Text of US HB 2954 (2011)

I 112TH CONGRESS 1ST SESSION H. R. 2954 To improve the health of minority individuals, and for other purposes. IN THE HOUSE OF REPRESENTATIVES SEPTEMBER 15, 2011 Ms. LEE of California (for herself, Mrs. CHRISTENSEN, Ms. ROYBAL-ALLARD, Ms. BASS of California, Mr. BISHOP of Georgia, Ms. BORDALLO, Mr. BROOKS, Ms. BROWN of Florida, Mr. BUTTERFIELD, Mr. CARSON of In- diana, Ms. CHU, Mr. CLARKE of Michigan, Ms. CLARKE of New York, Mr. CLAY, Mr. CLEAVER, Mr. COHEN, Mr. CONYERS, Mr. CUMMINGS, Mr. DAVIS of Illinois, Ms. DEGETTE, Ms. DELAURO, Ms. EDWARDS, Mr. ELLISON, Mr. FALEOMAVAEGA, Mr. FATTAH, Ms. FUDGE, Mr. GON- ZALEZ, Mr. AL GREEN of Texas, Mr. GRIJALVA, Mr. GUTIERREZ, Ms. HAHN, Ms. HANABUSA, Mr. HASTINGS of Florida, Ms. HIRONO, Mr. HONDA, Mr. JACKSON of Illinois, Ms. JACKSON LEE of Texas, Mr. JOHN- SON of Georgia, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. LEWIS of Georgia, Mr. KUCINICH, Ms. MATSUI, Mr. MCGOVERN, Mr. MEEKS, Ms. MOORE, Mrs. NAPOLITANO, Ms. NORTON, Mr. OLVER, Mr. PAYNE, Mr. PIERLUISI, Mr. RANGEL, Mr. REYES, Ms. RICHARDSON, Mr. RICHMOND, Mr. RUSH, Mr. SABLAN, Ms. LINDA T. SA´NCHEZ of California, Ms. SCHAKOWSKY, Mr. SCOTT of Virginia, Mr. DAVID SCOTT of Georgia, Mr. SERRANO, Mr. SIRES, Ms. SLAUGHTER, Mr. THOMPSON of Mississippi, Mr. TOWNS, Ms. WATERS, Mr. WATT, Ms. WILSON of Florida, and Ms. WOOLSEY) introduced the following bill; which was referred to the Com- mittee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and the Workforce, the Budget, Veterans’ Affairs, Armed Services, Agriculture, the Judiciary, and Natural Re- sources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdic- tion of the committee concerned VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 2 •HR 2954 IH A BILL To improve the health of minority individuals, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Health Equity and 4 Accountability Act of 2011’’. 5 SEC. 2. TABLE OF CONTENTS. 6 The table of contents of this Act is as follows: 7 Sec. 1. Short title. Sec. 2. Table of contents. Sec. 3. Findings. TITLE I—DATA COLLECTION AND REPORTING Sec. 101. Amendment to the Public Health Service Act. Sec. 102. Elimination of prerequisite of direct appropriations for data collection and analysis. Sec. 103. Collection of race and ethnicity data by the Social Security Adminis- tration. Sec. 104. Revision of HIPAA claims standards. Sec. 105. National Center for Health Statistics. Sec. 106. Oversampling of Asian-Americans, Native Hawaiians, or Pacific Is- landers and other underrepresented groups in Federal health surveys. Sec. 107. Geo-access study. Sec. 108. Racial, ethnic, and linguistic data collected by the Federal Govern- ment. Sec. 109. Data collection and analysis grants to minority-serving institutions. Sec. 110. Standards for measuring sexual orientation and gender identity in collection of health data. Sec. 111. Optional collection of health data on immigrants and individuals in their households. Sec. 112. Standards for measuring socioeconomic status in collection of health data. Sec. 113. Safety and effectiveness of drugs with respect to racial and ethnic background. Sec. 114. GAO study on compliance with existing FDA requirements to present drug and device safety and effectiveness data by sex, age, and racial and ethnic subgroups. Sec. 115. Improving health data regarding Native Hawaiians and other Pacific Islanders. VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 3 •HR 2954 IH TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE Sec. 201. Definitions. Sec. 202. Amendment to the Public Health Service Act. Sec. 203. Federal reimbursement for culturally and linguistically appropriate services under the Medicare, Medicaid, and State Children’s Health Insurance Programs. Sec. 204. Increasing understanding of and improving health literacy. Sec. 205. Assurances for receiving Federal funds. Sec. 206. Report on Federal efforts to provide culturally and linguistically ap- propriate health care services. Sec. 207. English for speakers of other languages. Sec. 208. Implementation. Sec. 209. Language access services. TITLE III—HEALTH WORKFORCE DIVERSITY Sec. 301. Amendment to the Public Health Service Act. Sec. 302. Hispanic-serving health professions schools. Sec. 303. Loan repayment program of Centers for Disease Control and Preven- tion. Sec. 304. Cooperative agreements for online degree programs at schools of pub- lic health and schools of allied health. Sec. 305. National report on the preparedness of health professionals to care for diverse populations. Sec. 306. Scholarship and fellowship programs. Sec. 307. Advisory Committee on Health Professions Training for Diversity. Sec. 308. McNair Postbaccalaureate Achievement Program. Sec. 309. Rules for determination of full-time equivalent residents for cost re- porting periods. Sec. 310. Developing and implementing strategies for local health equity. Sec. 311. Loan forgiveness for mental and behavioral health social workers. TITLE IV—IMPROVEMENT OF HEALTH CARE SERVICES Subtitle A—Health Empowerment Zones Sec. 401. Short title. Sec. 402. Findings. Sec. 403. Designation of health empowerment zones. Sec. 404. Assistance to those seeking designation. Sec. 405. Benefits of designation. Sec. 406. Definition. Sec. 407. Authorization of appropriations. Subtitle B—Other Improvements of Health Care Services CHAPTER 1—EXPANSION OF COVERAGE Sec. 411. Amendment to the Public Health Service Act. Sec. 412. Removing barriers to unsubsidized purchase of private insurance in American Health Benefit Exchanges. Sec. 413. Study on the uninsured. Sec. 414. Medicaid payment parity for the territories. Sec. 415. Clarification of Medicaid coverage for citizens of Freely Associated States. VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6211 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 4 •HR 2954 IH Sec. 416. Extension of Medicare secondary payer. Sec. 417. Border health grants. Sec. 418. Removing Medicare barrier to health care. Sec. 419. 100 percent FMAP for medical assistance provided by urban Indian health centers. Sec. 420. 100 percent FMAP for medical assistance provided to a Native Ha- waiian through a federally qualified health center or a Native Hawaiian health care system under the Medicaid program. CHAPTER 2—EXPANSION OF ACCESS Sec. 421. Grants for racial and ethnic approaches to community health. Sec. 422. Critical access hospital improvements. Sec. 423. Establishment of Rural Community Hospital (RCH) Program. Sec. 424. Medicare remote monitoring pilot projects. Sec. 425. Rural health quality advisory commission and demonstration projects. Sec. 426. Rural health care services. Sec. 427. Community health center collaborative access expansion. Sec. 428. Facilitating the provision of telehealth services across State lines. Sec. 429. Scoring of preventive health savings. Sec. 430. Sense of Congress. Sec. 431. Repeal of requirement for documentation evidencing citizenship or nationality under the Medicaid program. Sec. 432. Office of Minority Health in Veterans Health Administration of De- partment of Veterans Affairs. Sec. 433. Access for Native Americans under PPACA. TITLE V—IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES Sec. 501. Grants to promote positive health behaviors in women and children. Sec. 502. Removing barriers to health care and nutrition assistance for chil- dren, pregnant women, and lawfully present individuals. Sec. 503. Repeal of denial of benefits. Sec. 504. Birth defects prevention, risk reduction, and awareness. Sec. 505. Uniform State maternal mortality review committees on pregnancy- related deaths. Sec. 506. Eliminating disparities in maternity health outcomes. Sec. 507. Decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood. Sec. 508. Reducing teenage pregnancies. Sec. 509. Gestational diabetes. Sec. 510. Emergency contraception education and information programs. Sec. 511. Supporting healthy adolescent development. TITLE VI—MENTAL HEALTH Sec. 601. Coverage of marriage and family therapist services and mental health counselor services under part B of the Medicare program. Sec. 602. Community Mental Health and Addiction Safety Net Equity Act. Sec. 603. Minority Fellowship Program. Sec. 604. Integrated Health Care Demonstration Program. Sec. 605. Addressing racial and ethnic minority mental health disparities re- search gaps. TITLE VII—ADDRESSING HIGH IMPACT MINORITY DISEASES VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6211 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 5 •HR 2954 IH Subtitle A—Cancer Sec. 701. Lung Cancer Mortality Reduction Program. Sec. 702. Expanding prostate cancer research, outreach, screening, testing, ac- cess, and treatment effectiveness. Sec. 703. Improved Medicaid coverage for certain breast and cervical cancer pa- tients in the territories. Sec. 704. Cancer prevention and treatment demonstration for ethnic and racial minorities. Sec. 705. Reducing cancer disparities within Medicare. Subtitle B—Viral Hepatitis and Liver Cancer Control and Prevention Sec. 711. Viral hepatitis and liver cancer control and prevention. Subtitle C—Acquired Bone Marrow Failure Diseases Sec. 721. Acquired Bone Marrow Failure Diseases. Subtitle D—Cardiovascular Disease, Chronic Disease, and Other Disease Issues Sec. 731. Guidelines for disease screening for minority patients. Sec. 732. Coverage of the shingles vaccine under the Medicare program. Sec. 733. CDC Wisewoman Screening Program. Sec. 734. Report on cardiovascular care for women and minorities. Sec. 735. Coverage of comprehensive tobacco cessation services in Medicaid. Sec. 736. Clinical research funding for oral health. Subtitle E—HIV/AIDS Sec. 741. Findings. Sec. 742. Addressing HIV/AIDS in communities of color. Sec. 743. HIV/AIDS reduction in racial and ethnic minority communities. Sec. 744. Repealing ineffective and incomplete abstinence-only education pro- gram. Sec. 745. Dental Education Loan Repayment Program. Sec. 746. Report on the implementation of the national HIV/AIDS strategy. Sec. 747. Addressing HIV/AIDS in the African-American community. Sec. 748. National Black Clergy for the Elimination of HIV/AIDS. Sec. 749. Reducing the spread of sexually transmitted infections in correctional facilities. Sec. 750. Stop AIDS in prison. Sec. 751. Services to reduce HIV/AIDS in racial and ethnic minority commu- nities. Sec. 752. Health care professionals treating individuals with HIV/AIDS. Sec. 753. Report on impact of HIV/AIDS in racial and ethnic minority commu- nities. Sec. 754. Study on status of HIV/AIDS epidemic among African-Americans. Subtitle F—Diabetes Sec. 755. Treatment of diabetes in minority communities. Sec. 756. Eliminating disparities in diabetes prevention access and care. Subtitle G—Lung Disease VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6211 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 6 •HR 2954 IH Sec. 761. Expansion of the National Asthma Education and Prevention Pro- gram. Sec. 762. Asthma-related activities of the centers for disease control and pre- vention. Sec. 763. Influenza and pneumonia vaccination campaign. Sec. 764. Chronic obstructive pulmonary disease action plan. TITLE VIII—HEALTH INFORMATION TECHNOLOGY Subtitle A—Reducing Health Disparities Through Health IT Sec. 801. HRSA assistance to health centers for promotion of Health IT. Sec. 802. Assessment of impact of Health IT on racial and ethnic minority communities; outreach and adoption of Health IT in such com- munities. Subtitle B—Modifications to Achieve Parity in Existing Programs Sec. 811. Extending funding to strengthen the Health IT infrastructure in ra- cial and ethnic minority communities. Sec. 812. Prioritizing regional extension center assistance to racial and ethnic minority groups. Sec. 813. Extending competitive grants for the development of loan programs to facilitate adoption of certified EHR technology by providers serving racial and ethnic minority groups. Subtitle C—Additional Research and Studies Sec. 831. Data collection and assessments conducted in coordination with mi- nority-serving institutions. Sec. 832. IOM study and report on privacy concerns of certain minority popu- lations. Sec. 833. Study of health information technology in medically underserved com- munities. Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs Sec. 841. Application of Medicare HITECH payments to hospitals in Puerto Rico. Sec. 842. Extending Medicaid EHR incentive payments to long-term care facili- ties and home health agencies. Sec. 843. Extending physician assistant eligibility for Medicaid electronic health record incentive payments. TITLE IX—ACCOUNTABILITY AND EVALUATION Sec. 901. Prohibition on discrimination in Federal assisted health care services and research programs on the basis of sex, race, color, national origin, sexual orientation, gender identity, or disability status. Sec. 902. Treatment of Medicare payments under Title VI of the Civil Rights Act of 1964. Sec. 903. Accountability and transparency within the Department of Health and Human Services. Sec. 904. United States Commission on Civil Rights. Sec. 905. Sense of Congress concerning full funding of activities to eliminate racial and ethnic health disparities. Sec. 906. GAO and NIH reports. VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6211 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 7 •HR 2954 IH TITLE X—ADDRESSING SOCIAL DETERMINANTS AND IMPROVING ENVIRONMENTAL JUSTICE Sec. 1001. Codification of Executive Order 12898. Sec. 1002. Implementation of recommendations by Environmental Protection Agency. Sec. 1003. Grant program. Sec. 1004. Additional research on the relationship between the built environ- ment and the health of community residents. Sec. 1005. Environment and public health restoration. Sec. 1006. Healthy Food Financing Initiative. Sec. 1007. GAO report on health effects of Deepwater Horizon oil rig explosion in the Gulf Coast. SEC. 3. FINDINGS. 1 The Congress finds as follows: 2 (1) The population of racial and ethnic minori- 3 ties is expected to increase over the next few dec- 4 ades, yet racial and ethnic minorities have the poor- 5 est health status and face substantial cultural, so- 6 cial, and economic barriers to obtaining quality 7 health care. 8 (2) Health disparities are a function of not only 9 access to health care, but also the social deter- 10 minants of health—including the environment, the 11 physical structure of communities, nutrition and 12 food options, educational attainment, employment, 13 race, ethnicity, sex, geography, language preference, 14 immigrant or citizenship status, sexual orientation, 15 gender identity, socioeconomic status, or disability 16 status—that directly and indirectly affect the health, 17 health care, and wellness of individuals and commu- 18 nities. 19 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 8 •HR 2954 IH (3) By 2020, the Nation will face a shortage of 1 health care providers and allied health workers and 2 this shortage disproportionately affects health pro- 3 fessional shortage areas where many racial and eth- 4 nic minority populations reside. 5 (4) All efforts to reduce health disparities and 6 barriers to quality health services require better and 7 more consistent data. 8 (5) A full range of culturally and linguistically 9 appropriate health care and public health services 10 must be available and accessible in every community. 11 (6) Racial and ethnic minorities and under- 12 served populations must be included early and equi- 13 tably in health reform innovations. 14 (7) Efforts to improve minority health have 15 been limited by inadequate resources in funding, 16 staffing, stewardship and accountability. Targeted 17 investments that are focused on disparities elimi- 18 nation must be made in providing care and services 19 that are community-based, including prevention and 20 policies addressing social determinants of health. 21 (8) In 2011, the Department of Health and 22 Human Services developed the HHS Action Plan to 23 Reduce Racial and Ethnic Health Disparities and 24 the National Stakeholder Strategy for Achieving 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 9 •HR 2954 IH Health Equity, two strategic plans that represent 1 the country’s first coordinated roadmap to reducing 2 health disparities. Along with the National Preven- 3 tion Strategy and the National Health Care Quality 4 Strategy, these comprehensive plans will work to in- 5 crease the number of Americans who are healthy at 6 every stage of life. 7 (9) The Department of Health and Human 8 Services also developed other strategic planning doc- 9 uments to combat disease disparities with a high im- 10 pact on minority populations including the National 11 HIV/AIDS Strategy, and the Action Plan for the 12 Prevention, Care and Treatment of Viral Hepatitis. 13 (10) The Patient Protection and Affordable 14 Care Act, as amended by the Health Care and Edu- 15 cation Reconciliation Act, represents the biggest ad- 16 vancement for minority health in the last 40 years. 17 TITLE I—DATA COLLECTION 18 AND REPORTING 19 SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE 20 ACT. 21 (a) PURPOSE.—It is the purpose of this section to 22 promote data collection, analysis, and reporting by race, 23 ethnicity, sex, primary language, sexual orientation, dis- 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 10 •HR 2954 IH ability status, gender identity, and socioeconomic status 1 among federally supported health programs. 2 (b) AMENDMENT.—Title XXXIV of the Public 3 Health Service Act, as amended by titles II and III of 4 this Act, is further amended by inserting after subtitle A 5 the following: 6 ‘‘Subtitle B—Strengthening Data 7 Collection, Improving Data 8 Analysis, and Expanding Data 9 Reporting 10 ‘‘SEC. 3431. HEALTH DISPARITY DATA. 11 ‘‘(a) REQUIREMENTS.— 12 ‘‘(1) IN GENERAL.—Each health-related pro- 13 gram operated by or that receives funding or reim- 14 bursement, in whole or in part, either directly or in- 15 directly from the Department of Health and Human 16 Services shall— 17 ‘‘(A) require the collection, by the agency 18 or program involved, of data on the race, eth- 19 nicity, sex, primary language, sexual orienta- 20 tion, disability status, gender identity, and so- 21 cioeconomic status of each applicant for and re- 22 cipient of health-related assistance under such 23 program— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 11 •HR 2954 IH ‘‘(i) using, at a minimum, the stand- 1 ards for data collection on race, ethnicity, 2 sex, primary language, sexual orientation, 3 disability status, gender identity, and so- 4 cioeconomic status developed under section 5 3101; 6 ‘‘(ii) collecting data for additional 7 population groups if such groups can be 8 aggregated into the minimum race and 9 ethnicity categories; 10 ‘‘(iii) additionally referring, where 11 practicable, to the standards developed by 12 the Institute of Medicine in ‘Race, Eth- 13 nicity, and Language Data: Standardiza- 14 tion for Health Care Quality Improve- 15 ment’; and 16 ‘‘(iv) where practicable, through self- 17 reporting; 18 ‘‘(B) with respect to the collection of the 19 data described in subparagraph (A), for appli- 20 cants and recipients who are minors, require 21 communication assistance in speech or writing, 22 and for applicants and recipients who are other- 23 wise legally incapacitated, require that— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 12 •HR 2954 IH ‘‘(i) such data be collected from the 1 parent or legal guardian of such an appli- 2 cant or recipient; and 3 ‘‘(ii) the primary language of the par- 4 ent or legal guardian of such an applicant 5 or recipient be collected; 6 ‘‘(C) systematically analyze such data 7 using the smallest appropriate units of analysis 8 feasible to detect racial and ethnic disparities, 9 as well as disparities along the lines of primary 10 language, sex, disability status, sexual orienta- 11 tion, gender identity, and socioeconomic status 12 in health and health care, and report the results 13 of such analysis to the Secretary, the Director 14 of the Office for Civil Rights, each agency listed 15 in section 3101(c)(1), the Committee on 16 Health, Education, Labor, and Pensions and 17 the Committee on Finance of the Senate, and 18 the Committee on Energy and Commerce and 19 the Committee on Ways and Means of the 20 House of Representatives; 21 ‘‘(D) provide such data to the Secretary on 22 at least an annual basis; and 23 ‘‘(E) ensure that the provision of assist- 24 ance to an applicant or recipient of assistance 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 13 •HR 2954 IH is not denied or otherwise adversely affected be- 1 cause of the failure of the applicant or recipient 2 to provide race, ethnicity, primary language, 3 sex, sexual orientation, disability status, gender 4 identity, and socioeconomic status data. 5 ‘‘(2) RULES OF CONSTRUCTION.—Nothing in 6 this subsection shall be construed to— 7 ‘‘(A) permit the use of information col- 8 lected under this subsection in a manner that 9 would adversely affect any individual providing 10 any such information; and 11 ‘‘(B) diminish existing or future require- 12 ments on health care providers to collect data. 13 ‘‘(b) PROTECTION OF DATA.—The Secretary shall 14 ensure (through the promulgation of regulations or other- 15 wise) that all data collected pursuant to subsection (a) are 16 protected— 17 ‘‘(1) under the same privacy protections as the 18 Secretary applies to other health data under the reg- 19 ulations promulgated under section 264(c) of the 20 Health Insurance Portability and Accountability Act 21 of 1996 (Public Law 104–191; 110 Stat. 2033) re- 22 lating to the privacy of individually identifiable 23 health information and other protections; and 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 14 •HR 2954 IH ‘‘(2) from all inappropriate internal use by any 1 entity that collects, stores, or receives the data, in- 2 cluding use of such data in determinations of eligi- 3 bility (or continued eligibility) in health plans, and 4 from other inappropriate uses, as defined by the 5 Secretary. 6 ‘‘(c) NATIONAL PLAN OF THE DATA COUNCIL.—The 7 Secretary shall develop and implement a national plan to 8 ensure the collection of data in a culturally appropriate 9 and competent manner, to improve the collection, analysis, 10 and reporting of racial, ethnic, sex, primary language, sex- 11 ual orientation, disability status, gender identity, and so- 12 cioeconomic status data at the Federal, State, territorial, 13 tribal, and local levels, including data to be collected under 14 subsection (a), and to ensure that data collection activities 15 carried out under this section are in compliance with the 16 standards developed under section 3101. The Data Coun- 17 cil of the Department of Health and Human Services, in 18 consultation with the National Committee on Vital Health 19 Statistics, the Office of Minority Health, Office on Wom- 20 en’s Health, and other appropriate public and private enti- 21 ties, shall make recommendations to the Secretary con- 22 cerning the development, implementation, and revision of 23 the national plan. Such plan shall include recommenda- 24 tions on how to— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 15 •HR 2954 IH ‘‘(1) implement subsection (a) while minimizing 1 the cost and administrative burdens of data collec- 2 tion and reporting; 3 ‘‘(2) expand awareness among Federal agencies, 4 States, territories, Indian tribes, health providers, 5 health plans, health insurance issuers, and the gen- 6 eral public that data collection, analysis, and report- 7 ing by race, ethnicity, primary language, sexual ori- 8 entation, disability status, gender identity, and socio- 9 economic status is legal and necessary to assure eq- 10 uity and nondiscrimination in the quality of health 11 care services; 12 ‘‘(3) ensure that future patient record systems 13 have data code sets for racial, ethnic, primary lan- 14 guage, sexual orientation, disability status, gender 15 identity, and socioeconomic status identifiers and 16 that such identifiers can be retrieved from clinical 17 records, including records transmitted electronically; 18 ‘‘(4) improve health and health care data collec- 19 tion and analysis for more population groups if such 20 groups can be aggregated into the minimum race 21 and ethnicity categories, including exploring the fea- 22 sibility of enhancing collection efforts in States for 23 racial and ethnic groups that comprise a significant 24 proportion of the population of the State; 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 16 •HR 2954 IH ‘‘(5) provide researchers with greater access to 1 racial, ethnic, primary language, sexual orientation, 2 disability status, gender identity, and socioeconomic 3 status data, subject to privacy and confidentiality 4 regulations; and 5 ‘‘(6) safeguard and prevent the misuse of data 6 collected under subsection (a). 7 ‘‘(d) COMPLIANCE WITH STANDARDS.—Data col- 8 lected under subsection (a) shall be obtained, maintained, 9 and presented (including for reporting purposes) in ac- 10 cordance with the 1997 Office of Management and Budget 11 Standards for Maintaining, Collecting, and Presenting 12 Federal Data on Race and Ethnicity (at a minimum). 13 ‘‘(e) TECHNICAL ASSISTANCE FOR THE COLLECTION 14 AND REPORTING OF DATA.— 15 ‘‘(1) IN GENERAL.—The Secretary may, either 16 directly or through grant or contract, provide tech- 17 nical assistance to enable a health care program or 18 an entity operating under such program to comply 19 with the requirements of this section. 20 ‘‘(2) TYPES OF ASSISTANCE.—Assistance pro- 21 vided under this subsection may include assistance 22 to— 23 ‘‘(A) enhance or upgrade computer tech- 24 nology that will facilitate racial, ethnic, primary 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 17 •HR 2954 IH language, sexual orientation, disability status, 1 gender identity, and socioeconomic status data 2 collection and analysis; 3 ‘‘(B) improve methods for health data col- 4 lection and analysis including additional popu- 5 lation groups beyond the Office of Management 6 and Budget categories if such groups can be 7 aggregated into the minimum race and ethnicity 8 categories; 9 ‘‘(C) develop mechanisms for submitting 10 collected data subject to existing privacy and 11 confidentiality regulations; and 12 ‘‘(D) develop educational programs to in- 13 form health insurance issuers, health plans, 14 health providers, health-related agencies, and 15 the general public that data collection and re- 16 porting by race, ethnicity, primary language, 17 sexual orientation, disability status, gender 18 identity, and socioeconomic status are legal and 19 essential for eliminating health and health care 20 disparities. 21 ‘‘(f) ANALYSIS OF HEALTH DISPARITY DATA.—The 22 Secretary, acting through the Director of the Agency for 23 Healthcare Research and Quality and in coordination with 24 the Administrator of the Centers for Medicare & Medicaid 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 18 •HR 2954 IH Services, shall provide technical assistance to agencies of 1 the Department of Health and Human Services in meeting 2 Federal standards for health disparity data collection and 3 for analysis of racial and ethnic disparities in health and 4 health care in public programs by— 5 ‘‘(1) identifying appropriate quality assurance 6 mechanisms to monitor for health disparities; 7 ‘‘(2) specifying the clinical, diagnostic, or thera- 8 peutic measures which should be monitored; 9 ‘‘(3) developing new quality measures relating 10 to racial and ethnic disparities and their overlap 11 with other disparity factors in health and health 12 care; 13 ‘‘(4) identifying the level at which data analysis 14 should be conducted; and 15 ‘‘(5) sharing data with external organizations 16 for research and quality improvement purposes. 17 ‘‘(g) DEFINITION.—In this section, the term ‘health- 18 related program’ mean a program— 19 ‘‘(1) under the Social Security Act (42 U.S.C. 20 301 et seq.) that pays for health care and services; 21 and 22 ‘‘(2) under this Act that provides Federal finan- 23 cial assistance for health care, biomedical research, 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 19 •HR 2954 IH or health services research and or is designed to im- 1 prove the public’s health. 2 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 3 are authorized to be appropriated to carry out this section, 4 such sums as may be necessary for each of fiscal years 5 2012 through 2017. 6 ‘‘SEC. 3432. PROVISIONS RELATING TO NATIVE AMERICANS. 7 ‘‘(a) ESTABLISHMENT OF EPIDEMIOLOGY CEN- 8 TERS.—The Secretary shall establish an epidemiology cen- 9 ter in each service area to carry out the functions de- 10 scribed in subsection (b). Any new center established after 11 the date of the enactment of the Health Equity and Ac- 12 countability Act of 2011 may be operated under a grant 13 authorized by subsection (d), but funding under such a 14 grant shall not be divisible. 15 ‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 16 and upon the request of Indian tribes, tribal organizations, 17 and urban indian organizations, each service area epidemi- 18 ology center established under this subsection shall, with 19 respect to such service area— 20 ‘‘(1) collect data relating to, and monitor 21 progress made toward meeting, each of the health 22 status objectives of the service, the Indian tribes, 23 tribal organizations, and urban indian organizations 24 in the service area; 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 20 •HR 2954 IH ‘‘(2) evaluate existing delivery systems, data 1 systems, and other systems that impact the improve- 2 ment of Indian health; 3 ‘‘(3) assist Indian tribes, tribal organizations, 4 and urban indian organizations in identifying their 5 highest priority health status objectives and the 6 services needed to achieve such objectives, based on 7 epidemiological data; 8 ‘‘(4) make recommendations for the targeting 9 of services needed by the populations served; 10 ‘‘(5) make recommendations to improve health 11 care delivery systems for Indians and urban Indians; 12 ‘‘(6) provide requested technical assistance to 13 Indian tribes, tribal organizations, and urban indian 14 organizations in the development of local health 15 service priorities and incidence and prevalence rates 16 of disease and other illness in the community; and 17 ‘‘(7) provide disease surveillance and assist In- 18 dian tribes, tribal organizations, and urban Indian 19 organizations to promote public health. 20 ‘‘(c) TECHNICAL ASSISTANCE.—The Director of the 21 Centers for Disease Control and Prevention shall provide 22 technical assistance to the centers in carrying out the re- 23 quirements of this subsection. 24 ‘‘(d) GRANTS FOR STUDIES.— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 21 •HR 2954 IH ‘‘(1) IN GENERAL.—The Secretary may make 1 grants to Indian tribes, tribal organizations, urban 2 indian organizations, and eligible intertribal con- 3 sortia to conduct epidemiological studies of Indian 4 communities. 5 ‘‘(2) ELIGIBLE INTERTRIBAL CONSORTIA.—An 6 intertribal consortium is eligible to receive a grant 7 under this subsection if— 8 ‘‘(A) the intertribal consortium is incor- 9 porated for the primary purpose of improving 10 Indian health; and 11 ‘‘(B) the intertribal consortium is rep- 12 resentative of the Indian tribes or urban Indian 13 communities in which the intertribal consortium 14 is located. 15 ‘‘(3) APPLICATIONS.—An application for a 16 grant under this subsection shall be submitted in 17 such manner and at such time as the Secretary shall 18 prescribe. 19 ‘‘(4) REQUIREMENTS.—An applicant for a 20 grant under this subsection shall— 21 ‘‘(A) demonstrate the technical, adminis- 22 trative, and financial expertise necessary to 23 carry out the functions described in paragraph 24 (5); 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 22 •HR 2954 IH ‘‘(B) consult and cooperate with providers 1 of related health and social services in order to 2 avoid duplication of existing services; and 3 ‘‘(C) demonstrate cooperation from Indian 4 tribes or urban Indian organizations in the area 5 to be served. 6 ‘‘(5) USE OF FUNDS.—A grant awarded under 7 paragraph (1) may be used— 8 ‘‘(A) to carry out the functions described 9 in subsection (b); 10 ‘‘(B) to provide information to and consult 11 with tribal leaders, urban Indian community 12 leaders, and related health staff on health care 13 and health service management issues; and 14 ‘‘(C) in collaboration with Indian tribes, 15 tribal organizations, and urban Indian commu- 16 nities, to provide the service with information 17 regarding ways to improve the health status of 18 Indians. 19 ‘‘(e) ACCESS TO INFORMATION.—An epidemiology 20 center operated by a grantee pursuant to a grant awarded 21 under subsection (d) shall be treated as a public health 22 authority for purposes of the Health Insurance Portability 23 and Accountability Act of 1996 (Public Law 104–191; 110 24 Stat. 2033), as such entities are defined in part 164.501 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 23 •HR 2954 IH of title 45, Code of Federal Regulations (or a successor 1 regulation). The Secretary shall grant such grantees ac- 2 cess to and use of data, data sets, monitoring systems, 3 delivery systems, and other protected health information 4 in the possession of the Secretary.’’. 5 SEC. 102. ELIMINATION OF PREREQUISITE OF DIRECT AP- 6 PROPRIATIONS FOR DATA COLLECTION AND 7 ANALYSIS. 8 Section 3101 of the Public Health Service Act (42 9 U.S.C. 300kk) is amended— 10 (1) by striking subsection (h); and 11 (2) by redesignating subsection (i) as subsection 12 (h). 13 SEC. 103. COLLECTION OF RACE AND ETHNICITY DATA BY 14 THE SOCIAL SECURITY ADMINISTRATION. 15 Part A of title XI of the Social Security Act (42 16 U.S.C. 1301 et seq.) is amended by adding at the end 17 the following: 18 ‘‘SEC. 1150C. COLLECTION OF RACE AND ETHNICITY DATA 19 BY THE SOCIAL SECURITY ADMINISTRATION. 20 ‘‘(a) REQUIREMENT.—The Commissioner of Social 21 Security, in consultation with the Administrator of the 22 Centers for Medicare & Medicaid Services, shall— 23 ‘‘(1) require the collection of data on the race, 24 ethnicity, primary language, and disability status of 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 24 •HR 2954 IH all applicants for Social Security account numbers or 1 benefits under title II or part A of title XVIII and 2 all individuals with respect to whom the Commis- 3 sioner maintains records of wages and self-employ- 4 ment income in accordance with reports received by 5 the Commissioner or the Secretary of the Treas- 6 ury— 7 ‘‘(A) using, at a minimum, the standards 8 for data collection on race, ethnicity, primary 9 language, and disability status developed under 10 section 3101 of the Public Health Service Act; 11 ‘‘(B) where practicable, collecting data for 12 additional population groups if such groups can 13 be aggregated into the minimum race and eth- 14 nicity categories; and 15 ‘‘(C) additionally referring, where prac- 16 ticable, to the standards developed by the Insti- 17 tute of Medicine in ‘Race, Ethnicity, and Lan- 18 guage Data: Standardization for Health Care 19 Quality Improvement’ (released August 31, 20 2009); 21 ‘‘(2) with respect to the collection of the data 22 described in paragraph (1) for applicants who are 23 under 18 years of age or otherwise legally incapaci- 24 tated, require that— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 25 •HR 2954 IH ‘‘(A) such data be collected from the par- 1 ent or legal guardian of such an applicant; and 2 ‘‘(B) the primary language of the parent 3 or legal guardian of such an applicant or recipi- 4 ent be used; 5 ‘‘(3) require that such data be uniformly ana- 6 lyzed and reported at least annually to the Commis- 7 sioner of Social Security; 8 ‘‘(4) be responsible for storing the data re- 9 ported under paragraph (3); 10 ‘‘(5) ensure transmission to the Centers for 11 Medicare & Medicaid Services and other Federal 12 health agencies; 13 ‘‘(6) provide such data to the Secretary on at 14 least an annual basis; and 15 ‘‘(7) ensure that the provision of assistance to 16 an applicant is not denied or otherwise adversely af- 17 fected because of the failure of the applicant to pro- 18 vide race, ethnicity, primary language, and disability 19 status data. 20 ‘‘(b) PROTECTION OF DATA.—The Commissioner of 21 Social Security shall ensure (through the promulgation of 22 regulations or otherwise) that all data collected pursuant 23 to subsection (a) are protected— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 26 •HR 2954 IH ‘‘(1) under the same privacy protections as the 1 Secretary applies to health data under the regula- 2 tions promulgated under section 264(c) of the 3 Health Insurance Portability and Accountability Act 4 of 1996 (Public Law 104–191; 110 Stat. 2033) re- 5 lating to the privacy of individually identifiable 6 health information and other protections; and 7 ‘‘(2) from all inappropriate internal use by any 8 entity that collects, stores, or receives the data, in- 9 cluding use of such data in determinations of eligi- 10 bility (or continued eligibility) in health plans, and 11 from other inappropriate uses, as defined by the 12 Secretary. 13 ‘‘(c) RULE OF CONSTRUCTION.—Nothing in this sec- 14 tion shall be construed to permit the use of information 15 collected under this section in a manner that would ad- 16 versely affect any individual providing any such informa- 17 tion. 18 ‘‘(d) TECHNICAL ASSISTANCE.—The Secretary may, 19 either directly or by grant or contract, provide technical 20 assistance to enable any health entity to comply with the 21 requirements of this section. 22 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 23 are authorized to be appropriated to carry out this section, 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 27 •HR 2954 IH such sums as may be necessary for each of fiscal years 1 2012 through 2017.’’. 2 SEC. 104. REVISION OF HIPAA CLAIMS STANDARDS. 3 (a) IN GENERAL.—Not later than 1 year after the 4 date of enactment of this Act, the Secretary of Health and 5 Human Services shall revise the regulations promulgated 6 under part C of title XI of the Social Security Act (42 7 U.S.C. 1320d et seq.), relating to the collection of data 8 on race, ethnicity, and primary language in a health-re- 9 lated transaction, to require— 10 (1) the use, at a minimum, of the standards for 11 data collection on race, ethnicity, primary language, 12 disability, and sex developed under section 3101 of 13 the Public Health Service Act (42 U.S.C. 300kk); 14 and 15 (2) the designation of the racial, ethnic, pri- 16 mary language, disability, and sex code sets as re- 17 quired for claims and enrollment data. 18 (b) DISSEMINATION.—The Secretary of Health and 19 Human Services shall disseminate the new standards de- 20 veloped under subsection (a) to all health entities that are 21 subject to the regulations described in such subsection and 22 provide technical assistance with respect to the collection 23 of the data involved. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 28 •HR 2954 IH (c) COMPLIANCE.—The Secretary of Health and 1 Human Services shall require that health entities comply 2 with the new standards developed under subsection (a) not 3 later than 2 years after the final promulgation of such 4 standards. 5 SEC. 105. NATIONAL CENTER FOR HEALTH STATISTICS. 6 Section 306(n) of the Public Health Service Act (42 7 U.S.C. 242k(n)) is amended— 8 (1) in paragraph (1), by striking ‘‘2003’’ and 9 inserting ‘‘2016’’; 10 (2) in paragraph (2), in the first sentence, by 11 striking ‘‘2003’’ and inserting ‘‘2016’’; and 12 (3) in paragraph (3), by striking ‘‘2002’’ and 13 inserting ‘‘2016’’. 14 SEC. 106. OVERSAMPLING OF ASIAN-AMERICANS, NATIVE 15 HAWAIIANS, OR PACIFIC ISLANDERS AND 16 OTHER UNDERREPRESENTED GROUPS IN 17 FEDERAL HEALTH SURVEYS. 18 Part B of title III of the Public Health Service Act 19 (42 U.S.C. 243 et seq.) is amended by inserting after sec- 20 tion 317T the following: 21 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 29 •HR 2954 IH ‘‘SEC. 317U. OVERSAMPLING OF ASIAN-AMERICANS, NATIVE 1 HAWAIIANS, OR PACIFIC ISLANDERS AND 2 OTHER UNDERREPRESENTED GROUPS IN 3 FEDERAL HEALTH SURVEYS. 4 ‘‘(a) NATIONAL STRATEGY.— 5 ‘‘(1) IN GENERAL.—The Secretary of Health 6 and Human Services, acting through the Director of 7 the National Center for Health Statistics (referred 8 to in this section as ‘NCHS’) of the Centers for Dis- 9 ease Control and Prevention, and other agencies 10 within the Department of Health and Human Serv- 11 ices as the Secretary determines appropriate, shall 12 develop and implement an ongoing and sustainable 13 national strategy for oversampling Asian-Americans, 14 Native Hawaiians, or Pacific Islanders, and other 15 underrepresented populations as determined appro- 16 priate by the Secretary in Federal health surveys. 17 ‘‘(2) CONSULTATION.—In developing and imple- 18 menting a national strategy, as described in para- 19 graph (1), not later than 180 days after the date of 20 the enactment of the this section, the Secretary— 21 ‘‘(A) shall consult with representatives of 22 community groups, nonprofit organizations, 23 nongovernmental organizations, and govern- 24 ment agencies working with Asian-Americans, 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 30 •HR 2954 IH Native Hawaiians, or Pacific Islanders, and 1 other underrepresented populations; and 2 ‘‘(B) may solicit the participation of rep- 3 resentatives from other Federal departments 4 and agencies. 5 ‘‘(b) PROGRESS REPORT.—Not later than 2 years 6 after the date of the enactment of this section, the Sec- 7 retary shall submit to the Congress a progress report, 8 which shall include the national strategy described in sub- 9 section (a)(1). 10 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 11 carry out this section, there are authorized to be appro- 12 priated such sums as may be necessary for fiscal years 13 2012 through 2017.’’. 14 SEC. 107. GEO-ACCESS STUDY. 15 The Administrator of the Substance Abuse and Men- 16 tal Health Services Administration shall— 17 (1) conduct a study to— 18 (A) determine which geographic areas of 19 the United States have shortages of specialty 20 mental health providers; and 21 (B) assess the preparedness of speciality 22 mental health providers to deliver culturally and 23 linguistically appropriate, affordable, and acces- 24 sible services; and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 31 •HR 2954 IH (2) submit a report to the Congress on the re- 1 sults of such study. 2 SEC. 108. RACIAL, ETHNIC, AND LINGUISTIC DATA COL- 3 LECTED BY THE FEDERAL GOVERNMENT. 4 (a) COLLECTION; SUBMISSION.—Not later than 90 5 days after the date of the enactment of this Act, and Jan- 6 uary 31 of each year thereafter, each department, agency, 7 and office of the Federal Government that has collected 8 racial, ethnic, or linguistic data during the preceding cal- 9 endar year shall submit such data to the Secretary of 10 Health and Human Services. 11 (b) ANALYSIS; PUBLIC AVAILABILITY; REPORTING.— 12 Not later than April 30, 2012, and each April 30 there- 13 after, the Secretary of Health and Human Services, acting 14 through the Director of the National Institute on Minority 15 Health and Health Disparities and the Deputy Assistant 16 Secretary for Minority Health, shall— 17 (1) collect and analyze the racial, ethnic, and 18 linguistic data submitted under subsection (a) for 19 the preceding calendar year; 20 (2) make publicly available such data and the 21 results of such analysis; and 22 (3) submit a report to the Congress on such 23 data and analysis. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 32 •HR 2954 IH SEC. 109. DATA COLLECTION AND ANALYSIS GRANTS TO MI- 1 NORITY-SERVING INSTITUTIONS. 2 (a) AUTHORITY.—The Secretary of Health and 3 Human Services, acting through the National Institute on 4 Minority Health and Health Disparities and the Office of 5 Minority Health, may award grants to access and analyze 6 racial and ethnic, and where possible other health dis- 7 parity data, to monitor and report on progress to reduce 8 and eliminate disparities in health and health care. 9 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el- 10 igible entity’’ means a historically Black college or univer- 11 sity, an Hispanic-serving institution, a tribal college or 12 university, or an Asian-American, Native American, or Pa- 13 cific Islander-serving institution with an accredited public 14 health, health policy, or health services research program. 15 SEC. 110. STANDARDS FOR MEASURING SEXUAL ORIENTA- 16 TION AND GENDER IDENTITY IN COLLECTION 17 OF HEALTH DATA. 18 Section 3101(a) of the Public Health Service Act (42 19 U.S.C. 300kk(a)) is amended— 20 (1) in paragraph (1)(A), by inserting ‘‘sexual 21 orientation, gender identity,’’ before ‘‘and disability 22 status’’; 23 (2) in paragraph (1)(C), by inserting ‘‘sexual 24 orientation, gender identity,’’ before ‘‘and disability 25 status’’; and 26 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 33 •HR 2954 IH (3) in paragraph (2)(B), by inserting ‘‘sexual 1 orientation, gender identity,’’ before ‘‘and disability 2 status’’. 3 SEC. 111. OPTIONAL COLLECTION OF HEALTH DATA ON IM- 4 MIGRANTS AND INDIVIDUALS IN THEIR 5 HOUSEHOLDS. 6 Section 3101(a) of the Public Health Service Act (42 7 U.S.C. 300k(a)) is amended by adding at the end the fol- 8 lowing: 9 ‘‘(4) OPTIONAL UNIFORM CATEGORIES.—Not 10 later than 12 months after the date of the enact- 11 ment of this paragraph, the Secretary shall— 12 ‘‘(A) enter into an arrangement with the 13 Institute of Medicine of the National Academies 14 (or, if the Institute of Medicine declines to 15 enter into such an arrangement, another appro- 16 priate entity) to— 17 ‘‘(i) conduct a study and develop rec- 18 ommended standards for the optional col- 19 lection of data on immigrants, as well as 20 citizens living within immigrant households 21 (mixed-status households), in order to 22 measure disparities in health coverage, 23 health care access and quality, and health 24 status among these populations, and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 34 •HR 2954 IH ‘‘(ii) include ensuing recommendations 1 and results in a report to the Secretary 2 that includes best practices to protect the 3 privacy of respondents to the full extent of 4 applicable law; 5 ‘‘(B) promulgate standards based on the 6 recommendations and results of subparagraph 7 (A) for the optional collection of data in major 8 health surveys and research; and 9 ‘‘(C) provide clear guidance that immi- 10 grant and mixed-status households are optional 11 uniform categories and data concerning such 12 households shall— 13 ‘‘(i) not be required to be collected by 14 the standards under subparagraph (B); 15 ‘‘(ii) be collected only in accordance 16 with— 17 ‘‘(I) the ‘Tri-Agency Guidance’ 18 issued by the Food and Nutrition 19 Service of the Department of Agri- 20 culture, the Centers for Medicare & 21 Medicaid Services, the Administration 22 for Children and Families, and Office 23 for Civil Rights; and 24 ‘‘(II) other applicable law; and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 35 •HR 2954 IH ‘‘(iii) not be collected for program ap- 1 plication and enrollment processes beyond 2 statutory requirements.’’. 3 SEC. 112. STANDARDS FOR MEASURING SOCIOECONOMIC 4 STATUS IN COLLECTION OF HEALTH DATA. 5 Section 3101(a) of the Public Health Service Act (42 6 U.S.C. 300kk(a)), as amended, is amended— 7 (1) in paragraph (1)(A), by inserting ‘‘socio- 8 economic status,’’ before ‘‘and disability status’’; 9 (2) in paragraph (1)(C), by inserting ‘‘socio- 10 economic status,’’ before ‘‘and disability status’’; and 11 (3) in paragraph (2)(B), by inserting ‘‘socio- 12 economic status,’’ before ‘‘and disability status’’. 13 SEC. 113. SAFETY AND EFFECTIVENESS OF DRUGS WITH 14 RESPECT TO RACIAL AND ETHNIC BACK- 15 GROUND. 16 (a) IN GENERAL.—Chapter V of the Federal Food, 17 Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend- 18 ed by adding after section 505D the following: 19 ‘‘SEC. 505E. SAFETY AND EFFECTIVENESS OF DRUGS WITH 20 RESPECT TO RACIAL AND ETHNIC BACK- 21 GROUND. 22 ‘‘(a) PREAPPROVAL STUDIES.—If there is evidence 23 that there may be a disparity on the basis of racial or 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 36 •HR 2954 IH ethnic background as to the safety or effectiveness of a 1 drug, then— 2 ‘‘(1)(A) the investigations required under sec- 3 tion 505(b)(1)(A) shall include adequate and well- 4 controlled investigations of the disparity; or 5 ‘‘(B) the evidence required under section 351(a) 6 of the Public Health Service Act for approval of a 7 biologics license application for the drug shall in- 8 clude adequate and well-controlled investigations of 9 the disparity; and 10 ‘‘(2) if the investigations confirm that there is 11 a disparity, the labeling of the drug shall include ap- 12 propriate information about the disparity. 13 ‘‘(b) POSTMARKET STUDIES.— 14 ‘‘(1) IN GENERAL.—If there is evidence that 15 there may be a disparity on the basis of racial or 16 ethnic background as to the safety or effectiveness 17 of a drug for which there is an approved application 18 under section 505 or a license under section 351 of 19 the Public Health Service Act, the Secretary may by 20 order require the holder of the approved application 21 or license to conduct, by a date specified by the Sec- 22 retary, postmarketing studies to investigate the dis- 23 parity. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 37 •HR 2954 IH ‘‘(2) LABELING.—If the Secretary determines 1 that the postmarket studies confirm that there is a 2 disparity described in paragraph (1), the labeling of 3 the drug shall include appropriate information about 4 the disparity. 5 ‘‘(3) STUDY DESIGN.—The Secretary may 6 specify all aspects of study design, including the 7 number of studies and study participants, and the 8 other demographic characteristics of study partici- 9 pants included, in the order requiring postmarket 10 studies of the drug. 11 ‘‘(4) MODIFICATIONS OF STUDY DESIGN.—The 12 Secretary may by order modify any aspect of the 13 study design as necessary after issuing an order 14 under paragraph (1). 15 ‘‘(5) STUDY RESULTS.—The results from stud- 16 ies required under paragraph (1) shall be submitted 17 to the Secretary as supplements to the drug applica- 18 tion or biological license application. 19 ‘‘(c) DISPARITY.—The term ‘evidence that there may 20 be a disparity on the basis of racial or ethnic background 21 for adult and pediatric populations as to the safety or ef- 22 fectiveness of a drug’ includes— 23 ‘‘(1) evidence that there is a disparity on the 24 basis of racial or ethnic background as to safety or 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 38 •HR 2954 IH effectiveness of a drug in the same chemical class as 1 the drug; 2 ‘‘(2) evidence that there is a disparity on the 3 basis of racial or ethnic background in the way the 4 drug is metabolized; and 5 ‘‘(3) other evidence as the Secretary may deter- 6 mine. 7 ‘‘(d) APPLICATIONS UNDER SECTIONS 505(b)(2) 8 AND 505(j).— 9 ‘‘(1) IN GENERAL.—A drug for which an appli- 10 cation has been submitted or approved under section 11 505(j) shall not be considered ineligible for approval 12 under that section or misbranded under section 502 13 on the basis that the labeling of the drug omits in- 14 formation relating to a disparity on the basis of ra- 15 cial or ethnic background as to the safety or effec- 16 tiveness of the drug, whether derived from investiga- 17 tions or studies required under this section or de- 18 rived from other sources, when the omitted informa- 19 tion is protected by patent or by exclusivity under 20 clause (iii) or (iv) of section 505(j)(5)(B). 21 ‘‘(2) LABELING.—Notwithstanding clauses (iii) 22 and (iv) of section 505(j)(5)(B), the Secretary may 23 require that the labeling of a drug approved under 24 section 505(j) that omits information relating to a 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 39 •HR 2954 IH disparity on the basis of racial or ethnic background 1 as to the safety or effectiveness of the drug include 2 a statement of any appropriate contraindications, 3 warnings, or precautions related to the disparity 4 that the Secretary considers necessary.’’. 5 (b) ENFORCEMENT.—Section 502 of the Federal 6 Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend- 7 ed by adding at the end the following: 8 ‘‘(aa) If it is a drug and the holder of the approved 9 application under section 505 or license under section 351 10 of the Public Health Service Act for the drug has failed 11 to complete the investigations or studies, or comply with 12 any other requirement, of section 505E.’’. 13 (c) DRUG FEES.—Section 736(a)(1)(A)(ii) of the 14 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379h) 15 is amended by adding after ‘‘are required’’ the following: 16 ‘‘, including supplements required under section 505E’’. 17 SEC. 114. GAO STUDY ON COMPLIANCE WITH EXISTING FDA 18 REQUIREMENTS TO PRESENT DRUG AND DE- 19 VICE SAFETY AND EFFECTIVENESS DATA BY 20 SEX, AGE, AND RACIAL AND ETHNIC SUB- 21 GROUPS. 22 (a) IN GENERAL.—The Comptroller General of the 23 United States shall conduct a study investigating the ex- 24 tent to which sponsors of clinical studies of investigational 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 40 •HR 2954 IH drugs, biologics, and devices and sponsors of applications 1 for approval or licensure of new drugs, biologics, and de- 2 vices comply with Food and Drug Administration require- 3 ments and follow guidance for presentation of clinical 4 study safety and effectiveness data by sex, age, and racial 5 and ethnic subgroups. 6 (b) REPORT BY GAO.— 7 (1) SUBMISSION.—Not later than 18 months 8 after the date of the enactment of this Act, the 9 Comptroller General shall complete the study under 10 subsection (a) and submit to the Committee on En- 11 ergy and Commerce of the House of Representatives 12 and the Committee on Health, Education, Labor, 13 and Pensions of the Senate a report on the results 14 of such study. 15 (2) CONTENTS.—The report required by para- 16 graph (1) shall include each of the following: 17 (A) An assessment of the extent to which 18 the Food and Drug Administration assists 19 sponsors in complying with the requirements 20 and following the guidance referred to in sub- 21 section (a). 22 (B) An assessment of the effectiveness of 23 the Food and Drug Administration’s enforce- 24 ment of compliance with such requirements. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 41 •HR 2954 IH (C) An analysis of the extent to which fe- 1 males, racial and ethnic minorities, and adults 2 of all ages are adequately represented in Food 3 and Drug Administration-approved clinical 4 studies (at all phases) so that product safety 5 and effectiveness data can be evaluated by sex, 6 age, and racial and ethnic subgroup. 7 (D) An analysis of the extent to which a 8 summary of product safety and effectiveness 9 data disaggregated by sex, age, and racial and 10 ethnic subgroup is readily available to the pub- 11 lic in a timely manner by means of the product 12 label or the Food and Drug Administration’s 13 Web site. 14 (E) Recommendations for— 15 (i) modifications to the requirements 16 and guidance referred to in subsection (a); 17 or 18 (ii) oversight by the Food and Drug 19 Administration of such requirements. 20 (c) REPORT BY HHS.—Not later than 6 months 21 after the submission by the Comptroller General of the 22 report required under subsection (b), the Secretary of 23 Health and Human Services shall submit to the Com- 24 mittee on Energy and Commerce of the House of Rep- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 42 •HR 2954 IH resentatives and the Committee on Health, Education, 1 Labor, and Pensions of the Senate a response to that re- 2 port, including a corrective action plan as needed to re- 3 spond to the recommendations in that report. 4 (d) DEFINITIONS.—In this section: 5 (1) The term ‘‘biologic’’ has the meaning given 6 to the term ‘‘biological product’’ in section 351(i) of 7 the Public Health Service Act (42 U.S.C. 262(i)). 8 (2) The term ‘‘device’’ has the meaning given to 9 such term in section 201(h) of the Federal Food, 10 Drug, and Cosmetic Act (21 U.S.C. 321(h)). 11 (3) The term ‘‘drug’’ has the meaning given to 12 such term in section 201(g) of the Federal Food, 13 Drug, and Cosmetic Act (21 U.S.C. 321(g)). 14 SEC. 115. IMPROVING HEALTH DATA REGARDING NATIVE 15 HAWAIIANS AND OTHER PACIFIC ISLANDERS. 16 Part B of title III of the Public Health Service Act 17 (42 U.S.C. 243 et seq.) is amended by inserting after sec- 18 tion 317U, as added, the following: 19 ‘‘SEC. 317V. NATIVE HAWAIIAN AND OTHER PACIFIC IS- 20 LANDER HEALTH DATA. 21 ‘‘(a) DEFINITIONS.—In this section: 22 ‘‘(1) COMMUNITY GROUP.—The term ‘commu- 23 nity group’ means a group of NHOPI who are orga- 24 nized at the community level, and may include a 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 43 •HR 2954 IH church group, social service group, national advocacy 1 organization, or cultural group. 2 ‘‘(2) NONPROFIT, NONGOVERNMENTAL ORGANI- 3 ZATION.—The term ‘nonprofit, nongovernmental or- 4 ganization’ means a group of NHOPI with a dem- 5 onstrated history of addressing NHOPI issues, in- 6 cluding a NHOPI coalition. 7 ‘‘(3) DESIGNATED ORGANIZATION.—The term 8 ‘designated organization’ means an entity estab- 9 lished to represent NHOPI populations and which 10 has statutory responsibilities to provide, or has com- 11 munity support for providing, health care. 12 ‘‘(4) GOVERNMENT REPRESENTATIVES.—The 13 term ‘government representatives’ means representa- 14 tives from Hawaii, American Samoa, the Common- 15 wealth of the Northern Mariana Islands, the Fed- 16 erated States of Micronesia, Guam, the Republic of 17 Palau, and the Republic of the Marshall Islands. 18 ‘‘(5) NATIVE HAWAIIANS AND OTHER PACIFIC 19 ISLANDERS (NHOPI).—The term ‘Native Hawaiians 20 and Other Pacific Islanders’ or ‘NHOPI’ means peo- 21 ple having origins in any of the original peoples of 22 American Samoa, the Commonwealth of the North- 23 ern Mariana Islands, the Federated States of Micro- 24 nesia, Guam, Hawaii, the Republic of the Marshall 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 44 •HR 2954 IH Islands, the Republic of Palau, or any other Pacific 1 island. 2 ‘‘(6) INSULAR AREA.—The term ‘insular area’ 3 means Guam, the Commonwealth of Northern Mar- 4 iana Islands, American Samoa, the United States 5 Virgin Islands, the Federated States of Micronesia, 6 the Republic of Palau, or the Republic of the Mar- 7 shall Islands. 8 ‘‘(b) NATIONAL STRATEGY.— 9 ‘‘(1) IN GENERAL.—The Secretary, acting 10 through the Director of the National Center for 11 Health Statistics (referred to in this section as 12 ‘NCHS’) of the Centers for Disease Control and 13 Prevention, and other agencies within the Depart- 14 ment of Health and Human Services as the Sec- 15 retary determines appropriate, shall develop and im- 16 plement an ongoing and sustainable national strat- 17 egy for identifying and evaluating the health status 18 and health care needs of NHOPI populations living 19 in the continental United States, Hawaii, American 20 Samoa, the Commonwealth of the Northern Mariana 21 Islands, the Federated States of Micronesia, Guam, 22 the Republic of Palau, and the Republic of the Mar- 23 shall Islands. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 45 •HR 2954 IH ‘‘(2) CONSULTATION.—In developing and imple- 1 menting a national strategy, as described in para- 2 graph (1), not later than 180 days after the date of 3 enactment of the Health Equity and Accountability 4 Act of 2011, the Secretary— 5 ‘‘(A) shall consult with representatives of 6 community groups, designated organizations, 7 and nonprofit, nongovernmental organizations 8 and with government representatives of NHOPI 9 populations; and 10 ‘‘(B) may solicit the participation of rep- 11 resentatives from other Federal departments. 12 ‘‘(c) PRELIMINARY HEALTH SURVEY.— 13 ‘‘(1) IN GENERAL.