work with partners on special interest projects1 as specified by the ,centers for ,disease ,control and ,prevention and other relevant agencies within the ,department of ,health and ,human ,services1 and on projects funded by other sources2 and 7#c7 involve a minimum of two distinct birth setting models1 such as-- 7,a7 a hospital labor and delivery model and freestanding birth center model2 or 7,b7 a hospital labor and delivery model and planned home birth model4 7c7 ,interdisciplinary providers ,each ,center for ,excellence on ,optimal ,maternity ,outcomes shall include the following interdisciplinary providers of maternity care3 7#a7 ,obstetrician-gynecologists4 7#b7 ,at least two of the following providers3 7,a7 ,family practice physicians4 7,b7 ,nurse practitioners4 7,c7 ,physician assistants4 7,d7 ,certified professional midwives1 certified nurse-midwives1 or certified midwives4 7d7 ,services ,research conducted by each ,center for ,excellence on ,optimal ,maternity ,outcomes shall include at least #b 7and preferably more7 of the following supportive provider services3 7#a7 ,mental health4 7#b7 ,doula labor support4 7#c7 ,nutrition education4 7#d7 ,childbirth education4 7#e7 ,social work4 7#f7 ,physical therapy or occupation therapy4 7#g7 ,substance use disorder services4 7#h7 ,home visiting4 7e7 ,coordination ,the programs of research at each of the ,centers of ,excellence on ,optimal ,maternity ,outcomes shall complement and not replicate the work of the other4 7f7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #b1jjj1jjj for each of fiscal years #bjbe through #bjbi4 #ecjc4 ,expanding models to be tested by ,center for ,medicare and ,medicaid ,innovation to explicitly include maternity care and children's health models ,section #aaae;,a7b77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b771 as amended by section #ebji7;b71 is amended-- 7#a7 in subparagraph 7,b71 by adding at the end the following3 7xxix7 ,promoting evidence-based models of care that have been associated with reductions in pregnancy-related and infant health inequities1 including incorporating the use of and payment for doulas1 particularly community-based doulas1 and promoting support for people during pregnancy and for the one-year period after the last day of such person's pregnancy1 through evidence-based models of antepartum1 birth1 postpartum care1 and two-generation birthing person and newborn care models1 and supporting the risk-appropriate use of out-of-hospital birth models1 including births at home and in freestanding birth centers4 ,such models shall be selected and evaluated based on their impact on quality1 equity1 and developmental outcomes1 notwithstanding any other provision of this section4 2 7#b7 in subparagraph 7,c71 by adding at the end the following3 7ix7 ,whether the model includes a regular process for ensuring the provision of culturally and linguistically appropriate services4 7x7 ,whether health care services and supportive services included in the model are tailored to community health and health-related social needs and provided by community-based and community-led providers4 7xi7 ,whether the model is designed to mitigate harmful effects of discrimination on the basis of race1 sex1 disability1 ethnicity1 language1 and age4 2 and 7#c7 by adding at the end the following3 7,d7 ,mandatory health equity models to be tested ,the ,secretary shall select-- 7i7 ,medicaid payment models for culturally and linguistically appropriate antepartum1 labor and delivery1 and postpartum doula services1 including community-based doula services1 that are-- 7,i7 structured to provide payment to doulas as individuals1 health care entity staff1 or members of a doula group or collective1 or through a third-party administrator2 7,,ii7 designed to reduce racial and intersecting health inequities2 7,,iii7 designed to provide doulas providing support with an equitable and sustainable reimbursement rate2 7,,iv7 designed to reduce barriers to workforce entry for culturally and linguistically competent and racially congruent doulas to provide services to ,medicaid enrollees2 and 7,v7 designed with input from community-based doulas1 maternal health advocates1 reproductive justice advocates1 and ,medicaid beneficiaries2 7ii7 a ,medicaid episode-based payment model for pregnancy-related services1 including health care services and supportive services to address health-related social needs1 during the prenatal1 intrapartum1 and postpartum periods1 to improve health outcomes and reduce racial health inequities1 and to be designed with input from maternity care providers1 maternal health advocates1 reproductive justice advocates1 and ,medicaid beneficiaries2 7iii7 a ,medicaid alternative payment model for a pregnancy-related health home service to improve health outcomes during and for one year after pregnancy and during the newborn period1 and to reduce racial health inequities1 designed with input from maternity care providers1 maternal health advocates1 reproductive justice advocates1 and ,medicaid beneficiaries2 7iv7 a ,medicaid perinatal health worker service delivery model for culturally and linguistically appropriate and respectful health care and supportive services that are tailored to community health and health-related social needs1 designed to improve health outcomes and mitigate harmful effects of racism and other forms of discrimination1 and provided by community-based and community-led providers2 and 7v7 one or more models exclusively focused on early intervention and prevention for children enrolled in a ,state plan 7or waiver of such plan7 under title ,,xix or a ,state child health plan under title ,,xxi using evidence-based interventions including parenting support programs1 home-visiting services1 and dyadic therapy treatment for children and adolescents at risk4 ,such models shall be selected and evaluated based on their impact on quality1 equity1 and developmental outcomes1 notwithstanding any other provision of this section4 4 #ecjd4 ,interagency update to the quality family planning guidelines 7a7 ,in general ,not later than #ahj days after the date of enactment of this ,act1 the ,director of the ,centers for ,disease ,control and ,prevention and the ,office of ,population ,affairs shall review and expand the #bjad ,quality ,family ,planning ,guidelines to address-- 7#a7 health inequities2 and 7#b7 the importance of patient-directed contraceptive decision making4 7b7 ,consultation ,in carrying out subsection 7a71 the ,director of the ,centers for ,disease ,control and ,prevention and the ,office of ,population ,affairs shall convene a meeting1 and solicit the views of1 stakeholders including experts on health inequities1 experts on reproductive coercion1 representatives of provider organizations1 patient advocates1 reproductive justice organizations1 organizations that represent racial and ethnic minority communities1 organizations that represent people with disabilities1 organizations that represent ,,lgbtq persons1 and organizations that represent people with limited ,english proficiency4 ,e ,reproductive and ,sexual ,health #edja4 ,sense of ,congress on urgent issues concerning barriers to abortion access and vital solutions ,it is the sense of ,congress that eliminating the ,hyde amendment1 enacting the ,equal ,access to ,abortion ,coverage in ,health ,insurance ,act of #bjba1 and enacting the ,women's ,health ,protection ,act of #bjba1 are critical to-- 7#a7 promoting equitable abortion access1 including coverage1 for all who seek care2 7#b7 creating enforceable rights to receive1 and receive coverage for1 such care2 7#c7 advancing equitable access to comprehensive health coverage1 which cannot be achieved without abortion coverage2 and 7#d7 alleviating urgent racial1 gender1 and other inequities in health and health care and corresponding reproductive injustices4 #edjb4 ,emergency contraception education and information programs 7a7 ,emergency ,contraception ,public ,education ,program 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall develop and disseminate to the public medically accurate and complete information on emergency contraceptives4 7#b7 ,dissemination ,the ,secretary may disseminate medically accurate and complete information under paragraph 7#a7 directly or through arrangements with nonprofit organizations1 community health workers1 including patient advocates1 consumer groups1 institutions of higher education1 clinics1 the media1 and ,federal1 ,state1 and local agencies4 7#c7 ,information ,the information disseminated under paragraph 7#a7 shall-- 7,a7 include1 at a minimum1 a description of emergency contraceptives and an explanation of the use1 safety1 efficacy1 affordability1 and availability1 including over-the-counter access1 of such contraceptives and options for access to such contraceptives without cost-sharing through insurance and other programs2 and 7,b7 be pilot tested for consumer comprehension1 cultural and linguistic appropriateness1 and acceptance of the messages across geographically1 racially1 ethnically1 and linguistically di-verse populations4 7b7 ,emergency ,contraception ,information ,program for ,health ,care ,providers 7#a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration and in consultation with major medical and public health organizations1 shall develop and disseminate to health care providers1 including pharmacists1 information on emergency contraceptives4 7#b7 ,information ,the information disseminated under paragraph 7#a7 shall include1 at a minimum-- 7,a7 information describing the use1 safety1 efficacy1 and availability of emergency contraceptives1 and options for access without cost-sharing through insurance and other programs2 7,b7 a recommendation regarding the use of such contraceptives2 and 7,c7 information explaining how to obtain copies of the information developed under subsection 7a7 for distribution to the patients of the providers4 7c7 ,definitions ,in this section3 7#a7 ,health care provider ,the term health care provider means an individual who is licensed or certified under ,state law to provide health care services and who is operating within the scope of such license4 ,such term shall include a pharmacist4 7#b7 ,institution of higher education ,the term institution of higher education has the same meaning given such term in section #aja7;a7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja7;a774 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7d7 ,authorization of ,appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of the fiscal years #bjbe through #bjbi4 #edjc4 ,duties of pharmacies to ensure provision of ,,fda-approved contraception ,part ,b of title ,,ii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bch et seq47 is amended by adding at the end the following3 #bdi4 ,duties of pharmacies to ensure provision of ,,fda-approved contraception 7a7 ,in general ,subject to subsection 7c71 a pharmacy that receives ,food and ,drug ,administration-approved drugs or devices in interstate commerce shall maintain compliance with each of the following3 7#a7 ,if a customer requests a contraceptive or a medication related to a contraceptive1 including emergency contraception1 that is in stock1 the pharmacy shall ensure that the requested contraceptive or medication is provided to the customer without delay4 7#b7 ,if a customer requests a contraceptive or a medication related to a contraceptive that is not in stock and the pharmacy in the normal course of business stocks contraception1 the pharmacy shall immediately inform the customer that the requested contraceptive or medication is not in stock and without delay offer the customer the following options3 7,a7 ,if the customer prefers to obtain the requested contraceptive or medication through a referral or transfer1 the pharmacy shall-- 7i7 locate a pharmacy of the customer's choice or the closest pharmacy confirmed to have the requested contraceptive or medication in stock2 and 7ii7 refer the customer or transfer the prescription to that pharmacy4 7,b7 ,if the customer prefers for the pharmacy to order the requested contraceptive or medication1 the pharmacy shall obtain the contraceptive or medication under the pharmacy's standard procedure for expedited ordering of medication and notify the customer when the contraceptive or medication arrives4 7#c7 ,the pharmacy shall ensure that-- 7,a7 the pharmacy does not operate an environment in which customers are intimidated1 threatened1 or harassed in the delivery of services relating to a request for contraception or a medication related to a contraceptive2 7,b7 the pharmacy's employees do not interfere with or obstruct the delivery of services relating to a request for contraception or a medication related to a contraceptive2 7,c7 the pharmacy's employees do not intentionally misrepresent or deceive customers about the availability of a contraceptive or a medication related to a contraceptive1 or the mechanism of action of such contraceptive or medication2 7,d7 the pharmacy's employees do not breach medical confidentiality with respect to a request for a contraceptive or a medication related to a contraceptive or threaten to breach such confidentiality2 or 7,e7 the pharmacy's employees do not refuse to return a valid1 lawful prescription for a contraceptive or a medication related to a contraceptive upon customer request4 7b7 ,contraceptives not ordinarily stocked ,nothing in subsection 7a77#b7 shall be construed to require any pharmacy to comply with such subsection if the pharmacy does not ordinarily stock contraceptives or medications related to contraceptives1 as the case may be1 in the normal course of business4 7c7 ,refusals pursuant to standard pharmacy practice ,this section does not prohibit a pharmacy from refusing to provide a contraceptive or a medication related to a contraceptive to a customer in accordance with any of the following3 7#a7 ,if it is unlawful to dispense the requested contraceptive or medication to the customer without a valid1 lawful prescription and no such prescription is presented4 7#b7 ,if the customer is unable to pay for the requested contraceptive or medication4 7#c7 ,if the employee of the pharmacy refuses to provide the requested contraceptive or medication on the basis of a professional clinical judgment4 7d7 ,relation to other law 7#a7 ,rule of construction ,nothing in this section shall be construed to invalidate or limit rights1 remedies1 procedures1 or legal standards under title ,,vii of the ,civil ,rights ,act of #aifd4 7#b7 ,certain claims ,the ,religious ,freedom ,restoration ,act of #aiic shall not provide a basis for a claim concerning1 or a defense to a claim under1 this section1 or provide a basis for challenging the application or enforcement of this section4 7e7 ,preemption ,this section does not preempt any provision of ,state law or affect any professional obligation made applicable by a ,state board or other entity responsible for licensing or discipline of pharmacies or pharmacists1 to the extent that such ,state law or professional obligation provides protections for customers that are greater than the protections provided by this section4 7f7 ,enforcement 7#a7 ,civil penalty ,a pharmacy that violates a requirement of subsection 7a7 is liable to the ,united ,states for a civil penalty in an amount not exceeding #a1jjj per day of violation1 not to exceed #ajj1jjj for all violations adjudicated in a single proceeding4 7#b7 ,private cause of action ,any person aggrieved as a result of a violation of a requirement of subsection 7a7 may1 in any court of competent jurisdiction1 commence a civil action against the pharmacy involved to obtain appropriate relief1 including actual and punitive damages1 injunctive relief1 and a reasonable attorney's fee and costs4 7#c7 ,limitations ,a civil action under paragraph 7#a7 or 7#b7 may not be commenced against a pharmacy after the expiration of the #e-year period beginning on the date on which the pharmacy allegedly engaged in the violation involved4 7g7 ,definitions ,in this section3 7#a7 ,contraception ,the term contraception or contraceptive means any drug or device approved by the ,food and ,drug ,administration to prevent pregnancy4 7#b7 ,employee ,the term employee means a person hired1 by contract or any other form of an agreement1 by a pharmacy4 7#c7 ,medication related to a contraceptive ,the term medication related to a contraceptive means any drug or device approved by the ,food and ,drug ,administration that a medical professional determines necessary to use before or in conjunction with use of a contraceptive4 7#d7 ,pharmacy ,the term pharmacy means an entity that-- 7,a7 is authorized by a ,state to engage in the business of selling prescription drugs at retail2 and 7,b7 employs one or more employees4 7#e7 ,product ,the term product means a ,food and ,drug ,administration-approved drug or device4 7#f7 ,professional clinical judgment ,the term professional clinical judgment means a clinical judgment1 formed with the use of professional knowledge and skills1 in accordance with prevailing medical standards4 7#g7 ,without delay ,the term without delay1 with respect to a pharmacy providing1 providing a referral for1 or ordering contraception1 or transferring the prescription for contraception1 means within the usual and customary timeframe at the pharmacy for providing1 providing a referral for1 or ordering other products1 or transferring the prescription for other products1 respectively4 7h7 ,effective date ,this section shall take effect on the #cast day after the date of the enactment of this section1 without regard to whether the ,secretary has issued any guidance or final rule regarding this section4 4 #edjd4 ,real ,education and ,access for ,healthy ,youth ,act 7a7 ,short title ,this section may be cited as the ,real ,education and ,access for ,healthy ,youth ,act of #bjbd4 7b7 ,definitions ,in this section3 7#a7 ,age and developmentally appropriate ,the term age and developmentally appropriate means topics1 messages1 and teaching methods suitable to particular ages1 age groups1 or developmental levels1 based on cognitive1 emotional1 social1 and behavioral capacity of most young people at that age level4 7#b7 ,consent ,the term consent means affirmative1 conscious1 and voluntary agreement to engage in interpersonal1 physical1 or sexual activity4 7#c7 ,culturally responsive ,the term culturally responsive means education and services that-- 7,a7 embrace and actively engage and adjust to young people and their various cultural identities2 7,b7 recognize the ways in which many marginalized young people face unique barriers in society that result in increased adverse health outcomes and associated stereotypes2 and 7,c7 may address the ways in which racism has shaped national health care policy1 the lasting historical trauma associated with reproductive health experiments and forced sterilizations of ,black1 ,latine1 and ,indigenous communities1 or sexual stereotypes assigned to young ,people of ,color or ,,lgbtq people4 7#d7 ,evidence-informed ,the term evidence-informed means incorporates characteristics1 content1 or skills that have been proven to be effective through evaluation in changing sexual behavior4 7#e7 ,gender expression ,the term gender expression means the expression of one's gender1 such as through behavior1 clothing1 haircut1 or voice1 and which may or may not conform to socially defined behaviors and characteristics typically associated with being either masculine or feminine4 7#f7 ,gender identity ,the term gender identity means the gender-related identity1 appearance1 mannerisms1 or other gender-related characteristics of an individual1 regardless of the individual's designated sex at birth4 7#g7 ,inclusive ,the term inclusive means content and skills that ensure marginalized young people are valued1 respected1 centered1 and supported in sex education instruction and materials4 7#h7 ,institution of higher education ,the term institution of higher education has the meaning given the term in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja74 7#i7 ,interpersonal violence ,the term interpersonal violence means abuse1 assault1 bullying1 dating violence1 domestic violence1 harassment1 intimate partner violence1 or stalking4 7#aj7 ,local educational agency ,the term local educational agency has the meaning given the term in section #haja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja74 7#aa7 ,marginalized young people ,the term marginalized young people means young people who are disadvantaged by underlying structural barriers and social inequities1 including young people who are-- 7,a7 ,black1 ,indigenous1 ,latine1 ,asian ,american1 ,native ,hawaiian1 ,pacific ,islander1 and other ,people of ,color2 7,b7 immigrants2 7,c7 in contact with the foster care system2 7,d7 in contact with the juvenile justice system2 7,e7 experiencing homelessness2 7,f7 pregnant or parenting2 7,g7 lesbian1 gay1 bisexual1 transgender1 or queer2 7,h7 living with ,,hiv2 7,i7 living with disabilities2 7,j7 from families with low-incomes2 or 7,k7 living in rural areas4 7#ab7 ,medically accurate and complete ,the term medically accurate and complete means that-- 7,a7 the information provided through the education is verified or supported by the weight of research conducted in compliance with accepted scientific methods and is published in peer-reviewed journals1 where applicable2 or 7,b7 the education contains information that leading professional organizations and agencies with relevant expertise in the field recognize as accurate1 objective1 and complete4 7#ac7 ,resilience ,the term resilience means the ability to adapt to trauma and tragedy4 7#ad7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#ae7 ,sex education ,the term sex education means high quality teaching and learning that-- 7,a7 is delivered1 to the maximum extent practicable1 following the ,national ,sexuality ,education ,standards of the ,future of ,sex ,ed ,initiative2 7,b7 is about a broad variety of topics related to sex and sexuality1 including-- 7i7 puberty and adolescent development2 7ii7 sexual and reproductive anatomy and physiology2 7iii7 sexual orientation1 gender identity1 and gender expression2 7iv7 contraception1 pregnancy1 pregnancy options1 and reproduction2 7v7 ,,hiv and other ,s,t,is2 7vi7 consent and healthy relationships2 and 7vii7 interpersonal violence2 7,c7 explores values and beliefs about such topics2 and 7,d7 helps young people in gaining the skills that are needed to navigate relationships and manage one's own sexual health4 7#af7 ,sexual health services ,the term sexual health services includes-- 7,a7 sexual health information1 education1 and counseling2 7,b7 all methods of contraception approved by the ,food and ,drug ,administration2 7,c7 routine gynecological care1 including human papillomavirus 7,,hpv7 vaccines and cancer screenings2 7,d7 pre-exposure prophylaxis or post-exposure prophylaxis2 7,e7 substance use and mental health services2 7,f7 interpersonal violence survivor services2 and 7,g7 other pregnancy and ,,sti prevention1 care1 or treatment services4 7#ag7 ,sexual orientation ,the term sexual orientation means an individual's romantic1 emotional1 or sexual attraction to other people4 7#ah7 ,state educational agency ,the term ,state educational agency has the meaning given the term in section #haja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja74 7#ai7 ,trauma ,the term trauma means a response to an event1 series of events1 or set of circumstances that is experienced or witnessed by an individual or group of people as physically or emotionally harmful or life-threatening with lasting adverse effects on their functioning and mental1 physical1 social1 emotional1 or spiritual well-being4 7#bj7 ,trauma-informed and resilience-oriented ,the term trauma-informed and resilience-oriented means an approach that realizes the prevalence of trauma1 recognizes the various ways individuals1 organizations1 and communities may respond to trauma differently1 recognizes that resilience can be built1 and responds by putting this knowledge into practice4 7#ba7 ,young people ,the term young people means individuals who are ages #aj through #bi at the time of commencement of participation in a project supported under this section4 7#bb7 ,youth-friendly sexual health services ,the term youth-friendly sexual health services means sexual health services that are provided in a confidential1 equitable1 and accessible manner that makes it easy and comfortable for young people to seek out and receive services4 7c7 ,grants for sex education at elementary and secondary schools and youth-,serving organizations 7#a7 ,program authorized ,the ,secretary1 in coordination with the ,secretary of ,education1 shall award grants1 on a competitive basis1 to eligible entities to enable such eligible entities to carry out projects that provide young people with sex education4 7#b7 ,duration ,grants awarded under this section shall be for a period of #e years4 7#c7 ,eligible entity ,in this section1 the term eligible entity means a public or private entity that delivers evidence-based sex education to young people4 7#d7 ,applications ,an eligible entity desiring a grant under this section shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7#e7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to eligible entities that are-- 7,a7 ,state educational agencies or local educational agencies2 or 7,b7 ,indian ,tribes or ,tribal organizations1 as defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 7#f7 ,use of funds ,each eligible entity that receives a grant under this section shall use the grant funds to carry out a project that provides young people with sex education4 7d7 ,grants for sex education at institutions of higher education 7#a7 ,program authorized ,the ,secretary1 in coordination with the ,secretary of ,education1 shall award grants1 on a competitive basis1 to institutions of higher education or consortia of such institutions to enable such institutions to provide students with age and developmentally appropriate sex education4 7#b7 ,duration ,grants awarded under this section shall be for a period of #e years4 7#c7 ,applications ,an institution of higher education or consortium of such institutions desiring a grant under this section shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7#d7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to an institution of higher education that-- 7,a7 has an enrollment of needy students1 as defined in section #cah7;b7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;e7b772 7,b7 is a ,hispanic-serving institution1 as defined in section #ejb7;a7 of such ,act 7#bj ,u4,s4,c4 #aaja;a7a772 7,c7 is a ,tribal ,college or ,university1 as defined in section #caf7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;c7b772 7,d7 is an ,alaska ,native-serving institution1 as defined in section #cag7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7,e7 is a ,native ,hawaiian-serving institution1 as defined in section #cag7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7,f7 is a ,predominantly ,black ,institution1 as defined in section #cah7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;e7b772 7,g7 is a ,native ,american-serving1 nontribal institution1 as defined in section #cai7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;f7b772 7,h7 is an ,asian ,american and ,native ,american ,pacific ,islander-serving institution1 as defined in section #cbj7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;g7b772 or 7,i7 is a minority institution1 as defined in section #cfe of such ,act 7#bj ,u4,s4,c4 #ajfgk71 with an enrollment of needy students1 as defined in section #cab of such ,act 7#bj ,u4,s4,c4 #ajeh74 7#e7 ,uses of funds ,an institution of higher education or consortium of such institutions receiving a grant under this section shall use grant funds to develop and implement a project to integrate sex education into the institution of higher education in order to reach a large number of students1 by carrying out #a or more of the following activities3 7,a7 ,adopting and incorporating age and developmentally appropriate sex education into student orientation1 general education1 or courses4 7,b7 ,developing or adopting and implementing educational programming outside of class that delivers age and developmentally appropriate sex education to students4 7,c7 ,developing or adopting and implementing innovative technology-based approaches to deliver age and developmentally appropriate sex education to students4 7,d7 ,developing or adopting and implementing peer-led activities to generate discussion1 educate1 and raise awareness among students about age and developmentally appropriate sex education4 7,e7 ,developing or adopting and implementing policies and practices to link students to sexual health services4 7e7 ,grants for educator training 7#a7 ,program authorized ,the ,secretary1 in coordination with the ,secretary of ,education1 shall award grants1 on a competitive basis1 to eligible entities to enable such eligible entities to carry out the activities described in paragraph 7#e74 7#b7 ,duration ,grants awarded under this section shall be for a period of #e years4 7#c7 ,eligible entity ,in this section1 the term eligible entity means-- 7,a7 a ,state educational agency or local educational agency2 7,b7 an ,indian ,tribe or ,tribal organization1 as defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd72 7,c7 a ,state or local department of health2 7,d7 an educational service agency1 as defined in section #haja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja72 7,e7 a nonprofit institution of higher education or a consortium of such institutions2 or 7,f7 a national or statewide nonprofit organization or consortium of nonprofit organizations that has as its primary purpose the improvement of provision of sex education through training and effective teaching of sex education4 7#d7 ,application ,an eligible entity desiring a grant under this section shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7#e7 ,authorized activities 7,a7 ,required activity ,each eligible entity receiving a grant under this section shall use grant funds for professional development and training of relevant teachers1 health educators1 faculty1 administrators1 and staff1 in order to increase effective teaching of sex education to young people4 7,b7 ,permissible activities ,each eligible entity receiving a grant under this section may use grant funds to-- 7i7 provide training and support for educators about the content1 skills1 and professional disposition needed to implement sex education effectively2 7ii7 develop and provide training and support to educators on incorporating anti-racist and gender inclusive policies and practices in sex education2 7iii7 support the dissemination of information on effective practices and research findings concerning the teaching of sex education2 7iv7 support research on-- 7,i7 effective sex education teaching practices2 and 7,,ii7 the development of assessment instruments and strategies to document-- 7aa7 young people's understanding of sex education2 and 7bb7 the effects of sex education2 7v7 convene conferences on sex education1 in order to effectively train educators in the provision of sex education2 and 7vi7 develop and disseminate appropriate research-based materials to foster sex education4 7,c7 ,subgrants ,each eligible entity receiving a grant under this section may award subgrants to nonprofit organizations that possess a demonstrated record of providing training to teachers1 health educators1 faculty1 administrators1 and staff on sex education to-- 7i7 train educators in sex education2 7ii7 support internet or distance learning related to sex education2 7iii7 promote rigorous academic standards and assessment techniques to guide and measure student performance in sex education2 7iv7 encourage replication of best practices and model programs to promote sex education2 7v7 develop and disseminate effective1 research-based sex education learning materials2 or 7vi7 develop academic courses on the pedagogy of sex education at institutions of higher education4 7f7 ,authorization of grants to support the delivery of sexual health services to marginalized young people 7#a7 ,program authorized ,the ,secretary shall award grants1 on a competitive basis1 to eligible entities to enable such entities to provide youth-friendly sexual health services to marginalized young people4 7#b7 ,duration ,grants awarded under this section shall be for a period of #e years4 7#c7 ,eligible entity ,in this section1 the term eligible entity means-- 7,a7 a public or private youth-serving organization2 or 7,b7 a covered entity1 as defined in section #cdj;,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;b74 7#d7 ,applications ,an eligible entity desiring a grant under this section shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7#e7 ,uses of funds ,each eligible entity that receives a grant under this section may use the grant funds to-- 7,a7 develop and implement an evidence-informed project to deliver sexual health services to marginalized young people2 7,b7 establish1 alter1 or modify staff positions1 service delivery policies and practices1 service delivery locations1 service delivery environments1 service delivery schedules1 or other services components in order to increase youth-friendly sexual health services to marginalized young people2 7,c7 conduct outreach to marginalized young people to invite them to participate in the eligible entity's sexual health services and to provide feedback to inform improvements in the delivery of such services2 7,d7 establish and refine systems of referral to connect marginalized young people to other sexual health services and supportive services2 7,e7 establish partnerships and collaborations with entities providing services to marginalized young people to link such young people to sexual health services1 such as by delivering health services at locations where they congregate1 providing transportation to locations where sexual health services are provided1 or other linkages to services approaches2 7,f7 provide evidence-informed1 comprehensive in scope1 confidential1 equitable1 accessible1 medically accurate and complete1 age and developmentally appropriate1 culturally responsive1 and trauma-informed and resilience-oriented sexual health information to marginalized young people in the languages and cultural contexts that are most appropriate for the marginalized young people to be served by the eligible entity2 7,g7 promote effective communication regarding sexual health among marginalized young people2 and 7,h7 provide training and support for eligible entity personnel and community members who work with marginalized young people about the content1 skills1 and professional disposition needed to provide youth-friendly sex education and youth-friendly sexual health services4 7g7 ,reporting and impact evaluation 7#a7 ,grantee report to secretary ,for each year a grantee receives grant funds under subsection 7c71 7d71 7e71 or 7f7 the grantee shall submit to the ,secretary a report that includes-- 7,a7 a description of the use of grant funds by the grantee2 7,b7 a description of how the use of grant funds has increased the access of young people to sex education or sexual health services2 and 7,c7 such other information as the ,secretary may require4 7#b7 ,secretary's report to ,congress ,not later than #a year after the date of the enactment of this section1 and annually thereafter for a period of #e years1 the ,secretary shall prepare and submit to ,congress a report on the activities funded under this section4 ,the ,secretary's report to ,congress shall include-- 7,a7 a statement of how grants awarded by the ,secretary meet the purposes of the grants2 and 7,b7 information about-- 7i7 the number of grantees that are receiving grant funds under subsections 7c71 7d71 7e71 and 7f72 7ii7 the specific activities supported by grant funds awarded under subsections 7c71 7d71 7e71 and 7f72 7iii7 the number of young people served by projects funded under subsections 7c717d71 and 7f71 in the aggregate and disaggregated and cross-tabulated by grant program1 race and ethnicity1 sex1 sexual orientation1 gender identity1 and other characteristics determined by the ,secretary 7except that such disaggregation or cross-tabulation shall not be required in a case in which the results would reveal personally identifiable information about an individual young person72 7iv7 the number of teachers1 health educators1 faculty1 school administrators1 and staff trained under subsection 7e72 and 7v7 the status of the evaluation required under paragraph 7#c74 7#c7 ,multi-,year evaluation 7,a7 ,in general ,not later than #f months after the date of the enactment of this section1 the ,secretary shall enter into a contract with a nonprofit organization with experience in conducting impact evaluations to conduct a multi-year evaluation on the impact of the projects funded under subsections 7c71 7d71 7e71 and 7f7 and to report to ,congress and the ,secretary on the findings of such evaluation4 7,b7 ,evaluation ,the evaluation conducted under this subsection shall-- 7i7 be conducted in a manner consistent with relevant1 nationally recognized professional and technical evaluation standards2 7ii7 use sound statistical methods and techniques relating to the behavioral sciences1 including quasi-experimental designs1 inferential statistics1 and other methodologies and techniques that allow for conclusions to be reached2 7iii7 be carried out by an independent organization that has not received a grant under subsection 7c71 7d71 7e71 or 7f72 and 7iv7 be designed to provide information on output measures and outcome measures to be determined by the ,secretary4 7,c7 ,report ,not later than #f years after the date of enactment of this section1 the organization conducting the evaluation under this paragraph shall prepare and submit to the appropriate committees of ,congress and the ,secretary an evaluation report4 ,such report shall be made publicly available1 including on the website of the ,department of ,health and ,human ,services4 7h7 ,nondiscrimination ,activities funded under this section shall not discriminate on the basis of actual or perceived sex 7including sexual orientation and gender identity71 age1 parental status1 race1 color1 ethnicity1 national origin1 disability1 or religion4 ,nothing in this section shall be construed to invalidate or limit rights1 remedies1 procedures1 or legal standards available under any other ,federal law or any law of a ,state or a political subdivision of a ,state1 including the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;a et seq471 title ,,ix of the ,education ,amendments of #aigb 7#bj ,u4,s4,c4 #afha et seq471 section #ejd of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gid71 the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abaja et seq471 and section #aeeg of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahaaf74 7i7 ,limitation ,no ,federal funds provided under this section may be used for sex education or sexual health services that-- 7#a7 withhold health-promoting or life-saving information about sexuality-related topics1 including ,,hiv2 7#b7 are medically inaccurate or incomplete2 7#c7 promote gender or racial stereotypes or are unresponsive to gender or racial inequities2 7#d7 fail to address the needs of sexually active young people2 7#e7 fail to address the needs of pregnant or parenting young people2 7#f7 fail to address the needs of survivors of interpersonal violence2 7#g7 fail to address the needs of young people of all physical1 developmental1 or mental abilities2 7#h7 fail to be inclusive of individuals with varying gender identities1 gender expressions1 and sexual orientations2 or 7#i7 are inconsistent with the ethical imperatives of medicine and public health4 7j7 ,amendments to other laws 7#a7 ,amendment to the ,public ,health ,service ,act ,section #bejj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ee7 is amended by striking subsections 7b7 through 7d7 and inserting the following3 7b7 ,contents of programs ,all programs of education and information receiving funds under this subchapter shall include information about the potential effects of intravenous substance use4 4 7#b7 ,amendments to the ,elementary and ,secondary ,education ,act of #aife ,section #hebf of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #gijf7 is amended-- 7,a7 by striking paragraphs 7#c71 7#e71 and 7#f72 7,b7 by redesignating paragraph 7#d7 as paragraph 7#c72 7,c7 in paragraph 7#c71 as redesignated by paragraph 7#b71 by inserting or after the semicolon2 and 7,d7 by redesignating paragraph 7#g7 as paragraph 7#d74 7k7 ,funding 7#a7 ,authorization ,for the purpose of carrying out this section1 there is authorized to be appropriated #ajj1jjj1jjj for each of fiscal years #bjbe through #bjcj4 ,amounts appropriated under this subsection shall remain available until expended4 7#b7 ,reservations of funds 7,a7 ,in general ,the ,secretary-- 7i7 shall reserve not more than #cj percent of the amount authorized under paragraph 7#a7 for the purposes of awarding grants for sex education at elementary and secondary schools and youth-serving organizations under subsection 7c72 7ii7 shall reserve not more than #aj percent of the amount authorized under paragraph 7#a7 for the purpose of awarding grants for sex education at institutions of higher education under subsection 7d72 7iii7 shall reserve not more than #ae percent of the amount authorized under paragraph 7#a7 for the purpose of awarding grants for educator training under subsection 7e72 7iv7 shall reserve not more than #cj percent of the amount authorized under paragraph 7#a7 for the purpose of awarding grants for sexual health services for marginalized youth under subsection 7f72 and 7v7 shall reserve not less than #e percent of the amount authorized under paragraph 7#a7 for the purpose of carrying out the reporting and impact evaluation required under subsection 7g74 7,b7 ,research1 training1 and technical assistance ,the ,secretary shall reserve not less than #aj percent of the amount authorized under paragraph 7#a7 for expenditures by the ,secretary to provide1 directly or through a competitive grant process1 research1 training1 and technical assistance1 including dissemination of research and information regarding effective and promising practices1 providing consultation and resources1 and developing resources and materials to support the activities of recipients of grants4 ,in carrying out such functions1 the ,secretary shall collaborate with a variety of entities that have expertise in sex education and sexual health services standards setting1 design1 development1 delivery1 research1 monitoring1 and evaluation4 7#c7 ,reprogramming of abstinence only until marriage program funding ,the unobligated balance of funds made available to carry out section #eaj of the ,social ,security ,act 7#db ,u4,s4,c4 #gaj7 7as in effect on the day before the date of enactment of this section7 are transferred and shall be used by the ,secretary to carry out this section4 ,the amounts transferred and made available to carry out this section shall remain available until expended4 7#d7 ,repeal of abstinence only until marriage program ,section #eaj of the ,social ,security ,act 7#db ,u4,s4,c4 #gaj et seq47 is repealed4 #edje4 ,compassionate assistance for rape emergencies 7a7 ,medicare 7#a7 ,limitation on payment ,section #ahff7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a771 as amended by section #ebja7;f71 is further amended-- 7,a7 in subparagraph 7,w71 by moving the indentation #b ems to the left2 7,b7 in subparagraph 7,x71 by moving the indentation #b ems to the left2 7,c7 in subparagraph 7,y77ii77,v71 by striking and at the end2 7,d7 in subparagraph 7,z77iii71 by striking the period and inserting 1 and2 and 7,e7 by inserting after subparagraph 7,z7 the following new subparagraph3 7,,aa7 in the case of a hospital or critical access hospital1 to adopt and enforce a policy to ensure compliance with the requirements of subsection 7l7 and to meet the requirements of such subsection4 4 7#b7 ,assistance to victims ,section #ahff of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7 is amended by adding at the end the following new subsection3 7l7 ,compassionate assistance for rape emergencies 7#a7 ,in general ,for purposes of subsection 7a77#a77;,,aa71 a hospital meets the requirements of this subsection if the hospital provides each of the services described in paragraph 7#b7 to each individual1 whether or not eligible for benefits under this title or under any other form of health insurance1 who comes to the hospital on or after ,january #a1 #bjbe1 and-- 7,a7 who states to hospital personnel that they are victims of sexual assault2 7,b7 who is accompanied by an individual who states to hospital personnel that the individual is a victim of sexual assault2 or 7,c7 whom hospital personnel1 during the course of treatment and care for the individual1 have reason to believe is a victim of sexual assault4 7#b7 ,required services described ,for purposes of paragraph 7#a71 the services described in this subparagraph are the following3 7,a7 ,provision of medically and factually accurate and unbiased written and oral information about emergency contraception that-- 7i7 is written in clear and concise language2 7ii7 is readily comprehensible2 7iii7 includes an explanation that emergency contraceptives-- 7,i7 have been approved by the ,food and ,drug ,administration for individuals and are a safe and effective way to prevent pregnancy after unprotected intercourse or contraceptive failure if taken in a timely manner2 7,,ii7 are more effective the sooner it is taken2 and 7,,iii7 do not cause an abortion and cannot interrupt an established pregnancy2 7iv7 meet such conditions regarding the provision of such information in languages other than ,english as the ,secretary may establish2 and 7v7 are provided without regard to the ability of the individual or their family to pay costs associated with the provision of such information to the individual4 7,b7 ,immediate offer to provide emergency contraception to the individual at the hospital and1 in the case that such individual accepts such offer1 immediate provision to such individual of such contraception on the same day it is requested without regard to the inability of the individual or their family to pay costs associated with the offer and provision of such contraception4 7,c7 ,development and implementation of a written policy to ensure that an individual is present at the hospital1 or on-call1 who-- 7i7 has authority to dispense or prescribe emergency contraception1 independently1 or under a protocol prepared by a physician for the administration of emergency contraception at the hospital to a victim of sexual assault2 and 7ii7 is trained to comply with the requirements of this section4 7,d7 ,provision of medically and factually accurate and unbiased written and oral information and counseling about post-exposure prophylaxis 7referred to in this paragraph as ,,pep7 protocol for the prevention of ,,hiv4 7,e7 ,immediate offer to begin ,,pep to the individual at the hospital except in cases where the medical professional's best judgement is that further evaluation is required or that such a regimen will be substantially detrimental to the health of such individual4 ,such provision shall be offered regardless of the individual's ability to pay4 ,hospitals shall be responsible for ensuring adequate supply of ,,pep medications to provide to patients4 7#c7 ,hospital defined ,for purposes of this paragraph1 the term hospital includes a critical access hospital1 as defined in section #ahfa7mm77#a74 4 7b7 ,limitation on payment under ,medicaid ,section #aijc7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7i771 as amended by section #dajf7;b77#b71 is further amended-- 7#a7 in paragraph 7#bg71 by striking or after the semicolon2 7#b7 in paragraph 7#bh71 by striking the period and inserting 2 or2 and 7#c7 by inserting after paragraph 7#bh7 the following new paragraph3 7#bi7 with respect to any amount expended for care or services furnished under the plan by a hospital on or after ,january #a1 #bjbe1 unless such hospital meets the requirements specified in section #ahff7l7 for purposes of title ,,xviii4 4 #edjf4 ,menstrual ,equity for ,all ,act of #bjbd 7a7 ,short title ,this section may be cited as the ,menstrual ,equity ,for ,all ,act of #bjbd4 7b7 ,menstrual products for students at elementary and secondary schools 7#a7 ,in general ,section #dajh7e77;,c7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #gaah7e77;,c77 is amended-- 7,a7 in clause 7vi71 by striking or after the semicolon2 7,b7 in clause 7vii71 by inserting or after the semicolon2 and 7,c7 by adding at the end the following3 7viii7 provide free menstrual products to students who use menstrual products2 4 7#b7 ,definitions ,section #dajb of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #gaab7 is amended-- 7,a7 by redesignating paragraphs 7#f7 through 7#h7 as paragraphs 7#g7 through 7#i71 respectively2 and 7,b7 by inserting after paragraph 7#e7 the following3 7#f7 ,menstrual products ,the term menstrual products means sanitary napkins and tampons that conform to applicable industry standards4 4 7#c7 ,rulemaking ,not later than #a year after the date of enactment of this section1 the ,secretary of ,education1 in consultation with the ,secretary of ,health and ,human ,services1 shall promulgate rules with respect to the definition of menstrual products in paragraph 7#f7 of section #dajb of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #gaab71 as amended by paragraph 7#b74 7c7 ,menstrual products for students at institutions of higher education 7#a7 ,purpose ,the purpose of this subsection is to alleviate-- 7,a7 the barriers to academic success faced by many college and graduate students due to the inability of such students to afford to purchase menstrual products2 and 7,b7 the unique set of burdens that college and graduate students experiencing period poverty face that can be compounded by lack of access to basic needs such as housing1 food1 transportation1 and access to physical and mental health services4 7#b7 ,in general ,the ,secretary of ,education shall establish a program to award grants1 on a competitive basis1 to not less than #d institutions of higher education to-- 7,a7 support programs that provide free menstrual products to students2 and 7,b7 report on best practices of such programs4 7#c7 ,application ,to apply for a grant under this subsection1 an institution of higher education shall submit to the ,secretary an application in such form1 at such time1 and containing such information as the ,secretary determines appropriate1 including an assurance that such grant will be used to carry out the activities described in paragraph 7#e74 7#d7 ,community colleges ,not less than #ej percent of the grants awarded under this subsection shall be awarded to community colleges4 7#e7 ,grant uses ,a grant awarded under this subsection may only be used to-- 7,a7 carry out or expand activities that fund programs that support direct provision of free menstrual products to students in appropriate campus locations1 including-- 7i7 campus restroom facilities2 7ii7 wellness centers2 and 7iii7 on-campus residential buildings2 7,b7 report on best practices of such programs2 7,c7 conduct outreach to students to encourage participation in menstrual equity programs and services2 7,d7 help eligible students apply for and enroll in local1 ,state1 and ,federal public assistance programs2 and 7,e7 coordinate and collaborate with government or community-based organizations to carry out the activities described in subparagraphs 7,a7 through 7,d74 7#f7 ,priority ,in awarding grants under this subsection1 the ,secretary shall prioritize-- 7,a7 institutions with respect to which not less than #be percent of the enrolled students receive a ,federal ,pell ,grant2 and 7,b7 historically ,black colleges and universities1 ,hispanic-serving institutions1 ,asian ,american and ,native ,american ,pacific ,islander-serving institutions1 and other minority serving institutions4 7#g7 ,definitions ,in this subsection3 7,a7 ,institution of higher education ,the term institution of higher education has the meaning given that term in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja774 7,b7 ,menstrual product defined ,the term menstrual product means a sanitary napkin or tampon that conforms to industry standards4 7#h7 ,authorization of appropriations ,there are authorized to be appropriated #e1jjj1jjj out of funds appropriated for a fiscal year to the ,fund for the ,improvement of ,postsecondary ,education under section #gda of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #aach7 to carry out the grant program under this subsection4 7d7 ,menstrual products for incarcerated individuals and detainees 7#a7 ,menstrual products defined ,in this subsection1 the term menstrual products means sanitary napkins and tampons that conform to applicable industry standards4 7#b7 ,requirement for ,states ,beginning on the date that is #ahj days after the date of the enactment of this ,act1 and annually thereafter1 the chief executive officer of each ,state that receives a grant under subpart #a of part ,e of title ,i of the ,omnibus ,crime ,control and ,safe ,streets ,act of #aifh 7#cd ,u4,s4,c4 #ajaea et seq47 shall submit to the ,attorney ,general a certification1 in such form and containing such information as the ,attorney ,general may require1 that-- 7,a7 all incarcerated individuals and detainees in the ,state have access to menstrual products-- 7i7 on demand2 and 7ii7 at no cost to the incarcerated individuals and detainees2 and 7,b7 no visitor of an incarcerated individual or detainee of the ,state is prohibited from visiting an incarcerated individual or detainee due to the visitor's use of menstrual products4 7#c7 ,reduction in ,grant ,funding ,in the case of a ,state of which the chief executive officer fails to submit a certification required under paragraph 7#b7 in a fiscal year1 the ,attorney ,general shall reduce the amount that the ,state would otherwise receive under section #eje of title ,i of the ,omnibus ,crime ,control and ,safe ,streets ,act of #aifh 7#cd ,u4,s4,c4 #ajaef7 by #bj percent for the following fiscal year4 7#d7 ,reallocation ,amounts not allocated to a ,state under section #eje of title ,i of the ,omnibus ,crime ,control and ,safe ,streets ,act of #aifh 7#cd ,u4,s4,c4 #ajaef7 for a fiscal year pursuant to paragraph 7#c7 shall be reallocated under such section to ,states that submit certifications under paragraph 7#b74 7#e7 ,availability for ,federal prisoners ,the ,attorney ,general shall make rules requiring1 and the ,director of the ,bureau of ,prisons shall take such actions as may be necessary to ensure1 the distribution and accessibility without charge of menstrual products to prisoners in the custody of the ,bureau of ,prisons1 including any prisoner in a ,federal penal or correctional institution1 any ,federal prisoner in a ,state penal or correctional institution1 and any ,federal prisoner in a facility administered by a private detention entity1 to ensure that each prisoner who requires menstrual products may receive them in sufficient quantity4 7#f7 ,availability for detainees ,the ,secretary of ,homeland ,security shall take such actions as may be necessary to ensure that menstrual products are distributed and made accessible to each alien detained by the ,secretary of ,homeland ,security1 including any alien in a facility administered by a private detention entity1 at no expense to the alien4 7e7 ,menstrual products availability for homeless individuals under ,emergency ,food and ,shelter ,grant ,program ,subsection 7a7 of section #caf of the ,mc,kinney-,vento ,homeless ,assistance ,act 7#db ,u4,s4,c4 #aacdf7;a77 is amended-- 7#a7 in paragraph 7#e71 by striking and at the end2 7#b7 in paragraph 7#f71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following new paragraph3 7#g7 guidelines that ensure that amounts provided under the program to private nonprofit organizations and local governments may be used to provide sanitary napkins and tampons that conform to applicable industry standards4 4 7f7 ,menstrual products covered by ,medicaid 7#a7 ,in general ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 as amended by section #ebja1 is further amended-- 7,a7 in subsection 7a7-- 7i7 in paragraph 7#cb71 by striking 2 and and inserting a semicolon2 7ii7 by redesignating paragraph 7#cc7 as paragraph 7#cd72 and 7iii7 by inserting after paragraph 7#cb7 the following new paragraph3 7#cc7 menstrual products 7as defined in subsection 7qq772 and 2 and 7,b7 by adding at the end the following new subsection3 7qq7 ,menstrual products ,for purposes of subsection 7a77#cc71 the term menstrual products means menstrual cups1 menstrual discs1 menstrual underwear1 and sanitary napkins and tampons1 that conform to applicable industry standards4 4 7#b7 ,effective date 7,a7 ,in general ,subject to subparagraph 7,b71 the amendments made by this subsection shall apply with respect to medical assistance furnished during or after the first calendar quarter beginning on or after the date that is #a year after the date of the enactment of this ,act4 7,b7 ,exception for ,state legislation ,in the case of a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 that the ,secretary of ,health and ,human ,services determines requires ,state legislation in order for the respective plan to meet any requirement imposed by amendments made by this subsection1 the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of the enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session shall be considered to be a separate regular session of the ,state legislature4 7g7 ,menstrual products for employees ,section #f of the ,occupational ,safety and ,health ,act of #aigj 7#bi ,u4,s4,c4 #fee7 is amended by adding at the end the following3 7h7 ,the ,secretary shall by rule promulgate a requirement that each employer with not less than #ajj employees provide menstrual products free of charge for employees of the employer4 ,for purposes of the preceding sentence1 menstrual products means sanitary napkins and tampons that conform to applicable industry standards4 4 7h7 ,menstrual products in ,federal buildings 7#a7 ,definitions ,in this subsection3 7,a7 ,appropriate authority ,the term appropriate authority means the head of a ,federal agency1 the ,architect of the ,capitol1 or any other official authority responsible for the operation of a covered public building4 7,b7 ,covered public building 7i7 ,in general ,the term covered public building means a public building 7as defined in section #ccja7;a7 of title #dj1 ,united ,states ,code7 that is open to the public and contains a public restroom4 7ii7 ,inclusions ,the term covered public building includes specified buildings and grounds 7as defined in section #fcja of title #dj1 ,united ,states ,code7 and the ,capitol ,buildings 7as defined in section #eaja of that title74 7,c7 ,covered restroom ,the term covered restroom means a restroom in a covered public building4 7,d7 ,menstrual products ,the term menstrual products means sanitary napkins and tampons that conform to applicable industry standards4 7#b7 ,requirement ,each appropriate authority shall ensure that menstrual products are stocked in1 and available free of charge in1 each covered restroom in each covered public building under the jurisdiction of that authority4 7i7 ,menstrual products in the ,social ,services ,block ,grant ,program 7#a7 ,increase in funding for ,social ,services ,block ,grant ,program 7,a7 ,in general ,the amount specified in subsection 7c7 of section #bjjc of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;b7 for purposes of subsections 7a7 and 7b7 of such section is deemed to be #a1ijj1jjj1jjj for each of fiscal years #bjbe through #bjbh1 of which1 the amount equal to #bjj1jjj1jjj1 reduced by the amounts reserved under subparagraph 7,b77ii7 for each such fiscal year1 shall be obligated by ,states in accordance with paragraph 7#b74 7,b7 ,appropriation 7i7 ,in general ,out of any money in the ,treasury of the ,united ,states not otherwise appropriated1 there is appropriated #bjj1jjj1jjj for each of fiscal years #bjbe through #bjbh1 to carry out this subsection4 7ii7 ,reservations 7,i7 ,purposes ,the ,secretary shall reserve1 from the amount appropriated under clause 7i7 to carry out this subsection-- 7aa7 for each of fiscal years #bjbe through #bjbh1 not more than #b percent of the amount appropriated for the fiscal year for purposes of entering into an agreement with an eligible entity described in clause 7iii7 to assist in providing technical assistance and training1 to support effective policy1 practice1 research1 and cross-system collaboration among grantees and subgrantees1 and to assist in the administration of the program described in this subsection2 and 7bb7 for fiscal year #bjbe1 an amount1 not to exceed #b1jjj1jjj1 for purposes of conducting an evaluation under paragraph 7#d74 7,,ii7 ,no ,state entitlement to reserved funds ,the ,state entitlement under section #bjjb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;a7a77 shall not apply to the amounts reserved under subclause 7,i74 7iii7 ,eligible entity described ,an eligible entity described in this clause is a nonprofit organization described in section #eja7;c77#c7 of the ,internal ,revenue ,code of #aihf and exempt from taxation under section #eja7;a7 of such ,code1 that-- 7,i7 has experience in more than #a ,state in the area of community distributions of basic need services1 including experience collecting1 warehousing1 and distributing basic necessities such as menstrual products2 7,,ii7 demonstrates competency to implement a project1 provide fiscal accountability1 collect data1 and prepare reports and other necessary documentation2 and 7,,iii7 demonstrates a willingness to share information with researchers1 practitioners1 and other interested parties4 7#b7 ,rules governing use of additional funds 7,a7 ,in general ,funds are used in accordance with this paragraph if-- 7i7 the ,state1 in consultation with relevant stakeholders1 including agencies1 professional associations1 and nonprofit organizations1 distributes the funds to eligible entities to-- 7,i7 decrease the unmet need for menstrual products by low-income menstruating individuals through-- 7aa7 the distribution of free menstrual products2 7bb7 community outreach to assist in participation in existing menstrual product distribution programs2 or 7cc7 improving access to menstrual products among low-income individuals2 and 7,,ii7 increase the ability of communities and low-income families in such communities to provide for the need for menstrual products of low-income adults2 and 7ii7 the funds are used subject to the limitations in section #bjje of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;d74 7,b7 ,allowable uses by eligible entities 7i7 ,in general ,an eligible entity receiving funds made available under paragraph 7#a7 shall use the funds for any of the following3 7,i7 ,to pay for the purchase and distribution of menstrual products among low-income individuals4 7,,ii7 ,to integrate activities carried out under subclause 7,i7 with other basic needs assistance programs serving low-income families1 including the following3 7aa7 ,programs funded by the temporary assistance for needy families program under part ,a of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq471 including the ,state maintenance of effort provisions of such program4 7bb7 ,programs designed to support the health of eligible children1 such as the ,children's ,health ,insurance ,program under title ,,xxi of the ,social ,security ,act1 the ,medicaid program under title ,,xix of such ,act1 or ,state funded health care programs4 7cc7 ,programs funded through the special supplemental nutrition program for women1 infants1 and children under section #ag of the ,child ,nutrition ,act of #aiff4 7dd7 ,programs that offer early home visiting services1 including the maternal1 infant1 and early childhood home visiting program 7including the ,tribal home visiting program7 under section #eaa of the ,social ,security ,act 7#db ,u4,s4,c4 #gaa74 7,,iii7 ,to provide training or technical assistance in carrying out activities under this subsection4 7,,iv7 ,to cover administrative costs4 7ii7 ,limitation on use of funds for administrative costs ,an eligible entity receiving funds made available under this subsection shall not use more than #i percent of the funds for administrative costs incurred pursuant to this subsection4 7,c7 ,availability of funds 7i7 ,funds distributed to eligible entities ,funds made available under paragraph 7#a7 that are distributed to an eligible entity by a ,state for a fiscal year may be expended by the eligible entity only in such fiscal year or the succeeding fiscal year4 7ii7 ,evaluation ,funds reserved under paragraph 7#a77;,b77ii77,i77aa7 to carry out the evaluation under paragraph 7#d7 shall be available for expenditure through ,september #cj1 #bjbi4 7,d7 ,no effect on other programs ,any assistance or benefits received by a family through funds made available under paragraph 7#a7 shall be disregarded for purposes of determining the family's eligibility for1 or amount of1 benefits under any other ,federal needs-based programs4 7#c7 ,annual reports ,section #bjjd of the ,social ,security ,act shall apply with respect to payments made to a ,state under this section in the same way it applies with respect to payments made to a ,state under section #bjjb of such ,act4 7#d7 ,evaluation ,the ,secretary1 in consultation with ,states1 the eligible entities described in paragraph 7#a77;,b77iii7 receiving funds made available under this subsection1 shall-- 7,a7 not later than ,december #cj1 #bjca1 complete an evaluation of the effectiveness of the assistance program carried out pursuant to this subsection1 such as the effect of activities carried out under this ,act on mitigating the health risks of unmet menstrual products need among individuals in low-income families2 7,b7 not later than ,march #ca1 #bjcb1 submit to the ,committees on ,energy and ,commerce and on ,ways and ,means of the ,house of ,representatives and the ,committee on ,finance of the ,senate a report on the results of the evaluation2 and 7,c7 not later than ,april #cj1 #bjcb1 publish the results of the evaluation on the internet website of the ,department of ,health and ,human ,services4 7#e7 ,guidance ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary shall issue guidance regarding how the provisions of this subsection should be carried out1 including information regarding eligible entities1 allowable use of funds1 and reporting requirements4 7#f7 ,best practices ,the ,secretary of ,health and ,human ,services1 in cooperation with the ,secretary of ,education1 shall develop best practices for school officials to use in discussing menstruation with students1 and shall publish this information on the internet website of the ,department of ,health and ,human ,services4 7#g7 ,definitions ,in this subsection3 7,a7 ,menstrual products ,the term menstrual products means menstrual cups1 menstrual discs1 menstrual underwear1 and sanitary napkins and tampons1 that conform to applicable industry standards4 7,b7 ,eligible entities ,the term eligible entity means a ,state or local governmental entity1 an ,indian tribe or tribal organization 7as defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act71 or a nonprofit organization described in section #eja7;c77#c7 of the ,internal ,revenue ,code of #aihf and exempt from taxation under section #eja7;a7 of such ,code that-- 7i7 has experience in the area of community distributions of basic need services1 including experience collecting1 warehousing1 and distributing basic necessities such as diapers1 food1 or menstrual products2 7ii7 demonstrates competency to implement a project1 provide fiscal accountability1 collect data1 and prepare reports and other necessary documentation2 and 7iii7 demonstrates a willingness to share information with researchers1 practitioners1 and other interested parties4 7,c7 ,state ,the term ,state has the meaning given in section #aaja7;a77#a7 of the ,social ,security ,act for purposes of title ,,xx of such ,act4 7#h7 ,limitation on authorization of appropriations ,for the administration of this subsection1 there are authorized to be appropriated to the ,secretary of ,health and ,human ,services not more than #f1jjj1jjj for fiscal years #bjbe through #bjbh4 7#i7 ,exemption from sequestration ,funds made available to carry out this subsection shall be exempt from reduction under any order issued under the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 7j7 ,menstrual products and taxation 7#a7 ,in general ,it shall be unlawful for a ,state1 or unit of local government of a ,state1 to impose a tax on the retail sale of a menstrual product4 7#b7 ,definitions ,for purposes of this subsection3 7,a7 ,menstrual product ,the term menstrual products means menstrual cups1 menstrual discs1 menstrual underwear1 and sanitary napkins and tampons1 that conform to applicable industry standards4 7,b7 ,state ,the term ,state means any of the several ,states or the ,district of ,columbia4 7#c7 ,effective ,date ,this subsection shall take effect #abj days after the date of the enactment of this subsection4 7k7 ,menstrual products in ,,tanf 7#a7 ,in general ,section #djc7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fjc7;a77 is amended by adding at the end the following3 7#f7 ,grants for menstrual products 7,a7 ,in general ,the ,secretary may make grants1 on a competitive basis1 for each fiscal year to eligible applicants for the grants1 in such amounts as the ,secretary deems appropriate to enable the eligible applicants to provide1 to covered families that include an individual who is capable of menstruating1 such benefits as are needed to ensure that the individual can purchase menstrual products for personal use4 7,b7 ,definitions ,in subparagraph 7,a73 7i7 ,covered families ,the term covered families means families eligible for assistance under a ,state program funded under this part4 7ii7 ,eligible applicant ,the term eligible applicant means-- 7,i7 a ,state to which a grant is made under paragraph 7#a7 for a fiscal year2 and 7,,ii7 a political subdivision of a ,state that administers the ,state program funded under this part in the political subdivision4 7iii7 ,menstrual products ,the term menstrual products means menstrual cups1 menstrual discs1 menstrual underwear1 and sanitary napkins and tampons1 that conform to applicable industry standards4 7,c7 ,consideration of applications ,the ,secretary shall award grants under this paragraph on the basis of how effectively the programs proposed by the eligible applicants will help low-income individuals suffering from material deprivation meet their need for menstrual products4 7,d7 ,administration ,a ,state or political subdivision to which a grant is made under this paragraph may use the grant to provide benefits under this paragraph in such form and in such manner as the ,state or political subdivision deems appropriate4 7,e7 ,treatment of assistance ,benefits provided using funds made available under this paragraph shall not be considered assistance under any ,state program funded under this part4 7,f7 ,appropriation ,out of any money in the ,treasury of the ,united ,states not otherwise appropriated1 there are appropriated for fiscal year #bjbe and each succeeding fiscal year #aj1jjj1jjj for grants under this paragraph4 4 7#b7 ,evaluations ,section #dac of such ,act 7#db ,u4,s4,c4 #fac7 is amended by redesignating subsection 7h7 as subsection 7i7 and inserting after subsection 7g7 the following3 7h7 ,evaluations of grants for menstrual products 7#a7 ,in general ,the ,secretary shall submit to the ,congress reports1 in writing1 that evaluate the effectiveness of the benefit program provided for in section #djc7;a77#f74 ,each such report shall1 for the period covered by the report-- 7,a7 describe-- 7i7 the extent of material deprivation in the population1 including lacking sufficient funds to regularly purchase necessities such as menstrual products2 and 7ii7 the extent to which the program alleviated such material deprivation2 7,b7 specify the number and identity of the entities to which a grant has been made under such section1 and the amount of the grant made to each such entity2 7,c7 describe how the grantees used the grants to provide benefits under the program2 7,d7 specify the number of individuals who received the benefits2 7,e7 describe how efficacious the program has been in helping low-income individuals meet their need for menstrual products2 7,f7 describe the extent to which the program has improved the economic security of the benefit recipients2 and 7,g7 include such other relevant information as the ,secretary deems appropriate4 7#b7 ,timing ,the ,secretary shall submit a report that meets the requirements of paragraph 7#a7 within #b years after the date of the enactment of this paragraph and every #b years thereafter4 4 #edjg4 ,additional focus area for the ,office on ,women's ,health ,section #bbi7;b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bcg;a7b771 as amended by sections #ebae and #ecja1 is further amended by adding at the end the following3 7#aj7 facilitate the understanding of policymakers1 health system leaders and providers1 consumers1 and other stakeholders concerning optimal maternity care and support for the provision of such care1 including the priorities of-- 7,a7 protecting1 promoting1 and supporting the innate capacities of childbearing individuals and their newborns for childbirth1 breastfeeding1 and attachment2 7,b7 using obstetric interventions only when such interventions are supported by strong1 high-quality evidence1 and minimizing overuse of maternity practices that have been shown to have benefit in limited situations and that can expose people1 infants1 or both to risk of harm if used routinely and indiscriminately1 including overuse of continuous electronic fetal monitoring1 labor induction1 epidural analgesia1 primary cesarean section1 and routine repeat cesarean birth2 7,c7 reliably incorporating noninvasive1 evidence-based practices that have a documented correlation with considerable improvement in outcomes with no detrimental side effects1 such as incorporation of smoking cessation programs in pregnancy1 maternal immunizations1 and proven models 7including group prenatal care1 midwifery care1 and doula support7 that integrate health assessment1 education1 and support into a unified program1 and supporting evidence-based breastfeeding promotion efforts with respect for a breastfeeding individual's personal decisionmaking2 7,d7 a shared understanding of the qualifications of licensed providers of maternity care and the best evidence about the safety1 satisfaction1 outcomes1 and costs of maternity care1 and appropriate deployment of such caregivers within the maternity care workforce to address the needs of childbearing individuals and newborns and the growing shortage of maternity caregivers2 7,e7 a shared understanding of the results of the best available research comparing hospital1 birth center1 and planned home births1 including information about each setting's safety1 satisfaction1 outcomes1 and costs2 7,f7 a shared understanding of the importance for the safety and choices of birthing families of an integrated maternity care system with seamless processes for consultation1 shared care1 transfer and transport across maternity care settings1 and use of providers when birthing people and their newborns require a higher level of care2 7,g7 advancing high-quality1 evidence-based childbirth education that-- 7i7 promotes a healthy and safe approach to pregnancy1 childbirth1 and early parenting2 7ii7 is taught by certified educators1 peer counselors1 and health professionals2 and 7iii7 promotes informed decisionmaking by childbearing individuals2 and 7,h7 developing measures that enable a more robust1 balanced set of standardized maternity care measures1 including performance and quality measures4 4 #edjh4 ,including services furnished by certain students1 interns1 and residents supervised by certified nurse midwives or certified midwives within inpatient hospital services under ,medicare 7a7 ,in general ,section #ahfa7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7b77 is amended-- 7#a7 in paragraph 7#f71 by striking 2 or at the end and inserting 1 or in the case of services in a hospital or osteopathic hospital by a student midwife or an intern or resident-in-training under a teaching program previously described in this paragraph who is in the field of obstetrics and gynecology1 if such student midwife1 intern1 or resident-in-training is supervised by a certified nurse-midwife or certified midwife to the extent permitted under applicable ,state law and as may be authorized by the hospital22 7#b7 in paragraph 7#g71 by striking the period at the end and inserting 2 or2 and 7#c7 by adding at the end the following new paragraph3 7#h7 a certified nurse-midwife or certified midwife where the hospital has a teaching program approved as specified in paragraph 7#f71 if-- 7,a7 the hospital elects to receive any payment due under this title for reasonable costs of such services2 and 7,b7 all certified nurse-midwives or certified midwives in such hospital agree not to bill charges for professional services rendered in such hospital to individuals covered under the insurance program established by this title4 4 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply to services furnished on or after the date of the enactment of this ,act4 #edji4 ,grants to professional organizations and minority-serving institutions to increase diversity in maternal1 reproductive1 and sexual health professionals 7a7 ,grants to health professional organizations 7#a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,health ,resources and ,services ,administration 7referred to in this section as the ,secretary71 shall carry out a grant program under which the ,secretary may make to eligible organizations-- 7,a7 for fiscal year #bjbe1 planning grants described in paragraph 7#b72 and 7,b7 for the subsequent #d-year period1 implementation grants described in paragraph 7#c74 7#b7 ,planning grants 7,a7 ,in general ,planning grants described in this paragraph are grants for each of the following purposes3 7i7 ,to collect data and identify any workforce inequalities1 with respect to a health profession1 at each of the following stages along the health professional continuum3 7,i7 ,pipeline availability1 with respect to students at the high school and college or university levels considering1 and working toward1 entrance in the profession1 including inequalities due to barriers triggered by criminal records4 7,,ii7 ,entrance into the training program for the profession4 7,,iii7 ,graduation from such training program4 7,,iv7 ,entrance into practice1 including inequalities due to barriers triggered by criminal records4 7,v7 ,retention in practice for more than a #e-year period4 7ii7 ,to develop one or more strategies to address the workforce inequalities within the health profession1 as identified under 7and in response to the findings pursuant to7 clause 7i74 7,b7 ,application ,to be eligible to receive a grant under this paragraph1 an eligible health professional organization shall submit to the ,secretary an application in such form and manner and containing such information as specified by the ,secretary4 7,c7 ,amount ,each grant awarded under this paragraph shall be for an amount not to exceed #cjj1jjj4 7,d7 ,report ,each recipient of a grant under this paragraph shall submit to the ,secretary a report containing-- 7i7 information on the extent and distribution of workforce inequalities identified through the grant2 and 7ii7 reasonable objectives and strategies developed to address such inequalities within a #e-1 #aj-1 and #be-year period4 7#c7 ,implementation grants 7,a7 ,in general ,implementation grants described in this paragraph are grants to implement one or more of the strategies developed pursuant to a planning grant awarded under paragraph 7#b74 7,b7 ,application ,to be eligible to receive a grant under this paragraph1 an eligible health professional organization shall submit to the ,secretary an application in such form and manner as specified by the ,secretary4 ,each such application shall contain information on-- 7i7 the capability of the organization to carry out a strategy described in subparagraph 7,a72 7ii7 the involvement of partners or coalitions2 7iii7 the organization's plans for developing sustainability of the implementation efforts after the culmination of the grant cycle2 and 7iv7 any other matter specified by the ,secretary4 7,c7 ,amount2 duration ,each grant awarded under this paragraph shall be for an amount not to exceed #ejj1jjj for each year of the grant4 ,the term of a grant under this paragraph shall not exceed #d years4 7,d7 ,reports ,for each of the first #c years for which an eligible health professional organization is awarded a grant under this paragraph1 the organization shall submit to the ,secretary a report on the activities carried out by such organization through the grant during such year and objectives for the subsequent year4 ,for the fourth year for which an eligible health professional organization is awarded a grant under this paragraph1 the organization shall submit to the ,secretary a report that includes an analysis of all the activities carried out by the organization through the grant and a detailed plan for the continuation of the organization's implementation efforts4 7#d7 ,eligible health professional organization defined ,for purposes of this subsection1 the term eligible health professional organization means a professional organization representing obstetrician-gynecologists1 certified nurse midwives1 certified midwives1 family practice physicians1 nurse practitioners whose scope of practice includes pregnancy-related or sexual and reproductive health care1 physician assistants whose scope of practice includes obstetrical or sexual and reproductive health care1 certified professional midwives1 adolescent medicine specialists who provide sexual and reproductive health care1 or pediatricians who provide sexual and reproductive health care4 7b7 ,grants to minority-,serving institutions 7#a7 ,in general ,the ,secretary shall carry out a grant program under which the ,secretary may make to eligible minority-serving institutions-- 7,a7 for fiscal years #bjbe and #bjbf1 planning grants described in paragraph 7#b72 and 7,b7 for the subsequent #aj-year period1 implementation grants described in paragraph 7#c74 7#b7 ,planning grants 7,a7 ,in general ,planning grants described in this paragraph are grants for plans relating to #a or more of the following purposes3 7i7 ,to develop or expand academic programs to educate maternity care clinicians and maternity care support personnel1 including-- 7,i7 nurses who have the intention of providing maternity1 newborn1 or sexual and reproductive health care2 7,,ii7 nurse practitioners whose scope of practice includes maternity1 newborn1 or sexual and reproductive health care2 and 7,,iii7 maternity care support personnel1 such as doulas and lactation counselors4 7ii7 ,to develop or expand academic programs to educate obstetrician-gynecologists4 7,b7 ,application ,to be eligible to receive a grant under this paragraph1 an eligible minority-serving institution shall submit to the ,secretary an application in such form and manner and containing such information as specified by the ,secretary4 7,c7 ,amount ,each grant awarded under this paragraph shall be for an amount not to exceed #djj1jjj for each of #b years4 7,d7 ,report ,each recipient of a grant under this paragraph shall submit to the ,secretary an annual report describing the planned development or expansion of academic programs1 including-- 7i7 the types of clinical or support personnel to be served and the degrees or certificates to be conferred2 7ii7 the associated curricula2 7iii7 the faculty and their capabilities and commitments1 including any plans for recruitment2 7iv7 the anticipated number of students to be enrolled and plans for their recruitment and social1 emotional1 and financial support2 and 7v7 the objectives and strategies for addressing inequalities and preparing students to provide high-quality culturally congruent care4 7#c7 ,implementation grants 7,a7 ,in general ,implementation grants described in this paragraph are grants to implement the plans developed under paragraph 7#b74 7,b7 ,application ,to be eligible to receive a grant under this paragraph1 an eligible minority-serving institution shall submit to the ,secretary an application in such form and manner as specified by the ,secretary4 ,each such application shall contain information on the capability of the institution to carry out a plan described in paragraph 7#b71 plans for sustainability of the academic program involved after the culmination of the grant cycle1 and any other matter specified by the ,secretary4 7,c7 ,amount ,each grant under this paragraph shall be for an amount not to exceed #a1jjj1jjj for each year during the #aj-year period of the grant4 7,d7 ,reports 7i7 ,initial period ,for each of the first #i years for which an eligible minority-serving institution is awarded a grant under this paragraph1 the institution shall submit a report to the ,secretary on the activities carried out by such institution through the grant during such year and objectives for the subsequent year4 7ii7 ,final year ,for the tenth year for which an eligible minority-serving institution is awarded a grant under this paragraph1 the organization shall submit to the ,secretary a report that includes an analysis of all the activities carried out by the institution through the grant and a detailed plan for continuation of the academic program4 7#d7 ,minority-serving institution ,for the purposes of this subsection1 the term minority-serving institution means any of the following3 7,a7 ,a ,hispanic-serving institution1 as that term is defined in section #ejb7;a7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #aaja;a7a774 7,b7 ,a ,tribal ,college or ,university1 as that term is defined in section #caf7;b7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;c7b774 7,c7 ,an ,alaska ,native-serving institution1 as that term is defined in section #cag7;b7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;d7b774 7,d7 ,a ,native ,hawaiian-serving institution1 as that term is defined in section #cag7;b7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;d7b774 7,e7 ,a ,predominantly ,black ,institution1 as that term is defined in section #cah7;b7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;e7b774 7,f7 ,a ,native ,american-serving1 nontribal institution1 as that term is defined in section #cai7;b7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;f7b774 7,g7 ,an ,asian ,american and ,native ,american ,pacific ,islander-serving institution1 as that term is defined in section #cbj7;b7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;g7b774 7c7 ,authorization of appropriations ,there is authorized to be appropriated to carry out-- 7#a7 subsection 7a71 #b1jjj1jjj for fiscal year #bjbe and #c1jjj1jjj for each of the fiscal years #bjbf through #bjbi2 and 7#b7 subsection 7b71 #d1jjj1jjj for each of fiscal years #bjbe and #bjbf and #aj1jjj1jjj for each of fiscal years #bjbg through #bjcf4 ,f ,children's ,health #eeja4 ,,caring for ,kids ,act 7a7 ,permanent extension of ,children's ,health ,insurance ,program 7#a7 ,in general ,section #bajd7;a77#bh7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7a77#bh77 is amended to read as follows3 7#bh7 for fiscal year #bjbi and each subsequent year1 such sums as are necessary to fund allotments to ,states under subsections 7c7 and 7m74 4 7#b7 ,allotments 7,a7 ,in general ,section #bajd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7m77 is amended-- 7i7 in paragraph 7#b77;,b7-- 7,i7 in the matter preceding clause 7i71 by striking through 7#bg7 and inserting through 7#bh72 and 7,,ii7 in clause 7i71 by striking #bjbc1 and #bjbi and inserting and #bjbc2 7ii7 in paragraph 7#g7-- 7,i7 in subparagraph 7,a71 by striking and ending with fiscal year #bjbi12 and 7,,ii7 in the flush left matter at the end1 by striking fiscal year #bjbf1 or fiscal year #bjbh and inserting fiscal year #bjbf1 or a subsequent even-numbered fiscal year2 7iii7 in paragraph 7#i7-- 7,i7 by striking 7#aj71 or 7#aa7 and inserting or 7#aj72 and 7,,ii7 by striking #bjbc1 or #bjbi1 and inserting or #bjbc2 and 7iv7 by striking paragraph 7#aa74 7,b7 ,conforming amendment ,section #ejaja7;b77#b7 of the ,bipartisan ,budget ,act of #bjah 7,public ,law #aae-abc7 is repealed4 7b7 ,permanent extensions of other programs and demonstration projects 7#a7 ,pediatric quality measures program ,section #aaci;,a7i77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;a7i77#a77 is amended-- 7,a7 in subparagraph 7,d71 by striking 2 and and inserting a semicolon2 7,b7 in subparagraph 7,e71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,f7 for a subsequent fiscal year1 the amount appropriated under this paragraph for the previous fiscal year1 increased by the percentage increase in the consumer price index for all urban consumers 7all items2 ,united ,states city average7 over such previous fiscal year1 for the purpose of carrying out this section 7other than subsections 7e71 7f71 and 7g774 4 7#b7 ,express lane eligibility option ,section #aijb7;e77#ac7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#ac77 is amended by striking subparagraph 7,i74 7#c7 ,assurance of affordability standard for children and families 7,a7 ,in general ,section #baje7;d77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7d77#c77 is amended-- 7i7 in the paragraph heading1 by striking through ,september #cj1 #bjbi2 and 7ii7 in subparagraph 7,a71 in the matter preceding clause 7i7-- 7,i7 by striking ,during the period that begins on the date of enactment of the ,patient ,protection and ,affordable ,care ,act and ends on ,september #cj1 #bjbi and inserting ,beginning on the date of the enactment of the ,patient ,protection and ,affordable ,care ,act2 7,,ii7 by striking ,during the period that begins on ,october #a1 #bjai1 and ends on ,september #cj1 #bjbi and inserting ,beginning on ,october #a1 #bjai2 and 7,,iii7 by striking ,the preceding sentences shall not be construed as preventing a ,state during any such periods from and inserting ,the preceding sentences shall not be construed as preventing a ,state from4 7,b7 ,conforming amendments ,section #aijb7;gg77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7gg77#b77 is amended-- 7i7 in the paragraph heading1 by striking through ,september #cj1 #bjbi2 and 7ii7 by striking through ,september #cj and all that follows through ends on ,september #cj1 #bjbi and inserting 7but beginning on ,october #a1 #bjai4 7#d7 ,qualifying states option ,section #baje7;g77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7g77#d77 is amended-- 7,a7 in the paragraph heading1 by striking for fiscal years #bjji through #bjbi and inserting after fiscal year #bjjh2 and 7,b7 in subparagraph 7,a71 by striking for any of fiscal years #bjji through #bjbi and inserting for any fiscal year after fiscal year #bjjh4 7#e7 ,outreach and enrollment program ,section #baac of the ,social ,security ,act 7#db ,u4,s4,c4 #acigmm7 is amended-- 7,a7 in subsection 7a7-- 7i7 in paragraph 7#a71 by striking during the period of fiscal years #bjji through #bjbi and inserting 1 beginning with fiscal year #bjji12 7ii7 in paragraph 7#b7-- 7,i7 by striking #aj percent of such amounts and inserting #aj percent of such amounts for the period or the fiscal year for which such amounts are appropriated2 and 7,,ii7 by striking during such period and inserting 1 during such period or such fiscal year12 and 7iii7 in paragraph 7#c71 by striking ,for the period of fiscal years #bjbd through #bjbi1 an amount equal to #aj percent of such amounts and inserting ,beginning with fiscal year #bjbd1 an amount equal to #aj percent of such amounts for the period or the fiscal year for which such amounts are appropriated2 and 7,b7 in subsection 7g7-- 7i7 by striking and #dj1jjj1jjj and inserting #dj1jjj1jjj2 and 7ii7 by inserting after fiscal years #bjbh and #bjbi1 the following3 #ab1jjj1jjj for fiscal year #bjcj1 and1 for each fiscal year after fiscal year #bjcj1 the amount appropriated under this subsection for the previous fiscal year1 increased by the percentage increase in the consumer price index for all urban consumers 7all items2 ,united ,states city average7 over such previous fiscal year14 7#f7 ,child enrollment contingency fund ,section #bajd7n7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7n77 is amended-- 7,a7 in paragraph 7#b7-- 7i7 in subparagraph 7,a77ii7-- 7,i7 by striking and #bjbd through #bjbh and inserting and for each fiscal year after fiscal year #bjbc2 and 7,,ii7 by striking #bjbc1 and #bjbi and inserting and #bjbc2 and 7ii7 in subparagraph 7,b7-- 7,i7 by striking #bjbd through #bjbh and inserting and for each fiscal year after fiscal year #bjbc2 and 7,,ii7 by striking #bjbc1 and #bjbi and inserting and #bjbc2 and 7,b7 in paragraph 7#c77;,a7-- 7i7 by striking fiscal years #bjbd through #bjbh and inserting a fiscal year after fiscal year #bjbc2 and 7ii7 by striking #bjbc1 or #bjbi and inserting or #bjbc4 #eejb4 ,end ,diaper ,need ,act of #bjbd 7a7 ,targeted funding for diaper assistance 7,including diapering supplies and adult incontinence materials and supplies7 through the ,social ,services ,block ,grant ,program 7#a7 ,increase in funding for ,social ,services ,block ,grant ,program 7,a7 ,in general ,the amount specified in subsection 7c7 of section #bjjc of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;b7 for purposes of subsections 7a7 and 7b7 of such section is deemed to be #a1ijj1jjj1jjj for each of fiscal years #bjbe through #bjbh1 of which1 the amount equal to #bjj1jjj1jjj1 reduced by the amounts reserved under subparagraph 7,b77ii7 for each such fiscal year1 shall be obligated by ,states in accordance with paragraph 7#b74 7,b7 ,appropriation 7i7 ,in general ,out of any money in the ,treasury of the ,united ,states not otherwise appropriated1 there is appropriated #bjj1jjj1jjj for each of fiscal years #bjbe through #bjbh1 to carry out this subsection4 7ii7 ,reservations 7,i7 ,purposes ,the ,secretary shall reserve1 from the amount appropriated under clause 7i7 to carry out this subsection-- 7aa7 for each of fiscal years #bjbe through #bjbh1 not more than #b percent of the amount appropriated for the fiscal year for purposes of entering into an agreement with a national entity described in clause 7iii7 to assist in providing technical assistance and training1 to support effective policy1 practice1 research1 and cross-system collaboration among grantees and subgrantees1 and to assist in the administration of the program described in this subsection2 and 7bb7 for fiscal year #bjbe1 an amount1 not to exceed #b1jjj1jjj1 for purposes of conducting an evaluation under paragraph 7#d74 7,,ii7 ,no ,state entitlement to reserved funds ,the ,state entitlement under section #bjjb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;a7a77 shall not apply to the amounts reserved under subclause 7,i74 7iii7 ,national entity described ,a national entity described in this clause is a nonprofit organization described in section #eja7;c77#c7 of the ,internal ,revenue ,code of #aihf and exempt from taxation under section #eja7;a7 of such ,code1 that-- 7,i7 has experience in more than #a ,state in the area of-- 7aa7 community distributions of basic need services1 including experience collecting1 warehousing1 and distributing basic necessities such as diapers1 food1 or menstrual products2 7bb7 child care2 7cc7 child development activities in low-income communities2 or 7dd7 motherhood1 fatherhood1 or parent education efforts serving low-income parents of young children2 7,,ii7 demonstrates competency to implement a project1 provide fiscal accountability1 collect data1 and prepare reports and other necessary documentation2 and 7,,iii7 demonstrates a willingness to share information with researchers1 practitioners1 and other interested parties4 7#b7 ,rules governing use of additional funds 7,a7 ,in general ,funds are used in accordance with this paragraph if-- 7i7 the ,state1 in consultation with relevant stakeholders1 including agencies1 professional associations1 and nonprofit organizations1 distributes the funds to eligible entities to-- 7,i7 decrease the need for diapers and diapering supplies and adult incontinence materials and supplies in low-income families and meet such unmet needs of infants and toddlers1 medically complex children1 and low-income adults and adults with disabilities in such families through-- 7aa7 the distribution of free diapers and diapering supplies1 medically necessary diapers1 and adult incontinence materials and supplies2 7bb7 community outreach to assist in participation in existing diaper distribution programs or programs that distribute medically necessary diapers or adult incontinence materials and supplies2 or 7cc7 improving access to diapers and diapering supplies1 medically necessary diapers1 and adult incontinence materials and supplies2 and 7,,ii7 increase the ability of communities and low-income families in such communities to provide for the need for diapers and diapering supplies1 medically necessary diapers1 and adult incontinence materials and supplies1 of infants and toddlers1 medically complex children1 and low-income adults and adults with disabilities2 7ii7 the funds are used subject to the limitations in section #bjje of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;d72 7iii7 the funds are used to supplement1 not supplant1 ,state general revenue funds provided for the purposes described in clause 7i72 and 7iv7 the funds are not used for costs that are reimbursable by the ,federal ,emergency ,management ,agency1 under a contract for insurance1 or by self-insurance4 7,b7 ,allowable uses by eligible entities ,an eligible entity receiving funds made available under paragraph 7#a7 shall use the funds for any of the following3 7i7 ,to pay for the purchase and distribution of diapers and diapering supplies1 medically necessary diapers1 and funding diaper 7including medically necessary diapers7 distribution that serves low-income families with-- 7,i7 #a or more children #c years of age or younger2 or 7,,ii7 #a or more medically complex children4 7ii7 ,to pay for the purchase and distribution of adult incontinence materials and supplies and funding distribution of such materials and supplies that serves low-income families with #a or more low-income adults or adults with disabilities who rely on adult incontinence materials and supplies4 7iii7 ,to integrate activities carried out under clause 7i7 with other basic needs assistance programs serving eligible children and their families1 including the following3 7,i7 ,programs funded by the temporary assistance for needy families program under part ,a of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq471 including the ,state maintenance of effort provisions of such program4 7,,ii7 ,programs designed to support the health of eligible children1 such as the ,children's ,health ,insurance ,program under title ,,xxi of the ,social ,security ,act1 the ,medicaid program under title ,,xix of such ,act1 or ,state-funded health care programs4 7,,iii7 ,programs funded through the special supplemental nutrition program for women1 infants1 and children under section #ag of the ,child ,nutrition ,act of #aiff4 7,,iv7 ,programs that offer early home visiting services1 including the maternal1 infant1 and early childhood home visiting program 7including the ,tribal home visiting program7 under section #eaa of the ,social ,security ,act 7#db ,u4,s4,c4 #gaa74 7,v7 ,programs to provide improved and affordable access to child care1 including programs funded through the ,child ,care and ,development ,fund1 the temporary assistance for needy families program under part ,a of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq471 or a ,state-funded program4 7,c7 ,availability of funds 7i7 ,funds distributed to eligible entities ,funds made available under paragraph 7#a7 that are distributed to an eligible entity by a ,state for a fiscal year may be expended by the eligible entity only in such fiscal year or the succeeding fiscal year4 7ii7 ,evaluation ,funds reserved under paragraph 7#a77;,b77ii77,i77aa7 to carry out the evaluation under paragraph 7#d7 shall be available for expenditure during the #c-year period that begins on the date of enactment of this ,act4 7,d7 ,no effect on other programs ,any assistance or benefits received by a family through funds made available under paragraph 7#a7 shall be disregarded for purposes of determining the family's eligibility for1 or amount of1 benefits under any other ,federal needs-based programs4 7#c7 ,annual reports ,a ,state shall include in the annual report required under section #bjjf of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;e7 covering each of fiscal years #bjbd through #bjbg1 information detailing how eligible entities1 including subgrantees1 used funds made available under paragraph 7#a7 to distribute diapers and diapering supplies and adult incontinence materials and supplies to families in need4 ,each such report shall include the following3 7,a7 ,the number and age of infants1 toddlers1 medically complex children1 and low-income adults and adults with disabilities who received assistance or benefits through such funds4 7,b7 ,the number of families that have received assistance or benefits through such funds4 7,c7 ,the number of diapers1 medically necessary diapers1 or adult incontinence materials and supplies 7such as adult diapers1 briefs1 protective underwear1 pull-ons1 pull-ups1 liners1 shields1 guards1 pads1 undergarments71 and the number of each type of diapering or adult incontinence supply1 distributed through the use of such funds4 7,d7 ,the ,,zip ,code or ,,zip ,codes where the eligible entity 7or subgrantee7 distributed diapers and diapering supplies and adult incontinence materials and supplies4 7,e7 ,the method or methods the eligible entity 7or subgrantee7 uses to distribute diapers and diapering supplies and1 adult incontinence materials and supplies4 7,f7 ,such other information as the ,secretary may specify4 7#d7 ,evaluation ,the ,secretary1 in consultation with ,states1 the national entity described in paragraph 7#a77;,b77iii71 and eligible entities receiving funds made available under this subsection1 shall-- 7,a7 not later than #b years after the date of enactment of this ,act-- 7i7 complete an evaluation of the effectiveness of the assistance program carried out pursuant to this subsection1 such as the effect of activities carried out under this section on mitigating the health and developmental risks of unmet diaper need among infants1 toddlers1 medically complex children1 and other family members in low-income families1 including the risks of diaper dermatitis1 urinary tract infections1 and parental and child depression and anxiety2 7ii7 submit to the relevant congressional committees a report on the results of such evaluation2 and 7iii7 publish the results of the evaluation on the internet website of the ,department of ,health and ,human ,services2 7,b7 not later than #c years after the date of enactment of this ,act1 update the evaluation required by subparagraph 7,a77i72 and 7,c7 not later than #ij days after completion of the updated evaluation under subparagraph 7,b7-- 7i7 submit to the relevant congressional committees a report describing the results of such updated evaluation2 and 7ii7 publish the results of such evaluation on the internet website of the ,department of ,health and ,human ,services4 7#e7 ,guidance ,not later than #ahj days after enactment of this ,act1 the ,secretary shall issue guidance regarding how the provisions of this subsection should be carried out1 including information regarding eligible entities1 allowable use of funds1 and reporting requirements4 7#f7 ,definitions ,in this subsection3 7,a7 ,adult incontinence materials and supplies ,the term adult incontinence materials and supplies means those supplies that are used to assist low-income adults or adults with disabilities and includes adult diapers1 briefs1 protective underwear1 pull-ons1 pull-ups1 liners1 shields1 guards1 pads1 undergarments1 disposable wipes1 over-the-counter adult diaper rash cream products1 intermittent catheterization1 indwelling catheters1 condom catheters1 urinary drainage bags1 external collection devices1 wearable urinals1 and penile clamps4 7,b7 ,adults with disabilities ,the term adults with disabilities means individuals who-- 7i7 have attained age #ah2 and 7ii7 have a disability 7as such term is defined1 with respect to an individual1 in section #c of the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abajb774 7,c7 ,diaper ,the term diaper means an absorbent garment that-- 7i7 is washable or disposable that may be worn by an infant or toddler who is not toilet-trained2 and 7ii7 if disposable-- 7,i7 does not use any latex or common allergens2 and 7,,ii7 meets or exceeds the quality standards for diapers commercially available through retail sale in the following categories3 7aa7 ,absorbency 7with acceptable rates for first and second wetting74 7bb7 ,waterproof outer cover4 7cc7 ,flexible leg openings4 7dd7 ,refastening closures4 7,d7 ,diapering supplies ,the term diapering supplies means items1 including diaper wipes and diaper cream1 necessary to ensure that-- 7i7 an eligible child using a diaper is properly cleaned and protected from diaper rash2 or 7ii7 a medically complex child who uses a medically necessary diaper is properly cleaned and protected from diaper rash4 7,e7 ,eligible child ,the term eligible child means a child who-- 7i7 has not attained #d years of age2 and 7ii7 is a member of a low-income family4 7,f7 ,eligible entities ,the term eligible entity means a ,state or local governmental entity1 an ,indian tribe or tribal organization 7as defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act71 or a nonprofit organization described in section #eja7;c77#c7 of the ,internal ,revenue ,code of #aihf and exempt from taxation under section #eja7;a7 of such ,code that-- 7i7 has experience in the area of-- 7,i7 community distributions of basic need services1 including experience collecting1 warehousing1 and distributing basic necessities such as diapers1 food1 or menstrual products2 7,,ii7 child care2 7,,iii7 child development activities in low-income communities2 or 7,,iv7 motherhood1 fatherhood1 or parent education efforts serving low-income parents of young children2 7ii7 demonstrates competency to implement a project1 provide fiscal accountability1 collect data1 and prepare reports and other necessary documentation2 and 7iii7 demonstrates a willingness to share information with researchers1 practitioners1 and other interested parties4 7,g7 ,federal poverty line ,the term ,federal poverty line means the ,federal poverty line as defined by the ,office of ,management and ,budget and revised annually in accordance with section #fgc7b7 of the ,omnibus ,budget ,reconciliation ,act of #aiha applicable to a family of the size involved4 7,h7 ,low-income ,the term low-income1 with respect to a family1 means a family whose self-certified income is not more than #bjj percent of the ,federal poverty line4 7,i7 ,medically complex child ,the term medically complex child means an individual who has attained age #c and for whom a licensed health care provider has provided a diagnosis of bowel or bladder incontinence1 a bowel or bladder condition that causes excess urine or stool 7such as short gut syndrome or diabetes insipidus71 or a severe skin condition that causes skin erosions 7such as epidermolysis bullosa74 7,j7 ,medically necessary diaper ,the term medically necessary diaper means an absorbent garment that is-- 7i7 washable or disposable2 7ii7 worn by a medically complex child who has been diagnosed with bowel or bladder incontinence1 a bowel or bladder condition that causes excess urine or stool 7such as short gut syndrome or diabetes insipidus71 or a severe skin condition that causes skin erosions 7such as epidermolysis bullosa7 and needs such garment to correct or ameliorate such condition2 and 7iii7 if disposable-- 7,i7 does not use any latex or common allergens2 and 7,,ii7 meets or exceeds the quality standards for diapers commercially available through retail sale in the following categories3 7aa7 ,absorbency 7with acceptable rates for first and second wetting74 7bb7 ,waterproof outer cover4 7cc7 ,flexible leg openings4 7dd7 ,refastening closures4 7#g7 ,exemption of program from sequestration 7,a7 ,in general ,section #bee7;h7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe 7#b ,u4,s4,c4 #ije7;h77 is amended by inserting after ,supplemental ,security ,income ,program 7#bh-jdjf-j-a-fji74 the following3 ,targeted funding for ,states for diaper assistance 7including diapering supplies and adult incontinence materials and supplies7 through the ,social ,services ,block ,grant ,program4 4 7,b7 ,applicability ,the amendment made by this paragraph shall apply to any sequestration order issued under the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe 7#b ,u4,s4,c4 #ijj et seq47 on or after the date of enactment of this ,act4 7b7 ,improving access to diapers for medically complex children ,section #aiae7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifn7c77 is amended by adding at the end the following new paragraph3 7#aa7 7,a7 ,in the case of any waiver under this subsection that provides medical assistance to a medically complex child who has been diagnosed with bowel or bladder incontinence1 a bowel or bladder condition that causes excess urine or stool 7such as short gut syndrome or diabetes insipidus71 or a severe skin condition that causes skin erosions 7such as epidermolysis bullosa71 such medical assistance shall include1 for the duration of the waiver1 the provision of #bjj medically necessary diapers per month and diapering supplies4 ,such medical assistance may include the provision of medically necessary diapers in amounts greater than #bjj if a licensed health care provider 7such as a physician1 nurse practitioner1 or physician assistant7 specifies that such greater amounts are necessary for such medically complex child4 7,b7 ,for purposes of this paragraph3 7i7 ,the term medically complex child means an individual who has attained age #c and for whom a licensed health care provider has provided a diagnosis of #a or more significant chronic conditions4 7ii7 ,the term medically necessary diaper means an absorbent garment that is-- 7,i7 washable or disposable2 7,,ii7 worn by a medically complex child who has been diagnosed with a condition described in subparagraph 7,a7 and needs such garment to correct or ameliorate such condition2 and 7,,iii7 if disposable-- 7aa7 does not use any latex or common allergens2 and 7bb7 meets or exceeds the quality standards for diapers commercially available through retail sale in the following categories3 7,,aa7 ,absorbency 7with acceptable rates for first and second wetting74 7,,bb7 ,waterproof outer cover4 7,,cc7 ,flexible leg openings4 7,,dd7 ,refastening closures4 7iii7 ,the term diapering supplies means items1 including diaper wipes and diaper creams1 necessary to ensure that a medically complex child who has been diagnosed with a condition described in subparagraph 7,a7 and uses a medically necessary diaper is properly cleaned and protected from diaper rash4 4 7c7 ,inclusion of diapers and diapering supplies as qualified medical expenses 7#a7 ,health savings accounts ,section #bbc7;d77#b7 of the ,internal ,revenue ,code of #aihf is amended-- 7,a7 by inserting 1 medically necessary diapers1 and diapering supplies after menstrual care products in the last sentence of subparagraph 7,a72 and 7,b7 by adding at the end the following new subparagraph3 7,e7 ,medically necessary diapers and diapering supplies ,for purposes of this paragraph-- 7i7 ,medically necessary diapers ,the term medically necessary diaper means an absorbent garment which is washable or disposable and which is worn by an individual who has attained #c years of age because of medical necessity1 such as someone who has been diagnosed with bowel or bladder incontinence1 a bowel or bladder condition that causes excess urine or stool 7such as short gut syndrome or diabetes insipidus71 or a severe skin condition that causes skin erosions 7such as epidermolysis bullosa7 and needs such garment to correct or ameliorate such condition1 to serve a preventative medical purpose1 or to correct or ameliorate defects or physical or mental illnesses or conditions diagnosed by a licensed health care provider1 and1 if disposable-- 7,i7 does not use any latex or common allergens2 and 7,,ii7 meets or exceeds the quality standards for diapers commercially available through retail sale in the following categories3 7aa7 ,absorbency 7with acceptable rates for first and second wetting74 7bb7 ,waterproof outer cover4 7cc7 ,flexible leg openings4 7dd7 ,refastening closures4 7ii7 ,diapering supplies ,the term diapering supplies means items1 including diaper wipes and diaper creams1 necessary to ensure that an individual wearing medically necessary diapers is properly cleaned and protected from diaper rash4 4 7#b7 ,archer ,m,s,as ,the last sentence of section #bbj7;d77#b77;,a7 of such ,code is amended by inserting 1 medically necessary diapers 7as defined in section #bbc7;d77#b77;,e771 and diapering supplies 7as defined in section #bbc7;d77#b77;,e77 after menstrual care products 7as defined in section #bbc7;d77#b77;,d774 7#c7 ,health flexible spending arrangements and health reimbursement arrangements ,section #ajf7;f7 of such ,code is amended-- 7,a7 by inserting 1 medically necessary diapers 7as defined in section #bbc7;d77#b77;,e771 and diapering supplies 7as defined in section #bbc7;d77#b77;,e77 after menstrual care products 7as defined in section #bbc7;d77#b77;,d772 and 7,b7 in the heading1 by inserting 1 medically necessary diapers1 and diapering supplies after menstrual care products4 7#d7 ,effective dates 7,a7 ,distributions from certain accounts ,the amendments made by paragraphs 7#a7 and 7#b7 shall apply to amounts paid after ,december #ca1 #bjbd4 7,b7 ,reimbursements ,the amendment made by paragraph 7#c7 shall apply to expenses incurred after ,december #ca1 #bjbd4 #eejc4 ,decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood 7a7 ,establishment ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,health ,resources and ,services ,administration and in consultation with the ,director of the ,centers for ,disease ,control and ,prevention and the ,director of the ,national ,institutes of ,health 7in this section referred to as the ,secretary71 shall establish and implement a culturally and linguistically competent public health awareness and education campaign to provide information that is focused on decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood1 including educating individuals about safe sleep environments1 sleep positions1 and reducing exposure to smoking during pregnancy and after birth4 7b7 ,targeted ,populations ,the campaign under subsection 7a7 shall be designed to reduce health inequalities through the targeting of populations with high rates of sudden unexpected infant death or of sudden unexplained death in