—The Secretary, acting 14 through the Director of NCHS, shall conduct a pre- 15 liminary health survey in order to identify the major 16 areas and regions in the continental United States, 17 Hawaii, American Samoa, the Commonwealth of the 18 Northern Mariana Islands, the Federated States of 19 Micronesia, Guam, the Republic of Palau, and the 20 Republic of the Marshall Islands in which NHOPI 21 people reside. 22 ‘‘(2) CONTENTS.—The health survey described 23 in paragraph (1) shall include health data and any 24 other data the Secretary determines to be— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 46 •HR 2954 IH ‘‘(A) useful in determining health status 1 and health care needs; or 2 ‘‘(B) required for developing or imple- 3 menting a national strategy. 4 ‘‘(3) METHODOLOGY.—Methodology for the 5 health survey described in paragraph (1), including 6 plans for designing questions, implementation, sam- 7 pling, and analysis, shall be developed in consulta- 8 tion with community groups, designated organiza- 9 tions, nonprofit, nongovernmental organizations, and 10 government representatives of NHOPI populations, 11 as determined by the Secretary. 12 ‘‘(4) TIMEFRAME.—The survey required under 13 this subsection shall be completed not later than 18 14 months after the date of enactment of the Health 15 Equity and Accountability Act of 2011. 16 ‘‘(d) PROGRESS REPORT.—Not later than 2 years 17 after the date of enactment of the Health Equity and Ac- 18 countability Act of 2011, the Secretary shall submit to 19 Congress a progress report, which shall include the na- 20 tional strategy described in subsection (b)(1). 21 ‘‘(e) STUDY AND REPORT BY THE IOM.— 22 ‘‘(1) IN GENERAL.—The Secretary shall enter 23 into an agreement with the Institute of Medicine to 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 47 •HR 2954 IH conduct a study, with input from stakeholders in in- 1 sular areas, on the following: 2 ‘‘(A) The standards and definitions of 3 health care applied to health care systems in in- 4 sular areas and the appropriateness of such 5 standards and definitions. 6 ‘‘(B) The status and performance of health 7 care systems in insular areas, evaluated based 8 upon standards and definitions, as the Sec- 9 retary determines. 10 ‘‘(C) The effectiveness of donor aid in ad- 11 dressing health care needs and priorities in in- 12 sular areas. 13 ‘‘(D) The progress toward implementation 14 of recommendations of the Committee on 15 Health Care Services in the United States—As- 16 sociated Pacific Basin of the Institute of Medi- 17 cine that are set forth in the 1998 report, ‘Pa- 18 cific Partnerships for Health: Charting a New 19 Course for the 21st Century’. 20 ‘‘(2) REPORT.—An agreement described in 21 paragraph (1) shall require the Institute of Medicine 22 to submit to the Secretary and to Congress, not 23 later than 2 years after the date of the enactment 24 of the Health Equity and Accountability Act of 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 48 •HR 2954 IH 2011, a report containing a description of the results 1 of the study conducted under paragraph (1), includ- 2 ing the conclusions and recommendations of the In- 3 stitute of Medicine for each of the items described 4 in subparagraphs (A) through (D) of such para- 5 graph. 6 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 7 carry out this section, there are authorized to be appro- 8 priated such sums as may be necessary for fiscal years 9 2012 through 2017.’’. 10 TITLE II—CULTURALLY AND LIN- 11 GUISTICALLY APPROPRIATE 12 HEALTH CARE 13 SEC. 201. DEFINITIONS. 14 In this title, the definitions contained in section 3400 15 of the Public Health Service Act, as added by section 202, 16 shall apply. 17 SEC. 202. AMENDMENT TO THE PUBLIC HEALTH SERVICE 18 ACT. 19 (a) FINDINGS.—Congress finds the following: 20 (1) Effective communication is essential to 21 meaningful access to quality physical and mental 22 health care. 23 (2) Research indicates that the lack of appro- 24 priate language services creates languages barriers 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 49 •HR 2954 IH that result in increased risk of misdiagnosis, ineffec- 1 tive treatment plans and poor health outcomes for 2 limited-English-proficient individuals and individuals 3 with communication disabilities such as hearing, vi- 4 sion or print impairments. 5 (3) The number of limited-English-speaking 6 residents in the United States who speak English 7 less than very well and, therefore, cannot effectively 8 communicate with health and social service providers 9 continues to increase significantly. 10 (4) The responsibility to fund language services 11 in the provision of health care and health care-re- 12 lated services to limited-English-proficient individ- 13 uals and individuals with communication disabilities 14 such as hearing, vision, or print impairments is a so- 15 cietal one that cannot fairly be visited solely upon 16 the health care, public health or social services com- 17 munity. 18 (5) Title VI of the Civil Rights Act of 1964 19 prohibits discrimination based on the grounds of 20 race, color or national origin by any entity receiving 21 Federal financial assistance. In order to avoid dis- 22 crimination on the grounds of national origin, all 23 programs or activities administered by the Depart- 24 ment must take adequate steps to ensure that their 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 50 •HR 2954 IH policies and procedures do not deny or have the ef- 1 fect of denying limited-English-proficient individuals 2 with equal access to benefits and services for which 3 such persons qualify. 4 (6) Linguistic diversity in the healthcare and 5 health-care-related-services workforce is important 6 for providing all patients the environment most con- 7 ducive to positive health outcomes. 8 (7) All members of the health care and health- 9 care-related-services community should continue to 10 educate their staff and constituents about limited- 11 English proficient and disability communication 12 issues and help them identify resources to improve 13 access to quality care for limited-English-proficient 14 individuals and individuals with communication dis- 15 abilities such as hearing, vision, or print impair- 16 ments. 17 (8) Access to English as a second language and 18 sign language instructions is an important mecha- 19 nism for ensuring effective communication and elimi- 20 nating the language barriers that impede access to 21 health care. 22 (9) Competent languages services in health care 23 settings should be available as a matter of course. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 51 •HR 2954 IH (b) AMENDMENT.—The Public Health Service Act 1 (42 U.S.C. 201 et seq.) is amended by adding at the end 2 the following: 3 ‘‘TITLE XXXIV—CULTURALLY 4 AND LINGUISTICALLY APPRO- 5 PRIATE HEALTH CARE 6 ‘‘SEC. 3400. DEFINITIONS. 7 ‘‘In this title: 8 ‘‘(1) BILINGUAL.—The term ‘bilingual’ with re- 9 spect to an individual means a person who has suffi- 10 cient degree of proficiency in two languages. 11 ‘‘(2) COMMUNITY HEALTH WORKER.—The term 12 ‘community health worker’ includes a community 13 health advocate, a lay health educator, a community 14 health representative, a peer health promoter, a 15 community health outreach worker, and in Spanish, 16 promotores de salud. 17 ‘‘(3) COMPETENT INTERPRETER SERVICES.— 18 The term ‘competent interpreter services’ means a 19 translanguage rendition of a spoken or signed mes- 20 sage in which the interpreter comprehends the 21 source language and can communicate comprehen- 22 sively in the target language to convey the meaning 23 intended in the source language. The interpreter 24 knows health and health-related terminology and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 52 •HR 2954 IH provides accurate interpretations by choosing equiva- 1 lent expressions that convey the best matching and 2 meaning to the source language and captures, to the 3 greatest possible extent, all nuances intended in the 4 source message. 5 ‘‘(4) COMPETENT TRANSLATION SERVICES.— 6 The term ‘competent translation services’ means a 7 translanguage rendition of a written document in 8 which the translator comprehends the source lan- 9 guage and can write or sign comprehensively in the 10 target language to convey the meaning intended in 11 the source language. The translator knows health 12 and health-related terminology and provides accurate 13 translations by choosing equivalent expressions that 14 convey the best matching and meaning to the source 15 language and captures, to the greatest possible ex- 16 tent, all nuances intended in the source document. 17 ‘‘(5) CULTURAL COMPETENCE.—The term ‘cul- 18 tural competence’ means a set of congruent behav- 19 iors, attitudes, and policies that come together in a 20 system, agency, or among professionals that enables 21 effective work in cross-cultural situations. In the 22 preceding sentence— 23 ‘‘(A) the term ‘cultural’ refers to inte- 24 grated patterns of human behavior that include 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 53 •HR 2954 IH the language, thoughts, communications, ac- 1 tions, customs, beliefs, values, and institutions 2 of racial, ethnic, religious, or social groups, in- 3 cluding lesbian, gay, bisexual, transgender and 4 intersex individuals, and individuals with phys- 5 ical and mental disabilities; and 6 ‘‘(B) the term ‘competence’ implies having 7 the capacity to function effectively as an indi- 8 vidual and an organization within the context of 9 the cultural beliefs, behaviors, and needs pre- 10 sented by consumers and their communities. 11 ‘‘(6) EFFECTIVE COMMUNICATION.—The term 12 ‘effective communication’ means an exchange of in- 13 formation between the provider of health care or 14 health-care-related services and the recipient of such 15 services who is limited in English proficiency, or has 16 a communication impairment such as a hearing, vi- 17 sion, or learning impairment, that enables access, 18 understanding, and benefit from health care or 19 health-care-related services, and full participation in 20 the development of their treatment plan. 21 ‘‘(7) GRIEVANCE RESOLUTION PROCESS.—The 22 term ‘grievance resolution process’ means all aspects 23 of dispute resolution including filing complaints, 24 grievance and appeal procedures, and court action. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 54 •HR 2954 IH ‘‘(8) HEALTH CARE GROUP.—The term ‘health 1 care group’ means a group of physicians organized, 2 at least in part, for the purposes of providing physi- 3 cians’ services under the Medicaid, SCHIP, or Medi- 4 care programs and may include a hospital and any 5 other individual or entity furnishing services covered 6 under the Medicaid, SCHIP, or Medicare programs 7 that is affiliated with the health care group. 8 ‘‘(9) HEALTH-CARE SERVICES.—The term 9 ‘health care services’ means services that address 10 physical as well as mental health conditions in all 11 care settings. 12 ‘‘(10) HEALTH CARE-RELATED SERVICES.—The 13 term ‘health-care-related services’ means human or 14 social services programs or activities that provide ac- 15 cess, referrals or links to health care. 16 ‘‘(11) INDIAN TRIBE.—The term ‘Indian tribe’ 17 means any Indian tribe, band, nation, or other orga- 18 nized group or community, including any Alaska Na- 19 tive village or group or regional or village corpora- 20 tion as defined in or established pursuant to the 21 Alaska Native Claims Settlement Act (85 Stat. 688) 22 (43 U.S.C. 1601 et seq.), which is recognized as eli- 23 gible for the special programs and services provided 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 55 •HR 2954 IH by the United States to Indians because of their sta- 1 tus as Indians. 2 ‘‘(12) INTEGRATED HEALTH CARE DELIVERY 3 SYSTEM.—The term ‘integrated health care delivery 4 system’ means an interdisciplinary system that 5 brings together providers from the primary health, 6 mental health, substance use and related disciplines 7 to improve the health outcomes of an individual. 8 Providers may include but are not limited to hos- 9 pitals, health, mental health or substance use clinics 10 and providers, home health agencies, ambulatory 11 surgery centers, skilled nursing facilities, rehabilita- 12 tion centers, and employed, independent or con- 13 tracted physicians. 14 ‘‘(13) INTERPRETING/INTERPRETATION.—The 15 terms ‘interpreting’ and ‘interpretation’ mean the 16 transmission of a spoken, written, or signed message 17 from one language or format into another, faithfully, 18 accurately, and objectively. 19 ‘‘(14) LANGUAGE ACCESS.—The term ‘language 20 access’ means the provision of language services to 21 an LEP individual or individual with communication 22 disabilities designed to enhance that individual’s ac- 23 cess to, understanding of or benefit from health care 24 or health-care-related services. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00055 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 56 •HR 2954 IH ‘‘(15) LANGUAGE OR LANGUAGE ACCESS SERV- 1 ICES.—The term ‘language or language access serv- 2 ices’ means provision of health care services directly 3 in a non-English language, interpretation, trans- 4 lation, signage, video recording, and English or non- 5 English alternative formats. 6 ‘‘(16) LEP.—The term ‘LEP’ means limited- 7 English proficient. 8 ‘‘(17) LEP RELATED DATA COLLECTION AC- 9 TIVITIES.—The term ‘LEP related data collection 10 activities’ includes identifying, collecting, storing, 11 tracking, and analyzing primary language data, and 12 information on the methods used to meet the lan- 13 guage access needs of limited-English-proficient indi- 14 viduals. 15 ‘‘(18) MEDICARE, MEDICAID, AND SCHIP.—The 16 terms ‘Medicare’, ‘Medicaid’, and ‘SCHIP’ means 17 the respective programs under titles XVIII, XIX, 18 and XXI of the Social Security Act. 19 ‘‘(19) MINORITY.— 20 ‘‘(A) IN GENERAL.—The terms ‘minority’ 21 and ‘minorities’ refer to individuals from a mi- 22 nority group. 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 57 •HR 2954 IH ‘‘(B) POPULATIONS.—The term ‘minority’, 1 with respect to populations, refers to racial and 2 ethnic minority groups. 3 ‘‘(20) MINORITY GROUP.—The term ‘minority 4 group’ has the meaning given the term ‘racial and 5 ethnic minority group’. 6 ‘‘(21) RACIAL AND ETHNIC MINORITY GROUP.— 7 The term ‘racial and ethnic minority group’ means 8 American Indians and Alaska Natives, African- 9 Americans (including Caribbean Blacks, Africans 10 and other Blacks), Asian-Americans, Hispanics (in- 11 cluding Latinos), and Native Hawaiians and other 12 Pacific Islanders. 13 ‘‘(22) ON-SITE INTERPRETING/INTERPRETA- 14 TION.—The term ‘on-site interpreting/interpretation’ 15 means a method of interpreting or interpretation for 16 which the interpreter is in the physical presence of 17 the provider of health care or health-care-related 18 services and the recipient of such services who is 19 limited in English proficiency or has a communica- 20 tion impairment such as hearing, vision, or learning. 21 ‘‘(23) SECRETARY.—The term ‘Secretary’ 22 means the Secretary of Health and Human Services. 23 ‘‘(24) SIGHT TRANSLATION.—The term ‘sight 24 translation’ means the transmission of a written 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 58 •HR 2954 IH message in one language into a spoken or signed 1 message in another language, or an alternative for- 2 mat in English or another language. 3 ‘‘(25) STATE.—The term ‘State’ means each of 4 the several States, the District of Columbia, the 5 Commonwealth of Puerto Rico, the Indian tribes, 6 the United States Virgin Islands, Guam, American 7 Samoa, and the Commonwealth of the Northern 8 Mariana Islands. 9 ‘‘(26) TELEPHONIC INTERPRETATION.—The 10 term ‘telephonic interpretation’ (also known as over 11 the phone interpretation or OPI) means a method of 12 interpreting/interpretation for which the interpreter 13 is not in the physical presence of the provider of 14 health care or related services and the limited- 15 English-proficient recipient of such services but is 16 connected via telephone. 17 ‘‘(27) TRANSLATION.—The term ‘translation’ 18 means the transmission of a written message in one 19 language into a written or signed message in an- 20 other language, and includes translation into an- 21 other language or alternative format, such as large 22 print font, Braille, audio recording, or CD. 23 ‘‘(28) VIDEO INTERPRETATION.—The term 24 ‘video interpretation’ means a method of inter- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 59 •HR 2954 IH preting/interpretation for which the interpreter is 1 not in the physical presence of the provider of health 2 care or related services and the limited-English-pro- 3 ficient recipient of such services but is connected via 4 a video hook-up that includes both audio and video 5 transmission. 6 ‘‘(29) VITAL DOCUMENT.—The term ‘vital doc- 7 ument’ includes but is not limited to applications for 8 government programs that provide health care serv- 9 ices, medical or financial consent forms, financial as- 10 sistance documents, letters containing important in- 11 formation regarding patient instructions (such as 12 prescriptions, referrals to other providers, and dis- 13 charge plans) and participation in a program (such 14 as a Medicaid managed care program), notices per- 15 taining to the reduction, denial, or termination of 16 services or benefits, notices of the right to appeal 17 such actions, and notices advising limited-English- 18 proficient individuals and individuals with commu- 19 nication disabilities of the availability of free lan- 20 guage services, alternative formats, and other out- 21 reach materials. 22 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 60 •HR 2954 IH ‘‘SEC. 3401. IMPROVING ACCESS TO SERVICES FOR INDIVID- 1 UALS WITH LIMITED ENGLISH PROFICIENCY. 2 ‘‘(a) PURPOSE.—As provided in Executive Order 3 13166, it is the purpose of this section— 4 ‘‘(1) to improve Federal agency performance re- 5 garding access to federally conducted and federally 6 assisted programs and activities for individuals who 7 are limited in their English proficiency; 8 ‘‘(2) to require each Federal agency to examine 9 the services it provides and develop and implement 10 a system by which limited-English-proficient individ- 11 uals can obtain cultural competence and meaningful 12 access to those services consistent with, and without 13 substantially burdening, the fundamental mission of 14 the agency; 15 ‘‘(3) to require each Federal agency to ensure 16 that recipients of Federal financial assistance pro- 17 vide cultural competence and meaningful access to 18 their limited-English-proficient applicants and bene- 19 ficiaries; 20 ‘‘(4) to ensure that recipients of Federal finan- 21 cial assistance take reasonable steps, consistent with 22 the guidelines set forth in the Limited English Pro- 23 ficient Guidance of the Department of Justice (as 24 issued on June 12, 2002), to ensure cultural com- 25 petence and meaningful access to their programs 26 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 61 •HR 2954 IH and activities by limited-English-proficient individ- 1 uals; and 2 ‘‘(5) to ensure compliance with title VI of the 3 Civil Rights Act of 1964 and that health care pro- 4 viders and organizations do not discriminate in the 5 provision of services. 6 ‘‘(b) FEDERALLY CONDUCTED PROGRAMS AND AC- 7 TIVITIES.— 8 ‘‘(1) IN GENERAL.—Not later than 120 days 9 after the date of enactment of this title, each Fed- 10 eral agency that carries out health-care-related ac- 11 tivities shall prepare a plan to improve access cul- 12 tural competence to the federally conducted, health- 13 are-related programs and activities of the agency by 14 limited-English-proficient individuals. Each Federal 15 agency must ensure that such plan is fully imple- 16 mented not later than one year after the date of en- 17 actment of this Act. 18 ‘‘(2) PLAN REQUIREMENT.—Each plan under 19 paragraph (1) shall include— 20 ‘‘(A) the steps the agency will take to en- 21 sure that limited-English-proficient individuals 22 have access to the agency’s federally conducted 23 health care and health-care-related programs 24 and activities; 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 62 •HR 2954 IH ‘‘(B) the policies and procedures for identi- 1 fying, assessing, and meeting the language 2 needs and cultural competence needs of its lim- 3 ited-English-proficient beneficiaries served by 4 federally conducted programs and activities; 5 ‘‘(C) the steps the agency will take for its 6 federally conducted programs and activities to 7 improve cultural competence to provide a range 8 of language assistance options, notice to lim- 9 ited-English-proficient individuals of the right 10 to competent language services, periodic train- 11 ing of staff, monitoring and quality assessment 12 of the language services and, in appropriate cir- 13 cumstances, the translation of written mate- 14 rials; 15 ‘‘(D) the steps the agency will take to en- 16 sure that applications, forms, and other rel- 17 evant documents for its federally conducted pro- 18 grams and activities are competently translated 19 into the primary language of a limited-English- 20 proficient client where such materials are need- 21 ed to improve access to federally conducted and 22 federally assisted programs and activities for 23 such a limited-English-proficient individual; and 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00062 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 63 •HR 2954 IH ‘‘(E) the resources the agency will provide 1 to improve cultural competence to assist recipi- 2 ents of Federal funds to improve access to 3 health care or health-care-related programs and 4 activities for limited-English-proficient individ- 5 uals. 6 Each agency shall send a copy of such plan to the 7 Department of Justice, which shall serve as the cen- 8 tral repository of the Agency’s plans. 9 ‘‘(c) FEDERALLY ASSISTED PROGRAMS AND ACTIVI- 10 TIES.— 11 ‘‘(1) IN GENERAL.—Not later than 120 days 12 after the date of enactment of this title, each Fed- 13 eral agency providing health-care-related Federal fi- 14 nancial assistance shall ensure that the guidance for 15 recipients of Federal financial assistance developed 16 by the agency to ensure compliance with title VI of 17 the Civil Rights Act of 1964 (42 U.S.C. 2000d et 18 seq.) is specifically tailored to the recipients of such 19 assistance. Each agency shall send a copy of such 20 guidance to the Department of Justice which shall 21 serve as the central repository of the Agency’s plans. 22 After approval by the Department of Justice, each 23 agency shall publish its guidance document in the 24 Federal Register for public comment. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 64 •HR 2954 IH ‘‘(2) REQUIREMENTS.—The agency-specific 1 guidance developed under paragraph (1) shall take 2 into account the types of health care services pro- 3 vided by the recipients, the individuals served by the 4 recipients, and other factors set out in such stand- 5 ards. 6 ‘‘(3) EXISTING GUIDANCES.—A Federal agency 7 that has developed a guidance for purposes of title 8 VI of the Civil Rights Act of 1964 shall examine 9 such existing guidance, as well as the programs and 10 activities to which such guidance applies, to deter- 11 mine if modification of such guidance is necessary to 12 comply with this subsection. 13 ‘‘(4) CONSULTATION.—Each Federal agency 14 shall consult with the Department of Justice in es- 15 tablishing the guidances under this subsection. 16 ‘‘(d) CONSULTATIONS.— 17 ‘‘(1) IN GENERAL.—In carrying out this sec- 18 tion, each Federal agency that carriers out health 19 care and health-care-related activities shall ensure 20 that stakeholders, such as limited-English-proficient 21 individuals and their representative organizations, 22 recipients of Federal assistance, and other appro- 23 priate individuals or entities, have an adequate op- 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 65 •HR 2954 IH portunity to provide input with respect to the actions 1 of the agency. 2 ‘‘(2) EVALUATION.—Each Federal agency de- 3 scribed in paragraph (1) shall evaluate the— 4 ‘‘(A) particular needs of the limited- 5 English-proficient individuals served by the 6 agency; 7 ‘‘(B) particular needs of the limited- 8 English-proficient individuals served by the 9 agency’s recipients of Federal financial assist- 10 ance; and 11 ‘‘(C) burdens of compliance with the agen- 12 cy guidance and this section for the agency and 13 its recipients. 14 ‘‘SEC. 3402. NATIONAL STANDARDS FOR CULTURALLY AND 15 LINGUISTICALLY APPROPRIATE SERVICES IN 16 HEALTH CARE. 17 ‘‘Recipients of Federal financial assistance from the 18 Secretary shall, to the extent reasonable and practicable 19 after applying the 4-factor analysis described in title V 20 of the Guidance to Federal Financial Assistance Recipi- 21 ents Regarding Title VI Prohibition Against National Ori- 22 gin Discrimination Affecting Limited-English Proficient 23 Persons (June 12, 2002)— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 66 •HR 2954 IH ‘‘(1) implement strategies to recruit, retain, and 1 promote individuals at all levels of the organization 2 to maintain a diverse staff and leadership that can 3 provide culturally and linguistically appropriate 4 health care to patient populations of the service area 5 of the organization; 6 ‘‘(2) ensure that staff at all levels and across all 7 disciplines of the organization receive ongoing edu- 8 cation and training in culturally and linguistically 9 appropriate service delivery; 10 ‘‘(3) offer and provide language assistance serv- 11 ices, including trained bilingual staff and interpreter 12 services, at no cost to each patient with limited- 13 English proficiency at all points of contact, in a 14 timely manner during all hours of operation; 15 ‘‘(4) notify patients, in a culturally appropriate 16 manner, of their right to receive language assistance 17 services in their primary language; 18 ‘‘(5) ensure the competence of language assist- 19 ance provided to limited-English-proficient patients 20 by interpreters and bilingual staff, and ensure that 21 family, particularly minor children, and friends are 22 not used to provide interpretation services— 23 ‘‘(A) except in case of emergency; or 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 67 •HR 2954 IH ‘‘(B) except on request of the patient, who 1 has been informed in his or her preferred lan- 2 guage of the availability of free interpretation 3 services; 4 ‘‘(6) make available easily understood patient- 5 related materials, if such materials exist for non-lim- 6 ited-English-proficient patients, including informa- 7 tion or notices about termination of benefits and 8 post signage in the languages of the commonly en- 9 countered groups or groups represented in the serv- 10 ice area of the organization; 11 ‘‘(7) develop and implement clear goals, poli- 12 cies, operational plans, and management account- 13 ability and oversight mechanisms to provide cul- 14 turally and linguistically appropriate services; 15 ‘‘(8) conduct initial and ongoing organizational 16 assessments of culturally and linguistically appro- 17 priate services-related activities and integrate valid 18 linguistic, competence-related measures into the in- 19 ternal audits, performance improvement programs, 20 patient satisfaction assessments, and outcomes-based 21 evaluations of the organization; 22 ‘‘(9) ensure that, consistent with the privacy 23 protections provided for under the regulations pro- 24 mulgated under section 264(c) of the Health Insur- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 68 •HR 2954 IH ance Portability and Accountability Act of 1996 (42 1 U.S.C. 1320d–2 note)— 2 ‘‘(A) data on the individual patient’s race, 3 ethnicity, primary language, alternative format 4 preferences, and policy modification needs are 5 collected in health records, integrated into the 6 organization’s management information sys- 7 tems, and periodically updated; and 8 ‘‘(B) if the patient is a minor or is inca- 9 pacitated, the primary language of the parent 10 or legal guardian is collected; 11 ‘‘(10) maintain a current demographic, cultural, 12 and epidemiological profile of the community as well 13 as a needs assessment to accurately plan for and im- 14 plement services that respond to the cultural and 15 linguistic characteristics of the service area of the 16 organization; 17 ‘‘(11) develop participatory, collaborative part- 18 nerships with communities and utilize a variety of 19 formal and informal mechanisms to facilitate com- 20 munity and patient involvement in designing and im- 21 plementing culturally and linguistically appropriate 22 services-related activities; 23 ‘‘(12) ensure that conflict and grievance resolu- 24 tion processes are culturally and linguistically sen- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00068 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 69 •HR 2954 IH sitive and capable of identifying, preventing, and re- 1 solving cross-cultural conflicts or complaints by pa- 2 tients; 3 ‘‘(13) regularly make available to the public in- 4 formation about their progress and successful inno- 5 vations in implementing the standards under this 6 section and provide public notice in their commu- 7 nities about the availability of this information; and 8 ‘‘(14) if requested, regularly make available to 9 the head of each Federal entity from which Federal 10 funds are received, information about their progress 11 and successful innovations in implementing the 12 standards under this section as required by the head 13 of such entity. 14 ‘‘SEC. 3403. ROBERT T. MATSUI CENTER FOR CULTURAL 15 AND LINGUISTIC COMPETENCE IN HEALTH 16 CARE. 17 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 18 through the Director of the Agency for Healthcare Re- 19 search and Quality, shall establish and support a center 20 to be known as the ‘Robert T. Matsui Center for Cultural 21 and Linguistic Competence in Health Care’ (referred to 22 in this section as the ‘Center’) to carry out the following 23 activities: 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 70 •HR 2954 IH ‘‘(1) INTERPRETATION SERVICES.—The Center 1 shall provide resources via the Internet to identify 2 and link health care providers to competent inter- 3 preter and translation services. 4 ‘‘(2) TRANSLATION OF WRITTEN MATERIAL.— 5 ‘‘(A) The Center shall provide, directly or 6 through contract, vital documents from com- 7 petent translation services for providers of 8 health care and health-care-related services at 9 no cost to such providers. Materials may be 10 submitted for translation into non-English lan- 11 guages. Translation services shall be provided 12 in a timely and reasonable manner and in ac- 13 cordance with the guidelines and standards set 14 forth in subsection (c) when such standards be- 15 come available. The quality of such translation 16 services shall be monitored and reported pub- 17 licly. 18 ‘‘(B) For each form developed or revised 19 by the Secretary that will be used by LEP indi- 20 viduals in health care or health-care-related set- 21 tings, the Center shall translate the form, at a 22 minimum, into the top 15 non-English lan- 23 guages in the United States according to the 24 most recent data from the American Commu- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 71 •HR 2954 IH nity Survey or its replacement. The translation 1 must be completed within 45 days of the Sec- 2 retary receiving final approval of the form from 3 the Office of Management and Budget. 4 ‘‘(3) TOLL-FREE CUSTOMER SERVICE TELE- 5 PHONE NUMBER.—The Center shall provide, 6 through a toll-free number, a customer service line 7 for LEP individuals— 8 ‘‘(A) to obtain information about federally 9 conducted or funded health programs, including 10 Medicare, Medicaid, and SCHIP; 11 ‘‘(B) to obtain assistance with applying for 12 or accessing these programs and understanding 13 Federal notices written in English; and 14 ‘‘(C) to learn how to access language serv- 15 ices. 16 ‘‘(4) HEALTH INFORMATION CLEARING- 17 HOUSE.— 18 ‘‘(A) IN GENERAL.—The Center shall de- 19 velop and maintain an information clearing- 20 house to facilitate the provision of language 21 services by providers of health care and health- 22 care-related services to reduce medical errors, 23 improve medical outcomes, to improve cultural 24 competence, reduce health care costs caused by 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00071 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 72 •HR 2954 IH miscommunication with individuals with lim- 1 ited-English proficiency, and reduce or elimi- 2 nate the duplication of effort to translate mate- 3 rials. The clearinghouse shall make such infor- 4 mation available on the Internet and in print. 5 Such information shall include the information 6 described in the succeeding provisions of this 7 paragraph. 8 ‘‘(B) DOCUMENT TEMPLATES.—The Cen- 9 ter shall collect and evaluate for accuracy, de- 10 velop, and make available templates for stand- 11 ard documents that are necessary for patients 12 and consumers to access and make educated de- 13 cisions about their health care, including the 14 following: 15 ‘‘(i) Administrative and legal docu- 16 ments, including— 17 ‘‘(I) intake forms; 18 ‘‘(II) Medicare, Medicaid, and 19 SCHIP forms, including eligibility in- 20 formation; 21 ‘‘(III) forms informing patient of 22 HIPAA compliance and consent; and 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00072 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 73 •HR 2954 IH ‘‘(IV) documents concerning in- 1 formed consent, advanced directives, 2 and waivers of rights. 3 ‘‘(ii) Clinical information, such as how 4 to take medications, how to prevent trans- 5 mission of a contagious disease, and other 6 prevention and treatment instructions. 7 ‘‘(iii) Public health, patient education, 8 and outreach materials, such as immuniza- 9 tion notices, health warnings, or screening 10 notices. 11 ‘‘(iv) Additional health or health-care- 12 related materials as determined appro- 13 priate by the Director of the Center. 14 ‘‘(C) STRUCTURE OF FORMS.—The oper- 15 ating the clearinghouse, the Center shall— 16 ‘‘(i) ensure that the documents posted 17 in English and non-English languages are 18 culturally appropriate; 19 ‘‘(ii) allow public review of the docu- 20 ments before dissemination in order to en- 21 sure that the documents are understand- 22 able and culturally appropriate for the tar- 23 get populations; 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 74 •HR 2954 IH ‘‘(iii) allow health care providers to 1 customize the documents for their use; 2 ‘‘(iv) facilitate access to these docu- 3 ments; 4 ‘‘(v) provide technical assistance with 5 respect to the access and use of such infor- 6 mation; and 7 ‘‘(vi) carry out any other activities the 8 Secretary determines to be useful to fulfill 9 the purposes of the clearinghouse. 10 ‘‘(D) LANGUAGE ASSISTANCE PRO- 11 GRAMS.—The Center shall provide for the col- 12 lection and dissemination of information on cur- 13 rent examples of language assistance programs 14 and strategies to improve language services for 15 LEP individuals, including case studies using 16 de-identified patient information, program sum- 17 maries, and program evaluations. 18 ‘‘(E) CULTURAL AND LINGUISTIC COM- 19 PETENCE MATERIALS.—The Center shall pro- 20 vide information relating to culturally and lin- 21 guistically competent health care for minority 22 populations residing in the United States to all 23 health care providers and health-care-related 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 75 •HR 2954 IH services at no cost. Such information shall in- 1 clude— 2 ‘‘(i) tenets of culturally and linguis- 3 tically competent care; 4 ‘‘(ii) cultural and linguistic com- 5 petence self-assessment tools; 6 ‘‘(iii) cultural and linguistic com- 7 petence training tools; 8 ‘‘(iv) strategic plans to increase cul- 9 tural and linguistic competence in different 10 types of providers of health care and 11 health-care-related services, including re- 12 gional collaborations among health care or- 13 ganizations; and 14 ‘‘(v) cultural and linguistic com- 15 petence information for educators, practi- 16 tioners, and researchers. 17 ‘‘(F) INFORMATION ABOUT PROGRESS.— 18 The Center shall regularly collect and make 19 publicly available information about the 20 progress of entities receiving grants under sec- 21 tion 3404 regarding successful innovations in 22 implementing the obligations under this sub- 23 section and provide public notice in the entities’ 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 76 •HR 2954 IH communities about the availability of this infor- 1 mation; 2 ‘‘(b) DIRECTOR.—The Center shall be headed by a 3 Director who shall be appointed by, and who shall report 4 to, the Director of the Agency for Healthcare Research 5 and Quality. 6 ‘‘(c) INTERPRETATION AND TRANSLATION GUIDE- 7 LINES AND STANDARDS.—The Center shall convene a 8 working group to develop and adopt interpretation and 9 translation quality guidelines and standards for use by the 10 Center. The guidelines and standards must be sufficient 11 to ensure that LEP individuals have the equal opportunity 12 to benefit from health care services to the same extent 13 as non-LEP individuals. The guidelines and standards 14 shall address the training, assessment, and certification of 15 individuals to provide competent interpreter and trans- 16 lator services to work in health care and health-care-re- 17 lated settings and of bilingual staff who provide services 18 directly in non-English languages. The working group may 19 develop different guidelines and standards for bilingual 20 staff, interpreters, and translators. 21 ‘‘(d) MEMBERSHIP.— 22 ‘‘(1) QUALIFICATIONS.—The Working Group 23 shall consist of 14 members as follows: 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 77 •HR 2954 IH ‘‘(A) Four members from organizations 1 that advocate on behalf of LEP individuals. 2 ‘‘(B) One member who represents a profes- 3 sional interpreter association (that is not the 4 National Council on Interpreting in Health 5 Care) or translator association. 6 ‘‘(C) One member from a nonprofit com- 7 munity-based organization that provides lan- 8 guage services. 9 ‘‘(D) Three members recommended by the 10 National Council on Interpreting in Health 11 Care, including one who individual who is a 12 professional interpreter. 13 ‘‘(E) Four members who are health care or 14 mental health providers or represent health care 15 provider associations, including one individual 16 who represents a health care practice of fewer 17 than 5 clinicians. 18 ‘‘(F) One member who works in or has ex- 19 tensive knowledge of issues related to health 20 care risk management. 21 ‘‘(2) GEOGRAPHIC REPRESENTATION.—The 22 membership of the Working Group shall reflect a 23 broad geographic representation including both 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 78 •HR 2954 IH urban and rural representatives, including represent- 1 atives of the United States territories. 2 ‘‘(3) PROHIBITED APPOINTMENTS.—Members 3 of the Working Group shall not include Members of 4 Congress or other elected Federal, State, or local 5 government officials. 6 ‘‘(4) VACANCIES.—Any vacancies in the Work- 7 ing Group shall not affect the power and duties of 8 the Working Group but shall be filled in the same 9 manner as the original appointment. 10 ‘‘(5) SUBCOMMITTEES.—The Working Group 11 may establish subcommittees if doing so increases 12 the efficiency of the Working Group in completing 13 its tasks, including subcommittees to develop dif- 14 ferent guidelines and standards for interpreters, 15 translators, and bilingual staff. 16 ‘‘(6) ADVISORY PANEL TO THE WORKING 17 GROUP.—The Working Group shall consult with the 18 Advisory Panel in the development of the guidelines 19 and standards. The Advisory Panel shall include— 20 ‘‘(A) representatives from the American 21 Translators Association, Association of Lan- 22 guage Companies, the National Center for 23 State Courts, and States which have developed 24 interpreter standards such as California, Mas- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 79 •HR 2954 IH sachusetts, and Oregon who have experience in 1 the development or implementation of their or- 2 ganizations’ interpreter and translator certifi- 3 cation programs; 4 ‘‘(B) Federal agencies including the Office 5 for Civil Rights, the Office of Minority Health, 6 the Centers for Medicare & Medicaid Services, 7 and the National Institute on Minority Health 8 and Health Disparities; and 9 ‘‘(C) other individuals or entities deter- 10 mined appropriate by the Secretary who have 11 specific expertise that will be useful to the 12 Working Group. 13 ‘‘(7) PUBLICATION.— 14 ‘‘(A) DRAFT STANDARDS.—Not later than 15 18 months after the date of enactment of this 16 title, the Working Group shall— 17 ‘‘(i) prepare and make available to the 18 public through the Internet, the Federal 19 Register, and other appropriate public 20 channels, a proposed set of interpretation 21 and translation guidelines and standards 22 for training, assessment, and certification; 23 and 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 80 •HR 2954 IH ‘‘(ii) accept public comment on such 1 guidelines and standards for a period of 2 not less than 90 days. 3 ‘‘(B) FINAL STANDARDS.—Not later than 4 120 days after the expiration of the public com- 5 ment period described in subparagraph (A), the 6 Director of the Agency for Healthcare Research 7 and Quality shall publish, after consultation 8 with and the approval of the Working Group, 9 final guidelines and standards in the Federal 10 Register and on the Internet. 11 ‘‘(C) TESTING DEVELOPMENT.—Not later 12 than 120 days after the publication of the final 13 recommendations described in subparagraph 14 (B), the Director of the Agency for Healthcare 15 Research and Quality shall, if deemed necessary 16 by the Working Group, enter into a contract 17 with an entity experienced in the development 18 of designing certification tests in language re- 19 lated fields to develop such tests as may be nec- 20 essary to implement the guidelines and stand- 21 ards. 22 ‘‘(D) PILOT PROJECT.— 23 ‘‘(i) Not later than 120 days after 24 completion of the test development de- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 81 •HR 2954 IH scribed in subparagraph (C) or after publi- 1 cation of the final guidelines and stand- 2 ards, whichever is later, the Secretary shall 3 design, fund, and implement a pilot project 4 in up to 50 geographically and demo- 5 graphically diverse sites, two of which must 6 be in the United States territories, to test 7 and evaluate implementation of the rec- 8 ommendations. 9 ‘‘(ii) The Secretary shall consult with 10 the Working Group and the Advisory 11 Panel in development of the pilot project 12 and report progress to the Working Group 13 on an ongoing basis. 14 ‘‘(iii) The pilot project shall include 15 interpreters and translators working with 16 various provider types, including small 17 group practices, hospitals, mental health 18 and substance use clinics, and community 19 health clinics, and shall include broad geo- 20 graphic representation including both 21 urban and rural representatives. 22 ‘‘(iv) The pilot project shall operate 23 for not less than 2 nor more than 4 years, 24 as determined by the Secretary. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 82 •HR 2954 IH ‘‘(v) If the Working Group determines 1 that any revisions to guidelines and stand- 2 ards are necessary as a result of the pilot 3 project, it shall revise such guidelines and 4 standards and the Director of the Agency 5 for Healthcare Research and Quality shall 6 publish the revisions in the Federal Reg- 7 ister for notice and comment. Not later 8 than 120 days after the expiration of the 9 public comment period on such revisions, 10 the Director of the Agency for Healthcare 11 Research and Quality shall publish, after 12 consultation with and the approval of the 13 Working Group, final revisions to the 14 guidelines and standards in the Federal 15 Register and on the Internet. 16 ‘‘(8) ADMINISTRATION.— 17 ‘‘(A) CHAIRPERSON.—Not later than 15 18 days after the date on which all members of the 19 Working Group have been appointed under sub- 20 section (d), the Working Group shall designate 21 its chairperson. 22 ‘‘(B) COMPENSATION.—While serving on 23 the business of the Working Group (including 24 travel time), a member of the Working Group 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 83 •HR 2954 IH or the Advisory Panel shall be entitled to com- 1 pensation at the per diem equivalent of the rate 2 provided for level IV of the Executive Schedule 3 under section 5315 of title 5, United States 4 Code, and while so serving away from home and 5 the member’s regular place of business, a mem- 6 ber may be allowed travel expenses, as author- 7 ized by the chairperson of the Working Group. 8 For purposes of pay and employment benefits, 9 rights, and privileges, all personnel of the 10 Working Group shall be treated as if they were 11 employees of the House of Representatives. 12 ‘‘(C) INFORMATION FROM FEDERAL AGEN- 13 CIES.—The Working Group may secure directly 14 from any Federal department or agency such 15 information as the Working Group considers 16 necessary to carry out this section. Upon re- 17 quest of the Working Group, the head of such 18 department or agency shall furnish such infor- 19 mation. Any information that contains individ- 20 ually identifiable information received by the 21 Working Group shall not be disseminated or 22 disclosed outside of the Working Group and 23 shall not be used except by the Working Group. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00083 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 84 •HR 2954 IH ‘‘(D) DETAIL.—Not more than 10 Federal 1 Government employees employed by the Depart- 2 ment of Health and Human Services may be 3 detailed to staff the Working Group under this 4 section without further reimbursement. Any de- 5 tail of an employee shall be without interruption 6 or loss of civil service status or privilege. 7 ‘‘(E) TEMPORARY AND INTERMITTENT 8 SERVICES.—The Working Group may procure 9 temporary and intermittent services under sec- 10 tion 3109(b) of title 5, United States Code, at 11 rates for individuals which do not exceed the 12 daily equivalent of the annual rate of basic pay 13 prescribed for level V of the Executive Schedule 14 under section 5316 of such title. 15 ‘‘(F) AUTHORIZATION OF APPROPRIA- 16 TIONS.—There are authorized to be appro- 17 priated to carry out this section such sums as 18 may be necessary for the activities of the Work- 19 ing Group and Advisory Panel for each of fiscal 20 years 2012 through 2016, and for the funding 21 of the pilot project. 22 ‘‘(9) DEEMED STATUS.— 23 ‘‘(A) CERTIFICATION BY PRIVATE ORGANI- 24 ZATION.—If a private accreditation organization 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00084 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 85 •HR 2954 IH establishes training, assessment, or certification 1 standards for interpreters or translators in 2 health care which the Secretary determines are 3 at least equivalent to the training, assessment, 4 or certification standards promulgated by the 5 Secretary as described in subsection (c), the 6 Secretary shall find that all organizations or in- 7 dividuals accredited by such organization com- 8 ply also with the standard described in sub- 9 section (c) if— 10 ‘‘(i) such organization or individual 11 authorizes the organization to release to 12 the Secretary upon the Secretary’s request 13 (or such State agency as the Secretary 14 may designate) a copy of the most current 15 accreditation survey of such organization 16 or individual made by the organization, to- 17 gether with any other information directly 18 related to the survey as the Secretary may 19 require (including corrective action plans); 20 and 21 ‘‘(ii) such organization releases such a 22 copy and any such information to the Sec- 23 retary. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 86 •HR 2954 IH ‘‘(B) CERTIFICATION BY A STATE OR LO- 1 CALITY.—If a State or locality has or estab- 2 lishes training, assessment, or certification 3 standards for interpreters or translators in 4 health care which the Secretary determines are 5 at least equivalent to the training, assessment, 6 or certification standards promulgated by the 7 Secretary as described in subsection (c), the 8 Secretary shall find that all organizations or in- 9 dividuals accredited by such State or locality 10 comply also with the standard described in sub- 11 section (c) if— 12 ‘‘(i) such organization or individual 13 authorizes the State or locality to release 14 to the Secretary upon his request (or such 15 State agency as the Secretary may des- 16 ignate) a copy of the most current accredi- 17 tation survey of such organization or indi- 18 vidual made by such State or locality, to- 19 gether with any other information directly 20 related to the survey as the Secretary may 21 require (including corrective action plans); 22 and 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00086 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 87 •HR 2954 IH ‘‘(ii) such State or locality releases 1 such a copy and any such information to 2 the Secretary. 3 ‘‘(C) TIMELY ACTION ON APPLICATION.— 4 The Secretary shall determine, within 210 days 5 after the date the Secretary receives an applica- 6 tion by a private accrediting organization, 7 State, or locality whether the process of the pri- 8 vate accrediting organization, State, or locality 9 meets the requirements with respect to training, 10 assessment, or certification standards for inter- 11 preters or translators with respect to which 12 standards the application is made. The Sec- 13 retary may not deny an application on the basis 14 that it seeks to meet the requirements with re- 15 spect to only one, or more than one, training, 16 assessment, or certification standards for inter- 17 preters or translators. 18 ‘‘(D) DISCLOSURE OF ACCREDITATION 19 SURVEY.—The Secretary may not disclose any 20 accreditation survey made and released to him 21 by the National Council on Interpreting in 22 Health Care or any State or locality of an ac- 23 credited organization or individual, except that 24 the Secretary may disclose such a survey and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00087 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 88 •HR 2954 IH information related to such a survey to the ex- 1 tent such survey and information relate to an 2 enforcement action taken by the Secretary. 3 ‘‘(E) DEFICIENCIES.—If the Secretary 4 finds that an accredited organization or indi- 5 vidual has significant deficiencies (as defined in 6 regulations pertaining to the training, assess- 7 ment, or certification standards), the organiza- 8 tion or individual shall, after the date of notice 9 of such finding to the organization and for such 10 period as may be prescribed in regulations, be 11 deemed not to meet the conditions or require- 12 ments the organization or individual has been 13 treated as meeting pursuant to subparagraph 14 (A). 15 ‘‘(e) AVAILABILITY OF LANGUAGE ACCESS.—The Di- 16 rector shall collaborate with the Administrator of the Of- 17 fice of Minority Health, the Administrator of the Centers 18 for Medicare & Medicaid Services, and the Administrator 19 of the Health Resources and Services Administration to 20 notify health care providers and health care organizations 21 about the availability of language access services by the 22 Center. 23 ‘‘(f) EDUCATION.—The Secretary, directly or through 24 contract, shall undertake a national education campaign 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 89 •HR 2954 IH to inform providers, LEP individuals, health professionals, 1 graduate schools, and community health centers about— 2 ‘‘(1) Federal and State laws and guidelines gov- 3 erning access to language services; 4 ‘‘(2) the value of using trained interpreters and 5 the risks associated with using family members, 6 friends, minors, and untrained bilingual staff; 7 ‘‘(3) funding sources for developing and imple- 8 menting language services; and 9 ‘‘(4) promising practices to effectively provide 10 language services. 11 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—In ad- 12 dition to the amounts authorized under subsection 13 (e)(8)(F), there are authorized to be appropriated to carry 14 out this section such sums as may be necessary for each 15 of fiscal years 2012 through 2016. 16 ‘‘SEC. 3404. INNOVATIONS IN CULTURAL AND LINGUISTIC 17 COMPETENCE GRANTS. 18 ‘‘(a) IN GENERAL.—The Secretary, acting through 19 the Director of the Agency for Healthcare Research and 20 Quality, shall award grants to eligible entities to enable 21 such entities to design, implement, and evaluate innova- 22 tive, cost-effective programs to improve cultural com- 23 petence and language access in health care for individuals 24 with limited-English proficiency. The Director of the 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00089 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 90 •HR 2954 IH Agency for Healthcare Research and Quality shall coordi- 1 nate with, and ensure the participation of, other agencies 2 including but not limited to the Health Resources and 3 Services Administration, the Center on Minority Health 4 and Health Disparities at the National Institutes of 5 Health, and the Office of Minority Health, regarding the 6 design and evaluation of the grants program. 7 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 8 under subsection (a) an entity shall— 9 ‘‘(1) be— 10 ‘‘(A) a city, county, Indian tribe, State, 11 territory or subdivision thereof; 12 ‘‘(B) an organization described in section 13 501(c)(3) of the Internal Revenue Code of 14 1986; 15 ‘‘(C) a community health, mental health, 16 or substance use center or clinic; 17 ‘‘(D) a solo or group physician practice; 18 ‘‘(E) an integrated health care delivery 19 system; 20 ‘‘(F) a public hospital; 21 ‘‘(G) a health care group, university, or 22 college; or 23 ‘‘(H) other entity designated by the Sec- 24 retary; and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00090 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 91 •HR 2954 IH ‘‘(2) prepare and submit to the Secretary an 1 application, at such time, in such manner, and ac- 2 companied by such additional information as the 3 Secretary may require. 4 ‘‘(c) USE OF FUNDS.—An entity shall use funds re- 5 ceived under a grant under this section to— 6 ‘‘(1) develop, implement, and evaluate models of 7 providing competent interpretation services through 8 on-site interpretation, telephonic interpretation, or 9 video interpretation; 10 ‘‘(2) implement strategies to recruit, retain, and 11 promote individuals at all levels of the organization 12 to maintain a diverse staff and leadership that can 13 promote and provide language services to patient 14 populations of the service area of the organization; 15 ‘‘(3) develop and maintain a needs assessment 16 that identifies the current demographic, cultural, 17 and epidemiological profile of the community to ac- 18 curately plan for and implement language services 19 needed in service area of the organization; 20 ‘‘(4) develop a strategic plan to implement lan- 21 guage services; 22 ‘‘(5) develop participatory, collaborative part- 23 nerships with communities encompassing the LEP 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 92 •HR 2954 IH patient populations being served to gain input in de- 1 signing and implementing language services; 2 ‘‘(6) develop and implement grievance resolu- 3 tion processes that are culturally and linguistically 4 sensitive and capable of identifying, preventing, and 5 resolving complaints by LEP individuals; or 6 ‘‘(7) develop short-term medical mental health 7 interpretation training courses and incentives for bi- 8 lingual health care staff who are asked to interpret 9 in the workplace; 10 ‘‘(8) develop formal training programs, includ- 11 ing continued professional development and edu- 12 cation programs as well as supervision, for individ- 13 uals interested in becoming dedicated health care in- 14 terpreters and culturally competent providers; 15 ‘‘(9) provide staff language training instruction, 16 which shall include information on the practical limi- 17 tations of such instruction for non-native speakers; 18 ‘‘(10) develop policies that address compensa- 19 tion in salary for staff who receive training to be- 20 come either a staff interpreter or bi-lingual provider; 21 ‘‘(11) develop other language assistance services 22 as determined appropriate by the Secretary; 23 ‘‘(12) develop, implement, and evaluate models 24 of improving cultural competence; and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 93 •HR 2954 IH ‘‘(13) ensure that, consistent with the privacy 1 protections provided for under the regulations pro- 2 mulgated under section 264(c) of the Health Insur- 3 ance Portability and Accountability Act of 1996 (42 4 U.S.C. 1320d–2 note), and any applicable State pri- 5 vacy laws, data on the individual patient or recipi- 6 ent’s race, ethnicity, and primary language are col- 7 lected (and periodically updated) in health records 8 and integrated into the organization’s information 9 management systems or any similar system used to 10 store and retrieve data. 11 ‘‘(d) PRIORITY.—In awarding grants under this sec- 12 tion, the Secretary shall give priority to entities that pri- 13 marily engage in providing direct care and that have devel- 14 oped partnerships with community organizations or with 15 agencies with experience language access. 16 ‘‘(e) EVALUATION.— 17 ‘‘(1) An entity that receives a grant under this 18 section shall submit to the Secretary an evaluation 19 that describes, in the manner and to the extent re- 20 quired by the Secretary, the activities carried out 21 with funds received under the grant, and how such 22 activities improved access to health and health-care- 23 related services and the quality of health care for in- 24 dividuals with limited-English proficiency. Such eval- 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00093 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 94 •HR 2954 IH uation shall be collected and disseminated through 1 the Robert T. Matsui Center for Cultural and Lin- 2 guistic Competence in Health Care established under 3 section 3403. The Director of the Agency for 4 Healthcare Research and Quality shall notify grant- 5 ees of the availability of technical assistance for the 6 evaluation and provide such assistance upon request. 7 ‘‘(2) The Director of the Agency for Healthcare 8 Research and Quality shall evaluate or arrange with 9 other individuals or organizations to evaluate 10 projects funded under this section. 11 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 12 is authorized to be appropriated to carry out this section, 13 $5,000,000 for each of fiscal years 2012 through 2016. 14 ‘‘SEC. 3405. RESEARCH ON CULTURAL AND LANGUAGE COM- 15 PETENCE. 16 ‘‘(a) IN GENERAL.—The Secretary, acting through 17 the Director of the Agency for Healthcare Research and 18 Quality, shall expand research concerning language access 19 in the provision of health care. 20 ‘‘(b) ELIGIBILITY.—The Director of the Agency for 21 Healthcare Research and Quality may conduct the re- 22 search described in subsection (a) or enter into contracts 23 with other individuals or organizations to do so. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00094 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 95 •HR 2954 IH ‘‘(c) USE OF FUNDS.—Research under this section 1 shall be designed to do one or more of the following: 2 ‘‘(1) To identify the barriers to mental and be- 3 havioral services that are faced by LEP individuals. 4 ‘‘(2) To identify health care providers’ and 5 health administrators’ attitudes, knowledge, and 6 awareness of the barriers to quality health care serv- 7 ices that are faced by LEP individuals. 8 ‘‘(3) To identify optimal approaches for deliv- 9 ering language access. 10 ‘‘(4) To identify best practices for data collec- 11 tion, including— 12 ‘‘(A) the collection by providers of health 13 care and health-care-related services of data on 14 the race, ethnicity, and primary language of re- 15 cipients of such services, taking into account ex- 16 isting research conducted by the Government or 17 private sector; 18 ‘‘(B) the development and implementation 19 of data collection and reporting systems; and 20 ‘‘(C) effective privacy safeguards for col- 21 lected data. 22 ‘‘(5) To develop a minimum data collection set 23 for primary language. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 96 •HR 2954 IH ‘‘(6) To evaluate the most effective ways in 1 which the Department can create or coordinate, and 2 then subsidize or otherwise fund telephonic interpre- 3 tation providers for health care providers, taking 4 into consideration, among other factors, the flexi- 5 bility necessary for such a system to accommodate 6 variations in— 7 ‘‘(A) provider type; 8 ‘‘(B) languages needed and their frequency 9 of use; 10 ‘‘(C) type of encounter; 11 ‘‘(D) time of encounter, including regular 12 business hours and after hours; and 13 ‘‘(E) location of encounter. 14 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 15 are authorized to be appropriated to carry out this section, 16 such sums as may be necessary for each of fiscal years 17 2012 through 2016.’’. 18 SEC. 203. FEDERAL REIMBURSEMENT FOR CULTURALLY 19 AND LINGUISTICALLY APPROPRIATE SERV- 20 ICES UNDER THE MEDICARE, MEDICAID, AND 21 STATE CHILDREN’S HEALTH INSURANCE 22 PROGRAMS. 23 (a) LANGUAGE ACCESS GRANTS FOR MEDICARE 24 PROVIDERS.— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00096 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 97 •HR 2954 IH (1) ESTABLISHMENT.— 1 (A) IN GENERAL.—Not later than 6 2 months after the date of the enactment of this 3 Act, the Secretary of Health and Human Serv- 4 ices, acting through the Centers for Medicare & 5 Medicaid Services and in consultation with the 6 Center for Medicare and Medicaid Innovation, 7 shall establish demonstration program under 8 which the Secretary shall award grants to eligi- 9 ble Medicare service providers to improve com- 10 munication between such providers and limited- 11 English-proficient Medicare beneficiaries, in- 12 cluding beneficiaries who live in diverse and un- 13 derserved communities. 14 (B) APPLICATION OF INNOVATION 15 RULES.—The demonstration project under sub- 16 paragraph (A) shall be conducted in a manner 17 that is consistent with the applicable provisions 18 of subsections (b), (c), and (d) of section 1115A 19 of the Social Security Act. 20 (C) NUMBER OF GRANTS.—To the extent 21 practicible, the Secretary shall award not less 22 than 24 grants under this subsection. 23 (D) GRANT PERIOD.—Except as provided 24 under paragraph (2)(D), each grant awarded 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00097 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 98 •HR 2954 IH under this subsection shall be for a 3-year pe- 1 riod. 2 (2) ELIGIBILITY REQUIREMENTS.—To be eligi- 3 ble for a grant under this subsection, an entity must 4 meet the following requirements: 5 (A) MEDICARE PROVIDER.—The entity 6 must be— 7 (i) a provider of services under part A 8 of title XVIII of the Social Security Act; 9 (ii) a provider of services under part 10 B of such title; 11 (iii) a Medicare Advantage organiza- 12 tion offering a Medicare Advantage plan 13 under part C of such title; or 14 (iv) a PDP sponsor offering a pre- 15 scription drug plan under part D of such 16 title. 17 (B) UNDERSERVED COMMUNITIES.—The 18 entity must serve a community that with re- 19 spect to necessary langauge services for improv- 20 ing access and utilization of health care amoung 21 limited-English proficienct individuals, is 22 disproportinaly underserved. 23 (C) APPLICATION.—The entity must pre- 24 pare and submit to the Secretary an applica- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00098 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 99 •HR 2954 IH tion, at such time, in such manner, and accom- 1 panied by such additional information as the 2 Secretary may require. 3 (D) REPORTING.—In the case of a grantee 4 that received a grant under this subsection in 5 a previous year, such grantee is only eligible for 6 continued payments under a grant under this 7 subsection if the grantee met the reporting re- 8 quirements under paragraph (9) for such year. 9 If a grantee fails to meet the requirement of 10 such paragraph for the first year of a grant, the 11 Secretary may terminate the grant and solicit 12 applications from new grantees to participate in 13 the demonstration program. 14 (3) DISTRIBUTION.—To the extent feasible, the 15 Secretary shall award— 16 (A) at least 6 grants to providers of serv- 17 ices described in paragraph (2)(A)(i); 18 (B) at least 6 grants to service providers 19 described in paragraph (2)(A)(ii); 20 (C) at least 6 grants to organizations de- 21 scribed in paragraph (2)(A)(iii); and 22 (D) at least 6 grants to sponsors described 23 in paragraph (2)(A)(iv). 24 (4) CONSIDERATIONS IN AWARDING GRANTS.— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 100 •HR 2954 IH (A) VARIATION IN GRANTEES.—In award- 1 ing grants under this subsection, the Secretary 2 shall select grantees to ensure the following: 3 (i) The grantees provide many dif- 4 ferent types of language services. 5 (ii) The grantees serve Medicare bene- 6 ficiaries who speak different languages, 7 and who, as a population, have differing 8 needs for language services. 9 (iii) The grantees serve Medicare 10 beneficiaries in both urban and rural set- 11 tings. 12 (iv) The grantees serve Medicare 13 beneficiaries in at least two geographic re- 14 gions, as defined by the Secretary. 15 (v) The grantees serve Medicare bene- 16 ficiaries in at least two large metropolitan 17 statistical areas with racial, ethnic, and 18 economicly diverse populations. 19 (B) PRIORITY FOR PARTNERSHIPS WITH 20 COMMUNITY ORGANIZATIONS AND AGENCIES.— 21 In awarding grants under this subsection, the 22 Secretary shall give priority to eligible entities 23 that have a partnership with— 24 (i) a community organization; or 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 101 •HR 2954 IH (ii) a consortia of community 1 origanizations, state agecenices, and local 2 agencies, 3 that has experience in providing language serv- 4 ices. 5 (5) USE OF FUNDS FOR COMPETENT LANGUAGE 6 SERVICES.— 7 (A) IN GENERAL.—Subject to subpara- 8 graph (E), a grantee may only use grant funds 9 received under this subsection to pay for the 10 provision of competent language services to 11 Medicare beneficiaries who are limited-English 12 proficient. 13 (B) COMPETENT LANGUAGE SERVICES DE- 14 FINED.—For purposes of this subsection, the 15 term ‘‘competent language services’’ means— 16 (i) interpreter and translation services 17 that— 18 (I) subject to the exceptions 19 under subparagraph (C)— 20 (aa) if the grantee operates 21 in a State that has statewide 22 health care interpreter standards, 23 meet the State standards cur- 24 rently in effect; or 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00101 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 102 •HR 2954 IH (bb) if the grantee operates 1 in a State that does not have 2 statewide health care interpreter 3 standards, utilizes competent in- 4 terpreters who follow the Na- 5 tional Council on Interpreting in 6 Health Care’s Code of Ethics and 7 Standards of Practice; and 8 (II) that, in the case of inter- 9 preter services, are provided 10 through— 11 (aa) on-site interpretation; 12 (bb) telephonic interpreta- 13 tion; or 14 (cc) video interpretation; 15 and 16 (ii) the direct provision of health care 17 or health-care-related services by a com- 18 petent bilingual health care provider. 19 (C) EXCEPTIONS.—The requirements of 20 subparagraph (B)(i)(I) do not apply— 21 (i) to a Medicare beneficiary who is 22 limited-English-proficient who has been in- 23 formed, in the beneficiary’s primary lan- 24 guage, of the availability of free interpreter 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00102 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 103 •HR 2954 IH and translation services and who, instead, 1 requests that a family member, friend, or 2 other person provide such services, if the 3 grantee documents such request in the 4 beneficiary’s medical record; or 5 (ii) in the case of a medical emergency 6 where the delay directly associated with ob- 7 taining a competent interpreter or trans- 8 lation services would jeopardize the health 9 of the patient. 10 Subparagraph (C)(ii) shall not be construed to 11 exempt emergency rooms or similar entities 12 that regularly provide health care services in 13 medical emergencies to limited-English-pro- 14 ficient patients from any applicable legal or reg- 15 ulatory requirements related to providing com- 16 petent interpreter and translation services with- 17 out undue delay. 18 (D) MA ORGANIZATIONS AND PDP SPON- 19 SORS.—If a grantee is a MA organization or a 20 PDP sponsor, such entity must provide at least 21 50 percent of the grant funds that the entity 22 receives under this subsection directly to the en- 23 tity’s network providers (including physicians 24 and pharmacies) for the purpose of providing 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00103 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 104 •HR 2954 IH support for such providers to provide competent 1 language services to Medicare beneficiaries who 2 are limited-English proficient. 3 (E) ADMINISTRATIVE AND REPORTING 4 COSTS.—A grantee may use up to 10 percent of 5 the grant funds to pay for administrative costs 6 associated with the provision of competent lan- 7 guage services and for reporting required under 8 paragraph (9). 9 (6) DETERMINATION OF AMOUNT OF GRANT 10 PAYMENTS.— 11 (A) IN GENERAL.—Payments to grantees 12 under this subsection shall be calculated based 13 on the estimated numbers of limited-English- 14 proficient Medicare beneficiaries in a grantee’s 15 service area utilizing— 16 (i) data on the numbers of limited- 17 English-proficient individuals who speak 18 English less than ‘‘very well’’ from the 19 most recently available data from the Bu- 20 reau of the Census or other State-based 21 study the Secretary determines likely to 22 yield accurate data regarding the number 23 of such individuals in such service area; or 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00104 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 105 •HR 2954 IH (ii) data provided by the grantee, if 1 the grantee routinely collects data on the 2 primary language of the Medicare bene- 3 ficiaries that the grantee serves and the 4 Secretary determines that the data is accu- 5 rate and shows a greater number of lim- 6 ited-English-proficient individuals than 7 would be estimated using the data under 8 clause (i). 9 (B) DISCRETION OF SECRETARY.—Subject 10 to subparagraph (C), the amount of payment 11 made to a grantee under this subsection may be 12 modified annually at the discretion of the Sec- 13 retary, based on changes in the data under sub- 14 paragraph (A) with respect to the service area 15 of a grantee for the year. 16 (C) LIMITATION ON AMOUNT.—The 17 amount of a grant made under this subsection 18 to a grantee may not exceed $500,000 for the 19 period under paragraph (1)(D). 20 (7) ASSURANCES.—Grantees under this sub- 21 section shall— 22 (A) ensure that clinical and support staff 23 receive appropriate ongoing education and 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 106 •HR 2954 IH training in linguistically appropriate service de- 1 livery; 2 (B) ensure the linguistic competence of bi- 3 lingual providers; 4 (C) offer and provide appropriate language 5 services at no additional charge to each patient 6 with limited-English proficiency for all points of 7 contact between the patient and the grantee, in 8 a timely manner during all hours of operation; 9 (D) notify Medicare beneficiaries of their 10 right to receive language services in their pri- 11 mary language; 12 (E) post signage in the primary languages 13 commonly used by the patient population in the 14 service area of the organization; and 15 (F) ensure that— 16 (i) primary language data is collected 17 for recipients of language services and 18 such data is consistent with standards de- 19 veloped under title XXXIV of the Public 20 Health Service Act, as added by section 21 202 of this Act, to the extent such stand- 22 ards are available upon the initiation of the 23 demonstration program; and 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00106 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 107 •HR 2954 IH (ii) consistent with the privacy protec- 1 tions provided under the regulations pro- 2 mulgated pursuant to section 264(c) of the 3 Health Insurance Portability and Account- 4 ability Act of 1996 (42 U.S.C. 1320d–2 5 note), if the recipient of language services 6 is a minor or is incapacitated, primary lan- 7 guage data is collected on the parent or 8 legal guardian of such recipient. 9 (8) NO COST SHARING.—Limited-English-pro- 10 ficient Medicare beneficiaries shall not have to pay 11 cost-sharing or co-payments for competent language 12 services provided under this demonstration program. 13 (9) REPORTING REQUIREMENTS FOR GRANT- 14 EES.—Not later than the end of each calendar year, 15 a grantee that receives funds under this subsection 16 in such year shall submit to the Secretary a report 17 that includes the following information: 18 (A) The number of Medicare beneficiaries 19 to whom competent language services are pro- 20 vided. 21 (B) The primary languages of those Medi- 22 care beneficiaries. 23 (C) The types of language services pro- 24 vided to such beneficiaries. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 108 •HR 2954 IH (D) Whether such language services were 1 provided by employees of the grantee or 2 through a contract with external contractors or 3 agencies). 4 (E) The types of interpretation services 5 provided to such beneficiaries, and the approxi- 6 mate length of time such service is provided to 7 such beneficiaries. 8 (F) The costs of providing competent lan- 9 guage services. 10 (G) An account of the training or accredi- 11 tation of bilingual staff, interpreters, and trans- 12 lators providing services funded by the grant 13 under this subsection. 14 (10) EVALUATION AND REPORT TO CON- 15 GRESS.—Not later than 1 year after the completion 16 of a 3-year grant under this subsection, the Sec- 17 retary shall conduct an evaluation of the demonstra- 18 tion program under this subsection and shall submit 19 to the Congress a report that includes the following: 20 (A) An analysis of the patient outcomes 21 and the costs of furnishing care to the limited- 22 English-proficient Medicare beneficiaries par- 23 ticipating in the project as compared to such 24 outcomes and costs for limited-English-pro- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00108 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 109 •HR 2954 IH ficient Medicare beneficiaries not participating, 1 based on the data provided under paragraph (9) 2 and any other information available to the Sec- 3 retary. 4 (B) The effect of delivering langauge serv- 5 ices on— 6 (i) Medicare beneficiary access to care 7 and utilization of services; 8 (ii) the efficiency and cost effective- 9 ness of health care delivery; 10 (iii) patient satisfaction; 11 (iv) health outcomes; and 12 (v) the provision of culturally appro- 13 priate services provided to such 14 benificiaries. 15 (C) The extent to which bilingual staff, in- 16 terpreters, and translators providing services 17 under such demonstration were trained or ac- 18 credited and the nature of accreditation or 19 training needed by type of provider, service, or 20 other category as determined by the Secretary 21 to ensure the provision of high-quality interpre- 22 tation, translation, or other language services to 23 Medicare beneficiaries if such services are ex- 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 110 •HR 2954 IH panded pursuant to subsection (c) of section 1 1907 of this Act. 2 (D) Recommendations, if any, regarding 3 the extension of such project to the entire Medi- 4 care program, subject the to provision of section 5 1115A(c) of the Social Security Act. 6 (11) APPROPRIATIONS.—There is appropriated 7 to carry out this subsection, in equal parts from the 8 Federal Hospital Insurance Trust Fund and the 9 Federal Supplementary Medical Insurance Trust 10 Fund, $16,000,000 for each fiscal year of the dem- 11 onstration program. 12 (b) LANGUAGE SERVICES UNDER THE MEDICARE 13 PROGRAM.— 14 (1) Subsection (aa)(1) of section 1861 of the 15 Social Security Act (42 U.S.C. 1395x) is amended— 16 (A) in subparagraph (B), by striking the 17 ‘‘and’’ at the end; 18 (B) in subparagrpah (C), by inserting 19 ‘‘and’’ after the comma at the end; and 20 (C) by inserting after subparagraph (C) 21 the following: 22 ‘‘(D) language services as defined in sub- 23 section (iii),’’. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00110 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 111 •HR 2954 IH (2) Section 1833(a) of the Social Security Act 1 (42 U.S.C. 1395l(a)) is amended— 2 (A) by striking ‘‘and’’ at the end of para- 3 graph (8); 4 (B) by edesignating paragraph (9) as para- 5 graph (10); and 6 (C) by inserting after paragraph (8) the 7 following new paragraph: 8 ‘‘(9) in the case of language services described 9 in section 1861(iii), 100 percent of the reasonable 10 charges for such services, as determined in consulta- 11 tion with the Medicare Payment Advisory Commis- 12 sion; and’’. 13 (3) Section 1832(a)(2) of such Act (42 U.S.C. 14 1395k(a)(2)) is amended— 15 (A) by striking ‘‘and’’ at the end of sub- 16 paragraph (I); 17 (B) by striking the period at the end of 18 subparagraph (J) and inserting ‘‘; and’’; and 19 (C) by adding at the end of subparagraph 20 (J) the following: 21 ‘‘(K) language services (as defined in sec- 22 tion 1861(iii)) furnished by a interpreter or 23 translator.’’. 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00111 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 112 •HR 2954 IH (4) Section 1861 of the Social Security Act (42 1 U.S.C. 1395x) is amended by adding at the end the 2 following new subsection: 3 ‘‘Language Services and Related Terms 4 ‘‘(iii)(1) LANGUAGE SERVICES DEFINED.—The term 5 ‘language services’ has the same meaning given ‘language 6 or langauge access services’ in section 3400 of the Public 7 Health Service Act. 8 ‘‘(2) INTERPRETER SERVICES DEFINED.—For the 9 purposes of this subsection, the term ‘interpreter services’ 10 has the meaning given ‘competent interpreter services’ 11 under section 3400(3) of the Public Health Service Act. 12 ‘‘(3) INTERPRETER DEFINED.—The term ‘inter- 13 preter’— 14 ‘‘(A) means an individual— 15 ‘‘(i) who faithfully, accurately, and objec- 16 tively transmits a spoken message from one lan- 17 guage into another language; and 18 ‘‘(ii) who knows health and health-related 19 terminology in both languages; and 20 ‘‘(B) includes individuals who provide in-person, 21 telephonic, and video interpretation. 22 ‘‘(4) TRANSLATION DEFINED.—The term ‘trans- 23 lation’ means the transmission of a written message in one 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00112 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 113 •HR 2954 IH language into a written message in another language that 1 retains the intended meaning of the original message. 2 ‘‘(5) LIMITED-ENGLISH-PROFICIENT AND LEP DE- 3 FINED.—The terms ‘Limited-English-proficient’ and 4 ‘LEP’ have the meaning given the term ‘limited english 5 proficient’ under section 9101(25) of the Elementary and 6 Secondary Education Act of 1965, except that subpara- 7 graphs (A), (B), and (D) of such section not apply.’’. 8 (5) WAIVER OF BUDGET NEUTRALITY.—For 9 the 3-year period beginning on the date of enact- 10 ment of this section, the budget neutrality provision 11 of section 1848(c)(2)(B)(ii) of the Social Security 12 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 13 apply to language services (as such term is defined 14 in section 1861(iii) of such Act). 15 (c) MEDICARE PART C AND PART D.— 16 (1) IN GENERAL.—Medicare Advantage plans 17 under part C of the Social Security Act and Pre- 18 scription Drug Plans under part D of such Act shall 19 provide effective language services to enrollees of 20 such plans. 21 (2) REPORTING REQUIREMENTS.—Medicare 22 Advantage and Prescription Drug plans shall annu- 23 ally submit to the Secretary of Health and Human 24 Services a report that contains information on the 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00113 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 114 •HR 2954 IH plan’s internal policies and procedures related to re- 1 cruitment and retention efforts directed to workforce 2 diversity and linquistically and culturally appropriate 3 provision of services in each of the following con- 4 texts: 5 (A) The collection of data in a manner 6 that meets the requirements of title I of this 7 Act, regarding the enrollee population. 8 (B) Education of staff and contractors who 9 have routine contact with enrollees regarding 10 the various needs of the diverse enrollee popu- 11 lation. 12 (C) Evaluation of the health plan’s lan- 13 guage services programs and services with re- 14 spect to the plan’s enrollee population, such as 15 through analysis of complaints or satisfaction 16 survey results. 17 (D) Methods by which the plan provides to 18 the Secretary information regarding the ethnic 19 diversity of the plan’s enrollee population. 20 (E) The periodic provision of educational 21 information to plan enrollees on the plan’s lan- 22 guage services and programs. 23 (d) IMPROVING LANGUAGE SERVICES IN MEDICAID 24 AND SCHIP.— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00114 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 115 •HR 2954 IH (1) Section 1903(a)(2)(E) of the Social Secu- 1 rity Act (42 U.S.C. 1396b(a)(2)(E)) is amended 2 by— 3 (A) striking ‘‘75’’ and inserting ‘‘90’’; 4 (B) striking ‘‘translation or interpretation 5 services’’ and inserting ‘‘language services’’; 6 and 7 (C) striking ‘‘children of families’’ and in- 8 serting ‘‘individuals’’. 9 (2) Section 1902(a)(10)(A) of the Social Secu- 10 rity Act (42 U.S.C. 1396a(a)(10)(A)) is amended by 11 striking ‘‘and (28)’’ and inserting ‘‘(28), and (29)’’. 12 (3) Section 1905(a) of the Social Security Act 13 (42 U.S.C. 1396d(a)) is amended by— 14 (A) in paragraph (28), by striking ‘‘and’’ 15 at the end; 16 (B) by redesignating paragraph (29) as 17 paragraph (30); and 18 (C) by inserting after paragraph (28) the 19 following new paragraph: 20 ‘‘(29) language services, as such term is defined 21 in section 1861(iii), provided in a timely manner to 22 limited-English-proficient individuals who need such 23 services; and’’. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00115 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 116 •HR 2954 IH (4) Section 1916(a)(2) of the Social Security 1 Act (42 U.S.C. 1396o(2)) is amended by— 2 (A) by striking ‘‘or’’ at the end of subpara- 3 graph (D); 4 (B) by striking ‘‘; and’’ at the end of sub- 5 paragraph (E) and inserting ‘‘, or’’; and 6 (C) by adding at the end the following new 7 subparagraph: 8 ‘‘(F) language services described in section 9 1905(a)(29); and’’. 10 (5) Section 2103 of the Social Security Act (42 11 U.S.C. 1397cc) is amended— 12 (A) in subsection (a), in the matter before 13 paragraph (1), by striking ‘‘ and (7)’’ and in- 14 serting ‘‘(7), and (9)’’; and 15 (B) in subsection (c), by adding at the end 16 the following new paragraph: 17 ‘‘(9) LANGUAGE SERVICES.—The child health 18 assistance provided to a targeted low-income child 19 shall include coverage of language services, as such 20 term is defined in section 1861(iii), provided in a 21 timely manner to limited-English-proficient individ- 22 uals who need such services.’’; and 23 (C) in subsection (e)(2)— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00116 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 117 •HR 2954 IH (i) in the heading, by striking ‘‘PRE- 1 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 2 (ii) by inserting ‘‘, subsection (c)(9),’’ 3 after ‘‘subsection (c)(1)(C)’’. 4 (6) Section 2110(a)(27) of the Social Security 5 Act (42 U.S.C. 1397jj) is amended by striking 6 ‘‘translation’’ and inserting ‘‘language services as 7 described in section 2103(c)(9)’’. 8 (7) Pursuant to the reporting requirement de- 9 scribed in section 2107(b)(1) of the Social Security 10 Act (42 U.S.C. 1397gg(b)(1)), the Secretary of 11 Health and Human Services shall require that 12 States collect data on— 13 (A) the primary language of individuals re- 14 ceiving child health assistance under title XXI 15 of the Social Security Act; and 16 (B) in the case of such individuals who are 17 minors or incapacitated, the primary language 18 of the individual’s parent or guardian. 19 (8) Section 2105 of the Social Security Act (42 20 U.S.C. 1397ee(c)) is amended— 21 (A) in subsection (a)(1) by striking ‘‘75’’ 22 and inserting ‘‘90’’; and 23 (B) in subsection (c)(2)(A), by inserting 24 before the period ‘‘, except that expenditures 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00117 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 118 •HR 2954 IH pursuant to clause (iv) of subparagraph (D) of 1 such paragraph shall not count towards this 2 total’’. 3 (e) FUNDING LANGUAGE SERVICES FURNISHED BY 4 PROVIDERS OF HEALTH CARE AND HEALTH-CARE-RE- 5 LATED SERVICES THAT SERVE HIGH RATES OF UNIN- 6 SURED LEP INDIVIDUALS.— 7 (1) PAYMENT OF COSTS.— 8 (A) IN GENERAL.—Subject to subpara- 9 graph (B), the Secretary of Health and Human 10 Services shall make payments (on a quarterly 11 basis) directly to eligible entities to support the 12 provision of language services to limited- 13 English-proficient individuals in an amount 14 equal to an entity’s eligible costs (as defined 15 under paragraph (3)) for such services for the 16 quarter. 17 (B) FUNDING.—Out of any funds in the 18 Treasury not otherwise appropriated, there are 19 appropriated to the Secretary of Health and 20 Human Services such sums as may be nec- 21 essary for each of fiscal years 2012 through 22 2016. 23 (C) RELATION TO MEDICAID DSH.—Pay- 24 ments under this subsection shall not offset or 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 119 •HR 2954 IH reduce payments under section 1923 of the So- 1 cial Security Act, nor shall payments under 2 such section be considered when determining 3 uncompensated costs associated with the provi- 4 sion of language services. 5 (2) ELIGIBLE ENTITY.—In order to receive 6 grants under this paragraph, an entity must— 7 (A) be a Medicaid provider that is— 8 (i) a physician; 9 (ii) a hospital with a low-income utili- 10 zation rate (as defined in section 11 1923(b)(3) of the Social Security Act (42 12 U.S.C. 1396r–4(b)(3))) of greater than 25 13 percent; or 14 (iii) a federally qualified health center 15 (as defined in section 1905(l)(2)(B) of the 16 Social Security Act (42 U.S.C. 17 1396d(l)(2)(B))); 18 (B) provide language services to at least 8 19 percent of the entity’s total number of patients, 20 not later than 6 months after the date of the 21 enactment of the Act; and 22 (C) prepare and submit an application to 23 the Secretary, at such time, in such manner, 24 and accompanied by such information as the 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00119 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 120 •HR 2954 IH Secretary may require to ascertain the entity’s 1 eligibility for funding under this subsection. 2 (3) ELIGIBLE COSTS DEFINED.— 3 (A) IN GENERAL.—In this subsection, the 4 term ‘‘eligible costs’’ means, with respect to an 5 eligible entity that provides language services to 6 LEP individuals, the product of— 7 (i) the average per person cost of lan- 8 guage services, determined according to 9 the methodology devised under subpara- 10 graph (B); and 11 (ii) the number of limited-English-pro- 12 ficient individuals who are provided lan- 13 guage services by the entity and for whom 14 no reimbursement is available for such 15 services under the amendments made by 16 subsections (a), (b), (c), or (d) or by pri- 17 vate health insurance. 18 (B) METHODOLOGY.— 19 (i) IN GENERAL.—The Secretary shall 20 establish a methodology to determine the 21 average per person cost of language serv- 22 ices. 23 (ii) DIFFERENT ENTITIES.—In estab- 24 lishing such methodology, the Secretary 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00120 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 121 •HR 2954 IH may establish different methodologies for 1 different types of eligible entities. 2 (iii) NO INDIVIDUAL CLAIMS.—The 3 Secretary may not require eligible entities 4 to submit individual claims for language 5 services for individual patients as a re- 6 quirement for payment under this sub- 7 section. 8 (4) DATA COLLECTION INSTRUMENT.—For pur- 9 poses of this subsection, the Secretary shall create a 10 standard data collection instrument that is con- 11 sistent with any existing reporting requirements by 12 the Secretary or relevant accrediting organizations 13 regarding the number of individuals to whom lan- 14 guage access are provided. 15 (5) REPORTING REQUIREMENTS.—Entities re- 16 ceiving payment under this subsection shall provide 17 the Secretary with a quarterly report on how the en- 18 tity used such funds. Such report shall contain ag- 19 gregate (and may not contain individualized) data 20 collected using the instrument under paragraph (4) 21 and shall otherwise be in a form and manner deter- 22 mined by the Secretary. 23 (6) LANGUAGE SERVICES.—For purposes of 24 this subsection, the term ‘‘language services’’ has 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00121 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 122 •HR 2954 IH the meaning given such term in section 1861(iii) of 1 the Social Security Act. 2 (7) GUIDELINES AND REPORT.— 3 (A) ESTABLISHMENT.—Not later than 6 4 months after the date of enactment of this Act, 5 the Secretary of Health and Human Services 6 shall establish and distribute guidelines con- 7 cerning the implementation of this subsection. 8 (B) REPORT.—Not later than 2 years after 9 the date of enactment of this Act, and every 2 10 years thereafter, the Secretary shall submit a 11 report to Congress concerning the implementa- 12 tion of this subsection. 13 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964 AND 14 OTHER LAWS.—Nothing in this section shall be construed 15 to limit otherwise existing obligations of recipients of Fed- 16 eral financial assistance under title VI of the Civil Rights 17 Act of 1964 (42 U.S.C. 2000(d) et seq.) or other laws 18 that protect the civil rights of individuals. 19 (g) EFFECTIVE DATE.—The amendments made by 20 this section shall take effect on October 1, 2011. 21 SEC. 204. INCREASING UNDERSTANDING OF AND IMPROV- 22 ING HEALTH LITERACY. 23 (a) IN GENERAL.—The Secretary, acting through the 24 Director of the Agency for Healthcare Research and Qual- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 123 •HR 2954 IH ity and the Administrator of the Health Resources and 1 Services Administration, in consultation with the Director 2 of the National Institute on Minority Health and Health 3 Disparities and the Office of Minority Health, shall award 4 grants to eligible entities to improve health care for pa- 5 tient populations that have low functional health literacy. 6 (b) ELIGIBILITY.—To be eligible to receive a grant 7 under subsection (a), an entity shall— 8 (1) be a hospital, health center or clinic, health 9 plan, or other health entity (including a nonprofit 10 minority health organization or association); and 11 (2) prepare and submit to the Secretary an ap- 12 plication at such time, in such manner, and con- 13 taining such information as the Secretary may re- 14 quire. 15 (c) USE OF FUNDS.— 16 (1) AGENCY FOR HEALTHCARE RESEARCH AND 17 QUALITY.—Grants awarded under subsection (a) 18 through the Agency for Healthcare Research and 19 Quality shall be used— 20 (A) to define and increase the under- 21 standing of health literacy; 22 (B) to investigate the correlation between 23 low health literacy and health and health care; 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00123 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 124 •HR 2954 IH (C) to clarify which aspects of health lit- 1 eracy have an effect on health outcomes; and 2 (D) for any other activity determined ap- 3 propriate by the Director of the Agency. 4 (2) HEALTH RESOURCES AND SERVICES ADMIN- 5 ISTRATION.—Grants awarded under subsection (a) 6 through the Health Resources and Services Adminis- 7 tration shall be used to conduct demonstration 8 projects for interventions for patients with low 9 health literacy that may include— 10 (A) the development of new disease man- 11 agement programs for patients with low health 12 literacy; 13 (B) the tailoring of existing disease man- 14 agement programs addressing mental, physical, 15 oral, and behavioral health conditions for pa- 16 tients with low health literacy; 17 (C) the translation of written health mate- 18 rials for patients with low health literacy; 19 (D) the identification, implementation, and 20 testing of low health literacy screening tools; 21 (E) the conduct of educational campaigns 22 for patients and providers about low health lit- 23 eracy; and 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00124 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 125 •HR 2954 IH (F) other activities determined appropriate 1 by the Administrator of the Health Resources 2 and Services Administration. 3 (d) DEFINITIONS.—In this section, the term ‘‘low 4 health literacy’’ means the inability of an individual to ob- 5 tain, process, and understand basic health information 6 and services needed to make appropriate health decisions. 7 (e) AUTHORIZATION OF APPROPRIATIONS.—There 8 are authorized to be appropriated to carry out this section, 9 such sums as may be necessary for each of fiscal years 10 2012 through 2016. 11 SEC. 205. ASSURANCES FOR RECEIVING FEDERAL FUNDS. 12 (a) IN GENERAL.—Entities that receive Federal 13 funds under sections 201 or 202 (including under the 14 amendments made by such section), in order to ensure the 15 right of LEP individuals to receive access to quality health 16 care, shall— 17 (1) ensure that appropriate clinical and support 18 staff receive ongoing education and training in lin- 19 guistically appropriate service delivery; 20 (2) offer and provide appropriate language serv- 21 ices at no additional charge to each patient with lim- 22 ited-English proficiency at all points of contact, in a 23 timely manner during all hours of operation; 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00125 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 126 •HR 2954 IH (3) notify patients of their right to receive lan- 1 guage services in their primary language; and 2 (4) utilize only competent interpreter or trans- 3 lation services which— 4 (A) until adoption of the Interpreter and 5 Translator Guidelines and Standards described 6 in section 3403(c) of the Public Health Service 7 Act, are defined in section 3400 of the Public 8 Health Service Act; and 9 (B) after adoption of the Interpreter and 10 Translator Guidelines and Standards described 11 in section 3403(c) of the Public Health Service 12 Act, meet those guidelines and standards; 13 (b) EXEMPTIONS.—The requirements of subsection 14 (a)(4) shall not apply as follows: 15 (1) When a patient (who has been informed in 16 his or her primary language of the availability of 17 free interpreter and translation services) requests 18 the use of family, friends, or other persons untrained 19 in interpretation or translation if the following con- 20 ditions are met: 21 (A) The interpreter requested by the pa- 22 tient is over the age of 18. 23 (B) The recipient informs the patient that 24 he or she has the option of having the recipient 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00126 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 127 •HR 2954 IH provide an interpreter for him/her without 1 charge, or of using his/her own interpreter. 2 (C) The recipient informs the patient that 3 the recipient may not require an LEP person to 4 use a family member or friend as an inter- 5 preter. 6 (D) The recipient evaluates whether the 7 person the patient wishes to use as an inter- 8 preter is competent. If the recipient has reason 9 to believe that the interpreter is not competent, 10 the recipient provides the recipient’s own inter- 11 preter to protect the recipient from liability if 12 the patient’s interpreter is later found not com- 13 petent. 14 (E) If the recipient has reason to believe 15 that there is a conflict of interest between the 16 interpreter and patient, the recipient may not 17 use the patient’s interpreter. 18 (F) The recipient has the patient sign a 19 waiver, witnessed by at least 1 individual not 20 related to the patient, that includes the infor- 21 mation stated in subparagraphs (A) through 22 (E) and is translated into the patient’s lan- 23 guage. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00127 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 128 •HR 2954 IH (2) When a medical emergency exists and the 1 delay directly associated with obtaining competent 2 interpreter or translation services would jeopardize 3 the health of the patient but only until a competent 4 interpreter or translation service is available; how- 5 ever, nothing in this subsection shall exempt emer- 6 gency rooms or similar entities that regularly pro- 7 vide health care services in medical emergencies 8 from having in place systems to provide competent 9 interpreter and translation services without undue 10 delay. 11 SEC. 206. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL- 12 TURALLY AND LINGUISTICALLY APPRO- 13 PRIATE HEALTH CARE SERVICES. 14 (a) REPORT.—Not later than 1 year after the date 15 of enactment of this Act and annually thereafter, the Sec- 16 retary of Health and Human Services shall enter into a 17 contract with the Institute of Medicine for the preparation 18 and publication of a report that describes Federal efforts 19 to ensure that all individuals with limited-English pro- 20 ficiency have meaningful access culturally competent to 21 health care and health-care-related services. Such report 22 shall include— 23 (1) a description and evaluation of the activities 24 carried out under this Act; 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00128 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 129 •HR 2954 IH (2) a description and analysis of best practices, 1 model programs, guidelines, and other effective 2 strategies for providing access to culturally and lin- 3 guistically appropriate health care services; 4 (3) recommendations on the development and 5 implementation of policies and practices by providers 6 of health care and health-care-related services for 7 limited-English-proficient individuals; 8 (4) a description of the effect of providing lan- 9 guage services on quality of health care and access 10 to care; and 11 (5) a description of the costs associated with or 12 savings related to the provision of language services. 13 (b) AUTHORIZATION OF APPROPRIATIONS.—There 14 are authorized to be appropriated to carry out this section 15 such sums as may be necessary for each of fiscal years 16 2012 through 2016. 17 SEC. 207. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES. 18 (a) GRANTS AUTHORIZED.—The Secretary of Edu- 19 cation is authorized to provide grants to eligible entities 20 for the provision of English as a second language (here- 21 after referred to as ‘‘ESL’’) instruction and shall deter- 22 mine, after consultation with appropriate stakeholders, the 23 mechanism for administering and distributing such 24 grants. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00129 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 130 •HR 2954 IH (b) ELIGIBLE ENTITY DEFINED.—For purposes of 1 this section, the term ‘‘eligible entity’’ means a State or 2 community-based organization that employs, and serves, 3 minority populations. 4 (c) APPLICATION.—An eligible entity may apply for 5 a grant under this section by submitting such information 6 as the Secretary may require and in such form and man- 7 ner as the Secretary may require. 8 (d) USE OF GRANT.—As a condition of receiving a 9 grant under this section, an eligible entity shall— 10 (1) develop and implement a plan for assuring 11 the availability of ESL instruction that effectively 12 integrates information about the nature of the 13 United States health care system, how to access 14 care, and any special language skills that may be re- 15 quired for them to access and regularly negotiate the 16 system effectively; 17 (2) develop a plan, including, where appro- 18 priate, public-private partnerships, for making ESL 19 instruction progressively available to all individuals 20 seeking instruction; and 21 (3) maintain current ESL instruction efforts by 22 using the additional funds to supplement rather 23 than supplant any funds expended for ESL instruc- 24 tion in the State as of January 1, 2006. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00130 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 131 •HR 2954 IH (e) ADDITIONAL DUTIES OF THE SECRETARY.—The 1 Secretary of Education shall— 2 (1) collect and publicize annual data on how 3 much Federal, State, and local governments spend 4 on ESL instruction; 5 (2) collect data from State and local govern- 6 ments to identify the unmet needs of English lan- 7 guage learners for appropriate ESL instruction, in- 8 cluding— 9 (A) the preferred written and spoken lan- 10 guage of such English language learners; 11 (B) the extent of waiting lists including 12 how many programs maintain waiting lists and, 13 for programs that do not have waiting lists, the 14 reasons why not; 15 (C) the availability of programs to geo- 16 graphically isolated communities; 17 (D) the impact of course enrollment poli- 18 cies, including open enrollment, on the avail- 19 ability of ESL instruction; 20 (E) the number individuals in the State 21 and each participating locality; 22 (F) the effectiveness of the instruction in 23 meeting the needs of individuals receiving in- 24 struction and those needing instruction; 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00131 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 132 •HR 2954 IH (G) as assessment of the need for pro- 1 grams that integrate job training and ESL in- 2 struction, to assist individuals to obtain better 3 jobs; and 4 (H) the availability of ESL slots by State 5 and locality; 6 (3) determine the cost and most appropriate 7 methods of making ESL instruction available to all 8 English language learners seeking instruction; and 9 (4) within 1 year of the date of enactment of 10 this Act, issue a report to Congress that assesses the 11 information collected in paragraphs (1), (2), and (3) 12 and makes recommendations on steps that should be 13 taken to progressively realize the goal of making 14 ESL instruction available to all English language 15 learners seeking instruction. 16 (f) AUTHORIZATION OF APPROPRIATIONS.—There 17 are authorized to be appropriated to the Secretary of Edu- 18 cation for each of fiscal years 2012 through 2015 19 $250,000,000 to carry out this section. 20 SEC. 208. IMPLEMENTATION. 21 (a) GENERAL PROVISIONS.— 22 (1) A State shall not be immune under the 23 Eleventh Amendment of the Constitution of the 24 United States from suit in Federal court for failing 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00132 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 133 •HR 2954 IH to provide the language access funded pursuant to 1 this title. 2 (2) In a suit against a State for a violation of 3 this title, remedies (including remedies at both at 4 law and in equity) are available for such a violation 5 to the same extent as such remedies are available for 6 such a violation in the suit against any public or pri- 7 vate entity other than a State. 8 (b) RULE OF CONSTRUCTION.—Nothing in this title 9 shall be construed to limit otherwise existing obligations 10 of recipients of Federal financial assistance under title VI 11 of the Civil Rights Act of 1964 (42 U.S.C. 2000(d) et 12 seq.) or any other statute. 13 SEC. 209. LANGUAGE ACCESS SERVICES. 14 (a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 15 the Patient Protection and Affordable Care Act (42 16 U.S.C. 18022(b)(1)) is amended by adding at the end the 17 following: 18 ‘‘(K) Language access services, including 19 oral interpretation and written translations.’’. 20 (b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL 21 COVERAGE.—Section 36B(c)(2)(C) of the Internal Rev- 22 enue Code of 1986 is amended by adding at the end the 23 following: 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00133 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 134 •HR 2954 IH ‘‘(v) COVERAGE MUST INCLUDE LAN- 1 GUAGE ACCESS AND SERVICES.—Except as 2 provided in clause (iii), an employee shall 3 not be treated as eligible for minimum es- 4 sential coverage if such coverage consists 5 of an eligible employer-sponsored plan (as 6 defined in section 5000A(f)(2)) and the 7 plan does not provide coverage for lan- 8 guage access services, including oral inter- 9 pretation and written translations.’’. 10 (c) QUALITY REPORTING.—Section 2717(a)(1) of the 11 Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 12 amended— 13 (1) by striking ‘‘and’’ at the end of subpara- 14 graph (C); 15 (2) by striking the period at the end of sub- 16 paragraph (D) and inserting ‘‘; and’’; and 17 (3) by adding at the end the following new sub- 18 paragraph: 19 ‘‘(E) reduce health disparities through the 20 provision of language access services, including 21 oral interpretation and written translations.’’. 22 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00134 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 135 •HR 2954 IH TITLE III—HEALTH WORKFORCE 1 DIVERSITY 2 SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 3 ACT. 4 Title XXXIV of the Public Health Service Act, as 5 added by section 202, is amended by adding at the end 6 the following: 7 ‘‘Subtitle A—Diversifying the 8 Health Care Workplace 9 ‘‘SEC. 3411. REPORT ON WORKFORCE DIVERSITY. 10 ‘‘(a) IN GENERAL.—Not later than July 1, 2012, and 11 biannually thereafter, the Secretary, acting through the 12 director of each entity within the Department of Health 13 and Human Services, shall prepare and submit to the 14 Committee on Health, Education, Labor, and Pensions of 15 the Senate and the Committee on Energy and Commerce 16 of the House of Representatives a report on health work- 17 force diversity. 18 ‘‘(b) REQUIREMENT.—The report under subsection 19 (a) shall contain the following information: 20 ‘‘(1) A description of any grant support that is 21 provided by each entity for workforce diversity ini- 22 tiatives with the following information— 23 ‘‘(A) the number of grants made; 24 ‘‘(B) the purpose of the grants; 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00135 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 136 •HR 2954 IH ‘‘(C) the populations served through the 1 grants; 2 ‘‘(D) the organizations and institutions re- 3 ceiving the grants; and 4 ‘‘(E) the tracking efforts that were used to 5 follow the progress of participants. 6 ‘‘(2) A description of the entity’s plan to 7 achieve workforce diversity goals that includes, to 8 the extent relevant to such entity— 9 ‘‘(A) the number of underrepresented mi- 10 nority health professionals that will be needed 11 in various disciplines over the next 10 years to 12 achieve population parity; 13 ‘‘(B) the level of funding needed to fully 14 expand and adequately support health profes- 15 sions pipeline programs; 16 ‘‘(C) the impact such programs have had 17 on the admissions practices and policies of 18 health professions schools; 19 ‘‘(D) the management strategy necessary 20 to effectively administer and institutionalize 21 health profession pipeline programs; and 22 ‘‘(E) the impact that the Government Per- 23 formance and Results Act (GPRA) has had on 24 evaluating the performance of grantees and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00136 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 137 •HR 2954 IH whether the GPRA is the best assessment tool 1 for programs under titles VII and VIII. 2 ‘‘(3) A description of measurable objectives of 3 each entity relating to workforce diversity initiatives. 4 ‘‘(c) PUBLIC AVAILABILITY.—The report under sub- 5 section (a) shall be made available for public review and 6 comment. 7 ‘‘SEC. 3412. NATIONAL WORKING GROUP ON WORKFORCE 8 DIVERSITY. 9 ‘‘(a) IN GENERAL.—The Secretary, acting through 10 the Bureau of Health Professions within the Health Re- 11 sources and Services Administration, shall award a grant 12 to an entity determined appropriate by the Secretary for 13 the establishment of a national working group on work- 14 force diversity. 15 ‘‘(b) REPRESENTATION.—In establishing the national 16 working group under subsection (a): 17 ‘‘(1) The grantee shall ensure that the group 18 has representatives of the following: 19 ‘‘(A) The Health Resources and Services 20 Administration. 21 ‘‘(B) The Department of Health and 22 Human Services Data Council. 23 ‘‘(C) The Office of Minority Health. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00137 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 138 •HR 2954 IH ‘‘(D) The Bureau of Labor Statistics of 1 the Department of Labor. 2 ‘‘(E) The Public Health Practice Program 3 Office—Office of Workforce Policy and Plan- 4 ning. 5 ‘‘(F) The National Institute on Minority 6 Health and Health Disparities. 7 ‘‘(G) The Agency for Healthcare Research 8 and Quality. 9 ‘‘(H) The Institute of Medicine Study 10 Committee for the 2004 workforce diversity re- 11 port. 12 ‘‘(I) The Indian Health Service. 13 ‘‘(J) Minority-serving academic institu- 14 tions. 15 ‘‘(K) Consumer organizations. 16 ‘‘(L) Health professional associations, in- 17 cluding those that represent underrepresented 18 minority populations. 19 ‘‘(M) Researchers in the area of health 20 workforce. 21 ‘‘(N) Health workforce accreditation enti- 22 ties. 23 ‘‘(O) Private foundations that have spon- 24 sored workforce diversity initiatives. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00138 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 139 •HR 2954 IH ‘‘(2) The grantee shall ensure that, in addition 1 to the representatives under paragraph (1), the 2 group has not less than 5 health professions stu- 3 dents representing various health profession fields 4 and levels of training. 5 ‘‘(c) ACTIVITIES.—The working group established 6 under subsection (a) shall convene at least twice each year 7 to complete the following activities: 8 ‘‘(1) Review current public and private health 9 workforce diversity initiatives. 10 ‘‘(2) Identify successful health workforce diver- 11 sity programs and practices. 12 ‘‘(3) Examine challenges relating to the devel- 13 opment and implementation of health workforce di- 14 versity initiatives. 15 ‘‘(4) Draft a national strategic work plan for 16 health workforce diversity, including recommenda- 17 tions for public and private sector initiatives. 18 ‘‘(5) Develop a framework and methods for the 19 evaluation of current and future health workforce di- 20 versity initiatives. 21 ‘‘(6) Develop recommended standards for work- 22 force diversity that could be applicable to all health 23 professions programs and programs funded under 24 this Act. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00139 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 140 •HR 2954 IH ‘‘(7) Develop curriculum guidelines for diversity 1 training. 2 ‘‘(8) Develop a strategy for the inclusion of 3 community members on admissions committees for 4 health profession schools. 5 ‘‘(9) Other activities determined appropriate by 6 the Secretary. 7 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 8 the establishment of the working group under subsection 9 (a), and annually thereafter, the working group shall pre- 10 pare and make available to the general public for com- 11 ment, an annual report on the activities of the working 12 group. Such report shall include the recommendations of 13 the working group for improving health workforce diver- 14 sity. 15 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 16 is authorized to be appropriated to carry out this section 17 such sums as may be necessary for each of fiscal years 18 2012 through 2017. 19 ‘‘SEC. 3413. TECHNICAL CLEARINGHOUSE FOR HEALTH 20 WORKFORCE DIVERSITY. 21 ‘‘(a) IN GENERAL.—The Secretary, acting through 22 the Office of Minority Health, and in collaboration with 23 the Bureau of Health Professions within the Health Re- 24 sources and Services Administration, the National Insti- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00140 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 141 •HR 2954 IH tute on Minority Health and Health Disparities, shall es- 1 tablish a technical clearinghouse on health workforce di- 2 versity within the Office of Minority Health and coordi- 3 nate current and future clearinghouses. 4 ‘‘(b) INFORMATION AND SERVICES.—The clearing- 5 house established under subsection (a) shall offer the fol- 6 lowing information and services: 7 ‘‘(1) Information on the importance of health 8 workforce diversity. 9 ‘‘(2) Statistical information relating to under- 10 represented minority representation in health and al- 11 lied health professions and occupations. 12 ‘‘(3) Model health workforce diversity practices 13 and programs. 14 ‘‘(4) Admissions policies that promote health 15 workforce diversity and are in compliance with Fed- 16 eral and State laws. 17 ‘‘(5) Lists of scholarship, loan repayment, and 18 loan cancellation grants as well as fellowship infor- 19 mation for underserved populations for health pro- 20 fessions schools. 21 ‘‘(6) Foundation and other large organizational 22 initiatives relating to health workforce diversity. 23 ‘‘(c) CONSULTATION.—In carrying out this section, 24 the Secretary shall consult with non-Federal entities which 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00141 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 142 •HR 2954 IH may include minority health professional associations to 1 ensure the adequacy and accuracy of information. 2 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 3 is authorized to be appropriated to carry out this section 4 such sums as may be necessary for each of fiscal years 5 2012 through 2017. 6 ‘‘SEC. 3414. SUPPORT FOR INSTITUTIONS COMMITTED TO 7 WORKFORCE DIVERSITY. 8 ‘‘(a) IN GENERAL.—The Secretary, acting through 9 the Administrator of the Health Resources and Services 10 Administration and the Centers for Disease Control and 11 Prevention, shall award grants to eligible entities that 12 demonstrate a commitment to health workforce diversity. 13 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 14 under subsection (a), an entity shall— 15 ‘‘(1) be an educational institution or entity that 16 historically produces or trains meaningful numbers 17 of underrepresented minority health professionals, 18 including— 19 ‘‘(A) historically Black colleges and univer- 20 sities; 21 ‘‘(B) Hispanic-serving health professions 22 schools; 23 ‘‘(C) Hispanic-serving institutions; 24 ‘‘(D) tribal colleges and universities; 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00142 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 143 •HR 2954 IH ‘‘(E) Asian-American, Native American, 1 and Pacific Islander-serving institutions; 2 ‘‘(F) institutions that have programs to re- 3 cruit and retain underrepresented minority 4 health professionals, in which a significant 5 number of the enrolled participants are under- 6 represented minorities; 7 ‘‘(G) health professional associations, 8 which may include underrepresented minority 9 health professional associations; and 10 ‘‘(H) institutions— 11 ‘‘(i) located in communities with pre- 12 dominantly underrepresented minority pop- 13 ulations; 14 ‘‘(ii) with whom partnerships have 15 been formed for the purpose of increasing 16 workforce diversity; and 17 ‘‘(iii) in which at least 20 percent of 18 the enrolled participants are underrep- 19 resented minorities; and 20 ‘‘(2) submit to the Secretary an application at 21 such time, in such manner, and containing such in- 22 formation as the Secretary may require. 23 ‘‘(c) USE OF FUNDS.—Amounts received under a 24 grant under subsection (a) shall be used to expand existing 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00143 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 144 •HR 2954 IH workforce diversity programs, implement new workforce 1 diversity programs, or evaluate existing or new workforce 2 diversity programs, including with respect to mental 3 health care professions. Such programs shall enhance di- 4 versity by considering minority status as part of an indi- 5 vidualized consideration of qualifications. Possible activi- 6 ties may include— 7 ‘‘(1) educational outreach programs relating to 8 opportunities in the health professions; 9 ‘‘(2) scholarship, fellowship, grant, loan repay- 10 ment, and loan cancellation programs; 11 ‘‘(3) postbaccalaureate programs; 12 ‘‘(4) academic enrichment programs, particu- 13 larly targeting those who would not be competitive 14 for health professions schools; 15 ‘‘(5) kindergarten through 12th grade and 16 other health pipeline programs; 17 ‘‘(6) mentoring programs; 18 ‘‘(7) internship or rotation programs involving 19 hospitals, health systems, health plans and other 20 health entities; 21 ‘‘(8) community partnership development for 22 purposes relating to workforce diversity; or 23 ‘‘(9) leadership training. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00144 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 145 •HR 2954 IH ‘‘(d) REPORTS.—Not later than 1 year after receiving 1 a grant under this section, and annually for the term of 2 the grant, a grantee shall submit to the Secretary a report 3 that summarizes and evaluates all activities conducted 4 under the grant. 5 ‘‘(e) DEFINITION.—In this section, the term ‘Asian- 6 American, Native American, and Pacific Islander-serving 7 institutions’ has the same meaning as the term ‘Asian 8 American and Native American Pacific Islander-serving 9 institution’ as defined in section 371(c) of the Higher 10 Education Act of 1965 (20 U.S.C. 1067q(c)). 11 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 12 is authorized to be appropriated to carry out this section, 13 such sums as may be necessary for each of fiscal years 14 2012 through 2017. 15 ‘‘SEC. 3415. CAREER DEVELOPMENT FOR SCIENTISTS AND 16 RESEARCHERS. 17 ‘‘(a) IN GENERAL.—The Secretary, acting through 18 the Director of the National Institutes of Health, the Di- 19 rector of the Centers for Disease Control and Prevention, 20 the Commissioner of Food and Drugs, and the Director 21 of the Agency for Healthcare Research and Quality, shall 22 award grants that expand existing opportunities for sci- 23 entists and researchers and promote the inclusion of 24 underrepresented minorities in the health professions. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00145 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 146 •HR 2954 IH ‘‘(b) RESEARCH FUNDING.—The head of each entity 1 within the Department of Health and Human Services 2 shall establish or expand existing programs to provide re- 3 search funding to scientists and researchers in training. 4 Under such programs, the head of each such entity shall 5 give priority in allocating research funding to support 6 health research in traditionally underserved communities, 7 including underrepresented minority communities, and re- 8 search classified as community or participatory. 9 ‘‘(c) DATA COLLECTION.—The head of each entity 10 within the Department of Health and Human Services 11 shall collect data on the number (expressed as an absolute 12 number and a percentage) of underrepresented minority 13 and nonminority applicants who receive and are denied 14 agency funding at every stage of review. Such data shall 15 be reported annually to the Secretary and the appropriate 16 committees of Congress. 