childhood4 7c7 ,consultation ,in establishing and implementing the campaign under subsection 7a71 the ,secretary shall consult with national organizations representing 7collectively7 health care providers1 including nurses and physicians1 parents1 child care providers1 children's advocacy and safety organizations1 maternal and child health programs1 nutrition professionals focusing on 7collectively7 people1 infants1 and children1 and other individuals and groups determined necessary by the ,secretary for such establishment and implementation4 7d7 ,grants 7#a7 ,in general ,in carrying out the campaign under subsection 7a71 the ,secretary shall award grants to national organizations1 ,state and local health departments1 and community-based organizations for the conduct of education and outreach programs for nurses1 parents1 child care providers1 community health workers1 public health agencies1 and community organizations4 7#b7 ,application ,to be eligible to receive a grant under paragraph 7#a71 an entity shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 ,g ,elder ,care #efja4 ,expenses for household and elder care services necessary for gainful employment 7a7 ,in general ,subpart ,a of part ,,iv of subchapter ,a of chapter #a of the ,internal ,revenue ,code of #aihf is amended by inserting after section #be;,e the following new section3 #be;,f4 ,expenses for household and elder care services necessary for gainful employment 7a7 ,allowance of credit 7#a7 ,in general ,in the case of an individual for which there are one or more qualifying individuals 7as defined in subsection 7b77#a77 with respect to such individual1 there shall be allowed as a credit against the tax imposed by this chapter for the taxable year an amount equal to the applicable percentage of the employment-related expenses 7as defined in subsection 7b77#c77 paid by such individual during the taxable year4 7#b7 ,applicable percentage defined ,for purposes of paragraph 7#a71 the term applicable percentage means #ce percent reduced 7but not below #bj percent7 by #a percentage point for each #b1jjj 7or fraction thereof7 by which the taxpayer's adjusted gross income for the taxable year exceeds #ae1jjj4 7b7 ,definitions of qualifying individual and employment-,related expenses ,for purposes of this section-- 7#a7 ,qualifying individual ,the term qualifying individual means an individual who-- 7,a7 has attained age #ej1 and 7,b7 satisfies the requirements of any of the following clauses3 7i7 ,an individual who bears a relationship to the taxpayer described in subparagraph 7,c7 or 7,d7 of section #aeb7;d77#b7 7relating to fathers1 mothers1 and ancestors74 7ii7 ,an individual who would be a dependent of the taxpayer 7as defined in section #aeb1 determined without regard to subsections 7b77#a7 and 7b77#b77 as a qualifying relative described in section #aeb7;d77#a7 if-- 7,i7 in lieu of the requirements under subparagraphs 7,b7 and 7,c7 of such section1 with respect to such individual-- 7aa7 the taxpayer has provided over one-half of the individual's support for the calendar year in which such taxable year begins and each of the preceding #d taxable years1 and 7bb7 the individual's modified adjusted gross income for the calendar year in which such taxable year begins is less than the exemption amount 7as defined in section #aea7;d771 7,,ii7 the individual is physically or mentally incapable of caring for himself or herself1 and 7,,iii7 the individual has the same principal place of abode as the taxpayer for more than one-half of such taxable year4 7iii7 ,the spouse of the taxpayer1 if such spouse is physically or mentally incapable of caring for himself or herself4 7#b7 ,modified adjusted gross income ,the term modified adjusted gross income means adjusted gross income determined without regard to section #hf4 7#c7 ,employment-related expenses 7,a7 ,in general ,the term employment-related expenses means amounts paid for the following expenses1 but only if such expenses are incurred to enable the taxpayer to be gainfully employed for any period for which there are one or more qualifying individuals with respect to the taxpayer3 7i7 ,expenses for household services with respect to the qualifying individual4 7ii7 ,expenses for the care of a qualifying individual1 including expenses for respite care and hospice care4 7,b7 ,exception ,the term employment-related expenses shall not include services provided outside the taxpayer's household unless such expenses are incurred for the care of-- 7i7 a qualifying individual described in paragraph 7#a77;,a71 or 7ii7 a qualifying individual 7not described in paragraph 7#a77;,a77 who regularly spends at least #h hours each day in the taxpayer's household4 7,c7 ,dependent care centers ,the term employment-related expenses shall not include services provided outside the taxpayer's household by a dependent care center 7as defined in subparagraph 7,d77 unless-- 7i7 such center complies with all applicable laws and regulations of the ,state and local government in which such center is located1 and 7ii7 the requirements of subparagraph 7,b7 are met4 7,d7 ,dependent care center defined ,for purposes of this paragraph1 the term dependent care center means any facility which-- 7i7 provides care for more than #f individuals 7other than individuals who reside at the facility71 and 7ii7 receives a fee1 payment1 or grant for providing services for any of the individuals 7regardless of whether such facility is operated for profit74 7c7 ,dollar limit on amount creditable ,the amount of the employment-related expenses incurred during any taxable year which may be taken into account under subsection 7a7 shall not exceed-- 7#a7 if there is #a qualifying individual with respect to the taxpayer for such taxable year1 #c1jjj1 or 7#b7 if there are #b or more qualifying individuals with respect to the taxpayer for such taxable year1 #f1jjj4 ,the amount determined under this subsection shall be reduced by the aggregate amount excludable from gross income under section #abi for the taxable year4 7d7 ,earned income limitation ,the amount of the employment-related expenses incurred during any taxable year which may be taken into account under subsection 7a7 shall not exceed-- 7#a7 in the case of an individual who is not married at the close of such year1 such individual's earned income for such year1 or 7#b7 in the case of an individual who is married at the close of such year1 the lesser of such individual's earned income or the earned income of his spouse for such year4 7e7 ,special rules ,for purposes of this section-- 7#a7 ,place of abode ,an individual shall not be treated as having the same principal place of abode of the taxpayer if at any time during the taxable year of the taxpayer the relationship between the individual and the taxpayer is in violation of local law4 7#b7 ,married couples must file joint return ,in the case of an individual who is married as of the close of the taxable year1 the credit shall be allowed under subsection 7a7 only if a joint return is filed for the taxable year under section #fjac4 7#c7 ,marital status ,an individual legally separated from his or her spouse under a decree of divorce or of separate maintenance shall not be considered as married4 7#d7 ,certain married individuals living apart ,in the case of an individual who is married and does not file a joint return for the taxable year1 if-- 7,a7 such individual-- 7i7 maintains as his or her home a household which constitutes for more than one-half of the taxable year the principal place of abode of a qualifying individual1 and 7ii7 furnishes over half of the cost of maintaining such household during the taxable year1 and 7,b7 during the last #f months of such taxable year1 such individual's spouse is not a member of such household1 such individual shall not be considered as married4 7#e7 ,payments to related individuals ,no credit shall be allowed under subsection 7a7 for any amount paid by the taxpayer to an individual-- 7,a7 with respect to whom1 for the taxable year1 a deduction under section #aea7;c7 7relating to deduction for personal exemptions for dependents7 is allowable either to the taxpayer or the taxpayer's spouse1 or 7,b7 who-- 7i7 is a child of the taxpayer 7within the meaning of section #aeb7;f77#a771 and 7ii7 has not attained the age of #ai at the close of the taxable year4 ,for purposes of this paragraph1 the term taxable year means the taxable year of the taxpayer in which the service 7as described in clause 7i7 of subsection 7b77#c77;,a77 is performed or the care 7as described in clause 7ii7 of such subsection7 is provided4 7#f7 ,identifying information required with respect to service provider ,no credit shall be allowed under subsection 7a7 for any amount paid to any person unless-- 7,a7 the name1 address1 and taxpayer identification number of such person are included on the return of tax for the taxable year in which the credit under this section is being claimed1 or 7,b7 if such person is an organization described in section #eja7;c77#c7 and exempt from tax under section #eja7;a71 the name and address of such person are included on the return of tax for the taxable year in which the credit under this section is being claimed4 ,in the case of a failure to provide the information required under the preceding sentence1 the preceding sentence shall not apply if it is shown that the taxpayer exercised due diligence in attempting to provide the information so required4 7#g7 ,identifying information required with respect to qualifying individuals ,no credit shall be allowed under this section with respect to any qualifying individual unless the ,,tin of such individual is included on the return of tax for the taxable year in which the credit under this section is being claimed4 7f7 ,regulations ,the ,secretary shall prescribe such regulations as may be necessary to carry out the purposes of this section4 4 7b7 ,clerical amendment ,the table of sections for subpart ,a of part ,,iv of subchapter ,a of chapter #a of the ,internal ,revenue ,code of #aihf is amended by inserting after the item relating to section #be;,e the following new item3 ,sec4 #be;,f4 ,expenses for household and elder care services necessary for gainful employment4 4 7c7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after the date of the enactment of this ,act4 ,h ,miscellaneous provisions #egja4 ,clarification supporting permissible use of funds for stillbirth prevention activities ,section #eja7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #gja7;a77 is amended-- 7#a7 in paragraph 7#a77;,b71 by inserting to reduce the incidence of stillbirth1 after among children12 and 7#b7 in paragraph 7#b71 by inserting after follow-up services the following3 1 and for evidence-based programs and activities and outcome research to reduce the incidence of stillbirth 7including tracking and awareness of fetal movements1 improvement of birth timing for pregnancies with risk factors1 initiatives that encourage safe sleeping positions during pregnancy1 screening and surveillance for fetal growth restriction1 efforts to achieve smoking cessation during pregnancy1 community-based programs that provide home visits or other types of support1 and any other research or evidence-based programming to prevent stillbirths74 ,,vi ,mental health and substance use disorders #fjja4 ,sense of ,congress ,it is the sense of the ,congress that it is imperative that a comprehensive public health approach to addressing trauma and mental health care be focused on care delivery that is culturally and linguistically appropriate4 ,a ,access to care and funding streams #faja4 ,coverage of substance use disorder counselor services and peer support specialist services under part ,b of the ,medicare program 7a7 ,coverage of ,services 7#a7 ,in general ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b771 as amended by section #dbea7;c77#a71 is amended-- 7,a7 in subparagraph 7,,jj71 by striking and at the end2 7,b7 by inserting and at the end of subparagraph 7,,kk72 and 7,c7 by adding at the end the following new subparagraph3 7,,ll7 substance use disorder counselor services 7as defined in subsection 7qqq77#a771 and peer support specialist services 7as defined in subsection 7qqq77#c772 4 7#b7 ,definitions ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 as amended by sections #bjjg7;b71 #dbba7;a71 and #dbea7;c77#b71 is amended by adding at the end the following new subsection3 7qqq7 ,substance use disorder counselor services2 substance use disorder counselor2 peer support specialist services2 peer support specialist 7#a7 ,the term substance use disorder counselor services means services performed by a substance use disorder counselor 7as defined in paragraph 7#b77 for the diagnosis and treatment of substance use disorder and addiction that the substance use disorder counselor is legally authorized to perform under ,state law 7or the ,state regulatory mechanism provided by the ,state law7 of the ,state in which such services are performed1 as would otherwise be covered if furnished by a physician or as incident to a physician's professional service1 but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services4 7#b7 ,the term substance use disorder counselor means an individual who-- 7,a7 has performed at least #b years of supervised substance use disorder counselor practice2 7,b7 in the case of an individual performing services in a ,state that provides for licensure or certification of substance use disorder counselors or professional counselors1 is licensed or certified as a substance use disorder counselor or professional counselor in such ,state2 or 7,c7 is a drug and alcohol counselor as defined in section #dj4bha of title #di1 ,code of ,federal ,regulations4 7#c7 ,the term peer support specialist services means services performed by a peer support specialist 7as defined in paragraph 7#d77 for the well-being of individuals needing mental health support that the peer support specialist is legally authorized to perform under ,state law 7or the ,state regulatory mechanism provided by the ,state law7 of the ,state in which such services are performed1 as would otherwise be covered if furnished by a physician or as incident to a physician's professional service1 but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services4 7#d7 ,the term peer support specialist means an individual who-- 7,a7 is an individual living in recovery with mental illness1 addiction1 or justice system involvement2 7,b7 has skills learned in formal training2 7,c7 uses assets-based framing in speaking about mental health1 recovery1 and well-being2 and 7,d7 delivers services in behavioral health settings to promote mind-body recovery and resiliency4 4 7#c7 ,provision for payment under part ,b ,section #ahcb7;a77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciek7a77#b77;,b77 is amended by adding at the end the following new clause3 7v7 substance use disorder counselor services and peer support specialist services2 4 7#d7 ,amount of payment ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a771 as amended by section #dbea7;c77#c71 is amended-- 7,a7 by striking and before 7,,ii72 and 7,b7 by inserting before the semicolon at the end the following3 1 and 7,,jj7 with respect to substance use disorder counselor services and peer support specialist services under section #ahfa7s77#b77,,ll71 the amounts paid shall be #hj percent of the lesser of the actual charge for the services or #ge percent of the amount determined for payment of a psychologist under subparagraph 7,l74 7#e7 ,exclusion of peer support specialist services from skilled nursing facility prospective payment system ,section #ahhh7;e77#b77;,a77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieyy7e77#b77;,a77ii77 is amended by inserting peer support specialist services 7as defined in section #ahfa7qqq77#c771 after mental health counselor services 7as defined in section #ahfa7lll77#c774 7#f7 ,inclusion of substance use disorder counselors as practitioners for assignment of claims ,section #ahdb7;b77#ah77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieu7b77#ah77;,c77 is amended by adding at the end the following new clauses3 7ix7 ,a substance use disorder counselor 7as defined in section #ahfa7qqq77#b774 7x7 ,a peer support specialist 7as defined in section #ahfa7qqq77#d774 4 7b7 ,coverage of ,certain ,mental ,health ,services ,provided in ,rural ,health ,clinics and ,federally ,qualified ,health ,centers ,section #ahfa7;aa77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#a77;,b77 is amended by striking or by a mental health counselor 7as defined in subsection 7lll77#d77 and inserting by a mental health counselor 7as defined in subsection 7lll77#d771 by a substance use disorder counselor 7as defined in subsection 7qqq77#b771 or by a peer support specialist 7as defined in subsection 7qqq77#d774 7c7 ,effective ,date ,the amendments made by this section shall apply with respect to services furnished on or after ,january #a1 #bjbe4 #fajb4 ,reauthorization of ,minority ,fellowship ,program ,section #eig7;c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bijll7c77 is amended by striking #be1jjj1jjj for each of fiscal years #bjbc through #bjbg and inserting #cf1gjj1jjj for each of fiscal years #bjbe through #bjbi4 #fajc4 ,additional funds for ,national ,institutes of ,health 7a7 ,in general ,in addition to amounts otherwise authorized to be appropriated to the ,national ,institutes of ,health1 there is authorized to be appropriated to such ,institutes #aej1jjj1jjj for each of fiscal years #bjbe through #bjcj-- 7#a7 to build relations with communities and conduct or support clinical research1 including clinical research on racial or ethnic disparities in physical and mental health2 and 7#b7 to carry out the ,strategic ,framework ,for ,addressing ,youth ,mental ,health ,disparities developed by the ,national ,institute of ,mental ,health4 7b7 ,definition ,in this section1 the term clinical research has the meaning given to such term in section #dji of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhd;d74 #fajd4 ,additional funds for ,national ,institute on ,minority ,health and ,health ,disparities ,in addition to amounts otherwise authorized to be appropriated to the ,national ,institute on ,minority ,health and ,health ,disparities1 there is authorized to be appropriated to such ,institute #gej1jjj1jjj for each of fiscal years #bjbe through #bjcj4 #faje4 ,grants for increasing racial and ethnic minority access to high-quality trauma support services and mental health care 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary71 acting through the ,assistant ,secretary for ,mental ,health and ,substance ,use1 shall award grants to eligible entities to establish or expand programs for the purpose of increasing racial and ethnic minority access to high-quality trauma support services and mental health care4 7b7 ,eligible entities ,to seek a grant under this section1 an entity shall be a community-based program or organization that-- 7#a7 provides culturally and linguistically appropriate programs and resources that are aligned with evidence-based practices for trauma-informed care2 and 7#b7 has demonstrated expertise in serving communities of color or can partner with a program that has such demonstrated expertise4 7c7 ,use of funds ,as a condition on receipt of a grant under this section1 a grantee shall agree to use the grant to increase racial and ethnic minority access to high-quality trauma support services and mental health care1 such as by-- 7#a7 establishing and maintaining community-based programs providing evidence-based services in trauma-informed care and culturally specific services and other resources2 7#b7 developing innovative1 culturally specific strategies and projects to enhance access to trauma-informed care and resources for racial and ethnic minorities who face obstacles to using more traditional services and resources 7such as obstacles in geographic access to providers1 insurance coverage1 and access to audio and video technologies72 7#c7 working with ,state and local governments and social service agencies to develop and enhance effective strategies to provide culturally specific services to racial and ethnic minorities2 7#d7 increasing communities' capacity to provide culturally specific resources and support for communities of color2 7#e7 working in cooperation with the community to develop education and prevention strategies highlighting culturally specific issues and resources regarding racial and ethnic minorities2 7#f7 providing culturally specific programs for racial and ethnic minorities exposed to law enforcement violence2 and 7#g7 examining the dynamics of culture and its impact on victimization and healing4 7d7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to eligible entities proposing to serve communities that have faced high rates of community trauma1 including from exposure to law enforcement violence1 intergenerational poverty1 civil unrest1 discrimination1 or oppression4 7e7 ,grant period ,the period of a grant under this section shall be #d years4 7f7 ,evaluation ,not later than #f months after the end of the period of all grants under this section1 the ,secretary shall-- 7#a7 conduct an evaluation of the programs funded by a grant under this section2 7#b7 include in such evaluation an assessment of the outcomes of each such program2 and 7#c7 submit a report on the results of such evaluation to the ,congress4 7g7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #bj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 ,b ,interprofessional care #fbja4 ,health professions competencies to address racial and ethnic mental health inequities 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,assistant ,secretary for ,mental ,health and ,substance ,use1 shall award grants to qualified national organizations for the purposes of-- 7#a7 developing1 and disseminating to health professional educational programs1 culturally and linguistically appropriate curricula or core competencies addressing mental health inequities among racial and ethnic minority groups for use in the training of students in the professions of social work1 psychology1 psychiatry1 marriage and family therapy1 mental health counseling1 peer support1 and substance use disorder counseling2 and 7#b7 certifying community health workers and peer wellness specialists with respect to such curricula and core competencies and integrating and expanding the use of such workers and specialists into health care and community-based settings to address mental health inequities among racial and ethnic minority groups4 7b7 ,curricula2 core competencies ,organizations receiving funds under subsection 7a7 may use the funds to engage in the following activities related to the development and dissemination of curricula or core competencies described in subsection 7a77#a73 7#a7 ,formation of committees or working groups composed of experts from accredited health professions schools to identify core competencies relating to mental health inequities among racial and ethnic minority groups4 7#b7 ,planning of workshops in collaboration with community-based organizations and communities of color in national fora to directly facilitate public input1 including input from communities of color with lived experience1 into the educational needs associated with mental health inequities among racial and ethnic minority groups4 7#c7 ,dissemination and promotion of the use of curricula or core competencies in undergraduate and graduate health professions training programs nationwide4 7#d7 ,establishing external stakeholder advisory boards to provide meaningful input into policy and program development and best practices to reduce mental health inequities among racial and ethnic groups1 including participation and leadership from communities of color with lived experience of the impacts of mental health inequities4 7c7 ,definitions ,in this section3 7#a7 ,qualified national organization ,the term qualified national organization means a national organization that focuses on the education of students in programs of social work1 occupational therapy1 psychology1 psychiatry1 substance use counseling1 and marriage and family therapy4 7#b7 ,racial and ethnic minority group ,the term racial and ethnic minority group has the meaning given to such term in section #agjg7;g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g774 7d7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #fbjb4 ,interprofessional health care teams for behavioral health care ,part ,d of title ,v of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;dd et seq47 is amended by adding at the end the following3 #eec4 ,interprofessional health care teams for provision of behavioral health care in primary care settings 7a7 ,grants ,the ,secretary1 acting through the ,assistant ,secretary1 shall award grants to eligible entities for the purpose of establishing interprofessional health care teams that provide behavioral health care4 7b7 ,eligible entities ,to be eligible to receive a grant under this section1 an entity shall be a ,federally qualified health center 7as defined in section #ahfa7;aa7 of the ,social ,security ,act71 rural health clinic1 women's health clinic1 or behavioral health program 7including any such program operated by a community-based organization7 serving a high proportion of individuals from racial and ethnic minority groups 7as defined in section #agjg7;g774 7c7 ,loan forgiveness ,to encourage qualified and diverse allied health professionals to enter the mental health field1 an eligible entity receiving a grant under this section shall agree to use not less than #aj1jjj of the grant funds on a loan forgiveness program for practitioners who commit to working in the mental health field for a period of #b years4 7d7 ,scientifically and culturally based ,integrated health care funded through this section shall be scientifically and culturally based1 taking into consideration the results of the most recent peer-reviewed research available1 including information on language accessibility1 cultural humility1 diversity of practitioners1 and consideration of social determinants of health4 7e7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #bj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 4 #fbjc4 ,integrated ,health ,care ,demonstration ,program ,part ,d of title ,v of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;dd et seq471 as amended by section #fbjb1 is amended by adding at the end the following3 #eed4 ,interprofessional health care teams for provision of behavioral health care in primary care settings 7a7 ,grants ,the ,secretary shall award grants to eligible entities for the purpose of establishing interprofessional health care teams that provide behavioral health care4 7b7 ,eligible entities ,to be eligible to receive a grant under this section1 an entity shall be a ,federally qualified health center 7as defined in section #ahfa7;aa7 of the ,social ,security ,act71 rural health clinic1 or behavioral health program1 serving a high proportion of individuals from racial and ethnic minority groups 7as defined in section #agjg7;g774 7c7 ,scientifically based ,integrated health care funded through this section shall be scientifically based1 taking into consideration the results of the most recent peer-reviewed research available4 7d7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated #bj1jjj1jjj for each of the first #e fiscal years following the date of enactment of the ,health ,equity and ,accountability ,act #bjbd4 4 ,c ,workforce development #fcja4 ,building an effective workforce in mental health 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 in coordination with the ,assistant ,secretary for ,mental ,health and ,substance ,use1 the ,administrator of the ,health ,resources and ,services ,administration1 the ,secretary of ,labor1 and advocacy and behavioral and mental health organizations serving vulnerable populations1 including youth and young adults1 people with low incomes1 and people of color1 shall-- 7#a7 develop1 strengthen1 and implement strategies to bolster career pathways for diverse mental health professionals2 7#b7 identify the breadth of settings where mental health care and behavioral health care can take place2 and 7#c7 identify current mental health professional workforce shortages1 inclusive of shortages of diverse mental health professionals4 7b7 ,contents ,strategies under subsection 7a7 shall include-- 7#a7 the variety of settings where mental health professionals are needed1 including community-based organizations1 women's centers1 shelters1 organizations focused on youth development1 workforce agencies1 job placement and development centers1 emergency rooms1 the special supplemental nutrition program for women1 infants1 and children under section #ag of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aghf71 food banks1 legal aid1 and benefit issuers 7as defined in section #c of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjab772 7#b7 defining career pathways in mental and behavioral health1 to help diverse communities understand the variety of careers in mental and behavioral health that are available2 7#c7 building career pathways in mental and behavioral health as part of the curriculum at the postsecondary education level2 7#d7 providing accessible training and certification pathways for diverse lay health workers such as community health workers and other peer support specialists to ensure that careers pay a living wage2 7#e7 creating incentives for students in the fields of occupational therapy1 social work1 psychology1 medicine1 and nursing to learn more about mental health1 and to include a mental health rotation1 with a particular focus in racially and ethnically diverse communities1 as a part of the health professional curricula2 7#f7 including training and education for teachers about the basics of section #ejd of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gid7 and individualized education programs 7as defined in section #fad7;d7 of the ,individuals with ,disabilities ,education ,act 7#bj ,u4,s4,c4 #adad7;d7772 7#g7 researching1 developing1 and implementing programs for mental and behavioral health professionals to prevent burnout2 and 7#h7 finding better and increased avenues to ensure equity by providing better loan forgiveness programs1 including a focus area within the ,national ,health ,service ,corps focused on community trauma4 7c7 ,use of funds ,programs and activities funded under this section shall be consistent with subsection 7a77#a7 and shall include the following3 7#a7 ,subgrants to entities serving youth and young adults which demonstrate a need for an increased mental health workforce1 using strategies described in subsection 7a77#a74 7#b7 ,funding towards the ,health ,resources and ,services ,administration's ,behavioral ,health ,workforce ,education and ,training ,program4 7#c7 ,funding towards the development and implementation of a ,national ,health ,service ,corps program focused on community trauma4 7d7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #ej1jjj1jjj for each of fiscal years #bjbe through #bjce4 #fcjb4 ,demonstration program to increase language access at eligible health centers 7a7 ,grants ,the ,secretary shall carry out a demonstration program consisting of awarding grants to eligible health centers to recruit1 hire1 employ1 and supervise qualified behavioral health professionals who-- 7#a7 are proficient in speaking and understanding both spoken ,english and at least one other spoken language1 including any necessary specialized vocabulary1 terminology1 and phraseology2 7#b7 are able to effectively1 accurately1 and impartially communicate directly with limited ,english proficient individuals in their primary language2 and 7#c7 are1 or will be1 employed-- 7,a7 directly by the eligible health center2 or 7,b7 through a contract between the eligible health center and the qualified behavioral health professional under which such professional provides services as part of the eligible health center's workforce or under supervision by the health center1 in order to provide behavioral health services in another language4 7b7 ,preference ,in selecting grant recipients under subsection 7a71 the ,secretary shall give preference to eligible health centers at which at least #aj percent of the patients are best served in a language other than ,english1 as indicated by data in the ,uniform ,data ,system of the ,health ,resources and ,services ,administration 7or any successor database74 7c7 ,outreach ,an eligible health center receiving a grant under this section shall use a portion of the grant funds to disseminate information about the behavioral health services supported through the grant4 7d7 ,reports 7#a7 ,initial report ,not later than #f months after the first grants are awarded under subsection 7a71 the ,secretary shall submit to the ,committee on ,appropriations and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 the ,committee on ,appropriations and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate1 and other appropriate congressional committees1 a report on the implementation of the program under this section4 ,such report shall include-- 7,a7 the languages spoken by the qualified behavioral health professionals recruited pursuant to a grant under subsection 7a72 7,b7 the eligible health center at which each such professional was placed2 7,c7 how many eligible health centers received grants under subsection 7a72 7,d7 an analysis1 conducted in consultation with the eligible health centers receiving grants under subsection 7a71 of the effectiveness of such grants at increasing language access to behavioral health services2 and 7,e7 best practices1 developed in consultation with eligible health centers receiving grants under subsection 7a71 for the recruitment and retention of qualified behavioral health professionals at such health centers4 7#b7 ,final report ,not later than the end of fiscal year #bjbf1 the ,secretary shall submit to the ,committee on ,appropriations and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 the ,committee on ,appropriations and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate1 and other appropriate congressional committees1 a final report on the implementation of the program under this section1 including the information1 analysis1 and best practices described in subparagraphs 7,a7 through 7,e7 of paragraph 7#a74 7e7 ,definitions ,in this section3 7#a7 ,the term eligible health center means a health center 7as defined in section #ccj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b77 that is already receiving assistance pursuant to one or more grants under such section #ccj at the time of the award to such health center of a supplemental grant under subsection 7a74 7#b7 ,the term qualified behavioral health professional means-- 7,a7 a behavioral and mental health professional 7as defined in section #cca7;a77#c77;,e77i7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;d7a77#c77;,e77i7772 7,b7 a substance use disorder counselor2 7,c7 an occupational therapist2 or 7,d7 an individual who-- 7i7 has not yet been licensed or certified to serve as a professional listed in any of subparagraphs 7,a7 through 7,c72 and 7ii7 will serve at the eligible health center under the supervision of a licensed individual or certified professional so listed4 7#c7 ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7f7 ,funding ,subject to the availability of appropriations1 out of amounts otherwise appropriated under section #gfj7;g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bidk7g771 the ,secretary is authorized to use up to #aj1jjj1jjj for each of fiscal years #bjbe through #bjcj to carry out this section4 #fcjc4 ,health professions competencies to address racial and ethnic minority mental health disparities 7a7 ,in general ,the ,secretary of ,health and ,human ,services may award grants to qualified national organizations for the purposes of-- 7#a7 developing1 and disseminating to health professional educational programs1 best practices or core competencies addressing mental health disparities among racial and ethnic minority groups for use in the training of students in the professions of social work1 psychology1 psychiatry1 marriage and family therapy1 mental health counseling1 and substance use disorder counseling2 and 7#b7 certifying community health workers and peer wellness specialists with respect to such best practices and core competencies and integrating and expanding the use of such workers and specialists into health care to address mental health disparities among racial and ethnic minority groups4 7b7 ,best practices2 core competencies ,organizations receiving funds under subsection 7a7 may use the funds to engage in the following activities related to the development and dissemination of best practices or core competencies described in subsection 7a77#a73 7#a7 ,formation of committees or working groups composed of experts from accredited health professions schools to identify best practices and core competencies relating to mental health disparities among racial and ethnic minority groups4 7#b7 ,planning of workshops at the national level to allow for public input into the educational needs associated with mental health disparities among racial and ethnic minority groups4 7#c7 ,dissemination and promotion of the use of best practices or core competencies for culturally and linguistically appropriate mental health services in undergraduate and graduate health professions training programs nationwide4 7#d7 ,establishing external stakeholder advisory boards to provide meaningful input into policy and program development and best practices to reduce mental health disparities among racial and ethnic minority groups4 7c7 ,definitions ,in this section3 7#a7 ,qualified national organization ,the term qualified national organization means a national organization that focuses on the education of students in one or more of the professions of social work1 psychology1 psychiatry1 marriage and family therapy1 mental health counseling1 and substance misuse counseling4 7#b7 ,racial and ethnic minority group ,the term racial and ethnic minority group has the meaning given to such term in section #agjg7;g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g774 ,d ,children's mental health #fdja4 ,grant programs to support pediatric behavioral health care ,part ,d of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b et seq47 is amended by inserting after subpart ,v the following new subpart3 ,,vi ,pediatric behavioral health programs #cdj;,a-#a4 ,program to improve access to community-based pediatric behavioral health care 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall award grants1 contracts1 or cooperative agreements to eligible entities for the purpose of supporting pediatric behavioral health care integration and coordination within communities to meet local community needs4 7b7 ,eligible entities ,entities eligible for grants under subsection 7a7 include-- 7#a7 health care providers1 including family physicians1 pediatric medical sub-specialists1 and surgical specialists2 7#b7 children's hospitals2 7#c7 facilities that are eligible to receive funds under section #cdj;,e or #cdj;,h2 7#d7 nonprofit medical facilities that predominantly treat individuals under the age of #ba2 7#e7 rural health clinics and ,federally qualified health centers 7as such terms are defined in section #ahfa7;aa7 of the ,social ,security ,act72 7#f7 pediatric mental health and substance use disorder providers1 such as child and adolescent psychiatrists1 psychologists1 developmental and behavioral pediatricians1 general pediatricians1 advanced practice nurses1 social workers1 licensed professional counselors1 and other licensed professionals that provide mental health and substance use disorder services to patients under #ba years of age2 7#g7 children's advocacy centers described in section #bad7;c77#b77;,b7 of the ,victims of ,child ,abuse ,act of #aiij2 7#h7 school-based health centers2 and 7#i7 other entities as determined appropriate by the ,secretary4 7c7 ,prioritization ,in making awards under subsection 7a71 the ,secretary shall prioritize-- 7#a7 applicants that provide children and adolescents from high-need1 rural1 or under-resourced communities with services across the continuum of children's mental health and substance use disorder care2 and 7#b7 applicants that predominantly provide care to children and adolescents that demonstrate plans to utilize funds to expand provision of care to children1 adolescents1 and youth under age #ba4 7d7 ,use of funds ,activities that may be funded through an award under subsection 7a7 include-- 7#a7 increasing the capacity of pediatric practices1 family medicine practices1 and school-based health centers to integrate pediatric mental1 emotional1 and behavioral health services into their practices including through co-location of mental1 emotional1 and behavioral health providers2 7#b7 training for non-clinical pediatric health care workers1 including care coordinators and navigators1 on child and adolescent mental health and substance use disorder1 trauma-informed care1 and local resources to support children and caregivers2 7#c7 expanding evidence-based1 integrated models of care for pediatric mental health and substance use disorder services2 7#d7 pediatric practice integration for the provision of pediatric mental health and substance use disorder services2 7#e7 addressing surge capacity for pediatric mental health and substance use disorder needs2 7#f7 providing pediatric mental1 emotional1 and behavioral health services to children as delivered by mental health and substance use disorder professionals utilizing telehealth services2 7#g7 establishing or maintaining initiatives to allow more children to access care outside of emergency departments1 including partial hospitalization1 step down residency programs1 and intensive outpatient programs2 7#h7 supporting1 enhancing1 or expanding pediatric mental health and substance use disorder preventive and crisis intervention services2 7#i7 establishing or maintaining pediatric mental health and substance use disorder urgent care or walk-in clinics2 7#aj7 establishing or maintaining community-based pediatric mental health and substance use disorder initiatives1 such as partnerships with schools and early childhood education programs2 7#aa7 addressing other access and coordination gaps to pediatric mental health and substance use disorder services in the community for children2 and 7#ab7 supporting the collection of data on children and adolescents' mental health needs1 service utilization and availability1 and demographic data1 to capture community needs and identify gaps and barriers in children's access to care1 in a manner that protects personal privacy1 consistent with applicable ,federal and ,state privacy laws4 7e7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #cdj;,a-#b4 ,pediatric behavioral health workforce training program 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall award grants1 contracts1 or cooperative agreements to eligible entities for the purpose of supporting evidence-based pediatric mental health and substance use disorder workforce training4 7b7 ,eligible entities ,entities eligible for grants under subsection 7a7 include-- 7#a7 children's hospitals2 7#b7 facilities that are eligible to receive funds under section #cdj;,e or #cdj;,h2 7#c7 nonprofit medical facilities that predominantly treat individuals under the age of #ba2 7#d7 rural health clinics and ,federally qualified health centers 7as such terms are defined in section #ahfa7;aa7 of the ,social ,security ,act72 7#e7 entities that employ mental health and substance use disorder professionals1 such as child and adolescent psychiatrists1 psychologists1 developmental and behavioral pediatricians1 general pediatricians1 advanced practice nurses1 social workers1 licensed professional counselors1 or other licensed professionals that provide mental health or substance use disorder services to patients under #ba years of age2 and 7#f7 other pediatric health care providers as determined appropriate by the ,secretary4 7c7 ,use of funds ,activities that may be supported through an award under subsection 7a7 include the following3 7#a7 ,training to enhance the capabilities of the existing pediatric workforce1 including pediatricians1 primary care physicians1 advanced practice registered nurses1 and other pediatric health care providers1 including expanded training in pediatric mental health and substance use disorders1 and culturally and developmentally appropriate care for children with mental health conditions4 7#b7 ,training to support multi-disciplinary teams to provide pediatric mental health and substance use disorder treatment1 including through integrated care models4 7#c7 ,initiatives to accelerate the time to licensure within the pediatric mental health or substance use disorder workforce4 7#d7 ,activities to expand recruitment and retention1 increase workforce diversity1 or enhance workforce training for critical pediatric mental health professions1 including-- 7,a7 child and adolescent psychiatrists2 7,b7 psychiatric nurses2 7,c7 psychologists2 7,d7 family therapists2 7,e7 social workers2 7,f7 mental health counselors2 7,g7 developmental and behavioral pediatricians2 7,h7 pediatric substance use disorder specialists2 and 7,i7 other mental health care providers as determined appropriate by the ,secretary4 7d7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 4 #fdjb4 ,increasing ,federal investment in pediatric behavioral health services ,the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bja et seq47 7as amended by section #bjjd7 is amended by adding at the end the following3 ,,xxxv ,assistance for construction and modernization of children's mental health and substance use disorder infrastructure #ceja4 ,increasing ,federal investment in pediatric behavioral health services 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall award grants1 contracts1 or cooperative agreements to eligible entities for the purpose of improving their ability to provide pediatric behavioral health services1 including by-- 7#a7 constructing or modernizing sites of care for pediatric behavioral health services2 7#b7 expanding capacity to provide pediatric behavioral health services1 including enhancements to digital infrastructure1 telehealth capabilities1 or other improvements to patient care infrastructure2 7#c7 supporting the reallocation of existing resources to accommodate pediatric behavioral health patients1 including by converting or adding a sufficient number of beds to establish or increase the hospital's inventory of licensed and operational1 short-term psychiatric and substance use inpatient beds2 and 7#d7 addressing gaps in the continuum of care for children1 by expanding capacity to provide intermediate levels of care1 such as intensive outpatient services1 partial hospitalization programs1 and day programs that can prevent hospitalizations and support children as they transition back to their homes and communities4 7b7 ,eligibility ,to be eligible to seek an award under this section1 an entity shall be a hospital or rural health clinic that predominantly treats individuals under the age of #ba1 including any hospital that receives funds under section #cdj;,e4 7c7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 7d7 ,supplement1 not supplant ,funds provided under this section shall be used to supplement1 not supplant ,federal and non-,federal funds available for carrying out the activities described in this section4 7e7 ,reporting 7#a7 ,reports from award recipients ,not later than #ahj days after the completion of activities funded by an award under this section1 the entity that received such award shall submit a report to the ,secretary on the activities conducted using funds from such award1 and other information as the ,secretary may require4 7#b7 ,reports to ,congress ,not later than one year after the completion of activities funded by an award under this section1 the ,secretary shall submit to the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate a report on the projects and activities conducted with funds awarded under this section1 and the outcome of such projects and activities4 ,such report shall include-- 7,a7 the number of projects supported by awards made under this section2 7,b7 an overview of the impact1 if any1 of such projects on pediatric health care infrastructure1 including any impact on access to pediatric mental health and substance use disorder services2 7,c7 recommendations for improving the investment program under this section2 and 7,d7 any other considerations as the ,secretary determines appropriate4 4 #fdjc4 ,mental health in schools 7a7 ,technical amendments ,the second part ,g 7relating to services provided through religious organizations7 of title ,v of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bijkk et seq47 is amended-- 7#a7 by redesignating such part as part ,j2 and 7#b7 by redesignating sections #eha through #ehd as sections #eif through #eif;,c1 respectively4 7b7 ,school-,based mental health and children ,section #eha of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;hh7 7relating to children and violence7 is amended to read as follows3 #eha4 ,school-based mental health2 children and adolescents 7a7 ,in general ,the ,secretary1 in consultation with the ,secretary of ,education1 shall1 through grants1 contracts1 or cooperative agreements awarded to eligible entities described in subsection 7c71 provide comprehensive school-based mental health services and supports to assist children in local communities and schools 7including schools funded by the ,bureau of ,indian ,education7 dealing with traumatic experiences1 grief1 bereavement1 risk of suicide1 and violence4 ,such services and supports shall be-- 7#a7 developmentally1 linguistically1 and culturally appropriate2 7#b7 trauma-informed2 and 7#c7 incorporate positive behavioral interventions and supports4 7b7 ,activities ,grants1 contracts1 or cooperative agreements awarded under subsection 7a71 shall1 as appropriate1 be used for-- 7#a7 implementation of school- and community-based mental health programs that-- 7,a7 build awareness of individual trauma and the intergenerational1 continuum of impacts of trauma on populations2 7,b7 train appropriate staff to identify1 and screen for1 signs of trauma exposure1 mental health disorders1 or risk of suicide2 and 7,c7 incorporate positive behavioral interventions1 family engagement1 student treatment1 and multigenerational supports to foster the health and development of children1 prevent mental health disorders1 and ameliorate the impact of trauma2 7#b7 technical assistance to local communities with respect to the development of programs described in paragraph 7#a72 7#c7 facilitating community partnerships among families1 students1 law enforcement agencies1 education agencies1 mental health and substance use disorder service systems1 family-based mental health service systems1 child welfare agencies1 health care providers 7including primary care physicians1 mental health professionals1 and other professionals who specialize in children's mental health such as child and adolescent psychiatrists71 institutions of higher education1 faith-based programs1 trauma networks1 and other community-based systems to address child and adolescent trauma1 mental health issues1 and violence2 and 7#d7 establishing mechanisms for children and adolescents to report incidents of violence or plans by other children1 adolescents1 or adults to commit violence4 7c7 ,requirements 7#a7 ,in general ,to be eligible for a grant1 contract1 or cooperative agreement under subsection 7a71 an entity shall be a partnership that includes-- 7,a7 a ,state educational agency1 as defined in section #haja of the ,elementary and ,secondary ,education ,act of #aife1 in coordination with one or more local educational agencies1 as defined in section #haja of the ,elementary and ,secondary ,education ,act of #aife1 or a consortium of any entities described in subparagraph 7,b71 7,c71 7,d71 or 7,e7 of section #haja7cj7 of such ,act2 and 7,b7 at least #a community-based mental health provider1 including a public or private mental health entity1 health care entity1 family-based mental health entity1 trauma network1 or other community-based entity1 as determined by the ,secretary 7and which may include additional entities such as a human services agency1 law enforcement or juvenile justice entity1 child welfare agency1 agency1 an institution of higher education1 or another entity1 as determined by the ,secretary74 7#b7 ,compliance with ,,hipaa ,any patient records developed by covered entities through activities under the grant shall meet the regulations promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif4 7#c7 ,compliance with ,,ferpa ,section #ddd of the ,general ,education ,provisions ,act 7commonly known as the ,family ,educational ,rights and ,privacy ,act of #aigd7 shall apply to any entity that is a member of the partnership in the same manner that such section applies to an educational agency or institution 7as that term is defined in such section74 7d7 ,geographical distribution ,the ,secretary shall ensure that grants1 contracts1 or cooperative agreements under subsection 7a7 will be distributed equitably among the regions of the country and among urban and rural areas4 7e7 ,duration of awards ,with respect to a grant1 contract1 or cooperative agreement under subsection 7a71 the period during which payments under such an award will be made to the recipient shall be #e years1 with options for renewal4 7f7 ,evaluation and measures of outcomes 7#a7 ,development of process ,the ,assistant ,secretary shall develop a fiscally appropriate process for evaluating activities carried out under this section4 ,such process shall include-- 7,a7 the development of guidelines for the submission of program data by grant1 contract1 or cooperative agreement recipients2 7,b7 the development of measures of outcomes 7in accordance with paragraph 7#b77 to be applied by such recipients in evaluating programs carried out under this section2 and 7,c7 the submission of annual reports by such recipients concerning the effectiveness of programs carried out under this section4 7#b7 ,measures of outcomes ,the ,assistant ,secretary shall develop measures of outcomes to be applied by recipients of assistance under this section to evaluate the effectiveness of programs carried out under this section1 including outcomes related to the student1 family1 and local educational systems supported by this ,act4 7#c7 ,submission of annual data ,an eligible entity described in subsection 7c7 that receives a grant1 contract1 or cooperative agreement under this section shall annually submit to the ,assistant ,secretary a report that includes data to evaluate the success of the program carried out by the entity based on whether such program is achieving the purposes of the program4 ,such reports shall utilize the measures of outcomes under paragraph 7#b7 in a reasonable manner to demonstrate the progress of the program in achieving such purposes4 7#d7 ,evaluation by assistant secretary ,based on the data submitted under paragraph 7#c71 the ,assistant ,secretary shall annually submit to ,congress a report concerning the results and effectiveness of the programs carried out with assistance received under this section4 7#e7 ,limitation ,an eligible entity shall use not more than #bj percent of amounts received under a grant under this section to carry out evaluation activities under this subsection4 7g7 ,information and education ,the ,secretary shall disseminate best practices based on the findings of the knowledge development and application under this section4 7h7 ,amount of grants and authorization of appropriations 7#a7 ,amount of grants ,a grant under this section shall be in an amount that is not more than #b1jjj1jjj for each of the first #e fiscal years following the date of enactment of the ,health ,equity and ,accountability ,act #bjbd4 ,the ,secretary shall determine the amount of each such grant based on the population of children up to age #ba of the area to be served under the grant4 7#b7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section1 #cjj1jjj1jjj for each of fiscal years #bjbe through #bjbh4 4 7c7 ,conforming amendment ,part ,g of title ,v of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;hh et seq471 as amended by subsection 7b71 is amended by striking the part designation and heading and inserting the following3 ,g ,school-based mental health 4 #fdjd4 ,additional support for youth and young adult mental health service provision ,section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is amended by adding at the end the following new subsection3 7cc7 ,youth and young adult intervention services 7#a7 ,in general ,notwithstanding section #aijb7;a77#a7 7relating to ,statewideness71 section #aijb7;a77#aj77;,b7 7relating to comparability71 section #aijb7;a77#bc77;,a7 7relating to freedom of choice of providers71 or section #aijb7;a77#bg7 7relating to provider agreements71 a ,state may1 during the #e-year period beginning on the first day of the fiscal year quarter that begins on or after ,january #a1 #bjbd1 provide medical assistance for qualifying youth and young adult mental health and substance use intervention services 7as defined in paragraph 7#b77;,c77 under a ,state plan amendment or waiver approved under section #aaae or #aiae7;c74 7#b7 ,definitions ,for the purposes of this subsection3 7,a7 ,priority service ,the term priority service means any of the following if voluntarily received and provided in a manner that maintains the privacy and confidentiality of patient information consistent with ,federal and ,state requirements3 7i7 ,community-based mobile crisis intervention services1 as defined in section #aidg4 7ii7 ,telehealth4 7iii7 ,youth peer support4 7iv7 ,screening for adverse childhood experiences4 7v7 ,trauma responsive care4 7vi7 ,other priority services for youth1 as defined by the ,secretary4 7,b7 ,qualified mental health providers ,the term qualified mental health providers means a behavioral health care professional who is capable of conducting an assessment of the individual1 in accordance with the professional's permitted scope of practice under ,state law1 and other professionals or paraprofessionals with appropriate expertise in youth and young adult behavioral health or mental health1 including social workers1 peer support specialists1 recovery coaches1 community health workers1 mental health clinicians1 and others1 as designated by the ,state and approved by the ,secretary4 7,c7 ,qualifying youth and young adult mental health and substance use intervention services defined ,the term qualifying youth and young adult mental health and substance use intervention services means1 with respect to a ,state1 items and services for which medical assistance is available under the ,state plan under this title or a waiver of such plan1 that are-- 7i7 furnished to an individual #af to #be years of age who is-- 7,i7 experiencing a mental health or substance use disorder crisis2 7,,ii7 subject to the juvenile or adult justice system as defined in section #cajb of title #bi1 ,united ,states ,code2 7,,iii7 7aa7 experiencing homelessness 7as defined in section #dadjc7f7 of the ,violence ,against ,women ,act of #aiid 7#db ,u4,s4,c4 #adjdc;e-#b7f7772 7bb7 a homeless child or youth 7as defined in section #gbe7b7 of the ,mc,kinney-,vento ,homeless ,assistance ,act 7#db ,u4,s4,c4 #aadcd;a7#b7772 7cc7 a runaway1 in foster care1 or has aged out of the foster care system2 7dd7 a child eligible for assistance under section #dgg of the ,social ,security ,act 7#db ,u4,s4,c4 #fgg72 or 7ee7 in an out-of-home placement2 7,,iv7 pregnant or parenting as defined in section #cajb of title #bi1 ,united ,states ,code2 7,v7 a youth who is an individual with a disability as defined in section #cajb of title #bi1 ,united ,states ,code2 7,,vi7 a low-income youth requiring additional assistance to enter or complete an educational program or to secure or hold employment as defined in section #cajb of title #bi1 ,united ,states ,code2 or 7,,vii7 living in a community that has faced acute or long-term exposure to substantial discrimination1 historical oppression1 intergenerational poverty1 civil unrest1 or a high rate of violence or drug overdose deaths2 7ii7 furnished by qualified mental health providers2 and 7iii7 a priority service4 7,d7 ,telehealth ,the term telehealth means use of electronic information and telecommunications technologies1 including voice only audio1 text1 remote patient monitoring1 and m,health via applications1 to support clinical mental health care1 patient and professional health-related education1 public health1 and health administration4 7#c7 ,payments ,notwithstanding section #aije7;b71 beginning ,january #a1 #bjbd1 during each of the first #bj fiscal quarters that a ,state meets the requirements described in paragraph 7#d71 the ,federal medical assistance percentage applicable to amounts expended by the ,state for medical assistance for qualifying youth and young adult mental health and substance use intervention services furnished during such quarter shall be equal to #ajj percent4 7#d7 ,requirements ,the requirements described in this paragraph are the following3 7,a7 ,the ,state demonstrates1 to the satisfaction of the ,secretary-- 7i7 that it will be able to support the provision of qualifying youth and young adult mental health and substance use intervention services that meet the conditions specified in paragraphs 7#a7 and 7#b72 and 7ii7 how it will support coordination between qualified mental health providers and substance use teams and community partners1 including health care providers1 to enable the provision of services1 needed referrals1 and other activities identified by the ,secretary4 7,b7 ,the ,state provides assurances satisfactory to the ,secretary that-- 7i7 any additional ,federal funds received by the ,state for qualifying youth and young adult mental health and substance use intervention services provided under this subsection that are attributable to the increased ,federal medical assistance percentage under paragraph 7#c77;,a7 will be used to supplement1 and not supplant1 the level of ,state funds expended for such services for fiscal year #bjbd2 7ii7 if the ,state made qualifying youth and young adult mental health and substance use intervention services available in a region of the ,state in fiscal year #bjbc the ,state will continue to make such services available in such region under this subsection at the same level that the ,state made such services available in such fiscal year2 and 7iii7 the ,state will conduct the evaluation and assessment1 and submit the report required under paragraph 7#e74 7#e7 ,state evaluation and report 7,a7 ,state evaluation ,not later than #d fiscal quarters after a ,state begins providing qualifying youth and young adult mental health and substance use intervention services in accordance with this subsection1 the ,state shall enter into a contract with an independent entity or organization to conduct an evaluation for the purposes of-- 7i7 determining the effect of the provision of such services on-- 7,i7 emergency room visits2 7,,ii7 use of ambulatory services2 7,,iii7 hospitalizations2 7,,iv7 the involvement of law enforcement in mental health or substance use disorder crisis events2 and 7,v7 the diversion of individuals from jails or similar settings2 and 7ii7 assessing-- 7,i7 the types of services provided to individuals2 7,,ii7 the types of events responded to2 7,,iii7 cost savings or cost-effectiveness attributable to such services2 7,,iv7 the experiences of individuals who receive qualifying youth and young adult mental health and substance use intervention services2 7,v7 the successful connection of individuals with follow-up services2 and 7,,vi7 other relevant outcomes identified by the ,secretary4 7,b7 ,comparison to historical measures ,the contract described in subparagraph 7,a7 shall specify that the evaluation is based on a comparison of the historical measures of ,state performance with respect to the outcomes specified under such subparagraph to the ,state's performance with respect to such outcomes during the period beginning with the first quarter in which the ,state begins providing qualifying youth and young adult mental health and substance use intervention services in accordance with this subsection4 7,c7 ,report ,not later than #b years after a ,state begins to provide qualifying youth and young adult mental health and substance use intervention services in accordance with this subsection1 the ,state shall submit a report to the ,secretary on the following3 7i7 ,the results of the evaluation carried out under subparagraph 7,a74 7ii7 ,the number of individuals who received qualifying youth and young adult mental health and substance use intervention services4 7iii7 ,demographic information regarding such individuals when available1 including the race and ethnicity1 age1 sex1 sexual orientation1 gender identity1 and geographic location of such individuals4 7iv7 ,the processes and models developed by the ,state to provide qualifying youth and young adult mental health and substance use intervention services under such the ,state plan or waiver1 including the processes developed to provide referrals for1 or coordination with1 follow-up care and services4 7v7 ,lessons learned regarding the provision of such services4 7,d7 ,public availability ,the ,state shall make the report required under subparagraph 7,c7 publicly available1 including on the website of the appropriate ,state agency1 upon submission of such report to the ,secretary4 7#f7 ,best practices report 7,a7 ,in general ,not later than #c years after the first ,state begins to provide qualifying youth and young adult mental health and substance use intervention services in accordance with this subsection1 the ,secretary shall submit a report to ,congress that-- 7i7 identifies the ,states that elected to provide services in accordance with this subsection2 7ii7 summarizes the information reported by such ,states under paragraph 7#e77;,c72 and 7iii7 identifies best practices for the effective delivery of youth and young adult mental health and substance use intervention services4 7,b7 ,public availability ,the report required under subparagraph 7,a7 shall be made publicly available1 including on the website of the ,department of ,health and ,human ,services1 upon submission to ,congress4 7#g7 ,nondiscrimination 7,a7 ,federally funded activities 7i7 ,for the purpose of applying the prohibitions against discrimination on the basis of age under the ,age ,discrimination ,act of #aige 7#db ,u4,s4,c4 #faja et seq471 on the basis of handicap under section #ejd of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gid71 on the basis of sex under title ,,ix of the ,education ,amendments of #aigb 7#bj ,u4,s4,c4 #afha et seq471 or on the basis of race1 color1 or national origin under title ,,vi of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;d et seq471 programs and activities funded in whole or in part with funds made available under this subchapter are considered to be programs and activities receiving ,federal financial assistance4 7ii7 ,no person shall on the ground of sex or religion be excluded from participation in1 be denied the benefits of1 or be subjected to discrimination under1 any program or activity funded in whole or in part with funds made available under this title4 7,b7 ,compliance ,whenever the ,secretary finds that a ,state1 or an entity that has received a payment from an allotment to a ,state under section #gjb7;c7 of this title1 has failed to comply with a provision of law referred to in subsection 7a77#a71 with subsection 7a77#b71 or with an applicable regulation 7including one prescribed to carry out subsection 7a77#b771 he shall notify the chief executive officer of the ,state and shall request him to secure compliance4 ,if within a reasonable period of time1 not to exceed #fj days1 the chief executive officer fails or refuses to secure compliance1 the ,secretary may-- 7i7 refer the matter to the ,attorney ,general with a recommendation that an appropriate civil action be instituted2 7ii7 exercise the powers and functions provided by title ,,vi of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;d et seq471 the ,age ,discrimination ,act of #aige 7#db ,u4,s4,c4 #faja et seq471 or section #ejd of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gid71 as may be applicable2 or 7iii7 take such other action as may be provided by law4 7,c7 ,authority of attorney general2 civil actions ,when a matter is referred to the ,attorney ,general pursuant to subsection 7b77#a71 or whenever he has reason to believe that the entity is engaged in a pattern or practice in violation of a provision of law referred to in subsection 7a77#a7 or in violation of subsection 7a77#b71 the ,attorney ,general may bring a civil action in any appropriate district court of the ,united ,states for such relief as may be appropriate1 including injunctive relief4 4 #fdje4 ,early intervention and prevention programs for transition-age youth 7a7 ,in general ,section #aiab7;b77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjx-#a7;b77#a77 is amended-- 7#a7 by redesignating subparagraph 7,e7 as subparagraph 7,f72 and 7#b7 by inserting after subparagraph 7,d7 the following3 7,e7 ,early intervention and prevention programs for transition-age youth ,the plan shall describe the ,state's plans to carry out demonstration grants or contracts for early intervention and prevention programs for transition-age youth of #af to #be years of age who meet one or more of the criteria specified in section #abi7;a77#a77;,b7 of the ,workforce ,innovation and ,opportunity ,act to be considered out-of-school youth4 4 7b7 ,set-,aside ,section #aibj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjx-#i7 is amended by adding at the end the following3 7e7 ,early intervention and prevention programs for transition-,age youth 7#a7 ,in general ,except as provided in paragraph 7#b71 a ,state shall expend at least #ae percent of the amount of the allotment of the ,state pursuant to a funding agreement under section #aiaa for each fiscal year to support programs described in section #aiab7;b77#a77;,e74 7#b7 ,state flexibility ,in lieu of expending #ae percent of the amount of the allotment for a fiscal year as required by paragraph 7#a71 a ,state may elect to expend not less than #cj percent of such amount to support such programs by the end of two consecutive fiscal years4 4 #fdjf4 ,strategies to increase access to telehealth under ,medicaid and ,children's ,health ,insurance ,program 7a7 ,guidance ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall issue and disseminate guidance to ,states to clarify strategies to overcome existing barriers and increase access to telehealth under the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 and the ,children's ,health ,insurance ,program under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;aa et seq474 ,such guidance shall include technical assistance and best practices regarding-- 7#a7 telehealth delivery of covered services2 7#b7 recommended voluntary billing codes1 modifiers1 and place-of-service designations for telehealth and other virtual health care services2 7#c7 the simplification or alignment 7including through reciprocity7 of provider licensing1 credentialing1 and enrollment protocols with respect to telehealth across ,states1 ,state ,medicaid plans under such title ,,xix1 and ,medicaid managed care organizations1 including during national public health emergencies2 7#d7 existing strategies ,states can use to integrate telehealth and other virtual health care services into value-based health care models2 and 7#e7 examples of ,states that have used waivers under the ,medicaid program to test expanded access to telehealth1 including during the emergency period described in section #aace7;g77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#e7;g77#a77;,b774 7b7 ,studies 7#a7 ,telehealth impact on health care access ,not later than #a year after the date of the enactment of this ,act1 the ,medicaid and ,,chip ,payment and ,access ,commission shall conduct a study1 with respect to a minimum of #aj ,states across geographic regions of the ,united ,states1 and submit to ,congress a report1 on the impact of telehealth on health care access1 utilization1 cost1 and outcomes1 broken down by race1 ethnicity1 sex1 age1 disability status1 and ,,zip ,code4 ,such report shall-- 7,a7 evaluate cost1 access1 utilization1 outcomes1 and patient experience data from across the health care field1 including ,states1 ,medicaid managed care organizations1 provider organizations1 and other organizations that provide or pay for telehealth under the ,medicaid program and ,children's ,health ,insurance ,program2 7,b7 identify barriers and potential solutions to provider entry and participation in telehealth that ,states are experiencing1 as well as barriers to providing telehealth across ,state lines1 including during times of public health crisis or public health emergency2 7,c7 determine the frequency at which out-of-,state telehealth is provided to patients enrolled in the ,medicaid program and the potential impact on access to telehealth if ,state ,medicaid policies were more aligned2 and 7,d7 identify and evaluate opportunities for more alignment among such policies to promote access to telehealth across all ,states1 ,state ,medicaid plans under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 ,state child health plans under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;aa et seq471 and ,medicaid managed care organizations1 including the potential for regional compacts or reciprocity agreements4 7#b7 ,federal agency telehealth collaboration ,not later than #a year after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall conduct a study and submit to ,congress a report evaluating collaboration between ,federal agencies with respect to telehealth services furnished under the ,medicaid or ,,chip program to individuals under the age of #ah1 including such services furnished to such individuals in early care and education settings4 ,such report shall include recommendations on-- 7,a7 opportunities for ,federal agencies to improve collaboration with respect to such telehealth services2 and 7,b7 opportunities for collaboration between ,federal agencies to expand telehealth access to such individuals enrolled under the ,medicaid or ,,chip program1 including in early care and education settings4 #fdjg4 ,youth and young adult mental health promotion1 prevention1 intervention1 and treatment ,part ,q of title ,,iii of the ,public ,health ,service ,act 7as amended by section #ejja7 is amended by adding at the end the following3 #cii,z-#d4 ,youth and young adult mental health promotion1 prevention1 intervention1 and treatment 7a7 ,grants ,the ,secretary shall-- 7#a7 award grants to eligible entities to develop1 maintain1 or enhance youth and young adult mental health promotion1 prevention1 intervention1 and treatment programs1 including-- 7,a7 programs for youth and young adults who may be likely to develop1 are showing early signs of1 or have been diagnosed with a mental health condition1 including a serious emotional disturbance2 and 7,b7 infrastructure and organization change at a ,state1 tribal1 or territorial level to improve cross-system collaboration1 service capacity1 and expertise related to youth and young adults2 and 7#b7 ensure that programs funded through grants under this section use community-driven1 evidence-informed1 or evidence-based models1 practices1 and methods that are1 as appropriate1 culturally and linguistically appropriate1 and can be replicated in other appropriate settings4 7b7 ,eligible transition age youth and entities ,in this section3 7#a7 ,eligible entity ,the term eligible entity means-- 7,a7 a local educational agency2 7,b7 a ,state educational agency2 7,c7 an institution of higher education 7or consortium of such institutions71 which may include a recovery program at an institution of higher education2 7,d7 a local board1 or a one-stop operator1 as defined in section #c of the ,workforce ,innovation and ,opportunity ,act2 7,e7 a nonprofit organization with appropriate expertise in providing services or programs for children1 adolescents1 or young adults1 excluding a school2 7,f7 a ,state1 political subdivision of a ,state1 ,indian tribe1 or tribal organization2 or 7,g7 a high school or dormitory serving high school students that receives funding from the ,bureau of ,indian ,education4 7#b7 ,eligible transition age youth ,the term eligible transition age youth means a youth or young adult from age #af to not more than #be years of age who is-- 7,a7 an out-of-school youth as defined in section #abi7;a77#a77;,b7 of the ,workforce ,innovation and ,opportunity ,act2 7,b7 a homeless individual 7as defined in section #dadjc7f7 of the ,violence ,against ,women ,act of #aiid71 a homeless child or youth 7as defined in section #gbe7b7 of the ,mc,kinney-,vento ,homeless ,assistance ,act7 a runaway1 in foster care or has aged out of the foster care system1 a child eligible for assistance under section #dgg of the ,social ,security ,act1 or in an out-of-home placement2 7,c7 an individual who is pregnant or parenting1 as referred to in section #abi7;a77#a77;,b7 of the ,workforce ,innovation and ,opportunity ,act2 7,d7 a youth who is an individual with a disability1 as referred to in section #abi7;a77#a77;,b7 of the ,workforce ,innovation and ,opportunity ,act2 7,e7 a low-income individual who requires additional assistance to enter or complete an educational program or to secure or hold employment1 as referred to in section #abi7;a77#a77;,b7 of the ,workforce ,innovation and ,opportunity ,act2 or 7,f7 living in a community that has faced acute or long-term exposure to substantial discrimination1 historical oppression1 intergenerational poverty1 civil unrest1 a high rate of violence1 or drug overdose deaths4 7c7 ,application ,an eligible entity seeking a grant under subsection 7a7 shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7d7 ,use of funds for mental health promotion1 prevention1 intervention and treatment programs ,an eligible entity may use amounts awarded under a grant under subsection 7a77#a7 to carry out the following3 7#a7 ,creation1 implementation1 and expansion of services and supports that are culturally and linguistically appropriate and youth guided1 involve and include family and community members 7including business leaders and faith-based organizations71 and provide for continuity of care between child- and adult-serving systems to ensure seamless transition4 7#b7 ,infrastructure and organization change at a ,state1 ,tribal1 or territorial level to improve cross-system collaboration1 service capacity1 and expertise related to youth and young adults with1 or at risk of1 mental health conditions and substance use disorders as they transition into adult roles and responsibilities4 7#c7 ,public awareness and cross-system provider training for individuals employed at institutions of higher education and community colleges1 behavioral health providers1 individuals working in the criminal justice system1 primary care providers1 vocational service providers1 and child welfare workers4 7e7 ,matching funds ,the ,secretary may not award a grant under this section to an eligible entity unless the eligible entity agrees1 with respect to the costs to be incurred by the eligible entity in carrying out the activities described in subsection 7d71 to make available non-,federal contributions 7in cash or in kind7 toward such costs in an amount that is not less than #aj percent of the total amount of ,federal funds provided in the grant4 7f7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated #be1jjj1jjj for each of fiscal years #bjbe through #bjcd4 4 ,e ,community-,based care #feja4 ,mental health at the border 7a7 ,short title ,this section may be cited as the ,immigrants' ,mental ,health ,act of #bjbd4 7b7 ,definitions ,in this section3 7#a7 ,forward operating base ,the term forward operating base means a permanent facility established by ,u4,s4 ,customs and ,border ,protection in forward or remote locations1 and designated as such by ,u4,s4 ,customs and ,border ,protection4 7#b7 ,u4,s4 customs and border protection facility ,the term ,u4,s4 ,customs and ,border ,protection facility means any of the following facilities that typically detain migrants on behalf of ,u4,s4 ,customs and ,border ,protection3 7,a7 ,u4,s4 ,border ,patrol stations4 7,b7 ,ports of entry4 7,c7 ,checkpoints4 7,d7 ,forward operating bases4 7,e7 ,secondary inspection areas4 7,f7 ,short-term custody facilities4 7c7 ,training for certain ,,cbp personnel in mental health issues 7#a7 ,training to identify risk factors and warning signs in immigrants and refugees 7,a7 ,in general ,the ,commissioner for ,u4,s4 ,customs and ,border ,protection1 in consultation with the ,assistant ,secretary for ,mental ,health and ,substance ,use of the ,department of ,health and ,human ,services1 the ,administrator of the ,health ,resources and ,services ,administration1 and nongovernmental experts in the delivery of health care in humanitarian crises and in the delivery of health care to children1 shall develop and implement a training curriculum for ,u4,s4 ,customs and ,border ,protection agents and officers assigned to ,u4,s4 ,customs and ,border ,protection facilities to enable such agents and officers to identify the risk factors and warning signs in immigrants and refugees of mental health issues relating to trauma4 7,b7 ,requirements ,the training curriculum described in subparagraph 7,a7 shall-- 7i7 apply to all ,u4,s4 ,customs and ,border ,protection agents and officers working at ,u4,s4 ,customs and ,border ,protection facilities2 7ii7 provide for crisis intervention using a trauma-informed approach2 and 7iii7 provide for mental health screenings for immigrants and refugees arriving at the border in their preferred language or with appropriate language assistance4 7#b7 ,training to address mental health and wellness of ,,cbp agents and officers 7,a7 ,in general ,the ,commissioner of ,u4,s4 ,customs and ,border ,protection1 in consultation with the ,assistant ,secretary for ,mental ,health and ,substance ,use of the ,department of ,health and ,human ,services1 the ,administrator of the ,health ,resources and ,services ,administration1 and nongovernmental experts in the delivery of mental health care1 shall develop and implement a training curriculum for ,u4,s4 ,customs and ,border ,protection agents and officers assigned to ,u4,s4 ,customs and ,border ,protection facilities to address the mental health and wellness of individuals working at such facilities4 7,b7 ,requirement ,the training curriculum described in subparagraph 7,a7 shall be designed to help ,u4,s4 ,customs and ,border ,protection agents and officers working at ,u4,s4 ,customs and ,border ,protection facilities-- 7i7 to better manage their own stress and the stress of their coworkers2 and 7ii7 to be more aware of the psychological pressures experienced during their jobs4 7#c7 ,annual review of training ,beginning in fiscal year #bjbe1 the ,assistant ,secretary for ,mental ,health and ,substance ,use shall-- 7,a7 conduct an annual review of the training implemented pursuant to subsections 7a7 and 7b72 and 7,b7 submit the results of each such review1 including any recommendations for improvement of such training1 to-- 7i7 the ,commissioner of ,u4,s4 ,customs and ,border ,protection2 7ii7 the ,committee on ,appropriations of the ,senate2 7iii7 the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate2 7iv7 the ,committee on ,homeland ,security and ,governmental ,affairs of the ,senate2 7v7 the ,committee on ,appropriations of the ,house of ,representatives2 7vi7 the ,committee on ,energy and ,commerce of the ,house of ,representatives2 7vii7 the ,committee on ,homeland ,security of the ,house of ,representatives2 and 7viii7 the ,committee on the ,judiciary of the ,house of ,representatives4 7#d7 ,authorization of appropriations ,to carry out this section1 there is authorized to be appropriated-- 7,a7 for fiscal year #bjbe1 #ej1jjj to develop the training described in paragraphs 7#a7 and 7#b72 and 7,b7 for each of the fiscal years #bjbf through #bjcj-- 7i7 #bj1jjj to implement such training2 and 7ii7 such additional sums as may be necessary to review and make recommendations for such training pursuant to paragraph 7#c74 7d7 ,staffing border facilities and detention centers 7#a7 ,in general ,to adequately evaluate the mental health needs of immigrants1 refugees1 border patrol agents1 and staff1 the ,commissioner of ,u4,s4 ,customs and ,border ,protection shall assign not fewer than #a qualified mental or behavioral health expert to each ,u4,s4 ,customs and ,border ,protection facility4 7#b7 ,qualifications ,each mental or behavioral health expert assigned pursuant to paragraph 7#a7 shall be-- 7,a7 bilingual2 7,b7 well-versed in culturally appropriate and trauma-informed interventions2 and 7,c7 have particular expertise in child or adolescent mental health or family mental health4 7#c7 ,authorization of appropriations ,to carry out this subsection1 there is authorized to be appropriated #c1jjj1jjj for each of the fiscal years #bjbe through #bjbi4 7e7 ,no sharing of ,department of ,health and ,human ,services mental health information for asylum determinations1 immigration hearings1 or deportation proceedings ,the officers1 employees1 and agents of the ,department of ,health and ,human ,services1 including the ,office of ,refugee ,resettlement1 may not share with the ,department of ,homeland ,security1 and the officers1 employees1 and agents of the ,department of ,homeland ,security may not request or receive from the ,department of ,health and ,human ,services1 for the purposes of an asylum determination1 immigration hearing1 or deportation proceeding1 any information or record that-- 7#a7 concerns the mental health of an alien2 and 7#b7 was obtained or produced by a mental or behavioral health professional while the alien was in a shelter or otherwise in the custody of the ,federal ,government4 #fejb4 ,asian ,american1 ,african ,american1 ,native ,hawaiian1 ,pacific ,islander1 ,indigenous1 ,middle ,eastern and ,north ,african1 and ,hispanic and ,latino behavioral health outreach and education strategy ,part ,d of title ,v of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;dd et seq471 as amended by section #fbjc1 is amended by adding at the end the following3 #eee4 ,behavioral outreach and education strategy 7a7 ,in general ,the ,secretary1 acting through the ,assistant ,secretary for ,mental ,health and ,substance ,use1 shall1 in coordination with advocacy and behavioral organizations serving populations of ,asian ,american1 ,african ,american1 ,native ,hawaiian1 ,pacific ,islander1 ,indigenous1 ,middle ,eastern and ,north ,african 7in this section referred to as ,,mena71 and ,hispanic and ,latino_/a_/x individuals or communities1 develop and implement an outreach and education strategy to promote behavioral health1 emphasize that behavioral health conditions are treatable and that reasonable accommodations under section #ejd of the ,rehabilitation ,act of #aigc and titles ,,ii and ,,iii of the ,americans with ,disabilities ,act of #aiij are necessary and may help1 as well as reduce stigma associated with mental health conditions and substance use disorder among the ,asian ,american1 ,african ,american1 ,native ,hawaiian1 ,pacific ,islander1 ,indigenous1 ,,mena1 and ,hispanic and ,latino_/a_/x populations4 ,such strategy shall-- 7#a7 be designed to-- 7,a7 meet the diverse cultural and language needs of the various ,asian ,american1 ,african ,american1 ,indigenous1 ,,mena1 ,native ,hawaiian1 ,pacific ,islander1 and ,hispanic and ,latino_/a_/x populations2 and 7,b7 ensure that approaches recommended in the strategy are developmentally 7with respect to the beneficiary's relative age and experience7 and age appropriate1 as well as cognitively accessible to persons with cognitive disabilities2 7#b7 increase awareness of symptoms of mental illnesses common among such populations1 taking into account differences within subgroups 7such as gender1 gender identity1 age1 sexual orientation1 disability1 and ethnicity7 of such populations2 7#c7 provide information on evidence-based1 culturally and linguistically appropriate and adapted interventions and treatments2 7#d7 ensure full participation of1 and engage1 both consumers and community members representing the communities of focus in the development and implementation of materials2 and 7#e7 seek to broaden the perspective among both individuals in such communities and stakeholders serving such communities to use a comprehensive public health approach to promoting behavioral health that addresses a holistic view of health by focusing on the intersection between behavioral and physical health4 7b7 ,reports ,beginning not later than #a year after the date of the enactment of this section and annually thereafter1 the ,secretary1 acting through the ,assistant ,secretary1 shall submit to the ,congress1 and make publicly available1 a report on the extent to which the strategy developed and implemented under subsection 7a7 increased behavioral health outcomes associated with mental health conditions and substance use disorder among ,asian ,american1 ,african ,american1 ,native ,hawaiian1 ,pacific ,islander1 ,indigenous1 ,,mena1 and ,hispanic and ,latino_/a_/x populations4 7c7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #ae1jjj1jjj for each of fiscal years #bjbe through #bjcj4 4 ,f ,reports #ffja4 ,addressing racial and ethnic minority mental health disparities research gaps ,not later than #i months after the date of the enactment of this ,act1 the ,director of the ,national ,institutes of ,health1 in consultation with the ,director of the ,national ,institute of ,mental ,health and the ,assistant ,secretary of ,substance ,use and ,mental ,health1 shall enter into an arrangement with the ,national ,academies of ,sciences1 ,engineering1 and ,medicine 7or1 if the ,national ,academies of ,sciences1 ,engineering1 and ,medicine decline to enter into such an arrangement1 the ,patient-,centered ,outcomes ,research ,institute1 the ,agency for ,healthcare ,research and ,quality1 or another appropriate entity7-- 7#a7 to conduct a study with respect to mental health disparities research gaps in racial and ethnic minority groups 7as defined in section #agjg7;g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g7772 and 7#b7 to submit to the ,congress a report on the results of such study1 including-- 7,a7 a compilation of information on the prevalence of mental health outcomes in such racial and ethnic minority groups2 and 7,b7 an assessment of information on the impact of exposure to community violence1 adverse childhood experiences1 structural bias1 and other psychological traumas on mental health outcomes in such racial and minority groups4 #ffjb4 ,research on adverse health effects associated with interactions with law enforcement 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,office of ,minority ,health of the ,centers for ,disease ,control and ,prevention 7established pursuant to section #agjg;,a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f;a77 7in this section referred to as the ,secretary71 shall conduct research on the adverse health effects associated with interactions with law enforcement4 7b7 ,effects among racial and ethnic minorities ,the research under subsection 7a7 shall include research on-- 7#a7 the health consequences1 both individual and community-wide1 of trauma related to violence committed by law enforcement among racial and ethnic minorities2 and 7#b7 the disproportionate burden of morbidity and mortality associated with such trauma4 7c7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall-- 7#a7 complete the research under this section2 and 7#b7 submit to the ,congress a report on the findings1 conclusions1 and recommendations resulting from such research4 #ffjc4 ,geo,access study ,not later than #ahj days after the date of enactment of this ,act1 the ,assistant ,secretary for ,mental ,health and ,substance ,use shall-- 7#a7 conduct a study to-- 7,a7 determine which geographic areas of the ,united ,states have shortages of racially and ethnically diverse mental health providers1 as well as mental health providers trained to work with racially and ethnically diverse clients and clients with multiple mental health1 cognitive1 and developmental disabilities2 and 7,b7 assess the preparedness of mental health providers to deliver culturally and linguistically appropriate1 affordable1 and accessible services2 and 7#b7 submit a report to ,congress on the results of such study4 #ffjd4 ,co-occurring conditions 7a7 ,,gao report ,not later than #b years after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report on barriers to care for persons with co-occurring conditions and access to care in the ,united ,states4 ,such report shall include the information and recommendations described in subsection 7b74 7b7 ,content of report ,the report under subsection 7a7 shall include-- 7#a7 an assessment of current barriers to behavioral health and substance use disorder treatment for low-income1 uninsured1 and ,medicaid-enrolled adults1 and recommendations for addressing such barriers1 particularly for women and diverse racial and ethnic groups2 7#b7 an assessment of-- 7,a7 how many adults have a behavioral health condition and options for adults to receive behavioral health and substance use disorder treatment in nonexpansion ,states2 7,b7 ,medicaid expansion ,states who provide behavioral health coverage for newly eligible enrollees2 7,c7 how enrollment in coverage affects treatment availability2 and 7,d7 the impacts of ,,covid-#ai to receiving and accessing treatment for behavioral health1 substance use disorders1 and diverse racial and ethnic groups1 and recommendations for addressing such barriers2 7#c7 an assessment of current barriers1 inclusive of social determinants of health and cultural barriers1 that prevent adults from receiving behavioral health and substance use disorder treatment1 and recommendations for addressing such barriers1 particularly for low-income women and adults from racial and ethnic groups2 7#d7 an assessment of disparities in access to addiction counselors and mental or behavioral health care providers acting in accordance with ,state law1 stratified by race1 ethnicity1 gender identity1 geographic location1 and insurance type1 and recommendations to promote greater access equity2 and 7#e7 recommendations to promote greater equity in access to care for behavioral services and substance use disorders1 particularly for low-income women and adults from diverse racial and ethnic groups4 #ffje4 ,study and report on the ,,aanhpi youth mental health crisis 7a7 ,study 7#a7 ,in general ,the ,secretary1 acting through the ,assistant ,secretary for ,mental ,health and ,substance ,use 7referred to in this section as the ,secretary71 in coordination with the ,director of the ,national ,institutes of ,health1 the ,director of the ,centers for ,disease ,control and ,prevention1 and the ,director of the ,office of ,minority ,health1 shall conduct a study on behavioral health among ,,aanhpi youth4 7#b7 ,elements ,such study required under paragraph 7#a7 shall include an assessment of-- 7,a7 the prevalence1 risk factors1 and root causes of mental health challenges1 substance misuse1 and mental health and substance use disorders among ,,aanhpi youth2 7,b7 the prevalence among ,,aanhpi youth of attempted suicide1 nonfatal substance use overdose1 and death by suicide or substance use overdose2 and 7,c7 ,,aanhpi youth that received treatment for mental health and substance use disorders4 7b7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 and make publicly available1 a report on the findings of the study conducted under subsection 7a71 including-- 7#a7 identification of the barriers to accessing behavioral health services for ,,aanhpi youth2 7#b7 identification of root causes of mental health challenges and substance misuse among ,,aanhpi youth2 7#c7 recommendations for actions to be taken by the ,secretary to improve behavioral health among ,,aanhpi youth2 7#d7 recommendations for legislative or administrative action to improve the behavioral health of ,,aanhpi youth experiencing depression1 suicide1 and overdose1 and to reduce the prevalence of depression1 suicide1 and overdose among ,,aanhpi youth2 and 7#e7 such other recommendations as the ,secretary determines appropriate4 7c7 ,data ,any data included in the study or report under this section shall be disaggregated by race1 ethnicity1 age1 sex1 gender identity1 sexual orientation1 geographic region1 disability status1 and other relevant factors1 in a manner that protects personal privacy and that is consistent with applicable ,federal and ,state privacy law4 7d7 ,authorization of appropriations ,for purposes of carrying out this section1 there is authorized to be appropriated #a1ejj1jjj for fiscal year #bjbe4 #ffjf4 ,study and report on strategies on the ,,aanhpi behavioral health workforce shortage 7a7 ,study 7#a7 ,in general ,the ,secretary1 acting through the ,assistant ,secretary for ,mental ,health and ,substance ,use 7referred to in this section as the ,secretary71 in coordination with the ,administrator of the ,health ,resources and ,services ,administration1 the ,secretary of ,labor1 and the ,director of the ,office of ,minority ,health1 shall conduct a study on strategies for increasing the behavioral health professional workforce that identify as ,,aanhpi4 7#b7 ,elements ,such study required under paragraph 7#a7 shall consider-- 7,a7 the total number of licensed behavioral health providers in the ,united ,states who identify as ,,aanhpi2 7,b7 with respect to each such provider1 information regarding the current type of license1 geographic area of practice1 and type of employer 7such as hospital1 ,federally-qualified health center1 school1 or private practice72 7,c7 information regarding the cultural and linguistic capabilities of such providers1 including languages spoken proficiently2 and 7,d7 the relevant barriers to enrollment in behavioral health professional education programs and entering the behavioral workforce for ,,aanhpi individuals4 7b7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 and make publicly available1 a report on the findings of the study conducted under subsection 7a71 including-- 7#a7 identification of ,,aanhpi licensed behavioral health providers' knowledge and awareness of the barriers to quality behavioral health care services faced by ,,aanhpi individuals1 including stigma1 limited ,english proficiency1 and lack of health insurance coverage2 7#b7 recommendations for actions to be taken by the ,secretary to increase the number of ,,aanhpi licensed behavioral health professionals2 7#c7 recommendations for legislative or administrative action to improve the enrollment of ,,aanhpi individuals in behavioral health professional education programs2 and 7#d7 such other recommendations as the ,secretary determines appropriate4 7c7 ,data ,any data included in the study or report under this section shall be disaggregated by race1 ethnicity1 age1 sex1 gender identity1 sexual orientation1 geographic region1 disability status1 and other relevant factors1 in a manner that protects personal privacy and that is consistent with applicable ,federal and ,state privacy law4 7d7 ,definition ,in this section the term licensed behavioral health provider means any individual licensed to provide mental health or substance use disorder services1 including in the professions of social work1 psychology1 psychiatry1 marriage and family therapy1 mental health counseling1 and substance use disorder counseling4 7e7 ,authorization of appropriations ,for purposes of carrying out this section1 there is authorized to be appropriated #a1ejj1jjj for fiscal year #bjbe4 ,g ,miscellaneous provisions #fgja4 ,strengthening mental health supports for ,,bipoc communities 7a7 ,in general ,section #aidb7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjx-#eb7;a77 is amended-- 7#a7 by redesignating paragraphs 7#b7 and 7#c7 as paragraphs 7#e7 and 7#f71 respectively2 and 7#b7 by inserting after paragraph 7#a7 the following3 7#b7 services provided by the ,state to adults with a serious mental illness and children with a serious emotional disturbance who are members of racial and ethnic minority groups1 including-- 7,a7 the extent to which such services are provided to such adults and children2 and 7,b7 the outcomes experienced by such adults and children as a result of the provision of such services1 including with respect to-- 7i7 diversions from hospitalization and criminal justice system involvement2 7ii7 treatment for first episode psychosis or undefined psychosis2 7iii7 reductions in suicide and increased utilization of appropriate treatments and interventions for suicidal ideation2 7iv7 response through crisis services1 including mobile crisis services2 7v7 treatment of individuals who are experiencing homelessness or housing insecurity and individuals residing in rural communities2 and 7vi7 increased patient family and caregiver engagement and education on serious mental illness to reduce social stigma and promote healthy social support for patients2 7#c7 any outreach by the ,state to1 and the hiring of1 providers of mental health services from multiple disciplines 7such as a psychologist1 psychiatrist1 peer support provider1 or social worker7 who are members of racial and ethnic minority groups2 7#d7 any outreach by the ,state to providers from multiple disciplines of mental health services-- 7,a7 to provide training on culturally effective1 culturally affirming1 and linguistically competent services2 and 7,b7 to increase awareness of community-defined practices by practitioners of racial and ethnic minority groups2 4 7b7 ,applicability ,the amendments made by subsection 7a7 shall apply with respect to funding agreements entered into under section #aiaa or #aiba of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjx2 #db ,u4,s4,c4 #cjjx-#ba7 on or after the date of the enactment of this ,act4 #fgjb4 ,,strong support for children 7a7 ,data analysis and strategy implementation ,to prevent and mitigate childhood trauma ,title ,,xxxi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjkk7 is amended by adding at the end the following3 #cajb4 ,data analysis and strategy implementation to prevent and mitigate childhood trauma 7a7 ,in general ,the ,secretary shall establish a program-- 7#a7 to support the development and implementation of programs that use data analysis methods to identify and facilitate strategies for early intervention and prevention1 in order to prevent and mitigate childhood trauma and support communities and families1 including-- 7,a7 improving connections through care coordination2 7,b7 aligning community initiatives in targeted areas of need2 and 7,c7 expanding community capacity through cross-sector collaboration2 and 7#b7 to evaluate the effectiveness of these programs in improving outcomes for children4 7b7 ,grants ,the ,secretary shall award grants to up to #e eligible entities to carry out the activities described in subsection 7a74 7c7 ,use of funds ,a grant for activities under this section shall be used to support the development and implementation of programs that use data analysis methods to identify and facilitate strategies for early intervention and prevention1 in order to prevent and mitigate childhood trauma and support communities and families1 including as follows3 7#a7 ,utilize data analysis methods to-- 7,a7 identify specific geographic areas1 such as census tracts1 with a high prevalence of adverse childhood experiences and significant risk factors for poor outcomes for children 7such as increased risk of experiencing adverse childhood experiences71 including areas with high rates of-- 7i7 poor public health outcomes including illness1 disease1 suicide1 and mortality2 7ii7 exclusionary discipline practices1 including suspensions1 expulsions1 and referrals to law enforcement1 as well as low graduation rates2 7iii7 substance use disorders2 7iv7 poverty2 7v7 foster system involvement or referrals2 7vi7 housing instability and homelessness2 7vii7 food insecurity2 7viii7 inequity1 including disparities in income1 wealth1 employment1 educational attainment1 health care access1 and public health outcomes1 along lines of race1 sex1 sexuality and gender identity1 ethnicity1 or nationality2 7ix7 incarceration rates2 or 7x7 other indicators of adversity as defined by the ,secretary2 and 7,b7 identify strategies to improve outcomes for children aged #j through #ag that build on strengths in communities that could be further supported1 including-- 7i7 existing support networks for families2 and 7ii7 enhanced connections to community-based organizations4 7#b7 ,implement strategies identified pursuant to paragraph 7#a77;,b7 to facilitate outreach and involvement of children and their caregivers in ,federal1 ,state1 or local programs that provide reparative1 gender-responsive1 culturally specific1 and trauma-informed prevention services1 and for which children and their caregivers are eligible1 including-- 7,a7 home visiting programs2 7,b7 training and education on parenting skills2 7,c7 substance use disorder prevention and treatment that is voluntary and noncoercive2 7,d7 mental health supports and care that is voluntary and noncoercive2 7,e7 family and intimate partner violence prevention services2 7,f7 child advocacy center programming2 7,g7 economic and nutrition support services2 7,h7 housing support services1 including emergency and temporary shelter for those experiencing homelessness and housing insecurity1 as well as stable1 long-term housing2 7,i7 voluntary1 noncoercive1 gender-responsive1 and culturally specific mental health supports in school and early childhood education center-based settings2 7,j7 wraparound programs for transitioning youth and youth currently in the foster system2 7,k7 programming to support the health and well-being of lesbian1 gay1 bisexual1 transgender1 and intersex children and their families2 and 7,l7 family resource center services4 7d7 ,special rules 7#a7 ,primary payer restriction ,the ,secretary may not award a grant under this section to an eligible entity for a service if the service to be provided is available pursuant to the ,state plan approved under title ,,xix of the ,social ,security ,act for the ,state in which the program funded by the grant is being conducted unless the ,state and all eligible subdivisions involved-- 7,a7 will enter into agreements with public or nonprofit private entities under which the entities will provide the service2 and 7,b7 demonstrate that the ,state and all eligible subdivisions will ensure that the entities providing the service-- 7i7 will seek payment for each such service rendered in accordance with the usual payment schedule under the ,state plan2 and 7ii7 the entities have entered into a participation agreement and are qualified to receive payments under such plan4 7#b7 ,implementation ,an eligible entity that receives a grant under this section may use-- 7,a7 not more than #be percent of the amounts made available through the grant for the first #bd months of the grant period to utilize data analysis methods to-- 7i7 identify specific geographic areas where care coordination1 prevention and early intervention1 and facilitation services will be provided2 and 7ii7 identify support and intervention services to improve outcomes for children located in a geographic area identified under subsection 7c77#a77;,a72 and 7,b7 not more than #aj percent of the grant in each subsequent year to continue data analysis activities4 7#c7 ,administration ,an eligible entity that receives a grant under this section may not use more than #e percent of amounts received through the grant for administration1 reporting1 and program oversight functions1 including the development of systems to improve data collection and data sharing for the purposes of improving services and the provision of care4 7#d7 ,priority 7,a7 ,in general ,in awarding grants under this section1 the ,secretary shall give priority1 to the extent practical1 to eligible entities that use community-based system dynamic modeling as the primary data analysis method4 7,b7 ,system dynamic modeling defined ,the term system dynamic modeling means a method of data analysis and predictive modeling that includes-- 7i7 utilization of community-based participatory research methods for involving community in the process of understanding and changing systems and evaluating outcomes of grants2 7ii7 consideration of a multitude of environmental risk factors and ascertainment of the significance of contributing community risk factors for purposes of identifying strategies to reduce adverse child outcomes1 including-- 7,i7 maltreatment cases2 7,,ii7 involvement with the juvenile criminal legal system or foster system2 7,,iii7 exclusionary school discipline2 or 7,,iv7 exposure to violence2 and 7iii7 identification of cross-sector responses involving reparative1 trauma-informed1 culturally specific1 gender-responsive1 and community-based organizations to reduce adverse child outcomes4 7#e7 ,subgrant 7,a7 ,in general ,an eligible entity that receives a grant under this section shall use at least #be percent of the total amount of the grant to make subgrants to organizations that aid in implementing the strategy identified under subsection 7c77#a77;,b7 for preventing and mitigating childhood trauma and supporting communities and families4 7,b7 ,eligibility ,to be eligible to receive a subgrant under this paragraph1 an organization shall prepare and submit to the eligible entity an application in such form1 and containing such information1 as the eligible entity may require1 including evidence that the-- 7i7 needs of the population to be served are urgent and are not met by the services currently available in the geographic area2 and 7ii7 organization has the capacity to provide the services listed in subsection 7c77#b74 7,c7 ,supplement1 not supplant ,subgrant funds received pursuant to this paragraph by an organization shall be used to supplement and not supplant ,state or local funds provided to the partnership organization for services listed in subsection 7c77#b74 7e7 ,application ,to be eligible to receive a grant under this section1 an eligible entity shall submit to the ,secretary an application in such form1 and containing such information1 as the ,secretary may require1 to include the following3 7#a7 ,a demonstration that-- 7,a7 the applicant utilizes trauma-informed1 culturally specific1 and gender-responsive practices1 including a demonstration of the extent to which the applicant has trained staff in these practices2 7,b7 the applicant has the capacity to administer the grant1 including conducting all required data analysis activities2 and 7,c7 services will be provided to children and families in an accessible1 culturally relevant1 and linguistically specific manner consistent with local needs4 7#b7 ,a preliminary analysis of how the applicant will use the grant to-- 7,a7 identify the geographic area or areas to be served using data analysis methods2 7,b7 utilize data analysis methods to identify strategies to improve outcomes for children in the geographic area2 7,c7 facilitate strategies identified through care coordination efforts2 and 7,d7 track data for evaluation of outcomes4 7#c7 ,a detailed project plan for the use of the grant that includes anticipated technical assistance needs4 7#d7 ,additional funding sources1 including ,state and local funds1 supporting the prevention and mitigation of adverse childhood experiences4 7f7 ,grant amount ,the amount of a grant under this section shall not exceed #i1ejj1jjj4 7g7 ,period of a grant ,the period of a grant under this section shall not exceed #g years4 7h7 ,service provision without regard to ability ,to pay ,as a condition on receipt of a grant under this section1 an eligible entity shall agree that any assistance provided to an individual through the grant will be provided without regard to-- 7#a7 the ability of the individual to pay for such services2 7#b7 the current or past health condition of the individual to be served2 7#c7 the immigration status of the individual to be served2 7#d7 the sexual orientation and gender identity of the individual to be served2 and 7#e7 any prior involvement of the individual in the criminal legal system4 7i7 ,prohibitions ,in addition to any other prohibitions determined by the ,secretary1 an eligible entity may not use a grant under this section to-- 7#a7 use data analysis methods to inform individual case decisions1 including child removal or placement decisions1 or to target services at certain individuals or families2 7#b7 require any individual or family to participate in any service or program as a condition of receipt of a benefit to which the individual or family is otherwise eligible2 7#c7 increase the presence or funding of law enforcement surveillance1 involvement1 or activity in implementing the strategies identified under subsection 7c77#a77;,b72 or 7#d7 enable the practice of conversion therapy4 7j7 ,evaluation 7#a7 ,data model evaluation ,not later than #cf months after the date of enactment of this section1 the ,assistant ,secretary for ,planning and ,evaluation of the ,department of ,health and ,human ,services1 in coordination with the grantees receiving a grant under this section1 shall complete an evaluation of the effectiveness of the data model accuracy of the grant program under this section to address each of the following3 7,a7 ,determining the effectiveness of the grantees' use of data analysis methods to identify geographic areas pursuant to subsection 7c77#a74 7,b7 ,examining the grantees' development and utilization of data analysis methods4 7,c7 ,examining the grantees' ability to effectively utilize data analysis methods in future prevention work4 7,d7 ,establishing a method for rigorously evaluating the activities of grantees and comparing the reduction of child and family exposure to adverse experiences in other communities with similar demographics4 7,e7 ,examining the grantees' utilization of community-based system dynamics modeling methods and other community engagement methods4 7#b7 ,program evaluation ,not later than #f years after the date of enactment of this section1 the ,assistant ,secretary for ,planning and ,evaluation of the ,department of ,health and ,human ,services1 in coordination with eligible entities receiving grants under this section1 shall complete an evaluation of the effectiveness of the grant program under this section4 7#c7 ,data ,collection 7,a7 ,in general ,the ,assistant ,secretary for ,planning and ,evaluation of the ,department of ,health and ,human ,services and each eligible entity receiving a grant under this section shall collect any relevant data necessary to complete the evaluations required by paragraphs 7#a7 and 7#b7 to include-- 7i7 the activities funded by the grant under this section1 including development and implementation data analysis methods2 7ii7 the number of children and of families receiving coordination and facilitation of care and services2 and 7iii7 the effect of activities supported by the grant under this section on the local area