17 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec- 18 retary shall establish a student loan reimbursement pro- 19 gram to provide student loan reimbursement assistance to 20 researchers who focus on racial and ethnic disparities in 21 health. The Secretary shall promulgate regulations to de- 22 fine the scope and procedures for the program under this 23 subsection. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00146 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 147 •HR 2954 IH ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec- 1 retary shall establish a student loan cancellation program 2 to provide student loan cancellation assistance to research- 3 ers who focus on racial and ethnic disparities in health. 4 Students participating in the program shall make a min- 5 imum 5-year commitment to work at an accredited health 6 profession school. The Secretary shall promulgate addi- 7 tional regulations to define the scope and procedures for 8 the program under this subsection. 9 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 10 is authorized to be appropriated to carry out this section, 11 such sums as may be necessary for each of fiscal years 12 2012 through 2017. 13 ‘‘SEC. 3416. CAREER SUPPORT FOR NON-RESEARCH 14 HEALTH PROFESSIONALS. 15 ‘‘(a) IN GENERAL.—The Secretary, acting through 16 the Director of the Centers for Disease Control and Pre- 17 vention, the Administrator of the Substance Abuse and 18 Mental Health Services Administration, the Administrator 19 of the Health Resources and Services Administration, and 20 the Administrator of the Centers for Medicare and Med- 21 icaid Services shall establish a program to award grants 22 to eligible individuals for career support in non-research- 23 related health care. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00147 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 148 •HR 2954 IH ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 1 under subsection (a) an individual shall— 2 ‘‘(1) be a student in a health professions school, 3 a graduate of such a school who is working in a 4 health profession, or a faculty member of such a 5 school; and 6 ‘‘(2) submit to the Secretary an application at 7 such time, in such manner, and containing such in- 8 formation as the Secretary may require. 9 ‘‘(c) USE OF FUNDS.—An individual shall use 10 amounts received under a grant under this section to— 11 ‘‘(1) support the individual’s health activities or 12 projects that involve underserved communities, in- 13 cluding racial and ethnic minority communities; 14 ‘‘(2) support health-related career advancement 15 activities; 16 ‘‘(3) to pay, or as reimbursement for payments 17 of, student loans for individuals who are health pro- 18 fessionals and are focused on health issues affecting 19 underserved communities, including racial and eth- 20 nic minority communities; and 21 ‘‘(4) to establish and promote leadership train- 22 ing programs to decrease health disparities and to 23 increase cultural competence with the goal of in- 24 creasing diversity in leadership positions. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00148 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 149 •HR 2954 IH ‘‘(d) DEFINITION.—In this section, the term ‘career 1 in non-research-related health care’ means employment or 2 intended employment in the field of public health, health 3 policy, health management, health administration, medi- 4 cine, nursing, pharmacy, psychology, social work, psychi- 5 atry, other mental and behavioral health, allied health, 6 community health, social work, or other fields determined 7 appropriate by the Secretary, other than in a position that 8 involves research. 9 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 10 is authorized to be appropriated to carry out this section, 11 such sums as may be necessary for each of fiscal years 12 2012 through 2017. 13 ‘‘SEC. 3417. RESEARCH ON THE EFFECT OF WORKFORCE DI- 14 VERSITY ON QUALITY. 15 ‘‘(a) IN GENERAL.—The Director of the Agency for 16 Healthcare Research and Quality, in collaboration with 17 the Deputy Assistant Secretary for Minority Health and 18 the Director of the National Institute on Minority Health 19 and Health Disparities, shall award grants to eligible enti- 20 ties to expand research on the link between health work- 21 force diversity and quality health care. 22 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 23 under subsection (a) an entity shall— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00149 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 150 •HR 2954 IH ‘‘(1) be a clinical, public health, or health serv- 1 ices research entity or other entity determined ap- 2 propriate by the Director; and 3 ‘‘(2) submit to the Secretary an application at 4 such time, in such manner, and containing such in- 5 formation as the Secretary may require. 6 ‘‘(c) USE OF FUNDS.—Amounts received under a 7 grant awarded under subsection (a) shall be used to sup- 8 port research that investigates the effect of health work- 9 force diversity on— 10 ‘‘(1) language access; 11 ‘‘(2) cultural competence; 12 ‘‘(3) patient satisfaction; 13 ‘‘(4) timeliness of care; 14 ‘‘(5) safety of care; 15 ‘‘(6) effectiveness of care; 16 ‘‘(7) efficiency of care; 17 ‘‘(8) patient outcomes; 18 ‘‘(9) community engagement; 19 ‘‘(10) resource allocation; 20 ‘‘(11) organizational structure; 21 ‘‘(12) compliance of care; or 22 ‘‘(13) other topics determined appropriate by 23 the Director. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00150 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 151 •HR 2954 IH ‘‘(d) PRIORITY.—In awarding grants under sub- 1 section (a), the Director shall give individualized consider- 2 ation to all relevant aspects of the applicant’s background. 3 Consideration of prior research experience involving the 4 health of underserved communities shall be such a factor. 5 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 6 is authorized to be appropriated to carry out this section, 7 such sums as may be necessary for each of fiscal years 8 2012 through 2017. 9 ‘‘SEC. 3418. HEALTH DISPARITIES EDUCATION PROGRAM. 10 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 11 through the National Institute on Minority Health and 12 Health Disparities and in collaboration with the Office of 13 Minority Health, the Office for Civil Rights, the Centers 14 for Disease Control and Prevention, the Centers for Medi- 15 care & Medicaid Services, the Health Resources and Serv- 16 ices Administration, and other appropriate public and pri- 17 vate entities, shall establish and coordinate a health and 18 health care disparities education program to support, de- 19 velop, and implement educational initiatives and outreach 20 strategies that inform health care professionals and the 21 public about the existence of and methods to reduce racial 22 and ethnic disparities in health and health care. 23 ‘‘(b) ACTIVITIES.—The Secretary, through the edu- 24 cation program established under subsection (a) shall, 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00151 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 152 •HR 2954 IH through the use of public awareness and outreach cam- 1 paigns targeting the general public and the medical com- 2 munity at large— 3 ‘‘(1) disseminate scientific evidence for the ex- 4 istence and extent of racial and ethnic disparities in 5 health care, including disparities that are not other- 6 wise attributable to known factors such as access to 7 care, patient preferences, or appropriateness of 8 intervention, as described in the 2002 Institute of 9 Medicine Report entitled ‘Unequal Treatment: Con- 10 fronting Racial and Ethnic Disparities in Health 11 Care’, as well as the impact of disparities related to 12 age, disability status, socioeconomic status, sex, gen- 13 der identity, and sexual orientation on racial and 14 ethnic minorities; 15 ‘‘(2) disseminate new research findings to 16 health care providers and patients to assist them in 17 understanding, reducing, and eliminating health and 18 health care disparities; 19 ‘‘(3) disseminate information about the impact 20 of linguistic and cultural barriers on health care 21 quality and the obligation of health providers who 22 receive Federal financial assistance to ensure that 23 people with limited-English proficiency have access 24 to language access services; 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00152 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 153 •HR 2954 IH ‘‘(4) disseminate information about the impor- 1 tance and legality of racial, ethnic, disability status, 2 socioeconomic status, sex, gender identity, and sex- 3 ual orientation, and primary language data collec- 4 tion, analysis, and reporting; 5 ‘‘(5) design and implement specific educational 6 initiatives to health care providers relating to health 7 and health care disparities; and 8 ‘‘(6) assess the impact of the programs estab- 9 lished under this section in raising awareness of 10 health and health care disparities and providing in- 11 formation on available resources. 12 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 13 is authorized to be appropriated to carry out this section, 14 such sums as may be necessary for each of fiscal years 15 2012 through 2017.’’. 16 SEC. 302. HISPANIC-SERVING HEALTH PROFESSIONS 17 SCHOOLS. 18 Part B of title VII of the Public Health Service Act 19 (42 U.S.C. 293 et seq.) is amended by adding at the end 20 the following: 21 ‘‘SEC. 742. HISPANIC-SERVING HEALTH PROFESSIONS 22 SCHOOLS. 23 ‘‘(a) IN GENERAL.—The Secretary, acting through 24 the Administrator of the Health Resources and Services 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00153 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 154 •HR 2954 IH Administration, shall award grants to Hispanic-serving 1 health professions schools for the purpose of carrying out 2 programs to recruit Hispanic individuals to enroll in and 3 graduate from such schools, which may include providing 4 scholarships and other financial assistance as appropriate. 5 ‘‘(b) ELIGIBILITY.—In subsection (a), the term ‘His- 6 panic-serving health professions school’ means an entity 7 that— 8 ‘‘(1) is a school or program under section 9 799B; 10 ‘‘(2) has an enrollment of full-time equivalent 11 students that is made up of at least 9 percent His- 12 panic students; 13 ‘‘(3) has been effective in carrying out pro- 14 grams to recruit Hispanic individuals to enroll in 15 and graduate from the school; 16 ‘‘(4) has been effective in recruiting and retain- 17 ing Hispanic faculty members; 18 ‘‘(5) has a significant number of graduates who 19 are providing health services to medically under- 20 served populations or to individuals in health profes- 21 sional shortage areas; and 22 ‘‘(6) Regional Hispanic Centers of Excellence.’’. 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00154 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 155 •HR 2954 IH SEC. 303. LOAN REPAYMENT PROGRAM OF CENTERS FOR 1 DISEASE CONTROL AND PREVENTION. 2 Section 317F(c) of the Public Health Service Act (42 3 U.S.C. 247b–7(c)) is amended— 4 (1) by striking ‘‘and’’ after ‘‘1994,’’; and 5 (2) by inserting before the period the following: 6 ‘‘$750,000 for fiscal year 2012, and such sums as 7 may be necessary for each of the fiscal years 2013 8 through 2017.’’. 9 SEC. 304. COOPERATIVE AGREEMENTS FOR ONLINE DE- 10 GREE PROGRAMS AT SCHOOLS OF PUBLIC 11 HEALTH AND SCHOOLS OF ALLIED HEALTH. 12 Part B of title VII of the Public Health Service Act 13 (42 U.S.C. 293 et seq.), as amended by section 302, is 14 further amended by adding at the end the following: 15 ‘‘SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DE- 16 GREE PROGRAMS. 17 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 18 acting through the Administrator of the Health Resources 19 and Services Administration, in consultation with the Di- 20 rector of the Centers for Disease Control and Prevention, 21 the Director of the Agency for Healthcare Research and 22 Quality, and the Deputy Assistant Secretary for Minority 23 Health, shall award cooperative agreements to schools of 24 public health and schools of allied health to design and 25 implement online degree programs. 26 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00155 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 156 •HR 2954 IH ‘‘(b) PRIORITY.—In awarding cooperative agreements 1 under this section, the Secretary shall give priority to any 2 school of public health or school of allied health that has 3 an established track record of serving medically under- 4 served communities. 5 ‘‘(c) REQUIREMENTS.—Awardees must design and 6 implement an online degree program, that meet the fol- 7 lowing restrictions: 8 ‘‘(1) Enrollment of individuals who have ob- 9 tained a secondary school diploma or its recognized 10 equivalent. 11 ‘‘(2) Maintaining a significant enrollment of 12 underrepresented minority or disadvantaged stu- 13 dents. 14 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 15 are authorized to be appropriated to carry out this section, 16 such sums as may be necessary for each of fiscal years 17 2012 through 2017.’’. 18 SEC. 305. NATIONAL REPORT ON THE PREPAREDNESS OF 19 HEALTH PROFESSIONALS TO CARE FOR DI- 20 VERSE POPULATIONS. 21 The Secretary of Health and Human Services, in col- 22 laboration with the Bureau of Health Professions, the Of- 23 fice of Minority Health and the National Institute on Mi- 24 nority Health and Health Disparities, shall prepare and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00156 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 157 •HR 2954 IH disseminate a report that details and assesses the pre- 1 paredness of health professionals to care for racially and 2 ethnically diverse populations. Such information, which 3 shall be collected by the Bureau of Health Professions, 4 shall include— 5 (1) with respect to health professions education, 6 the number and percentage of hours of classroom 7 discussion relating to minority health issues, includ- 8 ing cultural competence; 9 (2) a description of the coursework involved in 10 such education; 11 (3) a description of the results of an evaluation 12 of the preparedness of students in such education; 13 (4) a description of the types of exposure that 14 students have during their education to minority pa- 15 tient populations; and 16 (5) a description of model programs and prac- 17 tices. 18 SEC. 306. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 19 Subtitle A of title XXXIV of the Public Health Serv- 20 ice Act, as amended by section 301, is further amended 21 by inserting after section 3418 the following: 22 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00157 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 158 •HR 2954 IH ‘‘SEC. 3419. DAVID SATCHER PUBLIC HEALTH AND HEALTH 1 SERVICES CORPS. 2 ‘‘(a) IN GENERAL.—The Administrator of the Health 3 Resources and Services Administration and the Director 4 of the Centers for Disease Control and Prevention, in col- 5 laboration with the Deputy Assistant Secretary for Minor- 6 ity Health, shall award grants to eligible entities to in- 7 crease awareness among postprimary and postsecondary 8 students of career opportunities in the health professions. 9 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 10 under subsection (a) an entity shall— 11 ‘‘(1) be a clinical, public health or health serv- 12 ices organization, community-based or nonprofit en- 13 tity, or other entity determined appropriate by the 14 Director of the Centers for Disease Control and Pre- 15 vention; 16 ‘‘(2) serve a health professional shortage area, 17 as determined by the Secretary; 18 ‘‘(3) work with students, including those from 19 racial and ethnic minority backgrounds, that have 20 expressed an interest in the health professions; and 21 ‘‘(4) submit to the Secretary an application at 22 such time, in such manner, and containing such in- 23 formation as the Secretary may require. 24 ‘‘(c) USE OF FUNDS.—Grant awards under sub- 25 section (a) shall be used to support internships that will 26 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00158 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 159 •HR 2954 IH increase awareness among students of non-research-based 1 and career opportunities in the following health profes- 2 sions: 3 ‘‘(1) Medicine. 4 ‘‘(2) Nursing. 5 ‘‘(3) Public Health. 6 ‘‘(4) Pharmacy. 7 ‘‘(5) Health administration and management. 8 ‘‘(6) Health policy. 9 ‘‘(7) Psychology. 10 ‘‘(8) Dentistry. 11 ‘‘(9) International health. 12 ‘‘(10) Social work. 13 ‘‘(11) Allied health. 14 ‘‘(12) Psychiatry. 15 ‘‘(13) Hospice care. 16 ‘‘(14) Other professions deemed appropriate by 17 the Director of the Centers for Disease Control and 18 Prevention. 19 ‘‘(d) PRIORITY.—In awarding grants under sub- 20 section (a), the Director of the Centers for Disease Con- 21 trol and Prevention shall give priority to those entities 22 that— 23 ‘‘(1) serve a high proportion of individuals from 24 disadvantaged backgrounds; 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00159 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 160 •HR 2954 IH ‘‘(2) have experience in health disparity elimi- 1 nation programs; 2 ‘‘(3) facilitate the entry of disadvantaged indi- 3 viduals into institutions of higher education; and 4 ‘‘(4) provide counseling or other services de- 5 signed to assist disadvantaged individuals in success- 6 fully completing their education at the postsecondary 7 level. 8 ‘‘(e) STIPENDS.—The Secretary may approve sti- 9 pends under this section for individuals for any period of 10 education in student-enhancement programs (other than 11 regular courses) at health professions schools, programs, 12 or entities, except that such a stipend may not be provided 13 to an individual for more than 6 months, and such a sti- 14 pend may not exceed $20 per day (notwithstanding any 15 other provision of law regarding the amount of stipends). 16 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 17 is authorized to be appropriated to carry out this section, 18 such sums as may be necessary for each of fiscal years 19 2012 through 2017. 20 ‘‘SEC. 3420. LOUIS STOKES PUBLIC HEALTH SCHOLARS 21 PROGRAM. 22 ‘‘(a) IN GENERAL.—The Director of the Centers for 23 Disease Control and Prevention, in collaboration with the 24 Deputy Assistant Secretary for Minority Health, shall 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00160 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 161 •HR 2954 IH award scholarships to postsecondary students who seek a 1 career in public health. 2 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol- 3 arship under subsection (a) an individual shall— 4 ‘‘(1) have experience in public health research 5 or public health practice, or other health professions 6 as determined appropriate by the Director of the 7 Centers for Disease Control and Prevention; 8 ‘‘(2) reside in a health professional shortage 9 area as determined by the Secretary; 10 ‘‘(3) have expressed an interest in public health; 11 ‘‘(4) demonstrate promise for becoming a leader 12 in public health; 13 ‘‘(5) secure admission to a 4-year institution of 14 higher education; 15 ‘‘(6) comply with subsection (f); and 16 ‘‘(7) submit to the Secretary an application at 17 such time, in such manner, and containing such in- 18 formation as the Secretary may require. 19 ‘‘(c) USE OF FUNDS.—Amounts received under an 20 award under subsection (a) shall be used to support oppor- 21 tunities for students to become public health professionals. 22 ‘‘(d) PRIORITY.—In awarding grants under sub- 23 section (a), the Director shall give priority to those stu- 24 dents that— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00161 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 162 •HR 2954 IH ‘‘(1) are from disadvantaged backgrounds; 1 ‘‘(2) have secured admissions to a minority- 2 serving institution; and 3 ‘‘(3) have identified a health professional as a 4 mentor at their school or institution and an aca- 5 demic advisor to assist in the completion of their 6 baccalaureate degree. 7 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 8 payment of scholarships under this section for such indi- 9 viduals for any period of education in student under- 10 graduate tenure, except that such a scholarship may not 11 be provided to an individual for more than 4 years, and 12 such scholarships may not exceed $10,000 per academic 13 year (notwithstanding any other provision of law regard- 14 ing the amount of scholarship). 15 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 16 is authorized to be appropriated to carry out this section, 17 such sums as may be necessary for each of fiscal years 18 2012 through 2017. 19 ‘‘SEC. 3420A. PATSY MINK HEALTH AND GENDER RESEARCH 20 FELLOWSHIP PROGRAM. 21 ‘‘(a) IN GENERAL.—The Director of the Centers for 22 Disease Control and Prevention, in collaboration with the 23 Deputy Assistant Secretary for Minority Health, the Ad- 24 ministrator of the Substance Abuse and Mental Health 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00162 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 163 •HR 2954 IH Services Administration, and the Director of the Indian 1 Health Services, shall award research fellowships to post- 2 baccalaureate students to conduct research that will exam- 3 ine gender and health disparities and to pursue a career 4 in the health professions. 5 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 6 ship under subsection (a) an individual shall— 7 ‘‘(1) have experience in health research or pub- 8 lic health practice; 9 ‘‘(2) reside in a health professional shortage 10 area as determined by the Secretary; 11 ‘‘(3) have expressed an interest in the health 12 professions; 13 ‘‘(4) demonstrate promise for becoming a leader 14 in the field of women’s health; 15 ‘‘(5) secure admission to a health professions 16 school or graduate program with an emphasis in 17 gender studies; 18 ‘‘(6) comply with subsection (f); and 19 ‘‘(7) submit to the Secretary an application at 20 such time, in such manner, and containing such in- 21 formation as the Secretary may require. 22 ‘‘(c) USE OF FUNDS.—Amounts received under an 23 award under subsection (a) shall be used to support oppor- 24 tunities for students to become researchers and advance 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00163 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 164 •HR 2954 IH the research base on the intersection between gender and 1 health. 2 ‘‘(d) PRIORITY.—In awarding grants under sub- 3 section (a), the Director of the Centers for Disease Con- 4 trol and Prevention shall give priority to those applicants 5 that— 6 ‘‘(1) are from disadvantaged backgrounds; and 7 ‘‘(2) have identified a mentor and academic ad- 8 visor who will assist in the completion of their grad- 9 uate or professional degree and have secured a re- 10 search assistant position with a researcher working 11 in the area of gender and health. 12 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 13 Disease Control and Prevention may approve fellowships 14 for individuals under this section for any period of edu- 15 cation in the student’s graduate or health profession ten- 16 ure, except that such a fellowship may not be provided 17 to an individual for more than 3 years, and such a fellow- 18 ship may not exceed $18,000 per academic year (notwith- 19 standing any other provision of law regarding the amount 20 of fellowship). 21 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 22 is authorized to be appropriated to carry out this section, 23 such sums as may be necessary for each of fiscal years 24 2012 through 2017. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00164 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 165 •HR 2954 IH ‘‘SEC. 3420B. PAUL DAVID WELLSTONE INTERNATIONAL 1 HEALTH FELLOWSHIP PROGRAM. 2 ‘‘(a) IN GENERAL.—The Director of the Agency for 3 Healthcare Research and Quality, in collaboration with 4 the Deputy Assistant Secretary for Minority Health, shall 5 award research fellowships to college students or recent 6 graduates to advance their understanding of international 7 health. 8 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 9 ship under subsection (a) an individual shall— 10 ‘‘(1) have educational experience in the field of 11 international health; 12 ‘‘(2) reside in a health professional shortage 13 area as determined by the Secretary; 14 ‘‘(3) demonstrate promise for becoming a leader 15 in the field of international health; 16 ‘‘(4) be a college senior or recent graduate of 17 a four-year higher education institution; 18 ‘‘(5) comply with subsection (f); and 19 ‘‘(6) submit to the Secretary an application at 20 such time, in such manner, and containing such in- 21 formation as the Secretary may require. 22 ‘‘(c) USE OF FUNDS.—Amounts received under an 23 award under subsection (a) shall be used to support oppor- 24 tunities for students to become health professionals and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00165 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 166 •HR 2954 IH to advance their knowledge about international issues re- 1 lating to health care access and quality. 2 ‘‘(d) PRIORITY.—In awarding grants under sub- 3 section (a), the Director shall give priority to those appli- 4 cants that— 5 ‘‘(1) are from a disadvantaged background; and 6 ‘‘(2) have identified a mentor at a health pro- 7 fessions school or institution, an academic advisor to 8 assist in the completion of their graduate or profes- 9 sional degree, and an advisor from an international 10 health non-governmental organization, private volun- 11 teer organization, or other international institution 12 or program that focuses on increasing health care 13 access and quality for residents in developing coun- 14 tries. 15 ‘‘(e) FELLOWSHIPS.—The Secretary shall approve 16 fellowships for college seniors or recent graduates, except 17 that such a fellowship may not be provided to an indi- 18 vidual for more than 6 months, may not be awarded to 19 a graduate that has not been enrolled in school for more 20 than 1 year, and may not exceed $4,000 per academic year 21 (notwithstanding any other provision of law regarding the 22 amount of fellowship). 23 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 24 is authorized to be appropriated to carry out this section, 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00166 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 167 •HR 2954 IH such sums as may be necessary for each of fiscal years 1 2012 through 2017. 2 ‘‘SEC. 3420C. EDWARD R. ROYBAL HEALTH CARE SCHOLAR 3 PROGRAM. 4 ‘‘(a) IN GENERAL.—The Director of the Agency for 5 Healthcare Research and Quality, the Director of the Cen- 6 ters for Medicaid & Medicare, and the Administrator for 7 Health Resources and Services Administration, in collabo- 8 ration with the Deputy Assistant Secretary for Minority 9 Health, shall award grants to eligible entities to expose 10 entering graduate students to the health professions. 11 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 12 under subsection (a) an entity shall— 13 ‘‘(1) be a clinical, public health or health serv- 14 ices organization, community-based or nonprofit en- 15 tity, or other entity determined appropriate by the 16 Director of the Agency for Healthcare Research and 17 Quality; 18 ‘‘(2) serve in a health professional shortage 19 area as determined by the Secretary; 20 ‘‘(3) work with students obtaining a degree in 21 the health professions; and 22 ‘‘(4) submit to the Secretary an application at 23 such time, in such manner, and containing such in- 24 formation as the Secretary may require. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00167 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 168 •HR 2954 IH ‘‘(c) USE OF FUNDS.—Amounts received under a 1 grant awarded under subsection (a) shall be used to sup- 2 port opportunities that expose students to non-research- 3 based health professions, including— 4 ‘‘(1) public health policy; 5 ‘‘(2) health care and pharmaceutical policy; 6 ‘‘(3) health care administration and manage- 7 ment; 8 ‘‘(4) health economics; and 9 ‘‘(5) other professions determined appropriate 10 by the Director of the Agency for Healthcare Re- 11 search and Quality. 12 ‘‘(d) PRIORITY.—In awarding grants under sub- 13 section (a), the Director of the Agency for Healthcare Re- 14 search and Quality shall give priority to those entities 15 that— 16 ‘‘(1) have experience with health disparity elimi- 17 nation programs; 18 ‘‘(2) facilitate training in the fields described in 19 subsection (c); and 20 ‘‘(3) provide counseling or other services de- 21 signed to assist such individuals in successfully com- 22 pleting their education at the postsecondary level. 23 ‘‘(e) STIPENDS.—The Secretary may approve the 24 payment of stipends for individuals under this section for 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00168 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 169 •HR 2954 IH any period of education in student-enhancement programs 1 (other than regular courses) at health professions schools 2 or entities, except that such a stipend may not be provided 3 to an individual for more than 2 months, and such a sti- 4 pend may not exceed $100 per day (notwithstanding any 5 other provision of law regarding the amount of stipends). 6 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 7 is authorized to be appropriated to carry out this section 8 such sums as may be necessary for each of fiscal years 9 2012 through 2017.’’. 10 SEC. 307. ADVISORY COMMITTEE ON HEALTH PROFES- 11 SIONS TRAINING FOR DIVERSITY. 12 (a) ESTABLISHMENT.—The Secretary of Health and 13 Human Services (referred to in this section as the ‘‘Sec- 14 retary’’) shall establish an advisory committee to be known 15 as the Advisory Committee on Health Professions Train- 16 ing for Diversity (in this section referred to as the ‘‘Advi- 17 sory Committee’’). 18 (b) COMPOSITION.— 19 (1) IN GENERAL.—The Secretary shall deter- 20 mine the appropriate number of individuals to serve 21 on the Advisory Committee. Such individuals shall 22 not be officers or employees of the Federal Govern- 23 ment. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00169 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 170 •HR 2954 IH (2) APPOINTMENT.—Not later than 60 days 1 after the date of enactment of this section, the Sec- 2 retary shall appoint the members of the Advisory 3 Committee from among individuals who are health 4 professionals. In making such appointments, the 5 Secretary shall ensure a fair balance between the 6 health professions, that at least 75 percent of the 7 members of the Advisory Committee are health pro- 8 fessionals, a broad geographic representation of 9 members and a balance between urban and rural 10 members. Members shall be appointed based on their 11 competence, interest, and knowledge of the mission 12 of the profession involved. 13 (3) MINORITY REPRESENTATION.—In appoint- 14 ing the members of the Advisory Committee under 15 paragraph (2), the Secretary shall ensure the ade- 16 quate representation of women and minorities. 17 (c) TERMS.— 18 (1) IN GENERAL.—A member of the Advisory 19 Committee shall be appointed for a term of 3 years, 20 except that of the members first appointed— 21 (A) 1⁄3 of such members shall serve for a 22 term of 1 year; 23 (B) 1⁄3 of such members shall serve for a 24 term of 2 years; and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00170 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 171 •HR 2954 IH (C) 1⁄3 of such members shall serve for a 1 term of 3 years. 2 (2) VACANCIES.— 3 (A) IN GENERAL.—A vacancy on the Advi- 4 sory Committee shall be filled in the manner in 5 which the original appointment was made and 6 shall be subject to any conditions which applied 7 with respect to the original appointment. 8 (B) FILLING UNEXPIRED TERM.—An indi- 9 vidual chosen to fill a vacancy shall be ap- 10 pointed for the unexpired term of the member 11 replaced. 12 (d) DUTIES.— 13 (1) IN GENERAL.—The Advisory Committee 14 shall— 15 (A) provide advice and recommendations to 16 the Secretary concerning policy and program 17 development and other matters of significance 18 concerning activities under this part; and 19 (B) not later than 2 years after the date 20 of enactment of this section, and annually 21 thereafter, prepare and submit to the Secretary, 22 and the Committee on Health, Education, 23 Labor, and Pensions of the Senate, and the 24 Committee on Energy and Commerce of the 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00171 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 172 •HR 2954 IH House of Representatives, a report describing 1 the activities of the Committee. 2 (2) CONSULTATION WITH STUDENTS.—In car- 3 rying out duties under paragraph (1), the Advisory 4 Committee shall consult with individuals who are at- 5 tending health professions schools with which this 6 part is concerned. 7 (e) MEETINGS AND DOCUMENTS.— 8 (1) MEETINGS.—The Advisory Committee shall 9 meet not less than 2 times each year. Such meetings 10 shall be held jointly with other related entities estab- 11 lished under this title where appropriate. 12 (2) DOCUMENTS.—Not later than 14 days prior 13 to the convening of a meeting under paragraph (1), 14 the Advisory Committee shall prepare and make 15 available an agenda of the matters to be considered 16 by the Advisory Committee at such meeting. At any 17 such meeting, the Advisory Committee shall dis- 18 tribute materials with respect to the issues to be ad- 19 dressed at the meeting. Not later than 30 days after 20 the adjourning of such a meeting, the Advisory Com- 21 mittee shall prepare and make available a summary 22 of the meeting and any actions taken by the Com- 23 mittee based upon the meeting. 24 (f) COMPENSATION AND EXPENSES.— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00172 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 173 •HR 2954 IH (1) COMPENSATION.—Each member of the Ad- 1 visory Committee shall be compensated at a rate 2 equal to the daily equivalent of the annual rate of 3 basic pay prescribed for level IV of the Executive 4 Schedule under section 5315 of title 5, United 5 States Code, for each day (including travel time) 6 during which such member is engaged in the per- 7 formance of the duties of the Committee. 8 (2) EXPENSES.—The members of the Advisory 9 Committee shall be allowed travel expenses, includ- 10 ing per diem in lieu of subsistence, at rates author- 11 ized for employees of agencies under subchapter I of 12 chapter 57 of title 5, United States Code, while 13 away from their homes or regular places of business 14 in the performance of services for the Committee. 15 (g) FACA.—The Federal Advisory Committee Act 16 shall apply to the Advisory Committee under this section 17 only to the extent that the provisions of such Act do not 18 conflict with the requirements of this section. 19 SEC. 308. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 20 PROGRAM. 21 Section 402E of the Higher Education Act of 1965 22 (20 U.S.C. 1070a–15) is amended by striking subsection 23 (g) and inserting the following: 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00173 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 174 •HR 2954 IH ‘‘(g) COLLABORATION IN HEALTH PROFESSION DI- 1 VERSITY TRAINING PROGRAMS.—The Secretary shall co- 2 ordinate with the Secretary of Health and Human Serv- 3 ices to ensure that there is collaboration between the goals 4 of the program under this section and programs of the 5 Health Resources and Services Administration that pro- 6 mote health workforce diversity. The Secretary of Edu- 7 cation shall take such measures as may be necessary to 8 encourage participants in programs under this section to 9 consider health profession careers. 10 ‘‘(h) FUNDING.—From amounts appropriated pursu- 11 ant to the authority of section 402A(g), the Secretary 12 shall, to the extent practicable, allocate funds for projects 13 authorized by this section in an amount which is not less 14 than $31,000,000 for each of the fiscal years 2012 15 through 2018.’’. 16 SEC. 309. RULES FOR DETERMINATION OF FULL-TIME 17 EQUIVALENT RESIDENTS FOR COST REPORT- 18 ING PERIODS. 19 (a) DGME DETERMINATIONS.—Section 1886(h)(4) 20 of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) 21 is amended— 22 (1) in subparagraph (E), by striking ‘‘Subject 23 to subparagraphs (J) and (K), such rules’’ and in- 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00174 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 175 •HR 2954 IH serting ‘‘Subject to subparagraphs (J), (K), and (L), 1 such rules’’; 2 (2) in subparagraph (J), by striking ‘‘Such 3 rules’’ and inserting ‘‘Subject to subparagraph (L), 4 such rules’’; 5 (3) in subparagraph (K), by striking ‘‘In deter- 6 mining’’ and inserting ‘‘Subject to subparagraph 7 (L), in determining’’; and 8 (4) by adding at the end the following new sub- 9 paragraph: 10 ‘‘(L) For purposes of cost-reporting peri- 11 ods beginning on or after October 1, 2011, in 12 determining the hospital’s number of full-time 13 equivalent residents for purposes of this sub- 14 paragraph, all the time spent by an intern or 15 resident in an approved medical residency train- 16 ing program shall be counted toward the deter- 17 mination of full-time equivalency if the hos- 18 pital— 19 ‘‘(i) is recognized as a subsection (d) 20 hospital; 21 ‘‘(ii) is recognized as a subsection (d) 22 Puerto Rico hospital; 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00175 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 176 •HR 2954 IH ‘‘(iii) is reimbursed under a reim- 1 bursement system authorized under section 2 1814(b)(3); or 3 ‘‘(iv) is a provider-based hospital out- 4 patient department.’’. 5 (b) IME DETERMINATIONS.—Section 1886(d)(5)(B) 6 of such Act (42 U.S.C. 1395ww(d)(5)(B)) is amended— 7 (1) in clause (x)(II), by striking ‘‘In deter- 8 mining’’ and inserting ‘‘Subject to subclause (x)(IV), 9 in determining’’; 10 (2) in clause (x)(III), by striking ‘‘In deter- 11 mining’’ and inserting ‘‘Subject to subclause (x)(IV), 12 in determining’’; and 13 (3) by adding at the end the following new sub- 14 clause: 15 ‘‘(IV) The provisions of subpara- 16 graph (L) of subsection (h)(4) shall 17 apply under this subparagraph in the 18 same manner as they apply under 19 such subsection.’’. 20 SEC. 310. DEVELOPING AND IMPLEMENTING STRATEGIES 21 FOR LOCAL HEALTH EQUITY. 22 (a) GRANTS.—The Secretaries of Health and Human 23 Services, Education, and Labor, acting jointly, shall make 24 grants to academic institutions for the purposes of— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00176 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 177 •HR 2954 IH (1) in accordance with subsection (b), devel- 1 oping capacity— 2 (A) to build an evidence base for successful 3 strategies for increasing local health equity; and 4 (B) to serve as national models of driving 5 local health equity; 6 (2) in accordance with subsection (c), devel- 7 oping a strategic partnership with the community in 8 which the academic institution is located; and 9 (3) collecting data on, and periodically evalu- 10 ating, the effectiveness of the institution’s programs 11 funded through this section to enable the institution 12 to adapt accordingly for maximum efficiency and 13 success. 14 (b) DEVELOPING CAPACITY FOR INCREASING LOCAL 15 HEALTH EQUITY.—As a condition on receipt of a grant 16 under subsection (a), an academic institution shall agree 17 to use the grant to build an evidence base for successful 18 strategies for increasing local health equity, and to serve 19 as a national model of driving local health equity, by sup- 20 porting— 21 (1) resources to strengthen institutional metrics 22 and capacity to execute institutionwide health work- 23 force goals that can serve as models for increasing 24 health equity in communities across the country ; 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00177 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 178 •HR 2954 IH (2) collaborations among a cohort of institu- 1 tions in implementing systemic change, partnership 2 development, and programmatic efforts supportive of 3 health equity goals across disciplines and popu- 4 lations; and 5 (3) enhanced or newly developed data systems 6 and research infrastructure capable of informing 7 current and future workforce efforts and building a 8 foundation for a broader research agenda targeting 9 urban health disparities. 10 (c) STRATEGIC PARTNERSHIPS.—As a condition on 11 receipt of a grant under subsection (a), an academic insti- 12 tution shall agree to use the grant to develop a strategic 13 partnership with the community in which the institution 14 is located for the purposes of— 15 (1) strengthening connections between the insti- 16 tution and the community— 17 (A) to improve evaluation of and address 18 the community’s health and health workforce 19 needs; and 20 (B) to engage the community in health 21 workforce development; 22 (2) developing, enhancing, or accelerating inno- 23 vative undergraduate and graduate programs in the 24 biomedical sciences and health professions; and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00178 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 179 •HR 2954 IH (3) strengthening the ‘‘birth to career’’ pipeline 1 in the biomedical sciences and health professions, in- 2 cluding by developing partnerships between institu- 3 tions of higher education and elementary and sec- 4 ondary schools to recruit the next generation of 5 health professionals earlier in the pipeline to a 6 health care career. 7 SEC. 311. LOAN FORGIVENESS FOR MENTAL AND BEHAV- 8 IORAL HEALTH SOCIAL WORKERS. 9 Section 455 of the Higher Education Act of 1965 (20 10 U.S.C. 1087e) is amended by adding at the end the fol- 11 lowing new subsection: 12 ‘‘(q) REPAYMENT PLAN FOR MENTAL AND BEHAV- 13 IORAL HEALTH SOCIAL WORKERS.— 14 ‘‘(1) IN GENERAL.—The Secretary shall cancel 15 the balance of interest and principal due on any eli- 16 gible Federal Direct Loan not in default for a bor- 17 rower who— 18 ‘‘(A) has made 120 monthly payments on 19 the eligible Federal Direct Loan after October 20 1, 2012, pursuant to any one or a combination 21 of the following— 22 ‘‘(i) payments under an income-based 23 repayment plan under section 493C; 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00179 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 180 •HR 2954 IH ‘‘(ii) payments under a standard re- 1 payment plan under subsection (d)(1)(A), 2 based on a 10-year repayment period; 3 ‘‘(iii) monthly payments under a re- 4 payment plan under subsection (d)(1) or 5 (g) of not less than the monthly amount 6 calculated under subsection (d)(1)(A), 7 based on a 10-year repayment period; or 8 ‘‘(iv) payments under an income con- 9 tingent repayment plan under subsection 10 (d)(1)(D); and 11 ‘‘(B)(i) is employed as a mental health or 12 behavioral health social worker, as defined by 13 the Secretary by regulation, at the time of such 14 forgiveness; and 15 ‘‘(ii) has been employed as such a mental 16 health or behavioral health social worker during 17 the period in which the borrower makes each of 18 the 120 payments as described in subparagraph 19 (A). 20 ‘‘(2) LOAN CANCELLATION AMOUNT.—After the 21 conclusion of the employment period described in 22 paragraph (1), the Secretary shall cancel the obliga- 23 tion to repay the balance of principal and interest 24 due as of the time of such cancellation, on the eligi- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00180 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 181 •HR 2954 IH ble Federal Direct Loans made to the borrower 1 under this part. 2 ‘‘(3) DEFINITION OF ELIGIBLE FEDERAL DI- 3 RECT LOAN.—In this subsection, the term ‘eligible 4 Federal Direct Loan’ means a Federal Direct Staf- 5 ford Loan, Federal Direct PLUS Loan, Federal Di- 6 rect Unsubsidized Stafford Loan, or a Federal Di- 7 rect Consolidation Loan.’’. 8 TITLE IV—IMPROVEMENT OF 9 HEALTH CARE SERVICES 10 Subtitle A—Health Empowerment 11 Zones 12 SEC. 401. SHORT TITLE. 13 This subtitle may be cited as the ‘‘Health Empower- 14 ment Zone Act of 2011’’. 15 SEC. 402. FINDINGS. 16 The Congress finds the following: 17 (1) Numerous studies and reports, including 18 the National Healthcare Disparities Report and Un- 19 equal Treatment, the 2002 Institute of Medicine Re- 20 port, document the extensiveness to which health 21 disparities exist across the country. 22 (2) These studies have found that, on average, 23 racial and ethnic minorities are disproportionately 24 afflicted with chronic and acute conditions—such as 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00181 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 182 •HR 2954 IH cancer, diabetes, and hypertension—and suffer 1 worse health outcomes, worse health status, and 2 higher mortality rates than their White counter- 3 parts. 4 (3) Several recent studies also show that health 5 disparities are a function of not only access to health 6 care, but also the social determinants of health—in- 7 cluding the environment, the physical structure of 8 communities, nutrition and food options, educational 9 attainment, employment, race, ethnicity, geography, 10 and language preference—that directly and indi- 11 rectly affect the health, health care, and wellness of 12 individuals and communities. 13 (4) Integrally involving and fully supporting the 14 communities most affected by health inequities in 15 the assessment, planning, launch, and evaluation of 16 health disparity elimination efforts is among the 17 leading recommendations made to adequately ad- 18 dress and ultimately reduce health disparities. 19 (5) Recommendations also include supporting 20 the efforts of community stakeholders from a broad 21 crosssection—including, but not limited to local 22 businesses, local departments of commerce, edu- 23 cation, labor, urban planning, and transportation, 24 and community-based and other nonprofit organiza- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00182 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 183 •HR 2954 IH tions—to find areas of common ground around 1 health disparity elimination and collaborate to im- 2 prove the overall health and wellness of a community 3 and its residents. 4 SEC. 403. DESIGNATION OF HEALTH EMPOWERMENT 5 ZONES. 6 (a) IN GENERAL.—At the request of an eligible com- 7 munity partnership, the Secretary may designate an eligi- 8 ble area as a health empowerment zone. 9 (b) ELIGIBILITY CRITERIA.— 10 (1) ELIGIBLE COMMUNITY PARTNERSHIP.—A 11 community partnership is eligible to submit a re- 12 quest under this section if the partnership— 13 (A) demonstrates widespread public sup- 14 port from key individuals and entities in the eli- 15 gible area, including State and local govern- 16 ments, nonprofit organizations, and community 17 and industry leaders, for designation of the eli- 18 gible area as a health empowerment zone; and 19 (B) includes representatives of— 20 (i) a broad cross section of stake- 21 holders and residents from communities in 22 the eligible area experiencing dispropor- 23 tionate disparities in health status and 24 health care; and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00183 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 184 •HR 2954 IH (ii) organizations, facilities, and insti- 1 tutions that have a history of working 2 within and serving such communities. 3 (2) ELIGIBLE AREA.—An area is eligible to be 4 designated as a health empowerment zone under this 5 section if one or more communities in the area expe- 6 rience disproportionate disparities in health status 7 and health care. In determining whether a commu- 8 nity experiences such disparities, the Secretary shall 9 consider the data collected by the Department of 10 Health and Human Services focusing on the fol- 11 lowing areas: 12 (A) Access to affordable high-quality 13 health services. 14 (B) Arthritis, osteoporosis, and chronic 15 back conditions. 16 (C) Cancer. 17 (D) Chronic kidney disease. 18 (E) Diabetes. 19 (F) Injury and violence prevention. 20 (G) Maternal, infant, and child health. 21 (H) Medical product safety. 22 (I) Mental health and mental disorders. 23 (J) Nutrition and overweight. 24 (K) Disability and secondary conditions. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00184 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 185 •HR 2954 IH (L) Educational and community-based 1 health programs. 2 (M) Environmental health. 3 (N) Family planning. 4 (O) Food safety. 5 (P) Health communication. 6 (Q) Health disease and stroke. 7 (R) HIV/AIDS. 8 (S) Immunization and infectious diseases. 9 (T) Occupational safety and health. 10 (U) Oral health. 11 (V) Physical activity and fitness. 12 (W) Public health infrastructure. 13 (X) Respiratory diseases. 14 (Y) Sexually transmitted diseases. 15 (Z) Substance abuse. 16 (AA) Tobacco use. 17 (BB) Vision and hearing. 18 (CC) The degree to which those who have 19 disabilities have access to health services, in- 20 cluding physical activity and fitness, including 21 the ability to physically access the locations 22 where such services are provided. 23 (c) PROCEDURE.— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00185 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 186 •HR 2954 IH (1) REQUEST.—A request under subsection (a) 1 shall— 2 (A) describe the bounds of the area to be 3 designated as a health empowerment zone and 4 the process used to select those bounds; 5 (B) demonstrate that the partnership sub- 6 mitting the request is an eligible community 7 partnership described in subsection (b)(1); 8 (C) demonstrate that the area is an eligible 9 area described in subsection (b)(2); 10 (D) include a comprehensive assessment of 11 disparities in health status and health care ex- 12 perience by one or more communities in the 13 area; 14 (E) set forth— 15 (i) a vision and a set of values for the 16 area; and 17 (ii) a comprehensive and holistic set of 18 goals to be achieved in the area through 19 designation as a health empowerment zone; 20 and 21 (F) include a strategic plan for achieving 22 the goals described in subparagraph (E)(ii). 23 (2) APPROVAL.—Not later than 60 days after 24 the receipt of a request for designation of an area 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00186 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 187 •HR 2954 IH as a health empowerment zone under this section, 1 the Secretary shall approve or disapprove the re- 2 quest. 3 (d) MINIMUM NUMBER.—The Secretary— 4 (1) shall designate not more than 110 health 5 empowerment zones under this section; and 6 (2) shall designate at least one health empower- 7 ment zone in each of the several States, the District 8 of Columbia, and each territory or possession of the 9 United States. 10 SEC. 404. ASSISTANCE TO THOSE SEEKING DESIGNATION. 11 At the request of any organization or entity seeking 12 to submit a request under section 403(a), the Secretary 13 shall provide technical assistance, and may award a grant, 14 to assist such organization or entity— 15 (1) to form an eligible community partnership 16 described in section 403(b)(1); 17 (2) to complete a health assessment, including 18 an assessment of health disparities under section 19 403(c)(1)(D); or 20 (3) to prepare and submit a request, including 21 a strategic plan, in accordance with section 403. 22 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00187 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 188 •HR 2954 IH SEC. 405. BENEFITS OF DESIGNATION. 1 (a) PRIORITY.—In awarding any competitive grant, 2 a Federal official shall give priority to any applicant 3 that— 4 (1) meets the eligibility criteria for the grant; 5 (2) proposes to use the grant for activities in a 6 health empowerment zone; and 7 (3) demonstrates that such activities will di- 8 rectly and significantly further the goals of the stra- 9 tegic plan approved for such zone under section 403. 10 (b) GRANTS FOR INITIAL IMPLEMENTATION OF 11 STRATEGIC PLAN.— 12 (1) IN GENERAL.—Upon designating an eligible 13 area as a health empowerment zone at the request 14 of an eligible community partnership, the Secretary 15 shall, subject to the availability of appropriations, 16 make a grant to the community partnership for im- 17 plementation of the strategic plan for such zone. 18 (2) GRANT PERIOD.—A grant under paragraph 19 (1) for a health empowerment zone shall be for a pe- 20 riod of 2 years and may be renewed, except that the 21 total period of grants under paragraph (1) for such 22 zone may not exceed 10 years. 23 (3) LIMITATION.—In awarding grants under 24 this subsection, the Secretary shall not give less pri- 25 ority to an applicant or reduce the amount of a 26 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00188 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 189 •HR 2954 IH grant because the Secretary rendered technical as- 1 sistance or made a grant to the same applicant 2 under section 404. 3 (4) REPORTING.—The Secretary shall require 4 each recipient of a grant under this subsection to re- 5 port to the Secretary not less than every 6 months 6 on the progress in implementing the strategic plan 7 for the health empowerment zone. 8 SEC. 406. DEFINITION. 9 In this subtitle, the term ‘‘Secretary’’ means the Sec- 10 retary of Health and Human Services, acting through the 11 Administrator of the Health Resources and Services Ad- 12 ministration and the Deputy Assistant Secretary for Mi- 13 nority Health, and in cooperation with the Director of the 14 Office of Community Services and the Director of the Na- 15 tional Institute for Minority Health and Health Dispari- 16 ties. 17 SEC. 407. AUTHORIZATION OF APPROPRIATIONS. 18 To carry out this subtitle, there is authorized to be 19 appropriated $100,000,000 for fiscal year 2012. 20 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00189 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 190 •HR 2954 IH Subtitle B—Other Improvements of 1 Health Care Services 2 CHAPTER 1—EXPANSION OF COVERAGE 3 SEC. 411. AMENDMENT TO THE PUBLIC HEALTH SERVICE 4 ACT. 5 Title XXXIV of the Public Health Service Act, as 6 amended by titles I, II, III, and IX of this Act, is further 7 amended by inserting after subtitle C the following: 8 ‘‘Subtitle D—Reconstruction and 9 Improvement Grants for Public 10 Health Care Facilities Serving 11 Pacific Islanders and the Insu- 12 lar Areas 13 ‘‘SEC. 3451. GRANT SUPPORT FOR QUALITY IMPROVEMENT 14 INITIATIVES. 15 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 16 with the Administrator of the Health Resources and Serv- 17 ices Administration, the Director of the Agency for 18 Healthcare Research and Quality, and the Administrator 19 of the Centers for Medicare & Medicaid Services, shall 20 award grants to eligible entities for the conduct of dem- 21 onstration projects to improve the quality of and access 22 to health care. 23 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 24 under subsection (a), an entity shall— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00190 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 191 •HR 2954 IH ‘‘(1) be a health center, hospital, health plan, 1 health system, community clinic. or other health en- 2 tity determined appropriate by the Secretary— 3 ‘‘(A) that, by legal mandate or explicitly 4 adopted mission, provides patients with access 5 to services regardless of their ability to pay; 6 ‘‘(B) that provides care or treatment for a 7 substantial number of patients who are unin- 8 sured, are receiving assistance under a State 9 program under title XIX of the Social Security 10 Act, or are members of vulnerable populations, 11 as determined by the Secretary; and 12 ‘‘(C)(i) with respect to which, not less than 13 50 percent of the entity’s patient population is 14 made up of racial and ethnic minorities; or 15 ‘‘(ii) that— 16 ‘‘(I) serves a disproportionate percent- 17 age of local, minority racial and ethnic pa- 18 tients, or that has a patient population, at 19 least 50 percent of which is limited-English 20 proficient; and 21 ‘‘(II) provides an assurance that 22 amounts received under the grant will be 23 used only to support quality improvement 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00191 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 192 •HR 2954 IH activities in the racial and ethnic popu- 1 lation served; and 2 ‘‘(2) prepare and submit to the Secretary an 3 application at such time, in such manner, and con- 4 taining such information as the Secretary may re- 5 quire. 6 ‘‘(c) PRIORITY.—In awarding grants under sub- 7 section (a), the Secretary shall give priority to applicants 8 under subsection (b)(2) that— 9 ‘‘(1) demonstrate an intent to operate as part 10 of a health care partnership, network, collaborative, 11 coalition, or alliance where each member entity con- 12 tributes to the design, implementation, and evalua- 13 tion of the proposed intervention; or 14 ‘‘(2) intend to use funds to carry out system- 15 wide changes with respect to health care quality im- 16 provement, including— 17 ‘‘(A) improved systems for data collection 18 and reporting; 19 ‘‘(B) innovative collaborative or similar 20 processes; 21 ‘‘(C) group programs with behavioral or 22 self-management interventions; 23 ‘‘(D) case management services; 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00192 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 193 •HR 2954 IH ‘‘(E) physician or patient reminder sys- 1 tems; 2 ‘‘(F) educational interventions; or 3 ‘‘(G) other activities determined appro- 4 priate by the Secretary. 5 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 6 received under a grant under subsection (a) to support 7 the implementation and evaluation of health care quality 8 improvement activities or minority health and health care 9 disparity reduction activities that include— 10 ‘‘(1) with respect to health care systems, activi- 11 ties relating to improving— 12 ‘‘(A) patient safety; 13 ‘‘(B) timeliness of care; 14 ‘‘(C) effectiveness of care; 15 ‘‘(D) efficiency of care; 16 ‘‘(E) patient centeredness; and 17 ‘‘(F) health information technology; and 18 ‘‘(2) with respect to patients, activities relating 19 to— 20 ‘‘(A) staying healthy; 21 ‘‘(B) getting well; 22 ‘‘(C) living with illness or disability; and 23 ‘‘(D) coping with end-of-life issues. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00193 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 194 •HR 2954 IH ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 1 provide financial and other technical assistance to grant- 2 ees under this section for the development of common data 3 systems. 4 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 5 are authorized to be appropriated to carry out this section, 6 such sums as may be necessary for each of fiscal years 7 2010 through 2015. 8 ‘‘SEC. 3452. CENTERS OF EXCELLENCE. 9 ‘‘(a) IN GENERAL.—The Secretary, acting through 10 the Administrator of the Health Resources and Services 11 Administration, shall designate centers of excellence at 12 public hospitals, and other health systems serving large 13 numbers of minority patients, that— 14 ‘‘(1) meet the requirements of section 15 3451(b)(1); 16 ‘‘(2) demonstrate excellence in providing care to 17 minority populations; and 18 ‘‘(3) demonstrate excellence in reducing dispari- 19 ties in health and health care. 20 ‘‘(b) REQUIREMENTS.—A hospital or health system 21 that serves as a Center of Excellence under subsection (a) 22 shall— 23 ‘‘(1) design, implement, and evaluate programs 24 and policies relating to the delivery of care in ra- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00194 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 195 •HR 2954 IH cially, ethnically, and linguistically diverse popu- 1 lations; 2 ‘‘(2) provide training and technical assistance 3 to other hospitals and health systems relating to the 4 provision of quality health care to minority popu- 5 lations; and 6 ‘‘(3) develop activities for graduate or con- 7 tinuing medical education that institutionalize a 8 focus on cultural competence training for health care 9 providers. 10 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 11 are authorized to be appropriated to carry out this section, 12 such sums as may be necessary for each of fiscal years 13 2010 through 2015. 14 ‘‘SEC. 3453. RECONSTRUCTION AND IMPROVEMENT GRANTS 15 FOR PUBLIC HEALTH CARE FACILITIES SERV- 16 ING PACIFIC ISLANDERS AND THE INSULAR 17 AREAS. 18 ‘‘(a) IN GENERAL.—The Secretary shall provide di- 19 rect financial assistance to designated health care pro- 20 viders and community health centers in American Samoa, 21 Guam, the Commonwealth of the Northern Mariana Is- 22 lands, the United States Virgin Islands, Puerto Rico, and 23 Hawaii for the purposes of reconstructing and improving 24 health care facilities and services. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00195 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 196 •HR 2954 IH ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi- 1 nancial assistance under subsection (a), an entity shall be 2 a public health facility or community health center located 3 in American Samoa, Guam, the Commonwealth of the 4 Northern Mariana Islands, the United States Virgin Is- 5 lands, Puerto Rico, or Hawaii that— 6 ‘‘(1) is owned or operated by— 7 ‘‘(A) the Government of American Samoa, 8 Guam, the Commonwealth of the Northern 9 Mariana Islands, the United States Virgin Is- 10 lands, Puerto Rico, or Hawaii or a unit of local 11 government; or 12 ‘‘(B) a nonprofit organization; and 13 ‘‘(2)(A) provides care or treatment for a sub- 14 stantial number of patients who are uninsured, re- 15 ceiving assistance under a State program under a 16 title XVIII of the Social Security Act, or a State 17 program under title XIX of such Act, or who are 18 members of a vulnerable population, as determined 19 by the Secretary; or 20 ‘‘(B) serves a disproportionate percentage of 21 local, minority racial and ethnic patients. 22 ‘‘(c) REPORT.—Not later than 180 days after the 23 date of enactment of this title and annually thereafter, the 24 Secretary shall submit to the Congress and the President 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00196 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 197 •HR 2954 IH a report that includes an assessment of health resources 1 and facilities serving populations in American Samoa, 2 Guam, the Commonwealth of the Northern Mariana Is- 3 lands, the United States Virgin Islands, Puerto Rico, and 4 Hawaii. In preparing such report, the Secretary shall— 5 ‘‘(1) consult with and obtain information on all 6 health care facilities needs from the entities de- 7 scribed in subsection (b); 8 ‘‘(2) include all amounts of Federal assistance 9 received by each entity in the preceding fiscal year; 10 ‘‘(3) review the total unmet needs of each juris- 11 diction for health care facilities, including needs for 12 renovation and expansion of existing facilities; and 13 ‘‘(4) include a strategic plan for addressing the 14 needs of each jurisdiction identified in the report. 15 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 16 are authorized to be appropriated such sums as necessary 17 to carry out this section.’’. 18 SEC. 412. REMOVING BARRIERS TO UNSUBSIDIZED PUR- 19 CHASE OF PRIVATE INSURANCE IN AMER- 20 ICAN HEALTH BENEFIT EXCHANGES. 21 (a) IN GENERAL.—Section 1312(f) of the Patient 22 Protection and Affordable Care Act (42 U.S.C.18032(f)) 23 is amended— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00197 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 198 •HR 2954 IH (1) in the subsection heading, by striking the 1 semicolon and all that follows through ‘‘RESI- 2 DENTS’’; and 3 (2) by striking paragraph (3). 4 (b) CONFORMING AMENDMENT.—Section 1411(a)(1) 5 of such Act (42 U.S.C. 18081(a)(1)) is amended by strik- 6 ing ‘‘1312(f)(3),’’. 7 SEC. 413. STUDY ON THE UNINSURED. 8 (a) IN GENERAL.—The Secretary of Health and 9 Human Services shall— 10 (1) conduct a study on the demographic charac- 11 teristics of the population of individuals who do not 12 have health insurance coverage; and 13 (2) predict, based on such study, the demo- 14 graphic characteristics of the population of individ- 15 uals who will not have health insurance coverage 16 after January 1, 2014. 17 (b) REPORTING REQUIREMENTS.— 18 (1) IN GENERAL.—Not later than 12 months 19 after the date of the enactment of this Act, the Sec- 20 retary shall submit to the Congress the results of 21 the study under subsection (a)(1) and the prediction 22 made under subsection (a)(2). 23 (2) REPORTING OF DEMOGRAPHIC CHARACTER- 24 ISTICS.—The Secretary shall report the demographic 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00198 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 199 •HR 2954 IH characteristics under paragraphs (1) and (2) of sub- 1 section (a) on the basis of racial and ethnic group, 2 and shall stratify the reporting on each racial and 3 ethnic group by other demographic characteristics 4 that can impact access to health insurance coverage, 5 such as sexual orientation, gender identity, primary 6 language, disability status, sex, socioeconomic sta- 7 tus, and citizenship and immigration status, in a 8 manner consistent with title I of this Act. 9 SEC. 414. MEDICAID PAYMENT PARITY FOR THE TERRI- 10 TORIES. 11 (a) ELIMINATION OF FUNDING LIMITATIONS FOR 12 PUERTO RICO, THE UNITED STATES VIRGIN ISLANDS, 13 GUAM, THE COMMONWEALTH OF THE NORTHERN MAR- 14 IANA ISLANDS, AND AMERICAN SAMOA.— 15 (1) IN GENERAL.—Section 1108 of the Social 16 Security Act (42 U.S.C. 1308) is amended— 17 (A) in subsection (f), in the matter before 18 paragraph (1), by striking ‘‘subsection (g)’’ and 19 inserting ‘‘subsections (g) and (h)’’; 20 (B) in subsection (g)(2), in the matter be- 21 fore subparagraph (A), by inserting ‘‘and sub- 22 section (h)’’ after ‘‘paragraphs (3) and (5)’’; 23 and 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00199 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 200 •HR 2954 IH (C) by adding at the end the following new 1 subsection: 2 ‘‘(h) SUNSET OF FUNDING LIMITATIONS FOR PUER- 3 TO RICO, THE UNITED STATES VIRGIN ISLANDS, GUAM, 4 THE COMMONWEALTH OF THE NORTHERN MARIANA IS- 5 LANDS, AND AMERICAN SAMOA.—Subsections (f) and (g) 6 shall not apply to Puerto Rico, the United States Virgin 7 Islands, Guam, the Commonwealth of the Northern Mar- 8 iana Islands, and American Samoa for any fiscal year 9 after fiscal year 2011.’’. 10 (2) CONFORMING AMENDMENT.—Section 11 1903(u) of such Act (42 U.S.C. 1396c(u)) is amend- 12 ed by striking paragraph (4). 13 (3) EFFECTIVE DATE.—The amendments made 14 by this subsection shall apply beginning with fiscal 15 year 2012. 16 (b) PARITY IN FMAP.— 17 (1) IN GENERAL.—Section 1905(b)(2) of such 18 Act (42 U.S.C. 1396d(b)(2)) is amended by insert- 19 ing after ‘‘50 per centum’’ the following: ‘‘(except 20 that, beginning with fiscal year 2014, the Federal 21 medical assistance percentage for Puerto Rico, the 22 United States Virgin Islands, Guam, the Common- 23 wealth of the Northern Mariana Islands, and Amer- 24 ican Samoa shall be the Federal medical assistance 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00200 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 201 •HR 2954 IH percentage determined by the Secretary in consulta- 1 tion (for the United States Virgin Islands, Guam, 2 the Commonwealth of the Northern Mariana Is- 3 lands, and American Samoa) with the Secretary of 4 the Interior)’’. 5 (2) 2-FISCAL-YEAR TRANSITION.—Notwith- 6 standing any other provision of law, during fiscal 7 years 2012 and 2013, the Federal medical assist- 8 ance percentage established under section 1905(b) of 9 the Social Security Act (42 U.S.C. 1396d(b)) for 10 Puerto Rico, the United States Virgin Islands, 11 Guam, the Commonwealth of the Northern Mariana 12 Islands, and American Samoa shall be the highest 13 such Federal medical assistance percentage applica- 14 ble to any of the 50 States or the District of Colum- 15 bia for the fiscal year involved, taking into account 16 the application of subsections (a) and (b)(1) of 5001 17 of division B of the American Recovery and Rein- 18 vestment Act of 2009 (Public Law 111–5) to such 19 States and District of Columbia for calendar quar- 20 ters during such fiscal years for which such sub- 21 sections apply respectively. 22 (3) PER CAPITA INCOME DATA.— 23 (A) REPORT TO CONGRESS.—Not later 24 than October 1, 2012, the Secretary of Health 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00201 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 202 •HR 2954 IH and Human Services shall submit to Congress 1 a report that describes the per capita income 2 data used to promulgate the Federal medical 3 assistance percentage in the territories and how 4 such data differ from the per capita income 5 data used to promulgate Federal medical assist- 6 ance percentages for the 50 States and the Dis- 7 trict of Columbia. The report should include 8 recommendations on how the Federal medical 9 assistance percentages can be calculated for the 10 territories to ensure parity with the 50 States 11 and the District of Columbia. 12 (B) APPLICATION.—Section 1101(a)(8)(B) 13 of the Social Security Act (42 U.S.C. 14 1308(a)(8)(B)) is amended— 15 (i) by striking ‘‘(other than Puerto 16 Rico, the United States Virgin Islands, and 17 Guam)’’ and inserting ‘‘(including Puerto 18 Rico, the United States Virgin Islands, 19 Guam, the Commonwealth of the Northern 20 Mariana Islands, and American Samoa)’’; 21 and 22 (ii) by inserting ‘‘(or, if such satisfac- 23 tory data are not available in the case of 24 the Virgin Islands, Guam, the Northern 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00202 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 203 •HR 2954 IH Mariana Islands, or American Samoa, sat- 1 isfactory data available from the Depart- 2 ment of the Interior for the same period, 3 or if such satisfactory data are not avail- 4 able in the case of Puerto Rico, satisfac- 5 tory data available from the government of 6 the Commonwealth of Puerto Rico for the 7 same period)’’ after ‘‘Department of Com- 8 merce’’. 9 (4) RELATION TO AMERICAN RECOVERY AND 10 REINVESTMENT ACT OF 2009.—For any period and 11 territory in which the provisions of this subsection 12 apply to a territory, the provisions of section 13 5001(b)(2) of division B of the American Recovery 14 and Reinvestment Act of 2009 (Public Law 111–5) 15 shall not apply (except as otherwise specifically pro- 16 vided in paragraph (2)). 17 SEC. 415. CLARIFICATION OF MEDICAID COVERAGE FOR 18 CITIZENS OF FREELY ASSOCIATED STATES. 19 (a) IN GENERAL.—Section 402(b)(2) of the Personal 20 Responsibility and Work Opportunity Reconciliation Act 21 of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at 22 the end the following: 23 ‘‘(G) MEDICAID EXCEPTION FOR CITIZENS 24 OF FREELY ASSOCIATED STATES.—With respect 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00203 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 204 •HR 2954 IH to eligibility for benefits for the program de- 1 fined in paragraph (3)(C) (relating to the Med- 2 icaid program), paragraph (1) shall not apply 3 to any individual who lawfully resides in the 4 United States (including territories and posses- 5 sions of the United States) in accordance with 6 the Compacts of Free Association between the 7 Government of the United States and the Gov- 8 ernments of the Federated States of Micro- 9 nesia, the Republic of the Marshall Islands, and 10 the Republic of Palau.’’. 11 (b) CONFORMING DEFINITION OF QUALIFIED 12 ALIEN.—Section 431(b) of such Act (8 U.S.C. 1641(b)) 13 is amended— 14 (1) in paragraph (6), by striking ‘‘or’’ at the 15 end; 16 (2) in paragraph (7), by striking the period at 17 the end and inserting ‘‘; or’’; and 18 (3) by adding at the end the following: 19 ‘‘(8) an individual who lawfully resides in the 20 United States (including territories and possessions 21 of the United States) in accordance with a Compact 22 of Free Association referred to in section 23 402(b)(2)(G), but only with respect to the program 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00204 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 205 •HR 2954 IH defined in section 402(b)(3)(C) (relating to the Med- 1 icaid program).’’. 2 (c) SETTING FMAP AT 100 PERCENT.—The third 3 sentence of section 1905(b) of the Social Security Act (42 4 U.S.C. 1396d(b)) is amended by inserting before the pe- 5 riod at the end the following: ‘‘; with respect to medical 6 assistance for individuals described in section 7 402(b)(2)(G) of the Personal Responsibility and Work Op- 8 portunity Reconciliation Act of 1996’’. 9 (d) EFFECTIVE DATE.—The amendments made by 10 this Act take effect on October 1, 2011, and apply to bene- 11 fits and assistance provided on or after that date. 12 SEC. 416. EXTENSION OF MEDICARE SECONDARY PAYER. 13 (a) IN GENERAL.—Section 1862(b)(1)(C) of the So- 14 cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend- 15 ed— 16 (1) in the last sentence, by inserting ‘‘, and be- 17 fore January 1, 2012’’ after ‘‘prior to such date)’’; 18 and 19 (2) by adding at the end the following new sen- 20 tence: ‘‘Effective for items and services furnished on 21 or after January 1, 2012 (with respect to periods 22 beginning on or after the date that is 42 months 23 prior to such date), clauses (i) and (ii) shall be ap- 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00205 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 206 •HR 2954 IH plied by substituting ‘42-month’ for ‘12-month’ each 1 place it appears in the first sentence.’’. 2 (b) EFFECTIVE DATE.—The amendments made by 3 this subsection shall take effect on the date of enactment 4 of this Act. For purposes of determining an individual’s 5 status under section 1862(b)(1)(C) of the Social Security 6 Act (42 U.S.C. 1395y(b)(1)(C)), as amended by para- 7 graph (1), an individual who is within the coordinating 8 period as of the date of enactment of this Act shall have 9 that period extended to the full 42 months described in 10 the last sentence of such section, as added by the amend- 11 ment made by paragraph (1)(B). 12 SEC. 417. BORDER HEALTH GRANTS. 13 (a) ELIGIBLE ENTITY DEFINED.—In this section, 14 the term ‘‘eligible entity’’ means a State, public institution 15 of higher education, local government, tribal government, 16 nonprofit health organization, community health center, or 17 community clinic receiving assistance under section 330 18 of the Public Health Service Act (42 U.S.C. 254b), that 19 is located in the border area. 20 (b) AUTHORIZATION.—From funds appropriated 21 under subsection (f), the Secretary of Health and Human 22 Services (in this section referred to as the ‘‘Secretary’’), 23 acting through the United States members of the United 24 States-Mexico Border Health Commission, shall award 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00206 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 207 •HR 2954 IH grants to eligible entities to address priorities and rec- 1 ommendations to improve the health of border area resi- 2 dents that are established by— 3 (1) the United States members of the United 4 States-Mexico Border Health Commission; 5 (2) the State border health offices; and 6 (3) the Secretary. 7 (c) APPLICATION.—An eligible entity that desires a 8 grant under subsection (b) shall submit an application to 9 the Secretary at such time, in such manner, and con- 10 taining such information as the Secretary may require. 11 (d) USE OF FUNDS.—An eligible entity that receives 12 a grant under subsection (b) shall use the grant funds 13 for— 14 (1) programs relating to— 15 (A) maternal and child health; 16 (B) primary care and preventative health; 17 (C) public health and public health infra- 18 structure; 19 (D) health education and promotion; 20 (E) oral health; 21 (F) mental and behavioral health; 22 (G) substance abuse; 23 (H) health conditions that have a high 24 prevalence in the border area; 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00207 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 208 •HR 2954 IH (I) medical and health services research; 1 (J) workforce training and development; 2 (K) community health workers or 3 promotoras; 4 (L) health care infrastructure problems in 5 the border area (including planning and con- 6 struction grants); 7 (M) health disparities in the border area; 8 (N) environmental health; and 9 (O) outreach and enrollment services with 10 respect to Federal programs (including pro- 11 grams authorized under titles XIX and XXI of 12 the Social Security Act (42 U.S.C. 1396 and 13 1397aa)); and 14 (2) other programs determined appropriate by 15 the Secretary. 16 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro- 17 vided to an eligible entity awarded a grant under sub- 18 section (b) shall be used to supplement and not supplant 19 other funds available to the eligible entity to carry out the 20 activities described in subsection (d). 21 (f) AUTHORIZATION OF APPROPRIATIONS.—There 22 are authorized to be appropriated to carry out this section, 23 $200,000,000 for fiscal year 2012, and such sums as may 24 be necessary for each succeeding fiscal year. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00208 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 209 •HR 2954 IH SEC. 418. REMOVING MEDICARE BARRIER TO HEALTH 1 CARE. 2 Section 1818(a)(3) of the Social Security Act (42 3 U.S.C. 1395i–2(a)(3)) is amended by amending subpara- 4 graph (B) to read as follows: ‘‘(B) an individual who is 5 lawfully present in the United States’’. 6 SEC. 419. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 7 PROVIDED BY URBAN INDIAN HEALTH CEN- 8 TERS. 9 (a) IN GENERAL.—Section 1905(b) of the Social Se- 10 curity Act (42 U.S.C. 1396(b)), as amended by section 11 415(c), is amended by inserting ‘‘or are received through 12 a program operated by an urban Indian organization 13 through a grant or contract under title V of such Act’’. 14 (b) EFFECTIVE DATE.—The amendment made by 15 this section shall apply to medical assistance provided on 16 or after the date of enactment of this Act. 17 SEC. 420. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 18 PROVIDED TO A NATIVE HAWAIIAN THROUGH 19 A FEDERALLY QUALIFIED HEALTH CENTER 20 OR A NATIVE HAWAIIAN HEALTH CARE SYS- 21 TEM UNDER THE MEDICAID PROGRAM. 22 (a) IN GENERAL.—The third sentence of section 23 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), 24 as amended by section 419, is amended by inserting ‘‘; 25 and, with respect to medical assistance provided to a Na- 26 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00209 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 210 •HR 2954 IH tive Hawaiian (as defined in section 12(2) of the Native 1 Hawaiian Health Care Improvement Act) through a feder- 2 ally qualified health center or a Native Hawaiian health 3 care system (as defined in section 12(6) of such Act), 4 whether directly, by referral, or under contract or other 5 arrangement between such federally qualified health cen- 6 ter or Native Hawaiian health care system and another 7 health care provider’’ before the period. 8 (b) EFFECTIVE DATE.—The amendment made by 9 this section shall apply to medical assistance provided on 10 or after the date of enactment of this Act. 11 CHAPTER 2—EXPANSION OF ACCESS 12 SEC. 421. GRANTS FOR RACIAL AND ETHNIC APPROACHES 13 TO COMMUNITY HEALTH. 14 (a) PURPOSE.—It is the purpose of this section to 15 provide for the awarding of grants to assist communities 16 in mobilizing and organizing resources in support of effec- 17 tive and sustainable programs that will reduce or eliminate 18 disparities in health and health care experienced by racial 19 and ethnic minority individuals. 20 (b) AUTHORITY TO AWARD GRANTS.—The Sec- 21 retary, acting through the Centers for Disease Control and 22 Prevention, shall award grants to eligible entities to assist 23 in designing, implementing, and evaluating culturally and 24 linguistically appropriate, science-based, and community- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00210 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 211 •HR 2954 IH driven sustainable strategies to eliminate racial and ethnic 1 health and health care disparities. 2 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 3 grant under this section, an entity shall— 4 (1) represent a coalition— 5 (A) whose principal purpose is to develop 6 and implement interventions to reduce or elimi- 7 nate a health or health care disparity in a tar- 8 geted racial or ethnic minority group in the 9 community served by the coalition; and 10 (B) that includes— 11 (i) members selected from among— 12 (I) public health departments; 13 (II) community-based organiza- 14 tions; 15 (III) university and research or- 16 ganizations; 17 (IV) American Indian tribal or- 18 ganizations, national American Indian 19 organizations, Indian Health Service, 20 or organizations serving Alaska Na- 21 tives; and 22 (V) interested public or private 23 health care providers or organizations 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00211 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 212 •HR 2954 IH as deemed appropriate by the Sec- 1 retary; and 2 (ii) at least 1 member from a commu- 3 nity-based organization that represents the 4 targeted racial or ethnic minority group; 5 and 6 (2) submit to the Secretary an application at 7 such time, in such manner, and containing such in- 8 formation as the Secretary may require, which shall 9 include— 10 (A) a description of the targeted racial or 11 ethnic populations in the community to be 12 served under the grant; 13 (B) a description of at least 1 health dis- 14 parity that exists in the racial or ethnic tar- 15 geted populations, including health issues such 16 as infant mortality, breast and cervical cancer 17 screening and management, cardiovascular dis- 18 ease, diabetes, child and adult immunization 19 levels, or other health priority areas as des- 20 ignated by the Secretary; and 21 (C) a demonstration of a proven record of 22 accomplishment of the coalition members in 23 serving and working with the targeted commu- 24 nity. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00212 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 213 •HR 2954 IH (d) SUSTAINABILITY.—The Secretary shall give pri- 1 ority to an eligible entity under this section if the entity 2 agrees that, with respect to the costs to be incurred by 3 the entity in carrying out the activities for which the grant 4 was awarded, the entity (and each of the participating 5 partners in the coalition represented by the entity) will 6 maintain its expenditures of non-Federal funds for such 7 activities at a level that is not less than the level of such 8 expenditures during the fiscal year immediately preceding 9 the first fiscal year for which the grant is awarded. 10 (e) NONDUPLICATION.—Funds provided through this 11 grant program should supplement, not supplant, existing 12 Federal funding, and the funds should not be used to du- 13 plicate the activities of the other health disparity grant 14 programs in this Act. 15 (f) TECHNICAL ASSISTANCE.—The Secretary may, 16 either directly or by grant or contract, provide any entity 17 that receives a grant under this section with technical and 18 other nonfinancial assistance necessary to meet the re- 19 quirements of this section. 20 (g) DISSEMINATION.—The Secretary shall encourage 21 and enable grantees to share best practices, evaluation re- 22 sults, and reports with communities not affiliated with 23 grantees using the Internet, conferences, and other perti- 24 nent information regarding the projects funded by this 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00213 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 214 •HR 2954 IH section, including the outreach efforts of the Office of Mi- 1 nority Health and Health Disparity Elimination and the 2 Centers for Disease Control and Prevention. 3 (h) ADMINISTRATIVE BURDENS.—The Secretary 4 shall make every effort to minimize duplicative or unneces- 5 sary administrative burdens on grantees. 6 (i) AUTHORIZATION OF APPROPRIATIONS.—There 7 are authorized to be appropriated such sums as may be 8 necessary to carry out this section. 9 SEC. 422. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 10 (a) ELIMINATION OF ISOLATION TEST FOR COST- 11 BASED AMBULANCE REIMBURSEMENT.— 12 (1) IN GENERAL.—Section 1834(l)(8) of the 13 Social Security Act (42 U.S.C. 1395m(l)(8)) is 14 amended— 15 (A) in subparagraph (B)— 16 (i) by striking ‘‘owned and’’; and 17 (ii) by inserting ‘‘(including when 18 such services are provided by the entity 19 under an arrangement with the hospital)’’ 20 after ‘‘hospital’’; and 21 (B) by striking the comma at the end of 22 subparagraph (B) and all that follows and in- 23 serting a period. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00214 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 215 •HR 2954 IH (2) EFFECTIVE DATE.—The amendments made 1 by this subsection shall apply to services furnished 2 on or after January 1, 2012. 3 (b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE 4 TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT 5 REQUIREMENT.— 6 (1) IN GENERAL.—Section 1820(c)(2) of the 7 Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 8 amended— 9 (A) in subparagraph (B)(iii), by striking 10 ‘‘provides not more than’’ and inserting ‘‘sub- 11 ject to subparagraph (F), provides not more 12 than’’; and 13 (B) by adding at the end the following new 14 subparagraph: 15 ‘‘(F) ALTERNATIVE TO 25 INPATIENT BED 16 LIMIT REQUIREMENT.— 17 ‘‘(i) IN GENERAL.—A State may elect 18 to treat a facility, with respect to the des- 19 ignation of the facility for a cost reporting 20 period, as satisfying the requirement of 21 subparagraph (B)(iii) relating to a max- 22 imum number of acute care inpatient beds 23 if the facility elects, in accordance with a 24 method specified by the Secretary and be- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00215 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 216 •HR 2954 IH fore the beginning of the cost reporting pe- 1 riod, to meet the requirement under clause 2 (ii). 3 ‘‘(ii) ALTERNATE REQUIREMENT.— 4 The requirement under this clause, with 5 respect to a facility and a cost reporting 6 period, is that the total number of inpa- 7 tient bed days described in subparagraph 8 (B)(iii) during such period will not exceed 9 7,300. For purposes of this subparagraph, 10 an individual who is an inpatient in a bed 11 in the facility for a single day shall be 12 counted as one inpatient bed day. 13 ‘‘(iii) WITHDRAWAL OF ELECTION.— 14 The option described in clause (i) shall not 15 apply to a facility for a cost reporting pe- 16 riod if the facility (for any two consecutive 17 cost-reporting periods during the previous 18 5 cost-reporting periods) was treated under 19 such option and had a total number of in- 20 patient bed days for each of such two cost- 21 reporting periods that exceeded the num- 22 ber specified in such clause.’’. 23 (2) EFFECTIVE DATE.—The amendments made 24 by paragraph (1) shall apply to cost-reporting peri- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00216 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 217 •HR 2954 IH ods beginning on or after the date of the enactment 1 of this Act. 2 SEC. 423. ESTABLISHMENT OF RURAL COMMUNITY HOS- 3 PITAL (RCH) PROGRAM. 4 (a) IN GENERAL.—Section 1861 of the Social Secu- 5 rity Act (42 U.S.C. 1395x), as amended by section 6 203(b)(1)(A), is amended by adding at the end of the fol- 7 lowing new subsection: 8 ‘‘Rural Community Hospital; Rural Community Hospital 9 Services 10 ‘‘(jjj)(1) The term ‘rural community hospital’ means 11 a hospital (as defined in subsection (e)) that— 12 ‘‘(A) is located in a rural area (as defined in 13 section 1886(d)(2)(D)) or treated as being so lo- 14 cated pursuant to section 1886(d)(8)(E); 15 ‘‘(B) subject to paragraph (2), has less than 51 16 acute care inpatient beds, as reported in its most re- 17 cent cost report; 18 ‘‘(C) makes available 24-hour emergency care 19 services; 20 ‘‘(D) subject to paragraph (3), has a provider 21 agreement in effect with the Secretary and is open 22 to the public as of January 1, 2010; and 23 ‘‘(E) applies to the Secretary for such designa- 24 tion. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00217 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 218 •HR 2954 IH ‘‘(2) For purposes of paragraph (1)(B), beds in a 1 psychiatric or rehabilitation unit of the hospital which is 2 a distinct part of the hospital shall not be counted. 3 ‘‘(3) Paragraph (1)(D) shall not be construed to pro- 4 hibit any of the following from qualifying as a rural com- 5 munity hospital: 6 ‘‘(A) A replacement facility (as defined by the 7 Secretary in regulations in effect on January 1, 8 2012) with the same service area (as defined by the 9 Secretary in regulations in effect on such date). 10 ‘‘(B) A facility obtaining a new provider num- 11 ber pursuant to a change of ownership. 12 ‘‘(C) A facility which has a binding written 13 agreement with an outside, unrelated party for the 14 construction, reconstruction, lease, rental, or financ- 15 ing of a building as of January 1, 2012. 16 ‘‘(4) Nothing in this subsection shall be construed as 17 prohibiting a critical access hospital from qualifying as a 18 rural community hospital if the critical access hospital 19 meets the conditions otherwise applicable to hospitals 20 under subsection (e) and section 1866. 21 ‘‘(5) Nothing in this subsection shall be construed as 22 prohibiting a rural community hospital participating in 23 the demonstration program under section 410A of the 24 Medicare Prescription Drug, Improvement, and Mod- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00218 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 219 •HR 2954 IH ernization Act of 2003 (Public Law 108–173; 117 Stat. 1 2313) from qualifying as a rural community hospital if 2 the rural community hospital meets the conditions other- 3 wise applicable to hospitals under subsection (e) and sec- 4 tion 1866.’’. 5 (b) PAYMENT.— 6 (1) INPATIENT HOSPITAL SERVICES.—Section 7 1814 of the Social Security Act (42 U.S.C. 1395f) 8 is amended by adding at the end the following new 9 subsection: 10 ‘‘Payment for Inpatient Services Furnished in Rural 11 Community Hospitals 12 ‘‘(m) The amount of payment under this part for in- 13 patient hospital services furnished in a rural community 14 hospital, other than such services furnished in a psy- 15 chiatric or rehabilitation unit of the hospital which is a 16 distinct part, is, at the election of the hospital in the appli- 17 cation referred to in section 1861(jjj)(1)(E)— 18 ‘‘(1) 101 percent of the reasonable costs of pro- 19 viding such services, without regard to the amount 20 of the customary or other charge, or 21 ‘‘(2) the amount of payment provided for under 22 the prospective payment system for inpatient hos- 23 pital services under section 1886(d).’’. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00219 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 220 •HR 2954 IH (2) OUTPATIENT SERVICES.—Section 1834 of 1 such Act (42 U.S.C. 1395m) is amended by adding 2 at the end the following new subsection: 3 ‘‘(p) PAYMENT FOR OUTPATIENT SERVICES FUR- 4 NISHED IN RURAL COMMUNITY HOSPITALS.—The 5 amount of payment under this part for outpatient services 6 furnished in a rural community hospital is, at the election 7 of the hospital in the application referred to in section 8 1861(jjj)(1)(E)— 9 ‘‘(1) 101 percent of the reasonable costs of pro- 10 viding such services, without regard to the amount 11 of the customary or other charge and any limitation 12 under section 1861(v)(1)(U), or 13 ‘‘(2) the amount of payment provided for under 14 the prospective payment system for covered OPD 15 services under section 1833(t).’’. 16 (3) EXEMPTION FROM 30-PERCENT REDUCTION 17 IN REIMBURSEMENT FOR BAD DEBT.—Section 18 1861(v)(1)(T) of such Act (42 U.S.C. 19 1395x(v)(1)(T)) is amended by inserting ‘‘(other 20 than for a rural community hospital)’’ after ‘‘In de- 21 termining such reasonable costs for hospitals’’. 22 (c) BENEFICIARY COST-SHARING FOR OUTPATIENT 23 SERVICES.—Section 1834(p) of such Act (as added by 24 subsection (b)(2)) is amended— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00220 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 221 •HR 2954 IH (1) by redesignating paragraphs (1) and (2) as 1 subparagraphs (A) and (B), respectively; 2 (2) by inserting ‘‘(1)’’ after ‘‘(p)’’; and 3 (3) by adding at the end the following: 4 ‘‘(2) The amounts of beneficiary costsharing for out- 5 patient services furnished in a rural community hospital 6 under this part shall be as follows: 7 ‘‘(A) For items and services that would have 8 been paid under section 1833(t) if provided by a 9 hospital, the amount of costsharing determined 10 under paragraph (8) of such section. 11 ‘‘(B) For items and services that would have 12 been paid under section 1833(h) if furnished by a 13 provider or supplier, no costsharing shall apply. 14 ‘‘(C) For all other items and services, the 15 amount of costsharing that would apply to the item 16 or service under the methodology that would be used 17 to determine payment for such item or service if pro- 18 vided by a physician, provider, or supplier, as the 19 case may be.’’. 20 (d) CONFORMING AMENDMENTS.— 21 (1) PART A PAYMENT.—Section 1814(b) of 22 such Act (42 U.S.C. 1395f(b)) is amended in the 23 matter preceding paragraph (1) by inserting ‘‘other 24 than inpatient hospital services furnished by a rural 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00221 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 222 •HR 2954 IH community hospital,’’ after ‘‘critical access hospital 1 services,’’. 2 (2) PART B PAYMENT.—Section 1833(a) of 3 such Act (42 U.S.C. 1395l(a)), as amended by sec- 4 tion 203(b)(2), is amended— 5 (A) in paragraph (2), in the matter before 6 subparagraph (A), by striking ‘‘and (I)’’ and in- 7 serting ‘‘(I), and (K)’’; 8 (B) by striking ‘‘and’’ at the end of para- 9 graph (9); 10 (C) by striking the period at the end of 11 paragraph (10) and inserting ‘‘; and’’; and 12 (D) by adding at the end the following: 13 ‘‘(11) in the case of outpatient services fur- 14 nished by a rural community hospital, the amounts 15 described in section 1834(p).’’. 16 (3) TECHNICAL AMENDMENTS.— 17 (A) CONSULTATION WITH STATE AGEN- 18 CIES.—Section 1863 of such Act (42 U.S.C. 19 1395z) is amended by striking ‘‘and (dd)(2)’’ 20 and inserting ‘‘(dd)(2), (mm)(1), and (jjj)(1)’’. 21 (B) PROVIDER AGREEMENTS.—Section 22 1866(a)(2)(A) of such Act (42 U.S.C. 23 1395cc(a)(2)(A)) is amended by inserting ‘‘sec- 24 tion 1834(p)(2),’’ after ‘‘section 1833(b),’’. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00222 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 223 •HR 2954 IH (e) EFFECTIVE DATE.—The amendments made by 1 this section shall apply to items and services furnished on 2 or after October 1, 2011. 3 SEC. 424. MEDICARE REMOTE MONITORING PILOT 4 PROJECTS. 5 (a) PILOT PROJECTS.— 6 (1) IN GENERAL.—Not later than 9 months 7 after the date of enactment of this Act, the Sec- 8 retary of Health and Human Services (in this sec- 9 tion referred to as the ‘‘Secretary’’) shall conduct 10 pilot projects under title XVIII of the Social Secu- 11 rity Act for the purpose of providing incentives to 12 home health agencies to utilize home monitoring and 13 communications technologies that— 14 (A) enhance health outcomes for Medicare 15 beneficiaries; and 16 (B) reduce expenditures under such title. 17 (2) SITE REQUIREMENTS.— 18 (A) URBAN AND RURAL.—The Secretary 19 shall conduct the pilot projects under this sec- 20 tion in both urban and rural areas. 21 (B) SITE IN A SMALL STATE.—The Sec- 22 retary shall conduct at least 3 of the pilot 23 projects in a State with a population of less 24 than 1,000,000. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00223 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 224 •HR 2954 IH (3) DEFINITION OF HOME HEALTH AGENCY.— 1 In this section, the term ‘‘home health agency’’ has 2 the meaning given that term in section 1861(o) of 3 the Social Security Act (42 U.S.C. 1395x(o)). 4 (b) MEDICARE BENEFICIARIES WITHIN THE SCOPE 5 OF PROJECTS.—The Secretary shall specify the criteria 6 for identifying those Medicare beneficiaries who shall be 7 considered within the scope of the pilot projects under this 8 section for purposes of the application of subsection (c) 9 and for the assessment of the effectiveness of the home 10 health agency in achieving the objectives of this section. 11 Such criteria may provide for the inclusion in the projects 12 of Medicare beneficiaries who begin receiving home health 13 services under title XVIII of the Social Security Act after 14 the date of the implementation of the projects. 15 (c) INCENTIVES.— 16 (1) PERFORMANCE TARGETS.—The Secretary 17 shall establish for each home health agency partici- 18 pating in a pilot project under this section a per- 19 formance target using one of the following meth- 20 odologies, as determined appropriate by the Sec- 21 retary: 22 (A) ADJUSTED HISTORICAL PERFORMANCE 23 TARGET.—The Secretary shall establish for the 24 agency— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00224 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 225 •HR 2954 IH (i) a base expenditure amount equal 1 to the average total payments made to the 2 agency under parts A and B of title XVIII 3 of the Social Security Act for Medicare 4 beneficiaries determined to be within the 5 scope of the pilot project in a base period 6 determined by the Secretary; and 7 (ii) an annual per capita expenditure 8 target for such beneficiaries, reflecting the 9 base expenditure amount adjusted for risk 10 and adjusted growth rates. 11 (B) COMPARATIVE PERFORMANCE TAR- 12 GET.—The Secretary shall establish for the 13 agency a comparative performance target equal 14 to the average total payments under such parts 15 A and B during the pilot project for comparable 16 individuals in the same geographic area that 17 are not determined to be within the scope of the 18 pilot project. 19 (2) INCENTIVE.—Subject to paragraph (3), the 20 Secretary shall pay to each participating home care 21 agency an incentive payment for each year under the 22 pilot project equal to a portion of the Medicare sav- 23 ings realized for such year relative to the perform- 24 ance target under paragraph (1). 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00225 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 226 •HR 2954 IH (3) LIMITATION ON EXPENDITURES.—The Sec- 1 retary shall limit incentive payments under this sec- 2 tion in order to ensure that the aggregate expendi- 3 tures under title XVIII of the Social Security Act 4 (including incentive payments under this subsection) 5 do not exceed the amount that the Secretary esti- 6 mates would have been expended if the pilot projects 7 under this section had not been implemented. 8 (d) WAIVER AUTHORITY.—The Secretary may waive 9 such provisions of titles XI and XVIII of the Social Secu- 10 rity Act as the Secretary determines to be appropriate for 11 the conduct of the pilot projects under this section. 12 (e) REPORT TO CONGRESS.—Not later than 5 years 13 after the date that the first pilot project under this section 14 is implemented, the Secretary shall submit to Congress a 15 report on the pilot projects. Such report shall contain a 16 detailed description of issues related to the expansion of 17 the projects under subsection (f) and recommendations for 18 such legislation and administrative actions as the Sec- 19 retary considers appropriate. 20 (f) EXPANSION.—If the Secretary determines that 21 any of the pilot projects under this section enhance health 22 outcomes for Medicare beneficiaries and reduce expendi- 23 tures under title XVIII of the Social Security Act, the Sec- 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00226 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 227 •HR 2954 IH retary may initiate comparable projects in additional 1 areas. 2 (g) INCENTIVE PAYMENTS HAVE NO EFFECT ON 3 OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen- 4 tive payment under this section— 5 (1) shall be in addition to the payments that a 6 home health agency would otherwise receive under 7 title XVIII of the Social Security Act for the provi- 8 sion of home health services; and 9 (2) shall have no effect on the amount of such 10 payments. 11 SEC. 425. RURAL HEALTH QUALITY ADVISORY COMMISSION 12 AND DEMONSTRATION PROJECTS. 13 (a) RURAL HEALTH QUALITY ADVISORY COMMIS- 14 SION.— 15 (1) ESTABLISHMENT.—Not later than 6 16 months after the date of the enactment of this sec- 17 tion, the Secretary of Health and Human Services 18 (in this section referred to as the ‘‘Secretary’’) shall 19 establish a commission to be known as the Rural 20 Health Quality Advisory Commission (in this section 21 referred to as the ‘‘Commission’’). 22 (2) DUTIES OF COMMISSION.— 23 (A) NATIONAL PLAN.—The Commission 24 shall develop, coordinate, and facilitate imple- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00227 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 228 •HR 2954 IH mentation of a national plan for rural health 1 quality improvement. The national plan shall— 2 (i) identify objectives for rural health 3 quality improvement; 4 (ii) identify strategies to eliminate 5 known gaps in rural health system capacity 6 and improve rural health quality; and 7 (iii) provide for Federal programs to 8 identify opportunities for strengthening 9 and aligning policies and programs to im- 10 prove rural health quality. 11 (B) DEMONSTRATION PROJECTS.—The 12 Commission shall design demonstration projects 13 to test alternative models for rural health qual- 14 ity improvement, including with respect to both 15 personal and population health. 16 (C) MONITORING.—The Commission shall 17 monitor progress toward the objectives identi- 18 fied pursuant to paragraph (1)(A). 19 (3) MEMBERSHIP.— 20 (A) NUMBER.—The Commission shall be 21 composed of 11 members appointed by the Sec- 22 retary. 23 (B) SELECTION.—The Secretary shall se- 24 lect the members of the Commission from 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00228 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 229 •HR 2954 IH among individuals with significant rural health 1 care and health care quality expertise, including 2 expertise in clinical health care, health care 3 quality research, population or public health, or 4 purchaser organizations. 5 (4) CONTRACTING AUTHORITY.—Subject to the 6 availability of funds, the Commission may enter into 7 contracts and make other arrangements, as may be 8 necessary to carry out the duties described in para- 9 graph (2). 10 (5) STAFF.—Upon the request of the Commis- 11 sion, the Secretary may detail, on a reimbursable 12 basis, any of the personnel of the Office of Rural 13 Health Policy of the Health Resources and Services 14 Administration, the Agency for Health care Quality 15 and Research, or the Centers for Medicare & Med- 16 icaid Services to the Commission to assist in car- 17 rying out this subsection. 18 (6) REPORTS TO CONGRESS.—Not later than 1 19 year after the establishment of the Commission, and 20 annually thereafter, the Commission shall submit a 21 report to the Congress on rural health quality. Each 22 such report shall include the following: 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00229 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 230 •HR 2954 IH (A) An inventory of relevant programs and 1 recommendations for improved coordination and 2 integration of policy and programs. 3 (B) An assessment of achievement of the 4 objectives identified in the national plan devel- 5 oped under paragraph (2) and recommenda- 6 tions for realizing such objectives. 7 (C) Recommendations on Federal legisla- 8 tion, regulations, or administrative policies to 9 enhance rural health quality and outcomes. 10 (b) RURAL HEALTH QUALITY DEMONSTRATION 11 PROJECTS.— 12 (1) IN GENERAL.—Not later than 270 days 13 after the date of the enactment of this section, the 14 Secretary, in consultation with the Rural Health 15 Quality Advisory Commission, the Office of Rural 16 Health Policy of the Health Resources and Services 17 Administration, the Agency for Healthcare Research 18 and Quality, and the Centers for Medicare & Med- 19 icaid Services, shall make grants to eligible entities 20 for 5 demonstration projects to implement and 21 evaluate methods for improving the quality of health 22 care in rural communities. Each such demonstration 23 project shall include— 24 (A) alternative community models that— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00230 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 231 •HR 2954 IH (i) will achieve greater integration of 1 personal and population health services; 2 and 3 (ii) address safety, effectiveness, 4 patient- or community-centeredness, timeli- 5 ness, efficiency, and equity (the 6 aims 6 identified by the Institute of Medicine of 7 the National Academies in its report enti- 8 tled ‘‘Crossing the Quality Chasm: A New 9 Health System for the 21st Century’’ re- 10 leased on March 1, 2001); 11 (B) innovative approaches to the financing 12 and delivery of health services to achieve rural 13 health quality goals; and 14 (C) development of quality improvement 15 support structures to assist rural health sys- 16 tems and professionals (such as workforce sup- 17 port structures, quality monitoring and report- 18 ing, clinical care protocols, and information 19 technology applications). 20 (2) ELIGIBLE ENTITIES.—In this subsection, 21 the term ‘‘eligible entity’’ means a consortium 22 that— 23 (A) shall include— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00231 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 232 •HR 2954 IH (i) at least one health care provider or 1 health care delivery system located in a 2 rural area; and 3 (ii) at least one organization rep- 4 resenting multiple community stakeholders; 5 and 6 (B) may include other partners such as 7 rural research centers. 8 (3) CONSULTATION.—In developing the pro- 9 gram for awarding grants under this subsection, the 10 Secretary shall consult with the Administrator of the 11 Agency for Healthcare Research and Quality, rural 12 health care providers, rural health care researchers, 13 and private and nonprofit groups (including national 14 associations) which are undertaking similar efforts. 15 (4) EXPEDITED WAIVERS.—The Secretary shall 16 expedite the processing of any waiver that— 17 (A) is authorized under title XVIII or XIX 18 of the Social Security Act (42 U.S.C. 1395 et 19 seq.); and 20 (B) is necessary to carry out a demonstra- 21 tion project under this subsection. 22 (5) DEMONSTRATION PROJECT SITES.—The 23 Secretary shall ensure that the 5 demonstration 24 projects funded under this subsection are conducted 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00232 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 233 •HR 2954 IH at a variety of sites representing the diversity of 1 rural communities in the Nation. 2 (6) DURATION.—Each demonstration project 3 under this subsection shall be for a period of 4 4 years. 5 (7) INDEPENDENT EVALUATION.—The Sec- 6 retary shall enter into an arrangement with an enti- 7 ty that has experience working directly with rural 8 health systems for the conduct of an independent 9 evaluation of the program carried out under this 10 subsection. 11 (8) REPORT.—Not later than 1 year after the 12 conclusion of all of the demonstration projects fund- 13 ed under this subsection, the Secretary shall submit 14 a report to the Congress on the results of such 15 projects. The report shall include— 16 (A) an evaluation of patient access to care, 17 patient outcomes, and an analysis of the cost 18 effectiveness of each such project; and 19 (B) recommendations on Federal legisla- 20 tion, regulations, or administrative policies to 21 enhance rural health quality and outcomes. 22 (c) APPROPRIATION.— 23 (1) IN GENERAL.—Out of funds in the Treas- 24 ury not otherwise appropriated, there are appro- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00233 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 234 •HR 2954 IH priated to the Secretary to carry out this section 1 $30,000,000 for the period of fiscal years 2012 2 through 2016. 3 (2) AVAILABILITY.— 4 (A) IN GENERAL.—Funds appropriated 5 under paragraph (1) shall remain available for 6 expenditure through fiscal year 2016. 7 (B) REPORT.—For purposes of carrying 8 out subsection (b)(8), funds appropriated under 9 paragraph (1) shall remain available for ex- 10 penditure through fiscal year 2017. 11 (3) RESERVATION.—Of the amount appro- 12 priated under paragraph (1), the Secretary shall re- 13 serve— 14 (A) $5,000,000 to carry out subsection (a); 15 and 16 (B) $25,000,000 to carry out subsection 17 (b), of which— 18 (i) 2 percent shall be for the provision 19 of technical assistance to grant recipients; 20 and 21 (ii) 5 percent shall be for independent 22 evaluation under subsection (b)(7). 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00234 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 235 •HR 2954 IH SEC. 426. RURAL HEALTH CARE SERVICES. 1 Section 330A of the Public Health Service Act (42 2 U.S.C. 254c) is amended to read as follows: 3 ‘‘SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, 4 RURAL HEALTH NETWORK DEVELOPMENT, 5 DELTA RURAL DISPARITIES AND HEALTH 6 SYSTEMS DEVELOPMENT, AND SMALL RURAL 7 HEALTH CARE PROVIDER QUALITY IMPROVE- 8 MENT GRANT PROGRAMS. 9 ‘‘(a) PURPOSE.—The purpose of this section is to 10 provide for grants— 11 ‘‘(1) under subsection (b), to promote rural 12 health care services outreach; 13 ‘‘(2) under subsection (c), to provide for the 14 planning and implementation of integrated health 15 care networks in rural areas; 16 ‘‘(3) under subsection (d), to assist rural com- 17 munities in the Delta Region to reduce health dis- 18 parities and to promote and enhance health system 19 development; and 20 ‘‘(4) under subsection (e), to provide for the 21 planning and implementation of small rural health 22 care provider quality improvement activities. 23 ‘‘(b) RURAL HEALTH CARE SERVICES OUTREACH 24 GRANTS.— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00235 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 236 •HR 2954 IH ‘‘(1) GRANTS.—The Director of the Office of 1 Rural Health Policy of the Health Resources and 2 Services Administration may award grants to eligible 3 entities to promote rural health care services out- 4 reach by expanding the delivery of health care serv- 5 ices to include new and enhanced services in rural 6 areas. The Director may award the grants for peri- 7 ods of not more than 3 years. 8 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 9 grant under this subsection for a project, an enti- 10 ty— 11 ‘‘(A) shall be a rural public or rural non- 12 profit private entity, a facility that qualifies as 13 a rural health clinic under title XVIII of the 14 Social Security Act, a public or nonprofit entity 15 existing exclusively to provide services to mi- 16 grant and seasonal farm workers in rural areas, 17 or a tribal government whose grant-funded ac- 18 tivities will be conducted within federally recog- 19 nized tribal areas; 20 ‘‘(B) shall represent a consortium com- 21 posed of members— 22 ‘‘(i) that include 3 or more independ- 23 ently owned health care entities; and 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00236 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 237 •HR 2954 IH ‘‘(ii) that may be nonprofit or for- 1 profit entities; and 2 ‘‘(C) shall not previously have received a 3 grant under this subsection for the same or a 4 similar project, unless the entity is proposing to 5 expand the scope of the project or the area that 6 will be served through the project. 7 ‘‘(3) APPLICATIONS.—To be eligible to receive a 8 grant under this subsection, an eligible entity shall 9 prepare and submit to the Director an application at 10 such time, in such manner, and containing such in- 11 formation as the Director may require, including— 12 ‘‘(A) a description of the project that the 13 eligible entity will carry out using the funds 14 provided under the grant; 15 ‘‘(B) a description of the manner in which 16 the project funded under the grant will meet 17 the health care needs of rural populations in 18 the local community or region to be served; 19 ‘‘(C) a plan for quantifying how health 20 care needs will be met through identification of 21 the target population and benchmarks of service 22 delivery or health status, such as— 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00237 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 238 •HR 2954 IH ‘‘(i) quantifiable measurements of 1 health status improvement for projects fo- 2 cusing on health promotion; or 3 ‘‘(ii) benchmarks of increased access 4 to primary care, including tracking factors 5 such as the number and type of primary 6 care visits, identification of a medical 7 home, or other general measures of such 8 access; 9 ‘‘(D) a description of how the local com- 10 munity or region to be served will be involved 11 in the development and ongoing operations of 12 the project; 13 ‘‘(E) a plan for sustaining the project after 14 Federal support for the project has ended; 15 ‘‘(F) a description of how the project will 16 be evaluated; 17 ‘‘(G) the administrative capacity to submit 18 annual performance data electronically as speci- 19 fied by the Director; and 20 ‘‘(H) other such information as the Direc- 21 tor determines to be appropriate. 22 ‘‘(c) RURAL HEALTH NETWORK DEVELOPMENT 23 GRANTS.— 24 ‘‘(1) GRANTS.— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00238 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 239 •HR 2954 IH ‘‘(A) IN GENERAL.—The Director may 1 award rural health network development grants 2 to eligible entities to promote, through planning 3 and implementation, the development of inte- 4 grated health care networks that have combined 5 the functions of the entities participating in the 6 networks in order to— 7 ‘‘(i) achieve efficiencies and economies 8 of scale; 9 ‘‘(ii) expand access to, coordinate, and 10 improve the quality of the health care de- 11 livery system through development of orga- 12 nizational efficiencies; 13 ‘‘(iii) implement health information 14 technology to achieve efficiencies, reduce 15 medical errors, and improve quality; 16 ‘‘(iv) coordinate care and manage 17 chronic illness; and 18 ‘‘(v) strengthen the rural health care 19 system as a whole in such a manner as to 20 show a quantifiable return on investment 21 to the participants in the network. 22 ‘‘(B) GRANT PERIODS.—The Director may 23 award such a rural health network development 24 grant— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00239 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 240 •HR 2954 IH ‘‘(i) for a period of 3 years for imple- 1 mentation activities; or 2 ‘‘(ii) for a period of 1 year for plan- 3 ning activities to assist in the initial devel- 4 opment of an integrated health care net- 5 work, if the proposed participants in the 6 network do not have a history of collabo- 7 rative efforts and a 3-year grant would be 8 inappropriate. 9 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 10 grant under this subsection, an entity— 11 ‘‘(A) shall be a rural public or rural non- 12 profit private entity, a facility that qualifies as 13 a rural health clinic under title XVIII of the 14 Social Security Act, a public or nonprofit entity 15 existing exclusively to provide services to mi- 16 grant and seasonal farm workers in rural areas, 17 or a tribal government whose grant-funded ac- 18 tivities will be conducted within federally recog- 19 nized tribal areas; 20 ‘‘(B) shall represent a network composed 21 of participants— 22 ‘‘(i) that include 3 or more independ- 23 ently owned health care entities; and 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00240 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 241 •HR 2954 IH ‘‘(ii) that may be nonprofit or for- 1 profit entities; and 2 ‘‘(C) shall not previously have received a 3 grant under this subsection (other than a 1- 4 year grant for planning activities) for the same 5 or a similar project. 6 ‘‘(3) APPLICATIONS.—To be eligible to receive a 7 grant under this subsection, an eligible entity, in 8 consultation with the appropriate State office of 9 rural health or another appropriate State entity, 10 shall prepare and submit to the Director an applica- 11 tion at such time, in such manner, and containing 12 such information as the Director may require, in- 13 cluding— 14 ‘‘(A) a description of the project that the 15 eligible entity will carry out using the funds 16 provided under the grant; 17 ‘‘(B) an explanation of the reasons why 18 Federal assistance is required to carry out the 19 project; 20 ‘‘(C) a description of— 21 ‘‘(i) the history of collaborative activi- 22 ties carried out by the participants in the 23 network; 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00241 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 242 •HR 2954 IH ‘‘(ii) the degree to which the partici- 1 pants are ready to integrate their func- 2 tions; and 3 ‘‘(iii) how the local community or re- 4 gion to be served will benefit from and be 5 involved in the activities carried out by the 6 network; 7 ‘‘(D) a description of how the local com- 8 munity or region to be served will experience in- 9 creased access to quality health care services 10 across the continuum of care as a result of the 11 integration activities carried out by the net- 12 work, including a description of— 13 ‘‘(i) return on investment for the com- 14 munity and the network members; and 15 ‘‘(ii) other quantifiable performance 16 measures that show the benefit of the net- 17 work activities; 18 ‘‘(E) a plan for sustaining the project after 19 Federal support for the project has ended; 20 ‘‘(F) a description of how the project will 21 be evaluated; 22 ‘‘(G) the administrative capacity to submit 23 annual performance data electronically as speci- 24 fied by the Director; and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00242 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 243 •HR 2954 IH ‘‘(H) other such information as the Direc- 1 tor determines to be appropriate. 2 ‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS- 3 TEMS DEVELOPMENT GRANTS.— 4 ‘‘(1) GRANTS.—The Director may award grants 5 to eligible entities to support reduction of health dis- 6 parities, improve access to health care, and enhance 7 rural health system development in the Delta Re- 8 gion. 9 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 10 grant under this subsection, an entity shall be a 11 rural public or rural nonprofit private entity, a facil- 12 ity that qualifies as a rural health clinic under title 13 XVIII of the Social Security Act, a public or non- 14 profit entity existing exclusively to provide services 15 to migrant and seasonal farm workers in rural 16 areas, or a tribal government whose grant-funded 17 activities will be conducted within federally recog- 18 nized tribal areas. 19 ‘‘(3) APPLICATIONS.—To be eligible to receive a 20 grant under this subsection, an eligible entity shall 21 prepare and submit to the Director an application at 22 such time, in such manner, and containing such in- 23 formation as the Director may require, including— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00243 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 244 •HR 2954 IH ‘‘(A) a description of the project that the 1 eligible entity will carry out using the funds 2 provided under the grant; 3 ‘‘(B) an explanation of the reasons why 4 Federal assistance is required to carry out the 5 project; 6 ‘‘(C) a description of the manner in which 7 the project funded under the grant will meet 8 the health care needs of the Delta Region; 9 ‘‘(D) a description of how the local com- 10 munity or region to be served will experience in- 11 creased access to quality health care services as 12 a result of the activities carried out by the enti- 13 ty; 14 ‘‘(E) a description of how health dispari- 15 ties will be reduced or the health system will be 16 improved; 17 ‘‘(F) a plan for sustaining the project after 18 Federal support for the project has ended; 19 ‘‘(G) a description of how the project will 20 be evaluated including process and outcome 21 measures related to the quality of care provided 22 or how the health care system improves its per- 23 formance; 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00244 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 245 •HR 2954 IH ‘‘(H) a description of how the grantee will 1 develop an advisory group made up of rep- 2 resentatives of the communities to be served to 3 provide guidance to the grantee to best meet 4 community need; and 5 ‘‘(I) other such information as the Director 6 determines to be appropriate. 