serviced by the program1 including such effects on-- 7,i7 children and adolescents' health and well-being2 7,,ii7 the number of children who enter into or depart from foster services2 and 7,,iii7 homelessness and housing insecurity4 7,b7 ,study 7i7 ,in general ,not later than #g years after the date of enactment of this section1 the ,assistant ,secretary for ,planning and ,evaluation of the ,department of ,health and ,human ,services shall-- 7,i7 complete a study on the results of the grant program under this section using the community-based participatory action research method1 which focuses on social1 structural1 and physical environmental inequities through active involvement of community members1 clients1 organizational representatives1 and researchers in all aspects of the research process2 and 7,,ii7 submit a report on the results of the study to the ,congress4 7ii7 ,partners ,in conducting the study under clause 7i71 the ,assistant ,secretary for ,planning and ,evaluation of the ,department of ,health and ,human ,services shall ensure that partners and persons that have participated in the grant program under this section on every level1 especially those such partners or persons receiving services and support through the program1 have an opportunity to contribute their expertise to evaluating the strategy and outcomes4 7k7 ,report ,not later than three months after the completion of the evaluation required by subsection 7j77#b71 the ,assistant ,secretary for ,planning and ,evaluation of the ,department of ,health and ,human ,services shall submit to ,congress and make available to the public on the internet website of the ,department of ,health and ,human ,services a report based upon the evaluation under subsection 7j77#b71 to include-- 7#a7 the impact of the program under this section on homelessness and housing insecurity1 substance use disorder and drug deaths1 incarceration1 foster system involvement1 and other child and family outcomes as identified by the ,assistant ,secretary for ,planning and ,evaluation of the ,department of ,health and ,human ,services2 7#b7 an analysis of which elements of the program should be replicated and scaled by governmental or non-governmental entities2 and 7#c7 such recommendations for legislation and administrative action as the ,secretary determines appropriate4 7l7 ,definitions ,in this section3 7#a7 ,the term adverse childhood experience means a potentially traumatic experience that occurs in childhood and can have a tremendous impact on the child's lifelong health and opportunity outcomes1 such as any of the following3 7,a7 ,abuse1 such as any of the following3 7i7 ,emotional and psychological abuse4 7ii7 ,physical abuse4 7iii7 ,sexual abuse4 7,b7 ,household challenges such as any of the following3 7i7 ,a household member is treated violently4 7ii7 ,a household member has a substance use disorder4 7iii7 ,a household member has a mental health condition4 7iv7 ,parental separation or divorce4 7v7 ,a household member is incarcerated1 is placed in immigrant detention1 or has been deported4 7vi7 ,a household member has a life-threatening illness such as ,,covid-#ai4 7,c7 ,neglect4 7,d7 ,living in-- 7i7 impoverished communities that lack access to human services2 7ii7 areas of high unemployment neighborhoods2 or 7iii7 communities experiencing de facto segregation4 7,e7 ,experiencing food insecurity and poor nutrition4 7,f7 ,witnessing violence4 7,g7 ,involvement with the foster system4 7,h7 ,experiencing discrimination4 7,i7 ,dealing with historical and ongoing traumas due to systemic and interpersonal racism4 7,j7 ,dealing with historical and ongoing traumas regarding systemic and interpersonal sexism1 homophobia1 biphobia1 and transphobia4 7,k7 ,dealing with the threat of deportation or detention as a result of immigration status4 7,l7 ,the impacts of multigenerational poverty resulting from limited educational and economic opportunities4 7,m7 ,living through natural disasters such as earthquakes1 forest fires1 floods1 or hurricanes4 7#b7 ,the term eligible entity means a ,state or local health department4 7#c7 ,the term practice of conversion therapy-- 7,a7 means any practice or treatment by any person that seeks to change another individual's sexual orientation or gender identity1 including efforts to change behaviors or gender expressions1 or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same gender1 if such person receives monetary compensation in exchange for any such practice or treatment2 and 7,b7 does not include any practice or treatment that does not seek to change sexual orientation or gender identity and-- 7i7 provides assistance to an individual undergoing a gender transition2 or 7ii7 provides acceptance1 support1 and understanding of a client or facilitation of a client's coping1 social support1 and identity exploration and development4 7m7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section for the period of fiscal years #bjbe through #bjca-- 7#a7 to carry out subsection 7a77#a7 through the award of grants under subsection 7b7-- 7,a7 #dg1ejj1jjj for grants2 and 7,b7 such sums as may be necessary for the administrative costs of carrying out such subsection2 and 7#b7 #g1ejj1jjj to carry out the evaluation under subsection 7a77#b74 4 7b7 ,care coordination grants ,part ,e of title ,,xii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;d-#ea et seq47 is amended by adding at the end the following new section3 #abee4 ,care coordination grants 7a7 ,in general ,the ,secretary shall award grants to eligible entities to establish or expand trauma-informed care coordination services to support-- 7#a7 children aged #j through #e at risk of adverse childhood experiences2 and 7#b7 their caregivers1 including prenatal people of any age4 7b7 ,number of grants ,subject to the availability of appropriations1 the ,secretary shall award not fewer than #i and not more than #dj grants under this section4 7c7 ,amount of grants ,subject to the availability of appropriations1 the amount of a grant under this section for a fiscal year shall be-- 7#a7 not less than #bej1jjj2 and 7#b7 not more than #a1jjj1jjj4 7d7 ,eligible entities ,to be eligible to receive a grant under this section1 an entity shall be a local government or ,indian ,tribe1 acting through the public health department thereof if such government or ,tribe has a public health department4 7e7 ,priority 7#a7 ,in general ,in awarding grants under this section1 the ,secretary shall give priority to eligible entities proposing to serve communities with a high need for trauma-informed care coordination services1 as demonstrated by indicators such as-- 7,a7 pregnant people who face barriers to prenatal care2 7,b7 mortality or morbidity of people giving birth or infants2 7,c7 caretakers and parents who are living with a mental health condition or substance use disorder2 7,d7 a high prevalence of community violence1 including domestic violence1 as demonstrated by instances of homicide and public health statistics1 including treatment of injury or trauma2 7,e7 high proportions of low-income children2 7,f7 a high prevalence of child fatalities or near fatalities related to child abuse and neglect2 7,g7 significant disparities in health outcomes for people giving birth and infants2 7,h7 a high rate of exclusionary discipline and referrals to law enforcement2 and 7,i7 a high rate of homelessness and housing instability4 7#b7 ,data from ,tribal areas ,the ,secretary1 acting through the ,director of the ,indian ,health ,service1 shall consult with ,indian ,tribes to establish criteria to measure indicators of need1 for purposes of paragraph 7#a71 with respect to ,tribal areas4 7f7 ,use of funds 7#a7 ,required uses 7,a7 ,in general ,a grant received under this section shall be used to establish or expand gender-responsive1 culturally specific1 trauma-informed care coordination services1 including by instituting and conducting risk and needs assessments including-- 7i7 using strengths-based approaches focused on protective factors for children and their caregivers1 including prenatal people of any age2 and 7ii7 inputting screening results into a centralized intake system to promote a single point of access system across providers and services4 7,b7 ,training ,a grant received under this section shall be used to ensure that individuals employed through the grant funds1 in whole or in part1 have received sufficient and up-to-date training on trauma-informed care and strategies that are reparative1 culturally sensitive1 gender responsive1 and healing centered4 7#b7 ,permissible uses ,a grant received under this section may be used for any of the following3 7,a7 ,employing care coordinators1 case managers1 community health workers1 certified infant mental health specialists1 and outreach and engagement specialists to work with children and their caregivers1 including prenatal individuals1 to prevent and respond to adverse childhood experiences by connecting clients with culturally specific1 trauma-informed care treatment services1 including economic1 social1 food1 and housing supports4 7,b7 ,providing training described in paragraph 7#a77;,b7 to community health providers and community partners4 7,c7 ,expanding1 enhancing1 modifying1 and connecting the existing network of community programs and services to achieve a more comprehensive and coordinated system of care approach1 including-- 7i7 developing local infrastructure to bolster and shape community support systems and map and build access to services in a coordinated and comprehensive way2 and 7ii7 creating infrastructure to conduct outreach to children and families1 including those experiencing homelessness and housing instability1 so they acquire access to the services and supports they need and the benefits to which they are entitled4 7,d7 ,compiling information on resources 7including any referral services7 available through community-based organizations and local1 ,state1 and ,federal agencies1 such as-- 7i7 programs addressing social determinants of health1 including-- 7,i7 emergency1 temporary1 and long-term housing2 7,,ii7 programs that offer free or affordable and nutritious food2 7,,iii7 vocational and workforce development2 and 7,,iv7 transportation supports2 7ii7 home visiting programs for new parents and their infants2 7iii7 workforce development programs to support caregivers in skill building2 7iv7 trauma-responsive1 parenting skills-building programs2 7v7 the continuum of substance use prevention1 intervention1 and treatment programs and mental health support programs1 including programs with trauma-informed1 gender-responsive1 and culturally specific counseling2 and 7vi7 childcare support and early childhood education1 including ,head ,start and ,early ,head ,start programs4 7,e7 ,subject to subsection 7g77#a71 establishing or updating a database that compiles data used to track the effectiveness of the care coordination services funded through the grant4 7,f7 ,developing and implementing referral partnership agreements with community-based organizations1 parent organizations1 substance use disorder treatment providers and facilities1 housing and shelter providers1 health care providers1 mental health care providers1 and ,federal and ,state offices and programs that implement practices to support children ages #j through #e who are at risk of adverse childhood experiences and their caregivers1 including prenatal people4 ,such practices shall include-- 7i7 a bilateral warm handoff system whereby a grantee understands the needs of the children and their families1 and families are involved in addressing these needs2 and 7ii7 an active service connection whereby the children and families are each actively connected with a resource in a well-coordinated way that ensures availability and direct contact4 7,g7 ,supporting cross-system planning and collaboration among employees who may work in emergency medical services1 health care services1 public health1 early childhood education1 and substance use disorder treatment and recovery support4 7,h7 ,providing or subsidizing services to address barriers that children1 prenatal individuals1 and caregivers face to utilizing community resources and services1 such as by providing or subsidizing transportation or childcare costs as applicable and within reasonable amounts4 7,i7 ,creating or expanding infrastructure and investing in technology1 including the provision of communications technology and internet service to children and their caregivers1 to enable increased telemedicine capabilities to reach participants4 7#c7 ,indian tribes ,in the case of an eligible entity that is an ,indian ,tribe1 the ,secretary may waive such provisions of this subsection as the ,secretary determines appropriate4 7#d7 ,prohibitions ,in addition to any other prohibitions determined by the ,secretary1 an eligible entity may not use a grant under this section to-- 7,a7 use data analysis methods to inform individual case decisions1 including child removal or placement decisions1 or to target services at certain individuals or families2 7,b7 require any individual or family to participate in any service or program as a condition of receipt of a benefit to which the individual or family is otherwise eligible2 or 7,c7 increase the presence or funding of law enforcement surveillance1 involvement1 or activity in connection with trauma-informed care coordination services supported pursuant to this section4 7g7 ,requirements ,as a condition on receipt of a grant under this section1 an eligible entity shall agree to each of the following funding conditions3 7#a7 ,restriction of funding allocation ,the eligible entity will not use more than #cj percent of the funds made available to the entity through the grant 7for the total grant period7 to establish or update a database pursuant to subsection 7f77#b77;,e74 7#b7 ,accessible setting 7,a7 ,in general ,the eligible entity will ensure that all care coordination services provided through the grant are provided in a setting that is accessible1 including through mobile settings1 to-- 7i7 low-income or no-income individuals1 including individuals experiencing homelessness or housing instability2 and 7ii7 individuals in rural areas4 7,b7 ,community outreach ,in complying with subparagraph 7,a71 the eligible entity will ensure that at least #ej percent of the care coordination services provided through the grant occur in community settings that are convenient to the children and caregivers who are being served1 such as homes1 schools1 and shelters1 whether for initial outreach or as part of long-term care4 7#c7 ,supplement1 not supplant ,the grant will be used to supplement1 not supplant other ,federal1 ,state1 or local funds available for care coordination services4 7#d7 ,confidentiality ,the eligible entity will maintain the confidentiality of individuals receiving services through the grant in a manner consistent with applicable law4 7#e7 ,partnering2 risk stratification ,in providing care coordination services through the grant1 the eligible entity will-- 7,a7 partner with community-based organizations with experience serving child populations prenatally through age #e2 7,b7 coordinate with the local agency responsible for administering the ,state plan approved under title ,,xix of the ,social ,security ,act2 and 7,c7 employ risk stratification to develop different effective models of care for different populations based on their needs4 7h7 ,application 7#a7 ,in general ,to seek a grant under this section1 an eligible entity shall submit an application to the ,secretary at such time1 in such manner1 and containing such information1 as the ,secretary may require4 7#b7 ,contents ,an application under paragraph 7#a7 shall1 at a minimum1 contain each of the following3 7,a7 ,goals to be achieved through the grant1 including the activities that will be undertaken to achieve those goals4 7,b7 ,the number of individuals likely to be served through the grant1 including demographic data on the populations to be served4 7,c7 ,existing programs and services that can be used to significantly increase the proportion of children and families who receive needed supports and services4 7,d7 ,a plan for expanding1 coordinating1 or modifying the existing network of programs and services to meet the needs of children and families for preventing and mitigating the traumatic impact of adverse childhood experiences4 7,e7 ,a demonstration of the ability of the eligible entity to reach the individuals to be served1 including by partnering with local stakeholders4 7,f7 ,an indication of how the personnel involved are reflective of the communities to be served4 7,g7 ,a list of stakeholders with whom the entity plans to partner or consult4 7i7 ,reporting by grantees ,not later than #d years after the date of enactment of this section1 an eligible entity receiving a grant under this section shall submit to the ,secretary a report on the activities funded through the grant4 ,such report shall include1 at a minimum1 a description of-- 7#a7 the number of individuals served through activities funded through the grant1 including demographics as applicable2 7#b7 the number of referrals made through the grant and the rate of such referrals successfully linked or closed2 7#c7 a qualitative analysis or number of collaborative partnerships with other organizations in carrying out the activities funded through the grant2 7#d7 the number of services provided to individuals through the grant2 7#e7 aggregated and de-identified outcomes experienced by individuals served through the grant such as-- 7,a7 the rate of successful service connections2 7,b7 any increases in development of protective factors for children2 7,c7 any increase in development of protective factors for the caregivers2 7,d7 any mitigation of the negative outcomes associated with adverse childhood experiences or decreased likelihood of children experiencing an adverse childhood experience as evidenced by-- 7i7 decreased presence of law enforcement or other punitive ,state surveillance in the community2 7ii7 a parent completing substance use treatment2 7iii7 a parent receiving voluntary treatment for mental health-related conditions2 7iv7 a family entering into or maintaining a stable housing situation2 7v7 a family achieving or maintaining economic security2 7vi7 a parent achieving or maintaining job stability2 or 7vii7 a child meeting developmental markers for school readiness2 and 7,e7 reports of satisfaction with the coordination of care by people served2 and 7#f7 any other information required by the ,secretary4 7j7 ,convening participants for sharing lessons learned ,after the period of all grants awarded under this section has concluded1 the ,assistant ,secretary for ,planning and ,evaluation of the ,department of ,health and ,human ,services shall provide an in-person or online opportunity for persons participating in the programs funded through this section to share with each other-- 7#a7 lessons learned2 7#b7 challenges experienced2 and 7#c7 ideas for next steps and solutions4 7k7 ,compiling findings and conclusions ,after providing the opportunity required by subsection 7j71 the ,secretary shall-- 7#a7 compile the findings and conclusions of grantees under this section on the provision of care coordination services described in subsection 7a72 7#b7 submit a report on such findings and conclusions to the appropriate congressional committees2 and 7#c7 make such report publicly available4 7l7 ,definitions ,in this section3 7#a7 ,adverse childhood experience ,the term adverse childhood experience means a potentially traumatic experience that occurs in childhood and can have a tremendous impact on the child's lifelong health and opportunity outcomes1 such as any of the following3 7,a7 ,abuse1 such as any of the following3 7i7 ,emotional and psychological abuse4 7ii7 ,physical abuse4 7iii7 ,sexual abuse4 7,b7 ,household challenges such as any of the following3 7i7 ,a household member is treated violently4 7ii7 ,a household member has a substance use disorder4 7iii7 ,a household member has a mental health condition4 7iv7 ,parental separation or divorce4 7v7 ,a household member is incarcerated1 is placed in immigrant detention1 or has been deported4 7vi7 ,a household member has a life-threatening illness such as ,,covid-#ai4 7,c7 ,neglect4 7,d7 ,living in-- 7i7 impoverished communities that lack access to human services2 7ii7 areas of high unemployment neighborhoods2 or 7iii7 communities experiencing de facto segregation4 7,e7 ,experiencing food insecurity and poor nutrition4 7,f7 ,witnessing violence4 7,g7 ,involvement with the foster system4 7,h7 ,experiencing discrimination4 7,i7 ,dealing with historical and ongoing traumas due to systemic and interpersonal racism4 7,j7 ,dealing with historical and ongoing traumas regarding systemic and interpersonal sexism1 homophobia1 biphobia1 and transphobia4 7,k7 ,dealing with the threat of deportation or detention as a result of immigration status4 7,l7 ,the impacts of multigenerational poverty resulting from limited educational and economic opportunities4 7,m7 ,living through natural disasters such as earthquakes1 forest fires1 floods1 or hurricanes4 7#b7 ,care coordination ,the term care coordination means an active1 ongoing process that-- 7,a7 assists children ages #j through #e at risk of1 or who have experienced1 an adverse childhood experience1 and their caregivers1 including prenatal people of any age1 to identify1 access1 and use community resources and services2 7,b7 is client centered and comprehensive of the services a child or caregiver may need2 7,c7 ensures a closed loop referral by obtaining feedback from the families served2 and 7,d7 works across systems and services to promote collaboration to effectively meet the needs of community members4 7#c7 ,indian ,tribe ,the term ,indian ,tribe has the meaning given such term in section #d of the ,indian ,self-,determination and ,education ,assistance ,act4 7#d7 ,protective factors ,the term protective factors refers to any supportive element in a child or caretaker's life that helps the child or caretaker to withstand trauma such as a stable school environment or supportive peer relationships4 7m7 ,authorization of appropriations 7#a7 ,in general ,to carry out this section1 there is authorized to be appropriated #ae1jjj1jjj for each of the #e fiscal years following the fiscal year in which this section is enacted4 7#b7 ,grants to ,indian tribes ,of the amount made available to carry out this section for a fiscal year1 the ,secretary shall use not less than #aj percent of such amount for grants to eligible entities that are ,indian ,tribes4 7#c7 ,administrative expenses ,of the amount made available to carry out this section for a fiscal year1 the ,secretary may use not more than #ae percent of such amount for administrative expenses1 including the expenses of the ,assistant ,secretary for ,planning and ,evaluation of the ,department of ,health and ,human ,services for compiling and reporting information4 7#d7 ,technical assistance ,of the amount made available to carry out this section for a fiscal year1 the ,secretary may reserve up to #e percent of such amount to provide technical assistance to eligible entities in preparing and submitting applications under this section4 4 #fgjc4 ,improving access to mental health 7a7 ,access to clinical social workers ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7#a7 in subparagraph 7,d71 by striking such negotiated rate11 and inserting such negotiated rate12 and 7#b7 in subparagraph 7,f77ii7 by striking #ge percent of the amount determined for payment of a psychologist under clause 7,l7 and inserting #he percent of the fee schedule amount provided under section #ahdh4 7b7 ,access to clinical social worker services provided to residents of skilled nursing facilities 7#a7 ,in general ,section #ahhh7;e77#b77;,a77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieyy7e77#b77;,a77ii771 as amended by section #faja7;a77#e71 is amended by inserting clinical social worker services1 after peer support specialist services 7as defined in section #ahfa7qqq77#c7714 7#b7 ,conforming amendment ,section #ahfa7;hh77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7hh77#b77 is amended by striking and other than services furnished to an inpatient of a skilled nursing facility which the facility is required to provide as a requirement for participation4 7c7 ,access to the complete set of clinical social worker services ,section #ahfa7;hh77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7hh77#b77 is further amended by striking for the diagnosis and treatment of mental illnesses 7other than services and inserting 7including services for the diagnosis and treatment of mental illnesses or services for health and behavior assessment and intervention 7identified as of ,january #a1 #bjbb1 by ,,hcpcs codes #ifaej through #ifafa 7and any succeeding codes771 but not including services4 7d7 ,effective date ,the amendments made by this section shall apply to items and services furnished on or after ,january #a1 #bjbe4 #fgjd4 ,program to establish public-private contributions to increase the available workforce of school-based mental health service providers 7a7 ,program authorized ,the ,secretary shall carry out a program under which eligible graduate institutions may enter into an agreement with the ,secretary to cover a portion of the cost of attendance of a participating student1 which contributions shall be matched by equivalent contributions towards such cost of attendance by the ,secretary4 7b7 ,designation of program ,the program under this section shall be known as the ,mental ,health ,excellence in ,schools ,program4 7c7 ,agreements ,the ,secretary shall enter into an agreement with each eligible graduate institution seeking to participate in the program under this section4 ,each agreement shall specify the following3 7#a7 ,the manner 7whether by direct grant1 scholarship1 or otherwise7 in which the eligible graduate institution will contribute to the cost of attendance of a participating student4 7#b7 ,the maximum amount of the contribution to be made by the eligible graduate institution with respect to any particular participating student in any given academic year4 7#c7 ,the maximum number of individuals for whom the eligible graduate institution will make contributions in any given academic year4 7#d7 ,that the eligible graduate institution1 in selecting participating students to receive assistance under the program1 shall prioritize the participating students described in subsection 7d77#b74 7#e7 ,such other matters as the ,secretary and the eligible graduate institution determine appropriate4 7d7 ,outreach ,the ,secretary shall-- 7#a7 make publicly available and periodically update on the internet website of the ,department of ,education a list of the eligible graduate institutions participating in the program under this section that shall specify1 for each such graduate institution1 appropriate information on the agreement between the ,secretary and such eligible graduate institution under subsection 7c72 and 7#b7 conduct outreach about the program under this section to participating students who1 as undergraduates-- 7,a7 received a ,federal ,pell ,grant under section #dja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajgj;a72 or 7,b7 attended an institution listed in section #cga7;a7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajfgq7a774 7e7 ,matching contributions ,the ,secretary may provide a contribution of not more than #ej percent of the cost of attendance of a participating student if the eligible graduate institution at which such student is enrolled enters into an agreement under subsection 7c7 with the ,secretary to match such contribution4 7f7 ,monitoring and evaluation ,as a condition of participation in the program under this section1 each eligible graduate institution shall agree to submit an annual report to the ,secretary describing-- 7#a7 the number of students served by the program2 7#b7 the percentage of tuition cost covered by the program2 7#c7 the number of participating students who were also recipients of a ,federal ,pell ,grant2 and 7#d7 as applicable1 the graduation rates and post-graduate employment of participating students4 7g7 ,interim report ,not later than #b years after the first contributions are provided under this section1 the ,secretary shall submit an interim report to ,congress based on the annual reports required by subsection 7f74 7h7 ,independent national evaluation 7#a7 ,in general ,not later than #d years after the date of enactment of this ,act1 the ,secretary shall provide for the commencement of an independent national evaluation of the outcomes and effectiveness of the program under this section4 7#b7 ,report to congress ,not later than #ij days after receiving the results of such independent national evaluation1 the ,secretary shall submit a report to ,congress containing the findings of the evaluation and the ,secretary's recommendations for improvements to the program4 7i7 ,definitions ,in this section3 7#a7 ,cost of attendance ,the term cost of attendance has the meaning given the term in section #dgb of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajhgll74 7#b7 ,eligible graduate institution ,the term eligible graduate institution means an institution of higher education that offers a program of study that leads to a graduate degree-- 7,a7 in school psychology that is accredited or approved by the ,national ,association of ,school ,psychologists' ,program ,accreditation ,board or the ,commission on ,accreditation of the ,american ,psychological ,association and that prepares students in such program for the ,state licensing or certification examination in school psychology at the specialist level2 7,b7 in an accredited school counseling program that prepares students in such program for the ,state licensing or certification examination in school counseling2 7,c7 in school social work that is accredited by the ,council on ,social ,work ,education and that prepares students in such program for the ,state licensing or certification examination in school social work2 7,d7 in another school-based mental health field that prepares students in such program for the ,state licensing or certification examination in such field1 if applicable2 or 7,e7 in any combination of study described in subparagraphs 7,a7 through 7,d74 7#c7 ,institution of higher education ,the term institution of higher education has the meaning given the term in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja74 7#d7 ,participating student ,the term participating student means an individual who is enrolled in a graduate degree program in a school-based mental health field at a participating eligible graduate institution4 7#e7 ,school-based mental health field ,the term school-based mental health field means any of the following fields3 7,a7 ,school counseling4 7,b7 ,school social work4 7,c7 ,school psychology4 7,d7 ,any other field of study that leads to employment as a school-based mental health services provider1 as determined by the ,secretary4 7#f7 ,school-based mental health services provider ,the term school-based mental health services provider has the meaning given the term in section #dajb of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #gaab74 7#g7 ,secretary ,the term ,secretary means the ,secretary of ,education4 7j7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section-- 7#a7 #bj1jjj1jjj for fiscal year #bjbe2 7#b7 #cj1jjj1jjj for fiscal year #bjbf2 and 7#c7 #ej1jjj1jjj for each of fiscal years #bjbg through #bjbi4 #fgje4 ,school social workers improving student success 7a7 ,school ,social ,worker ,grants 7#a7 ,purposes ,the purpose of this section is to assist ,states and local educational agencies in hiring additional school social workers in order to increase access to mental health and other student support services to students in elementary schools and secondary schools in the ,united ,states to the minimum ratios recommended by the ,national ,association of ,social ,workers1 the ,school ,social ,work ,association of ,america1 and the ,american ,council for ,school ,social ,work of #a school social worker for every #bej students1 and #a school social worker for every #ej students when a social worker is providing services to students with intensive needs4 7#b7 ,,esea amendments 7,a7 ,in general ,subpart #d of part ,f of title ,,iv of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #gbia et seq47 is amended by adding at the end the following3 #dfde4 ,grants for school social workers 7a7 ,grants authorized 7#a7 ,in general ,from the amounts appropriated under subsection 7g71 the ,secretary shall award grants to high-need local educational agencies to enable such agencies to retain school social workers employed by such agencies or to hire additional school social workers4 7#b7 ,duration ,a grant awarded under this section shall be awarded for a period not to exceed #d years4 7#c7 ,supplement1 not supplant ,funds made available under this section shall be used to supplement1 and not to supplant1 other ,federal1 ,state1 or local funds used for hiring and retaining school social workers4 7b7 ,application 7#a7 ,in general ,to be eligible to receive a grant under this section1 a high-need local educational agency shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7#b7 ,contents ,an application submitted under paragraph 7#a7 shall include an assurance that each school social worker who receives assistance under the grant will provide the services described in subsection 7d71 and a description of the specific services to be provided by such social worker4 7c7 ,use of funds ,a high-need local educational agency receiving a grant under this section-- 7#a7 shall use the grant-- 7,a7 to achieve a ratio of not less than #a school social worker for every #bej students served by the agency1 by-- 7i7 retaining school social workers employed by such agency2 or 7ii7 7,i7 employing additional school social workers2 or 7,,ii7 hiring contractors to serve as school social workers only in a case in which-- 7aa7 the local educational agency demonstrates to the ,secretary that the agency-- 7,,aa7 has not been able to employ a sufficient number of school social workers under subclause 7,i7 to achieve such ratio despite strong and continuing efforts to recruit and employ school social workers2 and 7,,bb7 hiring contractors is the only viable option to ensure students have adequate access to school social work services2 and 7bb7 each such contractor meets the requirements of subparagraphs 7,a7 and 7,b7 of subsection 7h77#b72 and 7,b7 to ensure that each school social worker who receives assistance under such grant provides the services described in subsection 7d72 and 7#b7 may use the grant to reimburse school social workers who receive assistance under such grant for-- 7,a7 in the case of a school served by the agency in which the majority of students are higher risk students1 to hire or retain additional school social workers in accordance with clauses 7i7 and 7ii7 of paragraph 7#a77;,a7 to achieve a ratio of not less than #a school social worker for every #ej students2 7,b7 travel expenses incurred during home visits and other school-related trips2 7,c7 any additional expenses incurred by such social workers in rendering any service described in subsection 7d72 and 7,d7 the cost of clinical social work supervision for such social workers4 7d7 ,responsibilities of a school social worker ,a school social worker who receives assistance under a grant under this section shall provide the following services3 7#a7 ,identifying high-need students in each school that the social worker serves1 and targeting services provided at the school to such students4 7#b7 ,providing students in each school that the school social worker serves1 social work services to promote school engagement and improve academic outcomes1 including-- 7,a7 counseling and crisis intervention2 7,b7 trauma-informed services2 7,c7 evidence-based educational1 behavioral1 and mental health services 7such as implementing multi-tiered programs and practices1 monitoring progress1 and evaluating service effectiveness72 7,d7 addressing the social and emotional learning needs of students2 7,e7 promoting a school climate and culture conducive to student learning and teaching excellence 7such as promoting effective school policies and administrative procedures1 enhancing the professional capacity of school personnel1 and facilitating engagement between student1 family1 school1 and community72 7,f7 providing access to school-based and community based resources 7such as promoting a continuum of services1 mobilizing resources and promoting assets1 and providing leadership1 interdisciplinary collaboration1 systems coordination1 professional consultation1 and connecting students and families to resource systems72 7,g7 working with students1 families1 schools1 and communities to address barriers to educational attainment 7such as homelessness and housing insecurity1 lack of transportation1 food insecurity1 equity1 social justice issues1 access to quality education1 and school1 family1 and community risk factors72 7,h7 providing assistance to schools and teachers to design social-emotional1 educational1 behavioral1 and mental health interventions2 7,i7 case management activities to coordinate the delivery of and access to the appropriate social work services to the highest-need students2 7,j7 home visits to meet the family of students in need of social work services in the home environment2 7,k7 supervising or coordinating district level school social work services2 and 7,l7 other services the ,secretary determines1 in partnership with students1 educators1 and community member voices are necessary to be carried out by such a social worker4 7e7 ,grant renewal 7#a7 ,in general ,a grant awarded under this section may be renewed for additional periods with the same duration as the original grant period4 7#b7 ,continuing eligibility application ,to be eligible for a renewal under this section a high-need local educational agency shall submit to the ,secretary1 for each renewal1 a report on the progress of such agency in retaining and hiring school social workers to achieve the ratio of not less than #a school social worker for every #bej students served by the agency1 and shall include-- 7,a7 a description of the staffing expansion of school social workers funded through the original grant received under this section2 and 7,b7 a description of the work conducted by such social workers for higher risk students4 7f7 ,technical assistance 7#a7 ,in general ,the ,secretary shall provide technical assistance to high-need local educational agencies1 including such agencies that do not have adequate staff1 in applying for grants under this section4 7#b7 ,extension of application period ,the ,secretary shall extend any application period for a grant under this section for any high-need local educational agency that-- 7,a7 submits to the ,secretary a written notification of the intent to apply for a grant under this section before requesting technical assistance under paragraph 7#a72 and 7,b7 after submitting the notification under paragraph 7#a71 requests such technical assistance4 7g7 ,authorization for appropriations ,there is authorized to be appropriated to carry out this section1 #ajj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7h7 ,definitions ,in this section3 7#a7 ,high-need local educational agency ,the term high-need local educational agency has the meaning given the term in section #bjj of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajba74 7#b7 ,school social worker ,the term school social worker means an individual who-- 7,a7 has a graduate degree in social work from a social work program that is accredited by the ,council on ,social ,work ,education2 and 7,b7 meets all other ,state and local credentialing requirements for practicing as a social worker in an elementary school or secondary school4 4 7,b7 ,table of contents ,the table of contents in section #b of the ,elementary and ,secondary ,education ,act of #aife is amended by inserting after the item relating to section #dfdd the following3 ,sec4 #dfde4 ,grants for school social workers4 4 7b7 ,national technical assistance center for school social work 7#a7 ,in general ,the ,secretary of ,education1 acting through the ,assistant ,secretary1 shall establish an evaluation1 documentation1 dissemination1 and technical assistance resource center to provide appropriate information1 training1 and technical assistance to ,states1 political subdivisions of ,states1 federally recognized ,indian tribes1 ,tribal organizations1 institutions of higher education1 ,state and local educational agencies1 and individual students and educators with respect to hiring and retaining school social workers at elementary schools and secondary schools served by local educational agencies4 7#b7 ,responsibilities of the ,center ,the center established under paragraph 7#a7 shall conduct activities for the purpose of-- 7,a7 developing and continuing statewide or ,tribal strategies for improving the effectiveness of the school social work workforce2 7,b7 studying the costs and effectiveness of school social work programs at institutions of higher education to identify areas of improvement and provide information on relevant issues of importance to ,state1 ,tribal1 and national policymakers2 7,c7 working with ,federal agencies and other ,state1 ,tribal1 and national stakeholders to collect1 evaluate1 and disseminate data regarding school social work ratios1 outcomes and best practices of school-based mental health services1 and the impact of expanding the number of school social workers within elementary schools and secondary schools2 7,d7 establishing partnerships among national1 ,state1 ,tribal1 and local governments1 and local educational agencies1 institutions of higher education1 non-profit organizations1 and ,state and national trade associations for the purposes of-- 7i7 data collection and dissemination2 7ii7 establishing a school social work workforce development program2 7iii7 documenting the success of school social work methods on a national level2 and 7iv7 conducting other activities determined appropriate by the ,secretary4 7#c7 ,definitions ,in this subsection3 7,a7 ,,esea terms ,except as otherwise provided1 any term used in this subsection that is defined in section #haja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja7 shall have the meaning given that term in such section4 7,b7 ,school social worker ,the term school social worker has the meaning given the term in section #dfde7;h7 of the ,elementary and ,secondary ,education ,act of #aife4 #fgjf4 ,opioid grants to support caregivers1 kinship care families1 and kinship caregivers 7a7 ,opioid grants ,section #ajjc7;b77#d7 of the #bast ,century ,cures ,act 7#db ,u4,s4,c4 #bij;ee-#c;a7b77#d77 is amended-- 7#a7 by redesignating subparagraph 7,f7 as subparagraph 7,g72 and 7#b7 by inserting after subparagraph 7,e7 the following3 7,f7 ,supporting opioid abuse prevention and treatment services within a ,state provided by ,state and local agencies for children and caregivers1 kinship care families1 and kinship caregivers through-- 7i7 workforce recruitment and training2 7ii7 health care services 7including such services described in subparagraph 7,d772 and 7iii7 foster and adoptive parent recruitment and training4 4 7b7 ,definitions ,section #ajjc7;h7 of the #bast ,century ,cures ,act 7#db ,u4,s4,c4 #bij;ee-#c;a7h77 is amended-- 7#a7 by redesignating paragraphs 7#b7 through 7#d7 as paragraphs 7#d7 through 7#f71 respectively2 and 7#b7 by inserting after paragraph 7#a7 the following3 7#b7 ,kinship care family ,the term kinship care family means a family with a kinship caregiver4 7#c7 ,kinship caregiver ,the term kinship caregiver means a relative of a child by blood1 marriage1 or adoption1 who-- 7,a7 lives with the child2 7,b7 is the primary caregiver of the child because the biological or adoptive parent of the child is unable or unwilling to serve as the primary caregiver of the child2 and 7,c7 has a legal relationship to the child or is raising the child informally4 4 7c7 ,authorization of appropriations ,section #ajjc7;i77#a7 of the #bast ,century ,cures ,act 7#db ,u4,s4,c4 #bij;ee-#c;a7i77#a77 is amended by striking #bjbc through #bjbg and inserting #bjbe through #bjbi4 7d7 ,set aside ,section #ajjc7;i77#c7 of the #bast ,century ,cures ,act 7#db ,u4,s4,c4 #bij;ee-#c;a7i77#c77 is amended by inserting before the period at the end 1 and set aside #a percent to carry out subsection 7b77#d77;,f74 #fgjg4 ,substance ,use and ,mental ,health ,services ,administration and subagencies 7a7 ,substance ,use and ,mental ,health ,services ,administration ,the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bja et seq47 is amended-- 7#a7 in section #dfd;,h7c7 7#db ,u4,s4,c4 #bhen7c771 section #dfd,r7c7 7#db ,u4,s4,c4 #bhep7c771 and subsections 7b7 and 7c77#a7 of section #bcjc 7#db ,u4,s4,c4 #cjj;cc-#b71 by striking ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration each place it appears and inserting ,assistant ,secretary for ,mental ,health and ,substance ,use2 7#b7 in title ,v 7#db ,u4,s4,c4 #bij;aa et seq47-- 7,a7 in the title heading1 by striking ,abuse and inserting ,use2 7,b7 in section #eja 7#db ,u4,s4,c4 #bij;aa7-- 7i7 in the section heading1 by striking ,abuse and inserting ,use2 and 7ii7 in subsection 7f77#d71 by striking ,substance ,abuse and ,mental ,health ,administration and inserting ,substance ,use and ,mental ,health ,services ,administration2 and 7#c7 by striking ,substance ,abuse and ,mental ,health ,services ,administration each place it appears and inserting ,substance ,use and ,mental ,health ,services ,administration4 7b7 ,center for ,substance ,use ,services2 ,center for ,substance ,use ,prevention ,services 7#a7 ,in general ,the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bja et seq47 is amended-- 7,a7 in part ,b of title ,v 7#db ,u4,s4,c4 #bij;bb et seq47-- 7i7 in subpart #a1 in the subpart heading1 by striking ,abuse ,treatment and inserting ,use ,services2 7ii7 in subpart #b1 in the subpart heading1 by striking ,abuse ,prevention and inserting ,use ,prevention ,services2 7iii7 in section #ejg 7#db ,u4,s4,c4 #bij;bb71 in the section heading1 by striking ,abuse ,treatment and inserting ,use ,services2 7iv7 in section #eac7;a7 7#db ,u4,s4,c4 #bij;bb-#f7;a771 in the subsection heading1 by striking ,abuse ,treatment and inserting ,use ,services2 and 7v7 in section #eae 7#db ,u4,s4,c4 #bij;bb-#ba71 in the section heading1 by striking ,abuse ,prevention and inserting ,use ,prevention ,services2 7,b7 in section #aicb7;b77#c7 7#db ,u4,s4,c4 #cjjx-#cb7;b77#c771 in the paragraph heading1 by striking abuse prevention and inserting use prevention services2 7,c7 in section #aice7;b77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjx-#ce7;b77#b771 in the paragraph heading1 by striking abuse prevention and inserting use prevention services2 7,d7 by striking ,center for ,substance ,abuse ,treatment each place it appears and inserting ,center for ,substance ,use ,services2 and 7,e7 by striking ,center for ,substance ,abuse ,prevention each place it appears and inserting ,center for ,substance ,use ,prevention ,services4 7c7 ,authorities ,the ,secretary of ,health and ,human ,services shall delegate to the ,substance ,use and ,mental ,health ,services ,administration1 the ,center for ,substance ,use ,services1 and the ,center for ,substance ,use ,prevention ,services all duties and authorities that1 as of the date of enactment of this ,act1 were vested in the ,substance ,abuse and ,mental ,health ,services ,administration1 the ,center for ,substance ,abuse ,treatment1 and the ,center for ,substance ,abuse ,prevention1 respectively4 7d7 ,references 7#a7 ,in general ,except as provided in paragraph 7#b71 any reference in any law1 regulation1 map1 document1 paper1 or other record of the ,united ,states-- 7,a7 to the ,substance ,abuse and ,mental ,health ,services ,administration shall be deemed to be a reference to the ,substance ,use and ,mental ,health ,services ,administration2 7,b7 to the ,center for ,substance ,abuse ,treatment of such ,administration shall be deemed to be a reference to the ,center for ,substance ,use ,services of such ,administration2 and 7,c7 to the ,center for ,substance ,abuse ,prevention of such ,administration shall be deemed to be a reference to the ,center for ,substance ,use ,prevention ,services of such ,administration4 7#b7 ,effect ,paragraph 7#a7 shall not be construed to alter or affect section #fjja7;d7 of the #bast ,century ,cures ,act 7#db ,u4,s4,c4 #bij;aa note71 providing that a reference to the ,administrator of the ,substance ,abuse and ,mental ,health ,services ,administration shall be construed to be a reference to the ,assistant ,secretary for ,mental ,health and ,substance ,use4 7#c7 ,references to ,,samhsa ,notwithstanding this section or the amendments made by this section1 the ,secretary of ,health and ,human ,services may continue to use the acronym ,,samhsa to refer to the ,substance ,use and ,mental ,health ,services ,administration in regulations1 maps1 documents1 papers1 and other records of the ,united ,states4 ,,vii ,addressing high-impact minority diseases ,a ,cancer #gjja4 ,lung cancer mortality reduction 7a7 ,sense of ,congress concerning investment in lung cancer research ,it is the sense of the ,congress that-- 7#a7 lung cancer mortality reduction should be made a national public health priority2 and 7#b7 a comprehensive mortality reduction program coordinated by the ,secretary of ,health and ,human ,services is justified and necessary to adequately address and reduce lung cancer mortality4 7b7 ,lung ,cancer ,mortality ,reduction ,program 7#a7 ,in ,general ,subpart #a of part ,c of title ,,iv of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe et seq47 is amended by adding at the end the following3 #dag;,h4 ,lung ,cancer ,mortality ,reduction ,program 7a7 ,in ,general ,not later than #f months after the date of the enactment of the ,health ,equity and ,accountability ,act of #bjbd1 the ,secretary1 in consultation with the ,secretary of ,defense1 the ,secretary of ,veterans ,affairs1 the ,director of the ,national ,institutes of ,health1 the ,director of the ,centers for ,disease ,control and ,prevention1 the ,commissioner of ,food and ,drugs1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities1 the ,administrator of the ,environmental ,protection ,agency1 and other members of the ,lung ,cancer ,advisory ,board established under section #gjja7;d7 of the ,health ,equity and ,accountability ,act of #bjbd1 shall implement a comprehensive program1 to be known as the ,lung ,cancer ,mortality ,reduction ,program1 to achieve a reduction of at least #be percent in the mortality rate of lung cancer by #bjbh4 7b7 ,requirements ,the ,program shall include at least the following3 7#a7 ,with respect to the ,national ,institutes of ,health-- 7,a7 a strategic review and prioritization by the ,national ,cancer ,institute of research grants to achieve the goal specified in subsection 7a72 7,b7 the provision of funds to enable the ,airway ,biology and ,disease ,branch of the ,national ,heart1 ,lung1 and ,blood ,institute to expand its research programs to include predispositions to lung cancer1 the interrelationship between lung cancer and other pulmonary and cardiac disease1 and the diagnosis and treatment of such diseases2 7,c7 the provision of funds to enable the ,national ,institute of ,biomedical ,imaging and ,bioengineering to expedite the development of computer-assisted diagnostic1 surgical1 treatment1 and drug-testing innovations to reduce lung cancer mortality1 such as through expansion of the ,institute's ,quantum ,grant ,program and ,image-,guided ,interventions program2 and 7,d7 the provision of funds to enable the ,national ,institute of ,environmental ,health ,sciences to implement research programs relative to the lung cancer incidence4 7#b7 ,with respect to the ,food and ,drug ,administration-- 7,a7 activities under section #ebi;,b of the ,federal ,food1 ,drug1 and ,cosmetic ,act2 and 7,b7 activities under section #efa of the ,federal ,food1 ,drug1 and ,cosmetic ,act to expand access to investigational drugs and devices for the diagnosis1 monitoring1 or treatment of lung cancer4 7#c7 ,with respect to the ,centers for ,disease ,control and ,prevention1 the establishment of an early disease research and management program under section #aeaa4 7#d7 ,with respect to the ,agency for ,healthcare ,research and ,quality1 the conduct of a biannual review of lung cancer screening1 diagnostic1 and treatment protocols1 and the issuance of updated guidelines4 7#e7 ,the promotion 7including education7 of lung cancer screening within minority and rural populations and the study of the effectiveness of efforts to increase such screening4 7#f7 ,the cooperation and coordination of all minority and health disparity programs within the ,department of ,health and ,human ,services to ensure that all aspects of the ,lung ,cancer ,mortality ,reduction ,program under this section adequately address the burden of lung cancer on minority and rural populations4 7#g7 ,the cooperation and coordination of all tobacco control and cessation programs within agencies of the ,department of ,health and ,human ,services to achieve the goals of the ,lung ,cancer ,mortality ,reduction ,program under this section with particular emphasis on the coordination of drug and other cessation treatments with early detection protocols4 4 7#b7 ,federal ,food1 ,drug1 and ,cosmetic ,act ,subchapter ,b of chapter ,v of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cfj;aaa et seq47 is amended by adding at the end the following3 #ebi;,b4 ,drugs relating to lung cancer 7a7 ,in general ,the provisions of this subchapter shall apply to a drug described in subsection 7b7 to the same extent and in the same manner as such provisions apply to a drug for a rare disease or condition 7as defined in section #ebf74 7b7 ,qualified drugs ,a drug described in this subsection is-- 7#a7 a chemoprevention drug for precancerous conditions of the lung2 7#b7 a drug for targeted therapeutic treatments1 including any vaccine1 for lung cancer2 or 7#c7 a drug to curtail or prevent nicotine addiction4 7c7 ,board ,the ,board established under section #gjja7;d7 of the ,health ,equity and ,accountability ,act of #bjbd shall monitor the program implemented under this section4 4 7#c7 ,access to ,unapproved ,therapies ,section #efa7;e7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cfj;bbb7e77 is amended by inserting before the period the following3 and shall include expanding access to drugs under section #ebi;,b1 with substantial consideration being given to whether the totality of information available to the ,secretary regarding the safety and effectiveness of an investigational drug1 as compared to the risk of morbidity and death from the disease1 indicates that a patient may obtain more benefit than risk if treated with the drug4 7#d7 ,,cdc ,title ,,xv of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjk et seq47 is amended by adding at the end the following3 #aeaa4 ,early disease research and management program ,the ,secretary shall establish and implement an early disease research and management program targeted at the high incidence and mortality rates of lung cancer among minority and low-income populations4 4 7c7 ,department of ,defense and ,department of ,veterans ,affairs ,the ,secretary of ,defense and the ,secretary of ,veterans ,affairs1 each in coordination with the ,secretary of ,health and ,human ,services1 shall engage-- 7#a7 in the implementation within the ,department of ,defense and the ,department of ,veterans ,affairs1 as the case may be1 of an early detection and disease management research program for members of the ,armed ,forces and veterans whose smoking history and exposure to carcinogens during service on active duty in the ,armed ,forces has increased their risk for lung cancer2 and 7#b7 in the implementation of coordinated care programs for members of the ,armed ,forces and veterans diagnosed with lung cancer4 7d7 ,lung cancer advisory board 7#a7 ,in ,general ,the ,secretary of ,health and ,human ,services shall convene a ,lung ,cancer ,advisory ,board 7referred to in this section as the ,board7-- 7,a7 to monitor the programs established under this section 7and the amendments made by this section72 and 7,b7 to provide annual reports to the ,congress concerning benchmarks1 expenditures1 lung cancer statistics1 and the public health impact of such programs4 7#b7 ,composition ,the ,board shall be composed of-- 7,a7 the ,secretary of ,health and ,human ,services2 7,b7 the ,secretary of ,defense2 7,c7 the ,secretary of ,veterans ,affairs2 and 7,d7 #b representatives each from the fields of clinical medicine focused on lung cancer1 lung cancer research1 imaging1 drug development1 and lung cancer advocacy1 to be appointed by the ,secretary of ,health and ,human ,services4 7e7 ,authorization of appropriations 7#a7 ,in general ,to carry out this section 7and the amendments made by this section71 there are authorized to be appropriated #ge1jjj1jjj for fiscal year #bjbe and such sums as may be necessary for each of fiscal years #bjbf through #bjbh4 7#b7 ,lung ,cancer ,mortality ,reduction ,program ,the amounts appropriated under paragraph 7#a7 shall be allocated as follows3 7,a7 #be1jjj1jjj for fiscal year #bjbe1 and such sums as may be necessary for each of fiscal years #bjbf through #bjbh1 for the activities described in section #dag;,h7b77#a77;,b7 of the ,public ,health ,service ,act1 as added by subsection 7b72 7,b7 #be1jjj1jjj for fiscal year #bjbe1 and such sums as may be necessary for each of fiscal years #bjbf through #bjbh1 for the activities described in section #dag;,h7b77#a77;,c7 of the ,public ,health ,service ,act2 7,c7 #aj1jjj1jjj for fiscal year #bjbe1 and such sums as may be necessary for each of fiscal years #bjbf through #bjbh1 for the activities described in section #dag;,h7b77#a77;,d7 of the ,public ,health ,service ,act2 and 7,d7 #ae1jjj1jjj for fiscal year #bjbe1 and such sums as may be necessary for each of fiscal years #bjbf through #bjbh1 for the activities described in section #dag;,h7b77#c7 of the ,public ,health ,service ,act4 #gjjb4 ,expansion of prostate cancer research1 outreach1 screening1 testing1 access1 and treatment effectiveness 7a7 ,prostate cancer coordination and education 7#a7 ,interagency prostate cancer coordination and education task force ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs1 in cooperation with the ,secretary of ,defense and the ,secretary of ,health and ,human ,services1 shall establish an ,interagency ,prostate ,cancer ,coordination and ,education ,task ,force 7in this section referred to as the ,prostate ,cancer ,task ,force74 7#b7 ,duties ,the ,prostate ,cancer ,task ,force shall-- 7,a7 develop a summary of advances in prostate cancer research supported or conducted by ,federal agencies relevant to the diagnosis1 prevention1 and treatment of prostate cancer1 including psychosocial impairments related to prostate cancer treatment1 and compile a list of best practices that warrant broader adoption in health care programs2 7,b7 consider establishing1 and advocating for1 a guidance to enable physicians to allow screening of men who are age #gd or older1 on a case-by-case basis1 taking into account quality of life and family history of prostate cancer2 7,c7 share and coordinate information on research and health care program activities by the ,federal ,government1 including activities related to-- 7i7 determining how to improve research and health care programs1 including psychosocial impairments related to prostate cancer treatment2 7ii7 identifying any gaps in the overall research inventory and in health care programs2 7iii7 identifying opportunities to promote translation of research into practice2 and 7iv7 maximizing the effects of ,federal ,government efforts by identifying opportunities for collaboration and leveraging of resources in research and health care programs that serve individuals who are susceptible to or diagnosed with prostate cancer2 7,d7 develop a comprehensive interagency strategy and advise relevant ,federal agencies in the solicitation of proposals for collaborative1 multidisciplinary research and health care programs1 including proposals to evaluate factors that may be related to the etiology of prostate cancer1 that would-- 7i7 result in innovative approaches to study emerging scientific opportunities or eliminate knowledge gaps in research to improve the prostate cancer research portfolio of the ,federal ,government2 and 7ii7 outline key research questions1 methodologies1 and knowledge gaps2 7,e7 develop a coordinated message related to screening and treatment for prostate cancer to be reflected in educational and beneficiary materials for ,federal health programs as such materials are updated2 and 7,f7 not later than two years after the date of the establishment of the ,prostate ,cancer ,task ,force1 submit to the expert advisory panels appointed under paragraph 7#d7 to be reviewed and returned within #cj days1 and then within #ij days submitted to ,congress1 recommendations-- 7i7 regarding any appropriate changes to research and health care programs1 including recommendations to improve the research portfolio of the ,department of ,veterans ,affairs1 the ,department of ,defense1 the ,national ,institutes of ,health1 and other ,federal agencies to ensure that scientifically based strategic planning is implemented in support of research and health care program priorities2 7ii7 designed to ensure that the research and health care programs and activities of the ,department of ,veterans ,affairs1 the ,department of ,defense1 the ,department of ,health and ,human ,services1 and other ,federal agencies are free of unnecessary duplication2 7iii7 regarding public participation in decisions relating to prostate cancer research and health care programs to increase the involvement of patient advocates1 community organizations1 and medical associations representing a broad geographical area2 7iv7 on how to best disseminate information on prostate cancer research and progress achieved by health care programs2 7v7 on how to expand partnerships between public entities1 including ,federal agencies1 and private entities to encourage collaborative1 cross-cutting research and health care delivery2 7vi7 assessing any cost savings and efficiencies realized through the efforts identified in1 and supported through1 this subsection and recommending expansion of those efforts that have proved most promising while also ensuring against any conflicts in directives in law2 7vii7 identifying key priority action items from among the recommendations specified in clauses 7i7 through 7vi72 and 7viii7 with respect to the level of funding needed by each agency to implement such recommendations4 7#c7 ,members of the ,prostate ,cancer ,task ,force ,the ,prostate ,cancer ,task ,force shall be composed of representatives from such ,federal agencies as the head of each such applicable agency determines necessary1 so as to coordinate a uniform message relating to prostate cancer screening and treatment where appropriate1 including representatives of each of the following3 7,a7 ,the ,department of ,veterans ,affairs1 including representatives of each relevant program area of the ,department of ,veterans ,affairs4 7,b7 ,the ,prostate ,cancer ,research ,program of the ,congressionally ,directed ,medical ,research ,program of the ,department of ,defense4 7,c7 ,the ,department of ,health and ,human ,services1 including1 at a minimum1 representatives of each of the following3 7i7 ,the ,national ,institutes of ,health4 7ii7 ,national research institutes and centers1 including the ,national ,cancer ,institute1 the ,national ,institute of ,allergy and ,infectious ,diseases1 and the ,office of ,minority ,health4 7iii7 ,the ,centers for ,medicare ,medicaid ,services4 7iv7 ,the ,food and ,drug ,administration4 7v7 ,the ,centers for ,disease ,control and ,prevention4 7vi7 ,the ,agency for ,healthcare ,research and ,quality4 7vii7 ,the ,health ,resources and ,services ,administration4 7#d7 ,appointing expert advisory panels ,the ,prostate ,cancer ,task ,force shall appoint expert advisory panels1 as the task force determines appropriate1 to provide input and concurrence from-- 7,a7 individuals and organizations from the medical1 prostate cancer patient and advocate1 research1 and delivery communities with expertise in prostate cancer diagnosis1 treatment1 and research1 including practicing urologists1 primary care providers1 and others2 and 7,b7 individuals with expertise in education and outreach to underserved populations affected by prostate cancer4 7#e7 ,meetings ,the ,prostate ,cancer ,task ,force shall convene not less frequently than twice each year1 or more frequently as the ,secretary of ,veterans ,affairs determines to be appropriate4 7#f7 ,federal ,advisory ,committee ,act ,the ,federal ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 shall apply to the ,prostate ,cancer ,task ,force4 7#g7 ,sunset ,date ,the ,prostate ,cancer ,task ,force shall terminate on ,september #cj1 #bjbf4 7b7 ,prostate cancer research 7#a7 ,research coordination program 7,a7 ,in general ,the ,secretary of ,veterans ,affairs1 in coordination with the ,secretary of ,defense and the ,secretary of ,health and ,human ,services1 shall establish and carry out a program to coordinate and intensify prostate cancer research4 7,b7 ,elements ,the program established under subparagraph 7,a7 shall-- 7i7 develop advances in diagnostic and prognostic methods and tests1 including biomarkers and an improved prostate cancer screening blood test1 including improvements or alternatives to the prostate specific antigen test and additional tests to distinguish indolent from aggressive disease2 7ii7 develop a better understanding of the etiology of the disease 7including an analysis of lifestyle factors proven to be involved in higher rates of prostate cancer1 such as obesity and diet1 and in different ethnic1 racial1 and socioeconomic groups1 such as the ,african-,american1 ,latino or ,hispanic1 and ,american ,indian populations and men with a family history of prostate cancer7 to improve prevention efforts2 7iii7 expand basic research into prostate cancer1 including studies of fundamental molecular and cellular mechanisms2 7iv7 identify and provide clinical testing of novel agents for the prevention and treatment of prostate cancer2 7v7 establish clinical registries for prostate cancer2 7vi7 use the ,national ,institute of ,biomedical ,imaging and ,bioengineering and the ,national ,cancer ,institute for assessment of appropriate imaging modalities2 and 7vii7 address such other matters relating to prostate cancer research as may be identified by the ,federal agencies participating in such program4 7,c7 ,underserved minority grant program 7i7 ,in general ,in carrying out the program established under subparagraph 7,a71 the ,secretary shall award grants to eligible entities-- 7,i7 to carry out components of the research outlined in subparagraph 7,b72 7,,ii7 to integrate and build upon existing knowledge gained from comparative effectiveness research2 and 7,,iii7 to recognize and address-- 7aa7 the racial and ethnic disparities in the incidence and mortality rates of prostate cancer and men with a family history of prostate cancer2 7bb7 any barriers in access to care and participation in clinical trials that are specific to racial1 ethnic1 and other underserved minorities and men with a family history of prostate cancer2 7cc7 outreach and educational efforts to raise awareness among the populations described in item 7bb72 and 7dd7 appropriate access and utilization of imaging modalities4 7ii7 ,eligible entity defined ,in this subparagraph1 the term eligible entity means any public1 private1 nonprofit1 or for-profit organization that the ,secretary determines would be capable to conduct medical research and other requirements under this paragraph and is otherwise eligible for research funding from the ,federal ,government4 7#b7 ,prostate ,cancer ,advisory ,board 7,a7 ,in general ,there is established in the ,office of the ,chief ,scientist of the ,food and ,drug ,administration a ,prostate ,cancer ,scientific ,advisory ,board4 7,b7 ,duties ,the board established under subparagraph 7,a7 shall be responsible for accelerating real-time sharing of the latest research data and accelerating movement of new medicines for the treatment of prostate cancer to patients4 7c7 ,telehealth and rural access pilot projects 7#a7 ,establishment of pilot projects 7,a7 ,in general ,the ,secretary of ,veterans ,affairs1 in cooperation with the ,secretary of ,defense and the ,secretary of ,health and ,human ,services 7referred to in this subsection collectively as the ,secretaries7 shall establish four-year telehealth pilot projects for the purpose of analyzing the clinical outcomes and cost-effectiveness associated with telehealth services in a variety of geographic areas that contain high proportions of medically underserved populations1 including ,african ,americans1 ,latinos or ,hispanics1 ,american ,indians or ,alaska ,natives1 and those in rural areas4 7,b7 ,efficient and effective care ,pilot projects established under subparagraph 7,a7 shall promote efficient use of specialist care through better coordination of primary care and physician extender teams in underserved areas and more effectively employ tumor boards to better counsel patients4 7#b7 ,eligible entities 7,a7 ,in general ,the ,secretaries shall select eligible entities to participate in the pilot projects established under this subsection4 7,b7 ,priority ,in selecting eligible entities to participate in the pilot projects under this subsection1 the ,secretaries shall give priority to entities located in medically underserved areas1 particularly those that include ,african ,americans1 ,latinos and ,hispanics1 and facilities of the ,indian ,health ,service1 including facilities operated by the ,indian ,health ,service1 tribally operated facilities1 and facilities administered by an ,urban ,indian organization 7as defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc77 pursuant to title ,v of that ,act 7#be ,u4,s4,c4 #afea et seq471 and those in rural areas4 7#c7 ,evaluation ,the ,secretaries shall1 through the pilot projects established under this subsection1 evaluate-- 7,a7 the effective and economic delivery of care in diagnosing and treating prostate cancer with the use of telehealth services in medically underserved and ,tribal areas including collaborative uses of health professionals and integration of the range of telehealth and other technologies2 7,b7 the effectiveness of improving the capacity of nonmedical providers and nonspecialized medical providers to provide health services for prostate cancer in medically underserved and ,tribal areas1 including the exploration of innovative medical home models with collaboration between urologists1 other relevant medical specialists1 including oncologists1 radiologists1 and primary care teams1 and coordination of care through the efficient use of primary care teams and physician extenders2 and 7,c7 the effectiveness of using telehealth services to provide prostate cancer treatment in medically underserved areas1 including the use of tumor boards to facilitate better patient counseling4 7#d7 ,report ,not later than one year after the completion of the pilot projects under this subsection1 the ,secretaries shall submit to ,congress a report describing the outcomes of such pilot projects1 including any cost savings and efficiencies realized1 and providing recommendations1 if any1 for expanding the use of telehealth services4 7d7 ,education and awareness 7#a7 ,campaign 7,a7 ,in general ,the ,secretary of ,veterans ,affairs shall develop a national education campaign for prostate cancer4 7,b7 ,elements ,the campaign developed under subparagraph 7,a7 shall involve the use of written educational materials and public service announcements consistent with the findings of the ,prostate ,cancer ,task ,force under subsection 7a7 that are intended to encourage men to seek prostate cancer screening when appropriate4 7#b7 ,racial disparities and the population of men with a family history of prostate cancer ,in developing the campaign under paragraph 7#a71 the ,secretary of ,veterans ,affairs shall ensure that educational materials and public service announcements used in the campaign are more readily available in communities experiencing racial disparities in the incidence and mortality rates of prostate cancer and to men of any race classification with a family history of prostate cancer4 7#c7 ,grants ,in carrying out the campaign under this subsection1 the ,secretary of ,veterans ,affairs shall award grants to nonprofit private entities to enable such entities to test alternative outreach and education strategies4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section for the period of fiscal years #bjbe through #bjbi an amount equal to the amount of savings for the ,federal ,government projected to be achieved over such period by implementation of this section4 #gjjc4 ,prostate research1 imaging1 and men's education 7a7 ,research and development of prostate cancer imaging technologies 7#a7 ,expansion of ,research ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 acting through the ,director of the ,national ,institutes of ,health and the ,administrator of the ,health ,resources and ,services ,administration1 and in consultation with the ,secretary of ,defense1 shall carry out a program to expand and intensify research to develop innovative advanced imaging technologies for prostate cancer detection1 diagnosis1 and treatment comparable to state-of-the-art mammography technologies4 7#b7 ,early ,stage ,research ,in implementing the program under paragraph 7#a71 the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall carry out a grant program to encourage the early stages of research in prostate imaging to develop and implement new ideas1 proof of concepts1 and pilot studies for high-risk technologic innovation in prostate cancer imaging that would have a high potential impact for improving patient care1 including individualized care1 quality of life1 and cost-effectiveness4 7#c7 ,large ,scale ,later ,stage ,research ,in implementing the program under paragraph 7#a71 the ,secretary1 acting through the ,director of the ,national ,institutes of ,health1 shall utilize the ,national ,institute of ,biomedical ,imaging and ,bioengineering and the ,national ,cancer ,institute for advanced stages of research in prostate imaging1 including technology development and clinical trials for projects determined by the ,secretary to have demonstrated promising preliminary results and proof of concept4 7#d7 ,interdisciplinary private-,public partnerships ,in developing the program under paragraph 7#a71 the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall establish interdisciplinary private-public partnerships to develop and implement research strategies for expedited innovation in imaging and image-guided treatment and to conduct such research4 7#e7 ,racial ,disparities ,in developing the program under paragraph 7#a71 the ,secretary shall recognize and address-- 7,a7 the racial disparities in the incidences of prostate cancer and mortality rates with respect to such disease2 and 7,b7 any barriers in access to care and participation in clinical trials that are specific to racial minorities4 7#f7 ,authorization of ,appropriations 7,a7 ,in general ,subject to subparagraph 7,b71 there is authorized to be appropriated to carry out this subsection1 #ajj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7,b7 ,specific allocations ,of the amount authorized to be appropriated under subparagraph 7,a7 for each of the fiscal years described in such subparagraph-- 7i7 no less than #aj percent may be used to carry out the grant program under paragraph 7#b72 and 7ii7 no more than #a percent may be used to carry out paragraph 7#d74 7b7 ,public awareness and education campaign 7#a7 ,national campaign ,the ,secretary shall carry out a national campaign to increase the awareness and knowledge of individuals in the ,united ,states with respect to the need for prostate cancer screening and for improved detection technologies4 7#b7 ,requirements ,the national campaign conducted under this subsection shall include-- 7,a7 roles for the ,health ,resources ,services ,administration1 the ,office of ,minority ,health of the ,department of ,health and ,human ,services1 the ,centers for ,disease ,control and ,prevention1 and the ,office of ,minority ,health and ,health ,equity of the ,centers for ,disease ,control and ,prevention2 and 7,b7 the development and distribution of written educational materials1 and the development and placing of public service announcements1 that are intended to encourage men to seek prostate cancer screening and to create awareness of the need for improved imaging technologies for prostate cancer screening and diagnosis1 including in-vitro blood testing and imaging technologies4 7#c7 ,racial ,disparities ,in developing the national campaign under paragraph 7#a71 the ,secretary shall recognize and address-- 7,a7 the racial disparities in the incidences of prostate cancer and mortality rates with respect to such disease2 and 7,b7 any barriers in access to care and participation in clinical trials that are specific to racial minorities4 7#d7 ,grants ,the ,secretary shall establish a program to award grants to nonprofit private entities to enable such entities to test alternative outreach and education strategies to increase the awareness and knowledge of individuals in the ,united ,states with respect to the need for prostate cancer screening and improved imaging technologies4 7#e7 ,authorization of ,appropriations ,there is authorized to be appropriated to carry out this subsection #aj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7c7 ,improving prostate cancer screening blood tests 7#a7 ,in ,general ,the ,secretary1 in coordination with the ,secretary of ,defense1 shall support research to develop an improved prostate cancer screening blood test using in-vitro detection4 7#b7 ,authorization of ,appropriations ,there is authorized to be appropriated to carry out this subsection1 #bj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7d7 ,reporting and compliance 7#a7 ,report and strategy ,not later than #ab months after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report that details the strategy of the ,secretary for implementing the requirements of this section and the status of such efforts4 7#b7 ,full ,compliance ,not later than #cf months after the date of the enactment of this ,act1 and annually thereafter1 the ,secretary shall submit to ,congress a report that-- 7,a7 describes the research and development and public awareness and education campaigns funded under this section2 7,b7 provides evidence that projects involving high-risk1 high-impact technologic innovation1 proof of concept1 and pilot studies are prioritized2 7,c7 provides evidence that the ,secretary recognizes and addresses any barriers in access to care and participation in clinical trials that are specific to racial minorities in the implementation of this section2 7,d7 contains assurances that all the other provisions of this section are fully implemented2 and 7,e7 certifies compliance with the provisions of this section1 or in the case of a ,federal agency that has not complied with any of such provisions1 an explanation as to such failure to comply4 #gjjd4 ,prostate cancer detection research and education 7a7 ,plan ,to develop and validate a test or tests for prostate cancer 7#a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 acting through the ,director of the ,national ,institutes of ,health1 shall establish an advisory council on prostate cancer 7referred to in this section as the advisory council7 to draft a plan for the development and validation of an accurate test or tests1 such as biomarkers or imaging1 to detect and diagnose prostate cancer4 7#b7 ,advisory council 7,a7 ,membership 7i7 ,federal members ,the advisory council shall be composed of the following experts3 7,i7 ,a designee of the ,centers for ,disease ,control and ,prevention4 7,,ii7 ,a designee of the ,centers for ,medicare ,medicaid ,services4 7,,iii7 ,a designee of the ,office of the ,director of the ,national ,cancer ,institute4 7,,iv7 ,a designee of the ,director of the ,department of ,defense ,congressionally ,directed ,medical ,research ,programs4 7,v7 ,a designee of the ,director of the ,national ,institute of ,biomedical ,imaging and ,bioengineering4 7,,vi7 ,a designee of the ,director of the ,national ,institute of ,general ,medical ,sciences4 7,,vii7 ,a designee of the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities4 7,,viii7 ,a designee of the ,director of the ,national ,institutes of ,health4 7,,ix7 ,a designee of the ,commissioner of ,food and ,drugs4 7,x7 ,a designee of the ,director of the ,agency for ,healthcare ,research and ,quality4 7,,xi7 ,a designee of the ,director of the ,telemedicine and ,advanced ,technology ,research ,center of the ,department of ,defense4 7ii7 ,non-federal members ,in addition to the members described in clause 7i71 the advisory council shall include #h expert members from outside the ,federal ,government to be appointed by the ,secretary1 which shall include-- 7,i7 #b prostate cancer patient advocates2 7,,ii7 #b health care providers with a range of expertise and experience in prostate cancer2 and 7,,iii7 #d leading researchers with prostate cancer-related expertise in a range of clinical disciplines4 7,b7 ,meetings ,the advisory council shall meet quarterly and such meetings shall be open to the public4 7,c7 ,advice ,the advisory council shall advise the ,secretary1 or the ,secretary's designee4 7,d7 ,annual report ,not later than #a year after the date of enactment of this ,act1 the advisory council shall provide to the ,secretary1 or the ,secretary's designee1 and ,congress-- 7i7 an initial evaluation of all federally funded efforts in prostate cancer research relating to the development and validation of an accurate test or tests to detect and diagnose prostate cancer2 7ii7 a plan for the development and validation of a reliable test or tests for the detection and accurate diagnosis of prostate cancer2 and 7iii7 a set of standards for prostate cancer screening1 developed in coordination with the ,united ,states ,preventive ,services ,task ,force1 to ensure that any tools for screening1 detection1 and diagnosis developed in accordance with the plan under clause 7ii7 will meet the requirements of the ,task ,force for recommendation as a proven preventive or diagnostic service4 7,e7 ,termination ,the advisory council shall terminate on ,december #ca1 #bjbh4 7#c7 ,funding ,notwithstanding any other provision of law1 the ,secretary may make available #a1jjj1jjj1 from any unobligated amounts appropriated to the ,national ,institutes of ,health1 for each of fiscal years #bjbe through #bjbi to carry out this subsection4 7b7 ,coordination and intensification of prostate cancer research 7#a7 ,in general ,the ,director of the ,national ,institutes of ,health1 in consultation with the ,secretary of ,defense1 shall coordinate and intensify research in accordance with the plan provided under subsection 7a77#b77;,d77ii71 with particular attention provided to leveraging existing research to develop and validate a test or tests1 such as biomarkers or imaging1 to detect and accurately diagnose prostate cancer in order to improve quality of life for millions of individuals in the ,united ,states1 and decrease health care system costs4 7#b7 ,funding ,notwithstanding any other provision of law1 the ,secretary may make available #cj1jjj1jjj1 from any unobligated amounts appropriated to the ,national ,institutes of ,health1 for each of fiscal years #bjbe through #bjbi to carry out this subsection4 #gjje4 ,national ,prostate ,cancer ,council 7a7 ,national prostate cancer council 7#a7 ,establishment ,there is established in the ,office of the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 the ,national ,prostate ,cancer ,council on ,screening1 ,early ,detection1 ,assessment1 and ,monitoring of ,prostate ,cancer 7referred to in this section as the ,council74 7#b7 ,purpose of the council ,the ,council shall-- 7,a7 develop and implement a national strategic plan for the accelerated creation1 advancement1 and testing of diagnostic tools to improve screening1 early detection1 assessment1 and monitoring of prostate cancer1 including-- 7i7 early detection of aggressive prostate cancer to save lives2 7ii7 monitoring of tumor response to treatment1 including recurrence and progression2 and 7iii7 accurate assessment and surveillance of indolent disease to reduce unnecessary biopsies and treatment2 7,b7 provide information and coordination of prostate cancer research and services across all ,federal agencies2 7,c7 review diagnostic tools and their overall effectiveness at screening1 detecting1 assessing1 and monitoring of prostate cancer2 7,d7 evaluate all programs in prostate cancer that are in existence on the date of enactment of this ,act1 including ,federal budget requests and approvals and public-private partnerships2 7,e7 submit an annual report to the ,secretary and ,congress on the creation and implementation of the national strategic plan under subparagraph 7,a72 and 7,f7 ensure the inclusion of men at high risk for prostate cancer1 including men from minority ethnic and racial populations and men who are least likely to receive care1 in clinical1 research1 and service efforts1 with the purpose of decreasing health disparities4 7#c7 ,membership 7,a7 ,federal members ,the ,council shall be led by the ,secretary or the ,secretary's designee and composed of the following experts3 7i7 ,two representatives of the ,national ,institutes of ,health1 including #a representative of the ,national ,institute of ,biomedical ,imaging and ,bioengineering and #a representative of the ,national ,cancer ,institute4 7ii7 ,a representative of the ,centers for ,disease ,control and ,prevention4 7iii7 ,a representative of the ,centers for ,medicare ,medicaid ,services4 7iv7 ,a designee of the ,director of the ,department of ,defense ,congressionally ,directed ,medical ,research ,programs4 7v7 ,a designee of the ,director of the ,office of ,minority ,health4 7vi7 ,a representative of the ,food and ,drug ,administration4 7vii7 ,a representative of the ,agency for ,healthcare ,research and ,quality4 7,b7 ,non-federal members ,in addition to the members described in subparagraph 7,a71 the ,council shall include #ad expert members from outside the ,federal ,government1 which shall include-- 7i7 #f prostate cancer patient advocates1 including-- 7,i7 #b patient-survivors2 7,,ii7 #b caregivers of prostate cancer patients2 and 7,,iii7 #b representatives from national prostate cancer disease organizations that fund research or have demonstrated experience in providing assistance to patients1 families1 and medical professionals1 including information on health care options1 education1 and referral2 and 7ii7 #h health care stakeholders with specific expertise in prostate cancer research in the critical areas of clinical expertise1 including medical oncology1 radiology1 radiation oncology1 urology1 and pathology4 7#d7 ,meetings ,the ,council shall meet quarterly and meetings shall be open to the public4 7#e7 ,advice ,the ,council shall advise the ,secretary1 or the ,secretary's designee4 7#f7 ,annual report ,the ,council shall submit annual reports1 beginning not later than #a year after the date of enactment of this ,act1 to the ,secretary or the ,secretary's designee and to ,congress4 ,the annual report shall include-- 7,a7 in the first year-- 7i7 an evaluation of all federally funded efforts in prostate cancer research and gaps relating to the development and validation of diagnostic tools for prostate cancer2 and 7ii7 recommendations for priority actions to expand1 eliminate1 coordinate1 or condense programs based on the performance1 mission1 and purpose of the programs2 and 7,b7 annually thereafter for #e years-- 7i7 an outline for the development and implementation of a national research plan for creation and validation of accurate diagnostic tools to improve prostate cancer care in accordance with paragraph 7#a72 7ii7 roles for the ,national ,cancer ,institute1 ,national ,institute on ,minority ,health and ,health ,disparities1 and the ,office of ,minority ,health of the ,department of ,health and ,human ,services2 7iii7 an analysis of the disparities in the incidence and mortality rates of prostate cancer in men at high risk of the disease1 including individuals with family history1 increasing age1 or ,african-,american heritage2 and 7iv7 a review of the progress towards the realization of the proposed strategic plan4 7#g7 ,termination ,the ,council shall terminate on ,december #ca1 #bjbg4 #gjjf4 ,improved ,medicaid coverage for certain breast and cervical cancer patients in the territories 7a7 ,elimination of funding limitations ,section #aajh7;g77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7;g77#d77 is amended-- 7#a7 by striking paragraphs 7#a71 7#b71 7#c71 and 7#d7 of 2 and 7#b7 by adding at the end the following3 ,with respect to fiscal years beginning with fiscal year #bjbd1 payment for medical assistance for individuals who are eligible for such assistance only on the basis of section #aijb7;a77#aj77;,a77ii77,,xviii7 shall not be taken into account in applying subsection 7f7 7as increased in accordance with this subsection7 to ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa for such fiscal year44 7b7 ,application of enhanced ,,fmap for highest ,state ,section #aije7;b7 of such ,act 7#db ,u4,s4,c4 #acif;d7b77 is amended by adding at the end the following3 ,notwithstanding the first sentence of this subsection1 with respect to medical assistance described in clause 7#d7 of such sentence that is furnished in ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa in a fiscal year1 the ,federal medical assistance percentage is equal to the highest such percentage applied under such clause for such fiscal year for any of the #ej ,states or the ,district of ,columbia that provides such medical assistance for any portion of such fiscal year44 7c7 ,effective date ,the amendments made by this section shall apply to payment for medical assistance for items and services furnished on or after ,october #a1 #bjbd4 #gjjg4 ,cancer prevention and treatment demonstration for ethnic and racial minorities 7a7 ,demonstration 7#a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall1 consistent with subsection 7b71 conduct demonstration projects for the purpose of developing models and evaluating methods that-- 7,a7 improve the quality of items and services provided to target individuals in order to facilitate reduced disparities in early detection and treatment of cancer2 7,b7 improve clinical outcomes1 satisfaction1 quality of life1 appropriate use of items and services covered under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 and referral patterns with respect to target individuals with cancer2 7,c7 eliminate disparities in the rate of preventive cancer screening measures1 such as ,pap smears1 prostate cancer screenings1 colon and colorectal cancer screenings1 breast cancer screenings1 and computed tomography scans1 for lung cancer among target individuals2 7,d7 promote collaboration with community-based organizations to ensure cultural competency of health care professionals and linguistic access for target individuals with limited ,english proficiency2 and 7,e7 encourage the incorporation of community health workers to increase the efficiency and appropriateness of cancer screening programs4 7#b7 ,community health worker defined ,in this section1 the term community health worker includes a community health advocate1 a lay health worker1 a community health representative1 a peer health promoter1 a community health outreach worker1 and a promotore de salud1 who promotes health or nutrition within the community in which the individual resides4 7#c7 ,target individual defined ,in this section1 the term target individual means an individual of a racial and ethnic minority group1 as defined in section #agjg7;g77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a771 who is entitled to benefits under part ,a1 and enrolled under part ,b1 of title ,,xviii of the ,social ,security ,act4 7b7 ,program design 7#a7 ,initial design ,not later than #a year after the date of the enactment of this ,act1 the ,secretary shall evaluate best practices in the private sector1 community programs1 and academic research of methods that reduce disparities among individuals of racial and ethnic minority groups in the prevention and treatment of cancer and shall design the demonstration projects based on such evaluation4 7#b7 ,number and project areas ,not later than #b years after the date of the enactment of this ,act1 the ,secretary shall implement at least #i demonstration projects1 including the following3 7,a7 ,two projects1 each of which shall target different ethnic subpopulations1 for each racial and ethnic minority group described in clauses 7i7 through 7vi7 of section #agjg7;g77#a77;,a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g77#a77;,a774 7,b7 ,one project within the ,pacific ,islands or ,united ,states insular areas4 7,c7 ,at least #a project in a rural area4 7,d7 ,at least #a project in an inner-city area4 7#c7 ,expansion of projects2 implementation of demonstration project results ,the ,secretary shall continue the demonstration projects and may expand the number of demonstration projects if the initial report under subsection 7c7 contains an evaluation that the demonstration projects-- 7,a7 reduce expenditures under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq472 or 7,b7 do not increase expenditures under such ,medicare program and reduce racial and ethnic health disparities in the quality of health care services provided to target individuals and increase satisfaction of ,medicare beneficiaries and health care providers4 7c7 ,report to ,congress 7#a7 ,in general ,not later than #b years after the date the ,secretary implements the initial demonstration projects under this section1 and biannually thereafter1 the ,secretary shall submit to ,congress a report regarding the demonstration projects4 7#b7 ,content of report ,each report under paragraph 7#a7 shall include the following3 7,a7 ,a description of the demonstration projects4 7,b7 ,an evaluation of-- 7i7 the cost-effectiveness of the demonstration projects2 7ii7 the quality of the health care services provided to target individuals under the demonstration projects2 and 7iii7 beneficiary and health care provider satisfaction under the demonstration projects4 7,c7 ,any other information regarding the demonstration projects that the ,secretary determines to be appropriate4 7d7 ,waiver authority ,the ,secretary shall waive compliance with the requirements of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 to such extent and for such period as the ,secretary determines is necessary to conduct the demonstration projects under this section4 #gjjh4 ,reducing cancer disparities within ,medicare 7a7 ,development of measures of disparities in quality of cancer care 7#a7 ,development of measures ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall enter into an agreement with an entity that specializes in developing quality measures for cancer care under which the entity shall develop a uniform set of measures to evaluate disparities in the quality of cancer care and annually update such set of measures4 7#b7 ,measures to be included ,such set of measures shall include1 with respect to the treatment of cancer1 measures of patient outcomes1 the process for delivering medical care related to such treatment1 patient counseling and engagement in decision making1 patient experience of care1 resource use1 and practice capabilities1 such as care coordination4 7b7 ,establishment of reporting process 7#a7 ,in general ,the ,secretary shall establish a reporting process that requires and provides for a method for health care providers specified under paragraph 7#b7 to submit to the ,secretary and make public data on the performance of such providers during each reporting period through use of the measures developed pursuant to subsection 7a74 ,such data shall be submitted in a form and manner and at a time specified by the ,secretary4 7#b7 ,specification of providers to report on measures ,the ,secretary shall specify the classes of ,medicare providers of services and suppliers1 including hospitals1 cancer centers1 physicians1 primary care providers1 and specialty providers1 that will be required under such process to publicly report on the measures specified under subsection 7a74 7#c7 ,assessment of changes ,under such reporting process1 the ,secretary shall establish a format that assesses changes in both the absolute and relative disparities in cancer care over time4 ,these measures shall be presented in an easily comprehensible format1 such as those presented in the final publications relating to ,healthy ,people #bjaj or the ,national ,healthcare ,disparities ,report4 7#d7 ,initial implementation ,the ,secretary shall implement the reporting process under this subsection for reporting periods beginning not later than #f months after the date that measures are first established under subsection 7a74 ,b ,viral hepatitis and liver cancer control and prevention #gaja4 ,biennial assessment of ,,hhs hepatitis ,b and hepatitis ,c prevention1 education1 research1 and medical management plan ,title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bda et seq47 is amended-- 7#a7 by striking section #cag,n 7#db ,u4,s4,c4 #bdg;b-#ae72 and 7#b7 by adding after part ,v the following3 ,w ,biennial assessment of ,,hhs ,hepatitis ,b and ,hepatitis ,c prevention1 education1 research1 and medical management plan #cii,,oo4 ,biennial ,update of the ,plan 7a7 ,in general ,the ,secretary shall conduct a biennial assessment of the ,secretary's plan for the prevention1 control1 and medical management of1 and education and research relating to1 hepatitis ,b and hepatitis ,c1 for the purposes of-- 7#a7 incorporating into such plan new knowledge or observations relating to hepatitis ,b and hepatitis ,c 7such as knowledge and observations that may be derived from clinical1 laboratory1 and epidemiological research and disease detection1 prevention1 and surveillance outcomes72 7#b7 addressing gaps in the coverage or effectiveness of the plan2 and 7#c7 evaluating and1 if appropriate1 updating recommendations1 guidelines1 or educational materials of the ,centers for ,disease ,control and ,prevention or the ,national ,institutes of ,health for health care providers or the public on viral hepatitis in order to be consistent with the plan4 7b7 ,publication of notice of assessments ,not later than ,october #a of the first even-numbered year beginning after the date of the enactment of this part1 and ,october #a of each even-numbered year thereafter1 the ,secretary shall publish in the ,federal ,register a notice of the results of the assessments conducted under subsection 7a74 ,such notice shall include-- 7#a7 a description of any revisions to the plan referred to in subsection 7a7 as a result of the assessment2 7#b7 an explanation of the basis for any such revisions1 including the ways in which such revisions can reasonably be expected to further promote the original goals and objectives of the plan2 and 7#c7 in the case of a determination by the ,secretary that the plan does not need revision1 an explanation of the basis for such determination4 #cii,,oo-#a4 ,elements of program 7a7 ,education and awareness programs ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 the ,administrator of the ,health ,resources and ,services ,administration1 and the ,assistant ,secretary for ,mental ,health and ,substance ,use1 and in accordance with the plan referred to in section #cii,,oo7a71 shall implement programs to increase awareness and enhance knowledge and understanding of hepatitis ,b and hepatitis ,c4 ,such programs shall include-- 7#a7 the conduct of culturally and linguistically appropriate health education in primary and secondary schools1 college campuses1 public awareness campaigns1 and community outreach activities 7especially to the ethnic communities with high rates of chronic hepatitis ,b and chronic hepatitis ,c and other high-risk groups7 to promote public awareness and knowledge about-- 7,a7 the value of hepatitis ,a and hepatitis ,b immunization2 7,b7 risk factors1 transmission1 and prevention of hepatitis ,b and hepatitis ,c2 7,c7 the value of screening for the early detection of hepatitis ,b and hepatitis ,c2 and 7,d7 options available for the treatment of chronic hepatitis ,b and chronic hepatitis ,c2 7#b7 the promotion of immunization programs that increase awareness and access to hepatitis ,a and hepatitis ,b vaccines for susceptible adults and children2 7#c7 the training of health care professionals regarding the importance of vaccinating individuals infected with hepatitis ,c and individuals who are at risk for hepatitis ,c infection against hepatitis ,a and hepatitis ,b2 7#d7 the training of health care professionals regarding the importance of vaccinating individuals chronically infected with hepatitis ,b and individuals who are at risk for chronic hepatitis ,b infection against the hepatitis ,a virus2 7#e7 the training of health care professionals and health educators to make them aware of the high rates of chronic hepatitis ,b and chronic hepatitis ,c in certain adult ethnic populations1 and the importance of prevention1 detection1 and medical management of hepatitis ,b and hepatitis ,c and of liver cancer screening2 7#f7 the development and distribution of health education curricula 7including information relating to the special needs of individuals infected with or at risk of hepatitis ,b and hepatitis ,c1 such as the importance of prevention and early intervention1 regular monitoring1 the recognition of psychosocial needs1 appropriate treatment1 and liver cancer screening7 for individuals providing hepatitis ,b and hepatitis ,c counseling2 and 7#g7 support for the implementation of the curricula described in paragraph 7#f7 by ,state and local public health agencies4 7b7 ,immunization1 prevention1 and control programs 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall support the integration of activities described in paragraph 7#c7 into existing clinical and public health programs at ,state1 local1 territorial1 and ,tribal levels 7including community health clinics1 programs for the prevention and treatment of ,,hiv_/,,aids1 sexually transmitted infections1 and substance use disorder1 and programs for individuals in correctional settings74 7#b7 ,coordination of development of ,federal screening guidelines 7,a7 ,references ,for purposes of this subsection1 the term ,,cdc ,director means the ,director of the ,centers for ,disease ,control and ,prevention1 and the term ,,ahrq ,director means the ,director of the ,agency for ,healthcare ,research and ,quality4 7,b7 ,agency for healthcare research and quality ,due to the rapidly evolving standard of care associated with diagnosing and treating viral hepatitis infection1 the ,,ahrq ,director shall convene the ,preventive ,services ,task ,force under section #iae7;a7 to review its recommendation for screening for ,,hbv and ,,hcv infection every #c years4 7#c7 ,activities 7,a7 ,voluntary testing programs 7i7 ,in general ,the ,secretary shall establish a mechanism by which to support and promote the development of ,state1 local1 territorial1 and ,tribal voluntary hepatitis ,b and hepatitis ,c testing programs to screen the high-prevalence populations to aid in the early identification of chronically infected individuals4 7ii7 ,confidentiality of the test results ,the ,secretary shall prohibit the use of the results of a hepatitis ,b or hepatitis ,c test conducted by a testing program developed or supported under this subparagraph for any of the following3 7,i7 ,issues relating to health insurance4 7,,ii7 ,to screen or determine suitability for employment4 7,,iii7 ,to discharge a person from employment4 7,b7 ,counseling regarding viral hepatitis ,the ,secretary shall support ,state1 local1 territorial1 and ,tribal programs in a wide variety of settings1 including those providing primary and specialty health care services in nonprofit private and public sectors1 to-- 7i7 provide individuals with ongoing risk factors for hepatitis ,b and hepatitis ,c infection with client-centered education and counseling which concentrates on-- 7,i7 promoting testing of individuals that have been exposed to their blood1 family members1 and their sexual partners2 and 7,,ii7 changing behaviors that place individuals at risk for infection2 7ii7 provide individuals chronically infected with hepatitis ,b or hepatitis ,c with education1 health information1 and counseling to reduce their risk of-- 7,i7 dying from end-stage liver disease and liver cancer2 and 7,,ii7 transmitting viral hepatitis to others2 and 7iii7 provide people chronically infected with hepatitis ,b or hepatitis ,c who are pregnant or of childbearing age with culturally and linguistically appropriate health information1 such as how to prevent hepatitis ,b perinatal infection1 and to alleviate fears associated with pregnancy or raising a family4 7,c7 ,immunization ,the ,secretary shall support ,state1 local1 territorial1 and ,tribal efforts to expand the current vaccination programs to protect every child in the ,nation and all susceptible adults1 particularly those infected with hepatitis ,c and high-prevalence ethnic populations and other high-risk groups1 from the risks of acute and chronic hepatitis ,b infection by-- 7i7 ensuring continued funding for hepatitis ,b vaccination for all children #ah years of age or younger through the ,vaccines for ,children program2 7ii7 ensuring that the recommendations of the ,advisory ,committee on ,immunization ,practices of the ,centers for ,disease ,control and ,prevention are followed regarding hepatitis ,b vaccination for infants1 children1 and adults2 7iii7 requiring proof of hepatitis ,b vaccination for entry into public or private daycare1 preschool1 elementary school1 secondary school1 and institutions of higher education2 7iv7 expanding the availability of hepatitis ,b vaccination for all adults to protect them from becoming acutely or chronically infected1 including ethnic and other populations with high prevalence rates of chronic hepatitis ,b infection2 7v7 expanding the availability of hepatitis ,b vaccination for all adults1 particularly those of reproductive age 7women and men less than #de years of age71 to protect them from the risk of hepatitis ,b infection2 7vi7 ensuring the vaccination of individuals infected1 or at risk for infection1 with hepatitis ,c against hepatitis ,a1 hepatitis ,b1 and other infectious diseases1 as appropriate1 for which such individuals may be at increased risk2 and 7vii7 ensuring the vaccination of individuals infected1 or at risk for infection1 with hepatitis ,b against hepatitis ,a virus and other infectious diseases1 as appropriate1 for which such individuals may be at increased risk4 7,d7 ,medical referral ,the ,secretary shall support ,state1 local1 territorial1 and ,tribal programs that support-- 7i7 referral of persons chronically infected with hepatitis ,b or hepatitis ,c-- 7,i7 for medical evaluation to determine the appropriateness for antiviral treatment to reduce the risk of progression to cirrhosis and liver cancer2 and 7,,ii7 for ongoing medical management including regular monitoring of liver function and screening for liver cancer2 and 7ii7 referral of persons infected with acute or chronic hepatitis ,b infection or acute or chronic hepatitis ,c infection for drug and alcohol abuse treatment where appropriate4 7#d7 ,increased support for adult viral hepatitis prevention coordinators ,the ,secretary1 acting through the ,,cdc ,director1 shall provide increased support to adult viral hepatitis prevention coordinators in ,state1 local1 territorial1 and ,tribal health departments in order to enhance the additional management1 networking1 and technical expertise needed to ensure successful integration of hepatitis ,b and hepatitis ,c prevention and control activities into existing public health programs4 7c7 ,epidemiological surveillance 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall support the establishment and maintenance of a national chronic and acute hepatitis ,b and hepatitis ,c surveillance program1 in order to identify-- 7,a7 trends in the incidence of acute and chronic hepatitis ,b and acute and chronic hepatitis ,c2 7,b7 trends in the prevalence of acute and chronic hepatitis ,b and acute and chronic hepatitis ,c infection among groups that may be disproportionately affected2 and 7,c7 trends in liver cancer and end-stage liver disease incidence and deaths1 caused by chronic hepatitis ,b and chronic hepatitis ,c in the high-risk ethnic populations4 7#b7 ,seroprevalence and liver cancer studies ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall prepare a report outlining the population-based seroprevalence studies currently underway1 future planned studies1 the criteria involved in determining which seroprevalence studies to conduct1 defer1 or suspend1 and the scope of those studies1 the economic and clinical impact of hepatitis ,b and hepatitis ,c1 and the impact of chronic hepatitis ,b and chronic hepatitis ,c infections on the quality of life4 ,not later than one year after the date of the enactment of this part1 the ,secretary shall submit the report to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives4 7#c7 ,confidentiality ,the ,secretary shall not disclose any individually identifiable information identified under paragraph 7#a7 or derived through studies under paragraph 7#b74 7d7 ,research ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 the ,director of the ,national ,cancer ,institute1 and the ,director of the ,national ,institutes of ,health1 shall-- 7#a7 conduct epidemiologic and community-based research to develop1 implement1 and evaluate best practices for hepatitis ,b and hepatitis ,c prevention especially in the ethnic populations with high rates of chronic hepatitis ,b and chronic hepatitis ,c and other high-risk groups2 7#b7 conduct research on hepatitis ,b and hepatitis ,c natural history1 pathophysiology1 improved treatments and prevention 7such as the hepatitis ,c vaccine71 and noninvasive tests that help to predict the risk of progression to liver cirrhosis and liver cancer2 7#c7 conduct research that will lead to better noninvasive or blood tests to screen for liver cancer1 and more effective treatments of liver cancer caused by chronic hepatitis ,b and chronic hepatitis ,c2 and 7#d7 conduct research comparing the effectiveness of screening1 diagnostic1 management1 and treatment approaches for chronic hepatitis ,b1 chronic hepatitis ,c1 and liver cancer in the affected communities4 7e7 ,underserved and disproportionately affected populations ,in carrying out this section1 the ,secretary shall provide expanded support for individuals with limited access to health education1 testing1 and health care services and groups that may be disproportionately affected by hepatitis ,b and hepatitis ,c4 7f7 ,evaluation of program ,the ,secretary shall develop benchmarks for evaluating the effectiveness of the programs and activities conducted under this section and make determinations as to whether such benchmarks have been achieved4 #cii,,oo-#b4 ,grants 7a7 ,in general ,the ,secretary may award grants to1 or enter into contracts or cooperative agreements with1 ,states1 political subdivisions of ,states1 territories1 ,indian ,tribes1 or nonprofit entities that have special expertise relating to hepatitis ,b1 hepatitis ,c1 or both1 to carry out activities under this part4 7b7 ,application ,to be eligible for a grant1 contract1 or cooperative agreement under subsection 7a71 an entity shall prepare and submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 #cii,,oo-#c4 ,authorization of appropriations ,there are authorized to be appropriated to carry out this part #ij1jjj1jjj for fiscal year #bjbe1 #aaj1jjj1jjj for fiscal year #bjbf1 #acj1jjj1jjj for fiscal year #bjbg1 and #aej1jjj1jjj for fiscal year #bjbh4 4 #gajb4 ,liver cancer and disease prevention1 awareness1 and patient tracking grants ,subpart ,i of part ,d of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b et seq47 is amended by adding at the end the following3 #ccj,q4 ,liver cancer and disease prevention1 awareness1 and patient tracking grants 7a7 ,prevention initiative grant program 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 may award grants and enter into cooperative agreements with entities for the purpose of expanding and supporting-- 7,a7 prevention activities 7including providing screenings1 vaccinations1 or other preventative interventions7 for conditions known to increase an individual's risk of developing a major liver disease1 such as liver cancer1 hepatitis ,b1 hepatitis ,c1 nonalcoholic fatty liver disease1 nonalcoholic steatohepatitis1 and cirrhosis of the liver2 7,b7 activities relating to detection and provision of guidance for individuals at high risk for contracting liver cancer and other liver diseases2 and 7,c7 viral hepatitis surveillance to provide for timely and accurate information regarding progress to eliminate viral hepatitis4 7#b7 ,report ,an entity that receives a grant or cooperative agreement under paragraph 7#a7 shall submit to the ,secretary1 at a time specified by the ,secretary1 a report describing each activity carried out pursuant to such paragraph and evaluating the effectiveness of such activity in promoting prevention and treatment of liver cancer and other liver diseases4 7#c7 ,authorization of appropriations ,for purposes of carrying out this subsection1 there is authorized to be appropriated #ij1jjj1jjj for each of fiscal years #bjbd through #bjbh4 7b7 ,awareness initiative grant program 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 may award grants to eligible entities for the purpose of raising awareness for liver cancer and other liver diseases1 which may include the production1 dissemination1 and distribution of informational materials targeted towards communities and populations with a higher risk for developing liver cancer and other liver diseases4 7#b7 ,eligible entities ,to be eligible to receive a grant under paragraph 7#a71 an entity shall submit to the ,secretary an application1 at such time1 in such manner1 and containing such information as the ,secretary may require1 including a description of how the entity1 in disseminating information on liver cancer and other liver diseases pursuant to paragraph 7#a71 will-- 7,a7 with respect to any community or population1 consult with members of such community or population and provide such information in a manner that is culturally and linguistically appropriate for such community or population2 7,b7 highlight the range of preventative measures and treatments available for liver cancer and other liver diseases2 7,c7 integrate information on available hepatitis ,b and hepatitis ,c testing programs into any liver cancer presentations carried out by the entity2 and 7,d7 address communities and populations with a higher risk for contracting liver cancer