7 ‘‘(e) SMALL RURAL HEALTH CARE PROVIDER QUAL- 8 ITY IMPROVEMENT GRANTS.— 9 ‘‘(1) GRANTS.—The Director may award grants 10 to provide for the planning and implementation of 11 small rural health care provider quality improvement 12 activities. The Director may award the grants for 13 periods of 1 to 3 years. 14 ‘‘(2) ELIGIBILITY.—To be eligible for a grant 15 under this subsection, an entity— 16 ‘‘(A) shall be— 17 ‘‘(i) a rural public or rural nonprofit 18 private health care provider or provider of 19 health care services, such as a rural health 20 clinic; or 21 ‘‘(ii) another rural provider or net- 22 work of small rural providers identified by 23 the Director as a key source of local care; 24 and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00245 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 246 •HR 2954 IH ‘‘(B) shall not previously have received a 1 grant under this subsection for the same or a 2 similar project. 3 ‘‘(3) PREFERENCE.—In awarding grants under 4 this subsection, the Director shall give preference to 5 facilities that qualify as rural health clinics under 6 title XVIII of the Social Security Act. 7 ‘‘(4) APPLICATIONS.—To be eligible to receive a 8 grant under this subsection, an eligible entity shall 9 prepare and submit to the Director an application at 10 such time, in such manner, and containing such in- 11 formation as the Director may require, including— 12 ‘‘(A) a description of the project that the 13 eligible entity will carry out using the funds 14 provided under the grant; 15 ‘‘(B) an explanation of the reasons why 16 Federal assistance is required to carry out the 17 project; 18 ‘‘(C) a description of the manner in which 19 the project funded under the grant will assure 20 continuous quality improvement in the provision 21 of services by the entity; 22 ‘‘(D) a description of how the local com- 23 munity or region to be served will experience in- 24 creased access to quality health care services as 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00246 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 247 •HR 2954 IH a result of the activities carried out by the enti- 1 ty; 2 ‘‘(E) a plan for sustaining the project after 3 Federal support for the project has ended; 4 ‘‘(F) a description of how the project will 5 be evaluated including process and outcome 6 measures related to the quality of care pro- 7 vided; and 8 ‘‘(G) other such information as the Direc- 9 tor determines to be appropriate. 10 ‘‘(f) GENERAL REQUIREMENTS.— 11 ‘‘(1) PROHIBITED USES OF FUNDS.—An entity 12 that receives a grant under this section may not use 13 funds provided through the grant— 14 ‘‘(A) to build or acquire real property; or 15 ‘‘(B) for construction. 16 ‘‘(2) COORDINATION WITH OTHER AGENCIES.— 17 The Director shall coordinate activities carried out 18 under grant programs described in this section, to 19 the extent practicable, with Federal and State agen- 20 cies and nonprofit organizations that are operating 21 similar grant programs, to maximize the effect of 22 public dollars in funding meritorious proposals. 23 ‘‘(g) REPORT.—Not later than September 30, 2014, 24 the Secretary shall prepare and submit to the appropriate 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00247 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 248 •HR 2954 IH committees of Congress a report on the progress and ac- 1 complishments of the grant programs described in sub- 2 sections (b), (c), (d), and (e). 3 ‘‘(h) DEFINITIONS.—In this section: 4 ‘‘(1) The term ‘Delta Region’ has the meaning 5 given to the term ‘region’ in section 382A of the 6 Consolidated Farm and Rural Development Act (7 7 U.S.C. 2009aa). 8 ‘‘(2) The term ‘Director’ means the Director of 9 the Office of Rural Health Policy of the Health Re- 10 sources and Services Administration. 11 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 12 are authorized to be appropriated to carry out this section 13 $40,000,000 for fiscal year 2012, and such sums as may 14 be necessary for each of fiscal years 2013 through 2016.’’. 15 SEC. 427. COMMUNITY HEALTH CENTER COLLABORATIVE 16 ACCESS EXPANSION. 17 Section 330 of the Public Health Service Act (42 18 U.S.C. 254b) is amended by adding at the end the fol- 19 lowing: 20 ‘‘(t) MISCELLANEOUS PROVISIONS.— 21 ‘‘(1) RULE OF CONSTRUCTION WITH RESPECT 22 TO RURAL HEALTH CLINICS.— 23 ‘‘(A) IN GENERAL.—Nothing in this sec- 24 tion shall be construed to prevent a community 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00248 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 249 •HR 2954 IH health center from contracting with a federally 1 certified rural health clinic (as defined by sec- 2 tion 1861(aa)(2) of the Social Security Act) for 3 the delivery of primary health care services that 4 are available at the rural health clinic to indi- 5 viduals who would otherwise be eligible for free 6 or reduced cost care if that individual were able 7 to obtain that care at the community health 8 center. Such services may be limited in scope to 9 those primary health care services available in 10 that rural health clinic. 11 ‘‘(B) ASSURANCES.—In order for a rural 12 health clinic to receive funds under this section 13 through a contract with a community health 14 center under paragraph (1), such rural health 15 clinic shall establish policies to ensure— 16 ‘‘(i) nondiscrimination based upon the 17 ability of a patient to pay; and 18 ‘‘(ii) the establishment of a sliding fee 19 scale for low-income patients.’’. 20 SEC. 428. FACILITATING THE PROVISION OF TELEHEALTH 21 SERVICES ACROSS STATE LINES. 22 (a) IN GENERAL.—For purposes of expediting the 23 provision of telehealth services, for which payment is made 24 under the Medicare program, across State lines, the Sec- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00249 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 250 •HR 2954 IH retary of Health and Human Services shall, in consulta- 1 tion with representatives of States, physicians, health care 2 practitioners, and patient advocates, encourage and facili- 3 tate the adoption of provisions allowing for multistate 4 practitioner practice across State lines. 5 (b) DEFINITIONS.—In subsection (a): 6 (1) TELEHEALTH SERVICE.—The term ‘‘tele- 7 health service’’ has the meaning given that term in 8 subparagraph (F) of section 1834(m)(4) of the So- 9 cial Security Act (42 U.S.C. 1395m(m)(4)). 10 (2) PHYSICIAN, PRACTITIONER.—The terms 11 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 12 given those terms in subparagraphs (D) and (E), re- 13 spectively, of such section. 14 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 15 program’’ means the program of health insurance 16 administered by the Secretary of Health and Human 17 Services under title XVIII of the Social Security Act 18 (42 U.S.C. 1395 et seq.). 19 SEC. 429. SCORING OF PREVENTIVE HEALTH SAVINGS. 20 Section 202 of the Congressional Budget and Im- 21 poundment Control Act of 1974 (2 U.S.C. 602) is amend- 22 ed by adding at the end the following new subsection: 23 ‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00250 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 251 •HR 2954 IH ‘‘(1) DETERMINATION BY THE DIRECTOR.— 1 Upon a request by the chairman or ranking minority 2 member of the Committee on the Budget of the Sen- 3 ate, or by the chairman or ranking minority member 4 of the Committee on the Budget of the House of 5 Representatives, the Director shall determine if a 6 proposed measure would result in reductions in 7 budget outlays in budgetary outyears through the 8 use of preventive health and preventive health serv- 9 ices. 10 ‘‘(2) PROJECTIONS.—If the Director determines 11 that a measure would result in substantial reduc- 12 tions in budget outlays as described in paragraph 13 (1), the Director— 14 ‘‘(A) shall include, in any projection pre- 15 pared by the Director, a description and esti- 16 mate of the reductions in budget outlays in the 17 budgetary outyears and a description of the 18 basis for such conclusions; and 19 ‘‘(B) may prepare a budget projection that 20 includes some or all of the budgetary outyears, 21 notwithstanding the time periods for projections 22 described in subsection (e) and sections 308, 23 402, and 424. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00251 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 252 •HR 2954 IH ‘‘(3) DEFINITIONS.—As used in this sub- 1 section— 2 ‘‘(A) the term ‘preventive health’ means an 3 action that focuses on the health of the public, 4 individuals, and defined populations in order to 5 protect, promote, and maintain health, wellness, 6 and functional ability, and prevent disease, dis- 7 ability, and premature death that is dem- 8 onstrated by credible and publicly available epi- 9 demiological projection models, incorporating 10 clinical trials or observational studies in hu- 11 mans, to avoid future health care costs; and 12 ‘‘(B) the term ‘budgetary outyears’ means 13 the 2 consecutive 10-year periods beginning 14 with the first fiscal year that is 10 years after 15 the budget year provided for in the most re- 16 cently agreed to concurrent resolution on the 17 budget.’’. 18 SEC. 430. SENSE OF CONGRESS. 19 It is the sense of the Congress that— 20 (1) the maintenance of effort (MOE) provisions 21 added to sections 1902 and 2105(d) of the Social 22 Security Act by sections 2001(b) and 2101(b) of the 23 Patient Protection and Affordable Care Act were 24 written to maintain the eligibility standards for the 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00252 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 253 •HR 2954 IH Medicaid program and Children’s Health Insurance 1 Program until the American Health Benefit Ex- 2 changes in the States are fully operational; 3 (2) it is imperative that the MOE provisions are 4 enforced to the strict standard intended by the Con- 5 gress; 6 (3) waiving the MOE provisions should not be 7 permitted, except in the case of a request for a waiv- 8 er that meets the explicit nonapplication require- 9 ments; 10 (4) the MOE provisions ensure the continued 11 success of the Medicaid program and CHIP and 12 were written deliberately to specifically protect vul- 13 nerable and disabled individuals, children, and senior 14 citizens, many of whom are also members of commu- 15 nities of color; and 16 (5) the MOE provisions must be strictly en- 17 forced and proposals to weaken the MOE provisions 18 must not be considered in this time of recession. 19 SEC. 431. REPEAL OF REQUIREMENT FOR DOCUMENTA- 20 TION EVIDENCING CITIZENSHIP OR NATION- 21 ALITY UNDER THE MEDICAID PROGRAM. 22 (a) REPEAL.—Subsections (i)(22) and (x) of section 23 1903 of the Social Security Act (42 U.S.C. 1396b), as 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00253 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 254 •HR 2954 IH added by section 6036 of the Deficit Reduction Act of 1 2005, are each repealed. 2 (b) CONFORMING AMENDMENTS.— 3 (1) Section 1903 of the Social Security Act (42 4 U.S.C. 1396b) is amended— 5 (A) in subsection (i)— 6 (i) in paragraph (20), by adding ‘‘or’’ 7 after the semicolon at the end; and 8 (ii) in paragraph (21), by striking ‘‘; 9 or’’ and inserting a period; 10 (B) by redesignating subsection (y), as 11 added by section 6043(b) of the Deficit Reduc- 12 tion Act of 2005, as subsection (x); and 13 (C) by redesignating subsection (z), as 14 added by section 6081(a) of the Deficit Reduc- 15 tion Act of 2005, as subsection (y). 16 (2) Subsection (c) of section 6036 of the Deficit 17 Reduction Act of 2005 is repealed. 18 (c) EFFECTIVE DATE.—The repeals and amend- 19 ments made by this section shall take effect as if included 20 in the enactment of the Deficit Reduction Act of 2005. 21 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00254 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 255 •HR 2954 IH SEC. 432. OFFICE OF MINORITY HEALTH IN VETERANS 1 HEALTH ADMINISTRATION OF DEPARTMENT 2 OF VETERANS AFFAIRS. 3 (a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 4 I of chapter 73 of title 38, United States Code, is amended 5 by adding at the end the following new section: 6 ‘‘§ 7309. Office of Minority Health 7 ‘‘(a) ESTABLISHMENT.—There is established in the 8 Department within the Office of the Under Secretary for 9 Health an office to be known as the ‘Office of Minority 10 Health’ (in this section referred to as the ‘Office’). 11 ‘‘(b) HEAD.—The Director of the Office of Minority 12 Health shall be the head of the Office. The Director of 13 the Office of Minority Health shall be appointed by the 14 Under Secretary of Health from among individuals quali- 15 fied to perform the duties of the position. 16 ‘‘(c) FUNCTIONS.—The functions of the Office are as 17 follows: 18 ‘‘(1) To establish short-range and long-range 19 goals and objectives and coordinate all other activi- 20 ties within the Veterans Health Administration that 21 relate to disease prevention, health promotion, health 22 care services delivery, and health care research con- 23 cerning veterans who are members of a racial or eth- 24 nic minority group. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00255 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 256 •HR 2954 IH ‘‘(2) To support research, demonstrations, and 1 evaluations to test new and innovative models for 2 the discharge of activities described in paragraph 3 (1). 4 ‘‘(3) To increase knowledge and understanding 5 of health risk factors for veterans who are members 6 of a racial or ethnic minority group. 7 ‘‘(4) To develop mechanisms that support bet- 8 ter health care information dissemination, education, 9 prevention, and services delivery to veterans from 10 disadvantaged backgrounds, including veterans who 11 are members of a racial or ethnic minority group. 12 ‘‘(5) To enter into contracts or agreements with 13 appropriate public and nonprofit private entities to 14 develop and carry out programs to provide bilingual 15 or interpretive services to assist veterans who are 16 members of a racial or ethnic minority group and 17 who lack proficiency in speaking the English lan- 18 guage in accessing and receiving health care services 19 through the Veterans Health Administration. 20 ‘‘(6) To carry out programs to improve access 21 to health care services through the Veterans Health 22 Administration for veterans with limited proficiency 23 in speaking the English language, including the de- 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00256 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 257 •HR 2954 IH velopment and evaluation of demonstration and pilot 1 projects for that purpose. 2 ‘‘(7) To advise the Under Secretary of Health 3 on matters relating to the development, implementa- 4 tion, and evaluation of health professions education 5 in decreasing disparities in health care outcomes be- 6 tween veterans who are members of a racial or eth- 7 nic minority group and other veterans, including 8 cutural competency as a method of eliminating such 9 health disparities. 10 ‘‘(8) To perform such other functions and du- 11 ties as the Secretary or the Under Secretary for 12 Health considers appropriate. 13 ‘‘(d) DEFINITIONS.—In this section: 14 ‘‘(1) The term ‘racial or ethnic minority group’ 15 means the following: 16 ‘‘(A) American Indians (including Alaska 17 Natives, Eskimos, and Aleuts). 18 ‘‘(B) Asian Americans. 19 ‘‘(C) Native Hawaiians and other Pacific 20 Islanders. 21 ‘‘(D) Blacks. 22 ‘‘(E) Hispanics. 23 ‘‘(2) The term ‘Hispanic’ means individuals 24 whose origin is Mexican, Puerto Rican, Cuban, Cen- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00257 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 258 •HR 2954 IH tral or South American, or any other Spanish-speak- 1 ing country.’’. 2 SEC. 433. ACCESS FOR NATIVE AMERICANS UNDER PPACA. 3 (a) IN GENERAL.—Title I of the Patient Protection 4 and Affordable Care Act is amended— 5 (1) in section 1311(c)(6)(D), by striking ‘‘(as 6 defined in section 4 of the Indian Health Care Im- 7 provement Act)’’ and inserting ‘‘(as defined in sec- 8 tion 447.50(b)(1) of title 42 of the Code of Federal 9 Regulations, as in effect on July 1, 2010)’’; and 10 (2) in section 1402(d)(1), by striking ‘‘(as de- 11 fined in section 4(d) of the Indian Self-Determina- 12 tion and Education Assistance Act (25 U.S.C. 13 450b(d)))’’ and inserting (f) ‘‘(as defined in section 14 447.50(b)(1) of title 42 of the Code of Federal Reg- 15 ulations, as in effect on July 1, 2010)’’. 16 (b) INDIVIDUAL MANDATE.—In section 5000A(e)(3) 17 of the Internal Revenue Code of 1986, by striking ‘‘(as 18 defined in section 45A(c)(6))’’ and inserting ‘‘(as defined 19 in section 447.50(b)(1) of title 42 of the Code of Federal 20 Regulations, as in effect on July 1, 2010)’’. 21 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00258 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 259 •HR 2954 IH TITLE V—IMPROVING HEALTH 1 OUTCOMES FOR WOMEN, 2 CHILDREN, AND FAMILIES 3 SEC. 501. GRANTS TO PROMOTE POSITIVE HEALTH BEHAV- 4 IORS IN WOMEN AND CHILDREN. 5 Part Q of title III of the Public Health Service Act 6 (42 U.S.C. 280g et seq.) is amended by adding at the end 7 the following: 8 ‘‘SEC. 399Z–2. GRANTS TO PROMOTE POSITIVE HEALTH BE- 9 HAVIORS IN WOMEN AND CHILDREN. 10 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col- 11 laboration with the Director of the Centers for Disease 12 Control and Prevention and other Federal officials deter- 13 mined appropriate by the Secretary, is authorized to 14 award grants to eligible entities to promote positive health 15 behaviors for women and children in target populations, 16 especially racial and ethnic minority women and children 17 in medically underserved communities. 18 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 19 subsection (a) may be used to support community health 20 workers— 21 ‘‘(1) to educate and provide outreach regarding 22 enrollment in health insurance including the State 23 Children’s Health Insurance Program under title 24 XXI of the Social Security Act, Medicare under title 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00259 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 260 •HR 2954 IH XVIII of such Act, and Medicaid under title XIX of 1 such Act; 2 ‘‘(2) to educate, guide, and provide outreach in 3 a community setting regarding health problems prev- 4 alent among women and children and especially 5 among racial and ethnic minority women and chil- 6 dren; 7 ‘‘(3) to educate, guide, and provide experiential 8 learning opportunities that target behavioral risk 9 factors including— 10 ‘‘(A) poor nutrition; 11 ‘‘(B) physical inactivity; 12 ‘‘(C) being overweight or obese; 13 ‘‘(D) tobacco use; 14 ‘‘(E) alcohol and substance use; 15 ‘‘(F) injury and violence; 16 ‘‘(G) risky sexual behavior; 17 ‘‘(H) mental health problems; 18 ‘‘(I) musculoskeletal health; 19 ‘‘(J) dental and oral health problems; and 20 ‘‘(K) understanding informed consent; 21 ‘‘(4) to educate and guide regarding effective 22 strategies to promote positive health behaviors with- 23 in the family; 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00260 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 261 •HR 2954 IH ‘‘(5) to promote community wellness and aware- 1 ness; and 2 ‘‘(6) to educate and refer target populations to 3 appropriate health care agencies and community- 4 based programs and organizations in order to in- 5 crease access to quality health care services, includ- 6 ing preventive health services. 7 ‘‘(c) APPLICATION.— 8 ‘‘(1) IN GENERAL.—Each eligible entity that 9 desires to receive a grant under subsection (a) shall 10 submit an application to the Secretary, at such time, 11 in such manner, and accompanied by such additional 12 information as the Secretary may require. 13 ‘‘(2) CONTENTS.—Each application submitted 14 pursuant to paragraph (1) shall— 15 ‘‘(A) describe the activities for which as- 16 sistance under this section is sought; 17 ‘‘(B) contain an assurance that with re- 18 spect to each community health worker pro- 19 gram receiving funds under the grant awarded, 20 such program provides training and supervision 21 to community health workers to enable such 22 workers to provide authorized program services; 23 ‘‘(C) contain an assurance that the appli- 24 cant will evaluate the effectiveness of commu- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00261 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 262 •HR 2954 IH nity health worker programs receiving funds 1 under the grant; 2 ‘‘(D) contain an assurance that each com- 3 munity health worker program receiving funds 4 under the grant will provide services in the cul- 5 tural context most appropriate for the individ- 6 uals served by the program; 7 ‘‘(E) contain a plan to document and dis- 8 seminate project description and results to 9 other States and organizations as identified by 10 the Secretary; and 11 ‘‘(F) describe plans to enhance the capac- 12 ity of individuals to utilize health services and 13 health-related social services under Federal, 14 State, and local programs by— 15 ‘‘(i) assisting individuals in estab- 16 lishing eligibility under the programs and 17 in receiving the services or other benefits 18 of the programs; and 19 ‘‘(ii) providing other services as the 20 Secretary determines to be appropriate, 21 that may include transportation and trans- 22 lation services. 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00262 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 263 •HR 2954 IH ‘‘(d) PRIORITY.—In awarding grants under sub- 1 section (a), the Secretary shall give priority to those appli- 2 cants— 3 ‘‘(1) who propose to target geographic areas— 4 ‘‘(A) with a high percentage of residents 5 who are eligible for health insurance but are 6 uninsured or underinsured; and 7 ‘‘(B) with a high percentage of families for 8 whom English is not their primary language; 9 ‘‘(2) with experience in providing health or 10 health-related social services to individuals who are 11 underserved with respect to such services; and 12 ‘‘(3) with documented community activity and 13 experience with community health workers. 14 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU- 15 TIONS.—The Secretary shall encourage community health 16 worker programs receiving funds under this section to col- 17 laborate with academic institutions, including minority- 18 serving institutions. Nothing in this section shall be con- 19 strued to require such collaboration. 20 ‘‘(f) QUALITY ASSURANCE AND 21 COSTEFFECTIVENESS.—The Secretary shall establish 22 guidelines for assuring the quality of the training and su- 23 pervision of community health workers under the pro- 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00263 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 264 •HR 2954 IH grams funded under this section and for assuring the 1 costeffectiveness of such programs. 2 ‘‘(g) MONITORING.—The Secretary shall monitor 3 community health worker programs identified in approved 4 applications and shall determine whether such programs 5 are in compliance with the guidelines established under 6 subsection (f). 7 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 8 provide technical assistance to community health worker 9 programs identified in approved applications with respect 10 to planning, developing, and operating programs under the 11 grant. 12 ‘‘(i) REPORT TO CONGRESS.— 13 ‘‘(1) IN GENERAL.—Not later than 4 years 14 after the date on which the Secretary first awards 15 grants under subsection (a), the Secretary shall sub- 16 mit to Congress a report regarding the grant 17 project. 18 ‘‘(2) CONTENTS.—The report required under 19 paragraph (1) shall include the following: 20 ‘‘(A) A description of the programs for 21 which grant funds were used. 22 ‘‘(B) The number of individuals served. 23 ‘‘(C) An evaluation of— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00264 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 265 •HR 2954 IH ‘‘(i) the effectiveness of these pro- 1 grams; 2 ‘‘(ii) the cost of these programs; and 3 ‘‘(iii) the impact of the project on the 4 health outcomes of the community resi- 5 dents. 6 ‘‘(D) Recommendations for sustaining the 7 community health worker programs developed 8 or assisted under this section. 9 ‘‘(E) Recommendations regarding training 10 to enhance career opportunities for community 11 health workers. 12 ‘‘(j) DEFINITIONS.—In this section: 13 ‘‘(1) COMMUNITY HEALTH WORKER.—The term 14 ‘community health worker’ means an individual who 15 promotes health or nutrition within the community 16 in which the individual resides— 17 ‘‘(A) by serving as a liaison between com- 18 munities and health care agencies; 19 ‘‘(B) by providing guidance and social as- 20 sistance to community residents; 21 ‘‘(C) by enhancing community residents’ 22 ability to effectively communicate with health 23 care providers; 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00265 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 266 •HR 2954 IH ‘‘(D) by providing culturally and linguis- 1 tically appropriate health or nutrition edu- 2 cation; 3 ‘‘(E) by advocating for individual and com- 4 munity health, including dental, oral, mental, 5 and environmental health, or nutrition needs; 6 and 7 ‘‘(F) by providing referral and followup 8 services. 9 ‘‘(2) COMMUNITY SETTING.—The term ‘commu- 10 nity setting’ means a home or a community organi- 11 zation located in the neighborhood in which a partic- 12 ipant resides. 13 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en- 14 tity’ means— 15 ‘‘(A) a unit of State, territorial, local, or 16 tribal government (including a federally recog- 17 nized tribe or Alaska Native village); or 18 ‘‘(B) a community-based organization. 19 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 20 The term ‘medically underserved community’ means 21 a community— 22 ‘‘(A) that has a substantial number of in- 23 dividuals who are members of a medically un- 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00266 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 267 •HR 2954 IH derserved population, as defined by section 1 330(b)(3); and 2 ‘‘(B) a significant portion of which is a 3 health professional shortage area as designated 4 under section 332. 5 ‘‘(5) SUPPORT.—The term ‘support’ means the 6 provision of training, supervision, and materials 7 needed to effectively deliver the services described in 8 subsection (b), reimbursement for services, and 9 other benefits. 10 ‘‘(6) TARGET POPULATION.—The term ‘target 11 population’ means women of reproductive age, re- 12 gardless of their current childbearing status and 13 children under 21 years of age. 14 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 15 are authorized to be appropriated to carry out this section 16 $15,000,000 for each of fiscal years 2012 through 2016.’’. 17 SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NU- 18 TRITION ASSISTANCE FOR CHILDREN, PREG- 19 NANT WOMEN, AND LAWFULLY PRESENT IN- 20 DIVIDUALS. 21 (a) MEDICAID.—Section 1903(v) of the Social Secu- 22 rity Act (42 U.S.C. 1396b(v)) is amended by striking 23 paragraph (4) and inserting the following new paragraph: 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00267 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 268 •HR 2954 IH ‘‘(4)(A) Notwithstanding sections 401(a), 1 402(b), 403, and 421 of the Personal Responsibility 2 and Work Opportunity Reconciliation Act of 1996, 3 payment shall be made under this section for care 4 and services that are furnished to aliens, including 5 those described in paragraph (1), if they otherwise 6 meet the eligibility requirements for medical assist- 7 ance under the State plan approved under this sub- 8 chapter (other than the requirement of the receipt of 9 aid or assistance under title IV, supplemental secu- 10 rity income benefits under title XVI, or a State sup- 11 plementary payment), and are— 12 ‘‘(i) lawfully present in the United 13 States; 14 ‘‘(ii) children under 21 years of age, 15 including any optional targeted low-income 16 child (as such term is defined in section 17 1905(u)(2)(B)); or 18 ‘‘(iii) pregnant women during preg- 19 nancy and during the 60-day period begin- 20 ning on the last day of the pregnancy. 21 ‘‘(B) No debt shall accrue under an affidavit of 22 support against any sponsor of such an alien on the 23 basis of provision of assistance to such alien under 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00268 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 269 •HR 2954 IH this paragraph and the cost of such assistance shall 1 not be considered as an unreimbursed cost.’’. 2 (b) SCHIP.—Section 2107(e)(1) of the Social Secu- 3 rity Act (42 U.S.C. 1397gg(e)(1)) is amended by amend- 4 ing subparagraph (J) to read as follows: 5 ‘‘(J) Paragraph (4) of section 1903(v) (re- 6 lating to individuals who, but for sections 7 401(a), 403, and 421 of the Personal Responsi- 8 bility and Work Opportunity Reconciliation Act 9 of 1996, would be eligible for medical assistance 10 under title XXI).’’. 11 (c) SUPPLEMENTAL NUTRITION ASSISTANCE.—Not- 12 withstanding sections 401(a), 402(a), and 403(a) of the 13 Personal Responsibility and Work Opportunity Reconcili- 14 ation Act of 1996 (8 U.S.C. 1611(a); 1612(a); 1613(a)) 15 and section 6(f) of the Food and Nutrition Act of 2008 16 (7 U.S.C. 2015(f)), persons who are lawfully present in 17 the United States shall be not be ineligible for benefits 18 under the supplemental nutrition assistance program on 19 the basis of their immigration status or date of entry into 20 the United States. 21 (d) ELIGIBILITY FOR FAMILIES WITH CHILDREN.— 22 Section of the 421(d)(3) of the Personal Responsibility 23 and Work Opportunity Reconciliation Act of 1996 (8 24 U.S.C. 1631(d)(3)) is amended by striking ‘‘to the extent 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00269 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 270 •HR 2954 IH that a qualified alien is eligible under section 1 402(a)(2)(J)’’ and inserting, ‘‘to the extent that a child 2 is a member of a household under the supplemental nutri- 3 tion assistance program’’. 4 (e) ENSURING PROPER SCREENING.—Section 5 11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 6 U.S.C. 2020(e)(2)(B)) is amended— 7 (1) by redesignating clauses (vi) and (vii) as 8 clauses (vii) and (viii); and 9 (2) by inserting after clause (v) the following: 10 ‘‘(vi) shall provide a method for imple- 11 menting section 421 of the Personal Re- 12 sponsibility and Work Opportunity Rec- 13 onciliation Act of 1996 (8 U.S.C. 1631) 14 that does not require any unnecessary in- 15 formation from persons who may be ex- 16 empt from that provision;’’. 17 SEC. 503. REPEAL OF DENIAL OF BENEFITS. 18 Section 115 of the Personal Responsibility and Work 19 Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) 20 is amended— 21 (1) in subsection (a) by striking paragraph (2); 22 (2) in subsection (b) by striking paragraph (2); 23 and 24 (3) in subsection (e) by striking paragraph (2). 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00270 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 271 •HR 2954 IH SEC. 504. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 1 AND AWARENESS. 2 (a) IN GENERAL.—The Secretary shall establish and 3 implement a birth defects prevention and public awareness 4 program, consisting of the activities described in sub- 5 sections (c) and (d). 6 (b) DEFINITIONS.—In this section: 7 (1) The term ‘‘pregnancy and breastfeeding in- 8 formation services’’ includes only— 9 (A) information services to provide accu- 10 rate, evidence-based, clinical information re- 11 garding maternal exposures during pregnancy 12 that may be associated with birth defects or 13 other health risks, such as exposures to medica- 14 tions, chemicals, infections, foodborne patho- 15 gens, illnesses, nutrition, or lifestyle factors; 16 (B) information services to provide accu- 17 rate, evidence-based, clinical information re- 18 garding maternal exposures during breast- 19 feeding that may be associated with health risks 20 to a breast-fed infant, such as exposures to 21 medications, chemicals, infections, foodborne 22 pathogens, illnesses, nutrition, or lifestyle fac- 23 tors; 24 (C) the provision of accurate, evidence- 25 based information weighing risks of exposures 26 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00271 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 272 •HR 2954 IH during breastfeeding against the benefits of 1 breastfeeding; and 2 (D) the provision of information described 3 in subparagraph (A), (B), or (C) through coun- 4 selors, Web sites, fact sheets, telephonic or elec- 5 tronic communication, community outreach ef- 6 forts, or other appropriate means. 7 (2) The term ‘‘Secretary’’ means the Secretary 8 of Health and Human Services, acting through the 9 Director of the Centers for Disease Control and Pre- 10 vention. 11 (c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 12 subsection (a), the Secretary shall conduct or support a 13 nationwide media campaign to increase awareness among 14 health care providers and at-risk populations about preg- 15 nancy and breastfeeding information services. 16 (d) GRANTS FOR PREGNANCY AND BREASTFEEDING 17 INFORMATION SERVICES.— 18 (1) IN GENERAL.—In carrying out subsection 19 (a), the Secretary shall award grants to State or re- 20 gional agencies or organizations for any of the fol- 21 lowing: 22 (A) INFORMATION SERVICES.—The provi- 23 sion of, or campaigns to increase awareness 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00272 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 273 •HR 2954 IH about, pregnancy and breastfeeding information 1 services. 2 (B) SURVEILLANCE AND RESEARCH.—The 3 conduct or support of— 4 (i) surveillance of or research on— 5 (I) maternal exposures and ma- 6 ternal health conditions that may in- 7 fluence the risk of birth defects, pre- 8 maturity, or other adverse pregnancy 9 outcomes; and 10 (II) maternal exposures that may 11 influence health risks to a breastfed 12 infant; or 13 (ii) networking to facilitate surveil- 14 lance or research described in this sub- 15 paragraph. 16 (2) PREFERENCE FOR CERTAIN STATES.—The 17 Secretary, in making any grant under this sub- 18 section, shall give preference to States, otherwise 19 equally qualified, that have or had a pregnancy and 20 breastfeeding information service in place on or after 21 January 1, 2006. 22 (3) MATCHING FUNDS.—The Secretary may 23 only award a grant under this subsection to a State 24 or regional agency or organization that agrees, with 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00273 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 274 •HR 2954 IH respect to the costs to be incurred in carrying out 1 the grant activities, to make available (directly or 2 through donations from public or private entities) 3 non-Federal funds toward such costs in an amount 4 equal to not less than 25 percent of the amount of 5 the grant. 6 (4) COORDINATION.—The Secretary shall en- 7 sure that activities funded through a grant under 8 this subsection are coordinated, to the maximum ex- 9 tent practicable, with other birth defects prevention 10 and environmental health activities of the Federal 11 Government, including with respect to pediatric envi- 12 ronmental health specialty units and children’s envi- 13 ronmental health centers. 14 (e) EVALUATION.—In furtherance of the program 15 under subsection (a), the Secretary shall provide for an 16 evaluation of pregnancy and breastfeeding information 17 services to identify efficient and effective models of— 18 (1) providing information; 19 (2) raising awareness and increasing knowledge 20 about birth defects prevention measures; 21 (3) modifying risk behaviors; or 22 (4) other outcome measures as determined ap- 23 propriate by the Secretary. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00274 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 275 •HR 2954 IH (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 1 out this section, there are authorized to be appropriated 2 $5,000,000 for fiscal year 2012, $6,000,000 for fiscal year 3 2013, $7,000,000 for fiscal year 2014, $8,000,000 for fis- 4 cal year 2015, and $9,000,000 for fiscal year 2016. 5 SEC. 505. UNIFORM STATE MATERNAL MORTALITY REVIEW 6 COMMITTEES ON PREGNANCY-RELATED 7 DEATHS. 8 (a) CONDITION OF RECEIPT OF PAYMENTS FROM 9 ALLOTMENT UNDER MATERNAL AND CHILD HEALTH 10 SERVICE BLOCK GRANT.—Title V of the Social Security 11 Act (42 U.S.C. 701 et seq.) is amended by adding at the 12 end the following new section: 13 ‘‘SEC. 514. UNIFORM STATE MATERNAL MORTALITY RE- 14 VIEW COMMITTEES ON PREGNANCY-RE- 15 LATED DEATHS. 16 ‘‘(a) GRANTS.— 17 ‘‘(1) IN GENERAL.—Notwithstanding any other 18 provision of this title, for each of fiscal years 2012 19 through 2018, in addition to payments from allot- 20 ments for States under section 502 for such year, 21 the Secretary shall, subject to paragraph (3) and in 22 accordance with the criteria established under para- 23 graph (2), award grants to States to— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00275 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 276 •HR 2954 IH ‘‘(A) carry out the activities described in 1 subsection (b)(1); 2 ‘‘(B) establish a State maternal mortality 3 review committee, in accordance with subsection 4 (b)(2), to carry out the activities described in 5 subsection (b)(2)(A), and to establish the proc- 6 esses described in subsection (b)(1); 7 ‘‘(C) ensure the State department of 8 health carries out the applicable activities de- 9 scribed in subsection (b)(3), with respect to 10 pregnancy-related deaths occurring within the 11 State during such fiscal year; 12 ‘‘(D) implement and use the comprehensive 13 case abstraction form developed under sub- 14 section (c), in accordance with such subsection; 15 and 16 ‘‘(E) provide for public disclosure of infor- 17 mation, in accordance with subsection (e). 18 ‘‘(2) CRITERIA.—The Secretary shall establish 19 criteria for determining eligibility for and the 20 amount of a grant awarded to a State under para- 21 graph (1). Such criteria shall provide that in the 22 case of a State that receives such a grant for a fiscal 23 year and is determined by the Secretary to have not 24 used such grant in accordance with this section, 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00276 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 277 •HR 2954 IH such State shall not be eligible for such a grant for 1 any subsequent fiscal year. 2 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 3 For purposes of carrying out the grant program 4 under this section, including for administrative pur- 5 poses, there is authorized to be appropriated 6 $10,000,000 for each of fiscal years 2012 through 7 2018. 8 ‘‘(b) PREGNANCY-RELATED DEATH REVIEW.— 9 ‘‘(1) REVIEW OF PREGNANCY-RELATED DEATH 10 AND PREGNANCY-ASSOCIATED DEATH CASES.—For 11 purposes of subsection (a), with respect to a State 12 that receives a grant under subsection (a), the fol- 13 lowing shall apply: 14 ‘‘(A) MANDATORY REPORTING OF PREG- 15 NANCY-RELATED DEATHS.— 16 ‘‘(i) IN GENERAL.—The State shall, 17 through the State maternal mortality re- 18 view committee, develop a process, sepa- 19 rate from any reporting process established 20 by the State department of health prior to 21 the date of the enactment of this section, 22 that provides for mandatory and confiden- 23 tial case reporting by individuals and enti- 24 ties described in clause (ii) of pregnancy- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00277 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 278 •HR 2954 IH related deaths to the State department of 1 health. 2 ‘‘(ii) INDIVIDUALS AND ENTITIES DE- 3 SCRIBED.—Individuals and entities de- 4 scribed in this clause include each of the 5 following: 6 ‘‘(I) Health care providers. 7 ‘‘(II) Medical examiners. 8 ‘‘(III) Medical coroners. 9 ‘‘(IV) Hospitals. 10 ‘‘(V) Free-standing birth centers. 11 ‘‘(VI) Other health care facilities. 12 ‘‘(VII) Any other individuals re- 13 sponsible for completing death certifi- 14 cates. 15 ‘‘(VIII) Any other appropriate in- 16 dividuals or entities specified by the 17 Secretary. 18 ‘‘(B) VOLUNTARY REPORTING OF PREG- 19 NANCY-RELATED AND PREGNANCY-ASSOCIATED 20 DEATHS.— 21 ‘‘(i) The State shall, through the 22 State maternal mortality review committee, 23 develop a process for and encourage, sepa- 24 rate from any reporting process established 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00278 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 279 •HR 2954 IH by the State department of health prior to 1 the date of the enactment of this section, 2 voluntary and confidential case reporting 3 by individuals described in clause (ii) of 4 pregnancy-associated deaths to the State 5 department of health. 6 ‘‘(ii) The State shall, through the 7 State maternal mortality review committee, 8 develop a process for voluntary and con- 9 fidential reporting by family members of 10 the deceased and by other individuals on 11 possible pregnancy-related and pregnancy- 12 associated deaths to the State department 13 of health. Such process shall include— 14 ‘‘(I) making publicly available on 15 the Internet Web site of the State de- 16 partment of health a telephone num- 17 ber, Internet Web link, and email ad- 18 dress for such reporting; and 19 ‘‘(II) publicizing to local profes- 20 sional organizations, community orga- 21 nizations, and social services agencies 22 the availability of the telephone num- 23 ber, Internet Web link, and email ad- 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00279 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 280 •HR 2954 IH dress made available under subclause 1 (I). 2 ‘‘(C) DEVELOPMENT OF CASE-FINDING.— 3 The State, through the vital statistics unit of 4 the State, shall annually identify pregnancy-re- 5 lated and pregnancy-associated deaths occur- 6 ring in such State during the year involved 7 by— 8 ‘‘(i) matching all death records, with 9 respect to such year, for women of child- 10 bearing age to live birth certificates and in- 11 fant death certificates to identify deaths of 12 women that occurred during pregnancy 13 and within one year after the end of a 14 pregnancy; 15 ‘‘(ii) identifying deaths reported dur- 16 ing such year as having an underlying or 17 contributing cause of death related to 18 pregnancy, regardless of the time that has 19 passed between the end of the pregnancy 20 and the death; 21 ‘‘(iii) collecting data from medical ex- 22 aminer and coroner reports; and 23 ‘‘(iv) any other methods the States 24 may devise to identify maternal deaths, 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00280 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 281 •HR 2954 IH such as through review of a random sam- 1 ple of reported deaths of women of child- 2 bearing age to ascertain cases of preg- 3 nancy-related and pregnancy-associated 4 deaths that are not discernable from a re- 5 view of death certificates alone. 6 When feasible and for purposes of effectively 7 collecting and obtaining data on pregnancy-re- 8 lated and pregnancy-associated deaths, the 9 State shall adopt the most recent standardized 10 birth and death certificates, as issued by the 11 National Center for Vital Health Statistics, in- 12 cluding the recommended checkbox section for 13 pregnancy on the death certificates. 14 ‘‘(D) CASE INVESTIGATION AND DEVELOP- 15 MENT OF CASE SUMMARIES.—Following receipt 16 of reports by the State department of health 17 pursuant to subparagraph (A) or (B) and col- 18 lection by the vital statistics unit of the State 19 of possible cases of pregnancy-related and preg- 20 nancy-associated deaths pursuant to subpara- 21 graph (C), the State, through the State mater- 22 nal mortality review committee established 23 under subsection (a), shall investigate each 24 case, utilizing the case abstraction form de- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00281 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 282 •HR 2954 IH scribed in subsection (c), and prepare de-identi- 1 fied case summaries, which shall be reviewed by 2 the committee and included in applicable re- 3 ports. For purposes of subsection (a), under the 4 processes established under subparagraphs (A), 5 (B), and (C), a State department of health or 6 vital statistics unit of a State shall provide to 7 the State maternal mortality review committee 8 access to information collected pursuant to such 9 subparagraphs as necessary to carry out this 10 subparagraph. Data and information collected 11 for the case summary and review are for pur- 12 poses of public health activities, in accordance 13 with HIPAA privacy and security law (as de- 14 fined in section 3009(a)(2) of the Public Health 15 Service Act). Such case investigations shall in- 16 clude data and information obtained through— 17 ‘‘(i) medical examiner and autopsy re- 18 ports of the woman involved; 19 ‘‘(ii) medical records of the woman, 20 including such records related to health 21 care prior to pregnancy, prenatal and post- 22 natal care, labor and delivery care, emer- 23 gency room care, hospital discharge 24 records, and any care delivered up until 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00282 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 283 •HR 2954 IH the time of death of the woman for pur- 1 poses of public health activities, in accord- 2 ance with HIPAA privacy and security law 3 (as defined in section 3009(a)(2) of the 4 Public Health Service Act); 5 ‘‘(iii) oral and written interviews of in- 6 dividuals directly involved in the maternal 7 care of the woman during and immediately 8 following the pregnancy of the woman, in- 9 cluding health care, mental health, and so- 10 cial service providers, as applicable; 11 ‘‘(iv) optional oral or written inter- 12 views of the family of the woman; 13 ‘‘(v) socioeconomic and other relevant 14 background information about the woman; 15 ‘‘(vi) information collected in subpara- 16 graph (C)(i); and 17 ‘‘(vii) other information on the cause 18 of death of the woman, such as social serv- 19 ices and child welfare reports. 20 ‘‘(2) STATE MATERNAL MORTALITY REVIEW 21 COMMITTEES.— 22 ‘‘(A) DUTIES.— 23 ‘‘(i) REQUIRED COMMITTEE ACTIVI- 24 TIES.—For purposes of subsection (a), a 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00283 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 284 •HR 2954 IH maternal mortality review committee estab- 1 lished by a State pursuant to a grant 2 under such subsection shall carry out the 3 following pregnancy-related death and 4 pregnancy-associated death review activi- 5 ties and shall include all information rel- 6 evant to the death involved on the case ab- 7 straction form developed under subsection 8 (d): 9 ‘‘(I) With respect to a case of 10 pregnancy-related or pregnancy-asso- 11 ciated death of a woman, review the 12 case summaries prepared under sub- 13 paragraphs (A), (B), (C), and (D) of 14 paragraph (1). 15 ‘‘(II) Review aggregate statistical 16 reports developed by the vital statis- 17 tics unit of the State under paragraph 18 (1)(C) regarding pregnancy-related 19 and pregnancy-associated deaths to 20 identify trends, patterns, and dispari- 21 ties in adverse outcomes and address 22 medical, non-medical, and system-re- 23 lated factors that may have contrib- 24 uted to such pregnancy-related and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00284 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 285 •HR 2954 IH pregnancy-associated deaths and dis- 1 parities. 2 ‘‘(III) Develop recommendations, 3 based on the review of the case sum- 4 maries under paragraph (1)(D) and 5 aggregate statistical reports under 6 subclause (II), to improve maternal 7 care, social and health services, and 8 public health policy and institutions, 9 including with respect to improving 10 access to maternal care, improving the 11 availability of social services, and 12 eliminating disparities in maternal 13 care and outcomes. 14 ‘‘(ii) OPTIONAL COMMITTEE ACTIVI- 15 TIES.—For purposes of subsection (a), a 16 maternal mortality review committee estab- 17 lished by a State under such subsection 18 may present findings and recommendations 19 regarding a specific case or set of cir- 20 cumstances directly to a health care facil- 21 ity or its local or State professional organi- 22 zation for the purpose of instituting policy 23 changes, educational activities, or other- 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00285 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 286 •HR 2954 IH wise improving the quality of care provided 1 by the facilities. 2 ‘‘(B) COMPOSITION OF MATERNAL MOR- 3 TALITY REVIEW COMMITTEES.— 4 ‘‘(i) IN GENERAL.—Each State mater- 5 nal mortality review committee established 6 pursuant to a grant under subsection (a) 7 shall be multi-disciplinary, consisting of 8 health care and social service providers, 9 public health officials, other persons with 10 professional expertise on maternal health 11 and mortality, and patient and community 12 advocates who represent those communities 13 within such State that are the most af- 14 fected by maternal mortality. Membership 15 on such a committee of a State shall be re- 16 viewed annually by the State department 17 of health to ensure that membership rep- 18 resentation requirements are being fulfilled 19 in accordance with this paragraph. 20 ‘‘(ii) REQUIRED MEMBERSHIP.—Each 21 such review committee shall include— 22 ‘‘(I) representatives from medical 23 specialities providing care to pregnant 24 and postpartum patients, including 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00286 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 287 •HR 2954 IH obstetricians (including generalists 1 and maternal fetal medicine special- 2 ists), and family practice physicians; 3 ‘‘(II) certified nurse midwives, 4 certified midwives, and advanced prac- 5 tice nurses; 6 ‘‘(III) hospital-based nurses; 7 ‘‘(IV) representatives of the State 8 department of health maternal and 9 child health department; 10 ‘‘(V) social service providers or 11 social workers; 12 ‘‘(VI) the chief medical exam- 13 iners or designees; 14 ‘‘(VII) facility representatives, 15 such as from hospitals or free-stand- 16 ing birth centers; and 17 ‘‘(VIII) community or patient ad- 18 vocates who represent those commu- 19 nities within the State that are the 20 most affected by maternal mortality. 21 ‘‘(iii) ADDITIONAL MEMBERS.—Each 22 such review committee may also include 23 representatives from other relevant aca- 24 demic, health, social service, or policy pro- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00287 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 288 •HR 2954 IH fessions, or community organizations, on 1 an ongoing basis, or as needed, as deter- 2 mined beneficial by the review committee, 3 including— 4 ‘‘(I) anesthesiologists; 5 ‘‘(II) emergency physicians; 6 ‘‘(III) pathologists; 7 ‘‘(IV) epidemiologists or biostat- 8 isticians; 9 ‘‘(V) intensivists; 10 ‘‘(VI) vital statistics officers; 11 ‘‘(VII) nutritionists; 12 ‘‘(VIII) mental health profes- 13 sionals; 14 ‘‘(IX) substance abuse treatment 15 specialists; 16 ‘‘(X) representatives of relevant 17 advocacy groups; 18 ‘‘(XI) academics; 19 ‘‘(XII) representatives of bene- 20 ficiaries of the State plan under the 21 Medicaid program under title XIX; 22 ‘‘(XIII) paramedics; 23 ‘‘(XIV) lawyers; 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00288 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 289 •HR 2954 IH ‘‘(XV) risk management special- 1 ists; 2 ‘‘(XVI) representatives of the de- 3 partments of health or public health 4 of major cities in the State involved; 5 and 6 ‘‘(XVII) policy makers. 7 ‘‘(iv) DIVERSE COMMUNITY MEMBER- 8 SHIP.—The composition of such a com- 9 mittee, with respect to a State, shall in- 10 clude— 11 ‘‘(I) representatives from diverse 12 communities, particularly those com- 13 munities within such State most se- 14 verely affected by pregnancy-related 15 deaths or pregnancy-associated deaths 16 and by a lack of access to relevant 17 maternal care services, from commu- 18 nity maternal child health organiza- 19 tions, and from minority advocacy 20 groups; 21 ‘‘(II) members, including health 22 care providers, from different geo- 23 graphic regions in the State, including 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00289 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 290 •HR 2954 IH any rural, urban, and tribal areas; 1 and 2 ‘‘(III) health care and social serv- 3 ice providers who work in commu- 4 nities that are diverse with regard to 5 race, ethnicity, immigration status, 6 Indigenous status, and English pro- 7 ficiency. 8 ‘‘(v) MATERNAL MORTALITY REVIEW 9 STAFF.—Staff of each such review com- 10 mittee shall include— 11 ‘‘(I) vital health statisticians, ma- 12 ternal child health statisticians, or 13 epidemiologists; 14 ‘‘(II) a coordinator of the State 15 maternal mortality review committee, 16 to be designated by the State; and 17 ‘‘(III) administrative staff. 18 ‘‘(C) OPTION FOR STATES TO FORM RE- 19 GIONAL MATERNAL MORTALITY REVIEWS.— 20 States with a low rate of occurrence of preg- 21 nancy-associated or pregnancy-related deaths 22 may choose to partner with one or more neigh- 23 boring States to fulfill the activities described in 24 paragraph (1)(C). In such a case, with respect 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00290 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 291 •HR 2954 IH to States in such a partnership, any require- 1 ment under this section relating to the report- 2 ing of information related to such activities 3 shall be deemed to be fulfilled by each such 4 State if a single such report is submitted for 5 the partnership. 6 ‘‘(3) STATE DEPARTMENT OF HEALTH ACTIVI- 7 TIES.—For purposes of subsection (a), a State de- 8 partment of health of a State receiving a grant 9 under such subsection shall— 10 ‘‘(A) in consultation with the maternal 11 mortality review committee of the State and in 12 conjunction with relevant professional organiza- 13 tions, develop a plan for ongoing health care 14 provider education, based on the findings and 15 recommendations of the committee, in order to 16 improve the quality of maternal care; and 17 ‘‘(B) take steps to widely disseminate the 18 findings and recommendations of the State ma- 19 ternal mortality review committees of the State 20 and to implement the recommendations of such 21 committee. 22 ‘‘(c) CASE ABSTRACTION FORM.— 23 ‘‘(1) DEVELOPMENT.—The Director of the Cen- 24 ters for Disease Control and Prevention shall de- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00291 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 292 •HR 2954 IH velop a uniform, comprehensive case abstraction 1 form and make such form available to States for 2 State maternal mortality review committees for use 3 by such committees in order to— 4 ‘‘(A) ensure that the cases and information 5 collected and reviewed by such committees can 6 be pooled for review by the Department of 7 Health and Human Services and its agencies; 8 and 9 ‘‘(B) preserve the uniformity of the infor- 10 mation and its use for Federal public health 11 purposes. 12 ‘‘(2) PERMISSIBLE STATE MODIFICATION.— 13 Each State may modify the form developed under 14 paragraph (1) for implementation and use by such 15 State or by the State maternal mortality review com- 16 mittee of such State by including on such form addi- 17 tional information to be collected, but may not alter 18 the standard questions on such form, in order to en- 19 sure that the information can be collected and re- 20 viewed centrally at the Federal level. 21 ‘‘(d) TREATMENT AS PUBLIC HEALTH AUTHORITY 22 FOR PURPOSES OF HIPAA.—For purposes of applying 23 HIPAA privacy and security law (as defined in section 24 3009(a)(2) of the Public Health Service Act), a State ma- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00292 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 293 •HR 2954 IH ternal mortality review committee of a State established 1 pursuant to this section to carry out activities described 2 in subsection (b)(2)(A) shall be deemed to be a public 3 health authority described in section 164.501 (and ref- 4 erenced in section 164.512(b)(1)(i)) of title 45, Code of 5 Federal Regulations (or any successor regulation), car- 6 rying out public health activities and purposes described 7 in such section 164.512(b)(1)(i) (or any such successor 8 regulation). 9 ‘‘(e) PUBLIC DISCLOSURE OF INFORMATION.— 10 ‘‘(1) IN GENERAL.—For fiscal year 2012 or a 11 subsequent fiscal year, each State receiving a grant 12 under this section for such year shall, subject to 13 paragraph (3), provide for the public disclosure, and 14 submission to the information clearinghouse estab- 15 lished under paragraph (2), of the information in- 16 cluded in the report of the State under section 17 506(a)(2)(F) for such year (relating to the findings 18 for such year of the State maternal mortality review 19 committee established by the State under this sec- 20 tion). 21 ‘‘(2) INFORMATION CLEARINGHOUSE.—The 22 Secretary of Health and Human Services shall es- 23 tablish an information clearinghouse, that shall be 24 administered by the Director of the Centers for Dis- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00293 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 294 •HR 2954 IH ease Control and Prevention, that will maintain find- 1 ings and recommendations submitted pursuant to 2 paragraph (1) and provide such findings and rec- 3 ommendations for public review and research pur- 4 poses by State health departments, maternal mor- 5 tality review committees, and health providers and 6 institutions. 7 ‘‘(3) CONFIDENTIALITY OF INFORMATION.—In 8 no case shall any individually identifiable health in- 9 formation be provided to the public, or submitted to 10 the information clearinghouse, under paragraph (1). 11 ‘‘(f) CONFIDENTIALITY OF REVIEW COMMITTEE 12 PROCEEDINGS.— 13 ‘‘(1) IN GENERAL.—All proceedings and activi- 14 ties of a State maternal mortality review committee 15 under this section, opinions of members of such a 16 committee formed as a result of such proceedings 17 and activities, and records obtained, created, or 18 maintained pursuant to this section, including 19 records of interviews, written reports, and state- 20 ments procured by the Department of Health and 21 Human Services or by any other person, agency, or 22 organization acting jointly with the Department, in 23 connection with morbidity and mortality reviews 24 under this section, shall be confidential, and not sub- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00294 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 295 •HR 2954 IH ject to discovery, subpoena, or introduction into evi- 1 dence in any civil, criminal, legislative, or other pro- 2 ceeding. Such records shall not be open to public in- 3 spection. 4 ‘‘(2) TESTIMONY OF MEMBERS OF COM- 5 MITTEE.— 6 ‘‘(A) IN GENERAL.—Members of a State 7 maternal mortality review committee under this 8 section may not be questioned in any civil, 9 criminal, legislative, or other proceeding regard- 10 ing information presented in, or opinions 11 formed as a result of, a meeting or communica- 12 tion of the committee. 13 ‘‘(B) CLARIFICATION.—Nothing in this 14 subsection shall be construed to prevent a mem- 15 ber of such a committee from testifying regard- 16 ing information that was obtained independent 17 of such member’s participation on the com- 18 mittee, or that is public information. 19 ‘‘(3) AVAILABILITY OF INFORMATION FOR RE- 20 SEARCH PURPOSES.