and other liver diseases4 7#c7 ,preference ,in awarding grants under paragraph 7#a71 the ,secretary shall give preference to entities that-- 7,a7 work with a ,federally qualified health center2 7,b7 are community-based organizations2 or 7,c7 serve communities and populations with a higher risk for contracting liver cancer and other liver diseases4 7#d7 ,report ,an entity that receives a grant under paragraph 7#a7 shall submit to the ,secretary1 at a time specified by the ,secretary1 a report describing each activity carried out pursuant to such paragraph and evaluating the effectiveness of such activity in raising awareness for liver cancer and other liver diseases4 7#e7 ,authorization of appropriations ,for purposes of carrying out this subsection1 there is authorized to be appropriated #aj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 4 ,c ,acquired bone marrow failure diseases #gbja4 ,acquired bone marrow failure diseases 7a7 ,national ,acquired ,bone ,marrow ,failure ,disease ,registry ,title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bda et seq47 is amended by inserting after section #cag,w1 as added by section #ajji1 the following3 #cag,x4 ,national ,acquired ,bone ,marrow ,failure ,disease ,registry 7a7 ,establishment of registry 7#a7 ,in general ,not later than #f months after the date of the enactment of this section1 the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall-- 7,a7 develop a system to collect data on acquired bone marrow failure diseases2 and 7,b7 establish and maintain a national and publicly available registry1 to be known as the ,national ,acquired ,bone ,marrow ,failure ,disease ,registry1 in accordance with paragraph 7#c74 7#b7 ,recommendations of advisory committee ,in carrying out this subsection1 the ,secretary shall take into consideration the recommendations of the ,advisory ,committee on ,acquired ,bone ,marrow ,failure ,diseases established under subsection 7b74 7#c7 ,purposes of registry ,the ,national ,acquired ,bone ,marrow ,failure ,disease ,registry shall-- 7,a7 identify the incidence and prevalence of acquired bone marrow failure diseases in the ,united ,states2 7,b7 be used to collect and store data on acquired bone marrow failure diseases1 including data concerning-- 7i7 the age1 race or ethnicity1 general geographic location1 sex1 and family history of individuals who are diagnosed with acquired bone marrow failure diseases1 and any other characteristics of such individuals determined appropriate by the ,secretary2 7ii7 the genetic and environmental factors that may be associated with developing acquired bone marrow failure diseases2 7iii7 treatment approaches for dealing with acquired bone marrow failure diseases2 7iv7 outcomes for individuals treated for acquired bone marrow failure diseases1 including outcomes for recipients of stem cell therapeutic products as contained in the database established pursuant to section #cgi;,a2 and 7v7 any other factors pertaining to acquired bone marrow failure diseases determined appropriate by the ,secretary2 and 7,c7 be made available-- 7i7 to the general public2 and 7ii7 to researchers to facilitate further research into the causes of1 and treatments for1 acquired bone marrow failure diseases in accordance with standard practices of the ,centers for ,disease ,control and ,prevention4 7b7 ,advisory committee 7#a7 ,establishment ,not later than #f months after the date of the enactment of this section1 the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall establish an advisory committee1 to be known as the ,advisory ,committee on ,acquired ,bone ,marrow ,failure ,diseases4 7#b7 ,members ,the members of the ,advisory ,committee on ,acquired ,bone ,marrow ,failure ,diseases shall be appointed by the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 and shall include at least one representative from each of the following3 7,a7 ,a national patient advocacy organization with experience advocating on behalf of patients suffering from acquired bone marrow failure diseases4 7,b7 ,the ,national ,institutes of ,health1 including at least one representative from each of-- 7i7 the ,national ,cancer ,institute2 7ii7 the ,national ,heart1 ,lung1 and ,blood ,institute2 and 7iii7 the ,office of ,rare ,diseases4 7,c7 ,the ,centers for ,disease ,control and ,prevention4 7,d7 ,clinicians with experience in-- 7i7 diagnosing or treating acquired bone marrow failure diseases2 or 7ii7 medical data registries4 7,e7 ,epidemiologists who have experience with data registries4 7,f7 ,publicly or privately funded researchers who have experience researching acquired bone marrow failure diseases4 7,g7 ,the entity operating the ,c4,w4 ,bill ,young ,cell ,transplantation ,program established pursuant to section #cgi and the entity operating the ,c4,w4 ,bill ,young ,cell ,transplantation ,program ,outcomes ,database4 7#c7 ,responsibilities ,the ,advisory ,committee on ,acquired ,bone ,marrow ,failure ,diseases shall provide recommendations to the ,secretary on the establishment and maintenance of the ,national ,acquired ,bone ,marrow ,failure ,disease ,registry1 including recommendations on the collection1 maintenance1 and dissemination of data4 7#d7 ,public availability ,the ,secretary shall make the recommendations of the ,advisory ,committee on ,acquired ,bone ,marrow ,failure ,disease publicly available4 7c7 ,grants ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 may award grants to1 and enter into contracts and cooperative agreements with1 public or private nonprofit entities for the management of1 as well as the collection1 analysis1 and reporting of data to be included in1 the ,national ,acquired ,bone ,marrow ,failure ,disease ,registry4 7d7 ,definition ,in this section1 the term acquired bone marrow failure disease means-- 7#a7 myelodysplastic syndromes2 7#b7 aplastic anemia2 7#c7 paroxysmal nocturnal hemoglobinuria2 7#d7 pure red cell aplasia2 7#e7 acute myeloid leukemia that has progressed from myelodysplastic syndromes2 or 7#f7 large granular lymphocytic leukemia4 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #c1jjj1jjj for each of fiscal years #bjbe through #bjbi4 4 7b7 ,pilot studies through the agency for toxic substances and disease registry 7#a7 ,pilot studies ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,agency for ,toxic ,substances and ,disease ,registry1 shall conduct pilot studies to determine which environmental factors1 including exposure to toxins1 may cause acquired bone marrow failure diseases4 7#b7 ,collaboration with the ,radiation ,injury ,treatment ,network ,in carrying out the directives of this section1 the ,secretary of ,health and ,human ,services may collaborate with the ,radiation ,injury ,treatment ,network of the ,c4,w4 ,bill ,young ,cell ,transplantation ,program established pursuant to section #cgi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bgdk7 to-- 7,a7 augment data for the pilot studies authorized by this section2 7,b7 access technical assistance that may be provided by the ,radiation ,injury ,treatment ,network2 or 7,c7 perform joint research projects4 7#c7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this subsection #a1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7c7 ,minority-,focused programs on acquired bone marrow failure diseases ,title ,,xvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju et seq47 is amended by inserting after section #agjg;,a the following3 #agjg;,b4 ,minority-focused programs on acquired bone marrow failure disease 7a7 ,information and referral services 7#a7 ,in general ,not later than #f months after the date of the enactment of this section1 the ,secretary1 acting through the ,deputy ,assistant ,secretary for ,minority ,health1 shall establish and coordinate outreach and informational programs targeted to minority populations affected by acquired bone marrow failure diseases4 7#b7 ,program requirements ,minority-focused outreach and informational programs authorized by this section at the ,national ,minority ,health ,resource ,center supported under section #agjg7;b77#h7 7including by means of the ,center's website1 through appropriate locations such as the ,center's knowledge center1 and through appropriate programs such as the ,center's resource persons network7 and through minority health consultants located at each ,department of ,health and ,human ,services regional office-- 7,a7 shall make information about treatment options and clinical trials for acquired bone marrow failure diseases publicly available2 and 7,b7 shall provide referral services for treatment options and clinical trials4 7b7 ,hispanic and ,asian-,american and pacific islander outreach 7#a7 ,in general ,the ,secretary1 acting through the ,deputy ,assistant ,secretary for ,minority ,health1 shall undertake a coordinated outreach effort to connect ,hispanic1 ,asian-,american1 and ,pacific ,islander communities with comprehensive services focused on treatment of1 and information about1 acquired bone marrow failure diseases4 7#b7 ,collaboration ,in carrying out this subsection1 the ,secretary may collaborate with public health agencies1 nonprofit organizations1 community groups1 and online entities to disseminate information about treatment options and clinical trials for acquired bone marrow failure diseases4 7c7 ,grants and cooperative agreements 7#a7 ,in general ,not later than #f months after the date of the enactment of this section1 the ,secretary1 acting through the ,deputy ,assistant ,secretary for ,minority ,health1 shall award grants to1 or enter into cooperative agreements with1 entities to perform research on acquired bone marrow failure diseases4 7#b7 ,requirement ,grants and cooperative agreements authorized by this subsection shall be awarded or entered into on a competitive1 peer-reviewed basis4 7#c7 ,scope of research ,research funded under this subsection shall examine factors affecting the incidence of acquired bone marrow failure diseases in minority populations4 7d7 ,definition ,in this section1 the term acquired bone marrow failure disease has the meaning given to such term in section #cag,x7d74 7e7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section #b1jjj1jjj for each of fiscal years #bjbe through #bjbi4 4 7d7 ,diagnosis and quality of care for acquired bone marrow failure diseases 7#a7 ,grants ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,agency for ,healthcare ,research and ,quality1 shall award grants to entities to improve diagnostic practices and quality of care with respect to patients with acquired bone marrow failure diseases4 7#b7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this subsection #b1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7e7 ,definition ,in this section1 the term acquired bone marrow failure disease has the meaning given such term in section #cag,x7d7 of the ,public ,health ,service ,act1 as added by subsection 7a74 ,d ,cardiovascular disease1 chronic disease1 obesity1 and other disease issues #gcja4 ,guidelines for disease screening for minority patients 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary71 acting through the ,director of the ,agency for ,healthcare ,research and ,quality1 shall convene a series of meetings to develop guidelines for disease screening for minority patient populations that have a higher than average risk for many chronic diseases and cancers4 7b7 ,participants ,in convening meetings under subsection 7a71 the ,secretary shall ensure that meeting participants include representatives of-- 7#a7 professional societies and associations2 7#b7 minority health organizations2 7#c7 health care researchers and providers1 including those with expertise in minority health2 7#d7 ,federal health agencies1 including the ,office of ,minority ,health1 the ,national ,institute on ,minority ,health and ,health ,disparities1 and the ,national ,institutes of ,health2 and 7#e7 other experts as the ,secretary determines appropriate4 7c7 ,diseases ,screening guidelines for minority populations shall be developed as appropriate under subsection 7a7 for-- 7#a7 hypertension2 7#b7 hypercholesterolemia2 7#c7 diabetes2 7#d7 cardiovascular disease2 7#e7 cancers1 including breast1 prostate1 colon1 cervical1 and lung cancer2 7#f7 other pulmonary problems including sleep apnea2 7#g7 asthma2 7#h7 kidney diseases2 7#i7 eye diseases and disorders1 including glaucoma2 7#aj7 ,,hiv_/,,aids and sexually transmitted infections2 7#aa7 uterine fibroids2 7#ab7 autoimmune diseases1 including lupus2 7#ac7 mental health conditions2 7#ad7 dental health conditions and oral diseases1 including oral cancer2 7#ae7 environmental and related health illnesses and conditions2 7#af7 sickle cell disease and sickle cell trait2 7#ag7 violence and injury prevention and control2 7#ah7 genetic and related conditions2 7#ai7 heart disease and stroke2 7#bj7 tuberculosis2 7#ba7 chronic obstructive pulmonary disease2 7#bb7 musculoskeletal diseases1 arthritis1 and obesity2 and 7#bc7 other diseases determined appropriate by the ,secretary4 7d7 ,dissemination ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall publish and disseminate to health care provider organizations the guidelines developed under subsection 7a74 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #gcjb4 ,,cdc ,wisewoman ,screening ,program ,section #aeji of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjjn-#d;a7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by striking the heading and inserting ,in ,general4--2 and 7,b7 in the matter preceding paragraph 7#a71 by striking may make grants and all that follows through purpose and inserting the following3 may make grants to such ,states for the purpose2 and 7#b7 in subsection 7d77#a71 by striking there are authorized and all that follows through the period and inserting there are authorized to be appropriated #bc1jjj1jjj for fiscal year #bjbe1 #be1cjj1jjj for fiscal year #bjbf1 #bg1hjj1jjj for fiscal year #bjbg1 #cj1hjj1jjj for fiscal year #bjbh1 and #cd1jjj1jjj for fiscal year #bjbi44 #gcjc4 ,report on cardiovascular care for women and minorities ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq471 as amended by section #ebja7;c77#c71 is amended by adding at the end the following3 #cii,v-#aj4 ,report on cardiovascular care for women and minorities ,not later than ,september #cj1 #bjbd1 and annually thereafter1 the ,secretary shall prepare and submit to ,congress a report on the quality of and access to care for women and minorities with heart disease1 stroke1 and other cardiovascular diseases4 ,the report shall contain recommendations for eliminating disparities in1 and improving the treatment of1 heart disease1 stroke1 and other cardiovascular diseases in women1 racial and ethnic minorities1 those for whom ,english is not their primary language1 and individuals with disabilities4 4 #gcjd4 ,,gao report on structural and systemic factors that perpetuate cardiovascular disparities 7a7 ,in ,general ,not later than ,september #cj1 #bjbe1 the ,government ,accountability ,office shall prepare and submit a report to ,congress that contains the results of an investigation of-- 7#a7 the structural and systemic factors that perpetuate disparities in access to screenings1 care1 and treatment of cardiovascular disease2 and 7#b7 how care navigation1 including community-based health workers1 can improve cardiovascular disease management and improve health outcomes4 7b7 ,contents ,the report shall-- 7#a7 identify the challenges and barriers facing healthcare providers and patients1 which contribute to postponed1 delayed1 or suboptimal treatments for cardiovascular disease2 7#b7 examine efforts by ,federal agencies and ,federal programs to improve screening and management of patients with cardiovascular disease2 7#c7 identify and examine existing quality measures from the ,centers for ,medicare ,medicaid ,services related to cholesterol management and whether these measures encourage providers and health systems to-- 7,a7 perform appropriate and timely low-density-lipoprotein cholesterol 7,,ldl-,c7 testing on patients at risk of a cardiovascular event2 and 7,b7 better manage patients' elevated ,,ldl-,c levels in concordance with clinical guidelines prescribing directives to ensure patients are progressing towards guideline-recommended ,,ldl-,c levels2 7#d7 identify actions the ,federal government could take to promote collaboration with community-based organizations to ensure improvement in clinical outcomes for patients with cardiovascular disease1 including by building on recommendations from the ,institutes of ,medicine and the ,centers for ,disease ,control to include community health workers to improve health care delivery for underserved and high-risk communities2 and 7#e7 assess whether racial and ethnic minority groups1 as defined in section #agjg7;g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;g-#f7;g771 have higher prior authorization rejection rates of prescription drugs to treat or prevent cardiovascular disease by health insurance providers and1 if so1 identify the resulting impacts on cardiovascular disease medication adherence1 morbidity1 and mortality1 as well as resulting postponed1 delayed1 or suboptimal treatment prescribing for cardiovascular disease among racial and ethnic minorities4 #gcje4 ,coverage of comprehensive tobacco cessation services in ,medicaid1 ,,chip1 and private health insurance 7a7 ,requiring ,medicaid coverage of counseling and pharmacotherapy for cessation of tobacco use and temporary enhanced ,,fmap for coverage of tobacco cessation services ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in subsection 7a77#d71 by striking and 7,d7 and all that follows through subsection 7bb77 and inserting the following3 7,d7 counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the ,state plan 7as defined in subsection 7bb772 7#b7 in subsection 7b71 by inserting 7bb77#b71 after 7aa712 and 7#c7 by striking subsection 7bb7 and inserting the following3 7bb7 ,counseling and pharmacotherapy for cessation of tobacco use 7#a7 ,in general ,for purposes of this title1 the term counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the ,state plan means diagnostic1 therapy1 and counseling services and pharmacotherapy 7including the coverage of prescription and nonprescription tobacco cessation agents approved by the ,food and ,drug ,administration7 for the cessation of tobacco use by individuals who use tobacco products or who are being treated for tobacco use that is furnished-- 7,a7 by or under the supervision of a physician2 or 7,b7 by any other health care professional who-- 7i7 is legally authorized to furnish such services under ,state law 7or the ,state regulatory mechanism provided by ,state law7 of the ,state in which the services are furnished2 and 7ii7 is authorized to receive payment for other services under this title or is designated by the ,secretary for this purpose1 which is recommended in the guideline entitled1 ,treating ,tobacco ,use and ,dependence3 #bjjh ,update3 ,a ,clinical ,practice ,guideline published by the ,public ,health ,service in ,may #bjjh 7or any subsequent modification of such guideline7 or is recommended for the cessation of tobacco use by the ,united ,states ,preventive ,services ,task ,force or any additional intervention approved by the ,food and ,drug ,administration as safe and effective in helping smokers quit4 7#b7 ,temporary enhanced ,,fmap for coverage of tobacco cessation services ,notwithstanding subsection 7b71 for calendar quarters occurring during the period beginning on the date of the enactment of this paragraph and ending #e years after the date of enactment of this paragraph1 the ,federal medical assistance percentage with respect to amounts expended by a ,state for medical assistance for counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the ,state plan 7as defined in paragraph 7#a77 shall be equal to #ij percent4 4 7b7 ,no cost sharing 7#a7 ,in general ,subsections 7a77#b7 and 7b77#b7 of section #aiaf of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo71 as amended by section #bjjg7;d77#d71 are each amended-- 7,a7 in subparagraph 7,b71 by striking 1 and counseling and all that follows through section #aije7;bb77#b77;,a72 7,b7 in subparagraph 7,j71 by striking or after the comma2 7,c7 in subparagraph 7,k71 by striking 2 and and inserting 1 or2 and 7,d7 by adding at the end the following new subparagraph3 7,l7 counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the ,state plan 7as defined in section #aije7;bb77 and covered outpatient drugs 7as defined in subsection 7k77#b7 of section #aibg and including nonprescription drugs described in subsection 7d77#b7 of such section7 that are prescribed for purposes of promoting tobacco cessation in accordance with the guideline specified in section #aije7;bb72 and 4 7#b7 ,application to alternative cost sharing ,section #aiaf;,a7b77#c77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo-#a7;b77#c77;,b77 is amended-- 7,a7 in clause 7iii71 by striking 1 and counseling and pharmacotherapy for cessation of tobacco use by pregnant women 7as defined in section #aije7;bb772 and 7,b7 by adding at the end the following new clause3 7xv7 ,counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the ,state plan 7as defined in section #aije7;bb77 and covered outpatient drugs 7as defined in subsection 7k77#b7 of section #aibg and including nonprescription drugs described in subsection 7d77#b7 of such section7 that are prescribed for purposes of promoting tobacco cessation in accordance with the guideline specified in section #aije7;bb74 4 7c7 ,exception from optional restriction under ,medicaid prescription drug coverage ,section #aibg7;d77#b77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7;d77#b77;,f77 is amended to read as follows3 7,f7 ,nonprescription drugs1 except1 when recommended in accordance with the guideline referred to in section #aije7;bb71 agents approved by the ,food and ,drug ,administration under the over-the-counter monograph process for purposes of promoting tobacco cessation4 4 7d7 ,state monitoring and promoting of comprehensive tobacco cessation services under ,medicaid ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a771 as amended by section #ebja7;c77#b77;,b71 is amended-- 7#a7 in paragraph 7#hg71 by striking and at the end2 7#b7 in paragraph 7#hh71 by striking the period at the end and inserting 2 and2 and 7#c7 by inserting after paragraph 7#hh7 the following new paragraph3 7#hi7 provide that the ,state will monitor and promote the use of comprehensive tobacco cessation services under the ,state plan 7including conducting an outreach campaign to increase awareness of the benefits of using such services7 among-- 7,a7 individuals entitled to medical assistance under the ,state plan who use tobacco products2 and 7,b7 clinicians and others who provide services to individuals entitled to medical assistance under the ,state plan4 4 7e7 ,federal reimbursement for outreach campaign ,section #aijc7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77 is amended-- 7#a7 in paragraph 7#f77;,b71 by striking plus at the end2 7#b7 in paragraph 7#g71 by striking the period at the end and inserting 2 plus2 and 7#c7 by inserting after paragraph 7#g7 the following new paragraph3 7#h7 with respect to the development1 implementation1 and evaluation of an outreach campaign to-- 7,a7 increase awareness of comprehensive tobacco cessation services covered in the ,state plan among-- 7i7 individuals who are likely to be eligible for medical assistance under the ,state plan2 and 7ii7 clinicians and others who provide services to individuals who are likely to be eligible for medical assistance under the ,state plan2 and 7,b7 increase awareness of the benefits of using comprehensive tobacco cessation services covered in the ,state plan among-- 7i7 individuals who are likely to be eligible for medical assistance under the ,state plan2 and 7ii7 clinicians and others who provide services to individuals who are likely to be eligible for medical assistance under the ,state plan about the benefits of using comprehensive tobacco cessation services1 for calendar quarters occurring during the period beginning on the date of the enactment of this paragraph and ending on the date that is #e years after the date of enactment of this paragraph1 an amount equal to #ij percent of the sums expended during each quarter which are attributable to such development1 implementation1 and evaluation1 and for calendar quarters succeeding such period1 an amount equal to ,federal medical assistance percentage determined under section #aije7;b7 of the sums expended during each quarter which are so attributable4 4 7f7 ,no prior authorization for tobacco cessation drugs under ,medicaid ,section #aibg7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7;d77 is amended-- 7#a7 in paragraph 7#a77;,a71 by striking ,a ,state and inserting ,subject to paragraph 7#h71 a ,state2 and 7#b7 by adding at the end the following new paragraph3 7#h7 ,no prior authorization programs for tobacco cessation drugs ,a ,state plan may not require1 as a condition of coverage or payment for a covered outpatient drug1 the approval of an agent to promote smoking cessation 7including agents approved by the ,food and ,drug ,administration7 or tobacco cessation4 4 7g7 ,exclusion of enhanced payments from territorial caps ,notwithstanding any other provision of law1 for purposes of section #aajh of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh71 with respect to any additional amount paid to a territory as a result of the application of section #aije7;bb77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7bb77#b77-- 7#a7 the limitation on payments to territories under subsections 7f7 and 7g7 of such section #aajh shall not apply to such additional amounts2 and 7#b7 such additional amounts shall be disregarded in applying such subsections4 7h7 ,requiring ,,chip coverage of counseling and pharmacotherapy for cessation of tobacco use 7#a7 ,in general ,section #bajc7;c77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7c77#b77 is amended by adding at the end the following new subparagraph3 7,d7 ,counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the ,state child health plan4 4 7#b7 ,counseling and pharmacotherapy for cessation of tobacco use defined ,section #baaj7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;jj7c77 is amended by adding at the end the following new paragraph3 7#aj7 ,counseling and pharmacotherapy for cessation of tobacco use ,the term counseling and pharmacotherapy for cessation of tobacco use means diagnostic1 therapy1 and counseling services and pharmacotherapy 7including the coverage of prescription and nonprescription tobacco cessation agents approved by the ,food and ,drug ,administration7 for the cessation of tobacco use by individuals who use tobacco products or who are being treated for tobacco use that are furnished-- 7,a7 by or under the supervision of a physician2 or 7,b7 by any other health care professional who-- 7i7 is legally authorized to furnish such services under ,state law 7or the ,state regulatory mechanism provided by ,state law7 of the ,state in which the services are furnished2 and 7ii7 is authorized to receive payment for other services under this title or is designated by the ,secretary for this purpose1 which is recommended in the guideline entitled1 ,treating ,tobacco ,use and ,dependence3 #bjjh ,update3 ,a ,clinical ,practice ,guideline published by the ,public ,health ,service in ,may #bjjh 7or any subsequent modification of such guideline7 or is recommended for the cessation of tobacco use by the ,united ,states ,preventive ,services ,task ,force or any additional intervention approved by the ,food and ,drug ,administration as safe and effective in helping smokers quit4 4 7i7 ,no cost sharing ,section #bajc7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7e77 is amended by adding at the end the following new paragraph3 7#e7 ,no cost sharing on benefits for counseling and pharmacotherapy for cessation of tobacco use ,the ,state child health plan may not impose deductibles1 coinsurance1 or other cost sharing with respect to benefits for counseling and pharmacotherapy for cessation of tobacco use 7as defined in section #baaj7;c77#aj77 and prescription drugs that are covered under a ,state child health plan that are prescribed for purposes of promoting tobacco cessation in accordance with the guideline specified in section #baaj7;c77#aj77;,b74 4 7j7 ,exception from optional restriction under ,,chip prescription drug coverage ,section #bajc of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7 is amended by adding at the end the following new subsection3 7g7 ,exception from optional restriction under ,,chip prescription drug coverage ,the ,state child health plan may exclude or otherwise restrict nonprescription drugs1 except1 in the case of-- 7#a7 pregnant women when recommended in accordance with the guideline specified in section #baaj7;c77#aj77;,b71 agents approved by the ,food and ,drug ,administration under the over-the-counter monograph process for purposes of promoting tobacco cessation2 and 7#b7 individuals who are eligible under the ,state child health plan when recommended in accordance with the ,guideline referred to in section #baaj7;c77#aj77;,b71 agents approved by the ,food and ,drug ,administration under the over-the-counter monograph process for purposes of promoting tobacco cessation4 4 7k7 ,state monitoring and promoting of comprehensive tobacco cessation services under ,,chip ,section #bajb of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;bb7 is amended by adding at the end the following new subsection3 7d7 ,state monitoring and promoting of comprehensive tobacco cessation services under ,,chip ,a ,state child health plan shall include a description of the procedures to be used by the ,state to monitor and promote the use of comprehensive tobacco cessation services under the ,state plan 7including conducting an outreach campaign to increase awareness of the benefits of using such services7 among-- 7#a7 individuals entitled to medical assistance under the ,state child health plan who use tobacco products2 and 7#b7 clinicians and others who provide services to individuals entitled to medical assistance under the ,state child health plan4 4 7l7 ,federal reimbursement for ,,chip coverage and outreach campaign 7#a7 ,in general ,section #baje7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7a77 is amended by adding at the end the following new paragraph3 7#e7 ,federal reimbursement for ,,chip coverage of comprehensive tobacco cessation services and outreach campaign ,in addition to the payments made under paragraph 7#a7 for calendar quarters occurring during the period beginning on the date of the enactment of this paragraph and ending #e years after such date1 the ,secretary shall pay-- 7,a7 an amount equal to #ij percent of the sums expended during each quarter which are attributable to the cost of furnishing counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the ,state child health plan 7net of any payments made to the ,state under paragraph 7#a7 with respect to such counseling and pharmacotherapy72 plus 7,b7 an amount equal to #ij percent of the sums expended during each quarter which are attributable to the development1 implementation1 and evaluation of an outreach campaign to-- 7i7 increase awareness of comprehensive tobacco cessation services covered in the ,state child health plan among-- 7,i7 individuals who are likely to be eligible for medical assistance under the ,state child health plan2 and 7,,ii7 clinicians and others who provide services to individuals who are likely to be eligible for medical assistance under the ,state child health plan2 and 7ii7 increase awareness of the benefits of using comprehensive tobacco cessation services covered in the ,state child health plan among-- 7,i7 individuals who are likely to be eligible for medical assistance under the ,state child health plan2 and 7,,ii7 clinicians and others who provide services to individuals who are likely to be eligible for medical assistance under the ,state child health plan about the benefits of using comprehensive tobacco cessation services4 4 7#b7 ,adjustment of ,,chip allotments ,section #bajd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7m77 is amended-- 7,a7 in paragraph 7#b77;,b71 by striking and 7#ab7 and inserting 7#ab71 and 7#ac72 and 7,b7 by adding at the end the following new paragraph3 7#ac7 ,adjusting allotments to account for ,federal payments for ,,chip coverage of comprehensive tobacco cessation services and outreach campaign ,if a ,state 7including the ,district of ,columbia and each commonwealth and territory7 receives a payment for a fiscal year under section #baje7;a77#e71 the allotment determined for the ,state for such fiscal year shall be increased by the amount of such payment4 4 7m7 ,no prior authorization for tobacco cessation drugs under ,,chip ,section #bajc of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc71 as amended by subsection 7h71 is further amended-- 7#a7 in subsection 7c77#b77;,a71 by inserting 7in accordance with subsection 7h77 after ,coverage of prescription drugs2 and 7#b7 by adding at the end the following new subsection3 7h7 ,no prior authorization programs for tobacco cessation drugs ,a ,state child health plan may not require1 as a condition of coverage or payment for prescription drugs1 the approval of an agent to promote smoking cessation 7including agents approved by the ,food and ,drug ,administration7 or tobacco cessation4 4 7n7 ,comprehensive coverage of tobacco cessation coverage in private health insurance ,section #bgac of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ac7 is amended by adding at the end the following3 7d7 ,no prior authorization ,a group health plan and a health insurance issuer offering group or individual health insurance coverage shall not impose any prior authorization requirement for tobacco cessation counseling and pharmacotherapy that has in effect a rating of ,a or ,b in the current recommendations of the ,united ,states ,preventive ,services ,task ,force4 4 7o7 ,rule of construction ,none of the amendments made by this section shall be construed to limit coverage of any counseling or pharmacotherapy for individuals under #ah years of age4 7p7 ,effective date ,the amendments made by this section shall take effect on the first day of the first fiscal year that begins on or after the date of enactment of this ,act4 #gcjf4 ,clinical research funding for oral health 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall expand and intensify the conduct and support of the research activities of the ,national ,institutes of ,health and the ,national ,institute of ,dental and ,craniofacial ,research to improve the oral health of the population through the prevention and management of oral diseases and conditions4 7b7 ,included research activities ,research activities under subsection 7a7 shall include-- 7#a7 comparative effectiveness research and clinical disease management research addressing early childhood cancer and oral cancer2 and 7#b7 awarding of grants and contracts to support the training and development of health services researchers1 comparative effectiveness researchers1 and clinical researchers whose research improves the oral health of the population4 #gcjg4 ,guide on evidence-based strategies for public health department obesity prevention programs 7a7 ,development and dissemination of an evidence-,based strategies guide ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 not later than #b years after the date of enactment of this ,act1 shall-- 7#a7 develop a guide on evidence-based strategies for ,state1 territorial1 and local health departments to use to build and maintain effective obesity prevention and reduction programs1 and1 in consultation with stakeholders that have expertise in ,tribal health1 a guide on such evidence-based strategies with respect to ,indian ,tribes and ,tribal organizations for such ,indian ,tribes and ,tribal organizations to use for such purpose1 both of which guides shall-- 7,a7 describe an integrated program structure for implementing interventions proven to be effective in preventing and reducing the incidence of obesity2 and 7,b7 recommend-- 7i7 optimal resources1 including staffing and infrastructure1 for promoting nutrition and obesity prevention and reduction2 and 7ii7 strategies for effective obesity prevention programs for ,state and local health departments1 ,indian ,tribes1 and ,tribal organizations1 including strategies related to-- 7,i7 the application of evidence-based and evidence-informed practices to prevent and reduce obesity rates2 7,,ii7 the development1 implementation1 and evaluation of obesity prevention and reduction strategies for specific communities and populations2 7,,iii7 demonstrated knowledge of obesity prevention practices that reduce associated preventable diseases1 health conditions1 death1 and health care costs2 7,,iv7 best practices for the coordination of efforts to prevent and reduce obesity and related chronic diseases2 7,v7 addressing the underlying risk factors and social determinants of health that impact obesity rates2 and 7,,vi7 interdisciplinary coordination between relevant public health officials specializing in fields such as nutrition1 physical activity1 epidemiology1 communications1 and policy implementation1 and collaboration between public health officials and community-based organizations2 and 7#b7 disseminate the guides and current research1 evidence-based practices1 tools1 and educational materials related to obesity prevention1 consistent with the guides1 to ,state and local health departments1 ,indian ,tribes1 and ,tribal organizations4 7b7 ,technical assistance ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall provide technical assistance to ,state and local health departments1 ,indian ,tribes1 and ,tribal organizations to support such health departments in implementing the guides developed under subsection 7a77#a74 7c7 ,indian ,tribes2 ,tribal organizations ,in this section1 the terms ,indian ,tribe and ,tribal organization have the meanings given the terms in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 #gcjh4 ,stephanie ,tubbs ,jones ,uterine ,fibroid ,research and ,education ,act 7a7 ,research with respect to uterine fibroids 7#a7 ,research ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall expand1 intensify1 and coordinate programs for the conduct and support of research with respect to uterine fibroids4 7#b7 ,administration and coordination ,the ,secretary shall carry out the conduct and support of research pursuant to paragraph 7#a71 in coordination with the appropriate institutes1 offices1 and centers of the ,national ,institutes of ,health and any other relevant ,federal agency1 as determined by the ,director of the ,national ,institutes of ,health4 7#c7 ,authorization of appropriations ,for the purpose of carrying out this subsection1 there are authorized to be appropriated #cj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7b7 ,research with respect to ,medicaid coverage of uterine fibroids treatment 7#a7 ,research ,the ,secretary 7or the ,secretary's designee7 shall establish a research database1 or expand an existing research database1 to collect data on services furnished to individuals diagnosed with uterine fibroids under a ,state plan 7or a waiver of such a plan7 under the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 or under a ,state child health plan 7or a waiver of such a plan7 under the ,children's ,health ,insurance ,program under title ,,xxi of such ,act 7#db ,u4,s4,c4 #acig;aa et seq47 for the treatment of such fibroids for purposes of assessing the frequency at which such individuals are furnished such services4 7#b7 ,report 7,a7 ,in general ,not later than #b years after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a report on the amount of ,federal and ,state expenditures with respect to services furnished for the treatment of uterine fibroids under ,state plans 7or waivers of such plans7 under the ,medicaid program under such title ,,xix and ,state child health plans 7or waivers of such plans7 under the ,children's ,health ,insurance ,program under such title ,,xxi4 7,b7 ,coordination ,the ,secretary shall coordinate the development and submission of the report required under paragraph 7#a7 with any other relevant ,federal agency1 as determined by the ,secretary4 7c7 ,education and dissemination of information with respect to uterine fibroids 7#a7 ,uterine fibroids public education program ,the ,secretary shall develop and disseminate to the public information regarding uterine fibroids1 including information on-- 7,a7 the awareness1 incidence1 and prevalence of uterine fibroids among individuals1 including all minority individuals2 7,b7 the elevated risk for minority individuals to develop uterine fibroids2 and 7,c7 the availability1 as medically appropriate1 of the range of treatment options for symptomatic uterine fibroids1 including non-hysterectomy treatments and procedures4 7#b7 ,dissemination of information ,the ,secretary may disseminate information under paragraph 7#a7 directly or through arrangements with intra-agency initiatives1 nonprofit organizations1 consumer groups1 institutions of higher education 7as defined in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja771 or ,federal1 ,state1 or local public private partnerships4 7#c7 ,authorization of appropriations ,for the purpose of carrying out this subsection1 there are authorized to be appropriated such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 7d7 ,information to health care providers with respect to uterine fibroids 7#a7 ,dissemination of information ,the ,secretary shall1 in consultation and in accordance with guidelines from relevant medical societies1 work with health care-related specialty societies and health systems to promote evidence-based care for individuals with fibroids4 ,such efforts shall include minority individuals who have an elevated risk to develop uterine fibroids and the range of available options for the treatment of symptomatic uterine fibroids1 including non-hysterectomy drugs and devices approved under the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cja et seq474 7#b7 ,authorization of appropriations ,for the purpose of carrying out this subsection1 there are authorized to be appropriated such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 7e7 ,definition ,in this section1 the term minority individuals means individuals who are members of a racial and ethnic minority group1 as defined in section #agjg7;g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g774 ,e ,,hiv_/,,aids #gdja4 ,statement of policy ,it is the policy of the ,united ,states to achieve an ,,aids-free generation1 and to-- 7#a7 expand access to lifesaving antiretroviral therapy for people living with ,,hiv and immediately link people to continuous and coordinated high-quality care when they learn they are living with ,,hiv2 7#b7 expand targeted efforts to prevent ,,hiv infection using a combination of effective1 evidence-based approaches1 including routine ,,hiv screening1 and universal access to ,,hiv prevention tools1 including preexposure prophylaxis1 in communities disproportionately impacted by ,,hiv1 particularly communities of color2 7#c7 ensure laws1 policies1 and regulations do not impede access to prevention1 treatment1 and care for people living with ,,hiv or disproportionately impacted by ,,hiv2 7#d7 accelerate research for more efficacious ,,hiv prevention and treatments1 tools1 a cure1 and a vaccine2 and 7#e7 respect the human rights and dignity of persons living with ,,hiv4 #gdjb4 ,additional funding for ,,aids drug assistance program treatments ,section #bfbc of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#ca;b7 is amended by adding at the end the following3 7c7 ,additional funding for ,,aids drug assistance program treatments ,in addition to amounts otherwise authorized to be appropriated for carrying out this subpart1 there are authorized to be appropriated such sums as may be necessary to carry out sections #bfab7;b77#c77;,b7 and #bfaf for each of fiscal years #bjbe through #bjbh4 4 #gdjc4 ,enhancing the national ,,hiv surveillance system 7a7 ,grants ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall make grants to ,states to support integration of public health surveillance systems into all electronic health records in order to allow rapid communications between the clinical setting and health departments1 by means that include-- 7#a7 providing technical assistance and policy guidance to ,state and local health departments1 clinical providers1 and other agencies serving individuals with ,,hiv to improve the interoperability of data systems relevant to monitoring ,,hiv care and supportive services2 7#b7 capturing longitudinal data pertaining to the initiation and ongoing prescription or dispensing of antiretroviral therapy for individuals diagnosed with ,,hiv 7such as through pharmacy-based reporting72 7#c7 obtaining information-- 7,a7 on a voluntary basis1 on sexual orientation and gender identity2 and 7,b7 on sources of coverage 7or the lack of coverage7 for medical treatment 7including coverage through the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 the ,medicare program under title ,,xviii of such ,act 7#db ,u4,s4,c4 #acie et seq471 the program under title ,,xxvi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq42 commonly referred to as the ,ryan ,white ,,hiv_/,,aids ,program71 other public funding1 private insurance1 and health maintenance organizations72 and 7#d7 obtaining and using current geographic markers of residence 7such as current address1 ,,zip ,code1 partial ,,zip ,code1 and census block74 7b7 ,privacy and security safeguards ,in carrying out this section1 the ,secretary of ,health and ,human ,services shall ensure that appropriate privacy and security safeguards are met to prevent unauthorized disclosure of protected health information and compliance with the ,,hipaa privacy and security law 7as defined in section #cjji of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ai77 and other relevant laws and regulations4 7c7 ,prohibition against improper use of data ,no grant under this section may be used to allow or facilitate the collection or use of surveillance or clinical data or records-- 7#a7 for punitive measures of any kind1 civil or criminal1 against the subject of such data or records2 or 7#b7 for imposing any requirement or restriction with respect to an individual without the individual's written consent4 7d7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for each of fiscal years #bjbe through #bjbh4 #gdjd4 ,evidence-based strategies for improving linkage to1 and retention in1 appropriate care 7a7 ,strategies ,the ,secretary of ,health and ,human ,services1 in collaboration with the ,director of the ,centers for ,disease ,control and ,prevention1 the ,assistant ,secretary for ,mental ,health and ,substance ,use1 the ,director of the ,office of ,,aids ,research1 the ,administrator of the ,health ,resources and ,services ,administration1 and the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall-- 7#a7 identify evidence-based strategies most effective at addressing the multifaceted issues that impede disease status awareness with respect to ,,hiv_/,,aids and linkage to1 and retention in1 appropriate care1 taking into consideration health care systems issues1 clinic and provider issues1 and individual psychosocial1 environmental1 and other contextual factors2 7#b7 support the wide-scale implementation of the evidence-based strategies identified pursuant to paragraph 7#a71 including through incorporating such strategies into health care coverage supported by the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 the program under title ,,xxvi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq42 commonly referred to as the ,ryan ,white ,,hiv_/,,aids ,program71 and health plans purchased through an ,exchange established under title ,i of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh72 and 7#c7 not later than #a year after the date of the enactment of this ,act1 submit a report to the ,congress on the status of activities under paragraphs 7#a7 and 7#b74 7b7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjbe through #bjbh4 #gdje4 ,improving entry into1 and retention in1 care and antiretroviral adherence for persons with ,,hiv 7a7 ,sense of congress ,it is the sense of ,congress that ,,aids research has led to scientific advancements that have-- 7#a7 saved the lives of millions of people living with ,,hiv2 7#b7 prevented millions of individuals from receiving new diagnoses of ,,hiv2 and 7#c7 had broad benefits that extend far beyond helping people at risk for1 or living with1 ,,hiv4 7b7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,national ,institutes of ,health1 shall expand1 intensify1 and coordinate operational and translational research and other activities of the ,national ,institutes of ,health regarding methods-- 7#a7 to increase adoption of evidence-based adherence strategies within ,,hiv care and treatment programs2 7#b7 to increase ,,hiv testing and case detection rates2 7#c7 to reduce ,,hiv-related health disparities2 7#d7 to ensure that research to improve adherence to ,,hiv care and treatment programs address the unique concerns of women2 7#e7 to integrate ,,hiv prevention and care services with mental health and substance use prevention and treatment delivery systems2 7#f7 to increase knowledge on the implementation of preexposure prophylaxis 7referred to in this section as ,pr,e,p71 including with respect to-- 7,a7 who can benefit most from ,pr,e,p2 7,b7 how to provide ,pr,e,p safely and efficiently2 7,c7 how to integrate ,pr,e,p with other essential prevention methods such as condoms2 and 7,d7 how to ensure high levels of adherence2 and 7#g7 to increase knowledge of undetectable and untransmittable1 when a person living with ,,hiv who is on antiretroviral therapy and is durably virally suppressed 7defined as having a consistent viral load of less than #bjj copies_/ml7 cannot sexually transmit ,,hiv4 7c7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjbe through #bjbh4 #gdjf4 ,services to reduce ,,hiv_/,,aids in racial and ethnic minority communities 7a7 ,in general ,for the purpose of reducing new ,,hiv diagnoses in racial and ethnic minority communities1 the ,secretary of ,health and ,human ,services1 acting through the ,deputy ,assistant ,secretary for ,minority ,health1 may make grants to public health agencies and faith-based organizations to conduct-- 7#a7 outreach activities related to ,,hiv prevention and testing activities2 7#b7 ,,hiv prevention activities2 7#c7 ,,hiv testing activities2 and 7#d7 public health education campaigns on accessing ,,hiv prevention medication4 7b7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjbe through #bjbh4 #gdjg4 ,minority ,,aids initiative 7a7 ,expanded funding ,the ,secretary of ,health and ,human ,services1 in collaboration with the ,deputy ,assistant ,secretary for ,minority ,health1 the ,director of the ,centers for ,disease ,control and ,prevention1 the ,administrator of the ,health ,resources and ,services ,administration1 and the ,assistant ,secretary for ,mental ,health and ,substance ,use1 shall provide funds and carry out activities to expand the ,minority ,,aids ,initiative4 7b7 ,use of funds ,the additional funds made available under this section may be used1 through the ,minority ,,aids ,initiative1 to support the following activities3 7#a7 ,providing technical assistance and infrastructure support to reduce ,,hiv_/,,aids in minority populations4 7#b7 ,increasing minority populations' access to ,,hiv prevention and care services4 7#c7 ,building strong community programs and partnerships to address ,,hiv prevention and the health care needs of specific racial and ethnic minority populations4 7c7 ,priority interventions ,within the racial and ethnic minority populations referred to in subsection 7b71 priority in conducting intervention services shall be given to-- 7#a7 men who have sex with men2 7#b7 youth2 7#c7 persons who engage in intravenous drug abuse2 7#d7 women2 7#e7 homeless individuals2 7#f7 individuals incarcerated or in the penal system2 7#g7 transgender individuals2 and 7#h7 nonbinary individuals4 7d7 ,authorization of appropriations ,for carrying out this section1 there are authorized to be appropriated #faj1jjj1jjj for fiscal year #bjbe and such sums as may be necessary for each of fiscal years #bjbf through #bjbi4 #gdjh4 ,health care professionals treating individuals with ,,hiv 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall expand1 intensify1 and coordinate workforce initiatives of the ,health ,resources and ,services ,administration to increase the capacity of the health workforce focusing primarily on ,,hiv to meet the demand for culturally competent care1 and may award grants for any of the following3 7#a7 ,development of curricula for training primary care providers in ,,hiv_/,,aids prevention and care1 including routine ,,hiv testing4 7#b7 ,support to expand access to culturally and linguistically accessible benefits counselors1 trained peer navigators1 and mental and behavioral health professionals with expertise in ,,hiv4 7#c7 ,training health care professionals to provide care to individuals living with ,,hiv4 7#d7 ,development by grant recipients under title ,,xxvi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq42 commonly referred to as the ,ryan ,white ,,hiv_/,,aids ,program7 and other persons1 of policies for providing culturally relevant and sensitive treatment to individuals living with ,,hiv1 with particular emphasis on treatment to racial and ethnic minorities1 men who have sex with men1 and women1 young people1 and children living with ,,hiv4 7#e7 ,development and implementation of programs to increase the use of telehealth to respond to ,,hiv-specific health care needs in rural and minority communities1 with particular emphasis given to medically underserved communities and insular areas4 7#f7 ,evaluating interdisciplinary medical provider care team models that promote high-quality care1 with particular emphasis on care to racial and ethnic minorities4 7#g7 ,training health care professionals to make them aware of the high rates of chronic hepatitis ,b and chronic hepatitis ,c in adult racial and ethnic minority populations1 and the importance of prevention1 detection1 and medical management of hepatitis ,b and hepatitis ,c and of liver cancer screening4 7#h7 ,development of curricula for training primary care providers that ,,hiv and tuberculosis are significant mutual comorbidities1 and that a patient who tests positive for one disease should be offered and encouraged to receive testing for the other4 7b7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjbe through #bjbh4 #gdji4 ,,hiv_/,,aids provider loan repayment program 7a7 ,in general ,the ,secretary may enter into an agreement with any physician1 nurse practitioner1 or physician assistant under which-- 7#a7 the physician1 nurse practitioner1 or physician assistant agrees to serve as a medical provider for a period of not less than #b years-- 7,a7 at a ,ryan ,white-funded or title ,x-funded facility with a critical shortage of doctors 7as determined by the ,secretary72 or 7,b7 in an area with a high incidence of ,,hiv_/,,aids2 and 7#b7 the ,secretary agrees to make payments in accordance with subsection 7b7 on the professional education loans of the physician1 nurse practitioner1 or physician assistant4 7b7 ,manner of payments ,the payments described in subsection 7a7 shall be made by the ,secretary as follows3 7#a7 ,upon completion by the physician1 nurse practitioner1 or physician assistant for whom the payments are to be made of the first year of the service specified in the agreement entered into with the ,secretary under subsection 7a71 the ,secretary shall pay #cj percent of the principal of and the interest on the individual's professional education loans4 7#b7 ,upon completion by the physician1 nurse practitioner1 or physician assistant of the second year of such service1 the ,secretary shall pay another #cj percent of the principal of and the interest on such loans4 7#c7 ,upon completion by that individual of a third year of such service1 the ,secretary shall pay another #be percent of the principal of and the interest on such loans4 7c7 ,applicability of certain provisions ,subpart ,,iii of part ,d of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedl et seq47 shall1 except as inconsistent with this section1 apply to the program carried out under this section in the same manner and to the same extent as such provisions apply to the ,national ,health ,service ,corps loan repayment program4 7d7 ,reports ,not later than #ah months after the date of the enactment of this ,act1 and annually thereafter1 the ,secretary shall prepare and submit to ,congress a report describing the program carried out under this section1 including statements regarding the following3 7#a7 ,the number of physicians1 nurse practitioners1 and physician assistants enrolled in the program4 7#b7 ,the number and amount of loan repayments provided through the program4 7#c7 ,the placement location of loan repayment recipients at facilities described in subsection 7a77#a74 7#d7 ,the default rate on such loans and actions required4 7#e7 ,the amount of outstanding default funds with respect to such loans4 7#f7 ,to the extent that it can be determined1 the reason for the default on such a loan4 7#g7 ,the demographics of individuals participating in the program4 7#h7 ,an evaluation of the overall costs and benefits of the program4 7e7 ,definitions ,in this section3 7#a7 ,,hiv_/,,aids ,the term ,,hiv_/,,aids means human immunodeficiency virus and acquired immune deficiency syndrome4 7#b7 ,nurse practitioner ,the term nurse practitioner means a registered nurse who has completed an accredited graduate degree program in advanced nurse practice and has successfully passed a national certification exam4 7#c7 ,physician ,the term physician means a graduate of a school of medicine who has completed postgraduate training in general or pediatric medicine4 7#d7 ,physician assistant ,the term physician assistant means a medical provider who completed an accredited physician assistant training program and successfully passed the ,physician ,assistant ,national ,certifying ,examination4 7#e7 ,professional education loan ,the term professional education loan-- 7,a7 means a loan that is incurred for the cost of attendance 7including tuition1 other reasonable educational expenses1 and reasonable living costs7 at a school of medicine1 school of nursing1 or physician assistant training program2 and 7,b7 includes only the portion of the loan that is outstanding on the date the physician1 nurse practitioner1 or physician assistant involved begins the service specified in the agreement under subsection 7a74 7#f7 ,ryan ,white-funded ,the term ,ryan ,white-funded means1 with respect to a facility1 receiving funds under title ,,xxvi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq474 7#g7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#h7 ,school of medicine ,the term school of medicine has the meaning given to that term in section #gii;,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #biep74 7#i7 ,title ,x-funded ,the term title ,x-funded means1 with respect to a facility1 receiving funds under title ,x of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj et seq474 7f7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjbe through #bjbh4 #gdaj4 ,dental education loan repayment program 7a7 ,in general ,the ,secretary may enter into an agreement with any dentist under which-- 7#a7 the dentist agrees to serve as a dentist for a period of not less than #b years at a facility with a critical shortage of dentists 7as determined by the ,secretary7 in an area with a high incidence of ,,hiv_/,,aids2 and 7#b7 the ,secretary agrees to make payments in accordance with subsection 7b7 on the dental education loans of the dentist4 7b7 ,manner of payments ,the payments described in subsection 7a7 shall be made by the ,secretary as follows3 7#a7 ,upon completion by the dentist for whom the payments are to be made of the first year of the service specified in the agreement entered into with the ,secretary under subsection 7a71 the ,secretary shall pay #cj percent of the principal of and the interest on the dental education loans of the dentist4 7#b7 ,upon completion by the dentist of the second year of such service1 the ,secretary shall pay another #cj percent of the principal of and the interest on such loans4 7#c7 ,upon completion by that individual of a third year of such service1 the ,secretary shall pay another #be percent of the principal of and the interest on such loans4 7c7 ,applicability of certain provisions ,subpart ,,iii of part ,d of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedl et seq47 shall1 except as inconsistent with this section1 apply to the program carried out under this section in the same manner and to the same extent as such provisions apply to the ,national ,health ,service ,corps ,loan ,repayment ,program4 7d7 ,reports ,not later than #ah months after the date of the enactment of this ,act1 and annually thereafter1 the ,secretary shall prepare and submit to the ,congress a report describing the program carried out under this section1 including statements regarding the following3 7#a7 ,the number of dentists enrolled in the program4 7#b7 ,the number and amount of loan repayments provided through the program4 7#c7 ,the placement location of loan repayment recipients at facilities described in subsection 7a77#a74 7#d7 ,the default rate on such loans and actions required4 7#e7 ,the amount of outstanding default funds with respect to such loans4 7#f7 ,to the extent that it can be determined1 the reason for the default on such a loan4 7#g7 ,the demographics of individuals participating in the program4 7#h7 ,an evaluation of the overall costs and benefits of the program4 7e7 ,definitions ,in this section3 7#a7 ,dental education loan ,the term dental education loan-- 7,a7 means a loan that is incurred for the cost of attendance 7including tuition1 other reasonable educational expenses1 and reasonable living costs7 at a school of dentistry2 and 7,b7 includes only the portion of the loan that is outstanding on the date the dentist involved begins the service specified in the agreement under subsection 7a74 7#b7 ,dentist ,the term dentist means a graduate of a school of dentistry who has completed postgraduate training in general or pediatric dentistry4 7#c7 ,,hiv_/,,aids ,the term ,,hiv_/,,aids means human immunodeficiency virus and acquired immune deficiency syndrome4 7#d7 ,school of dentistry ,the term school of dentistry has the meaning given to that term in section #gii;,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #biep74 7#e7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7f7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for each of fiscal years #bjbe through #bjbh4 #gdaa4 ,reducing new ,,hiv infections among injecting drug users 7a7 ,sense of congress ,it is the sense of ,congress that providing sterile syringes and sterilized equipment to injecting drug users substantially reduces risk of ,,hiv infection1 increases the probability that they will initiate drug treatment1 and does not increase drug use4 7b7 ,in general ,the ,secretary of ,health and ,human ,services may provide grants and technical assistance for the purpose of reducing the rate of ,,hiv infections among injecting drug users through a comprehensive package of services for such users1 including the provision of sterile syringes1 education and outreach1 access to infectious disease testing1 overdose prevention1 and treatment for drug dependence4 7c7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal years #bjbe through #bjbh4 #gdab4 ,report on impact of ,,hiv_/,,aids in vulnerable populations 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall submit to ,congress and the ,president an annual report on the impact of ,,hiv_/,,aids for racial and ethnic minority communities1 women1 and youth aged #bd and younger4 7b7 ,contents ,the report under subsection 7a7 shall include information on the-- 7#a7 progress that has been made in reducing the impact of ,,hiv_/,,aids in such communities2 7#b7 opportunities that exist to make additional progress in reducing the impact of ,,hiv_/,,aids in such communities2 7#c7 challenges that may impede such additional progress2 and 7#d7 ,federal funding necessary to achieve substantial reductions in ,,hiv_/,,aids in racial and ethnic minority communities4 #gdac4 ,national ,,hiv_/,,aids observance days 7a7 ,national observance days ,it is the sense of ,congress that national observance days highlighting the impact of ,,hiv on communities of color include the following3 7#a7 ,national ,black ,,hiv_/,,aids ,awareness ,day4 7#b7 ,national ,latino ,,aids ,awareness ,day4 7#c7 ,national ,asian and ,pacific ,islander ,,hiv_/,,aids ,awareness ,day4 7#d7 ,national ,native ,american ,,hiv_/,,aids ,awareness ,day4 7#e7 ,national ,youth ,,hiv_/,,aids ,awareness ,day4 7b7 ,call to action ,it is the sense of ,congress that the ,president should call on members of communities of color-- 7#a7 to become involved at the local community level in ,,hiv testing1 policy1 and advocacy2 7#b7 to become aware1 engaged1 and empowered on the ,,hiv epidemic within their communities2 and 7#c7 to urge members of their communities to reduce risk factors1 practice safe sex and other preventive measures1 be tested for ,,hiv1 and seek care when appropriate4 #gdad4 ,review of all ,federal and ,state laws1 policies1 and regulations regarding the criminal prosecution of individuals for ,,hiv-related offenses 7a7 ,sense of ,congress regarding laws or regulations directed at people living with ,,hiv ,it is the sense of ,congress that ,federal and ,state laws1 policies1 and regulations regarding people living with ,,hiv-- 7#a7 should not place unique or additional burdens on such individuals solely as a result of their ,,hiv status2 and 7#b7 should instead demonstrate a public health-oriented1 evidence-based1 medically accurate1 and contemporary understanding of-- 7,a7 the multiple factors that lead to ,,hiv transmission2 7,b7 the relative risk of demonstrated ,,hiv transmission routes2 7,c7 the current health implications of living with ,,hiv2 7,d7 the associated benefits of treatment and support services for people living with ,,hiv2 and 7,e7 the impact of punitive ,,hiv-specific laws1 policies1 regulations1 and judicial precedents and decisions on public health1 on people living with or affected by ,,hiv1 and on their families and communities4 7b7 ,review of ,federal and ,state laws 7#a7 ,review of ,federal and ,state laws 7,a7 ,in general ,not later than #ij days after the date of the enactment of this ,act1 the ,attorney ,general1 the ,secretary of ,health and ,human ,services1 and the ,secretary of ,defense acting jointly 7in this section referred to as the designated officials7 shall initiate a national review of ,federal and ,state laws1 including the ,uniform ,code of ,military ,justice 7referred to in this section as the ,,ucmj71 policies1 regulations1 and judicial precedents and decisions regarding criminal and related civil commitment cases involving people living with ,,hiv_/,,aids4 7,b7 ,consultation ,in carrying out the review under subparagraph 7,a71 the designated officials shall seek to include diverse participation from1 and consultation with1 each of the following3 7i7 ,each ,state4 7ii7 ,state attorneys general 7or their representatives74 7iii7 ,state public health officials 7or their representatives74 7iv7 ,state judicial and court system officers1 including judges1 district attorneys1 prosecutors1 defense attorneys1 law enforcement1 and correctional officers4 7v7 ,members of the ,united ,states ,armed ,forces1 including members of other ,federal services subject to the ,,ucmj4 7vi7 ,people living with ,,hiv_/,,aids1 particularly those who have been subject to ,,hiv-related prosecution or who are from minority communities whose members have been disproportionately subject to ,,hiv-specific arrests and prosecution4 7vii7 ,legal advocacy and ,,hiv_/,,aids service organizations that work with people living with ,,hiv_/,,aids4 7viii7 ,nongovernmental health organizations that work on behalf of people living with ,,hiv_/,,aids1 including syringe services programs1 ,,lgbtq-focused health organizations1 and organizations who serve people who engage in sex work4 7ix7 ,trade organizations or associations representing persons or entities described in clauses 7i7 through 7vii74 7,c7 ,relation to other reviews ,in carrying out the review under subparagraph 7,a71 the designated officials may utilize other existing reviews of criminal and related civil commitment cases involving people living with ,,hiv1 including any such review conducted by any ,federal or ,state agency or any public health1 legal advocacy1 or trade organization or association if the designated officials determines that such reviews were conducted in accordance with the principles set forth in subsection 7a74 7#b7 ,report ,not later than #ahj days after initiating the review required under paragraph 7#a71 the ,attorney ,general shall transmit to the ,congress and make publicly available a report containing the results of the review1 which includes the following3 7,a7 ,for each ,state and for the ,,ucmj1 a summary of the relevant laws1 policies1 regulations1 and judicial precedents and decisions regarding criminal cases involving people living with ,,hiv1 including the following3 7i7 ,a determination of whether such laws1 policies1 regulations1 and judicial precedents and decisions place any unique or additional burdens upon people living with ,,hiv4 7ii7 ,a determination of whether such laws1 policies1 regulations1 and judicial precedents and decisions demonstrate a public health-oriented1 evidence-based1 medically accurate1 and contemporary understanding of-- 7,i7 the multiple factors that lead to ,,hiv transmission2 7,,ii7 the relative risk of ,,hiv transmission routes1 including that a person that has an undetectable viral load cannot transmit ,,hiv2 7,,iii7 the current health implications of living with ,,hiv1 including data disaggregated by race and ethnicity2 7,,iv7 the current status of providing protection to people who engage in survival sex work against whom condom possession has been used as evidence of intent to commit a crime2 7,v7 ,states that have the classification of mandatory sex offenders2 7,,vi7 the associated benefits of treatment and support services for people living with ,,hiv2 and 7,,vii7 the impact of punitive ,,hiv-specific laws and policies on public health1 on people living with or affected by ,,hiv1 and on their families and communities1 including people who are in abusive1 dependent1 violent1 or nonconsensual relationships and are unable to both negotiate the use of condoms and status disclosure4 7iii7 ,an analysis of the public health and legal implications of such laws1 policies1 regulations1 and judicial precedents and decisions1 including an analysis of the consequences of having a similar penal scheme applied to comparable situations involving other communicable diseases4 7iv7 ,an analysis of the proportionality of punishments imposed under ,,hiv-specific laws1 policies1 regulations1 and judicial precedents1 taking into consideration penalties attached to violation of ,state laws against similar degrees of endangerment or harm1 such as driving while intoxicated or transmission of other communicable diseases1 or more serious harms1 such as vehicular manslaughter offenses4 7,b7 ,an analysis of common elements shared between ,state laws1 policies1 regulations1 and judicial precedents4 7,c7 ,a set of best practice recommendations directed to ,state governments1 including ,state attorneys general1 public health officials1 and judicial officers1 in order to ensure that laws1 policies1 regulations1 and judicial precedents regarding people living with ,,hiv are in accordance with the principles set forth in subsection 7a74 7,d7 ,recommendations for adjustments to the ,,ucmj1 including discontinuing the use of a service member's ,,hiv diagnosis as the basis for prosecution1 enhanced penalties1 or discharge from military service1 in order to ensure that laws1 policies1 regulations1 and judicial precedents regarding people living with ,,hiv are in accordance with the principles set forth in subsection 7a74 ,such recommendations should include any necessary and appropriate changes to ,orders to ,follow ,preventative ,medicine ,requirements4 7#c7 ,guidance ,not later than #ij days after the date of the release of the report required by paragraph 7#b71 the ,attorney ,general and the ,secretary of ,health and ,human ,services shall jointly develop and publicly release updated guidance for ,states based on the set of best practice recommendations required under paragraph 7#b77;,c7 in order to assist ,states dealing with criminal and related civil commitment cases regarding people living with ,,hiv4 7#d7 ,monitoring and evaluation system ,not later than #fj days after the date of the release of the guidance required under paragraph 7#c71 the ,attorney ,general and the ,secretary of ,health and ,human ,services shall jointly establish an integrated monitoring and evaluation system that includes1 where appropriate1 objective and quantifiable performance goals and indicators to measure progress toward statewide implementation in each ,state of the best practice recommendations required under paragraph 7#b77;,c74 7#e7 ,modernization of ,federal laws1 policies1 and regulations ,not later than #ij days after the date of the release of the report required under paragraph 7#b71 the designated officials shall develop and transmit to the ,president and the ,congress1 and make publicly available1 such proposals as may be necessary to implement adjustments to ,federal laws1 policies1 or regulations1 including the ,,ucmj1 based on the recommendations required under paragraph 7#b77;,d71 either through ,executive order or through changes to statutory law4 7c7 ,rule of construction ,nothing in this section shall be construed to discourage the prosecution of individuals who intentionally transmit or attempt to transmit ,,hiv to another individual4 7d7 ,no additional appropriations authorized ,this section shall not be construed to increase the amount of appropriations that are authorized to be appropriated for any fiscal year4 #gdae4 ,expanding support for condoms in prisons 7a7 ,sense of congress regarding distribution of sexual barrier protection devices in state prison systems ,it is the sense of the ,congress that ,states shall allow for the legal distribution of sexual barrier protection devices in ,state correctional facilities to reduce the prevalence and spread of ,s,t,is in those facilities4 7b7 ,authority ,to allow community organizations ,to provide ,,sti counseling1 ,,sti prevention education1 and sexual barrier protection devices in ,federal correctional facilities 7#a7 ,directive to attorney general ,not later than #cj days after the date of enactment of this ,act1 the ,attorney ,general shall direct the ,director of the ,bureau of ,prisons to allow community organizations to1 in accordance with all relevant ,federal laws and regulations that govern visitation in ,federal correctional facilities-- 7,a7 distribute sexual barrier protection devices in ,federal correctional facilities2 and 7,b7 engage in ,,sti counseling and ,,sti prevention education in ,federal correctional facilities4 7#b7 ,information requirement ,any community organization permitted to distribute sexual barrier protection devices under paragraph 7#a7 shall ensure that the individuals to whom the devices are distributed are informed about the proper use and disposal of sexual barrier protection devices in accordance with established public health practices4 ,any community organization conducting ,,sti counseling or ,,sti prevention education under paragraph 7#a7 shall offer comprehensive sexuality education4 7#c7 ,possession of device protected ,a ,federal correctional facility may not1 because of the possession or use of a sexual barrier protection device-- 7,a7 take adverse action against an incarcerated individual2 or 7,b7 consider possession or use as evidence of prohibited activity for the purpose of any ,federal correctional facility administrative proceeding4 7#d7 ,implementation ,the ,attorney ,general and the ,director of the ,bureau of ,prisons shall implement this section according to established public health practices in a manner that protects the health1 safety1 and privacy of incarcerated individuals and of correctional facility staff4 7c7 ,survey of and report on correctional facility programs aimed at reducing the spread of ,s,t,is 7#a7 ,survey ,not later than #ahj days after the date of enactment of this ,act1 and annually thereafter for #e years1 the ,attorney ,general1 after consulting with the ,secretary of ,health and ,human ,services1 ,state officials1 and community organizations1 shall1 to the maximum extent practicable1 conduct a survey of all ,federal and ,state correctional facilities1 to determine the following3 7,a7 ,counseling1 treatment1 and supportive services ,whether the correctional facility-- 7i7 requires incarcerated individuals to participate in counseling1 treatment1 and supportive services related to ,s,t,is2 or 7ii7 offers such programs to incarcerated individuals4 7,b7 ,access to sexual barrier protection devices ,whether incarcerated individuals can-- 7i7 possess sexual barrier protection devices2 7ii7 purchase sexual barrier protection devices2 7iii7 purchase sexual barrier protection devices at a reduced cost2 or 7iv7 obtain sexual barrier protection devices without cost4 7,c7 ,incidence of sexual violence ,the incidence of sexual violence and assault committed by incarcerated individuals and by correctional facility staff4 7,d7 ,prevention education offered ,the type of prevention education1 information1 or training offered to incarcerated individuals and correctional facility staff regarding sexual violence and the spread of ,s,t,is1 including whether such education1 information1 or training-- 7i7 constitutes comprehensive sexuality education2 7ii7 is compulsory for new incarcerated individuals and for new correctional facility staff2 and 7iii7 is offered on an ongoing basis4 7,e7 ,,sti testing ,whether the correctional facility tests incarcerated individuals for ,s,t,is or gives them the option to undergo such testing-- 7i7 at intake2 7ii7 on a regular basis2 and 7iii7 prior to release4 7,f7 ,,sti test results ,the number of incarcerated individuals who are tested for ,s,t,is and the outcome of such tests at each correctional facility1 disaggregated to include results for-- 7i7 the type of ,,sti tested for2 7ii7 the race and ethnicity of an individual tested2 7iii7 the age of an individual tested2 and 7iv7 the gender of the individual tested4 7,g7 ,prerelease referral policy ,whether incarcerated individuals are informed prior to release about ,,sti-related services or other health services in their communities1 including free and low-cost counseling and treatment options4 7,h7 ,prerelease referrals made ,the number of referrals to community-based organizations or public health facilities offering ,,sti-related or other health services provided to incarcerated individuals prior to release1 and the type of counseling or treatment for which the referral was made4 7,i7 ,reinstatement of medicaid benefits ,whether-- 7i7 the correctional facility assists incarcerated individuals that were enrolled in the ,state ,medicaid program prior to their incarceration in reinstating their enrollment upon release2 and 7ii7 such individuals receive referrals as described in subparagraph 7,g7 to entities that accept the ,state ,medicaid program1 including1 if applicable-- 7,i7 the number of such individuals1 including those diagnosed with ,,hiv1 that have been reinstated2 7,,ii7 a list of obstacles to reinstating enrollment or to making determinations of eligibility for reinstatement1 if any2 and 7,,iii7 the number of individuals denied enrollment4 7,j7 ,other actions taken ,whether the correctional facility has taken any other action1 in conjunction with community organizations or otherwise1 to reduce the prevalence and spread of ,s,t,is in that facility4 7#b7 ,privacy ,in conducting the survey under paragraph 7#a71 the ,attorney ,general shall not request or retain the identity of any individual who has sought or been offered counseling1 treatment1 testing1 or prevention education information regarding an ,,sti 7including information about sexual barrier protection devices71 or who has tested positive for an ,,sti4 7#c7 ,report 7,a7 ,in general ,the ,attorney ,general shall transmit to ,congress and make publicly available the results of the survey required under paragraph 7#a71 both for the ,united ,states as a whole and disaggregated as to each ,state and each correctional facility4 7,b7 ,deadlines ,to the maximum extent possible1 the ,attorney ,general shall-- 7i7 issue the first report under subparagraph 7,a7 not later than #a year after the date of enactment of this ,act2 and 7ii7 issue reports under subparagraph 7,a7 annually thereafter for #e years4 7d7 ,strategy 7#a7 ,directive to attorney general ,the ,attorney ,general1 in consultation with the ,secretary of ,health and ,human ,services1 ,state officials1 and community organizations1 shall develop and implement a #e-year strategy to reduce the prevalence and spread of ,s,t,is in ,federal and ,state correctional facilities4 ,to the maximum extent possible1 the strategy shall be developed1 transmitted to ,congress1 and made publicly available not later than #ahj days after the transmission of the first report required under subsection 7c77#c74 7#b7 ,contents of strategy ,the strategy developed under paragraph 7#a7 shall include the following3 7,a7 ,prevention education ,a plan for improving prevention education1 information1 and training offered to incarcerated individuals and correctional facility staff1 including information and training on sexual violence and the spread of ,s,t,is1 and comprehensive sexuality education4 7,b7 ,sexual barrier protection device access ,a plan for expanding access to sexual barrier protection devices in correctional facilities4 7,c7 ,sexual violence reduction ,a plan for reducing the incidence of sexual violence among incarcerated individuals and correctional facility staff4 7,d7 ,counseling and supportive services ,a plan for expanding access to counseling and supportive services related to ,s,t,is in correctional facilities4 7,e7 ,testing ,a plan for testing incarcerated individuals for ,s,t,is during intake1 during regular health exams1 and prior to release that-- 7i7 is conducted in accordance with guidelines established by the ,centers for ,disease ,control and ,prevention2 7ii7 includes pretest counseling2 7iii7 requires that incarcerated individuals are notified of their option to decline testing at any time2 7iv7 requires that incarcerated individuals are confidentially notified of their test results in a timely manner2 and 7v7 ensures that incarcerated individuals testing positive for ,s,t,is receive post-test counseling1 care1 treatment1 and supportive services4 7,f7 ,treatment ,a plan for ensuring that correctional facilities have the necessary medicine and equipment to treat and monitor ,s,t,is and for ensuring that incarcerated individuals living with or testing positive for ,s,t,is receive and have access to care and treatment services4 7,g7 ,strategies for demographic groups ,a plan for developing and implementing culturally appropriate1 sensitive1 and specific strategies to reduce the spread of ,s,t,is among demographic groups heavily impacted by ,s,t,is4 7,h7 ,linkages with communities and facilities ,a plan for establishing and strengthening linkages to local community and health facilities that-- 7i7 provide counseling1 testing1 care1 and treatment services2 7ii7 may receive individuals recently released from incarceration who are living with ,s,t,is2 and 7iii7 accept payment through the ,state ,medicaid program4 7,i7 ,enrollment in ,state ,medicaid programs ,plans to ensure that-- 7i7 incarcerated individuals who were enrolled in their ,state ,medicaid program prior to incarceration in a correctional facility are automatically reenrolled in such program upon their release2 and 7ii7 incarcerated individuals who were not enrolled in their ,state ,medicaid program prior to incarceration1 and who are diagnosed with ,,hiv while incarcerated in a correctional facility1 are automatically enrolled in such program upon their release4 7,j7 ,other plans ,any other plans developed by the ,attorney ,general for reducing the spread of ,s,t,is or improving the quality of health care in correctional facilities4 7,k7 ,monitoring system ,a monitoring system that establishes performance goals related to reducing the prevalence and spread of ,s,t,is in correctional facilities and which1 where feasible1 expresses such goals in quantifiable form4 7,l7 ,monitoring system performance indicators ,performance indicators that measure or assess the achievement of the performance goals described in subparagraph 7,k74 7,m7 ,cost estimate ,a detailed estimate of the funding necessary to implement the strategy at the ,federal and ,state levels for all #e years1 including the amount of funds required by community organizations to implement the parts of the strategy in which they take part4 7#c7 ,report ,not later than #a year after the date of the enactment of this ,act1 and annually thereafter1 the ,attorney ,general shall transmit to ,congress and make publicly available an annual progress report regarding the implementation and effectiveness of the strategy described in paragraph 7#a74 ,the progress report shall include an evaluation of the implementation of the strategy using the monitoring system and performance indicators provided for in subparagraphs 7,k7 and 7,l7 of paragraph 7#b74 7e7 ,authorization of appropriations 7#a7 ,in general ,there are authorized to be appropriated such sums as may be necessary to carry out this section for each of fiscal years #bjbe through #bjbi4 7#b7 ,availability of funds ,amounts made available under paragraph 7#a7 are authorized to remain available until expended4 7f7 ,definitions ,in this section3 7#a7 ,community organization ,the term community organization means a public health care facility or a nonprofit organization that provides health- or ,,sti-related services according to established public health standards4 7#b7 ,comprehensive sexuality education ,the term comprehensive sexuality education means sexuality education-- 7,a7 that includes information about abstinence and about the proper use and disposal of sexual barrier protection devices2 and 7,b7 that is-- 7i7 evidence based2 7ii7 medically accurate2 7iii7 age and developmentally appropriate2 7iv7 gender and identity sensitive2 7v7 culturally and linguistically appropriate2 and 7vi7 structured to promote critical thinking1 self-esteem1 respect for others1 and the development of healthy attitudes and relationships4 7#c7 ,correctional facility ,the term correctional facility means any prison1 penitentiary1 adult detention facility1 juvenile detention facility1 jail1 or other facility to which individuals may be sent after conviction of a crime or act of juvenile delinquency within the ,united ,states4 7#d7 ,incarcerated individual ,the term incarcerated individual means any individual who is serving a sentence in a correctional facility after conviction of a crime4 7#e7 ,sexual barrier protection device ,the term sexual barrier protection device means any physical device approved1 cleared1 or otherwise authorized by the ,food and ,drug ,administration that has not been tampered with and which reduces the probability of ,,sti transmission or infection between sexual partners1 including female condoms1 male condoms1 and dental dams4 7#f7 ,sexually transmitted infection ,the term sexually transmitted infection or ,,sti means any disease or infection that is commonly transmitted through sexual activity1 including ,,hiv1 gonorrhea1 chlamydia1 syphilis1 genital herpes1 viral hepatitis1 and human papillomavirus4 7#g7 ,state ,the term ,state includes the ,district of ,columbia1 ,american ,samoa1 the ,commonwealth of the ,northern ,mariana ,islands1 ,guam1 ,puerto ,rico1 and the ,united ,states ,virgin ,islands4 7#h7 ,state ,medicaid program ,the term ,state ,medicaid program means the ,state plan 7or a waiver of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 #gdaf4 ,automatic reinstatement or enrollment in ,medicaid for people who test positive for ,,hiv before reentering communities 7a7 ,in general ,section #aijb7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77 is amended by adding at the end the following3 7#ag7 ,enrollment of ex-offenders 7,a7 ,automatic enrollment or reinstatement 7i7 ,in general ,the ,state plan shall provide for the automatic enrollment or reinstatement of enrollment of an eligible individual-- 7,i7 if such individual is scheduled to be released from a public institution due to the completion of sentence1 not less than #cj days prior to the scheduled date of the release2 and 7,,ii7 if such individual is to be released from a public institution on parole or on probation1 as soon as possible after the date on which the determination to release such individual was made1 and before the date such individual is released4 7ii7 ,exception ,if a ,state makes a determination that an individual is not eligible to be enrolled under the ,state plan-- 7,i7 on or before the date by which the individual would be enrolled under clause 7i71 such clause shall not apply to such individual2 or 7,,ii7 after such date1 the ,state may terminate the enrollment of such individual4 7,b7 ,relationship of enrollment to payment for services 7i7 ,in general ,subject to subparagraph 7,a77ii71 an eligible individual who is enrolled1 or whose enrollment is reinstated1 under subparagraph 7,a7 shall be eligible for all services for which medical assistance is provided under the ,state plan after the date that the eligible individual is released from the public institution4 7ii7 ,relationship to payment prohibition for inmates ,no provision of this paragraph may be construed to permit payment for care or services for which payment is excluded under subdivision 7,a7 following the last numbered paragraph of section #aije7;a74 7,c7 ,treatment of continuous eligibility 7i7 ,suspension for inmates ,any period of continuous eligibility under this title shall be suspended on the date an individual enrolled under this title becomes an inmate of a public institution 7except as a patient of a medical institution74 7ii7 ,determination of remaining period ,notwithstanding any changes to ,state law related to continuous eligibility during the time that an individual is an inmate of a public institution 7except as a patient of a medical institution71 subject to clause 7iii71 with respect to an eligible individual who was subject to a suspension under clause 7i71 on the date that such individual is released from a public institution the suspension of continuous eligibility under such clause shall be lifted for a period that is equal to the time remaining in the period of continuous eligibility for such individual on the date that such period was suspended under such clause4 7iii7 ,exception ,if a ,state makes a determination that an individual is not eligible to be enrolled under the ,state plan-- 7,i7 on or before the date that the suspension of continuous eligibility is lifted under clause 7ii71 such clause shall not apply to such individual2 or 7,,ii7 after such date1 the ,state may terminate the enrollment of such individual4 7,d7 ,automatic enrollment or reinstatement of enrollment defined ,for purposes of this paragraph1 the term automatic enrollment or reinstatement of enrollment means that the ,state determines eligibility for medical assistance under the ,state plan without a program application from1 or on behalf of1 the eligible individual1 but an individual can only be automatically enrolled in the ,state ,medicaid plan if the individual affirmatively consents to being enrolled through affirmation in writing1 by telephone1 orally1 through electronic signature1 or through any other means specified by the ,secretary4 7,e7 ,eligible individual defined ,for purposes of this paragraph1 the term eligible individual means an individual who is an inmate of a public institution 7except as a patient in a medical institution7-- 7i7 who was enrolled under the ,state plan for medical assistance immediately before becoming an inmate of such an institution2 or 7ii7 who is diagnosed with human immunodeficiency virus4 4 7b7 ,supplemental funding for state implementation of automatic reinstatement of medicaid benefits 7#a7 ,in general ,subject to paragraph 7#c71 with respect to a ,state1 for each of the first #d calendar quarters in which the ,state plan meets the requirements of paragraph 7#ag7 of section #aijb7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77 7as added by subsection 7a771 the ,federal matching payments 7including payments based on the ,federal medical assistance percentage7 made to such ,state under section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 for the ,state expenditures described in paragraph 7#b7 shall be increased by #e percentage points4 7#b7 ,expenditures ,the expenditures described in this paragraph are the following3 7,a7 ,expenditures for which payment is available under section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 and which are attributable to strengthening the ,state's enrollment and administrative resources for the purpose of improving processes for enrolling 7or reinstating the enrollment of7 eligible individuals 7as such term is defined in subparagraph 7,e7 of paragraph 7#af7 of section #aijb7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77 7as amended by subsection 7a7774 7,b7 ,expenditures for medical assistance 7as such term is defined in section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a777 provided to such eligible individuals4 7#c7 ,requirements2 limitation 7,a7 ,report ,a ,state is not eligible for an increase in its ,federal matching payments under paragraph 7#a7 unless the ,state agrees to submit to the ,secretary of ,health and ,human ,services1 and make publicly available1 a report that contains the information required under paragraph 7#d7 by the end of the #a-year period during which the ,state receives increased ,federal matching payments in accordance with that paragraph4 7,b7 ,maintenance of eligibility 7i7 ,in general ,subject to clause 7ii71 a ,state is not eligible for an increase in its ,federal matching payments under paragraph 7#a7 if eligibility standards1 methodologies1 or procedures under its ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 or waiver of such a plan1 are more restrictive than the eligibility standards1 methodologies1 or procedures1 respectively1 under such plan or waiver as in effect on the date of enactment of this ,act4 7ii7 ,state reinstatement of eligibility permitted ,a ,state that has restricted eligibility standards1 methodologies1 or procedures under its ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 or a waiver of such plan1 after the date of enactment of this ,act1 is no longer ineligible under clause 7i7 beginning with the first calendar quarter in which the ,state has reinstated eligibility standards1 methodologies1 or procedures that are no more restrictive than the eligibility standards1 methodologies1 or procedures1 respectively1 under such plan 7or waiver7 as in effect on such date4 7,c7 ,limitation of matching payments to #ajj percent ,in no case shall an increase in ,federal matching payments under paragraph 7#a7 result in ,federal matching payments that exceed #ajj percent of ,state expenditures4 7#d7 ,required report information ,the information that is required in the report under paragraph 7#c77;,a7 shall include-- 7,a7 the results of an evaluation of the impact of the implementation of the requirements of paragraph 7#ag7 of section #aijb7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77 on improving the ,state's processes for enrolling individuals who are released from public institutions under the ,state ,medicaid plan2 7,b7 the number of individuals who were automatically enrolled 7or whose enrollment was reinstated7 under such paragraph during the #a-year period during which the ,state received increased payments under this subsection2 and 7,c7 any other information that is required by the ,secretary of ,health and ,human ,services4 7c7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendments made by subsection 7a7 shall take effect #ahj days after the date of the enactment of this ,act4 7#b7 ,rule for changes requiring ,state legislation ,in the case of a ,state plan for medical assistance under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirement imposed by the amendments made by subsection 7a71 the ,state plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of the enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4 #gdag4 ,stop ,,hiv in prison 7a7 ,,hiv policy ,the ,director of the ,bureau of ,prisons 7referred to in this section as the ,director7 shall develop a comprehensive policy to provide ,,hiv testing1 treatment1 and prevention for inmates within the correctional setting and upon reentry4 7b7 ,purpose ,the purposes of the policy required to be developed under subsection 7a7 shall be as follows3 7#a7 ,to stop the spread of ,,hiv among inmates4 7#b7 ,to protect guards and other personnel at correctional facilities from ,,hiv infection4 7#c7 ,to provide comprehensive medical treatment to inmates who are living with ,,hiv4 7#d7 ,to promote ,,hiv awareness and prevention among inmates4 7#e7 ,to encourage inmates to take personal responsibility for their health4 7#f7 ,to reduce the risk that inmates will transmit ,,hiv to other persons in the community following their release from a correctional facility4 7c7 ,consultation ,the ,director shall consult with appropriate officials of the ,department of ,health and ,human ,services1 the ,office of ,national ,drug ,control ,policy1 the ,office of ,national ,,aids ,policy1 and the ,centers for ,disease ,control and ,prevention regarding the development of the policy required under subsection 7a74 7d7 ,time limit ,not later than #a year after the date of enactment of this ,act1 the ,director shall draft appropriate regulations to implement the policy required to be developed under subsection 7a74 7e7 ,requirements for policy ,the policy required to be developed under subsection 7a7 shall provide for the following3 7#a7 ,testing and counseling upon intake 7,a7 ,health care personnel shall provide routine ,,hiv testing to all inmates as a part of a comprehensive medical examination immediately following admission to a facility4 ,health care personnel need not provide routine ,,hiv testing to an inmate who is transferred to a facility from another facility if the inmate's medical records are transferred with the inmate and indicate that the inmate has been tested previously4 7,b7 ,with respect to all inmates admitted to a facility prior to the effective date of the policy-- 7i7 health care personnel shall provide routine ,,hiv testing by not later than #ahj days after such effective date2 and 7ii7 ,,hiv testing described in clause 7i7 may be performed in conjunction with other health services provided to these inmates by health care personnel4 7,c7 ,all ,,hiv tests under this paragraph shall comply with the opt-out provision under paragraph 7#i74 7#b7 ,pre-test and post-test counseling ,health care personnel shall provide confidential pre-test and post-test counseling to all inmates who are tested for ,,hiv4 ,counseling may be included with other general health counseling provided to inmates by health care personnel4 7#c7 ,,hiv prevention education 7,a7 ,health care personnel shall improve ,,hiv awareness through frequent educational programs for all inmates4 ,,hiv educational programs may be provided by community-based organizations1 local health departments1 and inmate peer educators4 7,b7 ,,hiv educational materials shall be made available to all inmates at orientation1 at health care clinics1 at regular educational programs1 and prior to release4 ,both written and audiovisual materials shall be made available to all inmates4 7,c7 7i7 ,the ,,hiv educational programs and materials under this paragraph shall include information on-- 7,i7 modes of transmission1 including transmission through tattooing1 sexual contact1 and intravenous drug use2 7,,ii7 prevention methods2 7,,iii7 treatment2 and 7,,iv7 disease progression4 7ii7 ,the programs and materials shall be culturally sensitive1 written or designed for low-literacy levels1 available in a variety of languages1 and present scientifically accurate information in a clear and understandable manner4 7#d7 ,,hiv testing upon request 7,a7 ,health care personnel shall allow inmates to obtain ,,hiv tests upon request once per year or whenever an inmate has a reason to believe the inmate may have been exposed to ,,hiv4 ,health care personnel shall1 both orally and in writing1 inform inmates1 during orientation and periodically throughout incarceration1 of their right to obtain ,,hiv tests4 7,b7 ,health care personnel shall encourage inmates to request ,,hiv tests if the inmate is sexually active1 has been raped1 uses intravenous drugs1 receives a tattoo1 or if the inmate is concerned that the inmate may have been exposed to ,,hiv4 7,c7 ,an inmate's request for an ,,hiv test shall not be considered an indication that the inmate has put themselves at risk of infection or committed a violation of the rules of the correctional facility4 7#e7 ,,hiv testing of pregnant woman 7,a7 ,health care personnel shall provide routine ,,hiv testing to all inmates who become pregnant4 7,b7 ,all ,,hiv tests under this paragraph shall comply with the opt-out provision under paragraph 7#i74 7#f7 ,comprehensive treatment 7,a7 ,health care personnel shall provide all inmates who test positive for ,,hiv-- 7i7 timely1 comprehensive medical treatment2 7ii7 confidential counseling on managing their medical condition and preventing its transmission to other persons2 and 7iii7 voluntary partner notification services4 7,b7 ,health care provided under this paragraph shall be consistent with ,department of ,health and ,human ,services guidelines and standard medical practice4 ,health care personnel shall discuss treatment options1 the importance of adherence to antiretroviral therapy1 and the side effects of medications with inmates receiving treatment4 7,c7 ,health care personnel and pharmacy personnel shall ensure that the facility formulary contains all ,food and ,drug ,administration-approved medications necessary to provide comprehensive treatment for inmates living with ,,hiv1 and that the facility maintains adequate supplies of such medications to meet inmates' medical needs4 ,health care personnel and pharmacy personnel shall also develop and implement automatic renewal systems for these medications to prevent interruptions in care4 7,d7 ,correctional staff1 health care personnel1 and pharmacy personnel shall develop and implement distribution procedures to ensure timely and confidential access to medications4 7#g7 ,protection of confidentiality 7,a7 ,health care personnel shall develop and implement procedures to ensure the confidentiality of inmate tests1 diagnoses1 and treatment4 ,health care personnel and correctional staff shall receive regular training on the implementation of these procedures4 ,penalties for violations of inmate confidentiality by health care personnel or correctional staff shall be specified and strictly enforced4 7,b7 ,,hiv testing1 counseling1 and treatment shall be provided in a confidential setting where other routine health services are provided and in a manner that allows the inmate to request and obtain these services as routine medical services4 7#h7 ,testing1 counseling1 and referral prior to reentry 7,a7 ,health care personnel shall provide routine ,,hiv testing to all inmates not earlier than #ij days prior to their release and reentry into the community4 ,inmates who are already known to be infected need not be tested again4 ,this requirement may be waived if an inmate's release occurs without sufficient notice to the ,director to allow health care personnel to perform a routine ,,hiv test and notify the inmate of the results4 7,b7 ,all ,,hiv tests under this paragraph shall comply with the opt-out provision under paragraph 7#i74 7,c7 ,with respect to all inmates who test positive for ,,hiv and all inmates who already are known to have ,,hiv1 health care personnel shall provide-- 7i7 confidential prerelease counseling on managing their medical condition in the community1 accessing appropriate treatment and services in the community1 and preventing the transmission of their condition to family members and other persons in the community2 7ii7 referrals to appropriate health care providers and social service agencies in the community that meet the inmate's individual needs1 including voluntary partner notification services and prevention counseling services for people living with ,,hiv2 and 7iii7 a #cj-;day supply of any medically necessary medications the inmate is currently receiving4 7#i7 ,opt-out provision ,inmates shall have the right to refuse routine ,,hiv testing4 ,inmates shall be informed both orally and in writing of this right4 ,oral and written disclosure of this right may be included with other general health information and counseling provided to inmates by health care personnel4 ,if an inmate refuses a routine test for ,,hiv1 health care personnel shall make a note of the inmate's refusal in the inmate's confidential medical records4 ,however1 the inmate's refusal shall not be considered a violation of the rules of the correctional facility or result in disciplinary action4 7#aj7 ,exclusion of tests performed under section #djad7;b7 from the definition of routine ,,hiv ,testing ,,hiv testing of an inmate under section #djad7;b7 of title #ah1 ,united ,states ,code1 is not routine ,,hiv testing for the purposes of the opt-out provision under paragraph 7#i74 ,health care personnel shall document the reason for testing under section #djad7;b7 of title #ah1 ,united ,states ,code1 in the inmate's confidential medical records4 7#aa7 ,timely notification of test results ,health care personnel shall provide timely notification to inmates of the results of ,,hiv tests4 7f7 ,changes in existing law 7#a7 ,screening in ,general ,section #djad7;a7 of title #ah1 ,united ,states ,code1 is amended-- 7,a7 by striking for a period of #f months or more2 7,b7 by striking 1 as appropriate12 and 7,c7 by striking if such individual is determined to be at risk for infection with such virus in accordance with the guidelines issued by the ,bureau of ,prisons relating to infectious disease management4 and inserting unless the individual declines4 ,the ,attorney ,general shall also cause such individual to be so tested before release from that incarceration unless the individual declines44 7#b7 ,inadmissibility of ,,hiv ,test ,results in ,civil and ,criminal ,proceedings ,section #djad7;d7 of title #ah1 ,united ,states ,code1 is amended by inserting or under section #gdag of the ,health ,equity and ,accountability ,act of #bjbd after under this section4 7#c7 ,screening as ,part of ,routine ,screening ,section #djad7;e7 of title #ah1 ,united ,states ,code1 is amended by adding at the end the following3 ,such rules shall also provide that the initial test under this section be performed as part of the routine health screening conducted at intake44 7g7 ,reporting requirements 7#a7 ,report on ,hepatitis1 liver1 and ,other ,diseases ,not later than #a year after the date of enactment of this ,act1 the ,director shall submit to ,congress a report on the policies and procedures of the ,bureau of ,prisons to provide testing1 treatment1 and prevention education programs for hepatitis1 liver failure1 and other liver-related diseases transmitted through sexual activity1 intravenous drug use1 or other means4 ,the ,director shall consult with appropriate officials of the ,department of ,health and ,human ,services1 the ,office of ,national ,drug ,control ,policy1 the ,office of ,national ,,aids ,policy1 and the ,centers for ,disease ,control and ,prevention regarding the development of this report4 7#b7 ,annual ,reports 7,a7 ,generally ,not later than #b years after the date of enactment of this ,act1 and annually thereafter1 the ,director submit to ,congress a report on the incidence among inmates of diseases transmitted through sexual activity and intravenous drug use4 7,b7 ,matters pertaining to various diseases ,each report under subparagraph 7,a7 shall discuss-- 7i7 the incidence among inmates of ,,hiv1 hepatitis1 and other diseases transmitted through sexual activity and intravenous drug use2 and 7ii7 updates on the testing1 treatment1 and prevention education programs for these diseases conducted by the ,bureau of ,prisons4 7,c7 ,matters pertaining to ,,hiv only ,each report under subparagraph 7,a7 shall also include-- 7i7 the number of inmates who tested positive for ,,hiv upon intake2 7ii7 the number of inmates who tested positive for ,,hiv prior to reentry2 7iii7 the number of inmates who were not tested for ,,hiv prior to reentry because they were released without sufficient notice2 7iv7 the number of inmates who opted out of taking an ,,hiv test2 7v7 the number of inmates who were tested under section #djad7;b7 of title #ah1 ,united ,states ,code2 and 7vi7 the number of inmates under treatment for ,,hiv4 7,d7 ,consultation ,the ,director shall consult with appropriate officials of the ,department of ,health and ,human ,services1 the ,office of ,national ,drug ,control ,policy1 the ,office of ,national ,,aids ,policy1 and the ,centers for ,disease ,control and ,prevention regarding the development of each report under subparagraph 7,a74 #gdah4 ,transfer of funds for implementation of ,ending the ,,hiv ,epidemic3 ,a ,plan for ,america ,title ,,ii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bjb et seq47 is amended by inserting after section #bda 7#db ,u4,s4,c4 #bch;j7 the following3 #bda;,a4 ,transfer of funds for implementation of ,national ,,hiv_/,,aids ,strategy 7a7 ,transfer authorization ,of the discretionary appropriations made available to the ,department of ,health and ,human ,services for any fiscal year for programs and activities that1 as determined by the ,secretary1 pertain to ,,hiv1 the ,secretary may transfer up to #a percent of such appropriations to the ,office of the ,assistant ,secretary for ,health for implementation of the ,ending the ,,hiv ,epidemic3 ,a ,plan for ,america4 7b7 ,congressional notification ,not less than #cj days before making any transfer under this section1 the ,secretary shall give notice of the transfer to the ,congress4 7c7 ,definitions ,in this section1 the term ,ending the ,,hiv ,epidemic3 ,a ,plan for ,america means the initiative of the ,department of ,health and ,human ,services that seeks to reduce the number of new ,,hiv infections in the ,united ,states by #ge percent by #bjbe1 and then by at least #ij percent by #bjcj1 for an estimated #bej1jjj total ,,hiv infections averted4 4 #gdai4 ,pr,e,p access and coverage 7a7 ,coverage of ,,hiv testing and prevention services 7#a7 ,private insurance 7,a7 ,in general ,section #bgac7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ac7;a77 is amended-- 7i7 in paragraph 7#b71 by striking 2 and and inserting a semicolon2 7ii7 in paragraph 7#c71 by striking the period and inserting a semicolon2 7iii7 in paragraph 7#d71 by striking the period and inserting a semicolon2 7iv7 in paragraph 7#e71 by striking the period and inserting 2 and2 and 7v7 by adding at the end the following3 7#f7 any prescription drug approved by the ,food and ,drug ,administration for the prevention of ,,hiv 7other than a drug subject to preauthorization requirements consistent with section #bgbi;,a71 administrative fees for such drugs1 laboratory and other diagnostic procedures associated with the use of such drugs1 and clinical follow-up and monitoring1 including any related services recommended in current ,united ,states ,public ,health ,service clinical practice guidelines1 without limitation4 4 7,b7 ,prohibition on preauthorization requirements ,subpart ,,ii of part ,a of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq47 is amended by adding at the end the following3 #bgbi;,a4 ,prohibition on preauthorization requirements with respect to certain services ,a group health plan or a health insurance issuer offering group or individual health insurance coverage shall not impose any preauthorization requirements with respect to coverage of the services described in section #bgac7;a77#a77;,e71 except that a plan or issuer may impose preauthorization requirements with respect to coverage of a particular drug approved under section #eje7;c7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act or section #cea7;a7 of this ,act if such plan or issuer provides coverage without any preauthorization requirements for a drug that is therapeutically equivalent4 4 7#b7 ,coverage under ,federal employees health benefits program ,section #hijd of title #e1 ,united ,states ,code1 is amended by adding at the end the following3 7c7 ,any health benefits plan offered under this chapter shall include benefits for1 and may not impose any cost sharing requirements for1 any prescription drug approved by the ,food and ,drug ,administration for the prevention of ,,hiv1 administrative fees for such drugs1 laboratory and other diagnostic procedures associated with the use of such drugs1 and clinical follow-up and monitoring1 including any related services recommended in current ,united ,states ,public ,health ,service clinical practice guidelines1 without limitation4 4 7#c7 ,medicaid 7,a7 ,in general ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d71 as amended by section #edjf7;g71 is amended-- 7i7 in subsection 7a77#d7-- 7,i7 by striking 2 and 7,g7 and inserting 2 7,g72 and 7,,ii7 by striking the semicolon at the end and inserting 2 and 7,h7 ,,hiv prevention services22 and 7ii7 by adding at the end the following new subsection3 7rr7 ,,hiv prevention services ,for purposes of subsection 7a77#d77;,h71 the term ,,hiv prevention services means prescription drugs for the prevention of ,,hiv acquisition1 administrative fees for such drugs1 laboratory and other diagnostic procedures associated with the use of such drugs1 and clinical follow-up and monitoring1 including any related services recommended in current ,united ,states ,public ,health ,service clinical practice guidelines1 without limitation4 4 7,b7 ,no cost-sharing ,title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is amended-- 7i7 in section #aiaf1 by inserting ,,hiv prevention services described in section #aije7;a77#d77;,h71 after section #aije7;a77#d77;,c71 each place it appears2 and 7ii7 in section #aiaf;,a7b77#c77;,b71 as amended by section #gcje1 by adding at the end the following new clause3 7xvi7 ,,hiv prevention services described in section #aije7;a77#d77;,h74 4 7,c7 ,inclusion in benchmark coverage ,section #aicg7;b77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#g7;b77#g77 is amended-- 7i7 in the paragraph header1 by inserting and ,,hiv prevention services after supplies2 and 7ii7 by striking includes for any individual described in section #aije7;a77#d77;,c71 medical assistance for family planning services and supplies in accordance with such section and inserting includes medical assistance for ,,hiv prevention services described in section #aije7;a77#d77;,h71 and includes1 for any individual described in section #aije7;a77#d77;,h71 medical assistance for family planning services and supplies in accordance with such section4 7#d7 ,,chip 7,a7 ,in general ,section #bajc of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc71 as amended by section #bjjg7;d77#e71 is amended-- 7i7 in subsection 7a71 by striking through 7#ac7 and inserting through 7#ad72 and 7ii7 in subsection 7c71 by adding at the end the following new paragraph3 7#ad7 ,,hiv prevention services ,regardless of the type of coverage elected by a ,state under subsection 7a71 the child health assistance provided for a targeted low-income child1 and1 in the case of a ,state that elects to provide pregnancy-related assistance pursuant to section #baab1 the pregnancy-related assistance provided for a targeted low-income pregnant woman 7as such terms are defined for purposes of such section71 shall include coverage of ,,hiv prevention services 7as defined in section #aije7rr774 4 7,b7 ,no cost-sharing ,section #bajc7;e77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7e77#b77 is amended by inserting ,,hiv prevention services described in subsection 7c77#ad71 before or for pregnancy-related assistance4 7,c7 ,effective date 7i7 ,in general ,subject to clause 7ii71 the amendments made by paragraph 7#c7 and this paragraph shall take effect on ,january #a1 #bjbe4 7ii7 ,delay permitted if ,state legislation required ,in the case of a ,state plan approved under title ,,xix or ,,xxi of the ,social ,security ,act which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirements imposed by this subsection1 the ,state plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of the failure of the plan to meet such additional requirements before the #ast day of the #ast calendar quarter beginning after the close of the #ast regular session of the ,state legislature that ends after the #a-year period beginning with the date of the enactment of this ,act4 ,for purposes of the preceding sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session is deemed to be a separate regular session of the ,state legislature4 7#e7 ,coverage and elimination of cost-sharing under ,medicare 7,a7 ,coverage of ,,hiv prevention services under ,part ,b 7i7 ,coverage 7,i7 ,in general ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b771 as amended by section #dbea7;c77#a7 and #faja7;a77#a71 is amended-- 7aa7 by striking and at the end of subparagraph 7,,kk72 7bb7 by inserting and at the end of subparagraph 7,,ll72 and 7cc7 by adding at the end the following new subparagraph3 7,,mm7 ,,hiv prevention services 7as defined in subsection 7ppp772 4 7,,ii7 ,definition ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 as amended by sections #bjjg7;b71 #dbba7;a71 #dbea7;c77#b71 and #faja7;a77#b71 is amended by adding at the end the following new subsection3 7rrr7 ,,hiv prevention services ,the term ,,hiv prevention services means-- 7#a7 drugs or biologicals approved by the ,food and ,drug ,administration for the prevention of ,,hiv2 7#b7 administrative fees for such drugs2 7#c7 laboratory and other diagnostic procedures associated with the use of such drugs2 and 7#d7 clinical follow-up and monitoring1 including any related services recommended in current ,united ,states ,public ,health ,service clinical practice guidelines1 without limitation4 4 7ii7 ,elimination of coinsurance ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a771 as amended by sections #dbea7;c77#c7 and #faja7;a77#d71 is amended-- 7,i7 by striking and before 7,,jj72 and 7,,ii7 by inserting before the semicolon at the end the following3 and 7,,kk7 with respect to ,,hiv prevention services 7as defined in section #ahfa7rrr771 the amount paid shall be #ajj percent of 7i7 except as provided in clause 7ii71 the lesser of the actual charge for the service or the amount determined under the fee schedule that applies to such services under this part1 and 7ii7 in the case of such services that are covered ,,opd services 7as defined in subsection 7t77#a77;,b771 the amount determined under subsection 7t74 7iii7 ,exemption from part b deductible ,section #ahcc7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7b77 is amended-- 7,i7 in paragraph 7#ab71 by striking section #ahfa7s77#aj77;,a711 and and inserting section #ahfa7s77#aj77;,a712 7,,ii7 in paragraph 7#ac71 by striking section #ahfa7n744 and inserting section #ahfa7n71 and 7#ad7 such deductible shall not apply with respect to ,,hiv prevention services 7as defined in section #ahfa7rrr744 7iv7 ,effective date ,the amendments made by this subparagraph shall apply to items and services furnished on or after ,january #a1 #bjbe4 7,b7 ,elimination of cost-sharing for drugs for the prevention of ,,hiv under ,part ,d 7i7 ,in general ,section #ahfj;,d-#b of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7 is amended-- 7,i7 in subsection 7b7-- 7aa7 in paragraph 7#a77;,a71 in the matter preceding clause 7i71 by striking 7#h7 and 7#i7 and inserting 7#h71 7#i71 and 7#aj72 7bb7 in paragraph 7#b77;,a71 in subparagraph 7,a71 in the matter preceding clause 7i71 by striking 7#h7 and 7#i7 and inserting 7#h71 7#i71 and 7#aj72 and 7cc7 by adding at the end the following new paragraph3 7#aj7 ,elimination of cost-sharing for drugs for the prevention of ,,hiv ,for plan years beginning on or after ,january #a1 #bjbe1 with respect to a covered part ,d drug that is for the prevention of ,,hiv-- 7,a7 the deductible under paragraph 7#a7 shall not apply2 and 7,b7 there shall be no coinsurance or other cost-sharing under this part with respect to such drug4 2 and 7,,ii7 in subsection 7c71 by adding at the end the following new paragraph3 7#g7 ,treatment of cost-sharing for drugs for the prevention of ,,hiv ,the coverage is in accordance with subsection 7b77#aj74 4 7ii7 ,conforming amendments to cost-sharing for low-income individuals ,section #ahfj;,d-#ad7;a77#a77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#a77;,d77 is amended in each of clauses 7ii7 and 7iii71 by striking paragraph 7#f7 and inserting paragraph 7#f7 and section #ahfj;,d-#b7;b77#aj74 7#f7 ,coverage of ,,hiv prevention treatment by ,department of ,veterans ,affairs 7,a7 ,elimination of medication copayments ,section #agbb;,a7a7 of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new paragraph3 7#e7 ,paragraph 7#a7 does not apply to a medication for the prevention of ,,hiv4 4 7,b7 ,elimination of hospital care and medical services copayments ,section #agaj of such title is amended-- 7i7 in subsection 7f7-- 7,i7 by redesignating paragraph 7#e7 as paragraph 7#f72 and 7,,ii7 by inserting after paragraph 7#d7 the following new paragraph 7#e73 7#e7 ,a veteran shall not be liable to the ,united ,states under this subsection for any amounts for laboratory and other diagnostic procedures associated with the use of any prescription drug approved by the ,food and ,drug ,administration for the prevention of ,,hiv1 administrative fees for such drugs1 or for laboratory or other diagnostic procedures associated with the use of such drugs1 or clinical follow-up and monitoring1 including any related services recommended in current ,united ,states ,public ,health ,service clinical practice guidelines1 without limitation4 2 and 7ii7 in subsection 7g77#c71 by adding at the end the following new subparagraph3 7,c7 ,any prescription drug approved by the ,food and ,drug ,administration for the prevention of ,,hiv1 administrative fees for such drugs1 laboratory and other diagnostic procedures associated with the use of such drugs1 and clinical follow-up and monitoring1 including any related services recommended in current ,united ,states ,public ,health ,service clinical practice guidelines1 without limitation4 4 7,c7 ,inclusion as preventive health service ,section #agja7i7 of such title is amended-- 7i7 in subparagraph 7,k71 by striking 2 and and inserting a semicolon2 7ii7 by redesignating subparagraph 7,l7 as subparagraph 7,m72 and 7iii7 by inserting after subparagraph 7,k7 the following new subparagraph 7,l73 7,l7 any prescription drug approved by the ,food and ,drug ,administration for the prevention of ,,hiv1 administrative fees for such drugs1 laboratory and other diagnostic procedures associated with the use of such drugs1 and clinical follow-up and monitoring1 including any related services recommended in current ,united ,states ,public ,health ,service clinical practice guidelines1 without limitation2 and 4 7#g7 ,coverage of ,,hiv prevention treatment by ,department of ,defense 7,a7 ,in general ,chapter #ee of title #aj1 ,united ,states ,code1 is amended by inserting after section #ajgi;c the following new section3 #ajgi;d4 ,coverage of ,,hiv prevention treatment 7a7 ,in general ,the ,secretary of ,defense shall ensure coverage under the ,,tricare program of ,,hiv prevention treatment described in subsection 7b7 for any beneficiary under section #ajgd7;a7 of this title4 7b7 ,,hiv prevention treatment described ,,hiv prevention treatment described in this subsection includes any prescription drug approved by the ,food and ,drug ,administration for the prevention of ,,hiv1 administrative fees for such drugs1 laboratory and other diagnostic procedures associated with the use of such drugs1 and clinical follow-up and monitoring1 including any related services recommended in current ,united ,states ,public ,health ,service clinical practice guidelines1 without limitation4 7c7 ,no cost-,sharing ,notwithstanding section #ajge1 #ajge;a1 or #ajgd;g7a77#f7 of this title or any other provision of law1 there is no cost-sharing requirement for ,,hiv prevention treatment covered under this section4 4 7,b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #ajgi;c the following new item3 #ajgi;d4 ,coverage of ,,hiv prevention treatment4 4 7#h7 ,indian ,health ,service testing1 monitoring1 and prescription drugs for the prevention of ,,hiv ,title ,,ii of the ,indian ,health ,care ,improvement ,act is amended by inserting after section #bbc 7#be ,u4,s4,c4 #afbav7 the following3 #bbd4 ,testing1 monitoring1 and prescription drugs for the prevention of ,,hiv 7a7 ,in general ,the ,secretary1 acting through the ,service1 ,indian tribes1 and tribal organizations1 shall provide1 without limitation1 funding for any prescription drug approved by the ,food and ,drug ,administration for the prevention of human immunodeficiency virus 7commonly known as ,,hiv71 administrative fees for that drug1 laboratory and other diagnostic procedures associated with the use of that drug1 and clinical follow-up and monitoring1 including any related services recommended in current ,public ,health ,service clinical practice guidelines4 7b7 ,authorization of appropriations ,there are authorized to be appropriated such sums as are necessary to carry out this section4 4 7#i7 ,effective date ,the amendments made by paragraphs 7#a71 7#b71 7#e71 7#f71 7#g71 and 7#h7 shall take effect with respect to plan years beginning on or after ,january #a1 #bjbe4 7b7 ,prohibition on denial of coverage or increase in premiums of life1 disability1 or long-,term care insurance for individuals taking medication for the prevention of ,,hiv acquisition 7#a7 ,prohibition ,notwithstanding any other provision of law1 it shall be unlawful to-- 7,a7 decline or limit coverage of a person under any life insurance policy1 disability insurance policy1 or long-term care insurance policy1 on account of the individual taking medication for the purpose of preventing the acquisition of ,,hiv2 7,b7 preclude an individual from taking medication for the purpose of preventing the acquisition of ,,hiv as a condition of receiving a life insurance policy1 disability insurance policy1 or long-term care insurance policy2 7,c7 consider whether an individual is taking medication for the purpose of preventing the acquisition of ,,hiv in determining the premium rate for coverage of such individual under a life insurance policy1 disability insurance policy1 or long-term care insurance policy2 or 7,d7 otherwise discriminate in the offering1 issuance1 cancellation1 amount of such coverage1 price1 or any other condition of a life insurance policy1 disability insurance policy1 or long-term care insurance policy for an individual1 based solely and without any additional actuarial risks upon whether the individual is taking medication for the purpose of preventing the acquisition of ,,hiv4 7#b7 ,enforcement ,a ,state insurance regulator may take such actions to enforce paragraph 7#a7 as are specifically authorized under the laws of such ,state4 7#c7 ,definitions ,in this subsection3 7,a7 ,disability insurance policy ,the term disability insurance policy means a contract under which an entity promises to pay a person a sum of money in the event that an illness or injury resulting in a disability prevents such person from working4 7,b7 ,life insurance policy ,the term life insurance policy means a contract under which an entity promises to pay a designated beneficiary a sum of money upon the death of the insured4 7,c7 ,long-term care insurance policy ,the term long-term care insurance policy means a contract for which the only insurance protection provided under the contract is coverage of qualified long-term care services 7as defined in section #ggjb;,b7c7 of the ,internal ,revenue ,code of #aihf74 7c7 ,patient confidentiality ,the ,secretary of ,health and ,human ,services shall amend the regulations promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif 7#db ,u4,s4,c4 #acbj;d-#b note71 as necessary1 to ensure that individuals are able to access the benefits described in section #bgac7;a77#a77;,e7 of the ,public ,health ,service ,act under a family plan without any other individual enrolled in such family plan1 including a primary subscriber or policyholder of such plan1 being informed of such use of such benefits4 7d7 ,pre-,exposure prophylaxis and post-,exposure prophylaxis funding ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq471 as amended by section #gcjc1 is amended by adding at the end the following3 #cii,v-#aa4 ,pre-exposure prophylaxis and post-exposure prophylaxis funding 7a7 ,in general ,not later than #a year after the date of enactment of this section1 the ,secretary shall establish a program that awards grants to ,states1 territories1 ,indian ,tribes1 and directly eligible entities for the establishment and support of pre-exposure prophylaxis 7referred to in this section as ,pr,e,p7 and post-exposure prophylaxis 7referred to in this section as ,,pep7 ,,hiv programs4 7b7 ,applications ,to be eligible to receive a grant under subsection 7a71 a ,state1 territory1 ,indian ,tribe1 or directly eligible entity shall-- 7#a7 submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require1 including a plan describing how any funds awarded will be used to increase access to ,pr,e,p for uninsured and underinsured individuals and reduce disparities in access to ,pr,e,p and ,,pep for uninsured and underinsured individuals and reduce disparities in access to ,pr,e,p and ,,pep2 and 7#b7 appoint a ,pr,e,p and ,,pep grant administrator to manage the program4 7c7 ,directly eligible entity ,for purposes of this section1 the term directly eligible entity-- 7#a7 means a ,federally qualified health center or other nonprofit entity engaged in providing ,pr,e,p and ,,pep information and services2 and 7#b7 may include-- 7,a7 a ,federally qualified health center 7as defined in section #ahfa7;aa77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#d7772 7,b7 a family planning grantee 7other than ,states7 funded under section #ajja of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj72 7,c7 a rural health clinic 7as defined in section #ahfa7;aa77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#b7772 7,d7 a health facility operated by or pursuant to a contract with the ,indian ,health ,service2 7,e7 a community-based organization1 clinic1 hospital1 or other health facility that provides services to individuals at risk for or living with ,,hiv2 and 7,f7 a nonprofit private entity providing comprehensive primary care to populations at risk of ,,hiv1 including faith-based and community-based organizations4 7d7 ,awards ,in determining whether to award a grant1 and the grant amount for each grant awarded1 the ,secretary shall consider the grant application and the need for ,pr,e,p and ,,pep services in the area1 the number of uninsured and underinsured individuals in the area1 and how the ,state1 territory1 or ,indian ,tribe coordinates ,pr,e,p and ,,pep activities with the directly funded entity1 if the ,state1 territory1 or ,indian ,tribe applies for the funds4 7e7 ,use of funds 7#a7 ,in general ,any ,state1 territory1 ,indian ,tribe1 or directly eligible entity that is awarded funds under subsection 7a7 shall use such funds for eligible ,pr,e,p and ,,pep expenses4 7#b7 ,eligible prep expenses ,the ,secretary shall publish a list of expenses that qualify as eligible ,pr,e,p and ,,pep expenses for purposes of this section1 which shall include-- 7,a7 any prescription drug approved by the ,food and ,drug ,administration for the prevention of ,,hiv1 administrative fees for such drugs1 laboratory and other diagnostic procedures associated with the use of such drugs1 and clinical follow-up and monitoring1 including any related services recommended in current ,united ,states ,public ,health ,service clinical practice guidelines1 without limitation2 7,b7 outreach and public education activities directed toward populations overrepresented in the domestic ,,hiv epidemic that increase awareness about the existence of ,pr,e,p and ,,pep1 provide education about access to and health care coverage of ,pr,e,p and ,,pep1 ,pr,e,p and ,,pep adherence programs1 and counter stigma associated with the use of ,pr,e,p and ,,pep2 and 7,c7 outreach activities directed toward physicians and other providers that provide education about ,pr,e,p and ,,pep4 7f7 ,report to ,congress ,the ,secretary shall1 in each of the first #e years beginning one year after the date of the enactment of this section1 submit to ,congress1 and make public on the internet website of the ,department of ,health and ,human ,services1 a report on the impact of any grants provided to ,states1 territories1 and ,indian ,tribes and directly eligible entities for the establishment and support of pre-exposure prophylaxis programs under this section4 7g7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for each of fiscal years #bjbe through #bjcj4 4 7e7 ,clarification ,this section1 including the amendments made by this section1 shall apply notwithstanding any other provision of law1 including ,public ,law #ajc-ada4 7f7 ,private right of action ,any person aggrieved by a violation of this section1 including the amendments made by this section1 may commence a civil action in an appropriate ,united ,states ,district ,court or other court of competent jurisdiction to obtain relief as allowed by law as either an individual or member of a class4 ,if the plaintiff is the prevailing party in such an action1 the court shall order the defendant to pay the costs and reasonable attorney fees of the plaintiff4 ,f ,diabetes #geja4 ,research1 treatment1 and education ,subpart #c of part ,c of title ,,iv of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;c et seq47 is amended by adding at the end the following3 #dcd;,b4 ,diabetes in minority populations 7a7 ,in general ,the ,director of ,,nih shall expand1 intensify1 and support ongoing research and other activities with respect to prediabetes and diabetes1 particularly type #b1 in minority populations4 7b7 ,research 7#a7 ,description ,research under subsection 7a7 shall include investigation into-- 7,a7 the causes of diabetes1 including socioeconomic1 geographic1 clinical1 environmental1 genetic1 and other factors that may contribute to increased rates of diabetes in minority populations2 and 7,b7 the causes of increased incidence of diabetes complications in minority populations1 and possible interventions to decrease such incidence4 7#b7 ,inclusion of minority participants ,in conducting and supporting research described in subsection 7a71 the ,director of ,,nih shall seek to include minority participants as study subjects in clinical trials4 7c7 ,report2 comprehensive plan 7#a7 ,in general ,the ,diabetes ,mellitus ,interagency ,coordinating ,committee shall-- 7,a7 prepare and submit to ,congress1 not later than #f months after the date of enactment of this section1 a report on ,federal research and public health activities with respect to prediabetes and diabetes in minority populations2 and 7,b7 develop and submit to ,congress1 not later than #a year after the date of enactment of this section1 an effective and comprehensive ,federal plan 7including all appropriate ,federal health programs7 to address prediabetes and diabetes in minority populations4 7#b7 ,contents ,the report under paragraph 7#a77;,a7 shall at minimum address each of the following3 7,a7 ,research on diabetes and prediabetes in minority populations1 including such research on-- 7i7 genetic1 behavioral1 socioeconomic1 and environmental factors2 7ii7 prevention of diabetes within these populations and which of the populations have individuals at increased risk of developing diabetes2 7iii7 prevention of complications among individuals in these populations who have already developed diabetes2 and 7iv7 barriers to health care access and diabetes treatment within populations at increased risk of developing diabetes4 7,b7 ,surveillance and data collection on diabetes and prediabetes in minority populations1 including with respect to-- 7i7 efforts to better determine the prevalence of diabetes among ,asian-,american and ,pacific ,islander subgroups2 and 7ii7 efforts to coordinate data collection on the ,american ,indian population4 7,c7 ,community-based interventions to address diabetes and prediabetes targeting minority populations1 including-- 7i7 the evidence base for such interventions2 7ii7 the cultural appropriateness of such interventions2 and 7iii7 efforts to educate the public on the causes and consequences of diabetes4 7,d7 ,education and training programs for health professionals 7including community health workers7 on the prevention and management of diabetes and its related complications that is supported by the ,health ,resources and ,services ,administration1 including such programs supported by-- 7i7 the ,national ,health ,service ,corps2 or 7ii7 the community health centers program under section #ccj4 7d7 ,education ,the ,director of ,,nih shall-- 7#a7 through the ,national ,institute on ,minority ,health and ,health ,disparities and the ,national ,diabetes ,education ,program-- 7,a7 make grants to programs funded under section #dfdz-#d for the purpose of establishing a medical education program for health care professionals to be more involved in weight counseling1 obesity research1 nutrition1 and shared decision making2 and 7,b7 provide for the participation of minority health professionals in diabetes-focused research programs2 and 7#b7 make grants to programs that establish a professional pipeline that will increase the participation of minority individuals in diabetes-focused health fields by expanding ,minority ,access to ,research ,careers program internships and mentoring opportunities for the purposes of recruitment4 7e7 ,definitions ,for purposes of this section3 7#a7 ,diabetes ,mellitus ,interagency ,coordinating ,committee ,the ,diabetes ,mellitus ,interagency ,coordinating ,committee means the ,diabetes ,mellitus ,interagency ,coordinating ,committee established under section #dbi4 7#b7 ,minority population ,the term minority population means a racial and ethnic minority group1 as defined in section #agjg4 4 #gejb4 ,research1 education1 and other activities ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq471 as amended by section #gbja1 is amended by inserting after section #cag,x the following3 #cag,y4 ,diabetes in minority populations 7a7 ,research and other activities 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall conduct and support research and public health activities with respect to diabetes in minority populations4 7#b7 ,certain activities ,activities under paragraph 7#a7 regarding diabetes in minority populations shall include the following3 7,a7 ,further enhancing the ,national ,health and ,nutrition ,examination ,survey by oversampling ,asian ,americans1 ,native ,hawaiians1 and ,pacific ,islanders in appropriate geographic areas to better determine the prevalence of diabetes in such populations as well as to improve the data collection of diabetes penetration disaggregated into major ethnic groups within such populations4 ,the ,secretary shall ensure that any such oversampling does not reduce the oversampling of other minority populations including ,african-,american and ,latino populations4 7,b7 ,through the ,division of ,diabetes ,translation-- 7i7 providing for prevention research to better understand how to influence health care systems changes to improve quality of care being delivered to such populations2 7ii7 carrying out model demonstration projects to design1 implement1 and evaluate effective diabetes prevention and control interventions for minority populations1 including culturally appropriate community-based interventions2 7iii7 developing and implementing a strategic plan to reduce diabetes in minority populations through applied research to reduce disparities and culturally and linguistically appropriate community-based interventions2 7iv7 supporting1 through the national diabetes prevention program under section #cii,v-#c1 diabetes prevention program sites in underserved regions highly impacted by diabetes2 and 7v7 implementing1 through the national diabetes prevention program under section #cii,v-#c1 a demonstration program developing new metrics measuring health outcomes related to diabetes that can be stratified by specific minority populations4 7b7 ,education ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall direct the ,division of ,diabetes ,translation to conduct and support both programs to educate the public on diabetes in minority populations and programs to educate minority populations about the causes and effects of diabetes4 7c7 ,diabetes2 health promotion1 prevention initiatives1 and access ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention and the ,national ,diabetes ,education ,program1 shall conduct and support programs to educate specific minority populations through culturally appropriate and linguistically appropriate information campaigns and initiatives about prevention of1 and managing1 diabetes4 7d7 ,definition ,for purposes of this section1 the term minority population means a racial and ethnic minority group1 as defined in section #agjg4 4 #gejc4 ,programs to educate health providers on the causes and effects of diabetes in minority populations ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq471 as amended by section #gdai7;d71 is amended by adding at the end the following3 #cii,v-#ab ,programs to educate health providers on the causes and effects of diabetes in minority populations 7a7 ,in general ,the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall conduct and support programs described in subsection 7b7 to educate health professionals on the causes and effects of diabetes in minority populations4 7b7 ,programs ,programs described in this subsection1 with respect to education on diabetes in minority populations1 shall include the following3 7#a7 ,giving priority1 under the primary care training and enhancement program under section #gdg-- 7,a7 to awarding grants to focus on or address diabetes2 and 7,b7 to adding minority populations to the list of vulnerable populations that should be served by such grants4 7#b7 ,providing additional funds for the ,health ,careers ,opportunity ,program and the ,centers of ,excellence to partner with the ,office of ,minority ,health under section #agjg and the ,national ,institutes of ,health to strengthen programs for career opportunities focused on diabetes treatment and care within underserved regions highly impacted by diabetes4 7#c7 ,developing a diabetes focus within1 and providing additional funds for1 the ,national ,health ,service ,corps scholarship program-- 7,a7 to place individuals in areas that are disproportionately affected by diabetes and to provide diabetes treatment and care in such areas2 and 7,b7 to provide such individuals continuing medical education specific to diabetes care4 4 #gejd4 ,research1 education1 and other activities regarding diabetes in ,american ,indian populations ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq471 as amended by section #gejc1 is amended by adding at the end the following3 #cii,v-#ac4 ,research1 education1 and other activities regarding diabetes in ,american ,indian populations ,in addition to activities under sections #cag,x1 #cii,v-#ab1 and #dcd;,b1 the ,secretary1 acting through the ,indian ,health ,service and in collaboration with other appropriate ,federal agencies1 shall-- 7#a7 conduct and support research and other activities with respect to diabetes2 and 7#b7 coordinate the collection of data on clinically and culturally appropriate diabetes treatment1 care1 prevention1 and services by health care professionals to the ,american ,indian population4 4 #geje4 ,updated report on health disparities ,the ,secretary of ,health and ,human ,services shall seek to enter into an arrangement with the ,national ,academy of ,medicine under which the ,national ,academy will-- 7#a7 not later than #a year after the date of enactment of this ,act1 submit to ,congress an updated version of the #bjjc report entitled ,unequal ,treatment3 ,confronting ,racial and ,ethnic ,disparities in ,health ,care2 and 7#b7 in such updated version1 address how racial and ethnic health disparities have changed since the publication of the original report4 ,g ,lung disease #gfja4 ,asthma-related activities of the ,centers for ,disease ,control and ,prevention ,section #cag;,i of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdg;b-#aj7 is amended to read as follows3 #cag;,i4 ,asthma-related activities of the ,centers for ,disease ,control and ,prevention 7a7 ,program for providing information and education to the public ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall collaborate with ,state and local health departments to conduct activities1 including the provision of information and education to the public1 regarding asthma including-- 7#a7 deterring the harmful consequences of uncontrolled asthma2 and 7#b7 disseminating health education and information regarding prevention of asthma episodes and strategies for managing asthma4 7b7 ,development of ,state asthma plans ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall collaborate with ,state and local health departments to develop ,state plans incorporating public health responses to reduce the burden of asthma1 particularly regarding disproportionately affected populations4 7c7 ,compilation of data ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall1 in cooperation with ,state and local public health officials-- 7#a7 conduct asthma surveillance activities to collect data on the prevalence and severity of asthma1 the effectiveness of public health asthma interventions1 and the quality of asthma management1 including-- 7,a7 collection of data among people with asthma to monitor the impact on health and quality of life2 7,b7 surveillance of health care facilities2 and 7,c7 collection of data not containing individually identifiable information from electronic health records or other electronic communications2 7#b7 compile and annually publish data regarding the prevalence and incidence of childhood asthma1 the child mortality rate1 and the number of hospital admissions and emergency department visits by children associated with asthma nationally and in each ,state and at the county level by age1 sex1 race1 and ethnicity1 as well as lifetime and current prevalence2 and 7#c7 compile and annually publish data regarding the prevalence and incidence of adult asthma1 the adult mortality rate1 and the number of hospital admissions and emergency department visits by adults associated with asthma nationally and in each ,state and at the county level by age1 sex1 race1 ethnicity1 industry1 and occupation1 as well as lifetime and current prevalence4 7d7 ,coordination of data collection ,the ,director of the ,centers for ,disease ,control and ,prevention1 in conjunction with ,state and local health departments1 shall coordinate data collection activities under paragraphs 7#b7 and 7#c7 of subsection 7c7 so as to maximize comparability of results4 7e7 ,collaboration 7#a7 ,in general ,the ,centers for ,disease ,control and ,prevention may collaborate with national1 ,state1 and local nonprofit organizations to provide information and education about asthma1 and to strengthen such collaborations when possible4 7#b7 ,specific activities ,the ,director of the ,centers for ,disease ,control and ,prevention1 acting through the ,division of ,population ,health of the ,centers1 may expand activities relating to asthma with non-,federal partners1 especially ,state-level entities4 7f7 ,reports to ,congress 7#a7 ,in general ,not later than #c years after the date of the enactment of the ,health ,equity and ,accountability ,act of #bjbd1 and once #b years thereafter1 the ,secretary shall1 in consultation with patient groups1 nonprofit organizations1 medical societies1 and other relevant governmental and nongovernmental entities1 submit to ,congress a report that-- 7,a7 catalogs1 with respect to asthma prevention1 management1 and surveillance-- 7i7 the activities of the ,federal ,government1 including an assessment of the progress of the ,federal ,government and ,states1 with respect to achieving the goals of the ,healthy ,people #bjcj initiative2 and 7ii7 the activities of other entities that participate in the program under this section1 including nonprofit organizations1 patient advocacy groups1 and medical societies2 and 7,b7 makes recommendations for the future direction of asthma activities1 in consultation with researchers from the ,national ,institutes of ,health and other member bodies of the ,asthma ,disparities ,subcommittee1 including-- 7i7 a description of how the ,federal ,government may improve its response to asthma1 including identifying any barriers that may exist2 7ii7 a description of how the ,federal ,government may continue1 expand1 and improve its private-public partnerships with respect to asthma1 including identifying any barriers that may exist2 7iii7 identification of steps that may be taken to reduce the-- 7,i7 morbidity1 mortality1 and overall prevalence of asthma2 7,,ii7 financial burden of asthma on society2 7,,iii7 burden of asthma on disproportionately affected areas1 particularly those in medically underserved populations 7as defined in section #ccj7;b77#c772 and 7,,iv7 burden of asthma as a chronic disease that can be worsened by environmental exposures2 7iv7 the identification of programs and policies that have achieved the steps described under clause 7iii71 and steps that may be taken to expand such programs and policies to benefit larger populations2 and 7v7 recommendations for future research and interventions4 7#b7 ,subsequent reports 7,a7 ,congressional request ,during the #e-year period following the submission of the second report under paragraph 7#a71 the ,secretary shall submit updates and revisions of the report upon the request of the ,congress4 7,b7 ,five-year reevaluation ,at the end of the #e-year period referred to in subparagraph 7,a71 the ,secretary shall-- 7i7 evaluate the analyses and recommendations made in previous reports2 and 7ii7 determine whether an additional report is needed and if so submit such an updated report to the ,congress1 including appropriate recommendations4 7g7 ,authorization of appropriations funding ,in addition to any other authorization of appropriations that is available to the ,centers for ,disease ,control and ,prevention for the purpose of carrying out this section1 there is authorized to be appropriated to such ,centers #fe1jjj1jjj for the period of fiscal years #bjbe through #bjbi for the purpose of carrying out this section4 4 #gfjb4 ,influenza and pneumonia vaccination campaign 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall-- 7#a7 enhance the annual campaign by the ,department of ,health and ,human ,services to increase the number of people vaccinated each year for influenza and pneumonia2 and 7#b7 include in such campaign the use of written educational materials1 public service announcements1 physician education1 and any other means which the ,secretary determines effective4 7b7 ,materials and announcements ,in carrying out the annual campaign described in subsection 7a71 the ,secretary of ,health and ,human ,services shall ensure that-- 7#a7 educational materials and public service announcements are readily and widely available in communities experiencing disparities in the incidence and mortality rates of influenza and pneumonia2 and 7#b7 the campaign uses targeted1 culturally appropriate messages and messengers to reach underserved communities4 7c7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #gfjc4 ,chronic obstructive pulmonary disease 7a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention shall conduct1 support1 and expand public health strategies and prevention1 diagnosis1 surveillance1 and public and professional awareness activities regarding chronic obstructive pulmonary disease4 7b7 ,chronic disease prevention programs ,the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute shall carry out the following3 7#a7 ,conduct public education and awareness activities with patient and professional organizations to stimulate earlier diagnosis and improve patient outcomes from treatment of chronic obstructive pulmonary disease4 ,to the extent known and relevant1 such public education and awareness activities shall reflect differences in chronic obstructive pulmonary disease by cause 7tobacco1 environmental1 occupational1 biological1 and genetic7 and include a focus on outreach to undiagnosed and1 as appropriate1 minority populations4 7#b7 ,supplement and expand upon the activities of the ,national ,heart1 ,lung1 and ,blood ,institute by making grants to nonprofit organizations1 ,state and local jurisdictions1 and ,indian ,tribes for the purpose of reducing the burden of chronic obstructive pulmonary disease1 especially in disproportionately impacted communities1 through public health interventions and related activities4 7#c7 ,coordinate with the ,centers for ,disease ,control and ,prevention1 the ,indian ,health ,service1 the ,health ,resources and ,services ,administration1 and the ,department of ,veterans ,affairs to develop pilot programs to demonstrate best practices for the diagnosis and management of chronic obstructive pulmonary disease4 7#d7 ,develop improved techniques and identify best practices1 in coordination with the ,secretary of ,veterans ,affairs1 for assisting chronic obstructive pulmonary disease patients to successfully stop smoking1 including identification of subpopulations with different needs4 ,initiatives under this paragraph may include research to determine whether successful smoking cessation strategies are different for chronic obstructive pulmonary disease patients compared to such strategies for patients with other chronic diseases4 7c7 ,environmental and occupational health programs ,the ,director of the ,centers for ,disease ,control and ,prevention shall-- 7#a7 support research into the environmental and occupational causes and biological mechanisms that contribute to chronic obstructive pulmonary disease2 and 7#b7 develop and disseminate public health interventions that will lessen the impact of environmental and occupational causes of chronic obstructive pulmonary disease4 7d7 ,data ,collection ,not later than #ahj days after the date of enactment of this ,act1 the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute and the ,director of the ,centers for ,disease ,control and ,prevention1 acting jointly1 shall assess the depth and quality of information on chronic obstructive pulmonary disease that is collected in surveys and population studies conducted by the ,centers for ,disease ,control and ,prevention1 including whether there are additional opportunities for information to be collected in the ,national ,health and ,nutrition ,examination ,survey1 the ,national ,health ,interview ,survey1 and the ,behavioral ,risk ,factors ,surveillance ,system surveys4 7e7 ,authorization of ,appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 ,h ,tuberculosis #ggja4 ,united ,states ,government assistance to combat tuberculosis ,section #ajd;,b of the ,foreign ,assistance ,act of #aifa 7#bb ,u4,s4,c4 #baea;b-#c7 is amended to read as follows3 #ajd;,b4 ,assistance to combat tuberculosis 7a7 ,policy 7#a7 ,in general ,it is a major objective of the foreign assistance program of the ,united ,states to help end the ,,tb public health emergency through accelerated actions-- 7,a7 to support the diagnosis and treatment of all adults and children with all forms of ,,tb2 and 7,b7 to prevent new ,,tb infections from occurring4 7#b7 ,support for global plans and objectives ,in countries in which the ,united ,states ,government has established foreign assistance programs under this ,act1 particularly in countries with the highest burden of ,,tb and other countries with high rates of infection and transmission of ,,tb1 it is the policy of the ,united ,states-- 7,a7 to support the objectives of the ,world ,health ,organization ,end ,,tb ,strategy1 including its goals-- 7i7 to reduce ,,tb deaths by #ie percent by #bjce2 7ii7 to reduce the ,,tb incidence rate by #ij percent by #bjce2 and 7iii7 to reduce the number of families facing catastrophic health costs due to ,,tb by #ajj percent by #bjce2 7,b7 to support the ,stop ,,tb ,partnership's ,global ,plan to ,end ,,tb #bjbc-bjcj1 including by providing support for-- 7i7 developing and using innovative new technologies and therapies to increase active case finding and rapidly diagnose and treat children and adults with all forms of ,,tb1 alleviate suffering1 and ensure ,,tb treatment completion2 7ii7 expanding diagnosis and treatment in line with the goals established by the ,political ,declaration of the ,high-,level ,meeting of the ,general ,assembly on the ,fight ,against ,tuberculosis1 including-- 7,i7 successfully treating #dj1jjj1jjj people with active ,,tb by #bjbc1 including #c1ejj1jjj children1 and #a1ejj1jjj people with drug-resistant ,,tb2 and 7,,ii7 diagnosing and treating latent tuberculosis infection1 in support of the global goal of providing preventive therapy to at least #cj1jjj1jjj people by #bjbc1 including #d1jjj1jjj children younger than #e years of age1 #bj1jjj1jjj household contacts of people affected by ,,tb1 and #f1jjj1jjj people living with ,,hiv2 7iii7 ensuring high-quality ,,tb care by closing gaps in care cascades1 implementing continuous quality improvement at all levels of care1 and providing related patient support2 and 7iv7 sustainable procurements of ,,tb commodities to avoid interruptions in supply1 the procurement of commodities of unknown quality1 or payment of excessive commodity costs in countries impacted by ,,tb2 and 7,c7 to ensure1 to the greatest extent practicable1 that ,united ,states funding supports activities that simultaneously emphasize-- 7i7 the development of comprehensive person-centered programs1 including diagnosis1 treatment1 and prevention strategies to ensure that-- 7,i7 all people sick with ,,tb receive quality diagnosis and treatment through active case finding2 and 7,,ii7 people at high risk for ,,tb infection are found and treated with preventive therapies in a timely manner2 7ii7 robust ,,tb infection control practices are implemented in all congregate settings1 including hospitals and prisons2 7iii7 the deployment of diagnostic and treatment capacity-- 7,i7 in areas with the highest ,,tb burdens2 and 7,,ii7 for highly at-risk and impoverished populations1 including patient support services2 7iv7 program monitoring and evaluation based on critical ,,tb indicators1 including indicators relating to infection control1 the numbers of patients accessing ,,tb treatment and patient support services1 and preventative therapy for those at risk1 including all close contacts1 and treatment outcomes for all forms of ,,tb2 7v7 training and engagement of health care workers on the use of new diagnostic tools and therapies as they become available1 and increased support for training frontline health care workers to support expanded ,,tb active case finding1 contact tracing1 and patient support services2 7vi7 coordination with domestic agencies and organizations to support an aggressive research agenda to develop vaccines as well as new tools to diagnose1 treat1 and prevent ,,tb globally2 7vii7 linkages with the private sector on-- 7,i7 research and development of a vaccine1 and on new tools for diagnosis and treatment of ,,tb2 7,,ii7 improving current tools for diagnosis and treatment of ,,tb1 including telehealth solutions for prevention and treatment2 and 7,,iii7 training healthcare professionals on use of the newest and most effective diagnostic and therapeutic tools2 7viii7 the reduction of barriers to care1 including stigma and treatment and diagnosis costs1 including through-- 7,i7 training health workers2 7,,ii7 sensitizing policy makers2 7,,iii7 requiring that all relevant grants and funding agreements include access and affordability provisions2 7,,iv7 supporting education and empowerment campaigns for ,,tb patients regarding local ,,tb services2 7,v7 monitoring barriers to accessing ,,tb services2 and 7,,vi7 increasing support for patient-led and community-led ,,tb outreach efforts2 7ix7 support for country-level1 sustainable accountability mechanisms and capacity to measure progress and ensure that commitments made by governments and relevant stakeholders are met2 and 7x7 support for the integration of ,,tb diagnosis1 treatment1 and prevention activities into primary health care1 as appropriate4 7b7 ,definitions ,in this section3 7#a7 ,appropriate congressional committees ,the term appropriate congressional committees means the ,committee on ,foreign ,relations of the ,senate and the ,committee on ,foreign ,affairs of the ,house of ,representatives4 7#b7 ,end ,,tb ,strategy ,the term ,end ,,tb ,strategy means the strategy to eliminate ,,tb that was approved by the ,world ,health ,assembly in ,may #bjad1 and is described in ,the ,end ,,tb ,strategy3 ,global ,strategy and ,targets for ,tuberculosis ,prevention1 ,care and ,control ,after #bjae4 7#c7 ,global alliance for tuberculosis drug development ,the term ,global ,alliance for ,tuberculosis ,drug ,development means the public-private partnership that bring together leaders in health1 science1 philanthropy1 and private industry to devise new approaches to ,,tb4 7#d7 ,global tuberculosis drug facility ,the term ,global ,tuberculosis ,drug ,facility means the initiative of the ,stop ,tuberculosis ,partnership to increase access to the most advanced1 affordable1 quality-assured ,,tb drugs and diagnostics4 7#e7 ,,mdr-,,tb ,the term ,,mdr-,,tb means multi-drug-resistant ,,tb4 7#f7 ,stop tuberculosis partnership ,the term ,stop ,tuberculosis ,partnership means the partnership of #a1fjj organizations 7including international and technical organizations1 government programs1 research and funding agencies1 foundations1 nongovernmental organizations1 civil society and community groups1 and the private sector71 donors1 including the ,united ,states1 high ,,tb burden countries1 multilateral agencies1 and nongovernmental and technical agencies1 which is governed by the ,stop ,,tb ,partnership ,coordinating ,board and hosted by a ,united ,nations entity1 committed to short- and long-term measures required to control and eventually eliminate ,,tb as a public health problem in the world4 7#g7 ,,xdr-,,tb ,the term ,,xdr-,,tb means extensively drug-resistant ,,tb4 7c7 ,authorization ,to carry out this section1 the ,president is authorized1 consistent with section #ajd7;c71 to furnish assistance1 on such terms and conditions as the ,president may determine1 for the prevention1 treatment1 control1 and elimination of ,,tb4 7d7 ,goals ,in consultation with the appropriate congressional committees1 the ,president shall establish goals1 based on the policy and indicators described in subsection 7a71 for-- 7#a7 ,united ,states ,,tb programs to detect1 cure1 and prevent all forms of ,,tb globally for the period between #bjbc and #bjcj that are aligned with the ,end ,,tb ,strategy's #bjcj targets and the ,,usaid's ,global ,tuberculosis 7,,tb7 ,strategy #bjbc-bjcj2 and 7#b7 updating the ,national ,action ,plan for ,combating ,multidrug-,resistant ,tuberculosis4 7e7 ,coordination 7#a7 ,in general ,in carrying out this section1 the ,president shall coordinate with the ,world ,health ,organization1 the ,stop ,,tb ,partnership1 the ,global ,fund to ,fight ,,aids1 ,tuberculosis1 and ,malaria1 and other organizations with respect to the development and implementation of a comprehensive global ,,tb response program4 7#b7 ,bilateral assistance ,in providing bilateral assistance under this section1 the ,president1 acting through the ,administrator of the ,united ,states ,agency for ,international ,development1 shall-- 7,a7 catalyze support for research and development of new tools to prevent1 diagnose1 treat1 and control ,,tb worldwide1 particularly to reduce the incidence of1 and mortality from1 all forms of drug-resistant ,,tb2 7,b7 ensure ,united ,states programs and activities focus on finding individuals with active ,,tb disease and provide quality diagnosis and treatment1 including through digital health solutions1 and reaching those at high risk with preventive therapy2 and 7,c7 ensure coordination among relevant ,united ,states ,government agencies1 including the ,department of ,state1 the ,centers for ,disease ,control and ,prevention1 the ,national ,institutes of ,health1 the ,biomedical ,advanced ,research and ,development ,authority1 the ,food and ,drug ,administration1 the ,national ,science ,foundation1 the ,department of ,defense 7through its ,congressionally ,directed ,medical ,research ,programs71 and other relevant ,federal departments and agencies that engage in international ,,tb activities-- 7i7 to ensure accountability and transparency2 7ii7 to reduce duplication of efforts2 and 7iii7 to ensure appropriate integration and coordination of ,,tb services into other ,united ,states-supported health programs4 7f7 ,priority ,to ,end ,,tb strategy ,in furnishing assistance under subsection 7c71 the ,president shall prioritize-- 7#a7 building and strengthening ,,tb programs-- 7,a7 to increase the diagnosis and treatment of everyone who is sick with ,,tb2 and 7,b7 to ensure that such individuals have access to quality diagnosis and treatment2 7#b7 direct1 high-quality integrated services for all forms of ,,tb1 as described by the ,world ,health ,organization1 which call for the coordination of active case finding1 treatment of all forms of ,,tb disease and infection1 patient support1 and ,,tb prevention2 7#c7 treating individuals co-infected with ,,hiv and other co-morbidities1 and other individuals with ,,tb who may be at risk of stigma2 7#d7 strengthening the capacity of health systems to detect1 prevent1 and treat ,,tb1 including ,,mdr-,,tb and ,,xdr-,,tb1 as described in the latest international guidance related to ,,tb2 7#e7 researching and developing innovative diagnostics1 drug therapies1 and vaccines1 and program-based research2 7#f7 support for the ,stop ,tuberculosis ,partnership's ,global ,drug ,facility1 the ,global ,alliance for ,tuberculosis ,drug ,development1 and other organizations promoting the development of new products and drugs for ,,tb2 and 7#g7 ensuring that ,,tb programs can serve as key platforms for supporting national respiratory pandemic response against existing and new infectious respiratory disease4 7g7 ,assistance for the ,world ,health ,organization and the ,stop ,tuberculosis ,partnership ,in carrying out this section1 the ,president1 acting through the ,administrator of the ,united ,states ,agency for ,international ,development1 is authorized-- 7#a7 to provide resources to the ,world ,health ,organization and the ,stop ,tuberculosis ,partnership to improve the capacity of countries with high burdens or rates of ,,tb and other affected countries to implement the ,end ,,tb ,strategy1 the ,stop ,,tb ,global ,plan to ,end ,,tb1 their own national strategies and plans1 other global efforts to control ,,mdr-,,tb and ,,xdr-,,tb2 and 7#b7 to leverage the contributions of other donors for the activities described in paragraph 7#a74 7h7 ,annual report on ,,tb activities ,not later than ,december #ae of each year until the earlier of the date on which the goals specified in subsection 7a77#b77;,a7 are met or the last day of #bjcj1 the ,president shall submit an annual report to the appropriate congressional committees that describes ,united ,states foreign assistance to control ,,tb and the impact of such efforts1 including-- 7#a7 the number of individuals with active ,,tb disease that were diagnosed and treated1 including the rate of treatment completion and the number receiving patient support2 7#b7 the number of persons with ,,mdr-,,tb and ,,xdr-,,tb that were diagnosed and treated1 including the rate of completion1 in countries receiving ,united ,states bilateral foreign assistance for ,,tb control programs2 7#c7 the number of people trained by the ,united ,states ,government in ,,tb surveillance and control2 7#d7 the number of individuals with active ,,tb disease identified as a result of engagement with the private sector and other nongovernmental partners in countries receiving ,united ,states bilateral foreign assistance for ,,tb control programs2 7#e7 a description of the collaboration and coordination of ,united ,states anti-,,tb efforts with the ,world ,health ,organization1 the ,stop ,,tb ,partnership1 the ,global ,fund to ,fight ,,aids1 ,tuberculosis and ,malaria1 and other major public and private entities2 7#f7 a description of the collaboration and coordination among the ,united ,states ,agency for ,international ,development and other ,united ,states departments and agencies1 including the ,centers for ,disease ,control and ,prevention and the ,office of the ,global ,,aids ,coordinator1 for the purposes of combating ,,tb and1 as appropriate1 its integration into primary care2 7#g7 the constraints on implementation of programs posed by health workforce shortages1 health system limitations1 barriers to digital health implementation1 other challenges to successful implementation1 and strategies to address such constraints2 7#h7 a breakdown of expenditures for patient services supporting ,,tb diagnosis1 treatment1 and prevention1 including procurement of drugs and other commodities1 drug management1 training in diagnosis and treatment1 health systems strengthening that directly impacts the provision of ,,tb services1 and research2 and 7#i7 for each country1 and when practicable1 each project site receiving bilateral ,united ,states assistance for the purpose of ,,tb prevention1 treatment1 and control-- 7,a7 a description of progress toward the adoption and implementation of the most recent ,world ,health ,organization guidelines to improve diagnosis1 treatment1 and prevention of ,,tb for adults and children1 disaggregated by sex1 including the proportion of health facilities that have adopted the latest ,world ,health ,organization guidelines on strengthening monitoring systems and preventative1 diagnostic1 and therapeutic methods1 including the use of rapid diagnostic tests and orally administered ,,tb treatment regimens2 7,b7 the number of individuals screened for ,,tb disease and the number evaluated for ,,tb infection using active case finding outside of health facilities2 7,c7 the number of individuals with active ,,tb disease that were diagnosed and treated1 including the rate of treatment completion and the number receiving patient support2 7,d7 the number of adults and children1 including people with ,,hiv and close contacts1 who are evaluated for ,,tb infection1 the number of adults and children started on treatment for ,,tb infection1 and the number of adults and children completing such treatment1 disaggregated by sex and1 as possible1 income or wealth quintile2 7,e7 the establishment of effective ,,tb infection control in all relevant congregant settings1 including hospitals1 clinics1 and prisons2 7,f7 a description of progress in implementing measures to reduce ,,tb incidence1 including actions-- 7i7 to expand active case finding and contact tracing to reach vulnerable groups2 and 7ii7 to expand ,,tb preventive therapy1 engagement of the private sector1 and diagnostic capacity2 7,g7 a description of progress to expand diagnosis1 prevention1 and treatment for all forms of ,,tb1 including in pregnant women1 children1 and individuals and groups at greater risk of ,,tb1 including migrants1 prisoners1 miners1 people exposed to silica1 and people living with ,,hiv_/,,aids1 disaggregated by sex2 7,h7 the rate of successful completion of ,,tb treatment for adults and children1 disaggregated by sex1 and the number of individuals receiving support for treatment completion2 7,i7 the number of people1 disaggregated by sex1 receiving treatment for ,,mdr-,,tb1 the proportion of those treated with the latest regimens endorsed by the ,world ,health ,organization1 factors impeding scale up of such treatment1 and a description of progress to expand community-based ,,mdr-,,tb care2 7,j7 a description of ,,tb commodity procurement challenges1 including shortages1 stockouts1 or failed tenders for ,,tb drugs or other commodities2 7,k7 the proportion of health facilities with specimen referral linkages to quality diagnostic networks1 including established testing sites and reference labs1 to ensure maximum access and referral for second line drug resistance testing1 and a description of the turnaround time for test results2 7,l7 the number of people trained by the ,united ,states ,government to deliver high-quality ,,tb diagnostic1 preventative1 monitoring1 treatment1 and care services2 7,m7 a description of how supported activities are coordinated with-- 7i7 country national ,,tb plans and strategies2 and 7ii7 ,,tb control efforts supported by the ,global ,fund to ,fight ,,aids1 ,tuberculosis1 and ,malaria1 and other international assistance programs and funds1 including in the areas of program development and implementation2 and 7,n7 for the first #c years of the report required under this subsection1 a description of the progress in recovering from the negative impact of ,,covid-#ai on ,,tb1 including-- 7i7 whether there has been the development and implementation of a comprehensive plan to recover ,,tb activities from diversion of resources2 7ii7 the continued use of bidirectional ,,tb-,,covid testing2 and 7iii7 progress on increased diagnosis and treatment of active ,,tb4 7i7 ,annual report on ,,tb research and development ,the ,president1 acting through the ,administrator of the ,united ,states ,agency for ,international ,development1 and in coordination with the ,national ,institutes of ,health1 the ,centers for ,disease ,control and ,prevention1 the ,biomedical ,advanced ,research and ,development ,authority1 the ,food and ,drug ,administration1 the ,national ,science ,foundation1 and the ,office of the ,global ,,aids ,coordinator1 shall submit to the appropriate congressional committees until #bjcj an annual report that-- 7#a7 describes the current progress and challenges to the development of new tools for the purpose of ,,tb prevention1 treatment1 and control2 7#b7 identifies critical gaps and emerging priorities for research and development1 including for rapid and point-of-care diagnostics1 shortened treatments and prevention methods1 telehealth solutions for prevention and treatment1 and vaccines2 and 7#c7 describes research investments by type1 funded entities1 and level of investment4 7j7 ,evaluation report ,not later than #c years after the date of the enactment of the ,health ,equity and ,accountability ,act of #bjbd1 and #e years thereafter1 the ,comptroller ,general of the ,united ,states shall submit a report to the appropriate congressional committees that evaluates the performance and impact on ,,tb prevention1 diagnosis1 treatment1 and care efforts that are supported by ,united ,states bilateral assistance funding1 including recommendations for improving such programs4 4 ,i ,osteoarthritis and ,musculoskeletal ,diseases #ghja4 ,osteoarthritis and other musculoskeletal health-related activities of the ,centers for ,disease ,control and ,prevention 7a7 ,education and ,awareness activities ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall direct the ,national ,center for ,chronic ,disease ,prevention and ,health ,promotion to conduct and expand the ,health ,community ,program and ,arthritis ,program to educate the public on-- 7#a7 the causes of1 preventive health actions for1 and effects of arthritis1 lupus1 and other musculoskeletal conditions in minority patient populations2 and 7#b7 the effects of such conditions on other comorbidities including obesity1 hypertension1 and cardiovascular disease4 7b7 ,programs on arthritis and musculoskeletal conditions ,education and awareness programs of the ,centers for ,disease ,control and ,prevention on arthritis and other musculoskeletal conditions in minority communities shall-- 7#a7 be culturally and linguistically appropriate to minority patients1 targeting musculoskeletal health promotion and prevention programs of each major ethnic group1 including-- 7,a7 ,native ,americans and ,alaska ,natives2 7,b7 ,asian ,americans2 7,c7 ,african ,americans and ,blacks2 7,d7 ,hispanic and ,latino ,americans2 and 7,e7 ,native ,hawaiians and ,pacific ,islanders2 and 7#b7 include public awareness campaigns directed toward these patient populations that emphasize the importance of musculoskeletal health1 physical activity1 diet and healthy lifestyle1 and weight reduction for overweight and obese patients4 7c7 ,authorization of ,appropriations ,to carry out this section1 there are authorized to be appropriated such sums as are necessary for fiscal year #bjbe and each subsequent fiscal year4 #ghjb4 ,grants for comprehensive osteoarthritis and musculoskeletal disease health education within health professions schools 7a7 ,program authorized ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary71 in coordination with the ,secretary of ,education1 shall award grants1 on a competitive basis1 to academic health science centers1 health professions schools1 and institutions of higher education to enable such centers1 schools1 and institutions to provide people with comprehensive education on arthritis and musculoskeletal health1 particularly-- 7#a7 obesity-related musculoskeletal diseases2 7#b7 arthritis and osteoarthritis2 7#c7 arthritis and musculoskeletal health disparities2 and 7#d7 the relationship between arthritis and musculoskeletal diseases and metabolic activity1 psychological health1 and comorbidities such as diabetes1 cardiovascular disease1 lupus1 and hypertension4 7b7 ,duration ,grants awarded under this section shall be for a period of #e years4 7c7 ,applications ,an academic health science center1 health professions school1 or institution of higher education seeking a grant under this section shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7d7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to an institution of higher education that-- 7#a7 has an enrollment of needy students1 as defined in section #cah7;b7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;e7b772 7#b7 is a ,hispanic-serving institution1 as defined in section #ejb7;a7 of such ,act 7#bj ,u4,s4,c4 #aaja;a7a772 7#c7 is a ,tribal ,college or ,university1 as defined in section #caf7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;c7b772 7#d7 is an ,alaska ,native-serving institution1 as defined in section #cag7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7#e7 is a ,native ,hawaiian-serving institution1 as defined in section #cag7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7#f7 is a ,predominately ,black ,institution1 as defined in section #cah7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;e7b772 7#g7 is a ,native ,american-serving1 nontribal institution1 as defined in section #cai7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;f7b772 7#h7 is an ,asian ,american and ,native ,american ,pacific ,islander-serving institution1 as defined in section #cbj7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;g7b772 or 7#i7 is a minority institution1 as defined in section #cfe of such ,act 7#bj ,u4,s4,c4 #ajfgk71 with an enrollment of needy students1 as defined in section #cab of such ,act 7#bj ,u4,s4,c4 #ajeh74 7e7 ,uses of funds ,an academic health science center1 health professions school1 or institution of higher education receiving a grant under this section may use the grant funds to integrate issues relating to comprehensive arthritis and musculoskeletal health into the academic or support sectors of the center1 school1 or institution in order to reach a large number of students1 by carrying out #a or more of the following activities3 7#a7 ,developing educational content for issues relating to comprehensive arthritis and musculoskeletal health education that will be incorporated into first-year orientation or core courses4 7#b7 ,creating innovative technology-based approaches to deliver arthritis and musculoskeletal health education to students1 faculty1 and staff4 7#c7 ,developing and employing peer-outreach and education programs to generate discussion1 educate1 and raise awareness among students about issues relating to arthritis and musculoskeletal health disorders1 and their relationship to diabetes1 hypertension1 cardiovascular disease1 psychological health1 and other comorbid conditions4 7f7 ,report to ,congress 7#a7 ,in general ,not later than #a year after the date of the enactment of this ,act1 and annually thereafter for a period of #e years1 the ,secretary shall prepare and submit to the appropriate committees of ,congress a report on the activities to provide health professions students with comprehensive arthritis and musculoskeletal health education funded under this section4 7#b7 ,report elements ,the report described in paragraph 7#a7 shall include information about-- 7,a7 the number of entities that are receiving a grant under this section2 7,b7 the specific activities supported by grants under this section2 7,c7 the number of students served by programs supported by grants under this section2 and 7,d7 the status of evaluations of such programs4 7g7 ,definition of institution of higher education ,in this section1 the term institution of higher education has the meaning given such term in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja74 ,j ,sleep and circadian rhythm disorders #gija4 ,sleep and circadian rhythm disorders research activities of the ,national ,institutes of ,health 7a7 ,in general ,the ,director of the ,national ,institutes of ,health1 acting through the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute1 shall-- 7#a7 continue to expand research activities addressing sleep health disparities2 and 7#b7 continue implementation of the ,,nih ,sleep ,disorders ,research ,plan across all institutes and centers of the ,national ,institutes of ,health to improve treatment and prevention of sleep health disparities4 7b7 ,required research activities ,in conducting or supporting research relating to sleep and circadian rhythm1 the ,director of the ,national ,heart1 ,lung1 and ,blood ,institute shall-- 7#a7 advance epidemiology and clinical research to achieve a more complete understanding of disparities in domains of sleep health and across population subgroups for which cardiovascular and metabolic health disparities exist1 including-- 7,a7 prevalence and severity of sleep apnea2 7,b7 habitual sleep duration2 7,c7 sleep timing and regularity2 and 7,d7 insomnia2 7#b7 develop study designs and analytical approaches to explain and predict multilevel and life-course determinants of sleep health and to elucidate the sleep-related causes of cardiovascular and metabolic health disparities across the age spectrum1 including such determinants and causes that are-- 7,a7 environmental2 7,b7 biological or genetic2 7,c7 psychosocial2 7,d7 societal2 7,e7 political2 or 7,f7 economic2 7#c7 determine the contribution of sleep impairments such as sleep apnea1 insufficient sleep duration1 irregular sleep schedules1 and insomnia to unexplained disparities in cardiovascular and metabolic risk and disease outcomes2 7#d7 develop study designs1 data sampling and collection tools1 and analytical approaches to optimize understanding of mediating and moderating factors1 and feedback mechanisms coupling sleep to cardiovascular and metabolic health disparities2 7#e7 advance research to understand cultural and linguistic barriers 7on the person1 provider1 or system level7 to access to care1 medical diagnosis1 and treatment of sleep disorders in diverse population groups2 7#f7 develop and test multilevel interventions 7including sleep health education in diverse communities7 to reduce disparities in sleep health that will impact the ability to improve disparities in cardiovascular and metabolic risk or disease2 7#g7 create opportunities to integrate sleep and health disparity science by strategically utilizing resources 7involving existing or anticipated cohorts7 and exchanging scientific data and ideas 7including through cross-over into scientific meetings72 and 7#h7 enhance the diversity and foster career development of young investigators involved in sleep and health disparities science4 7c7 ,authorization of appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal year #bjbe and each subsequent fiscal year4 #gijb4 ,sleep and circadian rhythm health disparities-related activities of the ,centers for ,disease ,control and ,prevention 7a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention shall conduct1 support1 and expand public health strategies and prevention1 diagnosis1 surveillance1 and public and professional awareness activities regarding sleep and circadian rhythm disorders4 7b7 ,required surveillance and education awareness activities ,in conducting or supporting research relating to sleep and circadian rhythm disorders surveillance and education awareness activities1 the ,director of the ,centers for ,disease ,control and ,prevention shall-- 7#a7 ensure that such activities are culturally and linguistically appropriate to minority patients1 targeting sleep and circadian rhythm health promotion and prevention programs of each major ethnic group1 including-- 7,a7 ,native ,americans and ,alaska ,natives2 7,b7 ,asian ,americans2 7,c7 ,african ,americans and ,blacks2 7,d7 ,hispanic and ,latino-,americans2 and 7,e7 ,native ,hawaiians and ,pacific ,islanders2 7#b7 collect and compile national and ,state surveillance data on sleep disorders health disparities2 7#c7 continue to develop and implement new sleep questions in public health surveillance systems to increase public awareness of sleep health and sleep disorders and their impact on health2 7#d7 publish monthly reports highlighting geographic1 racial1 and ethnic disparities in sleep health1 as well as relationships between insufficient sleep and chronic disease1 health risk behaviors1 and other outcomes as determined necessary by the ,director2 and 7#e7 include public awareness campaigns that inform patient populations from major ethnic groups about the prevalence of sleep and circadian rhythm disorders and emphasize the importance of sleep health4 7c7 ,authorization of ,appropriations ,to carry out this section1 there are authorized to be appropriated such sums as may be necessary for fiscal year #bjbe and each subsequent fiscal year4 #gijc4 ,grants for comprehensive sleep and circadian health education within health professions schools 7a7 ,program authorized ,the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary71 in coordination with the ,secretary of ,education1 shall award grants1 on a competitive basis1 to academic health science centers1 health professions schools1 and institutions of higher education to enable such centers1 schools1 and institutions to provide people with comprehensive education on sleep and circadian health1 particularly-- 7#a7 poor sleep health2 7#b7 sleep disorders2 7#c7 sleep health disparities2 and 7#d7 the relationship between sleep and circadian health on metabolic activity1 neurological activity1 comorbidities1 and other diseases4 7b7 ,duration ,grants awarded under this section shall be for a period of #e years4 7c7 ,applications ,an academic health science center1 health professions school1 or institution of higher education seeking a grant under this section shall submit an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 7d7 ,priority ,in awarding grants under this section1 the ,secretary shall give priority to an institution of higher education that-- 7#a7 has an enrollment of needy students1 as defined in section #cah7;b7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;e7b772 7#b7 is a ,hispanic-serving institution1 as defined in section #ejb7;a7 of such ,act 7#bj ,u4,s4,c4 #aaja;a7a772 7#c7 is a ,tribal ,college or ,university1 as defined in section #caf7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;c7b772 7#d7 is an ,alaska ,native-serving institution1 as defined in section #cag7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7#e7 is a ,native ,hawaiian-serving institution1 as defined in section #cag7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;d7b772 7#f7 is a ,predominately ,black ,institution1 as defined in section #cah7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;e7b772 7#g7 is a ,native ,american-serving1 nontribal institution1 as defined in section #cai7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;f7b772 7#h7 is an ,asian ,american and ,native ,american ,pacific ,islander-serving institution1 as defined in section #cbj7;b7 of such ,act 7#bj ,u4,s4,c4 #ajei;g7b772 or 7#i7 is a minority institution1 as defined in section #cfe of such ,act 7#bj ,u4,s4,c4 #ajfgk71 with an enrollment of needy students1 as defined in section #cab of such ,act 7#bj ,u4,s4,c4 #ajeh74 7e7 ,uses of funds ,an academic health science center1 health professions school1 or institution of higher education receiving a grant under this section may use the grant funds to integrate issues relating to comprehensive sleep and circadian health into the academic or support sectors of the center1 school1 or institution1 in order to reach a large number of students1 by carrying out #a or more of the following activities3 7#a7 ,developing educational content for issues relating to comprehensive sleep and circadian health education that will be incorporated into first-year orientation or core courses4 7#b7 ,creating innovative technology-based approaches to deliver sleep health education to students1 faculty1 and staff4 7#c7 ,developing and employing peer-outreach and education programs to generate discussion1 educate1 and raise awareness among students about issues relating to poor quality sleep1 sleep and circadian disorders1 and the role sleep health plays in other diseases and comorbidities4 7f7 ,report to ,congress 7#a7 ,in general ,not later than #a year after the date of the enactment of this ,act1 and annually thereafter for a period of #e years1 the ,secretary shall prepare and submit to the appropriate committees of ,congress a report on the activities to provide health professions students with comprehensive sleep and circadian health education funded under this section4 7#b7 ,report elements ,the report described in paragraph 7#a7 shall include information about-- 7,a7 the number of entities that are receiving a grant under this section2 7,b7 the specific activities supported by grants under this section2 7,c7 the number of students served by programs supported by grants under this section2 and 7,d7 the status of evaluations of programs supported by such grants4 7g7 ,definition of institution of higher education ,in this section1 the term institution of higher education has the meaning given such term in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja74 #gijd4 ,report on impact of sleep and circadian health disorders in vulnerable and racial_/ethnic populations 7a7 ,in general ,not later than #a year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall submit to ,congress and the ,president a report on the impact of sleep and circadian health disorders for racial and ethnic minority communities and other vulnerable populations4 7b7 ,contents ,the report under subsection 7a7 shall include information on the-- 7#a7 progress that has been made in reducing the impact of sleep and circadian health disorders in such communities and populations2 7#b7 opportunities that exist to make additional progress in reducing the impact of sleep and circadian health disorders in such communities and populations2 7#c7 challenges that may impede such additional progress2 and 7#d7 ,federal funding necessary to achieve substantial reductions in sleep and circadian health disorders in racial and ethnic minority communities4 ,k ,kidney disease research1 surveillance1 prevention1 and treatment #gija;,a4 ,kidney disease research in minority populations 7a7 ,in general 7#a7 ,research and training centers ,section #dca7;c77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;c-#e7;c77#c77 is amended-- 7,a7 in subparagraph 7,b71 by striking and at the end2 7,b7 in subparagraph 7,c71 by striking and at the end2 and 7,c7 by adding at the end the following3 7,d7 improving data science through improvement in bioinformatics1 data integration1 and data sharing2 7,e7 defining the chronic kidney disease mechanism and identifying new therapeutic targets for chronic kidney disease using specific tools1 including mapping the genetic architecture of kidney function and disease and translating genetic maps to disease-causing genes and mechanisms1 especially among minority populations2 7,f7 improving models of human disease including better humanized animal models1 improved reproducibility1 and functional characterization of kidney organoids1 and accelerating the development of in vivo imaging technologies2 and 7,g7 developing cell-specific drug delivery systems and gene editing1 including targeted systems for the delivery of therapeutic compounds to specific kidney compartments or cell types and accelerating the implementation of gene editing and gene therapy for the treatment of kidney diseases in vivo2 and 4 7#b7 ,inclusion of minority participants ,in conducting and supporting research described in the amendment made by paragraph 7#a71 the ,director of the ,national ,institutes of ,health shall work with the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities to improve the number of minority participants as study subjects in clinical trials4 ,such work may include-- 7,a7 developing and sustaining clinical trial consortia that can recruit patients with chronic kidney disease to ensure adequate capacity for assessment of kidney outcomes and increase the enrollment of underrepresented populations2 7,b7 encouraging the use of novel designs in clinical trials to enhance the recruitment and retention of underrepresented populations which will enhance the generalizability of study findings2 7,c7 supporting outreach initiatives that incorporate acknowledgment of both historical and current grounds for participation reluctance1 and that prioritize demonstrating trustworthiness1 in order to enhance the ability to promote and effectively convey the benefits of clinical research participation2 7,d7 completing clinical trials that test interventions to improve patient quality of life and address patient-reported outcomes2 and 7,e7 encouraging inclusion of persons with chronic kidney disease in clinical trials of treatments for nonkidney diseases4 7b7 ,report2 comprehensive plan ,section #dbi of the ,public ,health ,services ,act 7#db ,u4,s4,c4 #bhe;c-#c7 is amended by adding at the end the following3 7c7 ,report by ,kidney1 ,urologic1 and ,hematologic ,diseases ,coordinating ,committee 7#a7 ,in general ,the ,kidney1 ,urologic1 and ,hematologic ,diseases ,coordinating ,committee1 in coordination with the ,chronic ,kidney ,disease ,initiative at the ,centers for ,disease ,control and ,prevention1 shall-- 7,a7 prepare and submit to the ,congress1 not later than #f months after the date of enactment of this subsection1 a report on ,federal research and public health activities with respect to kidney disease in minority populations2 and 7,b7 develop and submit to the ,congress1 the ,secretary1 the ,director of the ,national ,institutes of ,health1 and the ,advisory ,board established under section #dcj for the diseases for which the ,committee was established1 not later than #a year after the date of enactment of this subsection1 an effective and comprehensive ,federal plan 7including all appropriate ,federal health programs7 to address kidney disease in minority populations4 7#b7 ,contents ,the report under paragraph 7#a77;,a7 shall at minimum address each of the following3 7,a7 ,research on kidney disease in minority populations1 including such research on-- 7i7 genetic1 behavioral1 and environmental factors2 7ii7 prevention and complications among individuals within these populations who have already developed kidney disease2 7iii7 the delivery of evidenced-based care for all chronic kidney disease stages1 especially in underrepresented and underserved populations2 7iv7 expanding support for a root-cause analysis approach to disparities1 including causes1 detection1 and management of chronic kidney disease for underserved populations2 7v7 developing research teams that engage with community organizations to develop and implement interventions which halt or delay development and progression of chronic kidney disease2 and 7vi7 continued support of observational studies of kidney disease measures and outcomes4 7,b7 ,surveillance and data collection on kidney disease in minority populations1 including with respect to-- 7i7 efforts to better determine the prevalence of kidney disease among ,asian-,american and ,pacific ,islander subgroups2 and 7ii7 efforts to coordinate data collection on the ,american ,indian population4 7,c7 ,community-based interventions to address kidney disease targeting minority populations1 including-- 7i7 the evidence bases for such interventions2 7ii7 the cultural appropriateness of such interventions2 and 7iii7 efforts to educate the public on the causes and consequences of kidney disease4 7,d7 ,education and training programs for health professionals 7including community health workers7 on the prevention and management of kidney disease and its related complications that are supported by the ,health ,resources and ,services ,administration1 including such programs supported by the ,bureau of ,health ,workforce1 the ,bureau of ,primary ,health ,care1 and the ,health ,systems ,bureau4 ,this shall include-- 7i7 identification of effective strategies to increase implementation of proven therapies to slow chronic kidney disease incidence and progression1 especially in high-risk underrepresented populations2 and 7ii7 identification of effective practice improvement strategies in large and small health systems to reduce chronic kidney disease incidence and progression4 4 #gija;,a-#a4 ,kidney disease action plan 7a7 ,in general ,the ,director of the ,centers for ,disease ,control and ,prevention shall conduct1 support1 and expand public health strategies1 prevention1 diagnosis1 surveillance1 and public and professional awareness activities regarding kidney disease4 7b7 ,national action plan 7#a7 ,development ,pursuant to section #dbf of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;c71 not later than #b years after the date of the enactment of this ,act1 the ,director of the ,national ,institute of ,diabetes and ,digestive and ,kidney ,diseases1 in consultation with the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities and the ,director of the ,centers for ,disease ,control and ,prevention1 shall develop a national action plan to address kidney disease in the ,united ,states with participation from patients1 caregivers1 health professionals1 patient advocacy organizations1 researchers1 providers1 public health professionals1 and other stakeholders4 7#b7 ,contents ,at a minimum1 such plan shall include recommendations for-- 7,a7 public health interventions for the purpose of implementation of the national plan2 7,b7 biomedical1 health services1 and public health research on kidney disease2 and 7,c7 inclusion of kidney disease in the health data collections of all ,federal agencies4 7c7 ,kidney disease prevention programs ,the ,director of the ,centers for ,disease ,control and ,prevention1 through the ,chronic ,kidney ,disease ,initiative1 shall carry out the following3 7#a7 ,conduct public education and awareness activities with patient and professional organizations to stimulate earlier diagnosis and improve patient outcomes from treatment of kidney disease4 ,to the extent known and relevant1 such public education and awareness activities shall reflect differences in kidney disease by cause 7such as hypertension1 diabetes1 lupus nephritis1 ,,covid-#ai1 and polycystic kidney disease7 and include a focus on outreach to undiagnosed and1 as appropriate1 minority populations4 7#b7 ,supplement and expand upon the activities of the ,centers for ,disease ,control and ,prevention by making grants to nonprofit organizations1 ,state and local jurisdictions1 and ,indian ,tribes for the purpose of reducing the burden of kidney disease1 especially in disproportionately impacted communities1 through public health interventions and related activities4 7#c7 ,coordinate with the ,national ,institute of ,diabetes and ,digestive and ,kidney ,diseases1 the ,indian ,health ,service1 the ,health ,resources and ,services ,administration1 and the ,department of ,veterans ,affairs to develop pilot programs to demonstrate best practices for the diagnosis and management of kidney disease4 7#d7 ,develop improved techniques and identify best practices1 in coordination with the ,secretary of ,veterans ,affairs1 for assisting kidney disease patients4 7d7 ,data collection ,not later than #ahj days after the date of enactment of this ,act1 the ,director of the ,national ,institute of ,diabetes and ,digestive and ,kidney ,diseases and the ,director of the ,centers for ,disease ,control and ,prevention1 acting jointly1 shall assess the depth and quality of information on kidney disease that is collected in surveys and population studies conducted by the ,centers for ,disease ,control and ,prevention1 including whether there are additional opportunities for information to be collected in the ,national ,health and ,nutrition ,examination ,survey1 the ,national ,health ,interview ,survey1 and the ,behavioral ,risk ,factor ,surveillance ,system surveys4 ,the ,director of the ,national ,institute of ,diabetes and ,digestive and ,kidney ,diseases shall include the results of such assessment in the national action plan under subsection 7b74 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #a1jjj1jjj for fiscal year #bjbe1 #a1jjj1jjj for fiscal year #bjbf1 #a1jjj1jjj for fiscal year #bjbg1 #a1jjj1jjj for fiscal year #bjbh1 and #a1jjj1jjj for fiscal year #bjbi4 #gija;,a-#b4 ,providing for staff-assisted home dialysis for certain hemodialysis and peritoneal dialysis patients 7a7 ,in general ,section #ahha7;b77#ad7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#ad77 is amended by adding at the end the following new subparagraph3 7,j7 7i7 ,with respect to staff-assisted home dialysis 7as defined in clause 7iv77,,iv77 furnished on or after the date that is #a year after the date of the enactment of this subparagraph1 subject to the succeeding provisions of this subparagraph1 the ,secretary shall increase the single payment that would otherwise apply under this paragraph for renal dialysis services by the add-on payment amount established pursuant to clause 7iii74 7ii7 7,i7 ,subject to subclause 7,,ii71 staff-assisted home dialysis may only be furnished-- 7aa7 with respect to an initializing patient 7as defined in clause 7iv77,i77 or a returning patient 7as defined in clause 7iv77,,iii771 for a period of up to #ij days1 referred to as the initial period1 which may be extended as determined necessary by the care team of the individual in not more than #b intervals of up to #cj days each1 each of which is referred to as an extended interval2 and 7bb7 with respect to a temporary assistance patient 7as defined in clause 7iv77,v771 for any #cj-;day period as determined necessary by the care team of the individual1 notwithstanding whether such an individual receives any routine dialysis respite care during such period4 7,,ii7 ,notwithstanding subclause 7,i71 staff-assisted home dialysis may be furnished for as long as the ,secretary determines appropriate to an individual who-- 7aa7 is blind2 7bb7 has a cognitive or neurological impairment 7including a stroke1 ,alzheimer's ,disease1 dementia1 amyotrophic lateral sclerosis1 or any other impairment determined by the ,secretary72 or 7cc7 has any other illness or injury that reduces mobility 7including cerebral palsy1 spinal cord injuries1 an injury or illness that requires the individual to be on a ventilator1 or any other illness or injury determined by the ,secretary74 7iii7 ,the ,secretary shall1 by regulation1 establish an add-on payment amount for staff-assisted home dialysis to determine the amounts payable to a qualified provider 7as defined in clause 7iv77,,ii77 for assisting in the furnishing of staff-assisted home dialysis on a frequency as determined by the ,secretary and in consultation with clinicians1 patients1 and care partners to ensure maximum patient choice1 access1 and flexibility4 ,in establishing the add-on payment under this clause1 the ,secretary shall consult with stakeholders1 including providers of renal dialysis services1 individuals receiving home dialysis1 qualified providers1 private insurance payers1 and ,medicare ,advantage plans under part ,c4 7iv7 ,in this subparagraph3 7,i7 ,the term initializing patient means an individual who initiates a home dialysis modality1 including home hemodialysis and peritoneal dialysis4 7,,ii7 ,the term qualified provider means a trained professional 7as determined by the ,secretary1 including a registered or licensed practical nurse and a certified patient care technician7 who-- 7aa7 furnishes renal dialysis services2 7bb7 meets requirements 7as determined by the ,secretary7 that ensure competency in patient care and modality usage2 and 7cc7 during a period described in clause 7ii77,i71 provides in-person assistance to an individual for an appropriate number of dialysis sessions1 as determined by the care team of the individual based on the needs of the individual1 caregiver availability1 prescription1 and mode of home dialysis4 7,,iii7 ,the term returning patient means an individual who is returning to home dialysis after a period of hospitalization or other non-home dialysis modality4 7,,iv7 7aa7 ,the term staff-assisted home dialysis means dialysis furnished by the individual in a home1 residence1 or other approved setting with the assistance of a qualified provider1 the frequency of which is determined by the qualified provider in coordination with the individual1 the care partner1 and the care team of the individual and outlined in a patient plan of care4 7bb7 ,in this subclause1 the term care partner means a friend or family member who is designated by the individual who is trained to assist the individual with the furnishing of home dialysis4 7cc7 ,in this subclause1 the term patient plan of care has the meaning given such term in section #did4ij of title #db1 ,code of ,federal ,regulations 7or any successor regulations74 7,v7 ,the term temporary assistance patient means an individual who is receiving home dialysis and is temporarily unable to perform functions necessary to self-furnish unassisted home dialysis due to illness1 injury1 caregiver unavailability1 or other temporary circumstances not to exceed #cj days4 4 7b7 ,patient education and training relating to staff-,assisted home dialysis 7#a7 ,in general ,section #ahha7;b77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#e77 is amended-- 7,a7 in subparagraph 7,c71 by striking at the end and2 7,b7 in subparagraph 7,d71 by striking the period at the end and inserting a semicolon2 and 7,c7 by adding at the end the following new subparagraphs3 7,e7 educate individuals on the opportunity to receive staff-assisted home dialysis 7as defined in paragraph 7#ad77;,j77iv77,,iv77 during the periods described in paragraph 7#ad77;,j77ii72 and 7,f7 provide for registered or licensed nurses1 certified patient care technicians1 or other qualified providers 7as determined by a physician7 to train individuals and their care partners in skills and procedures needed to furnish staff-assisted home dialysis1 including-- 7i7 in a group-training environment with other individuals and their care partners when appropriate and in accordance with ,federal regulations 7concerning the privacy of individually identifiable health information7 promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif2 7ii7 via telehealth 7following an initial period of in-person competency training1 in accordance with standards specified by the ,secretary72 7iii7 through interdisciplinary team training 7as described in the interpretive guidance relating to tag number ,v#eij of ,advance ,copy--,end ,stage ,renal ,disease 7,,esrd7 ,program ,interpretive ,guidance ,version #a4a 7published on ,october #c1 #bjjh772 and 7iv7 in the home or residence of an individual1 in a dialysis facility1 in a stand-alone training facility1 or the place in which the individual has been approved to perform home dialysis by the care team4 4 7#b7 ,effective date ,the amendments made by this subsection shall take effect on the date that is #a year after the date of the enactment of this ,act4 7c7 ,other provisions 7#a7 ,anti-kickback statute ,section #aabh;,b7b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7b77#c77 is amended-- 7,a7 by moving subparagraphs 7,j7 and 7,k7 #b ems to the left2 7,b7 in subparagraph 7,k71 by striking and at the end2 7,c7 in subparagraph 7,l71 by striking the period at the end and inserting 2 and2 and 7,d7 by adding at the end the following new subparagraph3 7,m7 any remuneration relating to the furnishing of staff-assisted home dialysis 7as defined in section #ahha7;b77#ad77;,j77iv77,,iv774 4 7#b7 ,study ,not later than #b years 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 submit1 to the ,committee on ,finance of the ,senate and the ,committees on ,energy and ,commerce and ,ways and ,means of the ,house of ,representatives1 a report that-- 7,a7 examines racial disparities in the utilization of home dialysis 7as defined in section #ahha7;b77#ad77;,j77iv77,,iv7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#ad77;,j77iv77,,iv771 as added by subsection 7a771 and makes recommendations on how to improve access to home dialysis for communities of color2 7,b7 examines coverage for1 and utilization of1 home dialysis in rural communities1 and makes recommendations on how to improve access to home dialysis for such rural communities2 and 7,c7 analyzes clinical and quality of life outcomes for patients1 disaggregated by geographic and demographic indicators1 who receive different dialysis modalities1 including staff-assisted home dialysis1 unassisted home dialysis1 and dialysis furnished in a facility4 7#c7 ,patient decision tool ,not later than ,december #ca1 #bjbe1 for the purposes of section #ahha7;b77#ad77;,j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#ad77;,j771 as added by subsection 7a71 the ,secretary shall convene a patient panel to develop a patient-centered decision tool to assist dialysis patients in evaluating their lifestyle and goals and in choosing the dialysis setting and modality4 ,such tool shall include an acknowledgment that the patient is capable of home dialysis and wants home dialysis1 if that is the modality such patient chooses4 7#d7 ,patient quality of life metric ,section #ahha7;h77#b77;,a77iv7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acierr7h77#b77;,a77iv77 is amended-- 7,a7 in subclause 7,,ii71 by striking and at the end2 7,b7 in subclause 7,,iii71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following new subclause3 7,,iv7 patient quality of life for all individuals utilizing dialysis regardless of modality1 with the intent of measuring and improving patient quality of life on dialysis4 4 #gija;,a-#c4 ,increasing kidney transplants in minority populations 7a7 ,in general ,the ,director of the ,national ,institutes of ,health shall expand1 intensify1 and support ongoing research and other activities with respect to kidney transplants in minority populations4 7b7 ,,cms data collection and reporting ,the ,centers for ,medicare ,medicaid ,services shall collect and report annual data on dialysis facility and nephrologist performance on transplant referral1 with an emphasis on data relating to patients of color4 7c7 ,,optn data collection and reporting ,the ,organ ,procurement and ,transplantation ,network shall collect and the ,scientific ,registry of ,transplant ,recipients shall report annual data1 broken down by demographic and socioeconomic characteristics1 on individual transplant center performance as it relates to patients referred1 evaluated1 waitlisted1 and successfully transplanted4 7d7 ,transplant center data ,each organ transplant center shall report on the percent of appropriate waitlisted patients 7including socioeconomic and demographic data7 giving and receiving annual informed consent for offers for suboptimal kidneys 7such as kidneys with a kidney donor profile index of greater than #he percent or kidney age #ej with diabetes1 or age greater than #fj74 7e7 ,organ procurement organization data ,each organ procurement organization shall report annual data on referrals1 refusals 7patient or doctor71 and acceptance of organs by hospital1 ,,zip ,code1 race1 ethnicity1 and age strata except as prohibited by need for confidentiality4 7f7 ,data ,transparency for ,patients ,each organ transplant center shall provide to each patient of such center1 on an annual basis-- 7#a7 the number of times an organ was offered to the patient1 declined1 and transplanted into another patient from organs within a #ejj-mile radius2 and 7#b7 the number of times an organ was offered to and declined for the patient from a low-risk donor which was subsequently transplanted into another patient4 7g7 ,improved transplantation education ,the ,centers for ,medicare ,medicaid ,services shall certify a nonbiased1 third-party organization to accredit organ transplant education4 7h7 ,research ,research under subsection 7a7 shall include investigation into-- 7#a7 the causes of lower rates of kidney transplants in minority populations1 including socioeconomic1 geographic1 clinical1 environmental1 genetic1 and other factors that may contribute to lower rates of kidney transplants in minority populations2 and 7#b7 possible interventions to increase kidney transplants4 7i7 ,report2 comprehensive plan 7#a7 ,in general ,the ,secretary of ,health and ,human ,services shall-- 7,a7 prepare and submit to the ,congress1 not later than #f months after the date of enactment of this section1 a report on ,federal research and public health activities with respect to kidney transplants as a treatment for end-stage renal disease in minority populations2 and 7,b7 develop and submit to the ,congress1 not later than #a year after the date of enactment of this section1 an effective and comprehensive ,federal plan 7including all appropriate ,federal health programs7 to increase the number of kidney transplants in minority populations4 7#b7 ,contents ,the report under paragraph 7#a77;,a7 shall at a minimum address each of the following3 7,a7 ,research on kidney transplants in minority populations1 including such research on financial1 insurance coverage1 genetic1 behavioral1 and environmental factors4 7,b7 ,surveillance and data collection on kidney transplants in minority populations1 including with respect to-- 7i7 efforts to increase kidney transplants among ,asian-,american and ,pacific ,islander subgroups with end-stage renal disease2 and 7ii7 efforts to increase kidney transplants in the ,american ,indian population4 7,c7 ,community-based efforts to increase kidney transplants targeting minority populations1 including-- 7i7 the evidence base for such increases2 7ii7 the cultural appropriateness of such increases2 and 7iii7 efforts to educate the public on kidney transplants4 7,d7 ,education and training programs for health professionals 7including community health workers7 on the kidney transplants that are supported by the ,health ,resources and ,services ,administration1 including such programs supported by the ,bureau of ,health ,workforce1 the ,bureau of ,primary ,health ,care1 and the ,health ,systems ,bureau4 #gija;,a-#d4 ,environmental and occupational health programs ,the ,director of the ,centers for ,disease ,control and ,prevention shall-- 7#a7 support research into the environmental and occupational causes and biological mechanisms that contribute to kidney disease2 and 7#b7 develop and disseminate public health interventions that will lessen the impact of environmental and occupational causes of kidney disease4 #gija;,a-#e4 ,understanding the treatment patterns associated with providing care and treatment of kidney failure in minority populations 7a7 ,study ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall conduct a study on treatment patterns associated with providing care1 under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 under the ,medicaid program under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq471 and through private health insurance1 to minority populations that are disproportionately affected by kidney failure4 7b7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on the study conducted under subsection 7a71 together with such recommendations as the ,secretary determines to be appropriate4 #gija;,a-#f4 ,encouraging kidney care workforce in underserved areas 7a7 ,definition of primary health services ,section #cca7;a77#c77;,d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;d7a77#c77;,d77 is amended by inserting nephrology1 after dentistry14 7b7 ,national health service corps scholarship program ,section #cch;,a7a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedl7a77#b77 is amended by inserting 1 which may include kidney health professionals before the period at the end4 7c7 ,national health service corps loan repayment program ,section #cch;,b7a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bedl-#a7;a77#b77 is amended by inserting 1 which may include kidney health professionals before the period at the end4 #gija;,a-#g4 ,the ,jack ,reynolds ,memorial ,medigap ,expansion ,act2 ,medigap coverage for beneficiaries with end-stage renal disease 7a7 ,guaranteed availability of ,medigap policies to all ,,esrd ,medicare beneficiaries 7#a7 ,in general ,section #ahhb7s7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77 is amended-- 7,a7 in paragraph 7#b7-- 7i7 in subparagraph 7,a71 by striking is #fe and all that follows through the period at the end and inserting the following3 is-- 7i7 #fe years of age or older and is enrolled for benefits under part ,b2 or 7ii7 is entitled to benefits under #bbf;,a7b7 and is enrolled for benefits under part ,b4 2 and 7ii7 in subparagraph 7,d71 in the matter preceding clause 7i71 by inserting 7or is entitled to benefits under #bbf;,a7b77 after is #fe years of age or older2 and 7,b7 in paragraph 7#c77;,b7-- 7i7 in clause 7ii71 by inserting 7or is entitled to benefits under #bbf;,a7b77 after is #fe years of age or older2 and 7ii7 in clause 7vi71 by inserting 7or under #bbf;,a7b77 after at age #fe4 7#b7 ,effective date ,the amendments made by paragraph 7#a7 shall apply to ,medicare supplemental policies effective on or after ,january #a1 #bjbe4 7b7 ,additional enrollment period for certain individuals 7#a7 ,one-time enrollment period 7,a7 ,in general ,in the case of an individual described in paragraph 7#b71 the ,secretary of ,health and ,human ,services shall establish a one-time enrollment period during which such an individual may enroll in any ,medicare supplemental policy under section #ahhb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7 of the individual's choosing4 7,b7 ,enrollment period ,the enrollment period established under subparagraph 7,a7 shall begin on ,january #a1 #bjbe1 and shall end ,june #cj1 #bjbe4 7#b7 ,individual described ,an individual described in this paragraph is an individual who-- 7,a7 is entitled to hospital insurance benefits under part ,a of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq47 or under section #bbf;,a7b7 of such ,act 7#db ,u4,s4,c4 #dbf-a7;b772 7,b7 is enrolled for benefits under part ,b of such title ,,xviii 7#db ,u4,s4,c4 #acie;j et seq472 and 7,c7 would not1 but for the provisions of1 and amendments made by1 subsection 7a7 be eligible for the guaranteed issue of a ,medicare supplemental policy under paragraph 7#b7 or 7#c7 of section #ahhb7s7 of such ,act 7#db ,u4,s4,c4 #aciess7s774 ,l ,diversity in clinical trials #gija;,b4 ,,fda review of clinical trial best practices ,the ,commissioner of ,food and ,drugs shall-- 7#a7 aggregate information on the accumulated experience of sponsors of drugs that develop and execute clinical trial diversity plans during drug development2 7#b7 include in such aggregated information an analysis from the perspectives of the ,food and ,drug ,administration and such sponsors of which actions worked or which did not work to enhance clinical trial diversity2 7#c7 not later than ,september #cj1 #bjbe1 convene a public meeting1 including representatives from the regulated industry and patient organizations1 to discuss findings and recommendations for specific actions that have led to measurable improvements in the representation of racial and ethnic populations in clinical research2 and 7#d7 not later than ,september #cj1 #bjbf1 update the guidance of the ,food and ,drug ,administration titled ,enhancing the ,diversity of ,clinical ,trial ,populations--,eligibility ,criteria1 ,enrollment ,practices1 and ,trial ,designs to align such guidance with findings and recommendations that were discussed at the meeting under paragraph 7#c74 #gija;,b-#a4 ,diversifying ,investigations ,via ,equitable ,research ,studies for ,everyone ,trials ,act 7a7 ,encouragement of clinical trial enrollment by racially and ethnically diverse populations 7#a7 ,no cost provision of digital health technologies ,the free provision of digital health technologies by drug or device manufacturers to their clinical trial participants shall not be considered a violation of section #aabh;,a of the ,social ,security ,act 7commonly known as the ,civil ,monetary ,penalties ,law7 7#db ,u4,s4,c4 #acbj;a-#g;a71 section #aabh;,b of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b71 or sections #cgbi through #cgcc of title #ca1 ,united ,states ,code 7commonly known as the ,false ,claims ,act71 provided that-- 7,a7 the use of digital health technologies will facilitate in any phase of clinical development the inclusion of diversity of patient populations1 such as underrepresented racial and ethnic minorities1 low-income populations1 and the elderly2 7,b7 the digital health technologies will facilitate individuals' participation1 or are necessary to such participation2 7,c7 all features of the digital health technologies that are unrelated to use in the clinical trial are disabled or only allowed to remain activated to model real-world usage of the digital technology2 and 7,d7 the clinical trial sponsor requires participants to return1 purchase1 or disable the digital health technologies by the conclusion of the trial4 7#b7 ,grants and contracts 7,a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 may issue grants to1 and enter into contracts with1 entities to support community education1 outreach1 and recruitment activities for clinical trials with respect to drugs1 including vaccines for diseases or conditions which have a disproportionate impact on underrepresented populations 7including on racial and ethnic minority populations71 including for the diagnosis1 prevention1 or treatment of ,,covid-#ai4 ,such activities may include-- 7i7 working with community clinical trial sites1 including community health centers1 academic health centers1 and other facilities2 7ii7 training health care personnel including potential clinical trial investigators1 with a focus on significantly increasing the number of underrepresented racial and ethnic minority health care personnel who are clinical trial investigators at the community sites for ongoing clinical trials2 7iii7 engaging community stakeholders to encourage participation in clinical trials1 especially in underrepresented racial and ethnic minority communities2 and 7iv7 fostering partnerships with community-based organizations serving underrepresented racial and ethnic minority populations1 including labor organizations and frontline health care workers4 7,b7 ,priority for grant and contract awards ,in awarding grants and contracts under this paragraph1 the ,secretary shall prioritize entities that-- 7i7 develop educational1 recruitment1 and training materials in multiple languages2 or 7ii7 undertake clinical trial outreach efforts in more diverse racial and ethnic communities that are traditionally underrepresented in clinical trials1 such as ,tribal areas4 7,c7 ,authorization of appropriations ,there is authorized to be appropriated for fiscal years #bjbe and #bjbf such sums as may be necessary to carry out this paragraph4 7b7 ,clarification that certain remuneration related to participation in clinical trials does not constitute remuneration under the ,federal civil money penalties law 7#a7 ,in general ,section #aabh;,a7i77#f77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7i77#f77;,f77 is amended by inserting 7including remuneration offered or transferred to an individual to promote the participation in an approved clinical trial1 as defined in subsection 7d7 of the first section #bgji of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#h7 7relating to coverage for individuals participating in approved clinical trials71 as so designated by section #aefc7;c77#aj77;,c7 of the ,patient ,protection and ,affordable ,care ,act1 that is registered with the database of clinical trials maintained by the ,national ,library of ,medicine 7or any successor database71 so long as such remuneration facilitates equitable inclusion of patients from all relevant demographic and socioeconomic populations and is related to patient participation in the approved clinical trial7 after promotes access to care4 7#b7 ,effective date ,the amendment made by paragraph 7#a7 shall apply to remuneration provided on or after the date of the enactment of this ,act4 7c7 ,national ,academy of ,medicine study 7#a7 ,in general ,the ,secretary shall seek to enter into an arrangement with the ,national ,academy of ,medicine under which the ,national ,academy agrees to study and propose a design for a national interoperable data platform to improve access to health data1 and other relevant data needs1 during public health emergencies4 7#b7 ,report ,the arrangement under paragraph 7#a7 shall provide that the ,national ,academy of ,medicine1 not later than #ahj days after the date of enactment of this ,act1 shall submit a report to the ,secretary and ,congress on the results of the study under paragraph 7#a7 and the design proposed based on such study4 #gija;,b-#b4 ,clinical trial diversity 7a7 ,diversity requirements for applications for ,federal funding for clinical trials 7#a7 ,applications ,beginning on the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,national ,institutes of ,health 7in this subsection referred to as the ,secretary71 shall require that an entity seeking to conduct a clinical trial investigating a drug or device 7as those terms are defined in section #bja of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cba77 or biological product 7as defined in section #cea7;i7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bfb7;i777 that is funded by the ,national ,institutes of ,health and conducted at any national research institute or national center1 submit an application 7or renewal thereof7 for such funding that includes-- 7,a7 clear and measurable goals for the recruitment and retention of participants that reflect-- 7i7 the race1 ethnicity1 age1 and gender or sex of patients with the disease or condition being investigated2 or 7ii7 the race1 ethnicity1 age1 and gender or sex of the general population of the ,united ,states if the prevalence of the disease or condition is not known2 7,b7 a rationale for the goals specified under subparagraph 7,a7 that specifies-- 7i7 how investigators will calculate the number of participants for each population category that reflect the population groups specified in subparagraph 7,a72 and 7ii7 strategies that will be used to enroll and retain participants across the different racial1 ethnic1 age1 and gender or sex categories2 7,c7 a detailed plan for how the clinical trial will achieve the goals specified under subparagraph 7,a7 that specifies-- 7i7 the requirements for researchers1 in conducting the trial to analyze the population groups specified in subparagraph 7,a7 separately2 7ii7 the role of community partners or community institutional review boards in reviewing the plans2 and 7iii7 how the trial will recruit a study population that is-- 7,i7 in proportion to the prevalence of the disease or condition in such groups relative to the prevalence of the disease or condition in the overall population of the ,united ,states2 7,,ii7 in sufficient numbers to obtain clinically and statistically meaningful determinations of the safety and effectiveness of the drug being studied in the respective race1 ethnicity1 age1 and gender or sex groups2 and 7,,iii7 consistent with the guidance under section #eje7;b77#a7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cee7;b77#a77 and guidance issued by the ,national ,institutes of ,health on the inclusion of women and minorities in clinical trials2 7,d7 the entity's plan for implementing1 or an explanation of why the entity cannot implement1 alternative clinical trial follow-up requirements that are less burdensome for trial participants1 such as-- 7i7 requiring fewer follow-up visits2 7ii7 allowing phone follow-up or home visits by nurse trial coordinators 7in lieu of in-person visits by patients72 7iii7 allowing for online follow-up options2 7iv7 permitting the patient's primary care provider to perform some of the follow-up visit requirements and to reimburse the patient for any out-of-pocket costs incurred by the patient for such follow-up visits2 7v7 allowing for weekend hours for required follow-up visits2 7vi7 allowing virtual or telemedicine visits2 7vii7 use of wearable technology