—Nothing in this subsection 21 shall prohibit the publishing by such a committee or 22 the Department of Health and Human Services of 23 statistical compilations and research reports that— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00295 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 296 •HR 2954 IH ‘‘(A) are based on confidential information, 1 relating to morbidity and mortality review; and 2 ‘‘(B) do not contain identifying informa- 3 tion or any other information that could be 4 used to ultimately identify the individuals con- 5 cerned. 6 ‘‘(g) DEFINITIONS.—For purposes of this section: 7 ‘‘(1) The term ‘pregnancy-associated death’ 8 means the death of a woman while pregnant or dur- 9 ing the one-year period following the date of the end 10 of pregnancy, irrespective of the cause of such death. 11 ‘‘(2) The term ‘pregnancy-related death’ means 12 the death of a woman while pregnant or during the 13 one-year period following the date of the end of 14 pregnancy, irrespective of the duration or site of the 15 pregnancy, from any cause related to or aggravated 16 by the pregnancy or its management, but not from 17 any accidental or incidental cause. 18 ‘‘(3) The term ‘woman of childbearing age’ 19 means a woman who is at least 10 years of age and 20 not more than 54 years of age.’’. 21 (b) INCLUSION OF FINDINGS OF REVIEW COMMIT- 22 TEES IN REQUIRED REPORTS.— 23 (1) STATE TRIENNIAL REPORTS.—Paragraph 24 (2) of section 506(a) of such Act (42 U.S.C. 706(a)) 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00296 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 297 •HR 2954 IH is amended by inserting after subparagraph (E) the 1 following new subparagraph: 2 ‘‘(F) In the case of a State receiving a 3 grant under section 514, beginning for the first 4 fiscal year beginning after 3 years after the 5 date of establishment of the State maternal 6 mortality review committee established by the 7 State pursuant to such grant and once every 3 8 years thereafter, information containing the 9 findings and recommendations of such com- 10 mittee and information on the implementation 11 of such recommendations during the period in- 12 volved.’’. 13 (2) ANNUAL REPORTS TO CONGRESS.—Para- 14 graph (3) of such section is amended— 15 (A) in subparagraph (D), at the end, by 16 striking ‘‘and’’; 17 (B) in subparagraph (E), at the end, by 18 striking the period and inserting ‘‘; and’’; and 19 (C) by adding at the end the following new 20 subparagraph: 21 ‘‘(F) For fiscal year 2012 and each subse- 22 quent fiscal year, taking into account the find- 23 ings, recommendations, and implementation in- 24 formation submitted by States pursuant to 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00297 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 298 •HR 2954 IH paragraph (2)(F), on the status of pregnancy- 1 related deaths and pregnancy-associated deaths 2 in the United States and including rec- 3 ommendations on methods to prevent such 4 deaths in the United States.’’. 5 SEC. 506. ELIMINATING DISPARITIES IN MATERNITY 6 HEALTH OUTCOMES. 7 Part B of title III of the Public Health Service Act 8 is amended by inserting after section 317V, as added, the 9 following new section: 10 ‘‘SEC. 317W. ELIMINATING DISPARITIES IN MATERNITY 11 HEALTH OUTCOMES. 12 ‘‘(a) IN GENERAL.—The Secretary shall, in consulta- 13 tion with relevant national stakeholder organizations, such 14 as national medical specialty organizations, national ma- 15 ternal child health organizations, and national health dis- 16 parity organizations, carry out the following activities to 17 eliminate disparities in maternal health outcomes: 18 ‘‘(1) Conduct research into the determinants 19 and the distribution of disparities in maternal care, 20 health risks, and health outcomes, and improve the 21 capacity of the performance measurement infrastruc- 22 ture to measure such disparities. 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00298 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 299 •HR 2954 IH ‘‘(2) Expand access to services that have been 1 demonstrated to improve the quality and outcomes 2 of maternity care for vulnerable populations. 3 ‘‘(3) Establish a demonstration project to com- 4 pare the effectiveness of interventions to reduce dis- 5 parities in maternity services and outcomes, and im- 6 plement and assess effective interventions. 7 ‘‘(b) SCOPE AND SELECTION OF STATES FOR DEM- 8 ONSTRATION PROJECT.—The demonstration project 9 under subsection (a)(3) shall be conducted in no more 10 than 8 States, which shall be selected by the Secretary 11 based on— 12 ‘‘(1) applications submitted by States, which 13 specify which regions and populations the State in- 14 volved will serve under the demonstration project; 15 ‘‘(2) criteria designed by the Secretary to en- 16 sure that, as a whole, the demonstration project is, 17 to the greatest extent possible, representative of the 18 demographic and geographic composition of commu- 19 nities most affected by disparities; 20 ‘‘(3) criteria designed by the Secretary to en- 21 sure that a variety of type of models are tested 22 through the demonstration project and that such 23 models include interventions that have an existing 24 evidence base for effectiveness; and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00299 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 300 •HR 2954 IH ‘‘(4) criteria designed by the Secretary to as- 1 sure that the demonstration projects and models will 2 be carried out in consultation with local and regional 3 provider organizations, such as community health 4 centers, hospital systems, and medical societies rep- 5 resenting providers of maternity services. 6 ‘‘(c) DURATION OF DEMONSTRATION PROJECT.— 7 The demonstration project under subsection (a)(3) shall 8 begin on January 1, 2012, and end on December 31, 9 2016. 10 ‘‘(d) GRANTS FOR EVALUATION AND MONITORING.— 11 The Secretary may make grants to States and health care 12 providers participating in the demonstration project under 13 subsection (a)(3) for the purpose of collecting data nec- 14 essary for the evaluation and monitoring of such project. 15 ‘‘(e) REPORTS.— 16 ‘‘(1) STATE REPORTS.—Each State that par- 17 ticipates in the demonstration project under sub- 18 section (a)(3) shall report to the Secretary, in a 19 time, form, and manner specified by the Secretary, 20 the data necessary to— 21 ‘‘(A) monitor the— 22 ‘‘(i) outcomes of the project; 23 ‘‘(ii) costs of the project; and 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00300 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 301 •HR 2954 IH ‘‘(iii) quality of maternity care pro- 1 vided under the project; and 2 ‘‘(B) evaluate the rationale for the selec- 3 tion of the items and services included in any 4 bundled payment made by the State under the 5 project. 6 ‘‘(2) FINAL REPORT.—Not later than December 7 31, 2017, the Secretary shall submit to Congress a 8 report on the results of the demonstration project 9 under subsection (a)(3).’’. 10 SEC. 507. DECREASING THE RISK FACTORS FOR SUDDEN 11 UNEXPECTED INFANT DEATH AND SUDDEN 12 UNEXPLAINED DEATH IN CHILDHOOD. 13 (a) ESTABLISHMENT.—The Secretary of Health and 14 Human Services acting through the Administrator of the 15 Health Resources and Services Administration and in con- 16 sultation with the Director of the Centers for Disease Con- 17 trol and Prevention and the Director of the National Insti- 18 tutes of Health (in this section referred to as the ‘‘Sec- 19 retary’’) shall establish and implement a culturally com- 20 petent public health awareness and education campaign 21 to provide information that is focused on decreasing the 22 risk factors for sudden unexpected infant death and sud- 23 den unexplained death in childhood, including educating 24 individuals about safe sleep environments, sleep positions, 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00301 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 302 •HR 2954 IH and reducing exposure to smoking during pregnancy and 1 after birth. 2 (b) TARGETED POPULATIONS.—The campaign under 3 subsection (a) shall be designed to reduce health dispari- 4 ties through the targeting of populations with high rates 5 of sudden unexpected infant death and sudden unex- 6 plained death in childhood. 7 (c) CONSULTATION.—In establishing and imple- 8 menting the campaign under subsection (a), the Secretary 9 shall consult with national organizations representing 10 health care providers, including nurses and physicians, 11 parents, child care providers, children’s advocacy and safe- 12 ty organizations, maternal and child health programs and 13 women’s, infants, and children nutrition professionals, and 14 other individuals and groups determined necessary by the 15 Secretary for such establishment and implementation. 16 (d) GRANTS.— 17 (1) IN GENERAL.—In carrying out the cam- 18 paign under subsection (a), the Secretary shall 19 award grants to national organizations, State and 20 local health departments, and community-based or- 21 ganizations for the conduct of education and out- 22 reach programs for nurses, parents, child care pro- 23 viders, public health agencies, and community orga- 24 nizations. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00302 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 303 •HR 2954 IH (2) APPLICATION.—To be eligible to receive a 1 grant under paragraph (1), an entity shall submit to 2 the Secretary an application at such time, in such 3 manner, and containing such information as the Sec- 4 retary may require. 5 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 6 authorized to be appropriated to carry out this section 7 such sums as may be necessary for each of fiscal years 8 2012 through 2016. 9 SEC. 508. REDUCING TEENAGE PREGNANCIES. 10 Title III of the Public Health Service Act (42 U.S.C. 11 241 et seq.) is amended by adding at the end the following 12 new part: 13 ‘‘PART W—YOUTH PREGNANCY PREVENTION 14 PROGRAMS 15 ‘‘SEC. 399OO. PURPOSE. 16 ‘‘It is the purpose of this part to develop and carry 17 out research and demonstration projects on new and exist- 18 ing program interventions to provide youth in racial or 19 ethnic minority or immigrant communities the information 20 and skills needed to reduce teenage pregnancies, build 21 healthy relationships, and improve overall health and well- 22 being. 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00303 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 304 •HR 2954 IH ‘‘SEC. 399OO–1. DEMONSTRATION GRANTS TO REDUCE 1 TEENAGE PREGNANCIES. 2 ‘‘(a) IN GENERAL.—The Secretary shall award com- 3 petitive grants to eligible entities for establishing or ex- 4 panding programs to provide youth in racial or ethnic mi- 5 nority or immigrant communities the information and 6 skills needed to avoid teenage pregnancy and develop 7 healthy relationships. 8 ‘‘(b) PRIORITY.—In awarding grants under this sec- 9 tion, the Secretary shall give priority to applicants— 10 ‘‘(1) proposing to carry out projects in racial or 11 ethnic minority or immigrant communities; 12 ‘‘(2) that have a demonstrated history of effec- 13 tively working with such targeted communities; or 14 ‘‘(3) that have a demonstrated history of engag- 15 ing in a meaningful and significant partnership with 16 such targeted communities. 17 ‘‘(c) PROGRAM SETTINGS.—Programs funded 18 through a grant under subsection (a) shall be provided— 19 ‘‘(1) through classroom-based settings, such as 20 school health education, humanities, language arts, 21 or family and consumer science education; after- 22 school programs; community-based programs; work- 23 force development programs; and health care set- 24 tings; or 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00304 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 305 •HR 2954 IH ‘‘(2) in collaboration with systems that serve 1 large numbers of at-risk youth such as juvenile jus- 2 tice or foster care systems. 3 ‘‘(d) PROJECT REQUIREMENTS.—As a condition of 4 receipt of a grant under this section, an entity shall agree 5 that, with respect to information and skills provided 6 through the grant— 7 ‘‘(1) such information and skills will be— 8 ‘‘(A) age-appropriate; 9 ‘‘(B) evidence-based or evidence-informed; 10 ‘‘(C) provided in accordance with section 11 399OO–5(b); and 12 ‘‘(D) culturally sensitive and relevant to 13 the target populations; and 14 ‘‘(2) any information provided about contracep- 15 tives shall include the health benefits and side ef- 16 fects of all contraceptives and barrier methods. 17 ‘‘(e) EVALUATION.—Of the total amount made avail- 18 able to carry out this section for a fiscal year, the Sec- 19 retary, acting through the Director of the Centers for Dis- 20 ease Control and Prevention and other agencies as appro- 21 priate, shall allot up to 10 percent of such amount to carry 22 out a rigorous, independent evaluation to determine the 23 extent and the effectiveness of activities funded through 24 this section during such fiscal year in changing attitudes 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00305 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 306 •HR 2954 IH and behavior of teenagers with respect to healthy relation- 1 ships and childbearing. 2 ‘‘(f) GRANTS FOR INDIAN TRIBES OR TRIBAL ORGA- 3 NIZATIONS.—Of the total amount made available to carry 4 out this section for a fiscal year, the Secretary shall re- 5 serve 5 percent of such amount to award grants under 6 this section to Indian tribes and tribal organizations in 7 such manner, and subject to such requirements, as the 8 Secretary, in consultation with Indian tribes and tribal or- 9 ganizations, determines appropriate. 10 ‘‘(g) ELIGIBLE ENTITY DEFINED.— 11 ‘‘(1) IN GENERAL.—In this section, the term 12 ‘eligible entity’ means a State, local, or tribal agen- 13 cy; a school or postsecondary institution; an after- 14 school program; a nonprofit organization; or a com- 15 munity or faith-based organization. 16 ‘‘(2) PREVENTING EXCLUSION OF SMALLER 17 COMMUNITY-BASED ORGANIZATIONS.—In carrying 18 out this section, the Secretary shall ensure that the 19 amounts and requirements of grants provided under 20 this section do not preclude receipt of such grants 21 by community-based organizations with a dem- 22 onstrated history of effectively working with adoles- 23 cents in racial or ethnic minority or immigrant com- 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00306 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 307 •HR 2954 IH munities or engaged in meaningful and significant 1 partnership with such communities. 2 ‘‘SEC. 399OO–2. MULTIMEDIA CAMPAIGNS TO REDUCE 3 TEENAGE PREGNANCIES. 4 ‘‘(a) IN GENERAL.—The Secretary shall award com- 5 petitive grants to public and private entities to carry out 6 multimedia campaigns to provide public education and in- 7 crease public awareness regarding teenage pregnancy and 8 related social and emotional issues, such as violence pre- 9 vention. 10 ‘‘(b) PRIORITY.—In awarding grants under this sec- 11 tion, the Secretary shall give priority to applicants pro- 12 posing to carry out campaigns developed for racial or eth- 13 nic minority or immigrant communities. 14 ‘‘(c) INFORMATION TO BE PROVIDED.—As a condi- 15 tion of receipt of a grant under this section, an entity shall 16 agree to use the grant to carry out multimedia campaigns 17 described in subsection (a) that— 18 ‘‘(1) at a minimum, shall provide information 19 on— 20 ‘‘(A) the prevention of teenage pregnancy; 21 and 22 ‘‘(B) healthy relationship development; and 23 ‘‘(2) may provide information on the prevention 24 of dating violence. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00307 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 308 •HR 2954 IH ‘‘SEC. 399OO–3. RESEARCH ON REDUCING TEENAGE PREG- 1 NANCIES AND TEENAGE DATING VIOLENCE 2 AND IMPROVING HEALTHY RELATIONSHIPS. 3 ‘‘(a) IN GENERAL.—The Secretary, acting through 4 the Director of the Centers for Disease Control and Pre- 5 vention, shall make grants to public and private entities 6 to conduct, support, or coordinate research on teenage 7 pregnancy, dating violence, and healthy relationships 8 among racial or ethnic minority or immigrant communities 9 that— 10 ‘‘(1) improves data collection on— 11 ‘‘(A) sexual and reproductive health, in- 12 cluding teenage pregnancies and births, among 13 all minority communities and subpopulations in 14 which such data are not collected, including 15 American Indian and Alaska Native youth; 16 ‘‘(B) sexual behavior, sexual or reproduc- 17 tive coercion, and teenage contraceptive use 18 patterns at the State level, as appropriate; and 19 ‘‘(C) teenage pregnancies among youth in 20 and aging out of foster care or juvenile justice 21 systems and the underlying factors that lead to 22 teenage pregnancy among youth in foster care 23 or juvenile justice systems; 24 ‘‘(2) investigates— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00308 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 309 •HR 2954 IH ‘‘(A) the variance in the rates of teenage 1 pregnancy by— 2 ‘‘(i) racial and ethnic group (such as 3 Hispanic, Asian-American, African-Amer- 4 ican, Pacific Islander, American Indian, 5 and Alaska Native); and 6 ‘‘(ii) socioeconomic status, including 7 as based on the income of the family and 8 education attainment; 9 ‘‘(B) factors affecting the risk for youth of 10 teenage pregnancy or dating abuse, including 11 the physical and social environment, level of ac- 12 culturation, access to health care, aspirations 13 for the future, and history of physical or sexual 14 violence or abuse; 15 ‘‘(C) the role that violence and abuse play 16 in teenage sex, pregnancy, and childbearing; 17 ‘‘(D) strategies to address the dispropor- 18 tionate rates of teenage pregnancies and dating 19 violence in racial or ethnic minority or immi- 20 grant communities; 21 ‘‘(E) how effective interventions can be 22 replicated or adapted in other settings to serve 23 racial or ethnic minority or immigrant commu- 24 nities; and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00309 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 310 •HR 2954 IH ‘‘(F) the effectiveness of media campaigns 1 in addressing healthy relationship development, 2 dating violence prevention, and teenage preg- 3 nancy; and 4 ‘‘(3) tests research-based strategies for address- 5 ing high rates of unintended teenage pregnancy 6 through programs that emphasize healthy relation- 7 ships and violence prevention. 8 ‘‘(b) PRIORITY.—In carrying out this section, the 9 Secretary shall give priority to research that incor- 10 porates— 11 ‘‘(1) interdisciplinary approaches; 12 ‘‘(2) a strong emphasis on community-based 13 participatory research; or 14 ‘‘(3) translational research. 15 ‘‘SEC. 399OO–4. HHS ADOLESCENT HEALTH WORK GROUP. 16 ‘‘(a) PURPOSE.—Not later than 30 days after the 17 date of the enactment of this part, the Secretary shall di- 18 rect the interagency adolescent health workgroup within 19 the Office of Adolescent Health of the Department of 20 Health and Human Services to— 21 ‘‘(1) include in the work of the group strategies 22 for teenage dating violence prevention and healthy 23 teenage relationships with a particular focus among 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00310 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 311 •HR 2954 IH racial or ethnic minority or immigrant communities; 1 and 2 ‘‘(2) with respect to including such strategies, 3 consult, to the greatest extent possible, with the 4 Federal Interagency Workgroup on Teen Dating Vi- 5 olence formed under the leadership of the National 6 Institute of Justice of the Department of Justice. 7 ‘‘(b) REPORT REQUIREMENT.—The Secretary, 8 through the Office of Adolescent Health, shall periodically 9 submit to Congress a report that— 10 ‘‘(1) includes a review of the evidence-based 11 programs on preventing teenage pregnancy, which 12 are carried out and identified by the Office; and 13 ‘‘(2) identifies the programs of the Department 14 of Health and Human Services that include teenage 15 dating violence prevention and the promotion of 16 healthy teenage relationships as part of a strategy to 17 prevent teenage pregnancy. 18 ‘‘SEC. 399OO–5. GENERAL GRANT PROVISIONS. 19 ‘‘(a) APPLICATIONS.—To seek a grant under this 20 part, an entity shall submit an application to the Secretary 21 in such form, in such manner, and containing such agree- 22 ments, assurances, and information as the Secretary may 23 require. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00311 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 312 •HR 2954 IH ‘‘(b) ADDITIONAL REQUIREMENTS.—A grant may be 1 made under this part only if the applicant involved agrees 2 that information, activities, and services provided under 3 the grant— 4 ‘‘(1) will be evidence-based or evidence in- 5 formed; 6 ‘‘(2) will be factually and medically accurate 7 and complete; and 8 ‘‘(3) if directed to a particular population 9 group, will be provided in an appropriate language 10 and cultural context. 11 ‘‘(c) TRAINING AND TECHNICAL ASSISTANCE.— 12 ‘‘(1) IN GENERAL.—Of the total amount made 13 available to carry out this part for a fiscal year, the 14 Secretary shall use 10 percent to provide, directly or 15 through a competitive grant process, training and 16 technical assistance to the grant recipients under 17 this part, including by disseminating research and 18 information regarding effective and promising prac- 19 tices, providing consultation and resources on a 20 broad array of teenage and unintended pregnancy 21 and violence prevention strategies, and developing 22 resources and materials. 23 ‘‘(2) COLLABORATION.—In carrying out this 24 subsection, the Secretary shall collaborate with enti- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00312 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 313 •HR 2954 IH ties that have expertise in the prevention of teenage 1 pregnancy, healthy relationship development, minor- 2 ity health and health disparities, and violence pre- 3 vention. 4 ‘‘SEC. 399OO–6. DEFINITIONS. 5 ‘‘In this part: 6 ‘‘(1) MEDICALLY ACCURATE AND COMPLETE.— 7 The term ‘medically accurate and complete’ means, 8 with respect to information, activities, or services, 9 verified or supported by the weight of research con- 10 ducted in compliance with accepted scientific meth- 11 ods and— 12 ‘‘(A) published in peer-reviewed journals, 13 where applicable; or 14 ‘‘(B) comprising information that leading 15 professional organizations and agencies with 16 relevant expertise in the field recognize as accu- 17 rate, objective, and complete. 18 ‘‘(2) RACIAL OR ETHNIC MINORITY OR IMMI- 19 GRANT COMMUNITIES.—The term ‘racial or ethnic 20 minority or immigrant communities’ means commu- 21 nities with a substantial number of residents who 22 are members of racial or ethnic minority groups or 23 who are immigrants. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00313 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 314 •HR 2954 IH ‘‘(3) REPRODUCTIVE COERCION.—The term ‘re- 1 productive coercion’ means, with respect to a person, 2 coercive behavior that interferes with the ability of 3 such person to control the reproductive decision- 4 making of such person, such as intentionally expos- 5 ing such person to sexually transmitted infections; in 6 the case such person is a female, attempting to im- 7 pregnate such person against her will; intentionally 8 interfering with the person’s birth control; or threat- 9 ening or acting violent if the person does not comply 10 with the perpetrator’s wishes regarding contracep- 11 tion or the decision whether to terminate or continue 12 a pregnancy. 13 ‘‘(4) YOUTH.—The term ‘youth’ means individ- 14 uals who are 11 to 19 years of age. 15 ‘‘SEC. 399OO–7. REPORTS. 16 ‘‘(a) REPORT ON USE OF FUNDS.—Not later than 17 1 year after the date of the enactment of this part, the 18 Secretary shall submit to Congress a report on the use 19 of funds provided pursuant to this part. 20 ‘‘(b) REPORT ON IMPACT OF PROGRAMS.—Not later 21 than March 1, 2016, the Secretary shall submit to Con- 22 gress a report on the impact that the programs under this 23 part had on reducing teenage pregnancies. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00314 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 315 •HR 2954 IH ‘‘SEC. 399OO–8. AUTHORIZATION OF APPROPRIATIONS. 1 ‘‘(a) IN GENERAL.—There are authorized to be ap- 2 propriated to carry out this part such sums as may be 3 necessary for each of the fiscal years 2012 through 2016. 4 ‘‘(b) AVAILABILITY.—Amounts appropriated pursu- 5 ant to subsection (a)— 6 ‘‘(1) are authorized to remain available until ex- 7 pended; and 8 ‘‘(2) are in addition to amounts otherwise made 9 available for such purposes.’’. 10 SEC. 509. GESTATIONAL DIABETES. 11 Part B of title III of the Public Health Service Act 12 (42 U.S.C. 243 et seq.) is amended by adding after section 13 317H the following: 14 ‘‘SEC. 317H–1. GESTATIONAL DIABETES. 15 ‘‘(a) UNDERSTANDING AND MONITORING GESTA- 16 TIONAL DIABETES.— 17 ‘‘(1) IN GENERAL.—The Secretary, acting 18 through the Director of the Centers for Disease 19 Control and Prevention, in consultation with the Di- 20 abetes Mellitus Interagency Coordinating Committee 21 established under section 429 and representatives of 22 appropriate national health organizations, shall de- 23 velop a multisite gestational diabetes research 24 project within the diabetes program of the Centers 25 for Disease Control and Prevention to expand and 26 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00315 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 316 •HR 2954 IH enhance surveillance data and public health research 1 on gestational diabetes. 2 ‘‘(2) AREAS TO BE ADDRESSED.—The research 3 project developed under paragraph (1) shall ad- 4 dress— 5 ‘‘(A) procedures to establish accurate and 6 efficient systems for the collection of gestational 7 diabetes data within each State and common- 8 wealth, territory, or possession of the United 9 States; 10 ‘‘(B) the progress of collaborative activities 11 with the National Vital Statistics System, the 12 National Center for Health Statistics, and 13 State health departments with respect to the 14 standard birth certificate, in order to improve 15 surveillance of gestational diabetes; 16 ‘‘(C) postpartum methods of tracking 17 women with gestational diabetes after delivery 18 as well as targeted interventions proven to 19 lower the incidence of type 2 diabetes in that 20 population; 21 ‘‘(D) variations in the distribution of diag- 22 nosed and undiagnosed gestational diabetes, 23 and of impaired fasting glucose tolerance and 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00316 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 317 •HR 2954 IH impaired fasting glucose, within and among 1 groups of women; and 2 ‘‘(E) factors and culturally sensitive inter- 3 ventions that influence risks and reduce the in- 4 cidence of gestational diabetes and related com- 5 plications during childbirth, including cultural, 6 behavioral, racial, ethnic, geographic, demo- 7 graphic, socioeconomic, and genetic factors. 8 ‘‘(3) REPORT.—Not later than 2 years after the 9 date of the enactment of this section, and annually 10 thereafter, the Secretary shall generate a report on 11 the findings and recommendations of the research 12 project including prevalence of gestational diabetes 13 in the multisite area and disseminate the report to 14 the appropriate Federal and non-Federal agencies. 15 ‘‘(b) EXPANSION OF GESTATIONAL DIABETES RE- 16 SEARCH.— 17 ‘‘(1) IN GENERAL.—The Secretary shall expand 18 and intensify public health research regarding gesta- 19 tional diabetes. Such research may include— 20 ‘‘(A) developing and testing novel ap- 21 proaches for improving postpartum diabetes 22 testing or screening and for preventing type 2 23 diabetes in women with a history of gestational 24 diabetes; and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00317 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 318 •HR 2954 IH ‘‘(B) conducting public health research to 1 further understanding of the epidemiologic, 2 socioenvironmental, behavioral, translation, and 3 biomedical factors and health systems that in- 4 fluence the risk of gestational diabetes and the 5 development of type 2 diabetes in women with 6 a history of gestational diabetes. 7 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 8 There is authorized to be appropriated to carry out 9 this subsection $5,000,000 for each of fiscal years 10 2012 through 2016. 11 ‘‘(c) DEMONSTRATION GRANTS TO LOWER THE 12 RATE OF GESTATIONAL DIABETES.— 13 ‘‘(1) IN GENERAL.—The Secretary, acting 14 through the Director of the Centers for Disease 15 Control and Prevention, shall award grants, on a 16 competitive basis, to eligible entities for demonstra- 17 tion projects that implement evidence-based inter- 18 ventions to reduce the incidence of gestational diabe- 19 tes, the recurrence of gestational diabetes in subse- 20 quent pregnancies, and the development of type 2 di- 21 abetes in women with a history of gestational diabe- 22 tes. 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00318 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 319 •HR 2954 IH ‘‘(2) PRIORITY.—In making grants under this 1 subsection, the Secretary shall give priority to 2 projects focusing on— 3 ‘‘(A) helping women who have 1 or more 4 risk factors for developing gestational diabetes; 5 ‘‘(B) working with women with a history of 6 gestational diabetes during a previous preg- 7 nancy; 8 ‘‘(C) providing postpartum care for women 9 with gestational diabetes; 10 ‘‘(D) tracking cases where women with a 11 history of gestational diabetes developed type 2 12 diabetes; 13 ‘‘(E) educating mothers with a history of 14 gestational diabetes about the increased risk of 15 their child developing diabetes; 16 ‘‘(F) working to prevent gestational diabe- 17 tes and prevent or delay the development of 18 type 2 diabetes in women with a history of ges- 19 tational diabetes; and 20 ‘‘(G) achieving outcomes designed to assess 21 the efficacy and cost-effectiveness of interven- 22 tions that can inform decisions on long-term 23 sustainability, including third-party reimburse- 24 ment. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00319 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 320 •HR 2954 IH ‘‘(3) APPLICATION.—An eligible entity desiring 1 to receive a grant under this subsection shall submit 2 to the Secretary— 3 ‘‘(A) an application at such time, in such 4 manner, and containing such information as the 5 Secretary may require; and 6 ‘‘(B) a plan to— 7 ‘‘(i) lower the rate of gestational dia- 8 betes during pregnancy; or 9 ‘‘(ii) develop methods of tracking 10 women with a history of gestational diabe- 11 tes and develop effective interventions to 12 lower the incidence of the recurrence of 13 gestational diabetes in subsequent preg- 14 nancies and the development of type 2 dia- 15 betes. 16 ‘‘(4) USES OF FUNDS.—An eligible entity re- 17 ceiving a grant under this subsection shall use the 18 grant funds to carry out demonstration projects de- 19 scribed in paragraph (1), including— 20 ‘‘(A) expanding community-based health 21 promotion education, activities, and incentives 22 focused on the prevention of gestational diabe- 23 tes and development of type 2 diabetes in 24 women with a history of gestational diabetes; 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00320 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 321 •HR 2954 IH ‘‘(B) aiding State- and tribal-based diabe- 1 tes prevention and control programs to collect, 2 analyze, disseminate, and report surveillance 3 data on women with, and at risk for, gesta- 4 tional diabetes, the recurrence of gestational di- 5 abetes in subsequent pregnancies, and, for 6 women with a history of gestational diabetes, 7 the development of type 2 diabetes; and 8 ‘‘(C) training and encouraging health care 9 providers— 10 ‘‘(i) to promote risk assessment, high- 11 quality care, and self-management for ges- 12 tational diabetes and the recurrence of ges- 13 tational diabetes in subsequent preg- 14 nancies; and 15 ‘‘(ii) to prevent the development of 16 type 2 diabetes in women with a history of 17 gestational diabetes, and its complications 18 in the practice settings of the health care 19 providers. 20 ‘‘(5) REPORT.—Not later than 4 years after the 21 date of the enactment of this section, the Secretary 22 shall prepare and submit to the Congress a report 23 concerning the results of the demonstration projects 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00321 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 322 •HR 2954 IH conducted through the grants awarded under this 1 subsection. 2 ‘‘(6) DEFINITION OF ELIGIBLE ENTITY.—In 3 this subsection, the term ‘eligible entity’ means a 4 nonprofit organization (such as a nonprofit academic 5 center or community health center) or a State, trib- 6 al, or local health agency. 7 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 8 There is authorized to be appropriated to carry out 9 this subsection $5,000,000 for each of fiscal years 10 2012 through 2016. 11 ‘‘(d) POSTPARTUM FOLLOW-UP REGARDING GESTA- 12 TIONAL DIABETES.—The Secretary, acting through the 13 Director of the Centers for Disease Control and Preven- 14 tion, shall work with the State- and tribal-based diabetes 15 prevention and control programs assisted by the Centers 16 to encourage postpartum follow-up after gestational diabe- 17 tes, as medically appropriate, for the purpose of reducing 18 the incidence of gestational diabetes, the recurrence of 19 gestational diabetes in subsequent pregnancies, the devel- 20 opment of type 2 diabetes in women with a history of ges- 21 tational diabetes, and related complications.’’. 22 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00322 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 323 •HR 2954 IH SEC. 510. EMERGENCY CONTRACEPTION EDUCATION AND 1 INFORMATION PROGRAMS. 2 (a) EMERGENCY CONTRACEPTION PUBLIC EDU- 3 CATION PROGRAM.— 4 (1) IN GENERAL.—The Secretary, acting 5 through the Director of the Centers for Disease 6 Control and Prevention, shall develop and dissemi- 7 nate to the public information on emergency contra- 8 ception. 9 (2) DISSEMINATION.—The Secretary may dis- 10 seminate information under paragraph (1) directly 11 or through arrangements with nonprofit organiza- 12 tions, consumer groups, institutions of higher edu- 13 cation, clinics, the media, and Federal, State, and 14 local agencies. 15 (3) INFORMATION.—The information dissemi- 16 nated under paragraph (1) shall include, at a min- 17 imum, a description of emergency contraception and 18 an explanation of the use, safety, efficacy, and avail- 19 ability of such contraception. 20 (b) EMERGENCY CONTRACEPTION INFORMATION 21 PROGRAM FOR HEALTH CARE PROVIDERS.— 22 (1) IN GENERAL.—The Secretary, acting 23 through the Administrator of the Health Resources 24 and Services Administration and in consultation 25 with major medical and public health organizations, 26 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00323 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 324 •HR 2954 IH shall develop and disseminate to health care pro- 1 viders information on emergency contraception. 2 (2) INFORMATION.—The information dissemi- 3 nated under paragraph (1) shall include, at a min- 4 imum— 5 (A) information describing the use, safety, 6 efficacy, and availability of emergency contra- 7 ception; 8 (B) a recommendation regarding the use of 9 such contraception in appropriate cases; and 10 (C) information explaining how to obtain 11 copies of the information developed under sub- 12 section (a) for distribution to the patients of 13 the providers. 14 (c) DEFINITIONS.—In this section: 15 (1) EMERGENCY CONTRACEPTION.—The term 16 ‘‘emergency contraception’’ means a drug or device 17 (as the terms are defined in section 201 of the Fed- 18 eral Food, Drug, and Cosmetic Act (21 U.S.C. 321)) 19 or a drug regimen that— 20 (A) is used postcoitally; 21 (B) prevents pregnancy primarily by pre- 22 venting or delaying ovulation, and does not ter- 23 minate an established pregnancy; and 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00324 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 325 •HR 2954 IH (C) is approved by the Food and Drug Ad- 1 ministration. 2 (2) HEALTH CARE PROVIDER.—The term 3 ‘‘health care provider’’ means an individual who is li- 4 censed or certified under State law to provide health 5 care services and who is operating within the scope 6 of such license. Such term shall include a phar- 7 macist. 8 (3) INSTITUTION OF HIGHER EDUCATION.—The 9 term ‘‘institution of higher education’’ has the same 10 meaning given such term in section 101(a) of the 11 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 12 (4) SECRETARY.—The term ‘‘Secretary’’ means 13 the Secretary of Health and Human Services. 14 (d) AUTHORIZATION OF APPROPRIATIONS.—There 15 are authorized to be appropriated to carry out this section 16 such sums as may be necessary for each of the fiscal years 17 2012 through 2016. 18 SEC. 511. SUPPORTING HEALTHY ADOLESCENT DEVELOP- 19 MENT. 20 (a) IN GENERAL.—The Secretary may award a grant 21 to each eligible State to conduct programs of sex education 22 described in subsection (b), including education on both 23 abstinence and contraception for the prevention of teenage 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00325 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 326 •HR 2954 IH pregnancy and sexually transmitted diseases, including 1 HIV/AIDS. 2 (b) REQUIREMENTS FOR SEX EDUCATION PRO- 3 GRAMS.—A program of sex education described in this 4 subsection is a program that— 5 (1) is age appropriate and medically accurate; 6 (2) stresses the value of abstinence while not ig- 7 noring those young people who have been or are sex- 8 ually active; 9 (3) provides information about the health bene- 10 fits and side effects of contraceptive and barrier 11 methods used— 12 (A) as a means to prevent pregnancy; and 13 (B) to reduce the risk of contracting sexu- 14 ally transmitted disease, including HIV/AIDS; 15 (4) encourages family communication between 16 parent and child about sexuality; 17 (5) cultivates a respectful dialogue about sexu- 18 ality, including sexual orientation and gender iden- 19 tity, and embraces the principles of nondiscrimina- 20 tion based on sexual orientation and gender identity; 21 (6) counters the perpetuation of narrow gender 22 roles, including the sexualization of female children, 23 adolescents, and adults; 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00326 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 327 •HR 2954 IH (7) teaches young people the skills to make re- 1 sponsible decisions about sexuality, including how to 2 avoid unwanted verbal, physical, and sexual ad- 3 vances and how to avoid making verbal, physical, 4 and sexual advances that are not wanted by the 5 other party; 6 (8) develops healthy relationships, including the 7 prevention of dating and sexual violence; 8 (9) teaches young people how alcohol and drug 9 use can affect responsible decisionmaking; and 10 (10) does not teach or promote religion. 11 (c) ADDITIONAL ACTIVITIES.—In carrying out a pro- 12 gram of sex education, a State may expend grant funds 13 awarded under subsection (a) to carry out educational and 14 motivational activities that help young people— 15 (1) gain knowledge about the physical, emo- 16 tional, biological, and hormonal changes of adoles- 17 cence and subsequent stages of human maturation; 18 (2) develop the knowledge and skills necessary 19 to ensure and protect their sexual and reproductive 20 health from unintended pregnancy and sexually 21 transmitted disease, including HIV/AIDS, through- 22 out their lifespan; 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00327 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 328 •HR 2954 IH (3) gain knowledge about the specific involve- 1 ment and responsibility of each individual in sexual 2 decisionmaking; 3 (4) develop healthy attitudes and values about 4 adolescent growth and development, body image, 5 gender roles, racial and ethnic diversity, sexual ori- 6 entation and gender identity, and other subjects; 7 (5) develop and practice healthy life skills in- 8 cluding goal-setting, decisionmaking, negotiation, 9 communication, and stress management; and 10 (6) promote self-esteem and positive inter- 11 personal skills focusing on relationship dynamics, in- 12 cluding friendships, dating, romantic involvement, 13 marriage, and family interactions. 14 (d) MATCHING FUNDS.—The Secretary may not 15 make payments to a State under this section in an amount 16 exceeding Federal medical assistance percentage for such 17 State (as such term is defined in section 1905(b) of the 18 Social Security Act (42 U.S.C. 1396d(b))) of the costs of 19 the programs conducted by the State under this section. 20 (e) EVALUATION OF PROGRAMS.— 21 (1) IN GENERAL.—For the purpose of evalu- 22 ating the effectiveness of programs of sex education 23 carried out with a grant under this section, evalua- 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00328 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 329 •HR 2954 IH tions shall be carried out in accordance with para- 1 graphs (2) and (3). 2 (2) NATIONAL EVALUATION.— 3 (A) METHOD.—The Secretary shall pro- 4 vide for a national evaluation of a representa- 5 tive sample of programs of sex education car- 6 ried out with grants under this section to deter- 7 mine— 8 (i) the effectiveness of such programs 9 in helping to delay the initiation of sexual 10 intercourse and other high-risk behaviors; 11 (ii) the effectiveness of such programs 12 in preventing adolescent pregnancy; 13 (iii) the effectiveness of such pro- 14 grams in preventing sexually transmitted 15 disease, including HIV/AIDS; 16 (iv) the effectiveness of such programs 17 in increasing contraceptive knowledge and 18 contraceptive behaviors when sexual inter- 19 course occurs; and 20 (v) a list of best practices based upon 21 essential programmatic components of 22 evaluated programs that have led to suc- 23 cess described in clauses (i) through (iv). 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00329 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 330 •HR 2954 IH (B) GRANT CONDITION.—A condition for 1 the receipt of a grant to a State under this sec- 2 tion is that the State cooperate with the evalua- 3 tion under subparagraph (A). 4 (C) REPORT.—The Secretary shall submit 5 to the Congress— 6 (i) not later than the end of each fis- 7 cal year during the 5-year period beginning 8 with fiscal year 2012, an interim report on 9 the national evaluation under subpara- 10 graph (A); and 11 (ii) not later than March 31, 2017, a 12 final report providing the results of such 13 national evaluation. 14 (3) INDIVIDUAL STATE EVALUATIONS.—A con- 15 dition for the receipt of a grant under this section 16 is that the State evaluate of the programs of sex 17 education funded through such grant in accordance 18 with the following requirements: 19 (A) The evaluation will be conducted by an 20 external, independent entity. 21 (B) The purposes of the evaluation will be 22 the determination of— 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00330 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 331 •HR 2954 IH (i) the effectiveness of such programs 1 in helping to delay the initiation of sexual 2 intercourse and other high-risk behaviors; 3 (ii) the effectiveness of such programs 4 in preventing adolescent pregnancy; 5 (iii) the effectiveness of such pro- 6 grams in preventing sexually transmitted 7 disease, including HIV/AIDS; and 8 (iv) the effectiveness of such programs 9 in increasing contraceptive and barrier 10 method knowledge and contraceptive be- 11 haviors when sexual intercourse occurs. 12 (f) LIMITATIONS ON USE OF FUNDS.— 13 (1) LIMITATIONS ON SECRETARY.—Of the 14 amounts appropriated for a fiscal year for purposes 15 of this section, the Secretary may not use more 16 than— 17 (A) 7 percent of such amounts for admin- 18 istrative expenses related to carrying out this 19 section for that fiscal year; and 20 (B) 10 percent of such amounts for the 21 national evaluation under subsection (e)(2). 22 (2) LIMITATIONS TO STATES.—Of amounts pro- 23 vided to an eligible State under this subsection, the 24 State may not use more than 10 percent of the 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00331 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 332 •HR 2954 IH grant to conduct any evaluation under subsection 1 (e)(3). 2 (g) NONDISCRIMINATION REQUIRED.—Programs 3 funded under this section shall not discriminate on the 4 basis of sex, race, ethnicity, national origin, disability, reli- 5 gion, marital status, familial status, sexual orientation, or 6 gender identity. Nothing in this section shall be construed 7 to invalidate or limit rights, remedies, procedures, or legal 8 standards available to victims of discrimination under any 9 other Federal law or any law of a State or a political sub- 10 division of a State, including title VI of the Civil Rights 11 Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the 12 Education Amendments of 1972 (20 U.S.C. 1681 et seq.), 13 section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 14 794), and the Americans with Disabilities Act of 1990 (42 15 U.S.C. 12101 et seq.). 16 (h) DEFINITIONS.—For purposes of this section: 17 (1) The term ‘‘age appropriate’’ means, with re- 18 spect to topics, messages, and teaching methods, 19 those suitable to particular ages or age groups of 20 children, adolescents, and adults, based on devel- 21 oping cognitive, emotional, and behavioral capacity 22 typical for the age or age group. 23 (2) The term ‘‘eligible State’’ means a State 24 that submits to the Secretary an application for a 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00332 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 333 •HR 2954 IH grant under this section that is in such form, is 1 made in such manner, and contains such agree- 2 ments, assurances, and information as the Secretary 3 determines to be necessary to carry out this section. 4 (3) The term ‘‘HIV/AIDS’’ means the human 5 immunodeficiency virus, and includes acquired im- 6 mune deficiency syndrome. 7 (4) The term ‘‘medically accurate’’, with respect 8 to information, means information that is supported 9 by research, recognized as accurate and objective by 10 leading medical, psychological, psychiatric, and pub- 11 lic health organizations and agencies, and, published 12 in journals that are peer reviewed. 13 (5) The term ‘‘State’’ means the 50 States, the 14 District of Columbia, the Commonwealth of Puerto 15 Rico, the Commonwealth of the Northern Mariana 16 Islands, American Samoa, Guam, the United States 17 Virgin Islands, and any other territory or possession 18 of the United States. 19 (i) AUTHORIZATION OF APPROPRIATIONS.—For the 20 purpose of carrying out this section, there is authorized 21 to be appropriated $50,000,000 for each of the fiscal years 22 2012 through 2016. 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00333 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 334 •HR 2954 IH TITLE VI—MENTAL HEALTH 1 SEC. 601. COVERAGE OF MARRIAGE AND FAMILY THERA- 2 PIST SERVICES AND MENTAL HEALTH COUN- 3 SELOR SERVICES UNDER PART B OF THE 4 MEDICARE PROGRAM. 5 (a) COVERAGE OF SERVICES.— 6 (1) IN GENERAL.—Section 1861(s)(2) of the 7 Social Security Act (42 U.S.C. 1395x(s)(2)) is 8 amended— 9 (A) in subparagraph (EE), by striking 10 ‘‘and’’ at the end; 11 (B) in subparagraph (FF), by inserting 12 ‘‘and’’ at the end; and 13 (C) by adding at the end the following new 14 subparagraph: 15 ‘‘(GG) marriage and family therapist services 16 (as defined in subsection (kkk)(1)) and mental 17 health counselor services (as defined in subsection 18 (kkk)(3));’’. 19 (2) DEFINITIONS.—Section 1861 of such Act 20 (42 U.S.C. 1395x), as amended by sections 21 202(b)(1)(A) and 423(a), is amended by adding at 22 the end the following new subsection: 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00334 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 335 •HR 2954 IH ‘‘Marriage and Family Therapist Services; Marriage and 1 Family Therapist; Mental Health Counselor Serv- 2 ices; Mental Health Counselor 3 ‘‘(kkk)(1) The term ‘marriage and family therapist 4 services’ means services performed by a marriage and 5 family therapist (as defined in paragraph (2)) for the diag- 6 nosis and treatment of mental illnesses, which the mar- 7 riage and family therapist is legally authorized to perform 8 under State law (or the State regulatory mechanism pro- 9 vided by State law) of the State in which such services 10 are performed, as would otherwise be covered if furnished 11 by a physician or as an incident to a physician’s profes- 12 sional service, but only if no facility or other provider 13 charges or is paid any amounts with respect to the fur- 14 nishing of such services. 15 ‘‘(2) The term ‘marriage and family therapist’ means 16 an individual who— 17 ‘‘(A) possesses a master’s or doctoral degree 18 which qualifies for licensure or certification as a 19 marriage and family therapist pursuant to State 20 law; 21 ‘‘(B) after obtaining such degree has performed 22 at least 2 years of clinical supervised experience in 23 marriage and family therapy; and 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00335 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 336 •HR 2954 IH ‘‘(C) in the case of an individual performing 1 services in a State that provides for licensure or cer- 2 tification of marriage and family therapists, is li- 3 censed or certified as a marriage and family thera- 4 pist in such State. 5 ‘‘(3) The term ‘mental health counselor services’ 6 means services performed by a mental health counselor (as 7 defined in paragraph (4)) for the diagnosis and treatment 8 of mental illnesses which the mental health counselor is 9 legally authorized to perform under State law (or the 10 State regulatory mechanism provided by the State law) of 11 the State in which such services are performed, as would 12 otherwise be covered if furnished by a physician or as inci- 13 dent to a physician’s professional service, but only if no 14 facility or other provider charges or is paid any amounts 15 with respect to the furnishing of such services. 16 ‘‘(4) The term ‘mental health counselor’ means an 17 individual who— 18 ‘‘(A) possesses a master’s or doctor’s degree in 19 mental health counseling or a related field; 20 ‘‘(B) after obtaining such a degree has per- 21 formed at least 2 years of supervised mental health 22 counselor practice; and 23 ‘‘(C) in the case of an individual performing 24 services in a State that provides for licensure or cer- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00336 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 337 •HR 2954 IH tification of mental health counselors or professional 1 counselors, is licensed or certified as a mental health 2 counselor or professional counselor in such State.’’. 3 (3) PROVISION FOR PAYMENT UNDER PART 4 B.—Section 1832(a)(2)(B) of such Act (42 U.S.C. 5 1395k(a)(2)(B)) is amended by adding at the end 6 the following new clause: 7 ‘‘(v) marriage and family therapist 8 services and mental health counselor serv- 9 ices;’’. 10 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 11 of such Act (42 U.S.C. 1395l(a)(1)) is amended— 12 (A) by striking ‘‘and (Z)’’ and inserting 13 ‘‘(Z)’’; and 14 (B) by inserting before the semicolon at 15 the end the following: ‘‘, and (AA) with respect 16 to marriage and family therapist services and 17 mental health counselor services under section 18 1861(s)(2)(GG), the amounts paid shall be 80 19 percent of the lesser of the actual charge for 20 the services or 75 percent of the amount deter- 21 mined for payment of a psychologist under sub- 22 paragraph (L)’’. 23 (5) EXCLUSION OF MARRIAGE AND FAMILY 24 THERAPIST SERVICES AND MENTAL HEALTH COUN- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00337 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 338 •HR 2954 IH SELOR SERVICES FROM SKILLED NURSING FACILITY 1 PROSPECTIVE PAYMENT SYSTEM.—Section 2 1888(e)(2)(A)(ii) of such Act (42 U.S.C. 3 1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar- 4 riage and family therapist services (as defined in 5 section 1861(kkk)(1)), mental health counselor serv- 6 ices (as defined in section 1861(kkk)(3)),’’ after 7 ‘‘qualified psychologist services,’’. 8 (6) INCLUSION OF MARRIAGE AND FAMILY 9 THERAPISTS AND MENTAL HEALTH COUNSELORS AS 10 PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Sec- 11 tion 1842(b)(18)(C) of such Act (42 U.S.C. 12 1395u(b)(18)(C)) is amended by adding at the end 13 the following new clauses: 14 ‘‘(vii) A marriage and family therapist (as de- 15 fined in section 1861(kkk)(2)). 16 ‘‘(viii) A mental health counselor (as defined in 17 section 1861(kkk)(4)).’’. 18 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV- 19 ICES PROVIDED IN CERTAIN SETTINGS.— 20 (1) RURAL HEALTH CLINICS AND FEDERALLY 21 QUALIFIED HEALTH CENTERS.—Section 22 1861(aa)(1)(B) of the Social Security Act (42 23 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 24 by a clinical social worker (as defined in subsection 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00338 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 339 •HR 2954 IH (hh)(1)),’’ and inserting ‘‘, by a clinical social worker 1 (as defined in subsection (hh)(1)), by a marriage 2 and family therapist (as defined in subsection 3 (kkk)(2)), or by a mental health counselor (as de- 4 fined in subsection (kkk)(4)),’’. 5 (2) HOSPICE PROGRAMS.—Section 6 1861(dd)(2)(B)(i)(III) of such Act (42 U.S.C. 7 1395x(dd)(2)(B)(i)(III)) is amended by inserting ‘‘or 8 one marriage and family therapist (as defined in 9 subsection (kkk)(2))’’ after ‘‘social worker’’. 10 (c) AUTHORIZATION OF MARRIAGE AND FAMILY 11 THERAPISTS TO DEVELOP DISCHARGE PLANS FOR POST- 12 HOSPITAL SERVICES.—Section 1861(ee)(2)(G) of the So- 13 cial Security Act (42 U.S.C. 1395x(ee)(2)(G)) is amended 14 by inserting ‘‘marriage and family therapist (as defined 15 in subsection (kkk)(2)),’’ after ‘‘social worker,’’. 16 (d) EFFECTIVE DATE.—The amendments made by 17 this section shall apply with respect to services furnished 18 on or after January 1, 2012. 19 SEC. 602. COMMUNITY MENTAL HEALTH AND ADDICTION 20 SAFETY NET EQUITY ACT. 21 (a) FEDERALLY QUALIFIED BEHAVIORAL HEALTH 22 CENTERS.—Section 1913 of the Public Health Service Act 23 (42 U.S.C. 300x–3) is amended— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00339 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 340 •HR 2954 IH (1) in subsection (a)(2)(A), by striking ‘‘com- 1 munity mental health services’’ and inserting ‘‘be- 2 havioral health services (of the type offered by feder- 3 ally qualified behavioral health centers consistent 4 with subsection (c)(3))’’; 5 (2) in subsection (b)— 6 (A) by striking paragraph (1) and insert- 7 ing the following: 8 ‘‘(1) services under the plan will be provided 9 only through appropriate, qualified community pro- 10 grams (which may include federally qualified behav- 11 ioral health centers, child mental health programs, 12 psychosocial rehabilitation programs, mental health 13 peer-support programs, and mental health primary 14 consumer-directed programs); and’’; and 15 (B) in paragraph (2), by striking ‘‘commu- 16 nity mental health centers’’ and inserting ‘‘fed- 17 erally qualified behavioral health centers’’; and 18 (3) by striking subsection (c) and inserting the 19 following: 20 ‘‘(c) CRITERIA FOR FEDERALLY QUALIFIED BEHAV- 21 IORAL HEALTH CENTERS.— 22 ‘‘(1) IN GENERAL.—The Administrator shall 23 certify, and recertify at least every 5 years, federally 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00340 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 341 •HR 2954 IH qualified behavioral health centers as meeting the 1 criteria specified in this subsection. 2 ‘‘(2) REGULATIONS.—Not later than 18 months 3 after the date of the enactment of this section, the 4 Administrator shall issue final regulations for certi- 5 fying nonprofit or local government centers as cen- 6 ters under paragraph (1). 7 ‘‘(3) CRITERIA.—The criteria referred to in 8 subsection (b)(2) are that the center performs each 9 of the following: 10 ‘‘(A) Provide services in locations that en- 11 sure services will be promptly available, be 12 physically accessible, provide reasonable policy 13 modifications, and be provided in a manner 14 which preserves human dignity and assures con- 15 tinuity of care. 16 ‘‘(B) Provide services in a mode of service 17 delivery appropriate for the target population. 18 ‘‘(C) Provide individuals with a choice of 19 service options where there is more than one ef- 20 ficacious treatment. 21 ‘‘(D) Employ a core staff of clinical staff 22 that is multidisciplinary and culturally and lin- 23 guistically competent. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00341 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 342 •HR 2954 IH ‘‘(E) Provide services, within the limits of 1 the capacities of the center, to any individual 2 residing or employed in the service area of the 3 center, regardless of the ability of the individual 4 to pay. 5 ‘‘(F) Provide, directly or through contract, 6 to the extent covered for adults in the State 7 Medicaid plan under title XIX of the Social Se- 8 curity Act and for children in accordance with 9 section 1905(r) of such Act regarding early and 10 periodic screening, diagnosis, and treatment, 11 each of the following services: 12 ‘‘(i) Screening, assessment, and diag- 13 nosis, including risk assessment. 14 ‘‘(ii) Person-centered treatment plan- 15 ning or similar processes, including risk as- 16 sessment and crisis planning. 17 ‘‘(iii) Outpatient clinic mental health 18 services, including screening, assessment, 19 diagnosis, psychotherapy, substance abuse 20 counseling, medication management, and 21 integrated treatment for mental illness and 22 substance abuse which shall be evidence- 23 based (including cognitive behavioral ther- 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00342 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 343 •HR 2954 IH apy and other such therapies which are 1 evidence-based). 2 ‘‘(iv) Outpatient clinic primary care 3 services, including screening and moni- 4 toring of key health indicators and health 5 risk (including screening for diabetes, hy- 6 pertension, and cardiovascular disease and 7 monitoring of weight, height, body mass 8 index (BMI), blood pressure, blood glucose 9 or HbA1C, and lipid profile). 10 ‘‘(v) Crisis mental health services, in- 11 cluding 24-hour mobile crisis teams, emer- 12 gency crisis intervention services, and cri- 13 sis stabilization. 14 ‘‘(vi) Targeted case management 15 (services to assist individuals gaining ac- 16 cess to needed medical, social, educational, 17 and other home- and community-based 18 services and applying for income security 19 and other benefits to which they may be 20 entitled). 21 ‘‘(vii) Psychiatric rehabilitation serv- 22 ices including skills training, assertive com- 23 munity treatment, family psychoeducation, 24 disability self-management, supported em- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00343 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 344 •HR 2954 IH ployment, supported housing services, 1 therapeutic foster care services, and such 2 other evidence-based practices as the Sec- 3 retary may require. 4 ‘‘(viii) Peer support and counselor 5 services and family supports. 6 ‘‘(G) Maintain linkages, and where possible 7 enter into formal contracts with the following: 8 ‘‘(i) Inpatient psychiatric facilities and 9 substance abuse detoxification and residen- 10 tial programs. 11 ‘‘(ii) Adult and youth peer support 12 and counselor services. 13 ‘‘(iii) Family support services for fam- 14 ilies of children with serious mental dis- 15 orders. 16 ‘‘(iv) Other home- and community- 17 based or regional services, supports, and 18 providers, including schools, child welfare 19 agencies, juvenile and criminal justice 20 agencies and facilities, housing agencies 21 and programs, employers, and other social 22 services. 23 ‘‘(v) Onsite or offsite access to pri- 24 mary care services. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00344 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 345 •HR 2954 IH ‘‘(vi) Enabling services, including out- 1 reach, transportation, and translation. 