to record key health parameters2 and 7viii7 use of alternate labs or imaging centers1 which may be closer to the residence of the patients participating in the trial2 and 7,e7 the entity's education and training requirements for researchers and other individuals conducting or supporting the clinical trial with respect to diversity and health inequities in underrepresented populations1 including a requirement to consult with1 and review materials made available by1 such committees1 task forces1 and working groups other entities the ,secretary determines are appropriate1 including the following3 7i7 ,the ,equity ,committee of the ,national ,institutes of ,health4 7ii7 ,the ,national ,advisory ,council on ,minority ,health and ,health ,disparities4 7iii7 ,the ,advisory ,committee on ,research on ,women's ,health4 7iv7 ,the ,sexual ,gender ,minority ,research ,coordinating ,committee of the ,national ,institutes of ,health4 7v7 ,the ,tribal ,health ,research ,coordinating ,committee of the ,national ,institutes of ,health4 7#b7 ,terms 7,a7 ,in general ,as a condition on the receipt of funding through the ,national ,institutes of ,health1 as described in paragraph 7#a71 with respect to a clinical trial1 the sponsor of the clinical trial shall agree to terms requiring that-- 7i7 the aggregate demographic information of trial participants be shared on an annual basis with the ,secretary while participant recruitment and data collection in such trial is ongoing1 and that such information is provided with respect to-- 7,i7 underrepresented populations1 including populations grouped by race1 ethnicity1 age1 sex1 gender identity and expression1 geographic region1 primary written and spoken language1 disability status1 sexual orientation1 socioeconomic status1 occupation1 and other relevant factors2 and 7,,ii7 such populations that reflect the prevalence of the disease or condition that is the subject of the clinical trial involved 7as available and as appropriate to the scientific objective for the study1 as determined by the ,director of the ,national ,institutes of ,health72 7ii7 the sponsor submits to the program officer and grants management specialist of the specific ,national ,institutes of ,health national research institute or national center1 as frequently as such officer or specialist determines necessary1 the retention rate of participants in the clinical trial1 disaggregated by race1 ethnicity1 gender or sex1 and age2 7iii7 both the clinical trial researchers and the applicant reviewers complete education and training programs on diversity in clinical trials2 and 7iv7 at the conclusion of the trial1 the sponsor submits to the ,secretary the number of participants in the trial1 disaggregated by race1 ethnicity1 age1 and gender or sex4 7,b7 ,privacy protections ,any data shared under subparagraph 7,a7 may not include any individually identifiable information or protected health information with respect to clinical trial participants and shall only be disclosed to the extent allowed under ,federal privacy laws4 7#c7 ,exception ,in lieu of submitting an application under paragraph 7#a7 and documentation of goals as required by subparagraph 7,a7 of such paragraph1 an applicant may provide reasoning 7other than cost7 for why the recruitment of each of the population groups specified in subparagraph 7,a7 of paragraph 7#a7 is not necessary and why such recruitment is not scientifically justified or possible4 7#d7 ,publication ,the ,secretary shall-- 7,a7 publish on a public website of the ,national ,institutes of ,health1 upon receipt of an application to which paragraph 7#a7 applies or reasoning under paragraph 7#c7-- 7i7 a summary of the disease being targeted in the clinical trial that is the subject of the application and the prevalence of such disease across race1 ethnicity1 gender or sex1 age1 and clinical trial representation in each such category2 7ii7 the goals specified in such application1 as required by paragraph 7#a77;,a72 or 7iii7 the reasoning described in paragraph 7#c72 and 7,b7 ensure that1 in publishing information relating to an application or reasoning under subparagraph 7,a71 the design of the study involved is not disclosed4 7#e7 ,remediation 7,a7 ,in general ,in the case of a clinical trial subject to paragraph 7#a7 that fails to meet the condition specified pursuant to paragraph 7#a7 by such date as may be agreed upon by the sponsor of the trial and the program officer and grants management specialist of the specific ,national ,institutes of ,health national research institute or national center1 the ,secretary shall require the sponsor of that clinical trial1 not later than #fj days after such date occurs-- 7i7 to develop1 in consultation with the ,secretary and advocacy and community-based organizations representing individuals who are members of relevant demographic groups specified in paragraph 7#a77;,a71 a strategic plan to increase participation in such clinical trial of such individuals2 and 7ii7 to submit to the ,secretary1 such strategic plan4 7,b7 ,publication ,the ,secretary shall make publicly available on the website of the ,national ,institutes of ,health1 the strategic plan received under subparagraph 7,a7 as soon as possible after receipt4 ,the ,secretary shall ensure that1 in publishing such plan under the preceding sentence1 the design of the study involved is not disclosed4 7,c7 ,implementation ,the sponsor of the clinical trial that is the subject of the strategic plan published under subparagraph 7,b71 shall1 not later than #fj days after such date as may be agreed upon by the sponsor of the trial and the appropriate program officer and grants management specialist of the ,national ,institutes of ,health1 implement the strategic plan4 7,d7 ,technical assistance ,the ,secretary may provide technical assistance to a sponsor of a clinical trial1 as necessary for the sponsor to meet the requirements of subparagraph 7,c74 7#f7 ,penalties in case of failure of remediation 7,a7 ,in general ,in the case of a clinical trial subject to paragraph 7#a7 that1 after the close of the #fj-;day period specified in paragraph 7#e77;,c71 continues to fail to meet the condition specified pursuant to paragraph 7#a77;,a71 the ,secretary shall-- 7i7 hold the noncompeting continuation of funding received through the grant involved2 7ii7 apply specific conditions on the award of funds to such sponsor to conduct such clinical trial2 or 7iii7 terminate such funding4 7,b7 ,waiver 7i7 ,in general ,in the case of a clinical trial subject to the penalty under subparagraph 7,a7 that fails to meet the condition referred to in such subparagraph1 the sponsor of such clinical trial may1 prior to the conclusion of the #fj-;day period referred to in subparagraph 7,a71 submit an application to the relevant program officer and grants specialist requesting a waiver of such condition4 ,such an application shall specify reasoning for why the recruitment of each of the population groups specified in subparagraph 7,a7 of paragraph 7#a7 is not necessary or why such recruitment is not scientifically justified or possible4 7ii7 ,review ,not later than #cj days after a date agreed upon by the sponsor of the trial and the appropriate program officer and grants management specialist of the ,national ,institutes of ,health1 the ,secretary shall-- 7,i7 complete the review of such application2 and 7,,ii7 make a determination to approve or deny the application4 7iii7 ,no additional penalties ,no additional penalties may be applied with respect to a sponsor of a clinical trial under subparagraph 7,a7 during the #cj-;day period specified in clause 7ii74 7,c7 ,termination of funding ,in the case of a clinical trial described in subparagraph 7,b77i71 the ,secretary may elect to terminate funding described in paragraph 7#a7 for the clinical trial if no request for a waiver under subparagraph 7,b7 is received by the conclusion #fj-;day period referred to in subparagraph 7,a74 7#g7 ,waiver for certain clinical trials 7,a7 ,in general ,in the case of a clinical trial that received funding through the ,national ,institutes of ,health and is ongoing as of the date of the enactment of this ,act1 the sponsor of such clinical trial is exempt from the requirements of 7and associated penalties imposed by7 this section4 7,b7 ,report ,the ,secretary shall include in the triennial report required to be submitted under section #djc of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhc71 a list of all clinical trials receiving funding through the ,national ,institutes of ,health-- 7i7 that requested and received waivers under this subsection2 or 7ii7 with respect to which funding has been terminated pursuant to this subsection4 7#h7 ,nondiscrimination ,section #aeeg of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahaaf7 shall apply with respect to a clinical trial subject to paragraph 7#a74 7b7 ,eliminating cost barriers 7#a7 ,study on modernization of human subject regulations ,not later than #b years after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,national ,institutes of ,health 7referred to in this subsection as the ,secretary71 shall conduct and complete a study on-- 7,a7 the need for review of human subject regulations specified in part #df of title #de1 ,code of ,federal ,regulations 7or successor regulations71 and related guidance2 7,b7 the modernization of such regulations and guidance to establish updated guidelines for reimbursement of out-of-pocket expenses of human subjects1 compensation of human subjects for time spent participating in the clinical trial1 and incentives for recruitment of human subjects2 and 7,c7 the need for updated safe harbor rules under section #ajja4ieb of title #db1 ,code of ,federal ,regulations 7or successor regulations7 and section #aabh;,b of the ,social ,security ,act 7commonly referred to as the ,federal ,anti-,kickback ,statute 7#db ,u4,s4,c4 #acbj;a-#g;b77 with respect to the assistance provided under this subsection4 7#b7 ,reimbursement for costs associated with clinical trial participation ,as a condition on receipt of any funding provided through the ,national ,institutes of ,health to conduct a clinical trial investigating a drug or device 7as those terms are defined in section #bja of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cba77 or biological product 7as defined in section #cea7;i7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bfb7;i7771 the ,secretary shall require that the sponsor of such clinical trial-- 7,a7 works with institutional review boards and program officers of the ,national ,institutes of ,health to determine when reimbursement for the costs associated with clinical trial participation is warranted2 and 7,b7 subject to paragraph 7#c71 provides to clinical trial participants reimbursement for expenses 7using funds other than funds supplied through the ,national ,institutes of ,health7 incurred as a result of that participation1 which may include-- 7i7 missed or forgone salary2 7ii7 language assistance1 including interpreter services2 7iii7 food expenses2 7iv7 childcare expenses2 7v7 lodging expenses2 7vi7 transportation expenses2 or 7vii7 other expenses as identified by the participant1 subject to review by the clinical trial sponsor1 at its discretion1 on a case-by-case basis4 7#c7 ,provision of costs associated with clinical trial participation 7,a7 ,application and documentation 7i7 ,in general ,a sponsor of a clinical trial to which subsection 7a77#a7 applies1 may require that1 in order to receive reimbursement as described in paragraph 7#b71 a participant complete an application and share with the sponsor such documentation of expenses described in such paragraph1 as the sponsor may require4 7ii7 ,timing ,not later than #cj days after the date on which a sponsor of a clinical trial receives an application under clause 7i71 the sponsor shall-- 7,i7 review the application2 and 7,,ii7 provide for reimbursement of eligible expenses documented in such application1 as determined at the discretion of the clinical trial sponsor on a case-by-case basis4 7,b7 ,enforcement ,a sponsor of a clinical trial to which subsection 7a77#a7 applies1 shall submit on an annual basis1 as part of the progress reports submitted to the ,secretary pursuant to section #djb7;j7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhb7;j771 during the data collection period of the clinical trial1 to the ,secretary an accounting of the reimbursements made to clinical trial participants under subparagraph 7,a74 ,such data shall-- 7i7 include relevant aggregate data with respect to each population group specified in subsection 7a77#b77;,a77i7 when such data will not compromise the identities of study participants and in a manner consistent with applicable privacy protections2 and 7ii7 not later than #f months after receipt by the ,secretary1 be published on a public website of the ,national ,institutes of ,health4 7c7 ,public awareness and education campaign 7#a7 ,national campaign ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,national ,institutes of ,health and the ,commissioner of ,food and ,drugs 7referred to in this subsection as the ,secretary71 in consultation with the stakeholders specified in paragraph 7#e71 shall carry out a national campaign to increase the awareness and knowledge of individuals in the ,united ,states with respect to the need for diverse clinical trials among the demographic groups identified pursuant to subsection 7a77#a77;,a74 7#b7 ,requirements ,the national campaign conducted shall include-- 7,a7 the development and distribution of written educational materials1 and the development and placing of public service announcements1 that are intended to encourage individuals who are members of the demographic groups identified pursuant to subsection 7a77#b77;,a77i77,i7 to seek to participate in clinical trials2 7,b7 such efforts as are reasonable and necessary to ensure meaningful access by consumers with limited ,english proficiency2 7,c7 the development and distribution of best practices and training for recruiting underrepresented study populations1 including a method for sharing such best practices among clinical trial sponsors1 providers1 community-based organizations who assist with recruitment1 and with the public2 and 7,d7 the conduct of focus groups to better understand the concerns and fears of certain underrepresented groups who may be reluctant to participate in clinical trials4 7#c7 ,health inequities ,in developing the national campaign under paragraph 7#a71 the ,secretary shall recognize and address-- 7,a7 health inequities among individuals who are members of the population groups specified in subsection 7a77#b77;,a77i7 with respect to access to care and participation in clinical trials2 and 7,b7 any barriers in access to care and participation in clinical trials that are specific to individuals who are members of such groups4 7#d7 ,grants ,the ,secretary shall establish a program to award grants to nonprofit private entities1 including community-based organizations and faith communities1 institutions of higher education eligible to receive funds under section #cga of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajfgq7 and national organizations that serve underrepresented populations and community pharmacies to enable such entities-- 7,a7 to test alternative outreach and education strategies to increase the awareness and knowledge of individuals in the ,united ,states1 with respect to the need for diverse clinical trials that reflect the race1 ethnicity1 age1 and gender or sex of patients with the disease or condition being investigated2 and 7,b7 to cover administrative costs of such entities in assisting in diversifying clinical trials subject to subsection 7a74 7#e7 ,stakeholders specified ,the stakeholders specified in this paragraph are the following3 7,a7 ,representatives of the ,health ,resources ,services ,administration1 the ,office of ,minority ,health of the ,department of ,health and ,human ,services1 the ,centers for ,disease ,control and ,prevention1 and the ,national ,institutes of ,health4 7,b7 ,community-based resources and advocates4 7#f7 ,authorization of ,appropriations ,there is authorized to be appropriated to carry out this subsection #aj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7d7 ,definitions ,in this section3 7#a7 ,clinical trial ,the term clinical trial means a research study in which one or more human subjects are prospectively assigned to one or more interventions 7which may include placebo or other control7 to evaluate the effects of those interventions on health-related biomedical or behavioral outcomes4 7#b7 ,sponsor ,the term sponsor has the meaning given such term in section #ej4c of title #ba1 ,code of ,federal ,regulations 7or successor regulations74 #gija;,b-#c4 ,patient experience data 7a7 ,policy ,section #efi;,c of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cfj;bbb-#h;c7 is amended-- 7#a7 by redesignating subsections 7b7 and 7c7 as subsections 7c7 and 7d71 respectively2 and 7#b7 by inserting after subsection 7a7 the following3 7b7 ,collection1 submission1 and use of data 7#a7 ,in general ,the ,secretary shall-- 7,a7 for any drug for which an exemption is granted for investigational use under section #eje7;i7 of this ,act or section #cea7;a7 of the ,public ,health ,service ,act1 require the sponsor of the drug to collect standardized patient experience data as part of the clinical trials conducted pursuant to such exemption2 7,b7 require any application for the approval or licensing of such drug under section #eje7;b7 of this ,act or section #cea7;a7 of the ,public ,health ,service ,act to include-- 7i7 the standardized patient experience data so collected2 and 7ii7 such related information as the ,secretary may require2 and 7,c7 consider patient experience data and related information that is submitted pursuant to subparagraph 7,b7 in deciding whether to approve or license1 as applicable1 the drug involved4 7#b7 ,applicability ,paragraph 7#a7 applies only with respect to drugs for which a request for an exemption described in paragraph 7#a77;,a7 is submitted on or after the date of the enactment of the ,health ,equity and ,accountability ,act of #bjbd1 or an application under section #eje7;b7 of this ,act or section #cea7;a7 of the ,public ,health ,service ,act is filed1 as applicable1 on or after the day that is #b years after the date of the enactment of the ,health ,equity and ,accountability ,act of #bjbd4 4 7b7 ,regulations ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 acting through the ,commissioner of ,food and ,drugs1 shall promulgate final regulations to implement section #efi;,c7b7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act1 as added by this section4 ,m ,additional provisions addressing high-,impact minority diseases #gija;,c4 ,medicare coverage of multi-cancer early detection screening tests 7a7 ,coverage ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 as amended by sections #bjjg1 #dbba1 #dbea1 #faja1 and #gdai1 is amended-- 7#a7 in subsection 7s77#b7-- 7,a7 in subparagraph 7,,ll71 by striking and at the end2 7,b7 by inserting and at the end of subparagraph 7,,mm72 and 7,c7 by adding at the end the following new subparagraph3 7,,nn7 multi-cancer early detection screening tests 7as defined in subsection 7sss772 2 and 7#b7 by adding at the end the following new subsection3 7sss7 ,multi-,cancer early detection screening tests ,the term multi-cancer early detection screening test means any of the following tests1 approved or cleared by the ,food and ,drug ,administration1 furnished to an individual for the purpose of early detection of cancer across many cancer types 7as categorized in the ,annual ,report to the ,nation on the ,status of ,cancer issued by the ,national ,cancer ,institute73 7#a7 ,a genomic sequencing blood or blood product test that includes the analysis of cell-free nucleic acids4 7#b7 ,such other equivalent tests 7which are based on urine or another sample of biological material7 as the ,secretary determines appropriate4 4 7b7 ,payment and frequency limit 7#a7 ,payment under fee schedule ,section #ahcc7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7h77 is amended-- 7,a7 in paragraph 7#a77;,a71 by inserting after 7including the following3 multi-cancer early detection screening tests under section #ahfa7sss7 and including2 and 7,b7 by adding at the end the following new paragraph3 7#aj7 ,no payment may be made under this part for a multi-cancer early detection screening test 7as defined in section #ahfa7sss77 for an individual if such a test was furnished to the individual during the previous #aa months4 4 7#b7 ,conforming amendment ,section #ahfb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77 is amended-- 7,a7 in paragraph 7#a7-- 7i7 in subparagraph 7,o71 by striking and at the end2 7ii7 in subparagraph 7,p71 by striking the semicolon at the end and inserting 1 and2 and 7iii7 by adding at the end the following new subparagraph3 7,q7 in the case of multi-cancer early detection screening tests 7as defined in section #ahfa7sss771 which are performed more frequently than is covered under section #ahcc7;h77#aj72 2 and 7,b7 in paragraph 7#g71 by striking or 7,p7 and inserting 7,p71 or 7,q74 7c7 ,rule of construction relating to other cancer screening tests ,nothing in this section1 including the amendments made by this section1 shall be construed-- 7#a7 in the case of an individual who undergoes a multi-cancer early detection screening test1 to affect coverage under part ,b for other cancer screening tests covered under this section1 such as screening tests for breast1 cervical1 colorectal1 lung1 or prostate cancer2 or 7#b7 in the case of an individual who undergoes another cancer screening test1 to affect coverage for a multi-cancer early detection screening test or the use of such a test as a diagnostic or confirmatory test for a result of the other cancer screening test4 #gija;,c-#a4 ,amputation ,reduction and ,compassion ,act 7a7 ,peripheral artery disease education program ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq471 as amended by section #gejd1 is amended by adding at the end the following3 #cii,v-#ad4 ,peripheral artery disease education program 7a7 ,establishment ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 in collaboration with the ,administrator of the ,centers for ,medicare ,medicaid ,services and the ,administrator of the ,health ,resources and ,services ,administration1 shall establish and coordinate a peripheral artery disease education program to support1 develop1 and implement educational initiatives and outreach strategies that inform health care professionals and the public about the existence of peripheral artery disease and methods to reduce amputations related to such disease1 particularly with respect to at-risk populations4 7b7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 4 7b7 ,medicare coverage of peripheral artery disease screening tests furnished to at-,risk beneficiaries without imposition of cost sharing requirements 7#a7 ,in general ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 as amended by sections #bjjg1 #dbba1 #dbea1 #faja1 #gdai1 and #gija;,c1 is amended-- 7,a7 in subsection 7s77#b7-- 7i7 in subparagraph 7,,mm71 by striking and at the end2 7ii7 in subparagraph 7,,nn71 by striking the period at the end and inserting 2 and2 and 7iii7 by adding at the end the following new subparagraph3 7,,oo7 peripheral artery disease screening tests furnished to at-risk beneficiaries 7as such terms are defined in subsection 7ttt774 2 and 7,b7 by adding at the end the following new subsection3 7ttt7 ,peripheral artery disease screening test2 ,at-,risk beneficiary 7#a7 ,the term peripheral artery disease screening test means-- 7,a7 noninvasive physiologic studies of extremity arteries 7commonly referred to as ankle-brachial index testing72 7,b7 arterial duplex scans of lower extremity arteries vascular2 and 7,c7 such other items and services as the ,secretary determines1 in consultation with relevant stakeholders1 to be appropriate for screening for peripheral artery disease for at-risk beneficiaries4 7#b7 ,the term at-risk beneficiary means an individual entitled to1 or enrolled for1 benefits under part ,a and enrolled for benefits under part ,b-- 7,a7 who is #fe years of age or older2 7,b7 who is at least #ej years of age but not older than #fd years of age with risk factors for atherosclerosis 7such as diabetes mellitus1 a history of smoking1 hyperlipidemia1 and hypertension7 or a family history of peripheral artery disease2 7,c7 who is younger than #ej years of age with diabetes mellitus and #a additional risk factor for atherosclerosis2 or 7,d7 with a known atherosclerotic disease in another vascular bed such as coronary1 carotid1 subclavian1 renal1 or mesenteric artery stenosis1 or abdominal aortic aneurysm4 7#c7 ,the ,secretary shall1 in consultation with appropriate organizations1 establish standards regarding the frequency for peripheral artery disease screening tests described in subsection 7s77#b77,,oo7 for purposes of coverage under this title4 4 7#b7 ,inclusion of peripheral artery disease screening tests in initial preventive physical examination ,section #ahfa7ww77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ww77#b77 is amended-- 7,a7 in subparagraph 7,n71 by moving the margins of such subparagraph #b ems to the left2 7,b7 by redesignating subparagraph 7,o7 as subparagraph 7,p72 and 7,c7 by inserting after subparagraph 7,n7 the following new subparagraph3 7,o7 ,peripheral artery disease screening tests furnished to at-risk beneficiaries 7as such terms are defined in subsection 7ttt774 4 7#c7 ,payment 7,a7 ,in general ,section #ahcc7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a771 as amended by sections #dbea7;c77#c71 #faja7;a77#d71 and #gdai1 is amended-- 7i7 in paragraph 7#a7-- 7,i7 in subparagraph 7,n71 by inserting and other than peripheral artery disease screening tests furnished to at-risk beneficiaries 7as such terms are defined in section #ahfa7ttt77 after other than personalized prevention plan services 7as defined in section #ahfa7;hhh77#a772 7,,ii7 by striking and before 7,,kk72 and 7,,iii7 by inserting before the semicolon at the end the following3 1 and 7,,ll7 with respect to peripheral artery disease screening tests furnished to at-risk beneficiaries 7as such terms are defined in section #ahfa7ttt771 the amount paid shall be #ajj percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section #ahdh2 and 7ii7 in paragraph 7#b7-- 7,i7 in subparagraph 7,g71 by striking and at the end2 7,,ii7 in subparagraph 7,h71 by inserting and at the end2 and 7,,iii7 by inserting after subparagraph 7,h7 the following new subparagraph3 7,i7 with respect to peripheral artery disease screening tests 7as defined in paragraph 7#a7 of section #ahfa7ttt77 furnished by an outpatient department of a hospital to at-risk beneficiaries 7as defined in paragraph 7#b7 of such section71 the amount determined under paragraph 7#a77;,,ee71 4 7,b7 ,no deductible ,section #ahcc7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7b771 as amended by section #gdai7;a77#e77;,a77iii71 is amended1 in the first sentence-- 7i7 by striking and before 7#ad72 and 7ii7 by inserting 1 and 7#ae7 such deductible shall not apply with respect to peripheral artery disease screening tests furnished to at-risk beneficiaries 7as such terms are defined in section #ahfa7ttt77 before the period at the end4 7,c7 ,exclusion from prospective payment system for hospital outpatient department services ,section #ahcc7t77#a77;,b77iv7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#a77;,b77iv77 is amended-- 7i7 by striking 1 or personalized and inserting 1 personalized2 and 7ii7 by inserting 1 or peripheral artery disease screening tests furnished to at-risk beneficiaries 7as such terms are defined in section #ahfa7ttt77 after personalized prevention plan services 7as defined in section #ahfa7;hhh77#a774 7,d7 ,payment under physician fee schedule ,section #ahdh7;j77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c771 as amended by section #dbea7;c77#d71 is amended by inserting 1 7#b77,,oo71 after 7#b77,,kk74 7#d7 ,exclusion from coverage and ,medicare as secondary payer for tests performed more frequently than allowed ,section #ahfb7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#a771 as amended by subsection 7b77#b71 is amended-- 7,a7 in subparagraph 7,p71 by striking and at the end2 7,b7 in subparagraph 7,q71 by striking the semicolon at the end and inserting 1 and2 and 7,c7 by adding at the end the following new subparagraph3 7,r7 in the case of peripheral artery disease screening tests furnished to at-risk beneficiaries 7as such terms are defined in section #ahfa7ttt771 which are performed more frequently than is covered under such section2 4 7#e7 ,authority to modify or eliminate coverage of certain preventive services ,section #ahcd7n7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7n77 is amended-- 7,a7 by redesignating subparagraphs 7,a7 and 7,b7 of paragraph 7#a7 as clauses 7i7 and 7ii71 respectively1 and moving the margins of such clauses1 as so redesignated1 #b ems to the right2 7,b7 by redesignating paragraphs 7#a7 and 7#b7 as subparagraphs 7,a7 and 7,b71 respectively1 and moving the margins of such subparagraphs1 as so redesignated1 #b ems to the right2 7,c7 by striking ,certain ,preventive ,services and all that follows through any other provision of this title and inserting3 ,certain ,preventive ,services4-- 7#a7 ,in general ,notwithstanding any other provision of this title 2 and 7,d7 by adding at the end the following new paragraph3 7#b7 ,inapplicability ,the ,secretarial authority described in paragraph 7#a7 shall not apply with respect to preventive services described in section #ahfa7ww77#b77,o74 4 7#f7 ,effective date ,the amendments made by this subsection shall apply with respect to items and services furnished on or after ,january #a1 #bjbe4 7c7 ,medicaid coverage of peripheral artery disease screening tests furnished to at-,risk beneficiaries without imposition of cost sharing requirements 7#a7 ,in general ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 as amended by section #gdai7;a77#c77;,a77ii71 is amended-- 7,a7 in subsection 7a7-- 7i7 by redesignating paragraph 7#cd7 as paragraph 7#ce72 7ii7 in paragraph 7#cc71 by striking and after the semicolon2 and 7iii7 by inserting after paragraph 7#cc7 the following new paragraph3 7#cd7 peripheral artery disease screening tests furnished to at-risk beneficiaries 7as such terms are defined in subsection 7ss772 and 2 and 7,b7 by adding at the end the following new subsection3 7ss7 ,peripheral artery disease screening test2 at-,risk beneficiary 7#a7 ,peripheral artery disease screening test ,the term peripheral artery disease screening test means-- 7,a7 noninvasive physiologic studies of extremity arteries 7commonly referred to as ankle-brachial index testing72 7,b7 arterial duplex scans of lower extremity arteries vascular2 and 7,c7 such other items and services as the ,secretary determines1 in consultation with relevant stakeholders1 to be appropriate for screening for peripheral artery disease for at-risk beneficiaries4 7#b7 ,at-risk beneficiary ,the term at-risk beneficiary means an individual enrolled under a ,state plan 7or a waiver of such plan7-- 7,a7 who is #fe years of age or older2 7,b7 who is at least #ej years of age but not older than #fd years of age with risk factors for atherosclerosis 7such as diabetes mellitus1 a history of smoking1 hyperlipidemia1 and hypertension7 or a family history of peripheral artery disease2 7,c7 who is younger than #ej years of age with diabetes mellitus and one additional risk factor for atherosclerosis2 or 7,d7 with a known atherosclerotic disease in another vascular bed such as coronary1 carotid1 subclavian1 renal1 or mesenteric artery stenosis1 or abdominal aortic aneurysm4 7#c7 ,frequency ,the ,secretary shall1 in consultation with appropriate organizations1 establish standards regarding the frequency for peripheral artery disease screening tests described in subsection 7a77#cd7 for purposes of coverage under a ,state plan under this title4 4 7#b7 ,no cost sharing 7,a7 ,in general ,subsections 7a77#b7 and 7b77#b7 of section #aiaf of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo71 as amended by section #gcje7;b77#a71 are each amended-- 7i7 in subparagraph 7,j71 by striking or after the comma at the end2 7ii7 in subparagraph 7,k71 by striking 2 and and inserting 1 or2 and 7iii7 by adding at the end the following new subparagraph3 7,l7 peripheral artery disease screening tests furnished to at-risk beneficiaries 7as such terms are defined in section #aije7;hh772 and 4 7,b7 ,application to alternative cost sharing ,section #aiaf;,a7b77#c77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo-#a7;b77#c77;,b771 as amended by section #gcje7;b77#b71 is amended by adding at the end the following new clause3 7xv7 ,peripheral artery disease screening tests furnished to at-risk beneficiaries 7as such terms are defined in section #aije7qq774 4 7#c7 ,mandatory coverage ,section #aijb7;a77#aj77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a771 as amended by section #bjjg7;d77#b71 is amended by striking and 7#cb7 and inserting 7#cb71 and 7#cd74 7d7 ,requirement for group health plans and health insurance issuers offering group or individual health insurance coverage ,to provide coverage for peripheral artery disease screening tests furnished to at-,risk enrollees without imposition of cost sharing requirements 7#a7 ,in general ,section #bgac of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ac7 is amended-- 7,a7 by amending subsection 7a71 as amended by section #gdai7;a77#a77;,a71 to read as follows3 7a7 ,coverage of preventive health services 7#a7 ,in general ,a group health plan and a health insurance issuer offering group or individual health insurance coverage shall1 at a minimum1 provide coverage for and shall not impose any cost sharing requirements for-- 7,a7 evidence-based items or services that have in effect a rating of ,a or ,b in the current recommendations of the ,united ,states ,preventive ,services ,task ,force2 7,b7 immunizations that have in effect a recommendation from the ,advisory ,committee on ,immunization ,practices of the ,centers for ,disease ,control and ,prevention with respect to the individual involved2 7,c7 with respect to infants1 children1 and adolescents1 evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the ,health ,resources and ,services ,administration2 7,d7 with respect to women1 such additional preventive care and screenings not described in subparagraph 7,a7 as provided for in comprehensive guidelines supported by the ,health ,resources and ,services ,administration for purposes of this subparagraph2 7,e7 any prescription drug approved by the ,food and ,drug ,administration for the prevention of ,,hiv 7other than a drug subject to preauthorization requirements consistent with section #bgbi;,a71 administrative fees for such drugs1 laboratory and other diagnostic procedures associated with the use of such drugs1 and clinical follow-up and monitoring1 including any related services recommended in current ,united ,states ,public ,health ,service clinical practice guidelines1 without limitation2 and 7,f7 with respect to at-risk enrollees1 peripheral artery disease screening tests4 7#b7 ,frequency ,the ,secretary1 in consultation with appropriate organizations1 shall establish standards regarding the frequency for peripheral artery disease screening tests for purposes of coverage under this section4 7#c7 ,clarification regarding breast cancer screening1 mammography1 and prevention recommendations ,for the purposes of this ,act1 and for the purposes of any other provision of law1 the current recommendations of the ,united ,states ,preventive ,services ,task ,force regarding breast cancer screening1 mammography1 and prevention shall be considered the most current other than those issued in or around ,november #bjji4 7#d7 ,definitions ,in this subsection3 7,a7 ,at-risk enrollee ,the term at-risk enrollee means an individual enrolled in a group health plan or group or individual health insurance coverage-- 7i7 who is #fe years of age or older2 7ii7 who is at least #ej years of age but not older than #fd years of age with risk factors for atherosclerosis 7such as diabetes mellitus1 a history of smoking1 hyperlipidemia1 and hypertension7 or a family history of peripheral artery disease2 7iii7 who is younger than #ej years of age with diabetes mellitus and one additional risk factor for atherosclerosis2 or 7iv7 with a known atherosclerotic disease in another vascular bed such as coronary1 carotid1 subclavian1 renal1 or mesenteric artery stenosis1 or abdominal aortic aneurysm4 7,b7 ,peripheral artery disease screening test ,the term peripheral artery disease screening test means-- 7i7 noninvasive physiologic studies of extremity arteries 7commonly referred to as ankle-brachial index testing72 7ii7 arterial duplex scans of lower extremity arteries vascular2 and 7iii7 such other items and services as the ,secretary determines1 in consultation with relevant stakeholders1 to be appropriate for screening for peripheral artery disease for at-risk enrollees4 7#e7 ,rule of construction ,nothing in this subsection shall be construed to prohibit a plan or issuer from providing coverage for services in addition to those recommended by the ,united ,states ,preventive ,services ,task ,force or to deny coverage for services that are not recommended by such ,task ,force4 2 and 7,b7 in subsection 7b77#a7-- 7i7 by striking subsection 7a77#a7 or 7a77#b7 or a guideline under subsection 7a77#c7 and inserting subparagraph 7,a7 or 7,b7 of subsection 7a77#a7 or a guideline under subparagraph 7,c7 of such subsection2 and 7ii7 by striking described in subsection 7a7 and inserting described in subsection 7a77#a74 7#b7 ,effective date ,the amendments made by paragraph 7#a7 shall apply with respect to plan years beginning on or after ,january #a1 #bjbe4 7e7 ,disallowance of payment for nontraumatic amputation services furnished without anatomical testing services ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem71 as amended by section #dbba7;b77#b71 is amended by adding at the end the following new subsection3 7bb7 ,disallowance of payment for nontraumatic amputation services furnished without anatomical testing services 7#a7 ,in general ,in the case of nontraumatic amputation services furnished by a supplier on or after ,january #a1 #bjbe1 to an individual entitled to1 or enrolled for1 benefits under part ,a and enrolled for benefits under this part1 for which payment is made under this part1 payment may only be made under this part if-- 7,a7 such supplier furnishes anatomical testing services to such individual during the #c-month period preceding the date on which such nontraumatic amputation services is furnished2 or 7,b7 such individual has a pre-existing dysfunctional or unsalvageable limb1 life-threatening sepsis1 intractable infection1 extensive gangrene or necrotic tissue loss beyond salvage1 a poor functional status1 severe dementia1 or a short life expectancy after shared decision making with a health care team and patient1 family1 or caregiver4 7#b7 ,definitions ,in this subsection3 7,a7 ,anatomical testing services ,the term anatomical testing services means arterial duplex scanning1 computed tomography angiography1 and magnetic resonance angiography4 7,b7 ,nontraumatic amputation services ,the term nontraumatic amputation services means amputations as a result of atherosclerotic vascular disease or a related comorbidity of such disease 7including diabetes74 4 7f7 ,development and implementation of quality measures 7#a7 ,development ,the ,secretary of ,health and ,human ,services 7referred to in this subsection as the ,secretary7 shall1 in consultation with relevant stakeholders1 develop quality measures for nontraumatic1 lower-limb1 major amputation that utilize appropriate diagnostic screening 7including peripheral artery disease screening7 in order to encourage alternative treatments 7including revascularization7 in lieu of such an amputation4 7#b7 ,implementation ,after appropriate testing and validation of the measures developed under paragraph 7#a71 the ,secretary shall incorporate such measures in quality reporting programs for appropriate providers of services and suppliers under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 including for purposes of-- 7,a7 the merit-based incentive payment system under section #ahdh7q7 of such ,act 7#db ,u4,s4,c4 #aciew-#d7q772 7,b7 incentive payments for participation in eligible alternative payment models under section #ahcc7z7 of such ,act 7#db ,u4,s4,c4 #aciel7z772 7,c7 the shared savings program under section #ahii of such ,act 7#db ,u4,s4,c4 #acie;jjj72 7,d7 models under section #aaae;,a of such ,act 7#db ,u4,s4,c4 #acae;a72 and 7,e7 such other payment systems or models as the ,secretary may specify4 #gija;,c-#b4 ,eliminating the coinsurance requirement for certain colorectal cancer screening tests furnished under the ,medicare program ,section #ahcc7;dd7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7dd77 is amended-- 7#a7 in paragraph 7#a71 by striking and before ,january #a1 #bjcj12 and 7#b7 in paragraph 7#b7-- 7,a7 in subparagraph 7,a71 by adding and at the end2 7,b7 in subparagraph 7,b71 by striking through #bjbf and inserting through #bjbd2 and 7,c7 by striking subparagraph 7,c7 and inserting the following3 7,c7 for #bjbe and each subsequent year1 #ajj percent4 4 #gija;,c-#c4 ,expanding the availability of medical nutrition therapy services under the ,medicare program 7a7 ,in general ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended-- 7#a7 in subsection 7s77#b77,v71 by striking in the case of and all that follows through organizations2 and 7#b7 in subsection 7vv7-- 7,a7 in paragraph 7#a7-- 7i7 by striking disease management and inserting the prevention1 management1 or treatment of a disease or condition specified in paragraph 7#d72 and 7ii7 by striking by a physician and all that follows through the period at the end and inserting the following3 by a-- 7,a7 physician 7as defined in subsection 7r77#a772 7,b7 physician assistant2 7,c7 nurse practitioner2 7,d7 clinical nurse specialist 7as defined in subsection 7aa77#e77;,b772 or 7,e7 in the case of such services furnished to manage such a disease or condition that is an eating disorder1 a clinical psychologist 7as defined by the ,secretary74 ,such term shall not include any services furnished to an individual for the prevention1 management1 or treatment of a renal disease if such individual is receiving maintenance dialysis for which payment is made under section #ahha4 2 and 7,b7 by adding at the end the following new paragraph3 7#d7 ,for purposes of paragraph 7#a71 the diseases and conditions specified in this paragraph are the following3 7,a7 ,diabetes and prediabetes4 7,b7 ,a renal disease4 7,c7 ,obesity 7as defined for purposes of subsection 7yy77#b77;,c7 or as otherwise defined by the ,secretary74 7,d7 ,hypertension4 7,e7 ,dyslipidemia4 7,f7 ,malnutrition4 7,g7 ,eating disorders4 7,h7 ,cancer4 7,i7 ,gastrointestinal diseases1 including celiac disease4 7,j7 ,,hiv4 7,k7 ,,aids4 7,l7 ,cardiovascular disease4 7,m7 ,any other disease or condition-- 7i7 specified by the ,secretary relating to unintentional weight loss2 7ii7 for which the ,secretary determines the services described in paragraph 7#a7 to be medically necessary and appropriate for the prevention1 management1 or treatment of such disease or condition1 consistent with any applicable recommendations of the ,united ,states ,preventive ,services ,task ,force2 or 7iii7 for which the ,secretary determines the services described in paragraph 7#a7 are medically necessary1 consistent with either protocols established by registered dietitians or nutrition professional organizations or with accepted clinical guidelines identified by the ,secretary4 4 7b7 ,exclusion modification ,section #ahfb7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#a771 as amended by sections #gija;,c7b77#b7 and #gija;,c-#a7;b77#d71 is amended-- 7#a7 in subparagraph 7,q71 by striking and at the end2 7#b7 in subparagraph 7,r71 by striking the semicolon at the end and inserting 1 and2 and 7#c7 by adding at the end the following new subparagraph3 7,s7 in the case of medical nutrition therapy services 7as defined in section #ahfa7vv771 which are not furnished for the prevention1 management1 or treatment of a disease or condition specified in paragraph 7#d7 of such section2 4 7c7 ,effective date ,the amendments made by this section shall apply with respect to items and services furnished on or after ,january #a1 #bjbd4 #gija;,c-#d4 ,encouraging the development and use of ,,disarm antimicrobial drugs 7a7 ,additional payment for ,,disarm antimicrobial drugs under ,medicare 7#a7 ,in general ,section #ahhf7;d77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77 is amended by adding at the end the following new subparagraph3 7,n7 7i7 7,i7 ,effective for discharges beginning on or after ,october #a1 #bjbe1 or such sooner date as specified by the ,secretary1 subject to subclause 7,,ii71 the ,secretary shall1 after notice and opportunity for public comment 7in the publications required by subsection 7e77#e7 for a fiscal year or otherwise71 provide for an additional payment under a mechanism 7separate from the mechanism established under subparagraph 7,k771 with respect to such discharges involving any ,,disarm antimicrobial drug1 in an amount equal to-- 7aa7 the amount payable under section #ahdg;,a for such drug during the calendar quarter in which the discharge occurred2 or 7bb7 if no amount for such drug is determined under section #ahdg;,a1 an amount to be determined by the ,secretary in a manner similar to the manner in which payment amounts are determined under section #ahdg;,a based on information submitted by the manufacturer or sponsor of such drug 7as required under clause 7v774 7,,ii7 ,in determining the amount payable under section #ahdg;,a for purposes of items 7aa7 and 7bb7 of subclause 7,i71 subparagraphs 7,a7 and 7,b7 of subsection 7b77#a7 of such section shall be applied by substituting #ajb percent for #ajf percent each place it appears and paragraph 7#h77;,b7 of such section shall be applied by substituting #b percent for #f percent4 7ii7 ,for purposes of this subparagraph1 a ,,disarm antimicrobial drug is-- 7,i7 a drug-- 7aa7 that-- 7,,aa7 is approved by the ,food and ,drug ,administration2 7,,bb7 is designated by the ,food and ,drug ,administration as a qualified infectious disease product under subsection 7d7 of section #eje;,e of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cee;f7d772 and 7,,cc7 has received an extension of its exclusivity period pursuant to subsection 7a7 of such section2 and 7bb7 that has been designated by the ,secretary pursuant to the process established under clause 7iv77,i77bb72 or 7,,ii7 an antibacterial or antifungal biological product-- 7aa7 that is licensed for use1 or an antibacterial or antifungal biological product for which an indication is first licensed for use1 by the ,food and ,drug ,administration on or after ,june #e1 #bjad1 under section #cea7;a7 of the ,public ,health ,service ,act for human use to treat serious or life-threatening infections1 as determined by the ,food and ,drug ,administration1 including those caused by1 or likely to be caused by-- 7,,aa7 an antibacterial or antifungal resistant pathogen1 including novel or emerging infectious pathogens2 or 7,,bb7 a qualifying pathogen 7as defined under section #eje;,e7f7 of the ,federal ,food1 ,drug1 and ,cosmetic ,act 7#ba ,u4,s4,c4 #cee;f7f7772 and 7bb7 has been designated by the ,secretary pursuant to the process established under clause 7iv77,i77bb74 7iii7 ,the mechanism established pursuant to clause 7i7 shall provide that the additional payment under clause 7i7 shall-- 7,i7 with respect to a discharge1 only be made to a subsection 7d7 hospital that1 as determined by the ,secretary-- 7aa7 is participating in the ,national ,healthcare ,safety ,network ,antimicrobial ,use and ,resistance ,module of the ,centers for ,disease ,control and ,prevention2 and 7bb7 has an antimicrobial stewardship program that aligns with the ,core ,elements of ,hospital ,antibiotic ,stewardship ,programs of the ,centers for ,disease ,control and ,prevention or the ,antimicrobial ,stewardship ,standard set by the ,joint ,commission2 and 7,,ii7 apply to discharges occurring on or after ,october #a of the year in which the drug or biological product is designated by the ,secretary as a ,,disarm antimicrobial drug4 ,for purposes of this clause1 in the case of a similar reporting program described in item 7aa71 a subsection 7d7 hospital shall be treated as participating in such a program if the entity maintaining such program identifies to the ,secretary such hospital as so participating4 7iv7 7,i7 ,the mechanism established pursuant to clause 7i7 shall provide for a process for-- 7aa7 a manufacturer or sponsor of a drug or biological product to request the ,secretary to designate the drug or biological product as a ,,disarm antimicrobial drug2 and 7bb7 the designation 7and removal of such designation7 by the ,secretary of drugs and biological products as ,,disarm antimicrobial drugs4 7,,ii7 ,a designation of a drug or biological product as a ,,disarm antimicrobial drug may be revoked by the ,secretary if the ,secretary determines that-- 7aa7 the drug or biological product no longer meets the requirements for a ,,disarm antimicrobial drug under clause 7ii72 7bb7 the request for such designation contained an untrue statement of material fact2 or 7cc7 clinical or other information that was not available to the ,secretary at the time such designation was made shows that-- 7,,aa7 such drug or biological product is unsafe for use or not shown to be safe for use for individuals who are entitled to benefits under part ,a2 or 7,,bb7 an alternative to such drug or biological product is an advance that substantially improves the diagnosis or treatment of such individuals4 7,,iii7 ,not later than ,october #a1 #bjbd1 the ,secretary shall publish in the ,federal ,register a list of the ,,disarm antimicrobial drugs designated under this subparagraph pursuant to the process established under subclause 7,i77bb74 ,the ,secretary shall annually update such list4 7v7 7,i7 ,for purposes of determining additional payment amounts under clause 7i71 a manufacturer or sponsor of a drug or biological product that submits a request described in clause 7iv77,i77aa7 shall submit to the ,secretary information described in section #aibg7;b77#c77;,a77iii74 7,,ii7 ,the penalties for failure to provide timely information under clause 7i7 of subparagraph 7,c7 section #aibg7;b77#c7 and for providing false information under clause 7ii7 of such subparagraph shall apply to manufacturers and sponsors of a drug or biological product under this section with respect to information under subclause 7,i7 in the same manner as such penalties apply to manufacturers under such clauses with respect to information under subparagraph 7,a7 of such section4 7vi7 7,i7 ,the mechanism established pursuant to clause 7i7 shall provide that-- 7aa7 except as provided in item 7bb71 no additional payment shall be made under this subparagraph for discharges involving a ,,disarm antimicrobial drug if any additional payments have been made for discharges involving such drug as a new medical service or technology under subparagraph 7,k72 7bb7 additional payments may be made under this subparagraph for discharges involving a ,,disarm antimicrobial drug if any additional payments have been made for discharges occurring prior to the date of enactment of this subparagraph involving such drug as a new medical service or technology under subparagraph 7,k72 and 7cc7 no additional payment shall be made under subparagraph 7,k7 for discharges involving a ,,disarm antimicrobial drug as a new medical service or technology if any additional payments for discharges involving such drug have been made under this subparagraph4 4 7#b7 ,conforming amendment ,section #ahhf7;d77#e77,k77ii77,,iii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77,k77ii77,,iii77 is amended by striking provide and inserting subject to subparagraph 7,n77vi71 provide4 7b7 ,authorization of appropriations for the ,centers for ,disease ,control and ,prevention ,there is authorized to be appropriated to the ,centers for ,disease ,control and ,prevention #ejj1jjj1jjj1 to remain available until expended1 to support the establishment and implementation of antimicrobial stewardship programs and data reporting capabilities to the ,antimicrobial ,use and ,resistance option of the ,,cdc ,national ,healthcare ,safety ,network1 especially in critical access hospitals1 rural hospitals1 and community hospitals1 to support detection1 surveillance1 containment1 and prevention of resistant pathogens in the ,united ,states and overseas4 7c7 ,study and reports on removing barriers to the development of ,,disarm antimicrobial drugs 7#a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this subsection referred to as the ,comptroller ,general71 in consultation with the ,director of the ,national ,institutes of ,health1 the ,commissioner of ,food and ,drugs1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 and the ,director of the ,centers for ,disease ,control and ,prevention1 shall conduct a study over a #e-year period of the barriers that prevent the development of ,,disarm antimicrobial drugs 7as defined in section #ahhf7;d77#e77,n77ii7 of the ,social ,security ,act1 as added by subsection 7a771 including-- 7,a7 patient outcomes in conjunction with the use of ,,disarm drugs1 including-- 7i7 duration of stay in the intensive care unit2 7ii7 recidivism within #cj days2 and 7iii7 measures of additional follow-up care2 7,b7 the effectiveness of antimicrobial stewardship and surveillance programs1 including-- 7i7 changes in the percentage of hospitals in the ,united ,states with an antimicrobial stewardship program in place that aligns with the ,core ,elements of ,hospital ,antibiotic ,stewardship ,programs1 as outlined by the ,centers for ,disease ,control and ,prevention2 7ii7 changes in inpatient care of clostridioides difficile infection2 and 7iii7 changes in inpatient rates of resistance to key pathogens2 and 7,c7 considerations relating to ,medicare payment reform1 including-- 7i7 changes in the number of qualified antimicrobial products approved2 7ii7 changes in wholesale acquisition cost of individual qualified antimicrobial products over time2 7iii7 changes in year-over-year volume of individual qualified antimicrobial products sold2 and 7iv7 the overall cost of qualified antimicrobial products to the ,medicare program as a proportion of total ,medicare part ,a spending4 7#b7 ,report ,not later than #e years after the date of the enactment of this section1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 #gija;,c-#e4 ,treat and ,reduce ,obesity ,act 7a7 ,authority ,to expand health care providers qualified ,to furnish intensive behavioral therapy ,section #ahfa7;ddd7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ddd77 is amended by adding at the end the following new paragraph3 7#d7 7,a7 ,subject to subparagraph 7,b71 the ,secretary may1 in addition to qualified primary care physicians and other primary care practitioners1 cover intensive behavioral therapy for obesity furnished by any of the following3 7i7 ,a physician 7as defined in subsection 7r77#a77 who is not a qualified primary care physician4 7ii7 ,any other appropriate health care provider 7including a physician assistant1 nurse practitioner1 or clinical nurse specialist 7as those terms are defined in subsection 7aa77#e771 a clinical psychologist1 a registered dietitian or nutrition professional 7as defined in subsection 7vv7774 7iii7 ,an evidence-based1 community-based lifestyle counseling program approved by the ,secretary4 7,b7 ,in the case of intensive behavioral therapy for obesity furnished by a provider described in clause 7ii7 or 7iii7 of subparagraph 7,a71 the ,secretary may only cover such therapy if such therapy is furnished-- 7i7 upon referral from1 and in coordination with1 a physician or primary care practitioner operating in a primary care setting or any other setting specified by the ,secretary2 and 7ii7 in an office setting1 a hospital outpatient department1 a community-based site that complies with the ,federal regulations concerning the privacy of individually identifiable health information promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif1 or another setting specified by the ,secretary4 7,c7 ,in order to ensure a collaborative effort1 the coordination described in subparagraph 7,b77i7 shall include the health care provider or lifestyle counseling program communicating to the referring physician or primary care practitioner any recommendations or treatment plans made regarding the therapy4 4 7b7 ,medicare part ,d coverage of obesity medication 7#a7 ,in general ,section #ahfj;,d-#b7;e77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;e77#b77;,a77 is amended1 in the first sentence-- 7,a7 by striking and other than and inserting other than2 and 7,b7 by inserting after benzodiazepines71 the following3 and other than subparagraph 7,a7 of such section if the drug is used for the treatment of obesity 7as defined in section #ahfa7yy77#b77;,c77 or for weight loss management for an individual who is overweight 7as defined in section #ahfa7yy77#b77;,f77i77 and has #a or more related comorbidities14 7#b7 ,effective date ,the amendments made by paragraph 7#a7 shall apply to plan years beginning on or after the date that is #b years after the date of the enactment of this section4 7c7 ,report to ,congress 7#a7 ,in general ,not later than the date that is #a year after the date of the enactment of this section1 and every #b years thereafter1 the ,secretary of ,health and ,human ,services shall submit a report to ,congress describing the steps the ,secretary has taken to implement the provisions of1 and amendments made by1 this section4 7#b7 ,recommendations ,such report shall also include recommendations for better coordination and leveraging of programs within the ,department of ,health and ,human ,services and other ,federal agencies that relate in any way to supporting appropriate research and clinical care 7such as any interactions between physicians and other health care providers and their patients7 to treat1 reduce1 and prevent obesity in the adult population4 #gija;,c-#f4 ,incentives1 improvements1 and outreach to increase diversity in ,alzheimer's disease research 7a7 ,improving access for and outreach to underrepresented populations 7#a7 ,expanding access to ,alzheimer's research centers 7,a7 ,in general ,section #dde7;a77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;e-#b7;a77#a77 is amended-- 7i7 by striking 7a77#a7 ,the ,director of the ,institute may and inserting the following3 7a7 7#a7 ,the ,director of the ,institute-- 7,a7 may 2 7ii7 by striking disease4 and inserting disease2 and2 and 7iii7 by adding at the end the following3 7,b7 beginning ,january #a1 #bjbd1 shall enter into cooperative agreements and make grants to public or private nonprofit entities under this subsection for the planning1 establishment1 and operation of new such centers that are located in areas with a higher concentration of minority groups 7as determined under section #ddd7;d77#c77;,d771 such as entities that are historically ,black colleges and universities1 ,hispanic-serving institutions1 ,tribal colleges and universities1 or centers of excellence for other minority populations4 4 7,b7 ,use of funding for clinics to operate clinical trials ,section #dde7;b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;e-#b7;b77 is amended by adding at the end the following3 7#c7 ,federal payments made under a cooperative agreement or grant under subsection 7a7 from funds made available under section #gija;,c-#f7;g7 of the ,health ,equity and ,accountability ,act of #bjbd shall1 with respect to ,alzheimer's disease1 be used in part to establish and operate diagnostic and treatment clinics designed-- 7,a7 to meet the special needs of minority and rural populations and other underserved populations2 and 7,b7 to operate clinical trials4 4 7#b7 ,outreach 7,a7 ,alzheimer's disease centers ,section #dde7;b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;e-#b7;b771 as amended by paragraph 7#a77;,b71 is amended by adding at the end the following3 7#d7 ,federal payments made under a cooperative agreement or grant under subsection 7a7 shall be used to establish engagement centers to carry out public outreach1 education efforts1 and dissemination of information for members of minority groups about clinical trial participation4 ,activities funded pursuant to the preceding sentence shall include-- 7,a7 using established mechanisms to encourage members of minority groups to participate in clinical trials on ,alzheimer's disease2 7,b7 expanding education efforts to make members of minority groups aware of ongoing clinical trials2 7,c7 working with trial sponsors to increase the number of recruitment events for members of minority groups2 7,d7 conducting outreach to national1 ,state1 and local physician professional organizations1 especially for members of such organizations who are primary care physicians or physicians who specialize in dementia1 to increase awareness of clinical research opportunities for members of minority groups2 and 7,e7 using community-based participatory research methodologies to engage with minority populations4 4 7,b7 ,resource centers for minority aging research ,section #ddd7;c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;e-#a7;c77 is amended-- 7i7 by striking 7c7 ,the ,director and inserting 7c77#a7 ,the ,director2 and 7ii7 by adding at the end the following new paragraph3 7#b7 ,the ,director of the ,institute1 acting through the ,resource ,centers for ,minority ,aging ,research of the ,institute1 shall carry out public outreach1 education efforts1 and dissemination of information for members of minority groups about participation in clinical research on ,alzheimer's disease carried out or supported under this subpart4 4 7b7 ,incentives ,to increase diversity in ,alzheimer's disease research through principal investigators and researchers from underrepresented populations 7#a7 ,alzheimer's clinical research and training awards ,section #dde;,i of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;e-#aj;a7 is amended by adding at the end the following3 7d7 ,enhancing the participation of principal investigators and researchers who are members of underrepresented populations 7#a7 ,in general ,the ,director of the ,institute shall enhance diversity in the conduct or support of clinical research on ,alzheimer's disease under this subpart by encouraging the participation of individuals from groups that are underrepresented in the biomedical1 clinical1 behavioral1 and social sciences as principal investigators of such clinical research1 as researchers for such clinical research1 or both4 7#b7 ,training for principal investigators ,the ,director of the ,institute shall provide training for principal investigators who are members of a minority group with respect to skills for-- 7,a7 the design and conduct of clinical research and clinical protocols2 7,b7 applying for grants for clinical research2 and 7,c7 such other areas as the ,director of the ,institute determines to be appropriate4 4 7#b7 ,senior researcher awards ,section #dde;,b7a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;e-#d7;a77 is amended by inserting 1 including senior researchers who are members of a minority group before the period at the end of the first sentence4 7c7 ,incentives ,to increase diversity in ,alzheimer's disease research through trial sites ,section #ddd7;d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;e-#a7;d77 is amended-- 7#a7 by striking 7d7 ,the ,director and inserting 7d77#a7 ,the ,director2 and 7#b7 by adding at the end the following3 7#b7 ,in conducting or supporting clinical research on ,alzheimer's disease for purposes of this subpart1 in addition to requirements otherwise imposed under this title1 including under section #dib;,b1 the ,director of the ,institute shall increase the participation of members of minority groups in such clinical research through one or more of the activities described in paragraph 7#c74 7#c7 7,a7 ,the ,director of the ,institute shall provide incentives for the support of clinical research on ,alzheimer's disease with clinical trial sites established in areas with a higher concentration of minority groups1 including rural areas if practicable4 7,b7 ,in determining whether to conduct or support clinical research on ,alzheimer's disease1 the ,director of the ,institute shall encourage the conduct of clinical research with clinical trial sites in areas described in subparagraph 7,a7 as a higher-level priority criterion among the criteria established to evaluate whether to conduct or support clinical research4 7,c7 ,in determining the amount of funding to be provided for the conduct or support of such clinical research1 the ,director of the ,institute shall provide additional funding for the conduct of such clinical research with clinical trial sites in areas described in subparagraph 7,a74 7,d7 ,in determining whether an area is an area with a higher concentration of minority groups1 the ,director of the ,institute-- 7i7 shall consider the most recent data collected by the ,bureau of the ,census2 and 7ii7 may also consider-- 7,i7 data from the ,centers for ,medicare ,medicaid ,services on the incidence of ,alzheimer's disease in the ,united ,states by region2 and 7,,ii7 such other data as the ,director determines appropriate4 7#d7 ,in order to facilitate the participation of members of minority groups in clinical research supported under this subpart1 in addition to activities described in paragraph 7#c71 the ,director of the ,institute shall-- 7,a7 ensure that such clinical research uses community-based participatory research methodologies2 and 7,b7 encourage the use of remote health technologies1 including telehealth1 remote patient monitoring1 and mobile technologies1 that reduce or eliminate barriers to participation of members of minority groups in such clinical research4 7#e7 7,a7 ,clinical research on ,alzheimer's disease conducted or supported under this subpart shall ensure that such research includes outreach activities designed to increase the participation of members of minority groups in such research4 7,b7 7i7 ,each applicant for a grant under this subpart for clinical research on ,alzheimer's disease shall submit to the ,director of the ,institute in the application for such grant-- 7,i7 a budget for outreach activities to members of minority populations with respect to participation in such clinical research2 and 7,,ii7 a description of the plan to conduct such outreach4 7ii7 ,the ,director of the ,institute shall encourage applicants for1 and recipients of1 grants under this subpart to conduct clinical research on ,alzheimer's disease to engage with community-based organizations to increase participation of minority populations in such research4 7#f7 ,for purposes of this subpart3 7,a7 ,the term clinical research includes a clinical trial4 7,b7 ,the term minority group has the meaning given such term under section #dib;,b7g74 4 7d7 ,participant eligibility criteria ,section #dde;,i of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;e-#aj;a71 as amended by subsection 7b77#a71 is amended by adding at the end the following3 7e7 ,participant eligibility criteria ,the ,director of the ,institute shall take such actions as are necessary to ensure that clinical research on ,alzheimer's disease conducted or supported under this subpart is designed with eligibility criteria that ensure the clinical trial population reflects the diversity of the prospective patient population4 ,such actions may include the following3 7#a7 ,examination of criteria 7,a7 ,in general ,an examination of each exclusion criterion to determine if the criterion is necessary to ensure the safety of trial participants or to achieve the study objectives4 7,b7 ,modification of criteria ,in the case of an exclusion criterion that is not necessary to ensure the safety of trial participants or to achieve the study objectives-- 7i7 encouraging the modification or elimination of the criterion2 or 7ii7 encouraging tailoring the criterion as narrowly as possible to avoid unnecessary limits to the population of the clinical study4 7#b7 ,requirement for strong justification for exclusion ,a review of each exclusion criterion to ensure that populations are included in clinical trials1 such as older adults1 individuals with a mild form of disease1 individuals at the extremes of the weight range1 or children1 unless there is a strong clinical or scientific justification to exclude them4 7#c7 ,use of adaptive design ,encouraging the use of an adaptive clinical trial design that-- 7,a7 starts with a defined population where there are concerns about safety2 and 7,b7 may expand to a broader population based on initial data from the trial and external data4 4 7e7 ,resource center for successful strategies ,to increase participation of underrepresented populations in ,alzheimer's disease clinical research ,section #ddd of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;e-#a7 is amended by adding at the end the following3 7e7 7#a7 ,the ,director of the ,institute1 acting through the ,office of ,special ,populations and in consultation with the ,division of ,extramural ,activities1 shall support resource information and technical assistance to grantees under section #dde 7relating to ,alzheimer's disease centers71 other grantees1 and prospective grantees1 designed to increase the participation of minority populations in clinical research on ,alzheimer's disease conducted or supported under this subpart4 7#b7 ,the resource information and technical assistance provided under paragraph 7#a7 shall include the maintenance of a central resource library in order to collect1 prepare1 analyze1 and disseminate information relating to strategies and best practices used by recipients of grants under this subpart and other researchers in the development of the clinical research designed to increase the participation of minority populations in such clinical research4 4 7f7 ,annual reports ,section #ddd of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhe;e-#a71 as amended by subsection 7e71 is amended by adding at the end the following3 7f7 7#a7 7,a7 ,the ,director of the ,institute shall submit annual reports to the ,congress on the impact of the amendments made to this subpart by the ,health ,equity and ,accountability ,act of #bjbd4 7,b7 ,the ,secretary shall transmit a copy of each such report to the ,advisory ,council on ,alzheimer's ,research1 ,care1 and ,services established under section #b7;e7 of the ,national ,alzheimer's ,project ,act4 7#b7 ,in each report under paragraph 7#a71 the ,director of the ,institute shall include information and data on the following matters with respect to clinical trials on ,alzheimer's disease conducted during the preceding year3 7,a7 ,the number of participants who are members of a minority group in such clinical trials4 7,b7 ,the number of such clinical trials for which incentives under subsection 7d77#c7 were made available1 the nature of such incentives1 the amount of increased funding 7if any7 made available for research on ,alzheimer's disease1 and the training provided to principal investigators who are members of a minority group and the amount of funding 7if any7 for such training4 7,c7 ,the number of such clinical trials for which the principal investigator is a member of a minority group4 7,d7 ,the number of such clinical trials for which a significant percentage of researchers are members of a minority group4 7,e7 ,modifications to patient eligibility criteria in clinical trial designs under section #dde;,i7e74 7,f7 ,outreach and education efforts conducted under section #dde7;b77#d74 7#c7 ,the ,director of the ,institute shall make each report under paragraph 7#a7 available to the public1 including through posting on the appropriate website of the ,department of ,health and ,human ,services4 4 7g7 ,authorization of appropriations ,for each of fiscal years #bjbe through #bjbi1 there is authorized to be appropriated to the ,secretary of ,health and ,human ,services #fj1jjj1jjj to carry out the amendments made by this section1 to remain available until expended4 ,,viii ,health ,information ,technology #hjja4 ,definitions ,in this title3 7#a7 ,access ,the term access1 with respect to health information1 means access described in section #afd4ebd of title #de1 ,code of ,federal ,regulations 7or any successor regulations74 7#b7 ,certified electronic health record technology ,the term certified ,,ehr technology-- 7,a7 has the meaning given such term in section #cjjj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj72 7,b7 includes the health information infrastructure for interoperability1 access1 exchange1 and use of electronic health information required under title ,,xxx of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj et seq472 and 7,c7 is not limited to electronic health records maintained by doctors4 7#c7 ,,ehr ,the term ,,ehr-- 7,a7 means an electronic health record2 7,b7 includes the health information infrastructure for interoperability1 access1 exchange1 and use of electronic health information required under title ,,xxx of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj et seq472 and 7,c7 is not limited to electronic health records maintained by doctors4 7#d7 ,interoperability ,the term interoperability has the meaning given such term in section #cjjj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj74 ,a ,reducing ,health ,disparities ,through ,health ,,it #haja4 ,,hrsa assistance to health centers for promotion of ,health ,,it 7a7 ,in general ,the ,secretary of ,health and ,human ,services1 acting through the ,administrator of the ,health ,resources and ,services ,administration1 shall expand and intensify the programs and activities of the ,administration 7directly or through grants or contracts7 to provide technical assistance and resources to health centers 7as defined in section #ccj7;a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7a777 to adopt and meaningfully use certified ,,ehr technology for the management of chronic diseases and health conditions and reduction of health disparities4 7b7 ,funding initiatives ,the activities under subsection 7a7 may include funding initiatives1 including establishing basic connectivity such as #e;,g internet for telemedicine capabilities1 grant funding to implement the next generation of ,,ehr1 and funding for technology hardware4 #hajb4 ,assessment of impact of ,health ,,it on racial and ethnic minority communities2 outreach and adoption of ,health ,,it in such communities 7a7 ,national ,coordinator for ,health ,information ,technology 7#a7 ,in general ,not later than #ah months after the date of enactment of this ,act1 the ,national ,coordinator for ,health ,information ,technology 7referred to in this title as the ,national ,coordinator7 shall-- 7,a7 conduct an evaluation of the level of interoperability1 access1 use1 and accessibility of electronic health records in racial and ethnic minority communities1 focusing on whether patients in such communities have providers who use electronic health records1 and the degree to which patients in such communities can access1 exchange1 and use without special effort their health information in those electronic health records2 7,b7 include in such evaluation an indication of whether such providers-- 7i7 are participating in the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 or a ,state plan under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq47 7or a waiver of such plan72 7ii7 have received incentive payments or incentive payment adjustments under ,medicare and ,medicaid ,electronic ,health ,records ,incentive ,programs 7as defined in subsection 7c77#b772 7iii7 are ,,mips eligible professionals1 as defined in paragraph 7#a77;,c7 of section #ahdh7q7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q771 for purposes of the ,merit-,based ,incentive ,payment ,system under such section2 or 7iv7 have been recruited by any of the ,health ,information ,technology ,regional ,extension ,centers established under section #cjab of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#cb72 and 7,c7 publish the results of such evaluation including the indications under subparagraph 7,b71 the race and ethnicity of such providers1 and the populations served by such providers4 7#b7 ,evaluation of interoperability ,the evaluation of the level of interoperability described in paragraph 7#a77;,a7 shall consider exchange of electronic health information1 usability of exchanged electronic health information1 effective application and use of the exchanged electronic health information1 and impact on outcomes of interoperability4 7#c7 ,certification criterion ,not later than #a year after the date of enactment of this ,act1 the ,national ,coordinator shall-- 7,a7 promulgate a certification criterion and module of certified ,,ehr technology that stratifies quality measures for purposes of the ,merit-,based ,incentive ,payment ,system by disparity characteristics1 including race1 ethnicity1 language1 gender1 gender identity1 sexual orientation1 socio-economic status1 and disability status1 as such characteristics are defined for purposes of certified ,,ehr technology2 and 7,b7 report to the ,centers for ,medicare ,medicaid ,services the quality measures stratified by race and at least #b other disparity characteristics4 7b7 ,national ,center for ,health ,statistics ,not later than one year after the date of enactment of this ,act1 the ,director of the ,national ,center for ,health ,statistics shall provide to ,congress a report that details the adoption of certified electronic health record systems and electronic information sharing in physicians' offices in communities of color and rural communities during fiscal years #bjag through #bjbj4 7c7 ,centers for ,medicare ,medicaid ,services 7#a7 ,in general ,as part of the process of collecting information1 with respect to a provider1 at registration and attestation for purposes of ,medicare and ,medicaid ,electronic ,health ,records ,incentive ,programs 7as defined in paragraph 7#b77 or the ,merit-,based ,incentive ,payment ,system under section #ahdh7q7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q771 the ,secretary of ,health and ,human ,services shall collect the race and ethnicity of such provider4 7#b7 ,medicare and ,medicaid ,electronic ,health ,records ,incentive ,programs defined ,for purposes of paragraph 7#a71 the term ,medicare and ,medicaid ,electronic ,health ,records ,incentive ,programs means the incentive programs under the following3 7,a7 ,subsection 7l77#c7 of section #ahad7l77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f74 7,b7 ,subsections 7a77#g7 and 7o7 of section #ahdh of such ,act 7#db ,u4,s4,c4 #aciew-#d74 7,c7 ,subsections 7l7 and 7m7 of section #ahec of such ,act 7#db ,u4,s4,c4 #aciew-#bc74 7,d7 ,subsections 7b77#c77;,b77ix77,i7 and 7n7 of section #ahhf of such ,act 7#db ,u4,s4,c4 #acieww74 7,e7 ,subsections 7a77#c77;,f7 and 7t7 of section #aijc such ,act 7#db ,u4,s4,c4 #acif;b74 7d7 ,national ,coordinator's assessment of impact of ,,hit ,section #cjja7;c77#f77;,c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#aa7;c77#f77;,c77 is amended-- 7#a7 in the heading by inserting 1 racial and ethnic minority communities1 after health disparities2 7#b7 by inserting 1 in communities with a high proportion of individuals from racial and ethnic minority groups 7as defined in section #agjg7;g771 including people with disabilities in such groups1 after communities with health disparities2 7#c7 by striking ,the ,national ,coordinator and inserting the following3 7i7 ,in general ,the ,national ,coordinator 2 and 7#d7 by adding at the end the following3 7ii7 ,criteria ,in any publication under clause 7i71 the ,national ,coordinator shall include best practices for encouraging partnerships between the ,federal ,government1 ,states1 private entities1 national nonprofit intermediaries1 and community-based organizations to expand outreach and education for and the adoption of certified ,,ehr technology in communities with a high proportion of individuals from racial and ethnic minority groups 7as defined in section #agjg7;g771 while also maintaining the accessibility requirements of section #ejh of the ,rehabilitation ,act of #aigc to encourage patient involvement in patient health care4 ,the ,national ,coordinator shall-- 7,i7 not later than #f months after the submission of the report required under section #hcjb7;b7 of the ,health ,equity and ,accountability ,act of #bjbd1 establish criteria for evaluating the impact of health information technology on communities with a high proportion of individuals from racial and ethnic minority groups 7as so defined7 taking into account the findings in such report2 and 7,,ii7 not later than #a year after the submission of such report1 publish the results of an evaluation of such impact4 4 #hajc4 ,nondiscrimination and health equity in health information technology 7a7 ,in general ,covered entities shall ensure that electronic and information technology in their health programs or activities does not exclude individuals from participation in1 deny individuals the benefits of1 or subject individuals to discrimination under any health program or activity on the basis of race1 color1 national origin1 sex1 age1 or disability4 7b7 ,covered entities ,in this section1 the term covered entity means-- 7#a7 an entity that operates a health program or activity1 any part of which receives ,federal financial assistance2 7#b7 an entity established under title ,i of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aad-adh7 that administers a health program or activity2 or 7#c7 the ,department of ,health and ,human ,services4 #hajd4 ,language access in health information technology ,the ,national ,coordinator shall-- 7#a7 not later than #ah months after the date of enactment of this ,act1 propose a rule for providing access to patients1 through certified ,,ehr technology1 to their personal health information in a computable format1 including using patient portals or third-party applications 7as described in section #cjji7;e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ai7;e7771 in the #aj most common non-,english languages2 7#b7 hold a public hearing to identify best practices for carrying out paragraph 7#a72 and 7#c7 not later than #f months after the public hearing under paragraph 7#b71 promulgate a final regulation with respect to paragraph 7#a74 ,b ,modifications ,to ,achieve ,parity in ,existing ,programs #hbja4 ,extending funding to strengthen the ,health ,,it infrastructure in racial and ethnic minority communities ,section #cjaa of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ca7 is amended-- 7#a7 in subsection 7a71 in the matter preceding paragraph 7#a71 by inserting 1 including with respect to communities with a high proportion of individuals from racial and ethnic minority groups 7as defined in section #agjg7;g77 before the colon at the end2 and 7#b7 by adding at the end the following new subsection3 7e7 ,annual report on expenditures ,the ,national ,coordinator shall report annually to ,congress on activities and expenditures under this section4 4 #hbjb4 ,extending competitive grants for the development of loan programs to facilitate adoption of certified ,,ehr technology by providers serving racial and ethnic minority groups ,section #cjad7;e7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#cd7;e77 is amended1 in the matter preceding paragraph 7#a71 by inserting 1 including with respect to communities with a high proportion of individuals from racial and ethnic minority groups 7as defined in section #agjg7;g77 after health care provider to4 #hbjc4 ,authorization of appropriations ,section #cjah of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ch7 is amended by striking fiscal years #bjji through #bjac and inserting fiscal years #bjbe through #bjcj4 ,c ,additional ,research and ,studies #hcja4 ,data collection and assessments conducted in coordination with minority-serving institutions ,section #cjja7;c77#f7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#aa7;c77#f77 is amended by adding at the end the following new subparagraph3 7,f7 ,data collection and assessments conducted in coordination with minority-serving institutions 7i7 ,in general ,in carrying out subparagraph 7,c7 with respect to communities with a high proportion of individuals from racial and ethnic minority groups 7as defined in section #agjg7;g771 the ,national ,coordinator shall1 to the greatest extent possible1 coordinate with an entity described in clause 7ii74 7ii7 ,minority-serving institutions ,for purposes of clause 7i71 an entity described in this clause is a historically ,black college or university1 a ,hispanic-serving institution1 a ,tribal ,college or ,university1 or an ,asian-,american-1 ,native ,american-1 or ,pacific ,islander-serving institution with an accredited public health1 health policy1 or health services research program4 4 #hcjb4 ,study of health information technology in medically underserved communities 7a7 ,in general ,not later than #b years after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall-- 7#a7 enter into an agreement with the ,national ,academies of ,sciences1 ,engineering1 and ,medicine to conduct a study on the development1 implementation1 and effectiveness of health information technology within medically underserved areas2 and 7#b7 submit a report to ,congress describing the results of such study1 including any recommendations for legislative or administrative action4 7b7 ,study ,the study described in subsection 7a77#a7 shall-- 7#a7 identify barriers to successful implementation of health information technology in medically underserved areas2 7#b7 survey a cross-section of individuals in medically underserved areas and report their opinions about the various topics of study2 7#c7 examine the degree of interoperability among health information technology and users of health information technology in medically underserved areas1 including patients1 providers1 and community services1 which such examination shall consider the exchange of electronic health information1 usability of exchanged electronic health information1 effective application and use of the exchanged electronic health information1 and impact on outcomes of interoperability2 7#d7 examine the impact of health information technology on providing quality care and reducing the cost of care to individuals in such areas1 including the impact of such technology on improved health outcomes for individuals1 including which technology worked for which population and how it improved health outcomes for that population2 7#e7 examine the impact of health information technology on improving health care-related decisions by both patients and providers in such areas2 7#f7 identify specific best practices for using health information technology to foster the consistent provision of accessibility and reasonable policy accommodations in health care to individuals with disabilities in such areas2 7#g7 assess the feasibility and costs associated with the use of health information technology in such areas2 7#h7 evaluate whether the adoption and use of qualified electronic health records 7as defined in section #cjjj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj77 is effective in reducing health disparities1 including analysis of clinical quality measures reported by providers who are participating in the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 or a ,state plan under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq47 7or a waiver of such plan71 pursuant to programs to encourage the adoption and use of certified ,,ehr technology2 7#i7 identify providers in medically underserved areas that are not electing to adopt and use electronic health records and determine what barriers are preventing those providers from adopting and using such records2 and 7#aj7 examine urban and rural community health systems and determine the impact that health information technology may have on the capacity of primary health providers in those systems4 7c7 ,medically underserved area ,in this section1 the term medically underserved area means-- 7#a7 a population that has been designated as a medically underserved population under section #ccj7;b77#c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7b77#c772 7#b7 an area that has been designated as a health professional shortage area under section #ccb of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;e72 7#c7 an area or population that has been designated as a medically underserved community under section #gii;,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #biep72 or 7#d7 another area or population that-- 7,a7 experiences significant barriers to accessing quality health services2 and 7,b7 has a high prevalence of diseases or conditions described in title ,,vii1 with such diseases or conditions having a disproportionate impact on racial and ethnic minority groups 7as defined in section #agjg7;g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f7;g777 or a subgroup of people with disabilities who have specific functional impairments4 #hcjc4 ,assessment of use and misuse of de-identified health data 7a7 ,in general ,not later than #ah months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall-- 7#a7 enter into an agreement with the ,office of the ,national ,coordinator of ,health ,information ,technology to conduct a study1 in consultation with relevant stakeholders1 on the impact of digital health technology on medically underserved areas 7as defined in section #hcjb7;c772 and 7#b7 submit a report to ,congress describing the results of such study1 including any recommendations for legislative or administrative action4 7b7 ,study ,the study described in subsection 7a77#a7 shall-- 7#a7 examine the overall prevalence1 and historical and existing practices and their respective prevalence1 of use and misuse of de-identified protected health information to discriminate against or benefit medically underserved areas2 7#b7 identify best practices and tools to leverage the benefits and prevent misuse of de-identified protected health information to discriminate against medically underserved areas2 7#c7 examine the overall prevalence1 and historical and existing practices and their respective prevalence1 of use and misuse of de-identified personal health information other than protected health information to discriminate against or benefit medically underserved areas2 and 7#d7 identify best practices and tools to leverage the benefits and prevent misuse of de-identified personal health information other than protected health information to discriminate against medically underserved areas4 7c7 ,definition of protected health information ,in this section1 the term protected health information has the meaning given such term in section #afj4ajc1 title #de1 ,code of ,federal ,regulations 7or any successor regulations74 ,d ,closing ,gaps in ,funding ,to ,adopt ,certified ,e,h,rs #hdja4 ,extending ,medicaid ,,ehr incentive payments to rehabilitation facilities1 long-term care facilities1 and home health agencies 7a7 ,in general ,section #aijc7t77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7t77#b77;,b77 is amended-- 7#a7 in clause 7i71 by striking 1 or and inserting a semicolon2 7#b7 in clause 7ii71 by striking the period at the end and inserting a semicolon2 and 7#c7 by inserting after clause 7ii7 the following new clauses3 7iii7 a rehabilitation facility 7as defined in section #ahhf7;j77#a77 that furnishes acute or subacute rehabilitation services2 7iv7 a long-term care hospital described in section #ahhf7;d77#a77;,b77iv72 or 7v7 a home health agency 7as defined in section #ahfa7o774 4 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply with respect to amounts expended under section #aijc7;a77#c77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#c77;,f77 for calendar quarters beginning on or after the date of the enactment of this ,act4 #hdjb4 ,extending physician assistant eligibility for ,medicaid electronic health record incentive payments 7a7 ,in general ,section #aijc7t77#c77;,b77v7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7t77#c77;,b77v77 is amended to read as follows3 7v7 physician assistant4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply with respect to amounts expended under section #aijc7;a77#c77;,f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#c77;,f77 for calendar quarters beginning on or after the date of the enactment of this ,act4 ,e ,expanding ,access to ,telehealth ,services #heja4 ,removing geographic requirements for telehealth services ,section #ahcd7m77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c77 is amended-- 7#a7 in clause 7i71 in the matter preceding subclause 7,i71 by striking clause 7iii7 and inserting clauses 7iii7 and 7iv72 and 7#b7 by adding at the end the following new clause3 7iv7 ,removal of geographic requirements ,the geographic requirements described in clause 7i7 shall not apply with respect to telehealth services furnished on or after the first day after the end of the period for which clause 7iii7 applies4 4 #hejb4 ,expanding originating sites 7a7 ,expanding the home as an originating site ,section #ahcd7m77#d77;,c77ii77,x7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c77ii77,x77 is amended to read as follows3 7,x7 7aa7 ,prior to the date described in item 7bb71 the home of an individual but only for purposes of section #ahha7;b77#c77;,b7 or telehealth services described in paragraph 7#g7 or clause 7iii74 7bb7 ,on or after the first day after the end of the period for which clause 7iii7 applies1 the home of an individual4 4 7b7 ,allowing additional originating sites ,section #ahcd7m77#d77;,c77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c77ii77 is amended by adding at the end the following new subclause3 7,,xii7 ,any other site determined appropriate by the ,secretary at which an eligible telehealth individual is located at the time a telehealth service is furnished via a telecommunications system4 4 7c7 ,parameters for new originating sites ,section #ahcd7m77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c771 as amended by section #heja1 is amended by adding at the end the following new clause3 7v7 ,requirements for new sites 7,i7 ,in general ,the ,secretary may establish requirements for the furnishing of telehealth services at sites described in clause 7ii77,,xii7 to provide for beneficiary and program integrity protections4 7,,ii7 ,clarification ,nothing in this clause shall be construed to preclude the ,secretary from establishing requirements for other originating sites described in clause 7ii74 4 7d7 ,no originating site facility fee for new sites ,section #ahcd7m77#b77;,b77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#b77;,b77ii77 is amended-- 7#a7 in the heading1 by striking if originating site is the home and inserting for certain sites2 and 7#b7 by striking paragraph 7#d77;,c77ii77,x7 and inserting subclause 7,x7 or 7,,xii7 of paragraph 7#d77;,c74 ,,ix ,accountability and ,evaluation #ijja4 ,prohibition on discrimination in ,federal assisted health care services and research on the basis of sex 7including sexual orientation1 gender identity1 and pregnancy1 including termination of pregnancy71 race1 color1 national origin1 marital status1 familial status1 or disability status 7a7 ,in general ,no person in the ,united ,states shall1 on the basis of sex 7including sexual orientation1 gender identity1 and pregnancy1 including termination of pregnancy71 race1 color1 national origin1 marital status1 familial status1 sexual orientation1 gender identity1 or disability status1 be excluded from participation in1 be denied the benefits of1 or be subjected to discrimination under-- 7#a7 any health program or activity1 including any health research program or activity1 receiving ,federal financial assistance1 including credits1 subsidies1 or contracts of insurance2 or 7#b7 any health program or activity that is administered by an executive agency4 7b7 ,definition ,in this section1 the term familial status means1 with respect to one or more individuals-- 7#a7 being domiciled with any individual related by blood or affinity whose close association with the individual is the equivalent of a family relationship2 7#b7 being in the process of securing legal custody of any individual2 or 7#c7 being pregnant4 #ijjb4 ,treatment of ,medicare payments under title ,,vi of the ,civil ,rights ,act of #aifd ,for the purposes of title ,,vi of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;d et seq471 a payment made under part ,a1 ,b1 ,c1 or ,d of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 to a provider of services1 physician1 or other supplier 7including a payment made to a subcontractor of the provider of services1 physician1 or other supplier7 shall be deemed a grant1 not a contract of insurance or guaranty4 #ijjc4 ,accountability and transparency within the ,department of ,health and ,human ,services ,title ,,xxxiv of the ,public ,health ,service ,act1 as amended by titles ,i1 ,,ii1 ,,iii1 and ,,iv of this ,act1 is further amended by inserting after subtitle ,d the following3 ,e ,strengthening accountability #cdea4 ,elevation of the ,office for ,civil ,rights and ,health ,equity 7a7 ,in general 7#a7 ,name of ,office ,beginning on the date of enactment of this subtitle1 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 7#b7 ,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 7b7 ,purpose ,the ,director for ,civil ,rights and ,health ,equity shall ensure that the health programs1 activities1 policies1 projects1 procedures1 and operations of health entities that receive ,federal financial assistance are in compliance with title ,,vi of the ,civil ,rights ,act of #aifd 7#db ,u4,s4,c4 #bjjj;d et seq471 including through the following activities3 7#a7 ,the development and implementation of an action plan to address racial and ethnic health care disparities4 ,such plan shall-- 7,a7 address concerns relating to the ,office for ,civil ,rights and ,health ,equity as released by the ,united ,states ,commission on ,civil ,rights in the report entitled ,health ,care ,challenge3 ,acknowledging ,disparity1 ,confronting ,discrimination1 and ,ensuring ,equity 7,september #aiii71 in conjunction with existing and future reports of the ,national ,academy of ,medicine 7formerly known as the ,institute of ,medicine7 including the reports titled ,unequal ,treatment3 ,confronting ,racial and ,ethnic ,disparities in ,health ,care1 ,crossing the ,quality ,chasm3 ,a ,new ,health ,system for the #bast ,century1 ,in the ,nation's ,compelling ,interest3 ,ensuring ,diversity in the ,health ,care ,workforce1 ,the ,national ,partnership for ,action to ,end ,health ,disparities1 and ,the ,health of ,lesbian1 ,gay1 ,bisexual1 and ,transgender ,people1 and other related reports of the ,national ,academies of ,sciences1 ,engineering1 and ,medicine2 7,b7 be issued in proposed form for public review and comment2 and 7,c7 be finalized taking into consideration any comments or concerns that are received by the ,office4 7#b7 ,investigative and enforcement actions against intentional or in effect discrimination and policies and practices that have a disparate impact on racial and ethnic minority groups and communities of color pursuant to section #ijjg of the ,health ,equity and ,accountability ,act of #bjbd4 7#c7 ,the review of racial1 ethnic1 gender identity1 sexual orientation1 sex1 disability status1 socioeconomic status1 and primary language health data collected by ,federal health agencies to assess health care disparities related to intentional discrimination and policies and practices that have a disparate impact on minorities4 ,such review shall include an assessment of health disparities in communities with a combination of these classes4 7#d7 ,outreach and education activities relating to compliance with title ,,vi of the ,civil ,rights ,act of #aifd1 including the process of filing a complaint in accordance with section #ijjg of the ,health ,equity and ,accountability ,act of #bjbd4 7#e7 ,the provision of technical assistance for health entities to facilitate compliance with title ,,vi of the ,civil ,rights ,act of #aifd4 7#f7 ,coordination and oversight of activities of the civil rights compliance offices established under section #cdeb4 7#g7 ,ensuring-- 7,a7 at a minimum1 compliance with the most recent version of the ,office of ,management and ,budget statistical policy directive entitled ,standards for ,maintaining1 ,collecting1 and ,presenting ,federal ,data on ,race and ,ethnicity2 and 7,b7 consideration of available data and language standards such as-- 7i7 the standards for collecting1 monitoring1 and reporting data under section #caja2 and 7ii7 the ,national ,standards on ,culturally and ,linguistically ,appropriate ,services of the ,office of ,minority ,health4 7c7 ,funding and staff ,the ,secretary shall ensure the effectiveness of the ,office for ,civil ,rights and ,health ,equity by ensuring that the ,office is provided with-- 7#a7 adequate funding to enable the ,office to carry out its duties under this section2 and 7#b7 staff with expertise in-- 7,a7 epidemiology2 7,b7 statistics2 7,c7 health quality assurance2 7,d7 minority health and health disparities2 7,e7 health equity2 7,f7 cultural and linguistic competency2 7,g7 civil rights2 and 7,h7 social1 political1 mental1 behavioral1 economic1 and related determinants of health1 including education access and quality1 health care access and quality1 neighborhood and built environment1 and social and community context4 7d7 ,advisory board 7#a7 ,establishment ,the ,secretary1 in collaboration with the ,director ,civil ,rights and ,health ,equity and the ,deputy ,assistant ,secretary for ,minority ,health1 shall establish an advisory board 7in this subsection referred to as the advisory board7 to report in accordance with paragraph 7#b74 7#b7 ,reports to ,congress ,not later than ,december #ca1 #bjbe1 and annually thereafter1 the advisory board shall publish and submit to the ,office1 other ,federal agencies1 and the ,congress a report that includes-- 7,a7 the number of complaints filed in accordance with section #ijjg of the ,health ,equity and ,accountability ,act of #bjbd during the reporting period under title ,,vi of the ,civil ,rights ,act of #aifd1 broken down by category2 7,b7 the number of such complaints investigated and closed by the ,office2 7,c7 the outcomes of such complaints investigated2 7,d7 the staffing levels of the ,office1 including staff credentials2 7,e7 the number of such complaints that are pending 7including backlogged complaints7 in which civil rights inequities can be demonstrated and an explanation of why such complaints remain pending2 and 7,f7 trends among filed complaints and other systemic patterns or themes1 including an analysis from the ,department of ,justice about litigation concerning such complaints4 7#c7 ,composition ,the members of the advisory board shall include-- 7,a7 representatives of stakeholders2 and 7,b7 subject matter- and disciplinary-appropriate experts4 7e7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years #bjbe through #bjbi4 #cdeb4 ,establishment of health program offices for civil rights within agencies of ,department of ,health and ,human ,services 7a7 ,in general ,the ,secretary shall establish civil rights compliance offices in each agency within the ,department of ,health and ,human ,services that administers health programs4 7b7 ,purpose of offices ,each office established under subsection 7a7 shall ensure that recipients of ,federal financial assistance under ,federal health programs administer programs1 and determine and implement policies1 services1 and activities1 in a manner that-- 7#a7 does not discriminate1 either intentionally or in effect1 on the basis of race1 color1 national origin1 language1 ethnicity1 sex1 age1 disability status1 sexual orientation1 or gender identity2 and 7#b7 promotes the reduction and elimination of disparities in health and health care based on race1 color1 national origin1 language1 ethnicity1 sex1 age1 disability status1 sexual orientation1 or gender identity4 7c7 ,powers and duties ,the offices established in subsection 7a7 shall1 with respect to the applicable agency1 have the following powers and duties3 7#a7 ,the establishment of compliance and program participation standards for recipients of ,federal financial assistance under each program administered by the agency1 including the establishment of disparity reduction standards to encompass disparities in health and health care related to race1 color1 national origin1 language1 ethnicity1 sex1 age1 disability1 sexual orientation1 or gender identity4 7#b7 ,the development and implementation of policies1 procedures1 and program-specific guidelines that interpret and apply ,department of ,health and ,human ,services guidance under title ,,vi of the ,civil ,rights ,act of #aifd and section #aeeg of the ,patient ,protection and ,affordable ,care ,act to each ,federal health program administered by the agency4 7#c7 ,the development of a disparity-reduction impact analysis methodology that shall-- 7,a7 be applied to every rule issued by the agency and published as part of the formal rulemaking process under sections #eee1 #eef1 and #eeg of title #e1 ,united ,states ,code2 and 7,b7 include an analysis of the intersecting forms of discrimination4 7#d7 ,oversight of data collection1 reporting1 analysis1 and publication requirements for all recipients of ,federal financial assistance under each ,federal health program administered by the agency1 compliance with1 at a minimum1 the most recent version of the ,office of ,management and ,budget statistical policy directive entitled ,standards for ,maintaining1 ,collecting1 and ,presenting ,federal ,data on ,race and ,ethnicity1 and consideration of available data and language standards such as-- 7,a7 the standards for collecting and reporting data under section #caja2 7,b7 the ,national ,standards on ,culturally and ,linguistically ,appropriate ,services of the ,office of ,minority ,health2 and 7,c7 the disaggregation of all health and health care data by racial and ethnic minority group4 7#e7 ,the conduct of publicly available studies regarding discrimination within ,federal health programs administered by the agency as well as disparity reduction initiatives by recipients of ,federal financial assistance under ,federal health programs4 7#f7 ,annual reports to the ,committee on ,health1 ,education1 ,labor1 and ,pensions and the ,committee on ,finance of the ,senate and the ,committee on ,energy and ,commerce and the ,committee on ,ways and ,means of the ,house of ,representatives on the progress in reducing disparities in health and health care through the ,federal programs administered by the agency4 7d7 ,relationship to ,office for ,civil ,rights in the ,department of ,justice 7#a7 ,department of ,health and ,human ,services ,the ,office for ,civil ,rights of the ,department of ,health and ,human ,services shall provide standard-setting and compliance review investigation support services to each civil rights compliance office established under subsection 7a71 subject to paragraph 7#b74 7#b7 ,department of ,justice ,the ,office for ,civil ,rights of the ,department of ,justice may1 as appropriate1 institute formal proceedings when a civil rights compliance office established under subsection 7a7 determines that a recipient of ,federal financial assistance is not in compliance with the disparity reduction standards of the applicable agency4 7e7 ,definition ,in this section1 the term ,federal health programs mean programs-- 7#a7 under the ,social ,security ,act 7#db ,u4,s4,c4 #cja et seq47 that pay for health care and services2 and 7#b7 under this ,act that-- 7,a7 provide ,federal financial assistance for health care1 biomedical research1 or health services research2 or 7,b7 are designed to improve the public's health1 including health service programs4 4 #ijjd4 ,united ,states ,commission on ,civil ,rights 7a7 ,coordination within ,department of ,justice of activities regarding ,health disparities ,section #c7;a7 of the ,civil ,rights ,commission ,act of #aihc 7#db ,u4,s4,c4 #aige;a7a77 is amended-- 7#a7 in paragraph 7#a71 by striking and at the end2 7#b7 in paragraph 7#b71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following3 7#c7 shall1 with respect to activities carried out in health care and correctional facilities1 toward the goal of eliminating health disparities between the general population and members of minority groups based on race or color1 promote coordination of such activities of-- 7,a7 the ,office of ,justice ,programs of the ,department of ,justice1 including the ,office for ,civil ,rights within that ,office2 7,b7 the ,office for ,civil ,rights within the ,department of ,health and ,human ,services2 and 7,c7 the ,office of ,minority ,health within the ,department of ,health and ,human ,services4 4 7b7 ,authorization of appropriations ,section #e of the ,civil ,rights ,commission ,act of #aihc 7#db ,u4,s4,c4 #aige;c7 is amended by striking the first sentence and inserting the following3 ,for the purpose of carrying out this ,act1 there are authorized to be appropriated #cj1jjj1jjj for fiscal year #bjbe1 and such sums as may be necessary for each of the fiscal years #bjbf through #bjcj44 #ijje4 ,sense of ,congress concerning full funding of activities to eliminate racial and ethnic health disparities ,it is the sense of the ,congress that-- 7#a7 health disparities negatively impact outcomes for health and human security of the ,nation2 7#b7 reducing racial1 ethnic1 age1 sexual1 and gender disparities in prevention and treatment are unique civil and human rights challenges and1 as such1 ,federal agencies and health care entities and systems receiving ,federal funds should be accountable for their role in causing disparities and inequity2 7#c7 funding for the ,national ,institute on ,minority ,health and ,health ,disparities1 the ,office of ,civil ,rights in the ,department of ,health and ,human ,services1 the ,national ,institute of ,nursing ,research1 and the ,office of ,minority ,health should be doubled by fiscal year #bjbe1 to effectively address racial and ethnic disparities elimination in health and health care as a matter of health and national security2 7#d7 adequate funding by fiscal year #bjbe1 and subsequent funding increases1 should be provided for health and human service professions training programs1 the ,racial and ,ethnic ,approaches to ,community ,health ,initiative at the ,centers for ,disease ,control and ,prevention1 the ,minority ,,hiv_/,,aids ,initiative1 the ,excellence ,centers to ,eliminate ,ethnic_/,racial ,disparities ,program at the ,agency for ,healthcare ,research and ,quality1 and the ,national ,health ,service ,corps ,scholarship ,program initiatives1 programs1 policies1 projects1 and activities that are the backbone of the ,nation's agenda to eliminate racial and ethnic health disparities and inequities2 7#e7 adequate funding for fiscal year #bjbe and increased funding for future years should be provided for the ,racial and ,ethnic ,approaches to ,community ,health ,initiative's ,united ,states ,risk ,factor ,survey to ensure adequate data collection to track health disparities1 and there should be appropriate avenues provided to disseminate findings to the general public2 7#f7 current and newly created health disparity elimination incentives1 programs1 agencies1 and departments under this ,act 7and the amendments made by this ,act7 should receive adequate staffing and funding by fiscal year #bjbe2 and 7#g7 stewardship and accountability should be provided to the ,congress and the ,president for measurable and sustainable progress toward health disparity elimination under programs under this ,act1 including increased data collection and reporting1 capacity building for impacted communities1 technical assistance1 training programs1 and avenues to disseminate program details and successes to the public and to policymakers4 #ijjf4 ,,gao and ,,nih reports 7a7 ,,gao report on ,,nih grant racial and ethnic diversity 7#a7 ,in general ,the ,comptroller ,general of the ,united ,states shall conduct a study on the racial and ethnic diversity among the following groups3 7,a7 ,all applicants for grants1 contracts1 and cooperative agreements awarded by the ,national ,institutes of ,health during the period beginning on ,january #a1 #bjbe1 and ending ,december #ca1 #bjcd4 7,b7 ,all recipients of such grants1 contracts1 and cooperative agreements during such period4 7,c7 ,all members of the peer review panels of such applicants and recipients1 respectively4 7#b7 ,report ,not later than #f months after the date of enactment of this ,act1 the ,comptroller ,general shall complete the study under paragraph 7#a7 and submit to ,congress a report containing the results of such study4 7b7 ,,nih report on certain authority of ,national ,institute on ,minority ,health and ,health ,disparities ,not later than #f months after the date of enactment of this ,act1 and biennially thereafter1 the ,director of the ,national ,institutes of ,health1 in collaboration with the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities1 shall submit to ,congress a report that details and evaluates-- 7#a7 the steps taken during the applicable report period by the ,director of the ,national ,institutes of ,health to plan1 coordinate1 review1 and evaluate all minority health and health disparity research that is conducted or supported by the institutes and centers at the ,national ,institutes of ,health2 and 7#b7 the outcomes of such steps4 7c7 ,,gao report related to recipients of ,,ppaca funding ,not later than one year after the date of enactment of this ,act and biennially thereafter1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report that identifies-- 7#a7 the racial and ethnic diversity of community-based organizations that applied for ,federal enrollment funding provided pursuant to the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 7including the amendments made by such ,act72 7#b7 the percentage of such organizations that were awarded such funding2 and 7#c7 the impact of such community-based organizations' enrollment efforts on the insurance status of their communities4 7d7 ,annual report on activities of ,national ,institute on ,minority ,health and ,health ,disparities ,the ,director of the ,national ,institute on ,minority ,health and ,health ,disparities shall prepare an annual report on the activities carried out or to be carried out by such institute1 and shall submit each such report to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate1 the ,committee on ,energy and ,commerce of the ,house of ,representatives1 the ,secretary of ,health and ,human ,services1 and the ,director of the ,national ,institutes of ,health4 ,with respect to the fiscal year involved1 the report shall-- 7#a7 describe and evaluate the progress made in health disparities research conducted or supported by institutes and centers of the ,national ,institutes of ,health2 7#b7 summarize and analyze expenditures made for activities with respect to health disparities research conducted or supported by the ,national ,institutes of ,health2 7#c7 include a separate statement applying the requirements of paragraphs 7#a7 and 7#b7 specifically to minority health disparities research2 and 7#d7 contain such recommendations as the ,director of the ,institute considers appropriate4 #ijjg4 ,investigative and enforcement actions 7a7 ,in general ,in carrying out the investigative and enforcement actions of section #cdea7;b77#b7 of the ,public ,health ,service ,act1 as added by section #ijjc of this ,act1 the ,director for ,civil ,rights and ,health ,equity 7referred to in this section as the ,director7 shall pursue such investigative and enforcement actions pursuant to 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 outcomes4 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 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 ,publicly available agreement 7i7 ,in general ,subject to clause 7ii71 the ,secretary shall make available to the public 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 public 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 #ijjh4 ,federal ,health ,equity ,commission 7a7 ,establishment of ,commission 7#a7 ,in general ,there is established the ,federal ,health ,equity ,commission 7hereinafter in 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 listed 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 ,four members of the ,commission shall be appointed by the ,president4 7ii7 ,two 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 ,two 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 appointed under paragraph 7#b77;,b7 of the ,commission 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 #ad of the ,federal ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 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 ,x ,addressing ,social ,determinants and ,improving ,environmental ,justice ,a ,in ,general #ajjja4 ,definitions ,in this title3 7#a7 ,administrator ,the term ,administrator means the ,administrator of the ,environmental ,protection ,agency4 7#b7 ,agency ,the term ,agency means the ,environmental ,protection ,agency4 7#c7 ,built environment ,the term built environment means the components of the environment1 and the location of those components in a geographically defined space1 that are created or modified by individuals to form the physical and social characteristics of a community or enhance quality of human life1 including-- 7,a7 homes1 schools1 and places of work and worship2 7,b7 parks1 recreation areas1 and greenways2 7,c7 transportation systems2 7,d7 business1 industry1 and agriculture2 and 7,e7 land-use plans1 projects1 and policies that impact the physical or social characteristics of a community1 including access to services and amenities4 7#d7 ,determinants of health ,the term determinants of health-- 7,a7 means the range of nonclinical factors inclusive of personal1 social1 economic1 and environmental factors that directly influence health status2 and 7,b7 includes social determinants of health4 7#e7 ,economic determinants of health ,the term economic determinants of health means income and social status4 7#f7 ,environmental determinants of health ,the term environmental determinants of health means the broad physical 7including manmade and natural71 psychological1 social1 spiritual1 cultural1 and aesthetic environment4 7#g7 ,personal determinants of health ,the term personal determinants of health means an individual's behavior1 biology1 and genetics4 7#h7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#i7 ,social determinants of health ,the term social determinants of health-- 7,a7 means a subset of determinants of the health of individuals and environments 7such as communities1 neighborhoods1 and societies7 that describe an individual's or group of people's social identity1 describe the social and economic resources to which such individual or group has access1 and describe the conditions in which an individual or group of people works1 lives1 and plays2 and 7,b7 are sometimes referred to as social and economic determinants of health1 socioeconomic determinants of health1 environmental determinants of health1 social drivers of inequality1 or personal determinants of health4 #ajjjb4 ,health impact assessments ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq471 as amended by section #gija;,c-#a7;a71 is further amended by adding at the end the following3 #cii,v-#ae4 ,health impact assessments 7a7 ,definitions ,in this section3 7#a7 ,administrator ,the term ,administrator means the ,administrator of the ,environmental ,protection ,agency4 7#b7 ,director ,the term ,director means the ,director of the ,centers for ,disease ,control and ,prevention4 7#c7 ,health impact assessment ,the term health impact assessment means a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy1 plan1 program1 or project on the health of a population and the distribution of those effects within the population4 ,such term includes identifying and recommending appropriate actions on monitoring and maximizing potential benefits and minimizing potential harms4 7#d7 ,health inequity ,the term health inequity means a particular type of health difference that is closely linked with social1 economic1 or environmental disadvantage and that adversely affects groups of people who have systematically experienced greater obstacles to health based on their-- 7,a7 racial or ethnic group2 7,b7 religion2 7,c7 socioeconomic status2 7,d7 gender2 7,e7 age2 7,f7 mental health2 7,g7 cognitive1 sensory1 or physical disability2 7,h7 sexual orientation or gender identity2 7,i7 geographic location2 7,j7 citizenship status2 or 7,k7 other characteristics historically linked to discrimination or exclusion4 7b7 ,establishment ,the ,secretary1 acting through the ,director and in collaboration with the ,administrator1 shall-- 7#a7 in consultation with the ,director of the ,national ,center for ,chronic ,disease ,prevention and ,health ,promotion and the heads of relevant offices within the ,department of ,housing and ,urban ,development1 the ,department of ,transportation1 and the ,department of ,agriculture1 establish a program at the ,national ,center for ,environmental ,health of the ,centers for ,disease ,control and ,prevention focused on advancing the field of health impact assessment that includes-- 7,a7 collecting and disseminating best practices2 7,b7 administering capacity building grants to ,states1 ,indian ,tribes1 and ,tribal organizations to support subgrantees in initiating health impact assessments1 in accordance with subsection 7d72 7,c7 providing technical assistance2 7,d7 developing training tools and providing training on conducting a health impact assessment and the implementation of built environment and health indicators2 7,e7 making information available1 as appropriate1 regarding the existence of other community healthy living tools1 checklists1 and indices that help connect public health to other sectors1 and tools to help examine the effect of the indoor built environment and building codes on population health2 7,f7 conducting research and evaluations of health impact assessments2 and 7,g7 awarding competitive extramural research grants2 7#b7 develop guidance and guidelines to conduct health impact assessments in accordance with subsection 7c72 and 7#c7 establish a grant program to allow ,states1 ,indian ,tribes1 and ,tribal organizations to award subgrants to eligible entities to conduct health impact assessments4 7c7 ,guidance 7#a7 ,in general ,not later than #a year after the date of enactment of the ,health ,equity and ,accountability ,act of #bjbd1 the ,secretary1 acting through the ,director1 shall issue final guidance for conducting health impact assessments4 ,in developing such guidance1 the ,secretary shall-- 7,a7 consult with the ,director of the ,national ,center for ,environmental ,health1 the ,director of the ,national ,center for ,chronic ,disease ,prevention and ,health ,promotion1 and the heads of relevant offices within the ,department of ,housing and ,urban ,development1 the ,department of ,transportation1 and the ,department of ,agriculture2 and 7,b7 consider available international health impact assessment guidance1 ,north ,american health impact assessment practice standards1 and recommendations from the ,national ,academy of ,sciences4 7#b7 ,content ,the guidance under this subsection shall include-- 7,a7 background on national and international efforts to bridge urban planning1 climate forecasting1 and public health institutions and disciplines1 including a review of health impact assessment best practices internationally2 7,b7 evidence-based direct and indirect pathways that link land-use planning1 transportation1 and housing policy and objectives to human health outcomes2 7,c7 data resources and quantitative and qualitative forecasting methods to evaluate both the status of health determinants and health effects1 including identification of existing programs that can disseminate these resources2 7,d7 best practices for inclusive public involvement in conducting health impact assessments2 and 7,e7 technical assistance for other agencies seeking to develop their own guidelines and procedures for health impact assessment4 7d7 ,grant program 7#a7 ,in general ,the ,secretary1 acting through the ,director and in collaboration with the ,administrator1 shall-- 7,a7 award grants to ,states1 ,indian ,tribes1 and ,tribal organizations to award subgrants to eligible entities for capacity building or to prepare health impact assessments2 and 7,b7 ensure that ,states1 ,indian ,tribes1 and ,tribal organizations receiving a grant under this subsection further support training and technical assistance for subgrantees under subparagraph 7,a7 by funding and overseeing appropriate experts on health impact assessments from local1 ,state1 and ,tribal governments1 the ,federal ,government1 institutions of higher education1 and nonprofit organizations to provide such training and technical assistance4 7#b7 ,applications for subgrants 7,a7 ,in general ,to be eligible to receive a subgrant under this subsection1 an eligible entity shall-- 7i7 be a community-based organization serving individuals or populations1 the health of which are1 or will be1 affected by an activity or a proposed activity2 and 7ii7 submit to the grantee an application in accordance with this subsection1 at such time1 in such manner1 and containing such additional information as the ,secretary 7acting through the ,director and in collaboration with the ,administrator7 and the grantee may require4 7,b7 ,inclusion ,an application for a subgrant under this subsection shall include-- 7i7 a list of proposed activities that require or would benefit from conducting a health impact assessment by not later than #ahj days after receiving the subgrant2 7ii7 supporting documentation1 including letters of support1 from potential conductors of health impact assessments for the listed proposed activities2 7iii7 an assessment by the applicant of the health of the population to be served through the subgrant2 and 7iv7 a description of potential adverse or positive effects on health that the proposed activities may create4 7,c7 ,preference ,in awarding subgrants under this subsection1 a ,state may give preference to eligible entities that demonstrate the potential to significantly improve population health or lower health care costs as a result of potential health impact assessment work4 7#c7 ,use of funds 7,a7 ,in general ,a ,state1 ,indian ,tribe1 or ,tribal organization receiving a grant under this subsection shall use such grant to conduct health impact assessment capacity building in support of a subgrantee conducting a health impact assessment for a proposed activity in accordance with this subsection4 7,b7 ,purposes ,the purposes of a health impact assessment under this subsection are-- 7i7 to facilitate the involvement of ,tribal1 ,state1 and local public health officials in community planning1 transportation1 housing1 and land use decisions and other decisions affecting the built environment to identify any potential health concern or health benefit relating to an activity or proposed activity2 7ii7 to provide for an investigation of any health-related issue of concern raised in a planning process1 an environmental impact assessment process1 or policy appraisal relating to a proposed activity2 7iii7 to describe and compare alternatives 7including no-action alternatives7 to a proposed activity to provide clarification with respect to the potential health outcomes associated with the proposed activity and1 where appropriate1 to the related benefit-cost or cost-effectiveness of the proposed activity and alternatives2 7iv7 to contribute1 when applicable1 to the findings of a planning process1 policy appraisal1 or an environmental impact statement with respect to the terms and conditions of implementing a proposed activity or related mitigation recommendations1 as necessary2 7v7 to ensure that the disproportionate distribution of negative impacts among vulnerable populations is minimized as much as possible2 7vi7 to engage affected community members and ensure adequate opportunity for public comment on all stages of the health impact assessment2 7vii7 where appropriate1 to consult with local and county health departments and appropriate organizations1 including planning1 transportation1 and housing organizations1 and provide them information and tools regarding how to conduct and integrate health impact assessment into their work2 and 7viii7 to inspect homes1 water systems1 and other elements that pose risks to lead exposure1 with an emphasis on areas that pose a higher risk to children4 7#d7 ,assessments ,health impact assessments carried out using funds under this section shall-- 7,a7 take appropriate health factors into consideration as early as practicable during the planning1 review1 or decision-making processes2 7,b7 assess the effect on the health of individuals and populations of proposed policies1 projects1 or plans that result in modifications to the built environment2 and 7,c7 assess the distribution of health effects across various factors1 such as race1 income1 ethnicity1 age1 disability status1 gender1 and geography4 7#e7 ,eligible activities 7,a7 ,in general ,a ,state1 ,indian ,tribe1 or ,tribal organization receiving a grant under this section shall conduct an evaluation of any activity proposed to be funded through the grant1 including through a subgrant1 to determine whether such activity will have a significant adverse or positive effect on the health of the affected population to be served1 based on the criteria described in subparagraph 7,b74 7,b7 ,criteria ,the criteria described in this subparagraph include1 as applicable to the proposed activity1 the following3 7i7 ,any substantial adverse effect or significant health benefit on health outcomes or factors known to influence health1 including the following3 7,i7 ,physical activity4 7,,ii7 ,injury4 7,,iii7 ,mental health4 7,,iv7 ,accessibility to health-promoting goods and services4 7,v7 ,respiratory health4 7,,vi7 ,chronic disease4 7,,vii7 ,nutrition4 7,,viii7 ,land use changes that promote local1 sustainable food sources4 7,,ix7 ,infectious disease4 7,x7 ,health inequities4 7,,xi7 ,existing air quality1 ground or surface water quality or quantity1 or noise levels4 7,,xii7 ,lead exposure4 7,,xiii7 ,drinking water quality and accessibility4 7ii7 ,other factors that may be considered1 including-- 7,i7 the potential for a proposed activity to result in systems failure that leads to a public health emergency2 7,,ii7 the probability that the proposed activity will result in a significant increase in tourism1 economic development1 or employment in the population to be served2 7,,iii7 any other significant potential hazard or enhancement to human health1 as determined by the grantee2 or 7,,iv7 whether the evaluation of a proposed activity would duplicate another analysis or study being undertaken in conjunction with the proposed activity4 7,c7 ,factors for consideration ,in evaluating a proposed activity under subparagraph 7,a71 a grantee may take into consideration any reasonable1 direct1 indirect1 or cumulative effect that can be clearly related to potential health effects and that is related to the proposed activity1 including the effect of any action that is-- 7i7 included in the long-range plan relating to the proposed activity2 7ii7 likely to be carried out in coordination with the proposed activity2 7iii7 dependent on the occurrence of the proposed activity2 or 7iv7 likely to have a disproportionate impact on high-risk or vulnerable populations4 7#f7 ,requirements ,a health impact assessment prepared with funds awarded under this subsection shall incorporate the following1 after conducting the screening phase 7identifying projects or policies for which a health impact assessment would be valuable and feasible7 through the application process3 7,a7 ,scoping ,identifying which health effects to consider and the research methods to be utilized4 7,b7 ,assessing risks and benefits ,assessing the baseline health status and factors known to influence the health status in the affected community1 which may include aggregating and synthesizing existing health assessment evidence and data from the community4 7,c7 ,developing recommendations ,suggesting changes to proposals to promote positive or mitigate adverse health effects4 7,d7 ,reporting ,synthesizing the assessment and recommendations and communicating the results to decision makers4 7,e7 ,monitoring and evaluating ,tracking the decision and implementation effect on health determinants and health status4 7#g7 ,plan ,a subgrantee under this subsection shall develop and implement a plan1 to be approved by the ,secretary 7acting through the ,director and in collaboration with the ,administrator7 and the grantee1 for meaningful and inclusive stakeholder involvement in all phases of the health impact assessment4 ,stakeholders may include community leaders1 community-based organizations1 youth-serving organizations1 planners1 public health experts1 ,state and local public health departments and officials1 health care experts or officials1 housing experts or officials1 and transportation experts or officials4 7#h7 ,submission of findings ,a grantee under this subsection shall submit the findings of any funded health impact assessment activities to the ,secretary and make these findings publicly available4 7#i7 ,assessment of impacts ,a subgrantee under this subsection shall ensure the assessment of the distribution of health impacts 7related to the proposed activity7 across race1 ethnicity1 income1 age1 gender1 disability status1 and geography4 7#aj7 ,conduct of assessment ,to the greatest extent feasible1 a health impact assessment shall be conducted under this section in a manner that respects the needs and timing of the decision-making process such assessment evaluates4 7#aa7 ,methodology ,in preparing a health impact assessment funded under this subsection1 a subgrantee under this subsection shall follow the guidance published under subsection 7c74 7e7 ,health impact assessment database ,the ,secretary1 acting through the ,director and in collaboration with the ,administrator1 shall establish1 maintain1 and make publicly available a health impact assessment database1 including-- 7#a7 a catalog of health impact assessments received under this section2 7#b7 an inventory of tools used by subgrantees to conduct health impact assessments2 and 7#c7 guidance for subgrantees with respect to the selection of appropriate tools described in paragraph 7#b74 7f7 ,evaluation of grantee activities ,the ,secretary shall award competitive grants to ,prevention ,research ,centers1 or nonprofit organizations or academic institutions with expertise in health impact assessments1 to-- 7#a7 assist grantees and subgrantees with the provision of training and technical assistance in the conducting of health impact assessments2 7#b7 evaluate the activities carried out with grants and subgrants under subsection 7d72 and 7#c7 assist the ,secretary in disseminating evidence1 best practices1 and lessons learned from grantees and subgrantees4 7g7 ,report to ,congress ,not later than #a year after the date of enactment of the ,health ,equity and ,accountability ,act of #bjbd1 the ,secretary shall submit to ,congress a report concerning the evaluation of the programs under this section1 including recommendations as to how lessons learned from such programs can be incorporated into future guidance documents developed and provided by the ,secretary and other ,federal agencies1 as appropriate4 7h7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section such sums as may be necessary4 #cii,v-#af4 ,implementation of research findings to improve health outcomes through the built environment 7a7 ,research grant program ,the ,secretary1 in collaboration with the ,administrator of the ,environmental ,protection ,agency 7referred to in this section as the ,administrator71 shall award grants to public agencies or private nonprofit institutions to implement evidence-based programming to improve human health through improvements to the built environment and subsequently human health1 by addressing-- 7#a7 levels of physical activity2 7#b7 consumption of nutritional foods2 7#c7 rates of crime2 7#d7 air1 water1 and soil quality2 7#e7 risk or rate of injury2 7#f7 accessibility to health-promoting goods and services2 7#g7 chronic disease rates2 7#h7 community design2 7#i7 housing2 7#aj7 transportation options2 and 7#aa7 other factors as the ,secretary determines appropriate4 7b7 ,applications ,a public agency or private nonprofit institution desiring a grant under this section shall submit to the ,secretary an application at such time1 in such manner1 and containing such agreements1 assurances1 and information as the ,secretary1 in consultation with the ,administrator1 may require4 7c7 ,research ,the ,secretary1 in consultation with the ,administrator1 shall support1 through grants awarded under this section1 research that-- 7#a7 uses evidence-based research to improve the built environment and human health2 7#b7 examines-- 7,a7 the scope and intensity of the impacts that the built environment 7including the various characteristics of the built environment7 has on human health2 or 7,b7 the distribution of such impacts by-- 7i7 location2 and 7ii7 population subgroup2 7#c7 is used to develop-- 7,a7 measures and indicators to address health impacts and the connection of health to the built environment2 7,b7 efforts to link the measures to transportation1 land use1 and health databases2 and 7,c7 efforts to enhance the collection of built environment surveillance data2 7#d7 distinguishes carefully between personal attitudes and choices and external influences on behavior to determine how much the association between the built environment and the health of residents1 versus the lifestyle preferences of the people that choose to live in the neighborhood1 reflects the physical characteristics of the neighborhood2 and 7#e7 7,a7 identifies or develops effective intervention strategies focusing on enhancements to the built environment that promote increased use1 physical activity1 access to nutritious foods1 or other health-promoting activities by residents2 and 7,b7 in developing the intervention strategies under subparagraph 7,a71 ensures that the intervention strategies will reach out to high-risk or vulnerable populations1 including low-income urban and rural communities and aging populations1 in addition to the general population4 7d7 ,surveys ,the ,secretary may allow recipients of grants under this section to use such grant funds to support the expansion of national surveys and data tracking systems to provide more detailed information about the connection between the built environment and health4 7e7 ,priority ,in awarding grants under this section1 the ,secretary and the ,administrator shall give priority to entities with programming that incorporates-- 7#a7 interdisciplinary approaches2 or 7#b7 the expertise of the public health1 physical activity1 urban planning1 land use1 and transportation research communities in the ,united ,states and abroad4 7f7 ,authorization of appropriations ,there are authorized to be appropriated such sums as may be necessary to carry out this section4 ,the ,secretary may allocate not more than #bj percent of the amount so appropriated for a fiscal year for purposes of conducting research under subsection 7c74 4 #ajjjc4 ,grant program to conduct environmental health improvement activities and to improve social determinants of health 7a7 ,definitions ,in this section3 7#a7 ,director ,the term ,director means the ,director of the ,centers for ,disease ,control and ,prevention1 acting in collaboration with the ,administrator and the ,director of the ,national ,institute of ,environmental ,health ,sciences4 7#b7 ,eligible entity ,the term eligible entity means a ,state1 ,indian ,tribe1 ,tribal organization1 or local community that-- 7,a7 bears a disproportionate burden of exposure to environmental health hazards2 7,b7 bears a disproportionate burden of exposure to unhealthy living conditions1 low standard housing conditions1 low socioeconomic status1 poor nutrition1 less opportunity for educational attainment1 disproportionately high unemployment rates1 or lower literacy levels and access to information2 7,c7 has established a coalition-- 7i7 with not less than #a community-based organization or demonstration program2 and 7ii7 with not less than #a-- 7,i7 public health entity2 7,,ii7 health care provider organization2 7,,iii7 academic institution1 including any minority-serving institution described in section #cga7;a7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajfgq7a772 7,,iv7 child-serving institution2 or 7,v7 landlord or housing provider working on lead remediation2 7,d7 ensures planned activities and funding streams are coordinated to improve community health2 and 7,e7 submits an application in accordance with subsection 7c74 7b7 ,establishment ,the ,director shall establish a grant program under which eligible entities shall receive grants to conduct environmental health improvement activities and to improve social determinants of health4 7c7 ,application ,to receive a grant under this section1 an eligible entity shall submit an application to the ,director at such time1 in such manner1 and accompanied by such information as the ,director may require4 7d7 ,use of grant funds ,an eligible entity may use a grant under this section-- 7#a7 to promote environmental health2 7#b7 to address environmental health inequities among all populations1 including children2 and 7#c7 to address racial and ethnic inequities in social determinants of health4 7e7 ,amount of grants ,the ,director shall award grants to eligible entities at the following #c funding levels3 7#a7 ,level #a grants 7,a7 ,in general ,an eligible entity awarded a grant under this paragraph shall use the funds to identify environmental health problems and solutions by-- 7i7 establishing a planning and prioritizing council in accordance with subparagraph 7,b72 and 7ii7 conducting an environmental health assessment in accordance with subparagraph 7,c74 7,b7 ,planning and prioritizing council 7i7 ,in general ,a planning and prioritizing council established under subparagraph 7,a77i7 7referred to in this paragraph as a ,,ppc7 shall assist the environmental health assessment process and environmental health promotion activities of the eligible entity4 7ii7 ,membership ,membership of a ,,ppc shall consist of representatives from various organizations within public health1 planning1 development1 and environmental services and shall include stakeholders from vulnerable groups such as children1 the elderly1 disabled1 and minority ethnic groups that are often not actively involved in democratic or decision-making processes4 7iii7 ,duties ,a ,,ppc shall-- 7,i7 identify key stakeholders and engage and coordinate potential partners in the planning process2 7,,ii7 establish a formal advisory group to plan for the establishment of services2 7,,iii7 conduct an in-depth review of the nature and extent of the need for an environmental health assessment1 including a local epidemiological profile1 an evaluation of the service provider capacity of the community1 and a profile of any target populations2 and 7,,iv7 define the components of care and form essential programmatic linkages with related providers in the community4 7,c7 ,environmental health assessment 7i7 ,in general ,a ,,ppc shall carry out an environmental health assessment to identify environmental health concerns4 7ii7 ,assessment process ,the ,,ppc shall-- 7,i7 define the goals of the assessment2 7,,ii7 generate the environmental health issue list2 7,,iii7 analyze issues with a systems framework2 7,,iv7 develop appropriate community environmental health indicators2 7,v7 rank the environmental health issues2 7,,vi7 set priorities for action2 7,,vii7 develop an action plan2 7,,viii7 implement the plan2 and 7,,ix7 evaluate progress and planning for the future4 7,d7 ,evaluation ,each eligible entity that receives a grant under this paragraph shall evaluate1 report1 and disseminate program findings and outcomes4 7,e7 ,technical assistance ,the ,director may provide such technical and other non-financial assistance to eligible entities as the ,director determines to be necessary4 7#b7 ,level #b grants 7,a7 ,eligibility 7i7 ,in general ,the ,director shall award grants under this paragraph to eligible entities that have already-- 7,i7 established broad-based collaborative partnerships2 and 7,,ii7 completed environmental assessments4 7ii7 ,no level #a requirement ,to be eligible to receive a grant under this paragraph1 an eligible entity is not required to have successfully completed a ,level #a grant 7as described in paragraph 7#a774 7,b7 ,use of grant funds ,an eligible entity awarded a grant under this paragraph shall use the funds to further activities to carry out environmental health improvement activities1 including-- 7i7 addressing community environmental health priorities in accordance with paragraph 7#a77;,c77ii71 including-- 7,i7 geography2 7,,ii7 the built environment2 7,,iii7 air quality2 7,,iv7 water quality2 7,v7 land use2 7,,vi7 solid waste2 7,,vii7 housing2 7,,viii7 violence2 7,,ix7 socioeconomic status2 7,x7 ethnicity1 social construct1 and language preference2 7,,xi7 educational attainment2 7,,xii7 employment2 7,,xiii7 food safety1 accessibility1 and affordability2 7,,xiv7 nutrition2 7,,xv7 health care services2 and 7,,xvi7 injuries2 7ii7 building partnerships between planning1 public health1 and other sectors1 including child-serving institutions1 to address how the built environment impacts food availability and access and physical activity to promote healthy behaviors and lifestyles and reduce overweight and obesity1 musculoskeletal diseases1 respiratory conditions1 infectious diseases1 dental1 oral1 and mental health conditions1 poverty1 and related co-morbidities2 7iii7 establishing programs to address-- 7,i7 how environmental and social conditions of work and living choices influence physical activity and dietary intake2 or 7,,ii7 how the conditions described in subclause 7,i7 influence the concerns and needs of people who have impaired mobility and use assistance devices1 including wheelchairs1 lower limb prostheses1 and hip1 knee1 and other joint replacements2 and 7iv7 convening intervention and demonstration programs that examine the role of the social environment in connection with the physical and chemical environment in-- 7,i7 determining access to nutritional food2 7,,ii7 improving physical activity to reduce overweight1 obesity1 and co-morbidities and increase quality of life2 and 7,,iii7 location and access to medical facilities4 7#c7 ,level #c grants 7,a7 ,in general ,an eligible entity awarded a grant under this paragraph shall use the funds to identify and address racial and ethnic inequities in social determinants of health by creating demonstration programs that assess the feasibility of establishing a federally funded comprehensive program and describe key outcomes that address racial and ethnic inequities in social determinants of health4 7,b7 ,program ,design 7i7 ,evaluation ,not later than #a year after the date of enactment of this ,act1 the ,director shall evaluate the best practices of existing programs from the private1 public1 community-based1 and academically supported initiatives focused on reducing inequities in the social determinants of health for racial and ethnic populations4 7ii7 ,demonstration projects ,not later than #b years after the date of enactment of this ,act1 the ,director shall implement at least #ab demonstration projects1 including at least one project for each major racial and ethnic minority group1 each of which is unique to the cultural and linguistic needs of each of the following groups3 7,i7 ,native ,americans and ,alaska ,natives4 7,,ii7 ,asian ,americans4 7,,iii7 ,african ,americans_/,blacks4 7,,iv7 ,hispanic_/,latino-,americans4 7,v7 ,native ,hawaiians and ,pacific ,islanders4 7,,vi7 ,middle ,eastern and ,northern ,african communities4 7iii7 ,report to ,congress ,no later than #b years after the implementation of the initial demonstration projects under this paragraph1 the ,director shall submit to ,congress a report that includes-- 7,i7 a description of each demonstration project and design2 7,,ii7 an evaluation of the cost-effectiveness of each project's prevention and treatment efforts2 7,,iii7 an evaluation of the cultural and linguistic appropriateness of each project by racial and ethnic group2 and 7,,iv7 an evaluation of the beneficiary's health status improvement under the demonstration project4 7iv7 ,any other information determined appropriate by the ,director ,the ,director shall require eligible entities awarded a grant under this paragraph to report any other information the ,director determines appropriate to be shared by or developed by such entity1 including the following3 7,i7 ,developing models and evaluating methods that improve the cultural and linguistically appropriate services provided through the ,centers for ,disease ,control and ,prevention to target individuals impacted by health inequities based on their race1 ethnicity1 gender1 or sexual orientation4 7,,ii7 ,promoting the collaboration between primary and specialty care health care providers and patients1 to ensure patients impacted by health inequities based on race1 ethnicity1 gender1 or sexual orientation are receiving comprehensive and organized treatment and care4 7,,iii7 ,educating health care professionals on the causes and effects of inequities in the social determinants of health in relation to minority and racial and ethnic communities and the need for culturally and linguistically appropriate care in the prevention and treatment of high-impact diseases4 7,,iv7 ,encouraging collaboration among community- and patient-based organizations that work to address inequities in the social determinants of health in relation to high-impact diseases in minority and racial and ethnic populations4 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section-- 7#a7 #be1jjj1jjj for fiscal year #bjbe2 and 7#b7 such sums as may be necessary for fiscal years #bjbf through #bjbh4 #ajjjd4 ,additional research on the relationship between the built environment and the health of community residents 7a7 ,definition of eligible institution ,in this section1 the term eligible institution means a public or private nonprofit institution that submits to the ,secretary and the ,administrator an application for a grant under the grant program authorized under subsection 7b77#b7 at such time1 in such manner1 and containing such agreements1 assurances1 and information as the ,secretary and ,administrator may require4 7b7 ,research grant program 7#a7 ,definition of health ,in this section1 the term health includes-- 7,a7 levels of physical activity2 7,b7 degree of mobility due to factors such as musculoskeletal diseases1 arthritis1 and obesity2 7,c7 consumption of nutritional foods2 7,d7 rates of crime2 7,e7 air1 water1 and soil quality2 7,f7 risk of injury2 7,g7 accessibility to health care services2 7,h7 levels of educational attainment2 and 7,i7 other indicators as determined appropriate by the ,secretary4 7#b7 ,grants ,the ,secretary1 in collaboration with the ,administrator1 shall provide grants to eligible institutions to conduct and coordinate research on the built environment and its influence on individual and population-based health4 7#c7 ,research ,the ,secretary shall support research that-- 7,a7 investigates and defines the causal links between all aspects of the built environment and the health of residents2 7,b7 examines-- 7i7 the extent of the impact of the built environment 7including the various characteristics of the built environment7 on the health of residents2 7ii7 the variation in the health of residents by-- 7,i7 location 7such as inner cities1 inner suburbs1 outer suburbs1 reservations1 and rural areas72 and 7,,ii7 population subgroup 7including children1 young adults1 the elderly1 the disadvantaged72 or 7iii7 the importance of the built environment to the total health of residents1 which is the primary variable of interest from a public health perspective2 7,c7 is used to develop-- 7i7 measures to address health and the connection of health to the built environment2 and 7ii7 efforts to link the measures to travel and health databases2 7,d7 distinguishes carefully between personal attitudes and choices and external influences on observed behavior to determine how much an observed association between the built environment and the health of residents1 versus the lifestyle preferences of the people that choose to live in the neighborhood1 reflects the physical characteristics of the neighborhood2 and 7,e7 7i7 identifies or develops effective intervention strategies to promote better health among residents with a focus on behavioral interventions and enhancements of the built environment that promote increased use by residents2 and 7ii7 in developing the intervention strategies under clause 7i71 ensures that the intervention strategies will reach out to high-risk populations1 including racial and ethnic minorities1 low-income urban and rural communities1 and children4 7#d7 ,priority ,in providing assistance under the grant program authorized under paragraph 7#b71 the ,secretary and the ,administrator shall give priority to research that incorporates-- 7,a7 minority-serving institutions as grantees2 7,b7 interdisciplinary approaches2 or 7,c7 the expertise of the public health1 physical activity1 nutrition and health care 7including child health71 urban planning1 and transportation research communities in the ,united ,states and abroad4 #ajjje4 ,environment and public health restoration 7a7 ,statement of policy ,it is the policy of the ,federal ,government to work in conjunction with ,states1 territories1 ,tribal governments1 international organizations1 and foreign governments as a steward of the environment for the benefit of public health1 to maintain air quality and water quality1 to sustain the diversity of plant and animal species1 to combat global climate change1 and to protect the environment for future generations4 7b7 ,study and report on public health or environmental impact of revised rules1 regulations1 laws1 or other agency decisions 7#a7 ,study ,not later than #cj days after the date of enactment of this ,act1 the ,president shall seek to enter into an arrangement under which the ,national ,academy of ,sciences shall conduct a study to determine the effects on public health1 air quality1 water quality1 wildlife1 and the environment of the following regulations1 laws1 and other agency decisions3 7,a7 ,clean water 7i7 ,the final rule of the ,environmental ,protection ,agency and the ,corps of ,engineers entitled ,final ,revisions to the ,clean ,water ,act ,regulatory ,definitions of ,fill ,material and ,discharge of ,fill ,material and published in the ,federal ,register on ,may #i1 #bjjb 7#fg ,fed4 ,reg4 #caabi74 7ii7 ,the final rule of the ,environmental ,protection ,agency entitled ,national ,pollutant ,discharge ,elimination ,system ,permit ,regulation for ,concentrated ,animal ,feeding ,operations3 ,removal of ,vacated ,elements in ,response to #bjaa ,court ,decision and published in the ,federal ,register on ,july #cj1 #bjab 7#gg ,fed4 ,reg4 #dddid74 7iii7 ,the final rule of the ,environmental ,protection ,agency entitled ,withdrawal of ,revisions to the ,water ,quality ,planning and ,management ,regulation and ,revisions to the ,national ,pollutant ,discharge ,elimination ,system ,program in ,support of ,revisions to the ,water ,quality ,planning and ,management ,regulation and published in the ,federal ,register on ,march #ai1 #bjjc 7#fh ,fed4 ,reg4 #acfjh74 7iv7 ,the final rule of the ,environmental ,protection ,agency entitled ,consolidated ,permit ,regulations3 ,,rcra ,hazardous ,waste2 ,,sdwa ,underground ,injection ,control2 ,,cwa ,national ,pollutant ,discharge ,elimination ,system2 ,,cwa ,section #djd ,dredge or ,fill ,programs2 and ,,caa ,prevention of ,significant ,deterioration and published in the ,federal ,register on ,may #ai1 #aihj 7#de ,fed4 ,reg4 #ccbij71 with respect to the definition of the waters of the ,united ,states4 7v7 ,the final rule of the ,corps of ,engineers and the ,environmental ,protection ,agency entitled ,definition of ,waters of the ,united ,states--,recodification of ,pre-,existing ,rules and published in the ,federal ,register on ,october #bb1 #bjai 7#hd ,fed4 ,reg4 #effbf74 7vi7 ,the final rule of the ,corps of ,engineers and the ,environmental ,protection ,agency entitled ,the ,navigable ,waters ,protection ,rule3 ,definition of ,waters of the ,united ,states and published in the ,federal ,register on ,april #ba1 #bjbj 7#he ,fed4 ,reg4 #bbbej74 7,b7 ,forests and land management 7i7 ,the ,healthy ,forests ,restoration ,act of #bjjc 7#af ,u4,s4,c4 #feja et seq474 7ii7 ,the application of section #eec7;e7 of title #e1 ,united ,states ,code1 such that a ,state may petition for a special rule for the inventoried roadless areas within ,national ,forest ,system land within the ,state4 7iii7 ,the final rules of the ,forest ,service entitled ,national ,forest ,system ,land ,management ,planning 7#gg ,fed4 ,reg4 #baafb71 ,national ,forest ,system ,land ,management ,planning2 ,correction 7#gh ,fed4 ,reg4 #bcdia71 and ,national ,forest ,system ,land ,management ,planning 7#ha ,fed4 ,reg4 #ijgbc71 published on ,april #i1 #bjab1 ,april #ai1 #bjac1 and ,december #ae1 #bjaf1 respectively4 7iv7 ,the final rule of the ,bureau of ,land ,management entitled ,oil ,shale ,management--,general and published on ,november #ah1 #bjjh 7#gc ,fed4 ,reg4 #fidad74 7v7 ,the record of decision described in the notice of availability of the ,bureau of ,land ,management entitled ,notice of ,availability of ,approved ,land ,use ,plan ,amendments_/,record of ,decision for ,allocation of ,oil ,shale and ,tar ,sands ,resources on ,lands ,administered by the ,bureau of ,land ,management in ,colorado1 ,utah1 and ,wyoming and ,final ,programmatic ,environmental ,impact ,statement and published on ,april #a1 #bjac 7#gh ,fed4 ,reg4 #aieah74 7,c7 ,scientific review ,the final rule of the ,united ,states ,fish and ,wildlife ,service and the ,national ,oceanic and ,atmospheric ,administration entitled ,interagency ,cooperation ,under the ,endangered ,species ,act and published on ,december #af1 #bjjh 7#gc ,fed4 ,reg4 #gfbgb71 as amended by the final rule of the ,united ,states ,fish and ,wildlife ,service and the ,national ,oceanic and ,atmospheric ,administration entitled ,endangered and ,threatened ,wildlife and ,plants2 ,regulations for ,interagency ,cooperation and published on ,august #bg1 #bjai 7#hd ,fed4 ,reg4 #ddigf74 7#b7 ,method ,in conducting the study under paragraph 7#a71 the ,national ,academy of ,sciences may use and compare existing scientific studies regarding the regulations1 laws1 and other agency decisions described in paragraph 7#a74 7#c7 ,report ,not later than #bgj days after the date on which the ,president enters into the arrangement under paragraph 7#a71 the ,national ,academy of ,sciences shall make publicly available and shall submit to ,congress and to the head of each department and agency of the ,federal ,government that issued1 implements1 or would implement a regulation1 law1 or other agency decision described in paragraph 7#a71 a report that includes-- 7,a7 a description of the effects of each regulation1 law1 or other agency decision described in paragraph 7#a7 on public health1 air quality1 water quality1 wildlife1 and the environment1 compared to the impact of preexisting regulations1 laws1 or other agency decisions in effect1 as applicable1 including-- 7i7 any negative impacts to air quality or water quality2 7ii7 any negative impacts to wildlife2 7iii7 any delays in hazardous waste cleanup that are projected to be hazardous to public health2 and 7iv7 any other negative impact on public health or the environment2 and 7,b7 any recommendations that the ,national ,academy of ,sciences considers appropriate to maintain1 restore1 or improve in whole or in part protections for public health1 air quality1 water quality1 wildlife1 and the environment for each of the regulations1 laws1 and other agency decisions described in paragraph 7#a71 which may include recommendations for the adoption of any regulation or law in place or proposed prior to ,january #a1 #bjja4 7c7 ,department and agency revision of existing rules1 regulations1 or laws ,not later than #ahj days after the date on which the report is submitted pursuant to subsection 7b77#c71 the head of each department or agency that has issued or implemented a regulation1 law1 or other agency decision described in subsection 7b77#a7 shall submit to ,congress a plan describing the steps the department or agency will take1 or has taken1 to restore or improve protections for public health and the environment in whole or in part that were in existence prior to the issuance of the applicable regulation1 law1 or other agency decision4 #ajjjf4 ,,gao report on health effects of ,deepwater ,horizon oil rig explosion in the ,gulf ,coast 7a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study on the type and scope of health care services administered through the ,department of ,health and ,human ,services addressing the provision of health care to racial and ethnic minorities1 including residents1 cleanup workers1 and volunteers1 affected by the blowout and explosion of the mobile offshore drilling unit ,deepwater ,horizon that occurred on ,april #bj1 #bjaj1 and resulting hydrocarbon releases into the environment4 7b7 ,specific components ,in carrying out subsection 7a71 the ,comptroller ,general of the ,united ,states shall-- 7#a7 assess the type1 size1 and scope of programs administered by the ,secretary that focus on the provision of health care to communities on the ,gulf ,coast2 7#b7 identify the merits and disadvantages associated with each of the programs2 7#c7 perform an analysis of the costs and benefits of the programs2 and 7#d7 determine whether there is any duplication of programs4 7c7 ,report ,not later than #ahj days after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report that includes-- 7#a7 the findings of the study conducted under subsection 7a72 and 7#b7 recommendations for improving access to health care for racial and ethnic minorities4 #ajjjg4 ,establish an interagency council and grant programs on social determinants of health 7a7 ,purposes ,the purposes of this section are as follows3 7#a7 ,to establish effective1 coordinated ,federal technical assistance to help ,state and local governments to improve outcomes and cost-effectiveness of1 and return on investment from1 health and social services programs4 7#b7 ,to build a pipeline of ,state and locally designed1 cross-sector interventions and strategies that generate rigorous evidence about how to improve health and social outcomes1 and increase the cost-effectiveness of1 and return on investment from1 ,federal1 ,state1 local1 and ,tribal health and social services programs4 7#c7 ,to enlist ,state and local governments and the service providers of such governments as partners in identifying ,federal statutory1 regulatory1 and administrative challenges in improving the health and social outcomes of1 cost-effectiveness of1 and return on investment from1 ,federal spending on individuals enrolled in ,medicaid4 7#d7 ,to develop strategies to improve health and social outcomes without denying services to1 or restricting the eligibility of1 vulnerable populations4 7b7 ,social determinants accelerator council 7#a7 ,establishment ,the ,secretary1 in coordination with the ,administrator of the ,centers for ,medicare ,medicaid ,services 7referred to in this section as the ,administrator71 shall establish an interagency council1 to be known as the ,social ,determinants ,accelerator ,interagency ,council 7referred to in this section as the ,council7 to achieve the purposes listed in subsection 7a74 7#b7 ,membership 7,a7 ,federal composition ,the ,council shall be composed of at least one designee from each of the following ,federal agencies3 7i7 ,the ,office of ,management and ,budget4 7ii7 ,the ,department of ,agriculture4 7iii7 ,the ,department of ,education4 7iv7 ,the ,indian ,health ,service4 7v7 ,the ,department of ,housing and ,urban ,development4 7vi7 ,the ,department of ,labor4 7vii7 ,the ,department of ,transportation4 7viii7 ,any other ,federal agency the ,chair of the ,council determines necessary4 7,b7 ,designation 7i7 ,in general ,the head of each agency specified in subparagraph 7,a7 shall designate at least one employee described in clause 7ii7 to serve as a member of the ,council4 7ii7 ,responsibilities ,an employee described in this clause shall be a senior employee of the agency-- 7,i7 whose responsibilities relate to authorities1 policies1 and procedures with respect to the health and well-being of individuals receiving medical assistance under a ,state plan 7or a waiver of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq472 or 7,,ii7 who has authority to implement and evaluate transformative initiatives that harness data or conduct rigorous evaluation to improve the impact and cost-effectiveness of federally funded services and benefits4 7,c7 ,,hhs representation ,in addition to the designees under subparagraph 7,a71 the ,council shall include designees from at least #c agencies within the ,department of ,health and ,human ,services1 including the ,centers for ,medicare ,medicaid ,services1 at least one of whom shall meet the criteria under subparagraph 7,b77ii74 7,d7 ,,omb role ,the ,director of the ,office of ,management and ,budget shall facilitate the timely resolution of ,federal ,government-wide and multiagency issues to help the ,council achieve consensus recommendations described under this section4 7,e7 ,non-,federal composition ,the ,comptroller ,general of the ,united ,states may designate up to #f ,council designees-- 7i7 who have relevant subject matter expertise1 including expertise implementing and evaluating transformative initiatives that harness data and conduct evaluations to improve the impact and cost-effectiveness of ,federal ,government services2 and 7ii7 that each represent-- 7,i7 ,state1 local1 and ,tribal health and human services agencies2 7,,ii7 public housing authorities or ,state housing finance agencies2 7,,iii7 ,state and local government budget offices2 7,,iv7 ,state ,medicaid agencies2 or 7,v7 national consumer advocacy organizations4 7,f7 ,chair 7i7 ,in general ,the ,secretary shall select the ,chair of the ,council from among the members of the ,council4 7ii7 ,initiating guidance ,the ,chair1 on behalf of the ,council1 shall identify and invite individuals from diverse entities to provide the ,council with advice and information pertaining to addressing social determinants of health1 including-- 7,i7 individuals from ,state and local government health and human services agencies2 7,,ii7 individuals from ,state ,medicaid agencies2 7,,iii7 individuals from ,state and local government budget offices2 7,,iv7 individuals from public housing authorities or ,state housing finance agencies2 7,v7 individuals from nonprofit organizations1 small businesses1 and philanthropic organizations2 7,,vi7 advocates2 7,,vii7 researchers2 and 7,,viii7 any other individuals the ,chair determines to be appropriate4 7#c7 ,duties ,the duties of the ,council are-- 7,a7 to make recommendations to the ,secretary and the ,administrator regarding the criteria for making awards under this section2 7,b7 to identify ,federal authorities and opportunities for use by ,states or local governments to improve coordination of funding and administration of ,federal programs1 the beneficiaries of whom include individuals1 and which may be unknown or underutilized1 and to make information on such authorities and opportunities publicly available2 7,c7 to provide targeted technical assistance to ,states developing a social determinants accelerator plan under this section1 including identifying potential statutory or regulatory pathways for implementation of the plan and assisting in identifying potential sources of funding to implement the plan2 7,d7 to report to ,congress annually on the subjects set forth in this section2 7,e7 to develop and disseminate evaluation guidelines and standards that can be used to reliably assess the impact of an intervention or approach that may be implemented pursuant to this section on outcomes and cost-effectiveness of1 and return on investment from1 ,federal1 ,state1 local1 and ,tribal governments1 and to facilitate technical assistance1 where needed1 to help to improve ,state and local evaluation designs and implementation2 7,f7 to seek feedback from ,state1 local1 and ,tribal governments1 including through an annual survey by an independent third party1 on how to improve the technical assistance the ,council provides to better equip ,state1 local1 and ,tribal governments to coordinate health and social service programs2 7,g7 to solicit applications for grants under subsection 7c72 and 7,h7 to coordinate with other cross-agency initiatives focused on improving the health and well-being of low-income and at-risk populations in order to prevent unnecessary duplication between agency initiatives4 7#d7 ,schedule ,not later than #fj days after the date of enactment of this ,act1 the ,council shall convene to develop a schedule and plan for carrying out the duties described in this section1 including solicitation of applications for the grants under this section4 7#e7 ,report to ,congress ,the ,council shall submit an annual report to ,congress1 which shall include-- 7,a7 a list of the ,council members2 7,b7 activities and expenditures of the ,council2 7,c7 summaries of the interventions and approaches that will be supported by ,state1 local1 and ,tribal governments that received a grant under this section1 including-- 7i7 the best practices and evidence-based approaches such governments plan to employ to achieve the purposes listed in this section2 and 7ii7 a description of how the practices and approaches will impact the outcomes and cost-effectiveness of1 and return on investment from1 ,federal1 ,state1 local1 and ,tribal governments with respect to such purposes2 7,d7 the feedback received from ,state and local governments on ways to improve the technical assistance of the ,council1 including findings from a third-party survey and actions the ,council plans to take in response to such feedback2 and 7,e7 the major statutory1 regulatory1 and administrative challenges identified by ,state1 local1 and ,tribal governments that received a grant under subsection 7c71 and the actions that ,federal agencies are taking to address such challenges4 7#f7 ,,faca inapplicability ,chapter #aj of title #e1 ,united ,states ,code1 shall not apply to the ,council4 7#g7 ,council procedures ,the ,secretary1 in consultation with the ,comptroller ,general of the ,united ,states and the ,director of the ,office of ,management and ,budget1 shall establish procedures for the ,council to-- 7,a7 ensure that adequate resources are available to effectively execute the responsibilities of the ,council2 7,b7 effectively coordinate with other relevant advisory bodies and working groups to avoid unnecessary duplication2 7,c7 create transparency to the public and ,congress with regard to ,council membership1 costs1 and activities1 including through use of modern technology and social media to disseminate information2 and 7,d7 avoid conflicts of interest that would jeopardize the ability of the ,council to make decisions and provide recommendations4 7c7 ,social determinants accelerator grants to ,states or local governments 7#a7 ,grants to ,states1 local governments1 and ,tribes ,not later than #ahj days after the date of enactment of this ,act1 the ,administrator1 in consultation with the ,secretary and the ,council1 shall award on a competitive basis not more than #be grants to eligible applicants described in this subsection1 for the development of social determinants accelerator plans1 as described in this subsection4 7#b7 ,eligible applicant ,an eligible applicant described in this subsection is a ,state1 local1 or ,tribal health or human services agency that-- 7,a7 demonstrates the support of relevant parties across relevant ,state1 local1 or ,tribal jurisdictions2 and 7,b7 in the case of an applicant that is a local government agency1 provides to the ,secretary a letter of support from the lead ,state health or human services agency for the ,state in which the local government is located4 7#c7 ,amount of grant ,the ,administrator1 in coordination with the ,council1 shall determine the total amount that the ,administrator will make available to each grantee under this subsection4 7#d7 ,application ,an eligible applicant seeking a grant under this subsection shall include in the application the following information3 7,a7 ,the target population 7or populations7 that would benefit from implementation of the social determinants accelerator plan proposed to be developed by the applicant4 7,b7 ,a description of the objective or objectives and outcome goals of such proposed plan1 which shall include at least one health outcome and at least one other important social outcome4 7,c7 ,the sources and scope of inefficiencies that1 if addressed by the plan1 could result in improved cost-effectiveness of or return on investment from ,federal1 ,state1 local1 and ,tribal governments4 7,d7 ,a description of potential interventions that could be designed or enabled using such proposed plan4 7,e7 ,the ,state1 local1 and ,tribal governments1 academic institutions1 nonprofit organizations1 community-based organizations1 and other public and private sector partners that would participate in the development of the proposed plan and subsequent implementation of programs or initiatives included in such proposed plan4 7,f7 ,such other information as the ,administrator1 in consultation with the ,secretary and the ,council1 determines necessary to achieve the purposes of this section4 7#e7 ,use of funds ,a recipient of a grant under this subsection may use funds received through the grant for the following purposes3 7,a7 ,to convene and coordinate with relevant government entities and other stakeholders across sectors to assist in the development of a social determinant accelerator plan4 7,b7 ,to identify populations of individuals receiving medical assistance under a ,state plan 7or a waiver of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 who may benefit from the proposed approaches to improving the health and well-being of such individuals through the implementation of the proposed social determinants accelerator plan4 7,c7 ,to engage qualified research experts to advise on relevant research and to design a proposed evaluation plan1 in accordance with the standards and guidelines issued by the ,administrator4 7,d7 ,to collaborate with the ,council to support the development of social determinants accelerator plans4 7,e7 ,to prepare and submit a final social determinants accelerator plan to the ,council4 7#f7 ,contents of plans ,a social determinant accelerator plan developed under this subsection shall include the following3 7,a7 ,a description of the target population 7or populations7 that would benefit from implementation of the social determinants accelerator plan1 including an analysis describing the projected impact on the well-being of individuals described in paragraph 7#e77;,b74 7,b7 ,a description of the interventions or approaches designed under the social determinants accelerator plan and the evidence for selecting such interventions or approaches4 7,c7 ,the objectives and outcome goals of such interventions or approaches1 including at least one health outcome and at least one other important social outcome4 7,d7 ,a plan for accessing and linking relevant data to enable coordinated benefits and services for the jurisdictions described in this section and an evaluation of the proposed interventions and approaches4 7,e7 ,a description of the ,state1 local1 and ,tribal governments1 academic institutions1 nonprofit organizations1 or any other public or private sector organizations that would participate in implementing the proposed interventions or approaches1 and the role each would play to contribute to the success of the proposed interventions or approaches4 7,f7 ,the identification of the funding sources that would be used to finance the proposed interventions or approaches4 7,g7 ,a description of any financial incentives that may be provided1 including outcome-focused contracting approaches to encourage service providers and other partners to improve outcomes of1 cost-effectiveness of1 and return on investment from1 ,federal1 ,state1 local1 or ,tribal government spending4 7,h7 ,the identification of the applicable ,federal1 ,state1 local1 or ,tribal statutory and regulatory authorities1 including waiver authorities1 to be leveraged to implement the proposed interventions or approaches4 7,i7 ,a description of potential considerations that would enhance the impact1 scalability1 or sustainability of the proposed interventions or approaches and the actions the grant awardee would take to address such considerations4 7,j7 ,a proposed evaluation plan1 to be carried out by an independent evaluator1 to measure the impact of the proposed interventions or approaches on the outcomes of1 cost-effectiveness of1 and return on investment from1 ,federal1 ,state1 local1 and ,tribal governments4 7,k7 ,precautions for ensuring that vulnerable populations will not be denied access to ,medicaid or other essential services as a result of implementing the proposed plan4 7d7 ,funding 7#a7 ,in general ,out of any money in the ,treasury not otherwise appropriated1 there is appropriated to carry out this section #be1jjj1jjj1 to remain available for obligation until the date that is #e years after the date of enactment of this section4 7#b7 ,reservation of funds 7,a7 ,in general ,of the funds made available under paragraph 7#a71 the ,secretary shall reserve not less than #bj percent to award grants to eligible applicants for the development of social determinants accelerator plans under this section intended to serve rural populations4 7,b7 ,exception ,in the case of a fiscal year for which the ,secretary determines that there are not sufficient eligible applicants to award up to #be grants under subsection 7c7 that are intended to serve rural populations and the ,secretary cannot satisfy the #bj-percent requirement1 the ,secretary may reserve an amount that is less than #bj percent of amounts made available under paragraph 7#a7 to award grants for such purpose4 7#c7 ,rule of construction ,nothing in this section shall prevent ,federal agencies represented on the ,council from contributing additional funding from other sources to support activities to improve the effectiveness of the ,council4 #ajjjh4 ,correcting ,hurtful and ,alienating ,names in ,government ,expression 7,,change7 7a7 ,short title ,this section may be cited as the ,correcting ,hurtful and ,alienating ,names in ,government ,expression ,act or the ,,change ,act4 7b7 ,definitions ,in this section3 7#a7 ,employee ,the term employee has the meaning given the term in section #baje of title #e1 ,united ,states ,code4 7#b7 ,executive agency ,the term ,executive agency has the meaning given the term in section #aje of title #e1 ,united ,states ,code4 7#c7 ,officer ,the term officer has the meaning given the term in section #bajd of title #e1 ,united ,states ,code4 7#d7 ,prohibited term ,the term prohibited term means-- 7,a7 the term alien1 when used to refer to an individual who is not a citizen or national of the ,united ,states2 and 7,b7 the term illegal alien1 when used to refer to an individual who-- 7i7 is unlawfully present in the ,united ,states2 or 7ii7 lacks a lawful immigration status in the ,united ,states4 7c7 ,modernization of language referring to individuals who are not citizens or nationals of the ,united ,states 7#a7 ,in general ,except as provided in paragraph 7#b71 on and after the date of enactment of this ,act1 an ,executive agency may not use a prohibited term in any proposed or final rule1 regulation1 interpretation1 publication1 other document1 display1 or sign issued by the ,executive agency4 7#b7 ,exception ,an ,executive agency may use a prohibited term under paragraph 7#a7 if the ,executive agency uses the prohibited term while quoting or reproducing text written by a source that is not an officer or employee of the ,executive agency4 7d7 ,uniform definition 7#a7 ,in general ,chapter #a of title #a1 ,united ,states ,code1 is amended by adding at the end the following3 #i4 ,definition of foreign national ,in determining the meaning of any ,act of ,congress or any ruling1 regulation1 or interpretation of an administrative bureau or agency of the ,united ,states1 the term foreign national means any individual who is not an individual who-- 7#a7 is a citizen of the ,united ,states2 or 7#b7 though not a citizen of the ,united ,states1 owes permanent allegiance to the ,united ,states4 4 7#b7 ,technical amendment ,the table of sections for chapter #a of title #a1 ,united ,states ,code1 is amended by adding at the end the following3 #i4 ,definition of foreign national4 4 7e7 ,references ,any reference in any ,federal statute1 rule1 regulation1 ,executive order1 publication1 or other document of the ,united ,states-- 7#a7 to the term alien1 when used to refer to an individual who is not a citizen or national of the ,united ,states1 is deemed to refer to the term foreign national2 and 7#b7 to the term illegal alien is deemed to refer to the term undocumented foreign national1 when used to refer to an individual who-- 7,a7 is unlawfully present in the ,united ,states2 or 7,b7 lacks a lawful immigration status in the ,united ,states4 #ajjji4 ,andrew ,kearse ,accountability for ,denial of ,medical ,care 7a7 ,in general ,chapter #ac of title #ah1 ,united ,states ,code1 is amended by adding at the end the following3 #bea4 ,medical attention for individuals in ,federal custody displaying medical distress 7a7 ,definitions ,in this section-- 7#a7 the term appropriate ,inspector ,general1 with respect to a covered official1 means-- 7,a7 the ,inspector ,general of the ,federal agency that employs the covered official2 or 7,b7 in the case of a covered official employed by a ,federal agency that does not have an ,inspector ,general1 the ,inspector ,general of the ,department of ,justice2 7#b7 the term covered official means-- 7,a7 a ,federal law enforcement officer 7as defined in section #aae72 7,b7 an officer or employee of the ,bureau of ,prisons2 or 7,c7 an officer or employee of the ,united ,states ,marshals ,service2 and 7#c7 the term medical distress includes breathing difficulties4 7b7 ,requirement 7#a7 ,offense ,it shall be unlawful for a covered official to negligently fail to obtain or provide immediate medical attention to an individual in ,federal custody who displays medical distress in the presence of the covered official if the individual suffers unnecessary pain1 injury1 or death as a result of that failure4 7#b7 ,penalty ,a covered official who violates paragraph 7#a7 shall be fined under this title1 imprisoned for not more than #a year1 or both4 7#c7 ,state civil enforcement ,whenever an attorney general of a ,state has reasonable cause to believe that a resident of the ,state has been aggrieved by a violation of paragraph 7#a7 by a covered official1 the attorney general1 or another official1 agency1 or entity designated by the ,state1 may bring a civil action in any appropriate district court of the ,united ,states to obtain appropriate equitable and declaratory relief4 7c7 ,inspector ,general investigation 7#a7 ,in general ,the appropriate ,inspector ,general shall investigate any instance in which-- 7,a7 a covered official fails to obtain or provide immediate medical attention to an individual in ,federal custody who displays medical distress in the presence of the covered official2 and 7,b7 the individual suffers unnecessary pain1 injury1 or death as a result of the failure to obtain or provide immediate medical attention4 7#b7 ,referral for prosecution ,if an appropriate ,inspector ,general1 in conducting an investigation under paragraph 7#a71 concludes that the covered official acted negligently in failing to obtain or provide immediate medical attention to the individual in ,federal custody1 the appropriate ,inspector ,general shall refer the case to the ,attorney ,general for prosecution under this section4 7#c7 ,confidential complaint process ,the ,inspector ,general of a ,federal agency that employs covered officials shall establish a process under which an individual may confidentially submit a complaint to the ,inspector ,general regarding an incident described in paragraph 7#a7 involving a covered official employed by the ,federal agency 7or1 in the case of the ,inspector ,general of the ,department of ,justice1 involving a covered official employed by a ,federal agency that does not have an ,inspector ,general74 7d7 ,training ,the head of an agency that employs covered officials shall provide training to each such covered official on obtaining or providing medical assistance to individuals in medical distress4 4 7b7 ,technical and conforming amendment ,the table of sections for chapter #ac of title #ah1 ,united ,states ,code1 is amended by adding at the end the following3 #bea4 ,medical attention for individuals in ,federal custody displaying medical distress4 4 #ajjaj4 ,investing in community healing 7a7 ,sense of ,congress ,it is the sense of ,congress that it is imperative that a comprehensive public health approach to addressing trauma and mental health care be focused on care delivery that is culturally sensitive and competent4 7b7 ,research on adverse health effects associated with interactions with law enforcement 7#a7 ,in general ,the ,secretary1 acting through the ,director of the ,office of ,minority ,health of the ,centers for ,disease ,control and ,prevention 7established pursuant to section #agjg;,a of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjju-#f;a771 shall conduct research on the adverse health effects associated with interactions with law enforcement4 7#b7 ,effects among racial and ethnic minorities ,the research under paragraph 7#a7 shall include research on-- 7,a7 the health consequences1 both individual and community-wide1 of trauma related to violence committed by law enforcement among racial and ethnic minorities2 and 7,b7 the disproportionate burden of morbidity and mortality associated with such trauma4 7#c7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall-- 7,a7 complete the research under this subsection2 and 7,b7 submit to ,congress a report on the findings1 conclusions1 and recommendations resulting from such research4 7c7 ,grants for increasing racial and ethnic minority access to high-,quality trauma support services and mental health care 7#a7 ,in general ,the ,secretary1 acting through the ,assistant ,secretary for ,mental ,health and ,substance ,use1 shall award grants to eligible entities to establish or expand programs for the purpose of increasing racial and ethnic minority access to high-quality trauma support services and mental health care4 7#b7 ,eligible entities ,to seek a grant under this subsection1 an entity shall be a community-based program or organization that-- 7,a7 provides culturally competent programs and resources that are aligned with evidence-based practices for trauma-informed care2 and 7,b7 has demonstrated expertise in serving communities of color or can partner with a program that has such demonstrated expertise4 7#c7 ,use of funds ,as a condition on receipt of a grant under this subsection1 a grantee shall agree to use the grant to increase racial and ethnic minority access to high-quality trauma support services and mental health care1 such as by-- 7,a7 establishing and maintaining community-based programs providing evidence-based services in trauma-informed care and culturally specific services and other resources2 7,b7 developing innovative culturally specific strategies and projects to enhance access to trauma-informed care and resources for racial and ethnic minorities who face obstacles to using more traditional services and resources 7such as obstacles in geographic access to providers1 insurance coverage1 and access to audio and video technologies72 7,c7 working with ,state and local governments and social service agencies to develop and enhance effective strategies to provide culturally specific services to racial and ethnic minorities2 7,d7 increasing communities' capacity to provide culturally specific resources and support for communities of color2 7,e7 working in cooperation with the community to develop education and prevention strategies highlighting culturally specific issues and resources regarding racial and ethnic minorities2 7,f7 providing culturally specific programs for racial and ethnic minorities exposed to law enforcement violence2 and 7,g7 examining the dynamics of culture and its impact on victimization and healing4 7#d7 ,priority ,in awarding grants under this subsection1 the ,secretary shall give priority to eligible entities proposing to serve communities that have faced high rates of community trauma1 including from exposure to law enforcement violence1 intergenerational poverty1 civil unrest1 discrimination1 or oppression4 7#e7 ,grant period ,the period of a grant under this subsection shall be #d years4 7#f7 ,evaluation ,not later than #f months after the end of the period of all grants under this subsection1 the ,secretary shall-- 7,a7 conduct an evaluation of the programs funded by a grant under this subsection2 7,b7 include in such evaluation an assessment of the outcomes of each such program2 and 7,c7 submit a report on the results of such evaluation to ,congress4 7#g7 ,authorization of appropriations ,to carry out this subsection1 there is authorized to be appropriated #bj1jjj1jjj for each of fiscal years #bjbe through #bjbi4 7d7 ,behavioral and mental health outreach education strategy 7#a7 ,in general ,the ,secretary1 in coordination with advocacy and behavioral and mental health organizations serving racial and ethnic minority groups1 shall develop and implement an outreach and education strategy to promote behavioral and mental health1 and reduce stigma associated with mental health conditions1 among racial and ethnic minorities4 7#b7 ,design ,the strategy under this subsection shall be designed to-- 7,a7 meet the diverse cultural and language needs of racial and ethnic minority groups2 7,b7 provide information on evidence-based1 culturally and linguistically appropriate and adapted interventions and treatments2 7,c7 increase awareness of symptoms of mental illness among racial and ethnic minority groups2 and 7,d7 ensure full participation of1 and engage1 both consumers and community members in the development and implementation of materials4 7#c7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall submit to ,congress1 and make publicly available1 a report detailing the outreach and education strategy that is developed and implemented under this subsection and the results of such implementation4 #ajjaa4 ,environmental justice mapping and data collection 7a7 ,definitions ,in this section3 7#a7 ,advisory council ,the term advisory council means the advisory council established under subsection 7b77#d77;,b77i74 7#b7 ,committee ,the term ,committee means the ,environmental ,justice ,mapping ,committee established by subsection 7b77#a74 7#c7 ,environmental justice ,the term environmental justice means the fair treatment and meaningful involvement of all people regardless of race1 color1 culture1 national origin1 or income1 with respect to the development1 implementation1 and enforcement of environmental laws1 regulations1 and policies to ensure that each person enjoys-- 7,a7 the same degree of protection from environmental and health hazards2 and 7,b7 equal access to any ,federal agency action relating to the development1 implementation1 and enforcement of environmental laws1 regulations1 and policies for the purpose of having a healthy environment in which to live1 learn1 work1 and recreate4 7#d7 ,environmental justice community ,the term environmental justice community means a community with significant representation of communities of color1 low-income communities1 or ,tribal and indigenous communities1 that experiences1 or is at risk of experiencing1 higher or more adverse human health or environmental effects1 as compared to other communities4 7#e7 ,ground-truthing ,the term ground-truthing means a community fact-finding process by which residents of a community supplement technical information with local knowledge for the purpose of better informing policy and project decisions4 7#f7 ,relevant stakeholder ,the term relevant stakeholder means-- 7,a7 a representative of a regional1 ,state1 ,tribal1 or local government agency2 7,b7 a representative of a nongovernmental organization with experience in areas that may include ,tribal relations1 environmental conservation1 city and regional planning1 and public health2 7,c7 a representative of a labor union2 7,d7 a representative or member of-- 7i7 an environmental justice community2 or 7ii7 a community-based organization for an environmental justice community2 7,e7 an individual with expertise in cumulative impacts1 geospatial data1 and environmental justice1 particularly such an individual from an academic or research institution2 and 7,f7 an advocate with experience in environmental justice who represents an environmental justice community4 7b7 ,establishment of ,committee 7#a7 ,in general ,there is established a committee1 to be known as the ,environmental ,justice ,mapping ,committee4 7#b7 ,membership 7,a7 ,in general ,the ,committee shall be composed of not fewer than #a representative of each of the following3 7i7 ,of the ,environmental ,protection ,agency-- 7,i7 the ,office of ,air and ,radiation2 7,,ii7 the ,office of ,chemical ,safety and ,pollution ,prevention2 7,,iii7 the ,office of ,international and ,tribal ,affairs2 7,,iv7 the ,office of ,land and ,emergency ,management2 7,v7 the ,office of ,water2 7,,vi7 the ,office of ,environmental ,justice and ,external ,civil ,rights2 7,,vii7 the ,office of ,research and ,development2 and 7,,viii7 the ,office of ,public ,engagement and ,environmental ,education4 7ii7 ,the ,council on ,environmental ,quality4 7iii7 ,of the ,department of ,commerce-- 7,i7 the ,office of ,oceanic and ,atmospheric ,research of the ,national ,oceanic and ,atmospheric ,administration1 including not fewer than #a representative of the ,climate ,program ,office2 7,,ii7 the ,bureau of ,economic ,analysis2 and 7,,iii7 the ,national ,institute of ,standards and ,technology4 7iv7 ,of the ,department of ,health and ,human ,services-- 7,i7 the ,centers for ,disease ,control and ,prevention1 not including the ,agency for ,toxic ,substances and ,disease ,registry2 7,,ii7 the ,agency for ,toxic ,substances and ,disease ,registry2 7,,iii7 the ,administration for ,children and ,families2 7,,iv7 of the ,national ,institutes of ,health-- 7aa7 the ,national ,institute of ,environmental ,health ,sciences2 7bb7 the ,national ,institute of ,mental ,health2 and 7cc7 the ,national ,institute on ,minority ,health and ,health ,disparities2 and 7,v7 the ,office for ,civil ,rights4 7v7 ,of the ,department of the ,interior-- 7,i7 the ,bureau of ,indian ,affairs2 7,,ii7 the ,office of ,diversity1 ,inclusion1 and ,civil ,rights2 and 7,,iii7 the ,united ,states ,geological ,survey4 7vi7 ,the ,forest ,service4 7vii7 ,the ,department of ,housing and ,urban ,development4 7viii7 ,the ,department of ,energy4 7ix7 ,the ,department of ,transportation4 7x7 ,the ,department of ,justice4 7xi7 ,the ,federal ,energy ,regulatory ,commission4 7xii7 ,the ,department of the ,treasury4 7xiii7 ,such other ,federal departments1 agencies1 and offices as the ,administrator determines to be appropriate1 particularly offices relating to public engagement4 7,b7 ,selection of representatives ,the head of a department or agency described in subparagraph 7,a7 shall1 in appointing to the ,committee a representative of the department or agency1 select a representative-- 7i7 of a component of the department or agency that is among the components that are the most relevant to the responsibilities of the ,committee2 or 7ii7 who has expertise in areas relevant to those responsibilities1 such as demographic indicators relating to socioeconomic hardship1 environmental justice1 public engagement1 public health1 exposure to pollution1 future climate and extreme weather mapping1 affordable energy1 sustainable transportation1 and access to water1 food1 and green space4 7,c7 ,co-chairs 7i7 ,in general ,the members of the ,committee shall select #c members to serve as co-chairs of the ,committee-- 7,i7 #a of whom shall be a representative of the ,environmental ,protection ,agency2 7,,ii7 #a of whom shall be a representative of the ,council on ,environmental ,quality2 and 7,,iii7 #a of whom shall have substantial experience in public engagement4 7ii7 ,terms ,each co-chair shall serve for a term of not more than #c years4 7iii7 ,responsibilities of co-chairs ,the co-chairs of the ,committee shall-- 7,i7 determine the agenda of the ,committee1 in consultation with other members of the ,committee2 7,,ii7 direct the work of the ,committee1 including the oversight of a meaningful public engagement process2 and 7,,iii7 convene meetings of the ,committee not less frequently than once each fiscal quarter4 7#c7 ,administrative support 7,a7 ,in general ,the ,administrator shall provide technical and administrative support to the ,committee4 7,b7 ,funding ,the ,administrator may carry out subparagraph 7,a7 using1 in addition to any amounts made available under subsection 7e71 amounts authorized to be appropriated to the ,administrator before the date of enactment of this ,act and available for obligation as of that date of enactment4 7#d7 ,consultation 7,a7 ,in general ,in carrying out the duties of the ,committee1 the ,committee shall consult with relevant stakeholders4 7,b7 ,advisory council 7i7 ,in general ,the ,committee shall establish an advisory council composed of a balanced proportion of relevant stakeholders1 at least of whom shall represent environmental justice communities4 7ii7 ,chair ,the advisory council shall be chaired by an environmental justice advocate or other relevant stakeholder with substantial experience in environmental justice4 7iii7 ,requirements ,consultation described in subparagraph 7,a7 shall include-- 7,i7 early and regular engagement with the advisory council1 including in carrying out public engagement under subparagraph 7,c72 and 7,,ii7 consideration of the recommendations of the advisory council4 7iv7 ,recommendations not used ,if the ,committee does not use a recommendation of the advisory council1 not later than #fj days after the date on which the ,committee receives notice of the recommendation1 the ,committee shall-- 7,i7 make available to the public on an internet website of the ,environmental ,protection ,agency a written report describing the rationale of the ,committee for not using the recommendation2 and 7,,ii7 submit the report described in subclause 7,i7 to the ,committee on ,environment and ,public ,works of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives4 7v7 ,outreach ,the advisory council may carry out public outreach activities using amounts made available under subsection 7e7 to supplement public engagement carried out by the ,committee under subparagraph 7,c74 7,c7 ,public engagement 7i7 ,in general ,the ,committee shall1 throughout the process of carrying out the duties of the ,committee described in subsection 7c7-- 7,i7 meaningfully engage with relevant stakeholders1 particularly-- 7aa7 members and representatives of environmental justice communities2 7bb7 environmental justice advocates2 and 7cc7 individuals with expertise in cumulative impacts and geospatial data2 and 7,,ii7 ensure that the input of the stakeholders described in subclause 7,i7 is central to the activities of the ,committee4 7ii7 ,plan 7,i7 ,in general ,in carrying out clause 7i71 the ,committee shall develop a plan1 in consultation with the advisory council1 for comprehensive public engagement with1 and incorporation of feedback from1 environmental justice advocates and members of environmental justice communities4 7,,ii7 ,strategies to overcome barriers to public engagement ,the plan developed under subclause 7,i7 shall include strategies to overcome barriers to public engagement1 including-- 7aa7 language barriers2 7bb7 transportation barriers2 7cc7 economic barriers2 and 7dd7 lack of internet access4 7,,iii7 ,consideration ,in developing the plan under subclause 7,i71 the ,committee shall consider the diverse and varied experiences of environmental justice communities relating to the scope and types of environmental hazards and socioeconomic injustices4 7iii7 ,consultation and solicitation of public comment 7,i7 ,in general ,in carrying out clause 7i71 not less frequently than once each fiscal quarter1 the ,committee shall consult with the advisory council and solicit meaningful public comment1 particularly from relevant stakeholders1 on the activities of the ,committee4 7,,ii7 ,requirements ,the ,committee shall carry out subclause 7,i7 through means including-- 7aa7 public notice of a meeting of the ,committee occurring during the applicable fiscal quarter1 which shall include-- 7,,aa7 notice in publications relevant to environmental justice communities2 7,,bb7 notification to environmental justice communities through direct means1 such as community centers and schools2 and 7,,cc7 direct outreach to known environmental justice groups2 7bb7 public broadcast of that meeting1 including soliciting and receiving comments by virtual means2 and 7cc7 public availability of a transcript of that meeting through publication on an accessible website4 7,,iii7 ,languages ,the ,committee shall provide each notice1 notification1 direct outreach1 broadcast1 and transcript described in subclause 7,,ii7 in each language commonly used in the applicable environmental justice community1 including through oral interpretation1 if applicable4 7iv7 ,funding ,of amounts made available under subsection 7e71 the ,administrator shall make available to the ,committee such sums as are necessary for participation by relevant stakeholders in public engagement under this paragraph1 as determined by the ,administrator1 in consultation with the advisory council4 7c7 ,duties of ,committee 7#a7 ,in general ,the ,committee shall-- 7,a7 establish a tool described in paragraph 7#b7 to identify environmental justice communities1 including the identification of-- 7i7 criteria to be used in the tool2 and 7ii7 a methodology to determine the cumulative impacts of those criteria2 7,b7 assess and address data gaps in accordance with paragraph 7#d72 and 7,c7 collect data for the environmental justice data repository established under subsection 7d74 7#b7 ,establishment of tool 7,a7 ,in general ,the ,committee1 in consultation with relevant stakeholders and the advisory council1 shall establish an interactive1 transparent1 integrated1 and ,federal ,government-wide tool for assessing and mapping environmental justice communities based on the cumulative impacts of all indicators selected by the ,committee to be integrated into the tool4 7,b7 ,requirements ,in establishing the tool under subparagraph 7,a71 the ,committee shall-- 7i7 integrate into the tool multiple data layers of indicators that fall into categories including-- 7,i7 demographics1 particularly relating to socioeconomic hardship and social stressors1 such as-- 7aa7 race and ethnicity2 7bb7 low income2 7cc7 high unemployment2 7dd7 low levels of home ownership2 7ee7 high rent burden2 7ff7 high transportation burden2 7gg7 low levels of educational attainment2 7hh7 linguistic isolation2 7ii7 energy insecurity or high utility rate burden2 7jj7 food insecurity2 7kk7 health insurance status and access to health care2 and 7ll7 membership in an ,indian ,tribe2 7,,ii7 public health1 particularly data that are indicative of sensitive populations1 such as-- 7aa7 rates of asthma2 7bb7 rates of cardiovascular disease2 7cc7 childhood leukemia or other cancers that correlate with environmental hazards2 7dd7 low birth weight2 7ee7 maternal mortality2 7ff7 rates of lead poisoning2 and 7gg7 rates of diabetes2 7,,iii7 pollution burdens1 such as pollution burdens created by-- 7aa7 toxic chemicals2 7bb7 air pollutants2 7cc7 water pollutants2 7dd7 soil contaminants2 and 7ee7 perfluoroalkyl and polyfluoroalkyl substances2 and 7,,iv7 environmental effects1 such as effects created by proximity to-- 7aa7 risk management plan sites2 7bb7 hazardous waste facilities2 7cc7 sites on the ,national ,priorities ,list developed by the ,president in accordance with section #aje7;a77#h77;,b7 of the ,comprehensive ,environmental ,response1 ,compensation1 and ,liability ,act of #aihj 7#db ,u4,s4,c4 #ifje7;a77#h77;,b772 and 7dd7 fossil fuel infrastructure2 7ii7 investigate how further indicators of vulnerability to the impacts of climate change 7including proximity and exposure to sea level rise1 wildfire smoke1 flooding1 drought1 rising average temperatures1 extreme storms1 and extreme heat1 and financial burdens from flood and fire insurance7 should be incorporated into the tool as an additional set of layers2 7iii7 identify and consider the effects of other indicators relating to environmental justice for integration into the tool as layers1 including-- 7,i7 safe1 sufficient1 and affordable drinking water1 sanitation1 and stormwater services2 7,,ii7 access to and the quality of-- 7aa7 green space and tree canopy cover2 7bb7 healthy food2 7cc7 affordable energy and water2 7dd7 transportation2 7ee7 reliable communication systems1 such as broadband internet2 7ff7 child care2 7gg7 high-quality public schools1 early childhood education1 and child care2 and 7hh7 health care facilities2 7,,iii7 length of commute2 7,,iv7 indoor air quality in multiunit dwellings2 7,v7 mental health2 7,,vi7 labor market categories1 particularly relating to essential workers2 and 7,,vii7 each type of utility expense2 7iv7 consider the implementation of specific regional indicators1 with the potential-- 7,i7 to create regionally and locally downscaled maps in addition to a national map2 7,,ii7 to provide incentives for ,states to collect data and conduct additional analyses to capture conditions specific to their localities2 7,,iii7 to provide resources for and engage in ground-truthing to identify and verify important data with community members2 and 7,,iv7 to develop companion resources for1 and provide technical support to1 regional1 ,state1 local1 or ,tribal governments to create their own maps and environmental justice scores with relevant regional1 ,state1 local1 and ,tribal data2 7v7 identify a methodology to account for the cumulative impacts of all indicators selected by the ,committee under clause 7i71 in addition to other indicators as the ,committee determines to be necessary1 to provide relative environmental justice scores for regions that are-- 7,i7 as small as practicable to identify communities2 and 7,,ii7 not larger than a census tract2 7vi7 ensure that the tool is capable of providing maps of environmental justice communities based on environmental justice scores described in clause 7v72 7vii7 ensure that users of the tool are able to map available layers together or independently as desired2 7viii7 implement a method for users of the tool to generate a map and environmental justice score based on a subset of indicators1 particularly for the purpose of using the tool in addressing various policy needs1 permitting processes1 and investment goals2 7ix7 make the tool customizable to address specific policy needs1 permitting processes1 and investment goals2 7x7 account for conditions that are not captured by the quantitative data used to develop the #a or more maps and environmental justice scores comprising the tool1 by-- 7,i7 developing and executing a plan to perform outreach to relevant communities2 and 7,,ii7 establishing a mechanism by which communities can self-identify as environmental justice communities to be included in the tool1 which may include citing qualitative data on conditions for which quantitative data are lacking1 such as cultural loss in ,tribal communities2 7xi7 consider that the tool-- 7,i7 will be used across the ,federal ,government in screening ,federal policies1 permitting processes1 and investments for environmental and climate justice impacts2 and 7,,ii7 may be used to assess communities for pollution reduction programs2 and 7xii7 carry out such other activities as the ,committee determines to be appropriate4 7#c7 ,transparency and updates 7,a7 ,in general 7i7 ,notice and comment ,the ,committee shall establish the tool described in paragraph 7#b7 after providing notice and an opportunity for public comment4 7ii7 ,hearings ,in carrying out clause 7i71 the ,committee shall hold hearings1 which shall be time and language appropriate1 in communities affected by environmental justice issues in geographically disparate ,states and ,tribal areas4 7,b7 ,updates 7i7 ,annual updates ,the ,committee shall update the tool described in paragraph 7#b7 not less frequently than annually to account for data sets that are updated annually4 7ii7 ,other updates ,not less frequently than once every #c years1 the ,committee shall-- 7,i7 update the indicators1 methodology1 or both for the tool described in paragraph 7#b72 and 7,,ii7 reevaluate data submitted by ,federal departments and agencies that is used for the tool4 7iii7 ,reports ,after the initial establishment of the tool described in paragraph 7#b7 and each update under clause 7i7 or 7ii71 the ,committee shall publish a report describing-- 7,i7 the process for identifying indicators relating to environmental justice in the development of the tool2 7,,ii7 the methodology described in paragraph 7#b77;,b77v72 and 7,,iii7 the use of public input and community engagement in that process4 7,c7 ,training tutorials and sessions 7i7 ,in general ,the ,committee shall-- 7,i7 develop virtual training tutorials and sessions for environmental justice communities for the use of the tool described in paragraph 7#b72 and 7,,ii7 where practicable1 provide in-person training sessions for environmental justice communities for the use of that tool4 7ii7 ,languages ,the tutorials and sessions under clause 7i7 shall be made available in each language commonly used in the applicable environmental justice community4 7,d7 ,public availability 7i7 ,in general ,the ,committee shall make available to the public on an internet website of the ,environmental ,protection ,agency-- 7,i7 the tool described in paragraph 7#b72 7,,ii7 each update under clauses 7i7 and 7ii7 of subparagraph 7,b72 7,,iii7 each report under subparagraph 7,b77iii72 and 7,,iv7 the training tutorials and sessions developed under subparagraph 7,c77i77,i74 7ii7 ,accessibility ,the ,committee shall make the tool1 updates1 and reports described in clause 7i7 accessible to the public by publication in relevant languages and with accessibility functions1 as appropriate4 7iii7 ,requirement ,in carrying out clause 7i77,i71 the ,committee shall take measures to prevent the tool from being misused to discriminate against environmental justice communities1 such as by providing safeguards against the use of downscaled data that may enable the identification of individuals4 7#d7 ,data gap audit 7,a7 ,in general ,in establishing the tool described in paragraph 7#b71 the ,committee shall direct relevant ,federal departments and agencies to conduct an audit of data collected by the department or agency to identify any data that are relevant to environmental justice concerns1 including data relating to-- 7i7 public health metrics2 7ii7 toxic chemicals2 7iii7 socioeconomic demographics2 7iv7 air quality2 7v7 water quality2 and 7vi7 killings of individuals by law enforcement officers4 7,b7 ,requirements ,an audit described in subparagraph 7,a7 shall-- 7i7 examine the granularity and accessibility of the data2 7ii7 address the need for improved air quality monitoring2 and 7iii7 include recommendations to other ,federal departments and agencies on means to improve the quality1 granularity1 and transparency of1 and public involvement in1 data collection and dissemination4 7,c7 ,improvements ,the ,committee shall direct a ,federal department or agency1 in conducting an audit under subparagraph 7,a71 to address gaps in existing data collection that will assist the ,committee in establishing and operating the tool described in paragraph 7#b71 including by providing to the department or agency-- 7i7 benchmarks to meet in addressing the gaps2 7ii7 instructions for consistency in data formatting that will allow for inclusion of data in the environmental justice data repository described in subsection 7d72 and 7iii7 best practices for collecting data in collaboration with local organizations and partners1 such as engaging in ground-truthing4 7,d7 ,reports ,not later than #ahj days after a ,federal department or agency has conducted an audit under subparagraph 7,a71 the ,committee shall-- 7i7 make available to the public on an internet website of the ,environmental ,protection ,agency a report describing the findings and conclusions of the audit1 including the progress made by the ,federal department or agency in addressing environmental justice data gaps2 and 7ii7 submit the report described in clause 7i7 to-- 7,i7 the ,committee on ,environment and ,public ,works of the ,senate2 7,,ii7 the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate2 7,,iii7 the ,committee on ,energy and ,commerce of the ,house of ,representatives2 and 7,,iv7 the ,committee on ,education and the ,workforce of the ,house of ,representatives4 7d7 ,environmental justice data repository 7#a7 ,in general ,the ,administrator shall establish an environmental justice data repository to maintain-- 7,a7 the data collected by the ,committee through the establishment of the tool described in subsection 7c77#b7 and the audits conducted under subsection 7c77#d77;,a72 and 7,b7 any subnational data collected under paragraph 7#c77;,b74 7#b7 ,updates ,the ,administrator shall update the data in the data repository described in paragraph 7#a7 as frequently as practicable1 including every year if practicable1 but not less frequently than once every #c years4 7#c7 ,availability2 inclusion of subnational data ,the ,administrator-- 7,a7 shall make the data repository described in paragraph 7#a7 available to regional1 ,state1 local1 and ,tribal governments2 and 7,b7 may collaborate with the governments described in subparagraph 7,a7 to include within that data repository subnational data in existence before the establishment of the tool described in subsection 7c77#b7 and the completion of the audits under subsection 7c77#d77;,a74 7#d7 ,requirement ,the ,administrator shall take measures to prevent the data in the data repository described in paragraph 7#a7 from being misused to discriminate against environmental justice communities1 such as by providing safeguards against the use of downscaled data that may enable the identification of individuals4 7e7 ,authorization of appropriations ,there are authorized to be appropriated to the ,administrator to carry out this section1 including any necessary administrative costs of the ,committee-- 7#a7 #bj1jjj1jjj for each of fiscal years #bjbe and #bjbf2 and 7#b7 #ah1jjj1jjj for each of fiscal years #bjbg through #bjbi4 7f7 ,effect ,nothing in any provision of this section relating to the tool described in subsection 7c77#b7 prohibits a ,state from developing a map relating to environmental justice or pollution burden that relies on different data1 or analyzes data differently1 than that tool4 #ajjab4 ,antiracism in public health 7a7 ,public health research and investment in dismantling structural racism ,part ,b of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bdc et seq471 as amended by section #ebja7;e71 is further amended by adding at the end the following3 #cbj;,d4 ,national ,center on ,antiracism and ,health 7a7 ,in general 7#a7 ,national center ,there is established within the ,centers for ,disease ,control and ,prevention a center to be known as the ,national ,center on ,antiracism and ,health 7referred to in this section as the ,center74 ,the ,director of the ,centers for ,disease ,control and ,prevention shall appoint a director to head the ,center who has experience living in and working with racial and ethnic minority communities4 ,the ,center shall promote public health by-- 7,a7 declaring racism a public health crisis and naming racism as an historical and present threat to the physical and mental health and well-being of the ,united ,states and world2 7,b7 aiming to develop new knowledge in the science and practice of antiracism1 including by identifying the mechanisms by which racism operates in the provision of health care and in systems that impact health and well-being2 7,c7 transferring that knowledge into practice1 including by developing interventions that dismantle the mechanisms of racism and replace such mechanisms with equitable structures1 policies1 practices1 norms1 and values so that a healthy society can be realized2 and 7,d7 contributing to a national and global conversation regarding the impacts of racism on the health and well-being of the ,united ,states and world4 7#b7 ,general duties ,the ,secretary1 acting through the ,center1 shall undertake activities to carry out the mission of the ,center as described in paragraph 7#a71 such as the following3 7,a7 ,conduct research into1 collect1 analyze and make publicly available data on1 and provide leadership and coordination for the science and practice of antiracism1 the public health impacts of structural racism1 and the effectiveness of intervention strategies to address these impacts4 ,topics of research and data collection under this subparagraph may include identifying and understanding-- 7i7 policies and practices that have a disparate impact on the health and well-being of communities of color2 7ii7 the public health impacts of implicit racial bias1 ,white supremacy1 weathering1 xenophobia1 discrimination1 and prejudice2 7iii7 the social determinants of health resulting from structural racism1 including poverty1 housing1 employment1 political participation1 and environmental factors2 and 7iv7 the intersection of racism and other systems of oppression1 including as related to age1 sexual orientation1 gender identity1 and disability status4 7,b7 ,award noncompetitive grants and cooperative agreements to eligible public and nonprofit private entities1 including ,state1 local1 territorial1 and ,tribal health agencies and organizations1 for the research and collection1 analysis1 and reporting of data on the topics described in subparagraph 7,a74 7,c7 ,establish1 through grants or cooperative agreements1 at least #c regional centers of excellence1 located in racial and ethnic minority communities1 in antiracism for the purpose of developing new knowledge in the science and practice of antiracism in health by researching1 understanding1 and identifying the mechanisms by which racism operates in the health space1 racial and ethnic inequities in health care access and outcomes1 the history of successful antiracist movements in health1 and other antiracist public health work4 7,d7 ,establish a clearinghouse within the ,centers for ,disease ,control and ,prevention for the collection and storage of data generated under the programs implemented under this section for which there is not an otherwise existing surveillance system at the ,centers for ,disease ,control and ,prevention4 ,such data shall-- 7i7 be comprehensive and disaggregated1 to the extent practicable1 by including racial1 ethnic1 primary language1 sex1 gender identity1 sexual orientation1 age1 socioeconomic status1 and disability disparities2 7ii7 be made publicly available2 7iii7 protect the privacy of individuals whose information is included in such data2 and 7iv7 comply with privacy protections under the regulations promulgated under section #bfd7;c7 of the ,health ,insurance ,portability and ,accountability ,act of #aiif4 7,e7 ,provide information and education to the public on the public health impacts of structural racism and on antiracist public health interventions4 7,f7 ,consult with other ,centers and ,national ,institutes within the ,centers for ,disease ,control and ,prevention1 including the ,office of ,health ,equity1 the ,office of ,tribal ,affairs and ,strategic ,alliances1 the ,office of ,rural ,health1 and the ,office of ,island ,affairs1 to ensure that scientific and programmatic activities initiated by the agency consider structural racism in their designs1 conceptualizations1 and executions1 which shall include-- 7i7 putting measures of racism in population-based surveys2 7ii7 establishing a ,federal ,advisory ,committee on racism and health for the ,centers for ,disease ,control and ,prevention2 7iii7 developing training programs1 curricula1 and seminars for the purposes of training public health professionals and researchers around issues of race1 racism1 and antiracism2 7iv7 providing standards and best practices for programming and grant recipient compliance with ,federal data collection standards1 including section #caja of the ,public ,health ,service ,act2 and 7v7 establishing leadership and stakeholder councils with experts and leaders in racism and public health disparities4 7,g7 ,coordinate with the ,indian ,health ,service and with the ,tribal ,advisory ,committee of the ,centers for ,disease ,control and ,prevention to ensure meaningful ,tribal consultation1 the gathering of information from ,tribal authorities1 and respect for ,tribal data sovereignty4 7,h7 ,engage in government to government consultation with ,indian ,tribes and ,tribal organizations4 7,i7 ,at least every #b years1 produce and publicly post on the ,centers for ,disease ,control and ,prevention's website a report on antiracist activities completed by the ,center1 which may include newly identified antiracist public health practices4 7b7 ,definitions ,in this section3 7#a7 ,antiracism ,the term antiracism is a collection of antiracist policies that lead to racial equity1 and are substantiated by antiracist ideas4 7#b7 ,antiracist ,the term antiracist is any measure that produces or sustains racial equity between racial groups4 7c7 ,authorization of appropriations ,there is authorized to be appropriated such sums as may be necessary to carry out this section4 4 7b7 ,public health research and investment in police violence 7#a7 ,in general ,the ,secretary shall establish within the ,national ,center for ,injury ,prevention and ,control of the ,centers for ,disease ,control and ,prevention 7referred to in this subsection as the ,center7 a law enforcement violence prevention program4 7#b7 ,general duties ,in implementing the program under paragraph 7#a71 the ,center shall conduct research into1 and provide leadership and coordination for-- 7,a7 the understanding and promotion of knowledge about the public health impacts of uses of force by law enforcement1 including police brutality and violence2 7,b7 developing public health interventions and perspectives for eliminating deaths1 injury1 trauma1 and negative mental health effects from police presence and interactions1 including police brutality and violence2 and 7,c7 ensuring comprehensive data collection1 analysis1 and reporting regarding police violence and misconduct1 in consultation with the ,department of ,justice and independent researchers4 7#c7 ,functions ,under the program under paragraph 7#a71 the ,center shall-- 7,a7 summarize and enhance the knowledge of the distribution1 status1 and characteristics of law enforcement-related death1 trauma1 and injury2 7,b7 conduct research and prepare1 with the assistance of ,state public health departments-- 7i7 statistics on law enforcement-related death1 injury1 and brutality2 7ii7 studies of the factors1 including legal1 socioeconomic1 discrimination1 and other factors that correlate with or influence police brutality2 7iii7 public information about uses of force by law enforcement1 including police brutality and violence1 for the practical use of the public health community1 including publications that synthesize information relevant to the national goal of understanding police violence and methods for its control2 7iv7 information to identify socioeconomic groups1 communities1 and geographic areas in need of study1 and a strategic plan for research necessary to comprehend the extent and nature of police uses of force by law enforcement1 including police brutality and violence1 and determine what options exist to reduce or eradicate death and injury that result2 and 7v7 best practices in police violence prevention in other countries2 7,c7 award grants1 contracts1 and cooperative agreements to provide for the conduct of epidemiologic research on uses of force by law enforcement1 including police brutality and violence1 by ,federal1 ,state1 local1 and private agencies1 institutions1 organizations1 and individuals2 7,d7 award grants1 contracts1 and cooperative agreements to community groups1 independent research organizations1 academic institutions1 and other entities to support1 execute1 or conduct research on interventions to reduce or eliminate uses of force by law enforcement1 including police brutality and violence2 7,e7 coordinate with the ,department of ,justice and other ,federal1 ,state1 and local agencies on the standardization of data collection1 storage1 and retrieval necessary to collect1 evaluate1 analyze1 and disseminate information about the extent and nature of uses of force by law enforcement1 including police brutality and violence1 as well as options for the eradication of such practices2 7,f7 submit an annual report to ,congress on research findings with recommendations to improve data collection and standardization and to disrupt processes in policing that preserve and reinforce racism and racial disparities in public health2 7,g7 conduct primary research and explore uses of force by law enforcement1 including police brutality and violence1 and options for its control2 and 7,h7 study alternatives to law enforcement response as a method of reducing police violence4 7#d7 ,authorization of appropriations ,there is authorized to be appropriated such sums as may be necessary to carry out this subsection4 #ajjac4 ,,lgbtq essential data 7a7 ,improving data collection on the sexual orientation and gender identity of deceased individuals through the ,national ,violent ,death ,reporting ,system 7#a7 ,collection of sexual orientation and gender identity data 7,a7 ,in general ,not later than #abj days after the date of enactment of this ,act1 the ,director of the ,centers for ,disease ,control and ,prevention shall take measures to improve the incidence of the collection of information on the sexual orientation and gender identity of deceased individuals through the ,national ,violent ,death ,reporting ,system or any successor programs4 7,b7 ,confidentiality ,any information collected relating to the sexual orientation or gender identity of a decedent shall be maintained in accordance with the confidentiality and privacy standards and policies for the protection of individuals applicable to all other data collected for purposes of the ,national ,violent ,death ,reporting ,system4 7#b7 ,definitions ,in this subsection3 7,a7 ,gender identity ,the term gender identity means an individual's sense of being male1 female1 transgender1 or another gender1 as distinct from the individual's sex assigned at birth4 7,b7 ,sexual orientation ,the term sexual orientation means how a person identifies in terms of their emotional1 romantic1 or sexual attractions1 and includes identification as straight1 heterosexual1 gay1 lesbian1 or bisexual1 among other terms4 7#c7 ,authorization ,there is authorized to be appropriated #be1jjj1jjj for fiscal year #bjbe to carry out this subsection4 7b7 ,sense of ,congress ,it is the sense of ,congress that-- 7#a7 the ,centers for ,disease ,control and ,prevention has made significant efforts to encourage ,states and other jurisdictions to collect data on sexual orientation and gender identity through the ,national ,violent ,death ,reporting ,system2 and 7#b7 jurisdictions that participate in the collection of such data through the ,national ,violent ,death ,reporting ,system should be commended for their participation4 #ajjad4 ,social determinants accelerator 7a7 ,purposes ,the purposes of this section are as follows3 7#a7 ,to establish effective1 coordinated ,federal technical assistance to help ,state and local governments to improve outcomes and cost-effectiveness of1 and return on investment from1 health and social services programs4 7#b7 ,to build a pipeline of ,state and locally designed1 cross-sector interventions and strategies that generate rigorous evidence about how to improve health and social outcomes1 and increase the cost-effectiveness of1 and return on investment from1 ,federal1 ,state1 local1 and ,tribal health and social services programs4 7#c7 ,to enlist ,state and local governments and the service providers of such governments as partners in identifying ,federal statutory1 regulatory1 and administrative challenges in improving the health and social outcomes of1 cost-effectiveness of1 and return on investment from1 ,federal spending on individuals enrolled in the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#d7 ,to develop strategies to improve health and social outcomes without denying services to1 or restricting the eligibility of1 vulnerable populations4 7b7 ,social determinants accelerator council 7#a7 ,establishment ,the ,secretary1 in coordination with the ,administrator of the ,centers for ,medicare ,medicaid ,services 7referred to in this section as the ,administrator71 shall establish an interagency council1 to be known as the ,social ,determinants ,accelerator ,interagency ,council 7referred to in this section as the ,council71 to achieve the purposes listed in subsection 7a74 7#b7 ,membership 7,a7 ,federal composition ,the ,council shall be composed of at least one designee from each of the following ,federal agencies3 7i7 ,the ,office of ,management and ,budget4 7ii7 ,the ,department of ,agriculture4 7iii7 ,the ,department of ,education4 7iv7 ,the ,indian ,health ,service4 7v7 ,the ,department of ,housing and ,urban ,development4 7vi7 ,the ,department of ,labor4 7vii7 ,the ,department of ,transportation4 7viii7 ,any other ,federal agency the ,chair of the ,council determines necessary4 7,b7 ,designation 7i7 ,in general ,the head of each agency specified in subparagraph 7,a7 shall designate at least one employee described in clause 7ii7 to serve as a member of the ,council4 7ii7 ,responsibilities ,an employee described in this clause shall be a senior employee of the agency-- 7,i7 whose responsibilities relate to authorities1 policies1 and procedures with respect to the health and well-being of individuals receiving medical assistance under a ,state plan 7or a waiver of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq472 or 7,,ii7 who has authority to implement and evaluate transformative initiatives that harness data or conducts rigorous evaluation to improve the impact and cost-effectiveness of federally funded services and benefits4 7,c7 ,,hhs representation ,in addition to the designees under subparagraph 7,a71 the ,council shall include designees from at least three agencies within the ,department of ,health and ,human ,services1 including the ,centers for ,medicare ,medicaid ,services1 at least one of whom shall meet the criteria under subparagraph 7,b77ii74 7,d7 ,,omb role ,the ,director of the ,office of ,management and ,budget shall facilitate the timely resolution of ,government-wide and multiagency issues to help the ,council achieve consensus recommendations described under paragraph 7#c77;,a74 7,e7 ,non-,federal composition ,the ,comptroller ,general of the ,united ,states may designate up to #f ,council designees-- 7i7 who have relevant subject matter expertise1 including expertise implementing and evaluating transformative initiatives that harness data and conduct evaluations to improve the impact and cost-effectiveness of ,federal ,government services2 and 7ii7 that each represent-- 7,i7 ,state1 local1 and ,tribal health and human services agencies2 7,,ii7 public housing authorities or ,state housing finance agencies2 7,,iii7 ,state and local government budget offices2 7,,iv7 ,state ,medicaid agencies2 or 7,v7 national consumer advocacy organizations4 7,f7 ,chair 7i7 ,in general ,the ,secretary shall select the ,chair of the ,council from among the members of the ,council4 7ii7 ,initiating guidance ,the ,chair1 on behalf of the ,council1 shall identify and invite individuals from diverse entities to provide the ,council with advice and information pertaining to addressing social determinants of health1 including-- 7,i7 individuals from ,state and local government health and human services agencies2 7,,ii7 individuals from ,state ,medicaid agencies2 7,,iii7 individuals from ,state and local government budget offices2 7,,iv7 individuals from public housing authorities or ,state housing finance agencies2 7,v7 individuals from nonprofit organizations1 small businesses1 and philanthropic organizations2 7,,vi7 advocates2 7,,vii7 researchers2 and 7,,viii7 any other individuals the ,chair determines to be appropriate4 7#c7 ,duties ,the duties of the ,council are-- 7,a7 to make recommendations to the ,secretary and the ,administrator regarding the criteria for making awards under subsection 7b72 7,b7 to identify ,federal authorities and opportunities for use by ,states or local governments to improve coordination of funding and administration of ,federal programs1 the beneficiaries of whom include individuals described in subsection 7a71 and which may be unknown or underutilized and to make information on such authorities and opportunities publicly available2 7,c7 to provide targeted technical assistance to ,states developing a social determinants accelerator plan under subsection 7c71 including identifying potential statutory or regulatory pathways for implementation of the plan and assisting in identifying potential sources of funding to implement the plan2 7,d7 to report to ,congress annually on the subjects set forth in paragraph 7#e72 7,e7 to develop and disseminate evaluation guidelines and standards that can be used to reliably assess the impact of an intervention or approach that may be implemented pursuant to this section on outcomes1 cost-effectiveness of1 and return on investment from ,federal1 ,state1 local1 and ,tribal governments1 and to facilitate technical assistance1 where needed1 to help to improve ,state and local evaluation designs and implementation2 7,f7 to seek feedback from ,state1 local1 and ,tribal governments1 including through an annual survey by an independent third party1 on how to improve the technical assistance the ,council provides to better equip ,state1 local1 and ,tribal governments to coordinate health and social service programs2 7,g7 to solicit applications for grants under subsection 7c72 and 7,h7 to coordinate with other cross-agency initiatives focused on improving the health and well-being of low-income and at-risk populations in order to prevent unnecessary duplication between agency initiatives4 7#d7 ,schedule ,not later than #fj days after the date of enactment of this ,act1 the ,council shall convene to develop a schedule and plan for carrying out the duties described in paragraph 7#c71 including solicitation of applications for the grants under subsection 7c74 7#e7 ,report to ,congress ,the ,council shall submit an annual report to ,congress1 which shall include-- 7,a7 a list of the ,council members2 7,b7 a description of the activities and expenditures of the ,council2 7,c7 summaries of the interventions and approaches that will be supported by ,state1 local1 and ,tribal governments that received a grant under subsection 7c71 including-- 7i7 the best practices and evidence-based approaches such governments plan to employ to achieve the purposes listed in subsection 7a72 and 7ii7 a description of how the practices and approaches will impact the outcomes1 cost-effectiveness of1 and return on investment from1 ,federal1 ,state1 local1 and ,tribal governments with respect to such purposes2 7,d7 the feedback received from ,state and local governments on ways to improve the technical assistance of the ,council1 including findings from a third-party survey and actions the ,council plans to take in response to such feedback2 and 7,e7 the major statutory1 regulatory1 and administrative challenges identified by ,state1 local1 and ,tribal governments that received a grant under subsection 7c71 and the actions that ,federal agencies are taking to address such challenges4 7#f7 ,,faca applicability ,chapter #aj of title #e1 ,united ,states ,code1 shall not apply to the ,council4 7#g7 ,council procedures ,the ,secretary1 in consultation with the ,comptroller ,general of the ,united ,states and the ,director of the ,office of ,management and ,budget1 shall establish procedures for the ,council to-- 7,a7 ensure that adequate resources are available to effectively execute the responsibilities of the ,council2 7,b7 effectively coordinate with other relevant advisory bodies and working groups to avoid unnecessary duplication2 7,c7 create transparency to the public and ,congress with regard to ,council membership1 costs1 and activities1 including through use of modern technology and social media to disseminate information2 and 7,d7 avoid conflicts of interest that would jeopardize the ability of the ,council to make decisions and provide recommendations4 7c7 ,social determinants accelerator grants to ,states or local governments 7#a7 ,grants to ,states1 local governments1 and tribes ,not later than #ahj days after the date of enactment of this ,act1 the ,administrator1 in consultation with the ,secretary and the ,council1 shall award on a competitive basis not more than #be grants to eligible applicants described in paragraph 7#b71 for the development of social determinants accelerator plans1 as described in paragraph 7#f74 7#b7 ,eligible applicant ,an eligible applicant described in this subsection is a ,state1 local1 or ,tribal health or human services agency that-- 7,a7 demonstrates the support of relevant parties across relevant ,state1 local1 or ,tribal jurisdictions2 and 7,b7 in the case of an applicant that is a local government agency1 provides to the ,secretary a letter of support from the lead ,state health or human services agency for the ,state in which the local government is located4 7#c7 ,amount of grant ,the ,administrator1 in coordination with the ,council1 shall determine the total amount that the ,administrator will make available to each grantee under this subsection4 7#d7 ,application ,an eligible applicant seeking a grant under this subsection shall include in the application the following information3 7,a7 ,the target population 7or populations7 that would benefit from implementation of the social determinants accelerator plan proposed to be developed by the applicant4 7,b7 ,a description of the objective or objectives and outcome goals of such proposed plan1 which shall include at least one health outcome and at least one other important social outcome4 7,c7 ,the sources and scope of inefficiencies that1 if addressed by the plan1 could result in improved cost-effectiveness of or return on investment from ,federal1 ,state1 local1 and ,tribal governments4 7,d7 ,a description of potential interventions that could be designed or enabled using such proposed plan4 7,e7 ,the ,state1 local1 ,tribal1 academic1 nonprofit1 community-based organizations1 and other private sector partners that would participate in the development of the proposed plan and subsequent implementation of programs or initiatives included in such proposed plan4 7,f7 ,such other information as the ,administrator1 in consultation with the ,secretary and the ,council1 determines necessary to achieve the purposes of this section4 7#e7 ,use of funds ,a recipient of a grant under this subsection may use funds received through the grant for the following purposes3 7,a7 ,to convene and coordinate with relevant government entities and other stakeholders across sectors to assist in the development of a social determinants accelerator plan4 7,b7 ,to identify populations of individuals receiving medical assistance under a ,state plan 7or a waiver of such plan7 under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 who may benefit from the proposed approaches to improving the health and well-being of such individuals through the implementation of the proposed social determinants accelerator plan4 7,c7 ,to engage qualified research experts to advise on relevant research and to design a proposed evaluation plan1 in accordance with the standards and guidelines issued by the ,administrator4 7,d7 ,to collaborate with the ,council to support the development of social determinants accelerator plans4 7,e7 ,to prepare and submit a final social determinants accelerator plan to the ,council4 7#f7 ,contents of plans ,a social determinants accelerator plan developed under this subsection shall include the following3 7,a7 ,a description of the target population 7or populations7 that would benefit from implementation of the social determinants accelerator plan1 including an analysis describing the projected impact on the well-being of individuals described in paragraph 7#e77;,b74 7,b7 ,a description of the interventions or approaches designed under the social determinants accelerator plan and the evidence for selecting such interventions or approaches4 7,c7 ,the objectives and outcome goals of such interventions or approaches1 including at least one health outcome and at least one other important social outcome4 7,d7 ,a plan for accessing and linking relevant data to enable coordinated benefits and services for the jurisdictions described in paragraph 7#b77;,a7 and an evaluation of the proposed interventions and approaches4 7,e7 ,a description of the ,state1 local1 ,tribal1 academic1 nonprofit1 or community-based organizations1 or any other private sector organizations that would participate in implementing the proposed interventions or approaches1 and the role each would play to contribute to the success of the proposed interventions or approaches4 7,f7 ,the identification of the funding sources that would be used to finance the proposed interventions or approaches4 7,g7 ,a description of any financial incentives that may be provided1 including outcome-focused contracting approaches to encourage service providers and other partners to improve outcomes of1 cost-effectiveness of1 and return on investment from1 ,federal1 ,state1 local1 or ,tribal government spending4 7,h7 ,the identification of the applicable ,federal1 ,state1 local1 or ,tribal statutory and regulatory authorities1 including waiver authorities1 to be leveraged to implement the proposed interventions or approaches4 7,i7 ,a description of potential considerations that would enhance the impact1 scalability1 or sustainability of the proposed interventions or approaches and the actions the grant awardee would take to address such considerations4 7,j7 ,a proposed evaluation plan1 to be carried out by an independent evaluator1 to measure the impact of the proposed interventions or approaches on the outcomes of1 cost-effectiveness of1 and return on investment from1 ,federal1 ,state1 local1 and ,tribal governments4 7,k7 ,precautions for ensuring that vulnerable populations will not be denied access to ,medicaid or other essential services as a result of implementing the proposed plan4 7d7 ,funding 7#a7 ,in general ,out of any money in the ,treasury not otherwise appropriated1 there is appropriated to carry out this section #be1jjj1jjj for the period of fiscal years #bjbe through #bjbi1 of which up to #e1jjj1jjj may be used to carry out this section1 to remain available for obligation until the date that is #e years after the date of enactment of this ,act4 7#b7 ,reservation of funds 7,a7 ,in general ,of the funds made available under paragraph 7#a71 the ,secretary shall reserve not less than #bj percent to award grants to eligible applicants for the development of social determinants accelerator plans under subsection 7c7 intended to serve rural populations4 7,b7 ,exception ,in the case of a fiscal year for which the ,secretary determines that there are not sufficient eligible applicants for grants under subsection 7c7 that are intended to serve rural populations and the ,secretary cannot satisfy the #bj-percent requirement1 the ,secretary may reserve an amount that is less than #bj percent of amounts made available under paragraph 7#a7 to award grants for such purpose4 7#c7 ,rule of construction ,nothing in this section shall prevent ,federal agencies represented on the ,council from contributing additional funding from other sources to support activities to improve the effectiveness of the ,council4 #ajjae4 ,improving social determinants of health 7a7 ,social ,determinants of ,health ,program 7#a7 ,program ,to the extent and in the amounts made available in advance in appropriations ,acts1 the ,director of the ,centers for ,disease ,control and ,prevention 7in this section referred to as the ,director7 shall carry out a program1 to be known as the ,social ,determinants of ,health ,program 7in this section referred to as the ,program71 to achieve the following goals3 7,a7 ,improve health outcomes and reduce health inequities by coordinating social determinants of health activities across the ,centers for ,disease ,control and ,prevention4 7,b7 ,improve the capacity of public health agencies and community organizations to address social determinants of health in communities4 7#b7 ,activities ,to achieve the goals listed in paragraph 7#a71 the ,director shall carry out activities including the following3 7,a7 ,coordinating across the ,centers for ,disease ,control and ,prevention to ensure that relevant programs consider and incorporate social determinants of health in grant awards and other activities4 7,b7 ,awarding grants under subsection 7b7 to ,state1 local1 territorial1 and ,tribal health agencies and organizations1 and to other eligible entities1 to address social determinants of health in target communities4 7,c7 ,awarding grants under subsection 7c7 to nonprofit organizations and public or other nonprofit institutions of higher education-- 7i7 to conduct research on best practices to improve social determinants of health2 7ii7 to provide technical assistance1 training1 and evaluation assistance to grantees under subsection 7b72 and 7iii7 to disseminate best practices to grantees under subsection 7b74 7,d7 ,coordinating1 supporting1 and aligning activities of the ,centers for ,disease ,control and ,prevention related to social determinants of health with activities of other ,federal agencies related to social determinants of health1 including such activities of agencies in the ,department of ,health and ,human ,services such as the ,centers for ,medicare ,medicaid ,services4 7,e7 ,collecting and analyzing data related to the social determinants of health4 7b7 ,grants ,to address social determinants of health 7#a7 ,in general ,the ,director1 as part of the ,program1 shall award grants to eligible entities to address social determinants of health in their communities4 7#b7 ,eligibility ,to be eligible to apply for a grant under this subsection1 an entity shall be-- 7,a7 a ,state1 local1 territorial1 or ,tribal health agency or organization2 7,b7 a qualified nongovernmental entity1 as defined by the ,director2 or 7,c7 a consortium of entities that includes a ,state1 local1 territorial1 or ,tribal health agency or organization4 7#c7 ,use of funds 7,a7 ,in general ,a grant under this subsection shall be used to address social determinants of health in a target community by designing and implementing innovative1 evidence-based1 cross-sector strategies4 7,b7 ,target community ,for purposes of this subsection1 a target community shall be a ,state1 county1 city1 or other municipality4 7#d7 ,priority ,in awarding grants under this subsection1 the ,director shall prioritize applicants proposing to serve target communities with significant unmet health and social needs1 as defined by the ,director4 7#e7 ,application ,to seek a grant under this subsection1 an eligible entity shall-- 7,a7 submit an application at such time1 in such manner1 and containing such information as the ,director may require2 7,b7 propose a set of activities to address social determinants of health through evidence-based1 cross-sector strategies1 which activities may include-- 7i7 collecting quantifiable data from health care1 social services1 and other entities regarding the most significant gaps in health-promoting social1 economic1 and environmental needs2 7ii7 identifying evidence-based approaches to meeting the nonmedical1 social needs of populations identified by data collection described in clause 7i71 such as unstable housing or food insecurity2 7iii7 developing scalable methods to meet patients' social needs identified in clinical settings or other sites2 7iv7 convening entities such as local and ,state governmental and nongovernmental organizations1 health systems1 payors1 and community-based organizations to review1 plan1 and implement community-wide interventions and strategies to advance health-promoting social conditions2 7v7 monitoring and evaluating the impact of activities funded through the grant on the health and well-being of the residents of the target community and on the cost of health care2 and 7vi7 such other activities as may be specified by the ,director2 7,c7 demonstrate how the eligible entity will collaborate with-- 7i7 health systems2 7ii7 payors1 including1 as appropriate1 ,medicaid managed care organizations 7as defined in section #aijc7m77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7m77#a77;,a7771 ,medicare ,advantage plans under part ,c of title ,,xviii of such ,act 7#db ,u4,s4,c4 #aciew-#ba et seq471 and health insurance issuers and group health plans 7as such terms are defined in section #bgia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia772 7iii7 other relevant stakeholders and initiatives in areas of need1 such as the ,accountable ,health ,communities ,model of the ,centers for ,medicare ,medicaid ,services1 health homes under the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 community-based organizations1 and human services organizations2 7iv7 other non-health care sector organizations1 including organizations focusing on transportation1 housing1 or food access2 and 7v7 local employers2 and 7,d7 identify key health inequities in the target community and demonstrate how the proposed efforts of the eligible entity would address such inequities4 7#f7 ,monitoring and evaluation ,as a condition of receipt of a grant under this subsection1 a grantee shall agree to submit an annual report to the ,director describing the activities carried out through the grant and the outcomes of such activities4 7#g7 ,independent national evaluation 7,a7 ,in general ,not later than #e years after the first grants are awarded under this subsection1 the ,director shall provide for the commencement of an independent national evaluation of the program under this subsection4 7,b7 ,report to ,congress ,not later than #fj days after receiving the results of such independent national evaluation1 the ,director shall report such results to ,congress4 7c7 ,research and training ,the ,director1 as part of the ,program-- 7#a7 shall award grants to nonprofit organizations and public or other nonprofit institutions of higher education-- 7,a7 to conduct research on best practices to improve social determinants of health2 7,b7 to provide technical assistance1 training1 and evaluation assistance to grantees under subsection 7b72 and 7,c7 to disseminate best practices to grantees under subsection 7b72 and 7#b7 may require a grantee under paragraph 7#a7 to provide technical assistance and capacity building to entities that are eligible entities under subsection 7b7 but not receiving funds through such subsection4 7d7 ,funding 7#a7 ,in general ,there is authorized to be appropriated to carry out this section1 #ej1jjj1jjj for each of fiscal years #bjbe through #bjcj4 7#b7 ,allocation ,of the amount made available to carry out this section for a fiscal year1 not less than #ge percent shall be used for grants under subsections 7b7 and 7c74 #ajjaf4 ,notification regarding ,,snap for students receiving ,federal work-study assistance ,section #ddc of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajhg-ec7 is amended by adding at the end the following3 7f7 ,notification regarding ,,snap 7#a7 ,in general ,an institution receiving a grant under this part shall send a notification 7by email or other electronic means7 to each eligible student informing the student of their potential eligibility for participation in ,,snap and the process for obtaining more information1 confirming eligibility1 and accessing benefits under that program4 ,the notification shall be developed by the ,secretary of ,education in consultation with the ,secretary of ,agriculture1 and shall include details on eligibility requirements for participation in ,,snap that a student must satisfy4 ,the notification shall be1 to the extent practicable1 specific to the student's ,state of residence and shall provide contact information for the local office where an application for ,,snap may be made4 7#b7 ,evidence of participation in federally financed work-study program ,the notification under paragraph 7#a7 shall include an official document confirming that the recipient is an eligible student sufficient for purposes of demonstrating that the exclusion from ineligibility for participation in ,,snap under section #f7;e77#d7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjae7;e77#d77 applies to the student4 7#c7 ,guidance ,the ,secretary of ,education1 in consultation with the ,secretary of ,agriculture1 shall provide guidance to ,states and institutions of higher education on how to identify and communicate with students who are likely to be eligible for ,,snap1 including those eligible for a ,state or federally financed work-study program4 7#d7 ,definitions ,for purposes of this subsection3 7,a7 ,the term eligible student means a student receiving work-study assistance under this part4 7,b7 ,the term ,,snap means the supplemental nutrition assistance program 7as defined in section #c7t7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjab7t7774 4 ,b ,gun ,violence #ajaja4 ,reaffirming research authority of the ,centers for ,disease ,control and ,prevention 7a7 ,in general ,section #cia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;b7 is amended-- 7#a7 in subsection 7a77#a71 by striking research relating to the causes1 mechanisms1 prevention1 diagnosis1 treatment of injuries1 and rehabilitation from injuries2 and inserting the following3 research1 including data collection1 relating to-- 7,a7 the causes1 mechanisms1 prevention1 diagnosis1 and treatment of injuries1 including with respect to gun violence2 and 7,b7 rehabilitation from such injuries2 2 and 7#b7 by adding at the end the following3 7c7 ,no advocacy or promotion of gun control ,nothing in this section shall be construed to-- 7#a7 authorize the ,secretary to give assistance1 make grants1 or enter into cooperative agreements or contracts for the purpose of advocating or promoting gun control2 or 7#b7 permit a recipient of any assistance1 grant1 cooperative agreement1 or contract under this section to use such assistance1 grant1 agreement1 or contract for the purpose of advocating or promoting gun control4 4 #ajajb4 ,national ,violent ,death ,reporting ,system ,the ,secretary1 acting through the ,director of the ,centers for ,disease ,control and ,prevention1 shall improve the ,national ,violent ,death ,reporting ,system 7as authorized by sections #cja7;a7 and #cia7;a7 of the ,public ,service ,health ,act 7#db ,u4,s4,c4 #bda7;a71 #bhj;b7a771 particularly through the inclusion of additional ,states and activities to increase the quality1 type1 and timeliness of reported data4 ,participation in the ,system by the ,states shall be voluntary4 #ajajc4 ,report on effects of gun violence on public health ,not later than one year after the date of enactment of this ,act1 and annually thereafter1 the ,surgeon ,general shall submit to ,congress a report on the effects on public health1 including mental health1 of gun violence in the ,united ,states during the preceding year1 and the status of actions taken to address such effects4 #ajajd4 ,report on effects of gun violence on mental health in minority communities ,not later than one year after the date of enactment of this ,act1 the ,deputy ,assistant ,secretary for ,minority ,health shall submit to ,congress a report on the effects of gun violence on public health1 including mental health1 in minority communities in the ,united ,states1 and the status of actions taken to address such effects4 ,c ,nutrition for women1 children1 families #a ,senior hunger prevention #ajbja4 ,short title ,this chapter may be cited as the ,senior ,hunger ,prevention ,act of #bjbd4 #ajbjb4 ,improving ,,snap efficacy 7a7 ,certification period ,section #c7;f7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjab7;f77 is amended1 in the second sentence1 by striking #bd and inserting #cf4 7b7 ,standard medical expense deduction ,section #e7;e77#e7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjad7;e77#e77 is amended-- 7#a7 in the paragraph heading1 by striking ,excess medical and inserting ,medical2 7#b7 in subparagraph 7,a71 by striking an excess medical and all that follows through the period at the end and inserting a standard medical deduction or a medical expense deduction of actual costs for the allowable medical expenses incurred by the elderly or disabled member1 exclusive of special diets42 7#c7 in subparagraph 7,b77i71 by striking excess2 and 7#d7 by adding at the end the following3 7,d7 ,standard medical expense deduction amount 7i7 ,in general ,except as provided in clause 7ii71 the standard medical expense deduction shall be equal to-- 7,i7 for fiscal year #bjbd1 #aee2 and 7,,ii7 for each subsequent fiscal year1 the applicable amount for the immediately preceding fiscal year1 as adjusted to reflect changes for the #ab-month period ending the preceding ,june #cj in the ,consumer ,price ,index for ,all ,urban ,consumers3 ,medical ,care published by the ,bureau of ,labor ,statistics of the ,department of ,labor4 7ii7 ,exception ,for any fiscal year1 a ,state agency may establish a greater standard medical expense deduction than the deduction described in clause 7i7 if the greater deduction satisfies the applicable cost-neutrality standards established by the ,secretary for that fiscal year4 4 7c7 ,value of allotment ,section #h7;a7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjag7;a77 is amended1 in the proviso1 by striking #h percent and inserting #a_/c4 #ajbjc4 ,streamlining nutrition access for older adults and adults with disabilities 7a7 ,definition of elderly and disabled ,section #c7;j7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjab7;j77 is amended-- 7#a7 in the matter preceding paragraph 7#a71 by striking the subsection designation and all that follows through who and inserting the following3 7j7 ,elderly or disabled ,the term elderly or disabled1 with respect to an individual or member of a household1 means that the individual or member of the household 2 and 7#b7 in paragraph 7#b77;,b71 by inserting 7which includes medical assistance provided to an individual described in section #aijb7;e77#ad77;,d77i77,,iii7 of that ,act 7#db ,u4,s4,c4 #acif;a7e77#ad77;,d77i77,,iii777 after 7#db ,u4,s4,c4 #acif et seq474 7b7 ,elderly simplified application program ,the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjaa et seq47 is amended by adding at the end the following3 #ca4 ,elderly simplified application program 7a7 ,in general ,not later than #ahj days after the date of enactment of this section1 the ,secretary shall establish a program1 to be known as the elderly simplified application program 7referred to in this section as ,,esap71 under which a ,state1 in carrying out the supplemental nutrition assistance program1 may elect to implement a streamlined application and certification process for households in which all adult members-- 7#a7 are elderly or disabled members2 and 7#b7 have no earned income4 7b7 ,certification period ,the certification period for participants in ,,esap shall be #cf months4 7c7 ,income and other data verification 7#a7 ,in general ,a ,state agency determining the eligibility for an applicant household under ,,esap shall1 notwithstanding section #aa7;e77#c7-- 7,a7 to the maximum extent practicable1 use data matching for income verification and household size2 and 7,b7 7i7 allow self-declaration by the applicant of the information required under section #bgc4b7;f7 of title #g1 ,code of ,federal ,regulations 7or a successor regulation72 but 7ii7 verify1 prior to certification of the household1 factors of eligibility provided by the applicant that the ,state agency determines are questionable4 7#b7 ,accountability and fraud prevention ,in carrying out paragraph 7#a71 a ,state agency shall establish accountability and fraud protection measures to deter fraud and ensure the integrity of ,,esap and the supplemental nutrition assistance program4 7d7 ,interviews 7#a7 ,in general ,notwithstanding section #aa7;e77#f77;,a71 for recertification of a household under ,,esap1 a ,state agency shall not require an interview unless requested by the household4 7#b7 ,virtual interviews ,an interview under paragraph 7#a7 may be conducted virtually4 7e7 ,guidance ,prior to the establishment of ,,esap under subsection 7a71 the ,administrator of the ,food and ,nutrition ,service shall develop guidance for ,states1 including by consulting with ,states1 to carry out ,,esap1 which shall include-- 7#a7 general implementation guidelines2 7#b7 reporting requirements2 7#c7 quality control requirements2 and 7#d7 best practices4 4 7c7 ,combined application program ,the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjaa et seq47 7as amended by subsection 7b77 is amended by adding at the end the following3 #cb4 ,combined application program 7a7 ,in general ,not later than #ahj days after the date of enactment of this section1 the ,secretary1 in coordination with the ,commissioner of ,social ,security1 shall establish a program1 to be known as the combined application program 7referred to in this section as ,,cap71 under which a ,state1 in carrying out the supplemental nutrition assistance program1 may elect to implement a streamlined application process for households in which all adult members are applicants for or recipients of benefits under title ,,ii of the ,social ,security ,act 7#db ,u4,s4,c4 #dja et seq47 on the basis of a disability or supplemental security income under title ,,xvi of that ,act 7#db ,u4,s4,c4 #acha et seq474 7b7 ,purposes ,the purposes of ,,cap are-- 7#a7 to reduce the need for households described in subsection 7a7 to have in-person interviews with ,state offices administering the supplemental nutrition assistance program2 and 7#b7 to increase participation in the supplemental nutrition assistance program by simplifying the application process for the supplemental nutrition assistance program through increased automation and simplified calculation of benefits4 7c7 ,,cap models ,the ,secretary1 in coordination with the ,commissioner of the ,social ,security ,administration1 shall offer1 at a minimum1 each of the following models for ,states to implement ,,cap3 7#a7 ,standard model 7,a7 ,in general ,under the standard model1 the ,commissioner of the ,social ,security ,administration and the ,state agency administering the supplemental nutrition assistance program shall coordinate-- 7i7 to develop a simplified joint application process for the supplemental nutrition assistance program that uses standardized benefit amounts or standardized shelter expenses1 in accordance with this paragraph2 and 7ii7 to conduct outreach to adult members receiving supplemental security income under title ,,xvi of the ,social ,security ,act 7#db ,u4,s4,c4 #acha et seq47 that are not receiving benefits under the supplemental nutrition assistance program4 7,b7 ,standardized benefit amounts 7i7 ,in general ,under the standardized model described in subparagraph 7,a71 applicants shall receive a standardized or automated benefit level under the supplemental nutrition assistance program based on the shelter expenses and other income of the applicants4 7ii7 ,minimum standardized benefit levels ,at a minimum1 there shall be in effect #b standardized benefit levels under clause 7i71 including1 as determined by the ,state-- 7,i7 a level for participants with low shelter expenses2 and 7,,ii7 a level for participants with high shelter expenses4 7iii7 ,comparable amount ,a ,state shall ensure that the amount provided under a standardized benefit level under clause 7i7 is comparable to an amount that a participant would otherwise receive under the supplemental nutrition assistance program4 7iv7 ,referral ,a ,state shall refer a household described in subsection 7a7 to the supplemental nutrition assistance program instead of enrolling that household in ,,cap if the standardized amount that the household would receive under ,,cap would be significantly less than the amount of benefits that the household would receive under the supplemental nutrition assistance program4 7,c7 ,standardized shelter expenses ,in computing an excess shelter expense deduction under section #e7;e77#f71 a ,state agency may use a standard utility allowance in accordance with regulations promulgated by the ,secretary4 7#b7 ,modified model ,under the modified model1 a ,state agency administering the supplemental nutrition assistance program shall-- 7,a7 conduct outreach to prospective participants in the supplemental nutrition assistance program using information from the ,social ,security ,administration to identify households described in subsection 7a7 that are not participants in the supplemental nutrition assistance program2 and 7,b7 send to those households simplified application forms for the supplemental nutrition assistance program4 4 #ajbjd4 ,enrollment and outreach pilot program for older adults1 kinship families1 and adults with disabilities ,the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjaa et seq47 7as amended by section #ajbjc7;c77 is amended by adding at the end the following3 #cc4 ,enrollment and outreach pilot program for older adults1 kinship families1 and adults with disabilities 7a7 ,definitions ,in this section3 7#a7 ,disability ,the term disability has the meaning given the term in section #c of the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abajb74 7#b7 ,eligible entity ,the term eligible entity means-- 7,a7 a ,state or local government agency2 7,b7 an ,indian tribe or ,tribal organization2 7,c7 a nonprofit organization1 including a public or nonprofit provider of services2 7,d7 a community-based organization2 and 7,e7 an educational provider4 7#c7 ,kinship family ,the term kinship family means a family in which a child resides with1 and is being raised by1 a grandparent1 another extended family member1 or an adult with whom the child has a close family-like relationship1 such as a godparent or a close family friend4 7#d7 ,older adult ,the term older adult has the meaning given the term older individual in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb74 7#e7 ,pilot program ,the term pilot program means the ,enrollment and ,outreach ,pilot ,program for ,older ,adults1 ,kinship ,families1 and ,adults with ,disabilities established under subsection 7b74 7b7 ,establishment ,not later than #ahj days after the date of enactment of this section1 the ,secretary shall establish a pilot program1 to be known as the ,enrollment and ,outreach ,pilot ,program for ,older ,adults1 ,kinship ,families1 and ,adults with ,disabilities1 under which the ,secretary shall award grants to eligible entities-- 7#a7 to raise awareness among older adults1 kinship families1 and adults with disabilities of the availability1 eligibility requirements1 application procedures1 and benefits of the supplemental nutrition assistance program2 and 7#b7 to support older adults1 kinship families1 and adults with disabilities in enrolling in the supplemental nutrition assistance program4 7c7 ,priority ,in awarding grants under the pilot program1 the ,secretary shall give priority to-- 7#a7 eligible entities that-- 7,a7 provide services to older adults or adults with disabilities2 7,b7 provide services to kinship families1 including kinship navigator programs2 7,c7 have experience implementing programs that receive funding under the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjja et seq472 7,d7 have experience implementing programs administered by the ,food and ,nutrition ,service2 or 7,e7 receive1 plan to receive1 or demonstrate an ability to partner with a program that receives1 funding under-- 7i7 the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjja et seq472 7ii7 the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abaja et seq472 or 7iii7 #a or more nutrition programs administered by the ,secretary2 and 7#b7 projects that will-- 7,a7 serve communities with-- 7i7 high rates of food insecurity or malnutrition2 or 7ii7 low food access2 7,b7 serve rural communities1 indigenous communities1 or communities of color2 7,c7 serve members of the lesbian1 gay1 bisexual1 transgender1 and queer community2 7,d7 serve adults with limited ,english proficiency2 7,e7 serve veterans2 7,f7 serve residents in federally subsidized housing1 including federally subsidized housing units for older adults and adults with disabilities2 7,g7 serve residents living in housing serving kinship families2 and 7,h7 incorporate nutrition education activities that promote healthy eating and active lifestyles4 7d7 ,eligible activities ,an eligible entity receiving a grant under the pilot program shall use the grant to carry out #a or more of the following activities3 7#a7 ,application assistance1 including-- 7,a7 eligibility prescreening2 7,b7 assistance in completing an application for the supplemental nutrition assistance program2 7,c7 assistance in obtaining application verification documents2 7,d7 medical expense deduction counseling2 and 7,e7 translation of materials and bilingual accommodation4 7#b7 ,tailored dissemination of information relating to the supplemental nutrition assistance program1 including through-- 7,a7 community-based outreach workshops and events2 7,b7 a toll-free hotline to provide information relating to ,federal1 ,state1 and local food resources2 7,c7 informational websites and other social media sites2 and 7,d7 printed or digital informational content4 7#c7 ,transportation1 including-- 7,a7 transportation to or from a local office of the supplemental nutrition assistance program2 and 7,b7 administration of vouchers or similar items for the transportation described in subparagraph 7,a74 7#d7 ,identification1 implementation1 analysis1 and dissemination of replicable and scalable models for increasing enrollment in the supplemental nutrition assistance program among older adults1 kinship families1 and adults with disabilities4 7e7 ,grants 7#a7 ,maximum amount ,a grant awarded under the pilot program to an eligible entity for a fiscal year shall be-- 7,a7 not less than #ej1jjj2 and 7,b7 not more than #bej1jjj4 7#b7 ,duration ,an eligible entity may be awarded a grant under the pilot program for not more than #e years4 7f7 ,evaluation ,not later than #b years after the date of establishment of the pilot program1 the ,secretary shall conduct an evaluation of the pilot program4 7g7 ,funding 7#a7 ,in general ,in addition to amounts otherwise available1 there is appropriated1 out of any funds in the ,treasury not otherwise appropriated1 #ab1bej1jjj1 to remain available until expended1 to carry out the pilot program1 of which not more than #bej1jjj shall be used to carry out the evaluation under subsection 7f74 7#b7 ,administrative costs ,of the amounts made available under paragraph 7#a7 7excluding the amount made available to carry out subsection 7f771 not more than #c percent may be used by the ,secretary for administrative costs4 4 #ajbje4 ,food delivery under supplemental nutrition assistance program ,the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjaa et seq47 7as amended by section #ajbjd7 is amended by adding at the end the following3 #cd4 ,food delivery 7a7 ,definitions ,in this section3 7#a7 ,covered retail food store ,the term covered retail food store means a retail food store1 a public or private nonprofit meal delivery service1 or a public or nonprofit meal delivery provider participating in the supplemental nutrition assistance program that is unable to cover the cost of food delivery for participants of the supplemental nutrition assistance program4 7#b7 ,employee ,the term employee has the meaning given the term in section #c of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjc74 7b7 ,program modifications 7#a7 ,in general ,in carrying out the supplemental nutrition assistance program1 the ,secretary shall-- 7,a7 notify retail food stores participating in the supplemental nutrition assistance program of existing opportunities through which the retail food stores can deliver food to program participants1 including by-- 7i7 allowing an ,,ebt card to be swiped with a mobile device on delivery of food to the home2 and 7ii7 preparing food for pickup2 7,b7 authorize public-private partnerships between the ,department of ,agriculture1 retail food stores participating in the supplemental nutrition assistance program1 and community-based organizations to provide free or low-cost food delivery1 including through the use of private funds2 7,c7 in the case of a covered retail food store1 use funds made available under subparagraph 7,e7 of paragraph 7#c7 to provide1 in accordance with that paragraph1 free grocery delivery for participants in the supplemental nutrition assistance program who are older adults or adults with disabilities 7as those terms are defined in section #cc7;a77 who are unable to shop for food or lack safe and accessible transportation options to the covered retail food store2 and 7,d7 require each ,state to submit to the ,secretary a plan that describes the methods by which the ,state will-- 7i7 work with retail food stores participating in the supplemental nutrition assistance program and other community-based partners to establish a process for food delivery for program participants2 7ii7 administer the reimbursements described in paragraph 7#c71 including timing1 eligibility1 and distribution processes2 and 7iii7 ensure that retail food stores participating in the supplemental nutrition assistance program that are reimbursed for delivery costs under paragraph 7#c7 adhere to the requirements described in subparagraph 7,b7 of that paragraph4 7#b7 ,state plans ,not later than #aj days after the date on which the ,secretary receives a ,state plan under paragraph 7#a77;,d71 the ,secretary shall-- 7,a7 determine whether to approve or disapprove the ,state plan2 and 7,b7 make publicly available on the website of the ,department of ,agriculture-- 7i7 the ,state plan2 7ii7 the determination made under subparagraph 7,a7 with respect to that plan2 and 7iii7 any guidance issued to the ,state with respect to that plan4 7#c7 ,reimbursement of covered retail food stores 7,a7 ,in general ,notwithstanding any other provision of law 7including sections #bgd4g7;f7 and #bgh4b7;b7 of title #g1 ,code of ,federal ,regulations 7or successor regulations71 and any other regulations71 subject to the availability of funds1 a ,state agency shall reimburse a covered retail food store for the cost of food delivery to participants described in paragraph 7#a77;,c7 if-- 7i7 the covered retail food store meets the requirements under subparagraph 7,b72 and 7ii7 the majority of the number of food items delivered by the covered retail food store are eligible for redemption using benefits under the supplemental nutrition assistance program1 regardless of whether the delivery includes nonfood items1 subject to the condition that those nonfood items shall be of de minimis value4 7,b7 ,requirements ,a covered retail food store may receive reimbursement for the cost of food delivery to participants described in paragraph 7#a77;,c7 if the following requirements are met3 7i7 ,food delivery is performed by employees of the covered retail food store or employees of an entity contracted by the covered retail food store to perform deliveries4 7ii7 ,before any employee described in clause 7i7 begins making food deliveries1 that employee receives employer-provided health and safety training that reflects the most recent guidelines of the ,centers for ,disease ,control and ,prevention4 7iii7 ,all employees described in clause 7i7 performing deliveries are paid at a rate that is not less than the greater of-- 7,i7 the minimum wage rate established under section #f7;a77#a7 of the ,fair ,labor ,standards ,act of #aich 7#bi ,u4,s4,c4 #bjf7;a77#a772 and 7,,ii7 the minimum wage rate established by the applicable ,state or locality in which the employee works4 7iv7 ,the covered retail food store meets the size standard determined by the ,small ,business ,administration for a supermarket or other grocery retailer or a convenience retailer under section #aba4bja of title #ac1 ,code of ,federal ,regulations 7or a successor regulation74 7v7 ,the covered retail food store does not-- 7,i7 charge the supplemental nutrition assistance program participant for delivery costs for which the covered retail food store will be reimbursed2 7,,ii7 require minimum purchase thresholds in order to provide free delivery2 7,,iii7 restrict delivery times to least-favorable windows for those participants2 or 7,,iv7 charge surge pricing4 7,c7 ,reimbursable costs ,reimbursable costs under subparagraph 7,a7 include costs associated with purchasing point-of-sale devices or receiving technical assistance relating to point-of-sale devices4 7,d7 ,maximum reimbursement per delivery ,the maximum amount of reimbursement under subparagraph 7,a7 for a food delivery fee shall be #aj per delivery1 which may be adjusted by the ,secretary for inflation4 7,e7 ,authorization of appropriations ,there is authorized to be appropriated to the ,secretary #ejj1jjj1jjj for fiscal year #bjbe1 and each fiscal year thereafter1 to remain available until expended1 to cover the cost of food delivery described in paragraph 7#a77;,c71 to be distributed among ,states to fund reimbursements by ,states under subparagraph 7,a74 7#d7 ,report ,not later than ,april #cj1 #bjbf1 and ,april #cj of each year thereafter1 the ,secretary shall submit to the ,committee on ,agriculture1 ,nutrition1 and ,forestry of the ,senate and the ,committee on ,agriculture of the ,house of ,representatives a report that describes1 for the period covered by the report1 as applicable-- 7,a7 the number of supplemental nutrition assistance program participants using food delivery services1 including the percentage of those participants that are older adults and adults with disabilities 7as those terms are defined in section #cc7;a772 7,b7 the covered retail food stores that were reimbursed under paragraph 7#c71 including the amount of each reimbursement2 7,c7 any complications or difficulties experienced by ,states in administering reimbursements under paragraph 7#c72 and 7,d7 recommendations or best practices to assist ,states in implementing food delivery programs similar to the program under this section4 4 #ajbjf4 ,commodity supplemental food program 7a7 ,funds ,section #d of the ,agriculture and ,consumer ,protection ,act of #aigc 7#g ,u4,s4,c4 #fab;c note2 ,public ,law #ic-hf7 is amended-- 7#a7 in subsection 7a71 in the first sentence1 by striking #bjbc and inserting #bjbh2 and 7#b7 by adding at the end the following3 7d7 ,funds ,in addition to amounts otherwise available1 there is appropriated1 out of any funds in the ,treasury not otherwise appropriated1 to carry out the program under this section #aj1jjj1jjj for each of fiscal years #bjbd through #bjbh4 4 7b7 ,adults with disabilities ,section #e of the ,agriculture and ,consumer ,protection ,act of #aigc 7#g ,u4,s4,c4 #fab;c note2 ,public ,law #ic-hf7 is amended-- 7#a7 by striking #bjbc each place it appears and inserting #bjbh2 7#b7 in subsection 7g7-- 7,a7 in paragraph 7#a71 by striking to low-income persons aged #fj and older4 and inserting the following3 to-- 7,a7 low-income persons aged #fj and older2 and 7,b7 low-income adults with disabilities 7as defined in section #c of the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abajb774 2 7,b7 by redesignating paragraph 7#b7 as paragraph 7#c72 7,c7 by inserting after paragraph 7#a7 the following3 7#b7 ,income eligibility ,for purposes of paragraph 7#a71 a low-income individual described in subparagraph 7,a7 or 7,b7 of that paragraph shall have a gross income level that is less than #ahe percent of the ,federal poverty line4 2 and 7,d7 in subparagraph 7,b7 of paragraph 7#c7 7as so redesignated71 in the matter preceding clause 7i71 by striking of-- and all that follows through the period at the end of clause 7ii7 and inserting of #cf months42 and 7#c7 in subsection 7i71 in the matter preceding paragraph 7#a7-- 7,a7 by inserting or low-income adults with disabilities described in subsection 7g77#a77;,b7 after elderly persons2 and 7,b7 by striking to each elderly participant in1 or applicant for1 the commodity supplemental food program for the elderly and inserting to each participant in1 or applicant for1 such a program4 #ajbjg4 ,seniors farmers' market nutrition program 7a7 ,in general ,section #ddjb of the ,farm ,security and ,rural ,investment ,act of #bjjb 7#g ,u4,s4,c4 #cjjg7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by striking ,of the funds and inserting the following3 7#a7 ,mandatory funding ,of the funds 2 7,b7 in paragraph 7#a7 7as so designated71 by inserting 7referred to in this section as the ,secretary7 after ,agriculture2 and 7,c7 by adding at the end the following3 7#b7 ,authorization of appropriations ,there are authorized to be appropriated to the ,secretary to carry out and expand the seniors farmers' market nutrition program-- 7,a7 not less than #fj1jjj1jjj for fiscal year #bjbd2 7,b7 not less than #gj1jjj1jjj for fiscal year #bjbe2 and 7,c7 not less than #ajj1jjj1jjj for each of fiscal years #bjbf through #bjbh4 2 7#b7 in subsection 7b77#a71 by inserting and adults with disabilities 7as defined in section #c of the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abajb77 before the semicolon at the end2 7#c7 by redesignating subsections 7c7 through 7f7 as subsections 7f7 through 7i71 respectively2 and 7#d7 by inserting after subsection 7b7 the following3 7c7 ,benefit amounts ,under the seniors farmers' market nutrition program-- 7#a7 the minimum individual benefit shall be #ce2 and 7#b7 the maximum individual benefit shall be #hj4 7d7 ,certification period ,the certification period for participants in the seniors farmers' market nutrition program shall be #cf months4 7e7 ,modernization grants 7#a7 ,in general ,not later than #ahj days after the date of enactment of the ,senior ,hunger ,prevention ,act of #bjbd1 the ,secretary shall establish a grant program under which the ,secretary shall award grants to ,state agencies1 including ,tribal organizations 7as defined in section #c of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjab77 and territories1 that administer the senior farmers' market nutrition program to modernize program operations1 including-- 7,a7 by transitioning from paper-based coupons to an electronic transaction technology1 such as a web-based service or installable software2 and 7,b7 by increasing benefit use at farmers' markets4 7#b7 ,grant amount 7,a7 ,in general ,the amount of a grant awarded under paragraph 7#a7 shall not exceed #cej1jjj4 7,b7 ,supplies ,not more than #be1jjj may be used to carry out subparagraph 7,f7 of paragraph 7#c74 7#c7 ,eligible expenses ,an entity receiving a grant under paragraph 7#a7 may use the grant for-- 7,a7 costs associated with the procurement of electronic transaction technology2 7,b7 planning costs1 including personnel costs1 relating to electronic transaction technology procurement and implementation2 7,c7 costs associated with evaluating the impact of transitioning from coupon-based operations to an electronic transaction technology2 7,d7 training1 outreach1 and promotional material costs1 including the costs associated with translating materials2 7,e7 maintenance and operation of electronic transaction technology procured using the grant during the period of performance of the grant2 7,f7 subject to paragraph 7#b77;,b71 the purchase of supplies needed to perform electronic transactions onsite2 and 7,g7 additional costs associated with modernizing program operations1 as determined appropriate by the ,secretary4 7#d7 ,reports ,each entity that receives a grant under paragraph 7#a7 shall submit to the ,secretary and the ,administrator of the ,food and ,nutrition ,service quarterly performance progress reports on the use of the grant4 7#e7 ,authorization of appropriations ,there is authorized to be appropriated to the ,secretary to carry out this subsection #ae1jjj1jjj for fiscal year #bjbd and each fiscal year thereafter4 4 7b7 ,income guidelines ,the ,secretary of ,agriculture shall revise section #bdi4f7;a77#c7 of title #g1 ,code of ,federal ,regulations1 to ensure that income eligibility under that section is at or below #bjj percent of the poverty income guidelines4 #ajbjh4 ,infrastructure funding for farmers' markets2 local procurement pilot program ,the ,farm ,security and ,rural ,investment ,act of #bjjb is amended by inserting after section #ddjb 7#g ,u4,s4,c4 #cjjg7 the following3 #ddjc4 ,infrastructure funding for farmers' markets2 local procurement pilot program 7a7 ,definitions ,in this section3 7#a7 ,disability ,the term disability has the meaning given the term in section #c of the ,americans with ,disabilities ,act of #aiij 7#db ,u4,s4,c4 #abajb74 7#b7 ,older adult ,the term older adult has the meaning given the term older individual in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb74 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,agriculture4 7b7 ,infrastructure funding for farmers' markets 7#a7 ,definition of eligible entity ,in this subsection1 the term eligible entity means an entity that-- 7,a7 is-- 7i7 an agricultural cooperative or other agricultural business entity or a producer network or association1 including a community-supported agriculture network or association2 7ii7 a local or ,tribal government2 7iii7 a nonprofit corporation2 7iv7 a public benefit corporation2 7v7 an economic development corporation2 7vi7 a regional farmers' market authority2 7vii7 a food council2 or 7viii7 any other entity as determined by the ,secretary2 and 7,b7 can demonstrate financial need1 as determined by the ,secretary4 7#b7 ,establishment ,not later than #ahj days after the date of enactment of the ,senior ,hunger ,prevention ,act of #bjbd1 the ,secretary shall establish a program under which the ,secretary shall provide financial assistance1 in the form of loans1 loan guarantees1 and grants1 to eligible entities for-- 7,a7 the establishment of new farmers' markets2 7,b7 the improvement or rehabilitation of existing farmers' markets1 including by adding or improving payment technologies used in those farmers' markets2 and 7,c7 the expansion of community supported agriculture to serve older adults and adults with disabilities4 7#c7 ,requirements ,an eligible entity that receives financial assistance under paragraph 7#b7 shall be required-- 7,a7 to host farmers' markets or related activities at locations accessible-- 7i7 by public transportation2 7ii7 by paratransit2 or 7iii7 through transportation services provided under the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjja et seq472 and 7,b7 to reserve not less than #ej percent of the floor area of an applicable farmers' market for the sale of products that are produced locally1 as determined by the ,secretary1 by-- 7i7 farmers1 ranchers1 or aquaculture1 mariculture1 or fisheries operators2 or 7ii7 associations of farmers1 ranchers1 or aquaculture1 mariculture1 or fisheries operators4 7#d7 ,cost sharing ,the non-,federal share of a grant provided under this subsection shall be #bj percent of the amount of the grant1 which may comprise transportation costs1 volunteer contributions1 and in-kind staffing4 7#e7 ,funding ,of the funds of the ,commodity ,credit ,corporation1 the ,secretary shall use to carry out this subsection #ej1jjj1jjj for each of fiscal years #bjbd through #bjbh4 7c7 ,local procurement pilot program 7#a7 ,definitions ,in this subsection3 7,a7 ,agricultural producer ,the term agricultural producer includes-- 7i7 an agricultural cooperative2 7ii7 a person engaged in farming1 ranching1 or aquaculture2 7iii7 a person engaged in the packing of a food product2 and 7iv7 a person engaged in the minimal processing of a food product1 as determined by the ,secretary4 7,b7 ,eligible entity ,the term eligible entity means an entity that-- 7i7 7,i7 coordinates enrollment in1 and distribution of1 benefits under the seniors farmers' market nutrition program2 or 7,,ii7 demonstrates an ability to partner with an entity that coordinates enrollment in and distribution of benefits under the seniors farmers' market nutrition program2 and 7ii7 is-- 7,i7 a public or nonprofit provider of nutrition services or support to older adults or adults with disabilities1 including-- 7aa7 an ,aging and ,disability ,resource ,center 7as defined in section #ajb of the ,older ,americans ,act of #aife 7#db ,u4,s4,c4 #cjjb772 7bb7 an area agency on aging 7as defined in that section72 7cc7 a ,state health insurance program2 7dd7 a ,state unit on aging2 7ee7 a center for independent living2 7ff7 a community health center2 7gg7 a multipurpose senior center2 and 7hh7 federally subsidized housing1 including federally subsidized housing units for older adults and adults with disabilities2 or 7,,ii7 a local1 ,state1 or national parks and recreation department4 7#b7 ,establishment ,not later than #ahj days after the date of enactment of the ,senior ,hunger ,prevention ,act of #bjbd1 the ,secretary shall establish a pilot program under which the ,secretary shall award grants to eligible entities to contract with agricultural producers that will grow produce to support the local procurement and contracting of produce for eligible entities4 7#c7 ,priority ,in awarding grants under paragraph 7#b71 the ,secretary shall give priority to an eligible entity that will use grant funds to benefit underserved communities1 including communities that are located in areas of concentrated poverty with limited access to fresh locally or regionally grown food4 7#d7 ,methods ,under a contract described in paragraph 7#b71 an agricultural producer may grow produce through traditional or controlled environmental agriculture4 7#e7 ,evaluation ,not later than #b years after the date of establishment of the pilot program under paragraph 7#b71 the ,secretary shall conduct an evaluation of the pilot program4 7#f7 ,funding 7,a7 ,in general ,of the funds of the ,commodity ,credit ,corporation1 the ,secretary shall use to carry out this subsection #cej1jjj for each of fiscal years #bjbd through #bjbh4 7,b7 ,administrative costs ,of the amounts made available under subparagraph 7,a7 for a fiscal year1 not more than #e percent may be used for administrative costs4 7,c7 ,evaluation ,in addition to amounts made available under subparagraph 7,a71 there is appropriated to the ,secretary1 out of any funds in the ,treasury not otherwise appropriated1 #be1jjj to carry out paragraph 7#e74 4 #b ,closing the meal gap #ajbaa4 ,elimination of time limit 7a7 ,in general ,section #f of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjae7 is amended-- 7#a7 by striking subsection 7o72 and 7#b7 by redesignating subsections 7p7 through 7s7 as subsections 7o7 through 7r71 respectively4 7b7 ,conforming amendments 7#a7 ,section #e7;a7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjad7;a77 is amended1 in the second sentence1 by striking 7r7 and inserting 7q74 7#b7 ,section #f7;d77#d7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjae7;d77#d77 is amended-- 7,a7 in subparagraph 7,b77ii77,i77bb77,,dd71 by striking or subsection 7o72 and 7,b7 in subparagraph 7,n71 by striking or subsection 7o7 each place it appears4 7#c7 ,section #g7;i77#a7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjaf7;i77#a77 is amended by striking section #f7o77#b7 of this ,act or4 7#d7 ,section #af7;h7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjbe7;h77 is amended-- 7,a7 in paragraph 7#a7-- 7i7 in subparagraph 7,b71 in the matter preceding clause 7i71 by striking that-- and all that follows through the period at the end of clause 7ii7 and inserting that is determined and adjusted by the ,secretary42 7ii7 by striking subparagraph 7,e72 7iii7 by redesignating subparagraph 7,f7 as subparagraph 7,e72 and 7iv7 in clause 7ii77,,iii77ee77,,aa7 of subparagraph 7,e7 7as so redesignated71 by striking 1 individuals subject to the requirements under section #f7o712 and 7,b7 in paragraph 7#e77;,c7-- 7i7 in clause 7ii71 by adding and at the end2 7ii7 in clause 7iii71 by striking 2 and and inserting a period2 and 7iii7 by striking clause 7iv74 7#e7 ,section #ea7;d77#h77;,a77ii7 of the ,internal ,revenue ,code of #aihf is amended-- 7,a7 in subclause 7,i71 by striking 1 or at the end and inserting a period2 7,b7 in the matter preceding subclause 7,i71 by striking family-- and all that follows through receiving in subclause 7,i7 and inserting family receiving2 and 7,c7 by striking subclause 7,,ii74 7#f7 ,section #ajc7;a77#b7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #caac7 is amended-- 7,a7 by striking subparagraph 7,d72 and 7,b7 by redesignating subparagraphs 7,e7 through 7,k7 as subparagraphs 7,d7 through 7,j71 respectively4 7#g7 ,section #aba7;b77#b77;,b7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #caea7 is amended-- 7,a7 by striking clause 7iv72 and 7,b7 by redesignating clauses 7v7 through 7vii7 as clauses 7iv7 through 7vi71 respectively4 #ajbab4 ,inclusion of ,puerto ,rico in supplemental nutritional assistance program 7a7 ,definitions ,section #c of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjab7 is amended-- 7#a7 in subsection 7r71 by inserting the ,commonwealth of ,puerto ,rico1 after ,guam12 and 7#b7 in subsection 7u77#c71 by inserting the ,commonwealth of ,puerto ,rico1 after ,guam14 7b7 ,eligible households ,section #e of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjad7 is amended-- 7#a7 in subsection 7b71 in the first sentence1 by inserting the ,commonwealth of ,puerto ,rico1 after ,guam12 7#b7 in subsection 7c7-- 7,a7 in paragraph 7#a71 by striking and ,guam1 and inserting ,guam1 and the ,commonwealth of ,puerto ,rico12 and 7,b7 in the undesignated matter at the end1 by striking ,states or ,guam and inserting ,states1 ,guam1 or the ,commonwealth of ,puerto ,rico2 and 7#c7 in subsection 7e7-- 7,a7 in paragraph 7#a77;,a71 by inserting the ,commonwealth of ,puerto ,rico1 after ,hawaii1 each place it appears2 and 7,b7 in paragraph 7#f77;,b71 in the matter preceding clause 7i71 by inserting the ,commonwealth of ,puerto ,rico1 after ,guam14 7c7 ,effective date 7#a7 ,in general ,the amendments made by subsections 7a7 and 7b7 shall be effective with respect to the ,commonwealth of ,puerto ,rico on the date described in paragraph 7#b7 if the ,secretary of ,agriculture submits to ,congress a certification under subsection 7f77#b77;,c7 of section #ai of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjbh7 7as added by subsection 7d774 7#b7 ,date described ,the date referred to in paragraph 7#a7 is the date established by the ,commonwealth of ,puerto ,rico in the applicable plan of operation submitted to the ,secretary of ,agriculture under subsection 7f77#a7 of section #ai of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjbh7 7as added by subsection 7d774 7d7 ,transition of ,puerto ,rico to supplemental nutrition assistance program ,section #ai of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjbh7 is amended by adding at the end the following3 7f7 ,transition of ,puerto ,rico to supplemental nutrition assistance program 7#a7 ,request for participation ,the ,commonwealth of ,puerto ,rico may submit to the ,secretary a request to participate in the supplemental nutrition assistance program1 which shall include a plan of operation described in section #aa7;d71 including a description of the date on which the ,commonwealth of ,puerto ,rico intends to begin participation in the supplemental nutrition assistance program4 7#b7 ,certification by ,secretary 7,a7 ,in general ,on submission of a request by the ,commonwealth of ,puerto ,rico under paragraph 7#a71 the ,secretary shall certify the ,commonwealth of ,puerto ,rico as qualified to participate in the supplemental nutrition assistance program if the ,secretary-- 7i7 approves the plan of operation submitted with the request1 in accordance with this subsection2 and 7ii7 approves the applications described in paragraph 7#d7 in accordance with that paragraph4 7,b7 ,deadline ,the ,secretary shall certify or deny the request of the ,commonwealth of ,puerto ,rico under paragraph 7#a7 not later than #ij days after the date on which the ,secretary receives the request4 7,c7 ,submission to ,congress ,the ,secretary shall submit a certification under subparagraph 7,a7 to ,congress4 7#c7 ,determination of plan of operation 7,a7 ,approval ,the ,secretary shall approve a plan of operation submitted with a request under paragraph 7#a7 if the plan satisfies the requirements under this ,act4 7,b7 ,disapproval ,if the ,secretary does not approve a plan of operation submitted with a request under paragraph 7#a71 the ,secretary shall provide a statement that describes each requirement under this ,act that is not satisfied by the plan4 7#d7 ,approval of retail food stores ,if the ,secretary approves a plan of operation under paragraph 7#c77;,a7 for the ,commonwealth of ,puerto ,rico1 the ,secretary shall accept applications from retail food stores located in the ,commonwealth of ,puerto ,rico to be authorized under section #i to participate in the supplemental nutrition assistance program4 7#e7 ,family ,market ,program ,notwithstanding subsection 7g71 the ,secretary shall allow the ,commonwealth of ,puerto ,rico to continue to carry out under the supplemental nutrition assistance program the ,family ,market ,program established pursuant to this section4 7#f7 ,temporary funding ,if the ,commonwealth of ,puerto ,rico has a request under paragraph 7#a7 pending before the ,secretary 7including a plan of operation pending under paragraph 7#c771 the ,commonwealth of ,puerto ,rico shall receive block grants under this section1 in amounts determined by the ,secretary1 until the date on which the ,secretary certifies the ,commonwealth of ,puerto ,rico under paragraph 7#b77;,b74 7#g7 ,authorization of appropriations ,there are authorized to be appropriated to the ,secretary such sums as are necessary to carry out this subsection for fiscal year #bjbd1 to remain available until expended4 7g7 ,technical infrastructure implementation 7#a7 ,in general ,the ,commonwealth of ,puerto ,rico may request from the ,secretary a #a-time grant to pay for the cost of the technology infrastructure necessary to implement the supplemental nutrition assistance program1 including the cost of information technology1 information technology personnel1 and training relating to program implementation4 7#b7 ,application ,in making a request under paragraph 7#a71 the ,commonwealth of ,puerto ,rico shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require1 including-- 7,a7 a description of the costs to be paid for by the grant2 and 7,b7 a plan for implementing the technology infrastructure described in paragraph 7#a7-- 7i7 within #a year of receiving the grant2 and 7ii7 that is reasonably cost efficient1 as determined by the ,secretary4 7#c7 ,determination 7,a7 ,time limit ,the ,secretary shall approve or deny an application submitted under paragraph 7#b7 not later than #ij days after the date on which the application is submitted4 7,b7 ,denial ,if the ,secretary denies an application submitted under paragraph 7#b71 the ,commonwealth of ,puerto ,rico may amend the plan described in subparagraph 7,b7 of that paragraph1 in coordination with the ,secretary1 to resubmit to the ,secretary for approval4 7#d7 ,funding 7,a7 ,in general ,there is appropriated to the ,secretary1 out of funds in the ,treasury not otherwise appropriated1 #aab1ejj1jjj to carry out this subsection1 to remain available until #c years after the date of enactment of this subsection4 7,b7 ,reversion of funds ,any funds appropriated to the ,secretary under subparagraph 7,a7 that remain available by the date described in that subparagraph shall revert to the ,treasury4 7h7 ,termination of effectiveness 7#a7 ,in general ,subsections 7a7 through 7e7 shall cease to be effective with respect to the ,commonwealth of ,puerto ,rico on the date described in paragraph 7#b7 if the ,secretary submits to ,congress a certification under subsection 7f77#b77;,c7 for the ,commonwealth of ,puerto ,rico4 7#b7 ,date described ,the date referred to in paragraph 7#a7 is the date established by the ,commonwealth of ,puerto ,rico in the applicable plan of operation submitted to the ,secretary under subsection 7f77#a74 4 ,d ,universal school meals #ajcja4 ,short title ,this subtitle may be cited as the ,universal ,school ,meals ,program ,act of #bjbd4 #ajcjb4 ,effective date ,except as otherwise provided1 this subtitle1 and the amendments made by this subtitle1 take effect on the date that is #a year after the date of enactment of this ,act4 #a ,school breakfast program #ajcaa4 ,free school breakfast program 7a7 ,in general ,section #d7;a7 of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aggc7;a77 is amended1 in the first sentence-- 7#a7 by striking is hereby and inserting are2 and 7#b7 by inserting to provide free breakfast to all children enrolled at those schools before in accordance4 7b7 ,apportionment to ,states ,section #d7;b7 of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aggc7;b77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in subparagraph 7,a77i71 by striking subclause 7,,ii7 and inserting the following3 7,,ii7 the national average payment for free breakfasts1 as specified in subparagraph 7,b74 2 7,b7 by striking subparagraph 7,b7 and inserting the following3 7,b7 ,payment amounts 7i7 ,in general ,the national average payment for each free breakfast shall be #b4hj1 adjusted annually for inflation in accordance with clause 7ii7 and rounded in accordance with clause 7iii74 7ii7 ,inflation adjustment 7,i7 ,in general ,the annual inflation adjustment under clause 7i7 shall reflect changes in the cost of operating the free breakfast program under this section1 as indicated by the change in the ,consumer ,price ,index for food away from home for all urban consumers4 7,,ii7 ,basis ,each inflation annual adjustment under clause 7i7 shall reflect the changes in the ,consumer ,price ,index for food away from home for the most recent #ab-month period for which those data are available4 7iii7 ,rounding ,on ,july #a1 #bjbd1 and annually thereafter1 the national average payment rate for free breakfast shall be-- 7,i7 adjusted to the nearest lower-cent increment2 and 7,,ii7 based on the unrounded amounts for the preceding #ab-month period4 2 7,c7 by striking subparagraphs 7,c7 and 7,e72 and 7,d7 by redesignating subparagraph 7,d7 as subparagraph 7,c72 7#b7 by striking paragraphs 7#b7 and 7#c72 7#c7 by redesignating paragraphs 7#d7 and 7#e7 as paragraphs 7#b7 and 7#c71 respectively2 and 7#d7 in paragraph 7#c7 7as so redesignated71 by striking paragraph 7#c7 or 7#d7 and inserting paragraph 7#b74 7c7 ,state disbursement to schools ,section #d of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aggc7 is amended by striking subsection 7c7 and inserting the following3 7c7 ,state disbursement to schools ,funds apportioned and paid to any ,state for the purpose of this section shall be disbursed by the ,state educational agency to schools selected by the ,state educational agency to assist those schools in operating a breakfast program4 4 7d7 ,no collection of debt 7#a7 ,in general ,notwithstanding any other provision of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #agga et seq47 or any other provision of law1 effective beginning on the date of enactment of this ,act1 as a condition of participation in the breakfast program under section #d of that ,act 7#db ,u4,s4,c4 #aggc71 a school-- 7,a7 shall not collect any debt owed to the school for unpaid meal charges2 and 7,b7 shall continue to accrue debt for unpaid meal charges-- 7i7 for the purpose of receiving reimbursement under section #ajccb2 and 7ii7 until the effective date specified in section #ajcjb4 7#b7 ,child ,nutrition ,act of #aiff 7,a7 ,in general ,section #d of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aggc7 is amended by striking subsection 7d7 and inserting the following3 7d7 ,no collection of debt ,a school participating in the free breakfast program under this section shall not collect any debt owed to the school for unpaid meal charges4 4 7,b7 ,conforming amendment ,section #bc7;a7 of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #agic7;a77 is amended by striking a school in severe need1 as described in section #d7;d77#a7 and inserting the following3 a school-- 7#a7 participating in the free breakfast program under section #d1 or seeking to initiate a free breakfast program under that section2 and 7#b7 not less than #dj percent of the students of which are economically disadvantaged students 7as identified under a measure described in section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #fcac7;a77#e777 4 7e7 ,nutritional and other program requirements ,section #d7;e7 of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aggc7;e77 is amended-- 7#a7 in paragraph 7#a77;,a71 in the second sentence1 by striking free or and all that follows through the period at the end and inserting free to all children enrolled at a school participating in the school breakfast program42 and 7#b7 in paragraph 7#b71 in the second sentence1 by striking the full charge to the student for a breakfast meeting the requirements of this section or4 7f7 ,prohibition on breakfast shaming1 meal denial 7#a7 ,in general ,effective beginning on the date of enactment of this ,act1 a school or school food authority-- 7,a7 shall not-- 7i7 physically segregate for the purpose of debt shaming or otherwise discriminate against any child participating in the breakfast program under section #d of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aggc72 or 7ii7 overtly identify a child described in clause 7i7 by a special token or ticket1 an announced or published list of names1 or any other means2 and 7,b7 shall provide the program meal to each child eligible under the program described in subparagraph 7,a77i74 7#b7 ,child ,nutrition ,act of #aiff ,section #d of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aggc7 is amended by adding at the end the following3 7f7 ,prohibition on breakfast shaming ,a school or school food authority shall not-- 7#a7 physically segregate for the purpose of debt shaming or otherwise discriminate against any child participating in the free breakfast program under this section2 or 7#b7 overtly identify a child described in paragraph 7#a7 by a special token or ticket1 an announced or published list of names1 or any other means4 4 7g7 ,department of ,defense overseas dependents' schools ,section #bj7;b7 of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aghi7;b77 is amended by striking by this section and all that follows through the period at the end and inserting by this section44 7h7 ,conforming amendments ,the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #agga et seq47 is amended-- 7#a7 by striking or reduced price each place it appears2 7#b7 by striking and reduced price each place it appears2 and 7#c7 by striking a reduced price each place it appears4 #b ,school lunch program #ajcba4 ,apportionment to ,states ,section #d7;b7 of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agec7;b77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in subparagraph 7,a71 by striking of this ,act2 and 7,b7 in subparagraph 7,b71 by striking of this subsection2 and 7#b7 by striking paragraphs 7#b7 and 7#c7 and inserting the following3 7#b7 ,payment amounts 7,a7 ,in general ,the national average payment for each free lunch shall be #d4fc1 adjusted annually for inflation in accordance with subparagraph 7,c7 and rounded in accordance with subparagraph 7,d74 7,b7 ,additional payment for local food 7i7 ,in general ,during a school year1 a school food authority shall receive an additional payment described in clause 7ii7 if the ,state certifies that the school food authority served meals 7including breakfasts1 lunches1 suppers1 and supplements7 during the preceding school year not less than #be percent of which were made with farm products that were-- 7,i7 produced and distributed-- 7aa7 in the ,state in which the school food authority is located2 or 7bb7 not more than #bej miles from the location of the school food authority2 and 7,,ii7 marketed to consumers-- 7aa7 directly2 or 7bb7 through an intermediated channel 7such as a food hub or cooperative74 7ii7 ,payment amount 7,i7 ,in general ,the additional payment amount under this subparagraph shall be-- 7aa7 #j4cj for each free lunch and supper2 7bb7 #j4ba for each free breakfast2 and 7cc7 #j4jh for each free supplement4 7,,ii7 ,adjustments ,each additional payment amount under subclause 7,i7 shall be adjusted annually in accordance with subparagraph 7,c7 and rounded in accordance with subparagraph 7,d74 7iii7 ,disbursement ,the ,state agency shall disburse funds made available under this subparagraph to school food authorities eligible to receive additional reimbursement4 7,c7 ,inflation adjustment 7i7 ,in general ,the annual inflation adjustment under subparagraphs 7,a7 and 7,b77ii7 shall reflect changes in the cost of operating the free lunch program under this ,act1 as indicated by the change in the ,consumer ,price ,index for food away from home for all urban consumers4 7ii7 ,basis ,each annual inflation adjustment under subparagraphs 7,a7 and 7,b77ii7 shall reflect the changes in the ,consumer ,price ,index for food away from home for the most recent #ab-month period for which those data are available4 7,d7 ,rounding ,on ,july #a1 #bjbd1 and annually thereafter1 the national average payment rate for free lunch and the additional payment amount for free breakfast1 lunch1 supper1 and supplement under subparagraph 7,b7 shall be-- 7i7 adjusted to the nearest lower-cent increment2 and 7ii7 based on the unrounded amounts for the preceding #ab-month period4 4 #ajcbb4 ,nutritional and other program requirements 7a7 ,elimination of free lunch eligibility requirements 7#a7 ,in general ,section #i of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #ageh7 is amended by striking subsection 7b7 and inserting the following3 7b7 ,eligibility ,all children enrolled in a school that participates in the school lunch program under this ,act shall be eligible to receive free lunch under this ,act4 4 7#b7 ,conforming amendments 7,a7 ,section #i of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #ageh7 is amended-- 7i7 in subsection 7c71 in the third sentence1 by striking or at a reduced cost2 and 7ii7 in subsection 7e71 by striking 1 reduced price14 7,b7 7i7 ,section #ah of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agfi7 is amended-- 7,i7 in subsection 7b71 by striking 7b77#a7 ,upon and inserting the following3 7a7 ,extension of eligibility of certain school districts ,to receive cash or commodity letters of credit assistance for school lunch programs 7#a7 ,in general ,on 2 7,,ii7 in subsection 7c71 by striking 7c77#a7 ,the and inserting the following3 7b7 ,alternative counting and claiming procedures 7#a7 ,in general ,the 2 7,,iii7 in subsection 7g71 by striking the subsection designation and heading and inserting the following3 7c7 ,access to local foods3 ,patrick ,leahy ,farm to ,school ,program 2 7,,iv7 by striking subsection 7j72 and 7,v7 by redesignating subsections 7h71 7i71 and 7k7 as subsections 7d71 7e71 and 7f71 respectively4 7ii7 ,section #ag7r77#e7 of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agff7r77#e77 is amended by striking #ah7;h7 and inserting #ah7;d74 7iii7 ,section #ai7;i77#b7 of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agfi;a7i77#b77 is amended by striking ,state that received funding under section #ah7;f7 on the day before the date of enactment of the ,food1 ,conservation1 and ,energy ,act of #bjjh and inserting ,state that1 on the day before the date of enactment of the ,food1 ,conservation1 and ,energy ,act of #bjjh 7,public ,law #aaj-bdf2 #abb ,stat4 #afea71 received funding under section #ah7;f7 7as in effect on the day before that date of enactment74 7iv7 ,section #dac7;b77#b7 of the ,agricultural ,research1 ,extension1 and ,education ,reform ,act of #aiih 7#g ,u4,s4,c4 #gfcc7;b77#b77 is amended by striking section #ah7;g7 of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agfi7;g77 and inserting subsection 7c7 of section #ah of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agfi74 7,c7 ,section #bh of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agfi;i7 is amended-- 7i7 by striking subsection 7b72 and 7ii7 by redesignating subsection 7c7 as subsection 7b74 7,d7 ,section #aaed7;a77#b77;,a77i7 of title #aj1 ,united ,states ,code1 is amended by striking in accordance with section #i7;b77#a7 of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #ageh7;b77#a74 7,e7 ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77 is amended by striking paragraph 7#g7 and inserting the following3 7#g7 provide safeguards that restrict the use or disclosure of information concerning applicants and recipients to purposes directly connected with the administration of the plan2 4 7,f7 ,section #dcja of the ,food1 ,conservation1 and ,energy ,act of #bjjh 7#db ,u4,s4,c4 #ageh;a7 is repealed4 7,g7 ,section #ag of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aghf7 is amended-- 7i7 in subsection 7d7-- 7,i7 in paragraph 7#b77;,a7-- 7aa7 by striking clause 7i72 and 7bb7 by redesignating clauses 7ii7 and 7iii7 as clauses 7i7 and 7ii71 respectively2 and 7,,ii7 in paragraph 7#c7-- 7aa7 by striking subparagraph 7,d72 7bb7 by redesignating subparagraphs 7,e7 and 7,f7 as subparagraphs 7,d7 and 7,e71 respectively2 and 7cc7 in subparagraph 7,d7 7as so redesignated71 by striking clause 7ii7 or 7iii7 and inserting clause 7i7 or 7ii72 and 7ii7 in subsection 7f77#ag71 by striking ,notwithstanding subsection 7d77#b77;,a77i71 not later and inserting ,not later4 7b7 ,no collection of debt 7#a7 ,in general ,notwithstanding any other provision of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agea et seq47 or any other provision of law1 effective beginning on the date of enactment of this ,act1 as a condition of participation in the school lunch program under that ,act1 a school-- 7,a7 shall not collect any debt owed to the school for unpaid meal charges2 and 7,b7 shall continue to accrue debt for unpaid meal charges-- 7i7 for the purpose of receiving reimbursement under section #ajccb2 and 7ii7 until the effective date specified in section #ajcjb4 7#b7 ,national ,school ,lunch ,act ,section #i of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #ageh7 is amended by striking subsection 7d7 and inserting the following3 7d7 ,no collection of debt ,a school participating in the school lunch program under this ,act shall not collect any debt owed to the school for unpaid meal charges4 4 #ajcbc4 ,special assistance program 7a7 ,in general ,section #aa of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agei;a7 is repealed4 7b7 ,conforming amendments 7#a7 ,section #f of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agee7 is amended-- 7,a7 in subsection 7a77#b71 by striking sections #aa and #ac and inserting section #ac2 and 7,b7 in subsection 7e77#a71 in the matter preceding subparagraph 7,a71 by striking section #d1 this section1 and section #aa and inserting this section and section #d4 7#b7 ,section #g7;d7 of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agef7;d77 is amended by striking or #aa4 7#c7 ,section #h7;g7 of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #ageg7;g77 is amended by striking and under section #aa of this ,act4 7#d7 ,section #ab7;f7 of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agfj7;f77 is amended by striking #aa14 7#e7 ,section #g7;a7 of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #agff7;a77 is amended-- 7,a7 in paragraph 7#a77;,a71 by striking #d1 #aa1 and #ag and inserting #d and #ag2 and 7,b7 in paragraph 7#b77;,a71 by striking sections #d and #aa and inserting section #d4 7#f7 ,section #aaja7;j77#c7 of the ,families ,first ,coronavirus ,response ,act 7#g ,u4,s4,c4 #bjaa note2 ,public ,law #aaf-abg7 is amended-- 7,a7 by striking or served under section #aa7;a77#a7 of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agfj7;d71 #agei7;a77#a77 and inserting of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agfj7;d772 and 7,b7 by striking or reduced price4 #ajcbd4 ,price for paid lunch ,section #ab of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agfj7 is amended-- 7#a7 in subsection 7l77#d7-- 7,a7 by striking subparagraph 7,d72 and 7,b7 by redesignating subparagraphs 7,e7 through 7,m7 as subparagraphs 7,d7 through 7,l71 respectively2 7#b7 by striking subsection 7p72 and 7#c7 by redesignating subsections 7q7 and 7r7 as subsections 7p7 and 7q71 respectively4 #ajcbe4 ,summer food service program for children ,section #ac of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agfa7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#a77;,a77i7-- 7i7 in subclause 7,i71 by striking have been determined eligible for free or reduced price school meals under this ,act and the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #agga et seq47 and inserting are economically disadvantaged students 7as identified under a measure described in section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #fcac7;a77#e7772 7ii7 in subclause 7,,ii71 by striking are eligible for free or reduced price school meals under this ,act and the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #agga et seq47 and inserting are economically disadvantaged students 7as identified under a measure described in section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #fcac7;a77#e7772 7iii7 in subclause 7,,iii77bb71 by striking meet the income standards for free or reduced price school meals under this ,act and the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #agga et seq47 and inserting are economically disadvantaged students 7as identified under a measure described in section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #fcac7;a77#e7772 7iv7 in subclause 7,,iv71 by striking are eligible for free or reduced price school meals under this ,act and the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #agga et seq47 and inserting are economically disadvantaged students 7as identified under a measure described in section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #fcac7;a77#e7772 and 7v7 in subclause 7,v71 by striking are eligible for free or reduced price school meals under this ,act and the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #agga et seq47 and inserting are economically disadvantaged students 7as identified under a measure described in section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #fcac7;a77#e7772 7,b7 in paragraph 7#b71 by adding at the end the following3 7,c7 ,waiver ,if the ,secretary determines that a program requirement under this section limits the access of children to meals served under this section1 the ,secretary may waive that program requirement4 7,d7 ,eligibility ,all children shall be eligible to participate in the program under this section4 2 7,c7 in paragraph 7#e71 by striking only for and all that follows through the period at the end and inserting for meals served to all children42 and 7,d7 in paragraph 7#ac7-- 7i7 in subparagraph 7,c77ii71 by striking eligible for a free or reduced price lunch under this ,act or a free or reduced price breakfast under section #d of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aggc7 and inserting an economically disadvantaged student 7as identified under a measure described in section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #fcac7;a77#e7772 and 7ii7 in subparagraph 7,d77ii71 by striking eligible for free or reduced price lunch under this ,act or free or reduced price breakfast under section #d of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aggc7 and inserting economically disadvantaged students 7as identified under a measure described in section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #fcac7;a77#e7772 7#b7 in subsection 7b77#b71 by striking may only serve and all that follows through migrant children2 7#c7 by striking subsection 7c7 and inserting the following3 7c7 ,payments 7#a7 ,in general ,payments shall be made to service institutions for meals served-- 7,a7 during the months of ,may through ,september2 7,b7 during school vacation at any time during an academic school year2 7,c7 during a teacher in-service day2 and 7,d7 on days that school is closed due to a natural disaster1 building repair1 court order1 or similar cause1 as determined by the ,secretary4 7#b7 ,limitation on payments ,a service institution shall receive payments under this section for not more than #c meals and #a supplement per child per day4 2 and 7#d7 in subsection 7f77#c71 by striking 1 except that and all that follows through of this section4 #ajcbf4 ,summer electronic benefit transfer for children program ,section #ac;,a of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agfb7 is amended-- 7#a7 in subsection 7b77#b77;,a77i71 by striking #dj and inserting #fj2 7#b7 in subsection 7c77#a7-- 7,a7 in subparagraph 7,a71 by striking directly certified and all that follows through this section and inserting an economically disadvantaged student 7as identified under a measure described in section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #fcac7;a77#e7772 7,b7 by striking subparagraph 7,b72 and 7,c7 by redesignating subparagraphs 7,c7 through 7,e7 as subparagraphs 7,b7 through 7,d71 respectively2 7#c7 in subsection 7f7-- 7,a7 in paragraph 7#c71 in the matter preceding subparagraph 7,a71 by striking processes-- and all that follows through to reliably in subparagraph 7,b7 and inserting processes to reliably2 and 7,b7 in paragraph 7#d71 in the matter preceding subparagraph 7,a71 by striking by-- and all that follows through establishing in subparagraph 7,b7 and inserting by establishing2 and 7#d7 in subsection 7h71 by striking paragraph 7#b7 and inserting the following3 7#b7 ,eligible child ,the term eligible child means any child residing in a ,state or on land under the jurisdiction of a covered ,indian ,tribal organization that participates in the program established under this section4 4 #ajcbg4 ,child and adult care food program ,section #ag of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agff7 is amended-- 7#a7 in subsection 7a77#b71 by striking subparagraph 7,b7 and inserting the following3 7,b7 any other private organization providing nonresidential child care or day care outside school hours for school children2 2 7#b7 by striking subsection 7c7 and inserting the following3 7c7 ,free meals ,notwithstanding any other provision of law-- 7#a7 all meals and supplements served under the program authorized under this section shall be provided for free to participants of the program2 and 7#b7 an institution that serves those meals and supplements shall be reimbursed-- 7,a7 in the case of breakfast1 at the rate established for free breakfast under section #d7;b77#a77;,b77i7 of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aggc7;b77#a77;,b77i772 7,b7 in the case of lunch1 at the rate established for free lunch under section #d7;b77#b77;,a72 and 7,c7 in the case of a supplemental meal1 #a4bj1 adjusted for inflation in accordance with section #d7;b77#b77;,c74 2 7#c7 in subsection 7f7-- 7,a7 in paragraph 7#b71 by striking subparagraph 7,b7 and inserting the following3 7,b7 ,limitation to reimbursements ,an institution may claim reimbursement under this paragraph for not more than #c meals and #a supplement per day per child4 2 7,b7 by striking paragraph 7#c72 and 7,c7 by redesignating paragraph 7#d7 as paragraph 7#c72 7#d7 in subsection 7o7-- 7,a7 by striking paragraph 7#d72 and 7,b7 by redesignating paragraphs 7#e7 and 7#f7 as paragraphs 7#d7 and 7#e71 respectively2 and 7#e7 in subsection 7r7-- 7,a7 in the subsection heading1 by striking ,program for at-risk school children and inserting ,afterschool meal and snack program2 7,b7 by striking at-risk school each place it appears and inserting eligible2 7,c7 in paragraph 7#a7-- 7i7 in the paragraph heading1 by striking at-risk school and inserting eligible2 and 7ii7 in subparagraph 7,b71 by striking operated and all that follows through the period at the end and inserting a period2 and 7,d7 in paragraph 7#d77;,a71 by striking only for and all that follows through the period at the end and inserting the following3 for-- 7i7 not more than #a meal and #a supplement per child per day served on a regular school day2 and 7ii7 not more than #c meals and #a supplement per child per day served on any day other than a regular school day4 4 #ajcbh4 ,meals and supplements for children in afterschool care ,section #ag;,a of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agff;a7 is amended-- 7#a7 in the section heading1 by striking ,meal supplements and inserting ,meals and supplements2 7#b7 in subsection 7a77#a71 by striking meal supplements and inserting free meals and supplements2 7#c7 in subsection 7b71 by inserting meals and before supplements2 and 7#d7 by striking subsection 7c7 and inserting the following3 7c7 ,reimbursement 7#a7 ,in general 7,a7 ,meals ,a free meal provided under this section to a child shall be reimbursed at a rate of #d4fc1 adjusted annually for inflation in accordance with paragraph 7#c77;,a7 and rounded in accordance with paragraph 7#c77;,b74 7,b7 ,supplements ,a free supplement provided under this section to a child shall be reimbursed at the rate at which free supplements are reimbursed under section #ag7;c77#b77;,c74 7#b7 ,limitation to reimbursements ,an institution may claim reimbursement under this section for not more than #a meal and #a supplement per day per child served on a regular school day4 7#c7 ,inflation2 rounding 7,a7 ,inflation adjustment 7i7 ,in general ,the annual inflation adjustment under paragraph 7#a77;,a7 shall reflect changes in the cost of operating the program under this section1 as indicated by the change in the ,consumer ,price ,index for food away from home for all urban consumers4 7ii7 ,basis ,each inflation annual adjustment under paragraph 7#a77;,a7 shall reflect the changes in the ,consumer ,price ,index for food away from home for the most recent #ab-month period for which those data are available4 7,b7 ,rounding ,on ,july #a1 #bjbd1 and annually thereafter1 the reimbursement rate for a free meal under this section shall be-- 7i7 adjusted to the nearest lower-cent increment2 and 7ii7 based on the unrounded amounts for the preceding #ab-month period4 4 #ajcbi4 ,pilot projects ,section #ah of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agfi7 is amended-- 7#a7 in paragraph 7#e7 of subsection 7c7 7as redesignated by section #ajcbb7;a77#b77;,b77i77,,iii771 by striking subparagraph 7,b7 and inserting the following3 7,b7 serve a high proportion of economically disadvantaged students 7as identified under a measure described in section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #fcac7;a77#e7772 2 and 7#b7 in paragraph 7#a77;,a77ii7 of subsection 7d7 7as redesignated by section #ajcbb7;a77#b77;,b77i77,v771 by striking eligible for free or reduced price meals under this ,act and inserting economically disadvantaged students 7as identified under a measure described in section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #fcac7;a77#e7774 #ajccj4 ,fresh fruit and vegetable program ,section #ai7;d7 of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agfi;a7d77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in the matter preceding subparagraph 7,a71 by striking paragraph 7#b7 of this subsection and2 7,b7 in subparagraph 7,a71 in the matter preceding clause 7i71 by striking school-- and all that follows through submits in clause 7ii7 and inserting school that submits2 7,c7 in subparagraph 7,b71 by striking schools and all that follows through ,act and inserting high-need schools 7as defined in section #bbaa7;b7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ffca7;b7772 and 7,d7 in subparagraph 7,d7-- 7i7 by striking clause 7i72 and 7ii7 by redesignating clauses 7ii7 through 7iv7 as clauses 7i7 through 7iii71 respectively2 and 7#b7 by striking paragraphs 7#b7 and 7#c7 and inserting the following3 7#b7 ,outreach to high-need schools ,prior to making decisions regarding school participation in the program1 a ,state agency shall inform high-need schools 7as defined in section #bbaa7;b7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ffca7;b7771 including ,tribal schools1 of the eligibility of the schools for the program4 4 #ajcca4 ,training1 technical assistance1 and ,food ,service ,management ,institute ,section #ba7;a77#a77;,b7 of the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agfi;b-#a7;a77#a77;,b77 is amended1 in the matter preceding clause 7i71 by striking certified to receive free or reduced price meals and inserting who are economically disadvantaged students 7as identified under a measure described in section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #fcac7;a77#e7774 #ajccb4 ,reimbursement of school meal delinquent debt program 7a7 ,definitions ,in this section3 7#a7 ,delinquent debt ,the term delinquent debt means the debt owed by a parent or guardian of a child to a school-- 7,a7 as of the effective date specified in section #ajcjb2 and 7,b7 for meals served by the school under-- 7i7 the school breakfast program under section #d of the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #aggc72 7ii7 the school lunch program established under the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agea et seq472 or 7iii7 both of the programs described in clauses 7i7 and 7ii74 7#b7 ,program ,the term program means the program established under subsection 7b77#a74 7#c7 ,secretary ,the term ,secretary means the ,secretary of ,agriculture4 7b7 ,reimbursement program 7#a7 ,establishment ,not later than #fj days after the effective date specified in section #ajcjb1 the ,secretary shall establish a program under which the ,secretary shall reimburse each school participating in a program described in clause 7i7 or 7ii7 of subsection 7a77#a77;,b7 for all delinquent debt4 7#b7 ,form for reimbursement ,to carry out the program1 the ,secretary shall design and distribute to ,state agencies a form to collect data relating to all delinquent debt in applicable schools in the ,state1 organized by school food authority4 7#c7 ,completion date ,the ,secretary shall provide all reimbursements under the program not later than #ahj days after the effective date specified in section #ajcjb4 7c7 ,report ,not later than #b years after the effective date specified in section #ajcjb1 the ,comptroller ,general of the ,united ,states shall submit to ,congress and make publicly available a report that describes the successes and challenges of the program4 #ajccc4 ,conforming amendments ,the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agea et seq47 is amended-- 7#a7 by striking or reduced price each place it appears2 7#b7 by striking or a reduced price each place it appears2 7#c7 by striking and reduced price each place it appears2 and 7#d7 by striking a reduced price each place it appears4 #c ,elementary and secondary education data #ajcda4 ,measure of poverty ,section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #fcac7;a77#e77 is amended-- 7#a7 in subparagraph 7,a71 by striking the number of children eligible for a free or reduced price lunch under the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agea et seq47 and inserting the number of children from low-income backgrounds1 identified under subparagraph 7,d72 and 7#b7 by adding at the end the following3 7,d7 ,identification of children from low-income backgrounds 7i7 ,in general ,a local educational agency or ,state agency1 for the purpose of identifying children from low-income backgrounds enrolled in a school served by a local educational agency1 may-- 7,i7 maintain a record1 with respect to each student for whom the local educational agency provides a free public education that contains the information collected from the survey described in clause 7iii72 7,,ii7 distribute and collect a student survey based on the template developed under clause 7iii7 to identify children from low-income backgrounds2 and 7,,iii7 utilize direct certification data described in clause 7iv77,i7 to identify children from low-income backgrounds4 7ii7 ,privacy 7,i7 ,in general ,all individual data collected under this subparagraph shall be protected by the local educational agency or ,state agency in a manner consistent with all applicable local1 ,state1 and ,federal privacy laws4 7,,ii7 ,reporting data ,only aggregated data1 which may include data disaggregated at the school1 local educational agency1 or ,state level1 shall be reported to the ,secretary at such time and in such manner as the ,secretary may reasonably require4 7iii7 ,survey ,not later than #ahj days after the date of enactment of the ,universal ,school ,meals ,program ,act of #bjbd1 the ,secretary1 in consultation with the ,secretary of ,agriculture1 shall develop a template survey-- 7,i7 to identify children from low-income backgrounds that contains only the information necessary to identify a child as a child from a low-income background by using the criteria of eligibility for a free or reduced priced lunch under the ,richard ,b4 ,russell ,national ,school ,lunch ,act1 as such criteria were in effect on ,september #cj1 #bjbb2 and 7,,ii7 that shall be designed to be easily accessible and in a user-friendly manner4 7iv7 ,transition authority from ,,frpl to ,,esea measures ,the ,secretary1 in coordination with the ,secretary of ,agriculture1 shall have the authority to take such steps as are necessary to provide for the orderly transition to1 and implementation of-- 7,i7 activities that are necessary for the continuity of direct certification carried out by local educational agencies and ,state agencies specified in paragraphs 7#d71 7#e71 and 7#ae7 section #i7;b7 of the ,richard ,b4 ,russell ,national ,school ,lunch ,act1 as in effect on ,september #cj1 #bjbb1 for the purposes of identifying any child eligible for free or reduced priced lunch under such ,act1 as in effect on such date1 as a child from a low-income background2 7,,ii7 procedures for verification of information collected under this subparagraph1 which may include procedures modeled on the requirement specified in section #i7;b77#c7 of the ,richard ,b4 ,russell ,national ,school ,lunch ,act1 as in effect on ,september #cj1 #bjbb2 and 7,,iii7 data privacy provisions for information collected under this subparagraph1 in accordance with the requirements specified in section #i7;b77#f7 of the ,richard ,b4 ,russell ,national ,school ,lunch ,act1 as in effect on ,september #cj1 #bjbb4 7v7 ,special rule ,for the purposes of subparagraph 7,a71 a local educational agency may determine the number of children from low-income backgrounds enrolled in a school served by such agency using one or more of the following methods3 7,i7 ,results from surveys specified in clause 7i77,,ii74 7,,ii7 ,direct certification data specified in clause 7i77,,iii74 7,,iii7 ,utilization of both methods described in subclauses 7,i7 and 7,,ii74 4 #d ,amendments to other programs and laws #ajcea4 ,supplemental nutrition assistance program 7a7 ,agreement for direct certification 7#a7 ,in general ,section #aa of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjbj7 is amended-- 7,a7 by striking subsection 7u72 and 7,b7 by redesignating subsections 7v7 through 7x7 as subsections 7u7 through 7w71 respectively4 7#b7 ,conforming amendments ,section #aa7;e7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjbj7;e77 is amended-- 7,a7 in paragraph 7#h77;,f71 by striking or subsection 7u72 and 7,b7 in paragraph 7#bf77;,b71 by striking 7x7 and inserting 7w74 7b7 ,nutrition education and obesity prevention grant program ,section #bh7;a7 of the ,food and ,nutrition ,act of #bjjh 7#g ,u4,s4,c4 #bjcf;a7a77 is amended by striking paragraph 7#a7 and inserting the following3 7#a7 an individual eligible for benefits under this ,act2 4 #ajceb4 ,higher ,education ,act of #aife 7a7 ,teacher quality enhancement ,section #bjj7aa7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajba7aa77 is amended by striking subparagraph 7,a7 and inserting the following3 7,a7 ,in general ,the term high-need school means a school that is in the highest quartile of schools in a ranking of all schools served by a local educational agency1 ranked in descending order by percentage of students from low-income families enrolled in such schools1 as determined by the local educational agency based on one of the following measures of poverty3 7i7 ,the percentage of students aged #e through #ag in poverty counted in the most recent census data approved by the ,secretary4 7ii7 ,the percentage of students in families receiving assistance under the ,state program funded under the program of block grants to ,states for temporary assistance for needy families established under part ,a of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq474 7iii7 ,the percentage of students eligible to receive medical assistance under the program of medical assistance established under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7iv7 ,a composite of #b or more of the measures described in clauses 7i7 through 7iii74 4 7b7 ,,gear ,up ,section #djd;,b7d77#a7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajgj;a-#bb7;d77#a77 is amended by striking subparagraph 7,a7 and inserting the following3 7,a7 provide services under this chapter to at least one grade level of students1 beginning not later than #gth grade1 in a participating school-- 7i7 that has a #gth grade2 and 7ii7 in which-- 7,i7 at least #ej percent of the students enrolled are economically disadvantaged students 7as identified under a measure described in section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife72 or 7,,ii7 if an eligible entity determines that it would promote the effectiveness of a program1 an entire grade level of students1 beginning not later than the #gth grade1 reside in public housing1 as defined in section #c7;b77#a7 of the ,united ,states ,housing ,act of #aicg 7#db ,u4,s4,c4 #adcg;a7b77#a774 4 7c7 ,simplified ,application for ,federal ,student ,financial ,aid 7#a7 ,in ,general ,section #dhc7;a77#b77;,b77ii77,,xvii7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajij7;a77#b77;,b77ii77,,xvii77 is amended-- 7,a7 by striking item 7cc72 and 7,b7 by redesignating items 7dd7 through 7jj7 as items 7cc7 through 7ii71 respectively4 7#b7 ,effective date ,the amendments made by this section shall take effect as if included in section #gjb of division ,,ff of the ,consolidated ,appropriations ,act1 #bjba 7,public ,law #aaf-bfj7 and subject to the effective date of section #gja7;b7 of such ,,fafsa ,simplification ,act1 as amended by section #ajb7;a7 of the ,,fafsa ,simplification ,act ,technical ,corrections ,act 7division ,r of ,public ,law #aag-ajc7 7including the authorization provided under section #ajb7;c77#a77;,a7 of such ,act74 7d7 ,early ,federal ,pell ,grant commitment demonstration program ,section #hid7;b7 of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #aafay7b77 is amended-- 7#a7 in paragraph 7#a77;,b71 by striking qualify for a free or reduced price school lunch under the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agea et seq47 or the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #agga et seq47 and inserting are economically disadvantaged students 7as identified under a measure described in section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife72 and 7#b7 in paragraph 7#e71 by striking eligible for a free or reduced price school lunch under the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agea et seq47 or the ,child ,nutrition ,act of #aiff 7#db ,u4,s4,c4 #agga et seq47 and inserting economically disadvantaged students 7as identified under a measure described in section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife74 #ajcec4 ,elementary and ,secondary ,education ,act of #aife 7a7 ,literacy education for all ,section #bbba7;b77#c77;,b7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ffda7;b77#c77;,b77 is amended-- 7#a7 by striking clause 7i72 and 7#b7 by redesignating clauses 7ii7 and 7iii7 as clauses 7i7 and 7ii71 respectively4 7b7 ,grants for education innovation and research ,section #dfaa7;d77#b7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #gbfa7;d77#b77 is amended-- 7#a7 by striking subparagraph 7,b72 and 7#b7 by redesignating subparagraphs 7,c7 and 7,d7 as subparagraphs 7,b7 and 7,c71 respectively4 7c7 ,eligibility for heavily impacted local educational agencies ,section #gjjc7;b77#b77;,b77i77,,iii7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ggjc7;b77#b77;,b77i77,,iii77 is amended by striking item 7bb7 and inserting the following3 7bb7 has an enrollment of children described in subsection 7a77#a7 that constitutes a percentage of the total student enrollment of the agency that is not less than #cj percent2 and 4 #ajced4 ,america ,,competes ,act ,section #fabb7c7 of the ,america ,,competes ,act 7#bj ,u4,s4,c4 #ihcb7c77 is amended by striking data on children eligible for free or reduced-price lunches under the ,richard ,b4 ,russell ,national ,school ,lunch ,act14 #ajcee4 ,workforce ,innovation and ,opportunity ,act ,section #c7cf77;,a7 of the ,workforce ,innovation and ,opportunity ,act 7#bi ,u4,s4,c4 #cajb7cf77;,a77 is amended-- 7#a7 by striking clause 7iv72 and 7#b7 by redesignating clauses 7v7 and 7vi7 as clauses 7iv7 and 7v71 respectively4 #ajcef4 ,national ,science ,foundation ,authorization ,act of #bjjb ,section #d7h7 of the ,national ,science ,foundation ,authorization ,act of #bjjb 7#db ,u4,s4,c4 #ahfbn note2 ,public ,law #ajg-cfh7 is amended-- 7#a7 by striking subparagraph 7,a72 and 7#b7 by redesignating subparagraphs 7,b7 and 7,c7 as subparagraphs 7,a7 and 7,b71 respectively4 #ajceg4 ,child care and development block grant ,section #feh,o7b7 of the ,child ,care and ,development ,block ,grant ,act of #aiij 7#db ,u4,s4,c4 #ihehm7b77 is amended-- 7#a7 in paragraph 7#a77;,b71 by striking school lunch factor and inserting economically disadvantaged students factor2 and 7#b7 by striking paragraph 7#c7 and inserting the following3 7#c7 ,economically disadvantaged students factor ,in this subsection1 the term economically disadvantaged students factor means the ratio of the number of children in the ,state who are economically disadvantaged students 7as identified under a measure described in section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #fcac7;a77#e777 to the number of such children in all the ,states as determined annually by the ,secretary of ,education4 4 #ajceh4 ,children's ,health ,act of #bjjj ,section #adjd7;b7 of the ,children's ,health ,act of #bjjj 7#db ,u4,s4,c4 #ihei;c7b77 is amended-- 7#a7 in paragraph 7#a77;,b71 by striking school lunch factor and inserting economically disadvantaged students factor2 and 7#b7 by striking paragraph 7#c7 and inserting the following3 7#c7 ,economically disadvantaged students factor ,in this subsection1 the term economically disadvantaged students factor means the ratio of the number of children in the ,state who are economically disadvantaged students 7as identified under a measure described in section #aaac7;a77#e7 of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #fcac7;a77#e777 to the number of such children in all the ,states as determined annually by the ,secretary of ,education4 4 #ajcei4 ,juvenile justice and delinquency prevention ,section #beb of the ,juvenile ,justice and ,delinquency ,prevention ,act of #aigd 7#cd ,u4,s4,c4 #aaafb7 is amended by striking subsection 7i7 and inserting the following3 7i7 ,free school lunches for incarcerated juveniles 7#a7 ,definition of eligible juvenile detention center ,in this subsection1 the term eligible juvenile detention center does not include any private1 for-profit detention center4 7#b7 ,free lunch ,a juvenile who is incarcerated in an eligible juvenile detention center is eligible to receive free lunch under the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agea et seq474 7#c7 ,guidance ,not later than #a year after the date of enactment of the ,universal ,school ,meals ,program ,act of #bjbd1 the ,attorney ,general1 in consultation with the ,secretary of ,agriculture1 shall provide guidance to ,states relating to the options for school food authorities in the ,states to apply for reimbursement for free lunches under the ,richard ,b4 ,russell ,national ,school ,lunch ,act 7#db ,u4,s4,c4 #agea et seq47 for juveniles who are incarcerated4 4