2 ‘‘(vii) Health and wellness services, in- 3 cluding services for tobacco cessation.’’. 4 (b) MEDICAID COVERAGE AND PAYMENT FOR FED- 5 ERALLY QUALIFIED BEHAVIORAL HEALTH CENTER 6 SERVICES.— 7 (1) PAYMENT FOR SERVICES PROVIDED BY 8 FEDERALLY QUALIFIED BEHAVIORAL HEALTH CEN- 9 TERS.—Section 1902(bb) of the Social Security Act 10 (42 U.S.C. 1396a(bb)) is amended— 11 (A) in the heading, by striking ‘‘AND 12 RURAL HEALTH CLINICS’’ and inserting ‘‘, 13 FEDERALLY QUALIFIED BEHAVIORAL HEALTH 14 CENTERS, AND RURAL HEALTH CLINICS’’; 15 (B) in paragraph (1), by inserting ‘‘(and 16 beginning with fiscal year 2012 with respect to 17 services furnished on or after January 1, 2012, 18 and each succeeding fiscal year, for services de- 19 scribed in section 1905(a)(2)(D) furnished by a 20 federally qualified behavioral health center)’’ 21 after ‘‘by a rural health clinic’’; 22 (C) in paragraph (2)— 23 (i) by striking the heading and insert- 24 ing ‘‘INITIAL FISCAL YEAR’’; 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00345 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 346 •HR 2954 IH (ii) by inserting ‘‘(or, in the case of 1 services described in section 1905(a)(2)(D) 2 furnished by a federally qualified behav- 3 ioral health center, for services furnished 4 on and after January 1, 2012, during fis- 5 cal year 2012)’’ after ‘‘January 1, 2001, 6 during fiscal year 2001’’; 7 (iii) by inserting ‘‘(or, in the case of 8 services described in section 1905(a)(2)(D) 9 furnished by a federally qualified behav- 10 ioral health center, during fiscal years 11 2010 and 2011)’’ after ‘‘1999 and 2000’’; 12 and 13 (iv) by inserting ‘‘(or, in the case of 14 services described in section 1905(a)(2)(D) 15 furnished by a federally qualified behav- 16 ioral health center, during fiscal year 17 2012)’’ before the period; 18 (D) in paragraph (3)— 19 (i) in the heading, by striking ‘‘FIS- 20 CAL YEAR 2002 AND SUCCEEDING’’ and in- 21 serting ‘‘SUCCEEDING’’; and 22 (ii) by inserting ‘‘(or, in the case of 23 services described in section 1905(a)(2)(D) 24 furnished by a federally qualified behav- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00346 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 347 •HR 2954 IH ioral health center, for services furnished 1 during fiscal year 2013 or a succeeding fis- 2 cal year)’’ after ‘‘2002 or a succeeding fis- 3 cal year’’; 4 (E) in paragraph (4)— 5 (i) by inserting ‘‘(or as a federally 6 qualified behavioral health center after fis- 7 cal year 2011’’ after ‘‘or rural health clinic 8 after fiscal year 2000’’; 9 (ii) by striking ‘‘furnished by the cen- 10 ter or’’ and inserting ‘‘furnished by the 11 federally qualified health center, services 12 described in section 1905(a)(2)(D) fur- 13 nished by the federally qualified behavioral 14 health center, or’’; 15 (iii) in the second sentence, by strik- 16 ing ‘‘or rural health clinic’’ and inserting 17 ‘‘, federally qualified behavioral health cen- 18 ter, or rural health clinic’’; 19 (F) in paragraph (5), in each of subpara- 20 graphs (A) and (B), by striking ‘‘or rural 21 health clinic’’ and inserting ‘‘, federally quali- 22 fied behavioral health center, or rural health 23 clinic’’; and 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00347 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 348 •HR 2954 IH (G) in paragraph (6), by striking ‘‘or to a 1 rural health clinic’’ and inserting ‘‘, to a feder- 2 ally qualified behavioral health center for serv- 3 ices described in section 1905(a)(2)(D), or to a 4 rural health clinic’’. 5 (2) INCLUSION OF FEDERALLY QUALIFIED BE- 6 HAVIORAL HEALTH CENTER SERVICES IN THE TERM 7 MEDICAL ASSISTANCE.—Section 1905(a)(2) of the 8 Social Security Act (42 U.S.C. 1396d(a)(2)) is 9 amended— 10 (A) by striking ‘‘and’’ before ‘‘(C)’’; and 11 (B) by inserting before the semicolon at 12 the end the following: ‘‘, and (D) federally 13 qualified behavioral health center services (as 14 defined in subsection (l)(4))’’. 15 (3) DEFINITION OF FEDERALLY QUALIFIED BE- 16 HAVIORAL HEALTH CENTER SERVICES.—Section 17 1905(l) of the Social Security Act (42 U.S.C. 18 1396d(l)) is amended by adding at the end the fol- 19 lowing paragraph: 20 ‘‘(4)(A) The term ‘federally qualified behavioral 21 health center services’ means services furnished to 22 an individual at a federally qualified behavioral 23 health center (as defined by subparagraph (B)). 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00348 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 349 •HR 2954 IH ‘‘(B) The term ‘federally qualified behavioral 1 health center’ means an entity that is certified under 2 section 1913(c) of the Public Health Service Act as 3 meeting the criteria described in paragraph (3) of 4 such section.’’. 5 (c) MENTAL HEALTH AND ADDICTION SAFETY NET 6 STUDIES.— 7 (1) PAPERWORK REDUCTION STUDY.— 8 (A) IN GENERAL.—Not later than 12 9 months after the date of the enactment of this 10 Act, the Institute of Medicine shall submit to 11 the appropriate committees of Congress a re- 12 port that evaluates the combined paperwork 13 burden of federally qualified behavioral health 14 centers certified section 1913(c) of the Public 15 Health Service Act, as inserted by subsection 16 (a). 17 (B) SCOPE.—In preparing the report 18 under subparagraph (A), the Institute of Medi- 19 cine shall examine licensing, certification, serv- 20 ice definitions, claims payment, billing codes, 21 and financial auditing requirements utilized by 22 the Office of Management and Budget, the 23 Centers for Medicare & Medicaid Services, the 24 Health Resources and Services Administration, 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00349 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 350 •HR 2954 IH the Substance Abuse and Mental Health Serv- 1 ices Administration, the Office of the Inspector 2 General, State Medicaid agencies, State depart- 3 ments of health, State departments of edu- 4 cation, and State and local juvenile justice and 5 social services agencies to— 6 (i) establish an estimate of the com- 7 bined nationwide cost of complying with 8 the requirements described in this subpara- 9 graph, in terms of both administrative 10 funding and staff time; 11 (ii) establish an estimate of the per 12 capita cost to each federally qualified be- 13 havioral health center certified under sec- 14 tion 1913(c) of the Public Health Service 15 Act to comply with the requirements de- 16 scribed in this subparagraph, in terms of 17 both administrative funding and staff time; 18 and 19 (iii) make administrative and statu- 20 tory recommendations to Congress, which 21 may include a uniform methodology, to re- 22 duce the paperwork burden experienced by 23 such federally qualified behavioral health 24 centers. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00350 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 351 •HR 2954 IH (C) AUTHORIZATION OF APPROPRIA- 1 TIONS.—There are authorized to be appro- 2 priated to carry out this subsection $550,000 3 for each of the fiscal years 2012 and 2013. 4 (2) WAGE STUDY.— 5 (A) IN GENERAL.—Not later than 12 6 months after the date of the enactment of this 7 Act, the Institute of Medicine shall conduct a 8 nationwide analysis, and submit a report to the 9 appropriate committees of Congress, concerning 10 the compensation structure of professional and 11 paraprofessional personnel employed by feder- 12 ally qualified behavioral health centers certified 13 under section 1913(c) of the Public Health 14 Service Act, as inserted by subsection (a), as 15 compared with the compensation structure of 16 comparable health safety net providers and rel- 17 evant private sector health care employers. 18 (B) SCOPE.—In preparing the report 19 under subparagraph (A), the Institute of Medi- 20 cine shall examine compensation disparities, if 21 such disparities are determined to exist, by type 22 of personnel, type of provider or private sector 23 employer, and by geographic region. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00351 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 352 •HR 2954 IH (C) AUTHORIZATION OF APPROPRIA- 1 TIONS.—There are authorized to be appro- 2 priated to carry out this paragraph, $550,000 3 for each of the fiscal years 2012 and 2013. 4 SEC. 603. MINORITY FELLOWSHIP PROGRAM. 5 Title V of the Public Health Service Act is amended 6 by inserting after section 506B of such Act (42 U.S.C. 7 290aa–5b) the following: 8 ‘‘SEC. 506C. MINORITY FELLOWSHIP PROGRAM. 9 ‘‘(a) FELLOWSHIPS.—The Administrator shall main- 10 tain a program, to be known as the Minority Fellowship 11 Program, under which the Administrator awards grants 12 or contracts to national associations or other appropriate 13 entities for the financial support of graduate students, 14 postdoctoral fellows, and residents in the professions of 15 psychology, psychiatry, social work, psychiatric advance- 16 practice nursing, and marriage and family therapy to stu- 17 dents who demonstrate a commitment to clinical or re- 18 search careers focused on racial and ethnic minority popu- 19 lations. 20 ‘‘(b) TERM OF FINANCIAL SUPPORT.—Financial sup- 21 port provided to an individual pursuant to subsection (a) 22 shall be for a term of not more than 12 months and may 23 be renewed thereafter. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00352 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 353 •HR 2954 IH ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 1 carry out this section, there is authorized to be appro- 2 priated $10,000,000 for each of fiscal years 2012 through 3 2016’’. 4 SEC. 604. INTEGRATED HEALTH CARE DEMONSTRATION 5 PROGRAM. 6 Part D of title V of the Public Health Service Act 7 (42 U.S.C. 290dd et seq.) is amended by adding at the 8 end the following: 9 ‘‘SEC. 544. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 10 PROVISION OF BEHAVIORAL HEALTH CARE 11 IN PRIMARY CARE SETTINGS. 12 ‘‘(a) GRANTS.—The Secretary, acting through the 13 Director of the Office of Minority Health of the Adminis- 14 tration, shall award grants to eligible entities for the pur- 15 pose of providing technical assistance and training regard- 16 ing the effective development and implementation of inte- 17 grated interprofessional health care teams that provide be- 18 havioral health care. 19 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 20 a grant under this section, an entity shall be a federally 21 qualified health center (as defined in section 1861(aa) of 22 the Social Security Act) serving a high proportion of indi- 23 viduals from racial and ethnic minority groups (as defined 24 in section 1707(g)). 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00353 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 354 •HR 2954 IH ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 1 carry out this section, there is authorized to be appro- 2 priated $20,000,000 for each of fiscal years 2012 through 3 2014.’’. 4 SEC. 605. ADDRESSING RACIAL AND ETHNIC MINORITY 5 MENTAL HEALTH DISPARITIES RESEARCH 6 GAPS. 7 Not later than 6 months after the date of the enact- 8 ment of this Act, the Director of the National Institute 9 on Minority Health and Health Disparities shall enter into 10 an arrangement with the Institute of Medicine (or, if the 11 Institute declines to enter into such an arrangement, an- 12 other appropriate entity)— 13 (1) to conduct a study with respect to mental 14 and behavioral health disparities in racial and ethnic 15 minority groups (as defined in section 1707(g) of 16 the Public Health Service Act (42 U.S.C. 300u– 17 6(g)); and 18 (2) to submit to the Congress a report on the 19 results of such study, including— 20 (A) a compilation of information on the dy- 21 namics of mental disorders in such racial and 22 ethnic minority groups; 23 (B) an identification of gaps in knowledge 24 and research needs; and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00354 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 355 •HR 2954 IH (C) recommendations for an interprofes- 1 sional research agenda at the National Insti- 2 tutes of Health aimed at reducing and ulti- 3 mately eliminating mental and behavioral health 4 disparities in such racial and ethnic minority 5 groups. 6 TITLE VII—ADDRESSING HIGH 7 IMPACT MINORITY DISEASES 8 Subtitle A—Cancer 9 SEC. 701. LUNG CANCER MORTALITY REDUCTION. 10 (a) SHORT TITLE.—This section may be cited as the 11 ‘‘Lung Cancer Mortality Reduction Act of 2011’’. 12 (b) FINDINGS.—Congress makes the following find- 13 ings: 14 (1) Lung cancer is the leading cause of cancer 15 death for both men and women, accounting for 28 16 percent of all cancer deaths. 17 (2) Lung cancer kills more people annually 18 than breast cancer, prostate cancer, colon cancer, 19 liver cancer, melanoma, and kidney cancer combined. 20 (3) Since the National Cancer Act of 1971 21 (Public Law 92–218; 85 Stat. 778), coordinated and 22 comprehensive research has raised the 5-year sur- 23 vival rates for breast cancer to 88 percent, for pros- 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00355 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 356 •HR 2954 IH tate cancer to 99 percent, and for colon cancer to 1 64 percent. 2 (4) However, the 5-year survival rate for lung 3 cancer is still only 15 percent and a similar coordi- 4 nated and comprehensive research effort is required 5 to achieve increases in lung cancer survivability 6 rates. 7 (5) Sixty percent of lung cancer cases are now 8 diagnosed nonsmokers or former smokers. 9 (6) Two-thirds of nonsmokers diagnosed with 10 lung cancer are women. 11 (7) Certain minority populations, such as Afri- 12 can-American males, have disproportionately high 13 rates of lung cancer incidence and mortality, not- 14 withstanding their similar smoking rate. 15 (8) Members of the baby boomer generation are 16 entering their sixties, the most common age at which 17 people develop lung cancer. 18 (9) Tobacco addiction and exposure to other 19 lung cancer carcinogens such as Agent Orange and 20 other herbicides and battlefield emissions are serious 21 problems among military personnel and war vet- 22 erans. 23 (10) Significant and rapid improvements in 24 lung cancer mortality can be expected through great- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00356 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 357 •HR 2954 IH er use and access to lung cancer screening tests for 1 at-risk individuals. 2 (11) Additional strategies are necessary to fur- 3 ther enhance the existing tests and therapies avail- 4 able to diagnose and treat lung cancer in the future. 5 (12) The August 2001 Report of the Lung 6 Cancer Progress Review Group of the National Can- 7 cer Institute stated that funding for lung cancer re- 8 search was ‘‘far below the levels characterized for 9 other common malignancies and far out of propor- 10 tion to its massive health impact’’. 11 (13) The Report of the Lung Cancer Progress 12 Review Group identified as its ‘‘highest priority’’ the 13 creation of integrated, multidisciplinary, multi-insti- 14 tutional research consortia organized around the 15 problem of lung cancer rather than around specific 16 research disciplines. 17 (14) The United States must enhance its re- 18 sponse to the issues raised in the Report of the 19 Lung Cancer Progress Review Group, and this can 20 be accomplished through the establishment of a co- 21 ordinated effort designed to reduce the lung cancer 22 mortality rate by 50 percent by 2015 and targeted 23 funding to support this coordinated effort. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00357 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 358 •HR 2954 IH (c) SENSE OF CONGRESS CONCERNING INVESTMENT 1 IN LUNG CANCER RESEARCH.—It is the sense of the Con- 2 gress that— 3 (1) lung cancer mortality reduction should be 4 made a national public health priority; and 5 (2) a comprehensive mortality reduction pro- 6 gram coordinated by the Secretary of Health and 7 Human Services is justified and necessary to ade- 8 quately address and reduce lung cancer mortality. 9 (d) LUNG CANCER MORTALITY REDUCTION PRO- 10 GRAM.— 11 (1) IN GENERAL.—Subpart 1 of part C of title 12 IV of the Public Health Service Act (42 U.S.C. 285 13 et seq.) is amended by adding at the end the fol- 14 lowing: 15 ‘‘SEC. 417H. LUNG CANCER MORTALITY REDUCTION PRO- 16 GRAM. 17 ‘‘(a) IN GENERAL.—Not later than 6 months after 18 the date of the enactment of this section, the Secretary, 19 in consultation with the Secretary of Defense, the Sec- 20 retary of Veterans Affairs, the Director of the National 21 Institutes of Health, the Director of the Centers for Dis- 22 ease Control and Prevention, the Commissioner of Food 23 and Drugs, the Administrator of the Centers for Medicare 24 & Medicaid Services, the Director of the National Institute 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00358 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 359 •HR 2954 IH on Minority Health and Health Disparities, and other 1 members of the Lung Cancer Advisory Board established 2 under section 546 of the Lung Cancer Mortality Reduc- 3 tion Act of 2011, shall implement a comprehensive pro- 4 gram, to be known as the Lung Cancer Mortality Reduc- 5 tion Program, to achieve a reduction of at least 25 percent 6 in the mortality rate of lung cancer by 2017. 7 ‘‘(b) REQUIREMENTS.—The Program shall include at 8 least the following: 9 ‘‘(1) With respect to the National Institutes of 10 Health— 11 ‘‘(A) a strategic review and prioritization 12 by the National Cancer Institute of research 13 grants to achieve the goal of the Lung Cancer 14 Mortality Reduction Program in reducing lung 15 cancer mortality; 16 ‘‘(B) the provision of funds to enable the 17 Airway Biology and Disease Branch of the Na- 18 tional Heart, Lung, and Blood Institute to ex- 19 pand its research programs to include pre- 20 dispositions to lung cancer, the interrelationship 21 between lung cancer and other pulmonary and 22 cardiac disease, and the diagnosis and treat- 23 ment of these interrelationships; 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00359 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 360 •HR 2954 IH ‘‘(C) the provision of funds to enable the 1 National Institute of Biomedical Imaging and 2 Bioengineering to expedite the development of 3 computer assisted diagnostic, surgical, treat- 4 ment, and drug-testing innovations to reduce 5 lung cancer mortality, such as through expan- 6 sion of the Institute’s Quantum Grant Program 7 and Image-Guided Interventions programs; and 8 ‘‘(D) the provision of funds to enable the 9 National Institute of Environmental Health 10 Sciences to implement research programs rel- 11 ative to the lung cancer incidence. 12 ‘‘(2) With respect to the Food and Drug Ad- 13 ministration— 14 ‘‘(A) activities under section 529 of the 15 Federal Food, Drug, and Cosmetic Act; and 16 ‘‘(B) activities under section 561 of the 17 Federal Food, Drug, and Cosmetic Act to ex- 18 pand access to investigational drugs and devices 19 for the diagnosis, monitoring, or treatment of 20 lung cancer. 21 ‘‘(3) With respect to the Centers for Disease 22 Control and Prevention, the establishment of an 23 early disease research and management program 24 under section 1511. 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00360 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 361 •HR 2954 IH ‘‘(4) With respect to the Agency for Healthcare 1 Research and Quality, the conduct of a biannual re- 2 view of lung cancer screening, diagnostic, and treat- 3 ment protocols, and the issuance of updated guide- 4 lines. 5 ‘‘(5) The cooperation and coordination of all 6 minority and health disparity programs within the 7 Department of Health and Human Services to en- 8 sure that all aspects of the Lung Cancer Mortality 9 Reduction Program under this section adequately 10 address the burden of lung cancer on minority and 11 rural populations. 12 ‘‘(6) The cooperation and coordination of all to- 13 bacco control and cessation programs within agen- 14 cies of the Department of Health and Human Serv- 15 ices to achieve the goals of the Lung Cancer Mor- 16 tality Reduction Program under this section with 17 particular emphasis on the coordination of drug and 18 other cessation treatments with early detection pro- 19 tocols.’’. 20 (2) FEDERAL FOOD, DRUG, AND COSMETIC 21 ACT.—Subchapter B of chapter V of the Federal 22 Food, Drug, and Cosmetic Act (21 U.S.C. 360aaa et 23 seq.) is amended by adding at the end the following: 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00361 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 362 •HR 2954 IH ‘‘DRUGS RELATING TO LUNG CANCER 1 ‘‘SEC. 529. (a) IN GENERAL.—The provisions of this 2 subchapter shall apply to a drug described in subsection 3 (b) to the same extent and in the same manner as such 4 provisions apply to a drug for a rare disease or condition. 5 ‘‘(b) QUALIFIED DRUGS.—A drug described in this 6 subsection is— 7 ‘‘(1) a chemoprevention drug for precancerous 8 conditions of the lung; 9 ‘‘(2) a drug for targeted therapeutic treat- 10 ments, including any vaccine, for lung cancer; and 11 ‘‘(3) a drug to curtail or prevent nicotine addic- 12 tion. 13 ‘‘(c) BOARD.—The Board established under the Lung 14 Cancer Mortality Reduction Act of 2011 shall monitor the 15 program implemented under this section.’’. 16 (3) ACCESS TO UNAPPROVED THERAPIES.—Sec- 17 tion 561(e) of the Federal Food, Drug, and Cos- 18 metic Act (21 U.S.C. 360bbb(e)) is amended by in- 19 serting before the period the following: ‘‘and shall 20 include expanding access to drugs under section 21 529, with substantial consideration being given to 22 whether the totality of information available to the 23 Secretary regarding the safety and effectiveness of 24 an investigational drug, as compared to the risk of 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00362 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 363 •HR 2954 IH morbidity and death from the disease, indicates that 1 a patient may obtain more benefit than risk if treat- 2 ed with the drug’’. 3 (4) CDC.—Title XV of the Public Health Serv- 4 ice Act (42 U.S.C. 300k et seq.) is amended by add- 5 ing at the end the following: 6 ‘‘SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT 7 PROGRAM. 8 ‘‘The Secretary shall establish and implement an 9 early disease research and management program targeted 10 at the high incidence and mortality rates of lung cancer 11 among minority and low-income populations.’’. 12 (e) DEPARTMENT OF DEFENSE AND THE DEPART- 13 MENT OF VETERANS AFFAIRS.—The Secretary of Defense 14 and the Secretary of Veterans Affairs shall coordinate 15 with the Secretary of Health and Human Services— 16 (1) in the development of the Lung Cancer 17 Mortality Reduction Program under section 417H; 18 (2) in the implementation within the Depart- 19 ment of Defense and the Department of Veterans 20 Affairs of an early detection and disease manage- 21 ment research program for military personnel and 22 veterans whose smoking history and exposure to car- 23 cinogens during active duty service has increased 24 their risk for lung cancer; and 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00363 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 364 •HR 2954 IH (3) in the implementation of coordinated care 1 programs for military personnel and veterans diag- 2 nosed with lung cancer. 3 (f) LUNG CANCER ADVISORY BOARD.— 4 (1) IN GENERAL.—The Secretary of Health and 5 Human Services shall convene a Lung Cancer Advi- 6 sory Board (referred to in this section as the 7 ‘‘Board’’)— 8 (A) to monitor the programs established 9 under this section (and the amendments made 10 by this section); and 11 (B) to provide annual reports to the Con- 12 gress concerning benchmarks, expenditures, 13 lung cancer statistics, and the public health im- 14 pact of such programs. 15 (2) COMPOSITION.—The Board shall be com- 16 posed of— 17 (A) the Secretary of Health and Human 18 Services; 19 (B) the Secretary of Defense; 20 (C) the Secretary of Veterans Affairs; and 21 (D) two representatives each from the 22 fields of clinical medicine focused on lung can- 23 cer, lung cancer research, imaging, drug devel- 24 opment, and lung cancer advocacy, to be ap- 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00364 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 365 •HR 2954 IH pointed by the Secretary of Health and Human 1 Services. 2 (g) AUTHORIZATION OF APPROPRIATIONS.— 3 (1) IN GENERAL.—To carry out this section 4 (and the amendments made by this section), there 5 are authorized to be appropriated such sums as may 6 be necessary for each of fiscal years 2012 through 7 2016. 8 (2) LUNG CANCER MORTALITY REDUCTION PRO- 9 GRAM.—Of the amounts authorized to be appro- 10 priated by subsection (a), there are authorized to be 11 appropriated— 12 (A) $25,000,000 for fiscal year 2012, and 13 such sums as may be necessary for each of fis- 14 cal years 2013 through 2016, for the activities 15 described in section 417H(b)(1)(B) of the Pub- 16 lic Health Service Act, as added by subsection 17 (d)(1); 18 (B) $25,000,000 for fiscal year 2012, and 19 such sums as may be necessary for each of fis- 20 cal years 2013 through 2016, for the activities 21 described in section 417H(b)(1)(C) of such Act; 22 (C) $10,000,000 for fiscal year 2012, and 23 such sums as may be necessary for each of fis- 24 cal years 2013 through 2016, for the activities 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00365 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 366 •HR 2954 IH described in section 417H(b)(1)(D) of such Act; 1 and 2 (D) $15,000,000 for fiscal year 2012, and 3 such sums as may be necessary for each of fis- 4 cal years 2013 through 2016, for the activities 5 described in section 417H(b)(3) of such Act. 6 SEC. 702. EXPANDING PROSTATE CANCER RESEARCH, OUT- 7 REACH, SCREENING, TESTING, ACCESS, AND 8 TREATMENT EFFECTIVENESS. 9 (a) SHORT TITLE.—This section may be cited as the 10 ‘‘Prostate Research, Outreach, Screening, Testing, Access, 11 and Treatment Effectiveness Act of 2011’’ or the ‘‘PROS- 12 TATE Act’’. 13 (b) FINDINGS.—Congress makes the following find- 14 ings: 15 (1) Prostate cancer is the second leading cause 16 of cancer death among men. 17 (2) In 2010, more than 217,730 new patients 18 were diagnosed with prostate cancer and more than 19 32,000 men died from this disease. 20 (3) Roughly 2,000,000 Americans are living 21 with a diagnosis of prostate cancer and its con- 22 sequences. 23 (4) While prostate cancer generally affects older 24 individuals, younger men are also at risk for the dis- 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00366 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 367 •HR 2954 IH ease, and when prostate cancer appears in early 1 middle age it frequently takes on a more aggressive 2 form. 3 (5) There are significant racial and ethnic dis- 4 parities that demand attention, namely African- 5 Americans have prostate cancer mortality rates that 6 are more than double those in the White population. 7 (6) Underserved rural populations have higher 8 rates of mortality compared to their urban counter- 9 parts, and innovative and cost-efficient methods to 10 improve rural access to high quality care should take 11 advantage of advances in telehealth to diagnose and 12 treat prostate cancer when appropriate. 13 (7) Certain veterans populations may have 14 nearly twice the incidence of prostate cancer as the 15 general population of the United States. 16 (8) Urologists may constitute the specialists 17 who diagnose and treat the vast majority of prostate 18 cancer patients. 19 (9) Although much basic and translational re- 20 search has been completed and much is currently 21 known, there are still many unanswered questions. 22 For example, it is not fully understood how much of 23 known disparities are attributable to disease eti- 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00367 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 368 •HR 2954 IH ology, access to care, or education and awareness in 1 the community. 2 (10) Causes of prostate cancer are not known. 3 There is not good information regarding how to dif- 4 ferentiate accurately, early on, between aggressive 5 and indolent forms of the disease. As a result, there 6 is significant overtreatment in prostate cancer. 7 There are no treatments that can durably arrest 8 growth or cure prostate cancer once it has metasta- 9 sized. 10 (11) A significant proportion (roughly 23 to 54 11 percent) of cases may be clinically indolent and 12 ‘‘overdiagnosed’’, resulting in significant overtreat- 13 ment. More accurate tests will allow men and their 14 families to face less physical, psychological, financial, 15 and emotional trauma and billions of dollars could 16 be saved in private and public health care systems 17 in an area that has been identified by the Medicare 18 program as one of eight high-volume, high-cost areas 19 in the Resource Utilization Report program author- 20 ized by Congress under the Medicare Improvements 21 for Patients and Providers Act of 2008. 22 (12) Prostate cancer research and health care 23 programs across Federal agencies should be coordi- 24 nated to improve accountability and actively encour- 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00368 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 369 •HR 2954 IH age the translation of research into practice, to iden- 1 tify and implement best practices, in order to foster 2 an integrated and consistent focus on effective pre- 3 vention, diagnosis, and treatment of this disease. 4 (c) PROSTATE CANCER COORDINATION AND EDU- 5 CATION.— 6 (1) INTERAGENCY PROSTATE CANCER COORDI- 7 NATION AND EDUCATION TASK FORCE.—Not later 8 than 180 days after the date of the enactment of 9 this section, the Secretary of Veterans Affairs, in co- 10 operation with the Secretary of Defense and the Sec- 11 retary of Health and Human Services, shall estab- 12 lish an Interagency Prostate Cancer Coordination 13 and Education Task Force (in this section referred 14 to as the ‘‘Prostate Cancer Task Force’’). 15 (2) DUTIES.—The Prostate Cancer Task Force 16 shall— 17 (A) develop a summary of advances in 18 prostate cancer research supported or con- 19 ducted by Federal agencies relevant to the diag- 20 nosis, prevention, and treatment of prostate 21 cancer, including psychosocial impairments re- 22 lated to prostate cancer treatment, and compile 23 a list of best practices that warrant broader 24 adoption in health care programs; 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00369 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 370 •HR 2954 IH (B) consider establishing, and advocating 1 for, a guidance to enable physicians to allow 2 screening of men who are over age 74, on a 3 case-by-case basis, taking into account quality 4 of life and family history of prostate cancer; 5 (C) share and coordinate information on 6 Federal research and health care program ac- 7 tivities, including activities related to— 8 (i) determining how to improve re- 9 search and health care programs, including 10 psychosocial impairments related to pros- 11 tate cancer treatment; 12 (ii) identifying any gaps in the overall 13 research inventory and in health care pro- 14 grams; 15 (iii) identifying opportunities to pro- 16 mote translation of research into practice; 17 and 18 (iv) maximizing the effects of Federal 19 efforts by identifying opportunities for col- 20 laboration and leveraging of resources in 21 research and health care programs that 22 serve those susceptible to or diagnosed 23 with prostate cancer; 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00370 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 371 •HR 2954 IH (D) develop a comprehensive interagency 1 strategy and advise relevant Federal agencies in 2 the solicitation of proposals for collaborative, 3 multidisciplinary research and health care pro- 4 grams, including proposals to evaluate factors 5 that may be related to the etiology of prostate 6 cancer, that would— 7 (i) result in innovative approaches to 8 study emerging scientific opportunities or 9 eliminate knowledge gaps in research to 10 improve the prostate cancer research port- 11 folio of the Federal Government; 12 (ii) outline key research questions, 13 methodologies, and knowledge gaps; and 14 (iii) ensure consistent action, as out- 15 lined by section 402(b) of the Public 16 Health Service Act; 17 (E) develop a coordinated message related 18 to screening and treatment for prostate cancer 19 to be reflected in educational and beneficiary 20 materials for Federal health programs as such 21 documents are updated; and 22 (F) not later than 2 years after the date 23 of the establishment of the Prostate Cancer 24 Task Force, submit to the Expert Advisory 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00371 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 372 •HR 2954 IH Panel to be reviewed and returned within 30 1 days, and then within 90 days submitted to 2 Congress recommendations— 3 (i) regarding any appropriate changes 4 to research and health care programs, in- 5 cluding recommendations to improve the 6 research portfolio of the Department of 7 Veterans Affairs, Department of Defense, 8 National Institutes of Health, and other 9 Federal agencies to ensure that scientif- 10 ically based strategic planning is imple- 11 mented in support of research and health 12 care program priorities; 13 (ii) designed to ensure that the re- 14 search and health care programs and ac- 15 tivities of the Department of Veterans Af- 16 fairs, the Department of Defense, the De- 17 partment of Health and Human Services, 18 and other Federal agencies are free of un- 19 necessary duplication; 20 (iii) regarding public participation in 21 decisions relating to prostate cancer re- 22 search and health care programs to in- 23 crease the involvement of patient advo- 24 cates, community organizations, and med- 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00372 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 373 •HR 2954 IH ical associations representing a broad geo- 1 graphical area; 2 (iv) on how to best disseminate infor- 3 mation on prostate cancer research and 4 progress achieved by health care programs; 5 (v) about how to expand partnerships 6 between public entities, including Federal 7 agencies, and private entities to encourage 8 collaborative, cross-cutting research and 9 health care delivery; 10 (vi) assessing any cost savings and ef- 11 ficiencies realized through the efforts iden- 12 tified and supported in this section and 13 recommending expansion of those efforts 14 that have proved most promising while also 15 ensuring against any conflicts in directives 16 from other congressional or statutory man- 17 dates or enabling statutes; 18 (vii) identifying key priority action 19 items from among the recommendations; 20 and 21 (viii) with respect to the level of fund- 22 ing needed by each agency to implement 23 the recommendations contained in the re- 24 port. 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00373 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 374 •HR 2954 IH (3) MEMBERS OF THE PROSTATE CANCER TASK 1 FORCE.—The Prostate Cancer Task Force described 2 in subsection (a) shall be composed of representa- 3 tives from such Federal agencies, as each Secretary 4 determines necessary, to coordinate a uniform mes- 5 sage relating to prostate cancer screening and treat- 6 ment where appropriate, including representatives of 7 the following: 8 (A) The Department of Veterans Affairs, 9 including representatives of each relevant pro- 10 gram areas of the Department of Veterans Af- 11 fairs. 12 (B) The Prostate Cancer Research Pro- 13 gram of the Congressionally Directed Medical 14 Research Program of the Department of De- 15 fense. 16 (C) The Department of Health and 17 Human Services, including at a minimum rep- 18 resentatives of the following: 19 (i) The National Institutes of Health. 20 (ii) National research institutes and 21 centers, including the National Cancer In- 22 stitute, the National Institute of Allergy 23 and Infectious Diseases, and the Office of 24 Minority Health. 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00374 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 375 •HR 2954 IH (iii) The Centers for Medicare & Med- 1 icaid Services. 2 (iv) The Food and Drug Administra- 3 tion. 4 (v) The Centers for Disease Control 5 and Prevention. 6 (vi) The Agency for Healthcare Re- 7 search and Quality. 8 (vii) The Health Resources and Serv- 9 ices Administration. 10 (4) APPOINTING EXPERT ADVISORY PANELS.— 11 The Prostate Cancer Task Force shall appoint ex- 12 pert advisory panels, as determined appropriate, to 13 provide input and concurrence from individuals and 14 organizations from the medical, prostate cancer pa- 15 tient and advocate, research, and delivery commu- 16 nities with expertise in prostate cancer diagnosis, 17 treatment, and research, including practicing urolo- 18 gists, primary care providers, and others and indi- 19 viduals with expertise in education and outreach to 20 underserved populations affected by prostate cancer. 21 (5) MEETINGS.—The Prostate Cancer Task 22 Force shall convene not less than twice a year, or 23 more frequently as the Secretary determines to be 24 appropriate. 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00375 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 376 •HR 2954 IH (6) SUBMISSION OF RECOMMENDATIONS TO 1 CONGRESS.—The Secretary of Veterans Affairs shall 2 submit to Congress any recommendations submitted 3 to the Secretary under paragraph (2)(E). 4 (7) FEDERAL ADVISORY COMMITTEE ACT.— 5 (A) IN GENERAL.—Except as provided in 6 subparagraph (B), the Federal Advisory Com- 7 mittee Act (5 U.S.C. App.) shall apply to the 8 Prostate Cancer Task Force. 9 (B) EXCEPTION.—Section 14(a)(2)(B) of 10 such Act (relating to the termination of advi- 11 sory committees) shall not apply to the Prostate 12 Cancer Task Force. 13 (8) SUNSET DATE.—The Prostate Cancer Task 14 Force shall terminate at the end of fiscal year 2016. 15 (d) PROSTATE CANCER RESEARCH.— 16 (1) RESEARCH COORDINATION.—The Secretary 17 of Veterans Affairs, in coordination with the Secre- 18 taries of Defense and of Health and Human Serv- 19 ices, shall establish and carry out a program to co- 20 ordinate and intensify prostate cancer research as 21 needed. Specifically, such research program shall— 22 (A) develop advances in diagnostic and 23 prognostic methods and tests, including bio- 24 markers and an improved prostate cancer 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00376 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 377 •HR 2954 IH screening blood test, including improvements or 1 alternatives to the prostate specific antigen test 2 and additional tests to distinguish indolent from 3 aggressive disease; 4 (B) better understand the etiology of the 5 disease (including an analysis of lifestyle factors 6 proven to be involved in higher rates of prostate 7 cancer, such as obesity and diet, and in dif- 8 ferent ethnic, racial, and socioeconomic groups, 9 such as the African-American, Latin-American, 10 and American Indian populations and men with 11 a family history of prostate cancer) to improve 12 prevention efforts; 13 (C) expand basic research into prostate 14 cancer, including studies of fundamental molec- 15 ular and cellular mechanisms; 16 (D) identify and provide clinical testing of 17 novel agents for the prevention and treatment 18 of prostate cancer; 19 (E) establish clinical registries for prostate 20 cancer; 21 (F) use the National Institute of Bio- 22 medical Imaging and Bioengineering and the 23 National Cancer Institute for assessment of ap- 24 propriate imaging modalities; and 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00377 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 378 •HR 2954 IH (G) address such other matters relating to 1 prostate cancer research as may be identified by 2 the Federal agencies participating in the pro- 3 gram under this section. 4 (2) PROSTATE CANCER ADVISORY BOARD.— 5 There is established in the Office of the Chief Sci- 6 entist of the Food and Drug Administration a Pros- 7 tate Cancer Scientific Advisory Board. Such board 8 shall be responsible for accelerating real-time shar- 9 ing of the latest research data and accelerating 10 movement of new medicines to patients. 11 (3) UNDERSERVED MINORITY GRANT PRO- 12 GRAM.—In carrying out such program, the Secretary 13 shall— 14 (A) award grants to eligible entities to 15 carry out components of the research outlined 16 in paragraph (1); 17 (B) integrate and build upon existing 18 knowledge gained from comparative effective- 19 ness research; and 20 (C) recognize and address— 21 (i) the racial and ethnic disparities in 22 the incidence and mortality rates of pros- 23 tate cancer and men with a family history 24 of prostate cancer; 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00378 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 379 •HR 2954 IH (ii) any barriers in access to care and 1 participation in clinical trials that are spe- 2 cific to racial, ethnic, and other under- 3 served minorities and men with a family 4 history of prostate cancer; 5 (iii) needed outreach and educational 6 efforts to raise awareness in these commu- 7 nities; and 8 (iv) appropriate access and utilization 9 of imaging modalities. 10 (e) TELEHEALTH AND RURAL ACCESS PILOT 11 PROJECT.— 12 (1) IN GENERAL.—The Secretary of Veterans 13 Affairs, the Secretary of Defense, and the Secretary 14 of Health and Human Services (in this section re- 15 ferred to as the ‘‘Secretaries’’) shall establish 4-year 16 telehealth pilot projects for the purpose of analyzing 17 the clinical outcomes and cost effectiveness associ- 18 ated with telehealth services in a variety of geo- 19 graphic areas that contain high proportions of medi- 20 cally underserved populations, including African- 21 Americans, Latin-Americans, American Indians, and 22 those in rural areas. Such projects shall promote ef- 23 ficient use of specialist care through better coordina- 24 tion of primary care and physician extender teams 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00379 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 380 •HR 2954 IH in underserved areas and more effectively employ 1 tumor boards to better counsel patients. 2 (2) ELIGIBLE ENTITIES.— 3 (A) IN GENERAL.—The Secretaries shall 4 select eligible entities to participate in the pilot 5 projects under this section. 6 (B) PRIORITY.—In selecting eligible enti- 7 ties to participate in the pilot projects under 8 this section, the Secretaries shall give priority 9 to such entities located in medically under- 10 served areas, particularly those that include Af- 11 rican-Americans, Latin-Americans, and facili- 12 ties of the Indian Health Service, and those in 13 rural areas. 14 (3) EVALUATION.—The Secretaries shall, 15 through the pilot projects, evaluate— 16 (A) the effective and economic delivery of 17 care in diagnosing and treating prostate cancer 18 with the use of telehealth services in medically 19 underserved and tribal areas including collabo- 20 rative uses of health professionals and integra- 21 tion of the range of telehealth and other tech- 22 nologies; 23 (B) the effectiveness of improving the ca- 24 pacity of nonmedical providers and nonspecial- 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00380 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 381 •HR 2954 IH ized medical providers to provide health services 1 for prostate cancer in medically underserved 2 and tribal areas, including the exploration of in- 3 novative medical home models with collabora- 4 tion between urologists, other relevant medical 5 specialists, including oncologists, radiologists, 6 and primary care teams and coordination of 7 care through the efficient use of primary care 8 teams and physician extenders; and 9 (C) the effectiveness of using telehealth 10 services to provide prostate cancer treatment in 11 medically underserved areas, including the use 12 of tumor boards to facilitate better patient 13 counseling. 14 (4) REPORT.—Not later than 12 months after 15 the completion of the pilot projects under this sub- 16 section, the Secretaries shall submit to Congress a 17 report describing the outcomes of such pilot projects, 18 including any cost savings and efficiencies realized, 19 and providing recommendations, if any, for expand- 20 ing the use of telehealth services. 21 (f) EDUCATION AND AWARENESS.— 22 (1) IN GENERAL.—The Secretary of Veterans 23 Affairs shall develop a national education campaign 24 for prostate cancer. Such campaign shall involve the 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00381 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 382 •HR 2954 IH use of written educational materials and public serv- 1 ice announcements consistent with the findings of 2 the Prostate Cancer Task Force under subsection 3 (c), that are intended to encourage men to seek 4 prostate cancer screening when appropriate. 5 (2) RACIAL DISPARITIES AND THE POPULATION 6 OF MEN WITH A FAMILY HISTORY OF PROSTATE 7 CANCER.—In developing the national campaign 8 under paragraph (1), the Secretary shall ensure that 9 such educational materials and public service an- 10 nouncements are more readily available in commu- 11 nities experiencing racial disparities in the incidence 12 and mortality rates of prostate cancer and by men 13 of any race classification with a family history of 14 prostate cancer. 15 (3) GRANTS.—In carrying out the national 16 campaign under this section, the Secretary shall 17 award grants to nonprofit private entities to enable 18 such entities to test alternative outreach and edu- 19 cation strategies. 20 (g) AUTHORIZATION OF APPROPRIATIONS.— 21 (1) IN GENERAL.—There is authorized to be 22 appropriated to carry out this section for the period 23 of fiscal years 2012 through 2016 an amount equal 24 to the savings described in paragraph (2). 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00382 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 383 •HR 2954 IH (2) CORRESPONDING REDUCTION.—The 1 amount authorized to be appropriated by provisions 2 of law other than this section for the period of fiscal 3 years 2012 through 2016 for Federal research and 4 health care program activities related to prostate 5 cancer is reduced by the amount of Federal savings 6 projected to be achieved over such period by imple- 7 mentation of subsection (c)(2)(C) of this section. 8 SEC. 703. IMPROVED MEDICAID COVERAGE FOR CERTAIN 9 BREAST AND CERVICAL CANCER PATIENTS 10 IN THE TERRITORIES. 11 (a) ELIMINATION OF FUNDING LIMITATIONS.— 12 (1) IN GENERAL.—Section 1108(g)(4) of the 13 Social Security Act (42 U.S.C. 1308(g)(4)) is 14 amended by adding at the end the following: ‘‘With 15 respect to fiscal years beginning with fiscal year 16 2012, payment for medical assistance for individuals 17 who are eligible for such assistance only on the basis 18 of section 1902(a)(10)(A)(ii)(XVIII) shall not be 19 taken into account in applying subsection (f) (as in- 20 creased in accordance with paragraphs (1), (2), and 21 (3) of this subsection) to such commonwealth or ter- 22 ritory for such fiscal year.’’. 23 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00383 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 384 •HR 2954 IH (2) TECHNICAL AMENDMENT.—Such section is 1 further amended by striking ‘‘(3), and (4)’’ and in- 2 serting ‘‘and (3)’’. 3 (b) APPLICATION OF ENHANCED FMAP FOR HIGH- 4 EST STATE.—Section 1905(b) of such Act (42 U.S.C. 5 1396d(b)) is amended by adding at the end the following: 6 ‘‘Notwithstanding the first sentence of this subsection, 7 with respect to medical assistance described in clause (4) 8 of such sentence that is furnished in Puerto Rico, the 9 United States Virgin Islands, Guam, the Commonwealth 10 of the Northern Mariana Islands, or American Samoa in 11 a fiscal year, the Federal medical assistance percentage 12 is equal to the highest such percentage applied under such 13 clause for such fiscal year for any of the 50 States or the 14 District of Columbia that provides such medical assistance 15 for any portion of such fiscal year.’’ 16 (c) EFFECTIVE DATE.—The amendments made by 17 this section shall apply to payment for medical assistance 18 for items and services furnished on or after October 1, 19 2011. 20 SEC. 704. CANCER PREVENTION AND TREATMENT DEM- 21 ONSTRATION FOR ETHNIC AND RACIAL MI- 22 NORITIES. 23 (a) DEMONSTRATION.— 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00384 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 385 •HR 2954 IH (1) IN GENERAL.—The Secretary of Health and 1 Human Services (in this section referred to as the 2 ‘‘Secretary’’) shall conduct demonstration projects 3 (in this section referred to as ‘‘demonstration 4 projects’’) for the purpose of developing models and 5 evaluating methods that— 6 (A) improve the quality of items and serv- 7 ices provided to target individuals in order to 8 facilitate reduced disparities in early detection 9 and treatment of cancer; 10 (B) improve clinical outcomes, satisfaction, 11 quality of life, and appropriate use of Medicare- 12 covered services and referral patterns among 13 those target individuals with cancer; 14 (C) eliminate disparities in the rate of pre- 15 ventive cancer screening measures, such as Pap 16 smears, prostate cancer screenings, and CT 17 scans for lung cancer among target individuals; 18 (D) promote collaboration with community- 19 based organizations to ensure cultural com- 20 petency of health care professionals and lin- 21 guistic access for persons with limited-English 22 proficiency; and 23 (E) encourage the incorporation of commu- 24 nity health workers to increase the efficiency 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00385 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 386 •HR 2954 IH and appropriateness of cervical cancer pro- 1 grams. 2 (2) COMMUNITY HEALTH WORKER DEFINED.— 3 In this section, the term ‘‘community health worker’’ 4 includes a community health advocate, a lay health 5 worker, a community health representative, a peer 6 health promotor, a community health outreach work- 7 ers, and promotores de salud, who promotes health 8 or nutrition within the community in which the indi- 9 vidual resides. 10 (3) TARGET INDIVIDUAL DEFINED.—In this 11 section, the term ‘‘target individual’’ means an indi- 12 vidual of a racial and ethnic minority group, as de- 13 fined in section 1707(g)(1) of the Public Health 14 Service Act (42 U.S.C. 300u–6(g)(1)), who is enti- 15 tled to benefits under part A, and enrolled under 16 part B, of title XVIII of the Social Security Act. 17 (b) PROGRAM DESIGN.— 18 (1) INITIAL DESIGN.—Not later than 1 year 19 after the date of the enactment of this Act, the Sec- 20 retary shall evaluate best practices in the private 21 sector, community programs, and academic research 22 of methods that reduce disparities among individuals 23 of racial and ethnic minority groups in the preven- 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00386 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 387 •HR 2954 IH tion and treatment of cancer and shall design the 1 demonstration projects based on such evaluation. 2 (2) NUMBER AND PROJECT AREAS.—Not later 3 than 2 years after the date of the enactment of this 4 Act, the Secretary shall implement at least nine 5 demonstration projects, including the following: 6 (A) Two projects for each of the four fol- 7 lowing major racial and ethnic minority groups: 8 (i) American Indians and Alaska Na- 9 tives, Eskimos and Aleuts. 10 (ii) Asian-Americans. 11 (iii) Blacks/African-Americans. 12 (iv) Hispanic/Latin-Americans. 13 (v) Native Hawaiians and other Pa- 14 cific Islanders. 15 The two projects must target different ethnic 16 subpopulations. 17 (B) One project within the Pacific Islands 18 or United States insular areas. 19 (C) At least one project each in a rural 20 area and inner-city area. 21 (3) EXPANSION OF PROJECTS; IMPLEMENTA- 22 TION OF DEMONSTRATION PROJECT RESULTS.—If 23 the initial report under subsection (c) contains an 24 evaluation that demonstration projects— 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00387 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 388 •HR 2954 IH (A) reduce expenditures under the Medi- 1 care program under title XVIII of the Social 2 Security Act; or 3 (B) do not increase expenditures under the 4 Medicare program and reduce racial and ethnic 5 health disparities in the quality of health care 6 services provided to target individuals and in- 7 crease satisfaction of beneficiaries and health 8 care providers; 9 the Secretary shall continue the existing demonstra- 10 tion projects and may expand the number of dem- 11 onstration projects. 12 (c) REPORT TO CONGRESS.— 13 (1) IN GENERAL.—Not later than 2 years after 14 the date the Secretary implements the initial dem- 15 onstration projects, and biannually thereafter, the 16 Secretary shall submit to Congress a report regard- 17 ing the demonstration projects. 18 (2) CONTENTS OF REPORT.—Each report under 19 paragraph (1) shall include the following: 20 (A) A description of the demonstration 21 projects. 22 (B) An evaluation of— 23 (i) the cost effectiveness of the dem- 24 onstration projects; 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00388 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 389 •HR 2954 IH (ii) the quality of the health care serv- 1 ices provided to target individuals under 2 the demonstration projects; and 3 (iii) beneficiary and health care pro- 4 vider satisfaction under the demonstration 5 projects. 6 (C) Any other information regarding the 7 demonstration projects that the Secretary de- 8 termines to be appropriate. 9 (d) WAIVER AUTHORITY.—The Secretary shall waive 10 compliance with the requirements of title XVIII of the So- 11 cial Security Act to such extent and for such period as 12 the Secretary determines is necessary to conduct dem- 13 onstration projects. 14 SEC. 705. REDUCING CANCER DISPARITIES WITHIN MEDI- 15 CARE. 16 (a) DEVELOPMENT OF MEASURES OF DISPARITIES 17 IN QUALITY OF CANCER CARE.— 18 (1) DEVELOPMENT OF MEASURES.—The Sec- 19 retary of Health and Human Services (in this sec- 20 tion referred to as the ‘‘Secretary’’) shall enter into 21 an agreement with the National Quality Forum 22 under which the National Quality Forum shall de- 23 velop a uniform set of measures to evaluate dispari- 24 ties in the quality of cancer care, endorse such set 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00389 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 390 •HR 2954 IH of measures through its multistakeholder consensus 1 development process, and annually update such set 2 of measures. 3 (2) MEASURES TO BE INCLUDED.—Such set of 4 measures shall include, with respect to the treatment 5 of cancer, measures of patient outcomes, the process 6 for delivering medical care related to such treat- 7 ment, patient counseling and engagement in deci- 8 sionmaking, patient experience of care, resource use, 9 and practice capabilities, such as care coordination. 10 (b) ESTABLISHMENT OF REPORTING PROCESS.— 11 (1) IN GENERAL.—The Secretary shall establish 12 a reporting process that provides for a method for 13 health care providers specified under paragraph (2) 14 to submit to the Secretary and make public data on 15 the performance of such providers during each re- 16 porting period through use of the measures devel- 17 oped pursuant to subsection (a). Such data shall be 18 submitted in a form and manner and at a time spec- 19 ified by the Secretary. 20 (2) SPECIFICATION OF PROVIDERS TO REPORT 21 ON MEASURES.—The Secretary shall specify the 22 classes of Medicare providers of services and sup- 23 pliers, including hospitals, cancer centers, physi- 24 cians, primary care providers, and specialty pro- 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00390 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 391 •HR 2954 IH viders, that will be required under such process to 1 publicly report on the measures specified under sub- 2 section (a). 3 (3) ASSESSMENT OF CHANGES.—Within this re- 4 porting process, the Secretary shall also establish a 5 format that assesses changes in both the absolute 6 and relative disparities over time. These measures 7 shall be presented in an easily comprehensible for- 8 mat, such as those presented in the final publica- 9 tions relating to Healthy People 2010 or the Na- 10 tional Healthcare Disparities Report. 11 (4) INITIAL IMPLEMENTATION.—The Secretary 12 shall implement the reporting process under this 13 subsection for reporting periods beginning not later 14 than 6 months after the date that measures are first 15 established under subsection (a). 16 Subtitle B—Viral Hepatitis and 17 Liver Cancer Control and Pre- 18 vention 19 SEC. 711. VIRAL HEPATITIS AND LIVER CANCER CONTROL 20 AND PREVENTION. 21 (a) SHORT TITLE.—This subtitle may be cited as the 22 ‘‘Viral Hepatitis and Liver Cancer Control and Prevention 23 Act of 2011’’. 24 (b) FINDINGS.—Congress finds the following: 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00391 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 392 •HR 2954 IH (1) Approximately 5,300,000 Americans are 1 chronically infected with the hepatitis B virus (re- 2 ferred to in this section as ‘‘HBV’’), the hepatitis C 3 virus (referred to in this section as ‘‘HCV’’), or 4 both. 5 (2) In the United States, chronic HBV and 6 HCV are the most common cause of liver cancer, 7 one of the most lethal and fastest growing cancers 8 in this country. It is the most common cause of 9 chronic liver disease, liver cirrhosis, and the most 10 common indication for liver transplantation. It is 11 also a leading cause of death in Americans living 12 with HIV/AIDS, many of whom are coinfected with 13 chronic HBV, chronic HCV, or both. At least 15,000 14 deaths per year in the United States can be attrib- 15 uted to chronic HBV and HCV. 16 (3) According to the Centers for Disease Con- 17 trol and Prevention (referred to in this section as 18 the ‘‘CDC’’ ‘‘’’), approximately 2 percent of the pop- 19 ulation of the United States is living with chronic 20 HBV, chronic HCV, or both. The CDC has recog- 21 nized HCV as the Nation’s most common chronic 22 bloodborne virus infection and HBV as the deadliest 23 vaccine-preventable disease. 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00392 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 393 •HR 2954 IH (4) HBV is easily transmitted and is 100 times 1 more infectious than HIV. According to the CDC, 2 HBV is transmitted through percutaneous (i.e., 3 puncture through the skin) or mucosal contact with 4 infectious blood or body fluids. HCV is transmitted 5 by percutaneous exposures to infectious blood. 6 (5) The CDC conservatively estimates that in 7 2008 approximately 18,000 Americans were newly 8 infected with HCV and more than 38,000 Americans 9 were newly infected with HBV. 10 (6) There were 6 outbreaks reported to CDC 11 for investigation in 2008 related to health care ac- 12 quired infection of HBV and HCV, potentially ex- 13 posing more than 52,000 Americans to the viruses, 14 in 2009–2010 there were 15 outbreaks in which 15 more than 30,000 people were potentially exposed. 16 (7) Chronic HBV and chronic HCV usually do 17 not cause symptoms early in the course of the dis- 18 ease, but after many years of a clinically ‘‘silent’’ 19 phase, more than 50 percent of infected individuals 20 will develop cirrhosis, end-stage liver disease, or liver 21 cancer. Since most of those with chronic HBV and 22 HCV are unaware of their infection, they do not 23 know to take precautions to prevent the spread of 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00393 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 394 •HR 2954 IH their infection and can unknowingly exacerbate their 1 own disease progression. 2 (8) HBV and HCV disproportionately affect 3 certain populations in the United States. Although 4 representing only 5 percent of the population, Asian- 5 Americans and Pacific Islanders account for over 6 half of the 1,400,000 domestic chronic HBV cases. 7 Baby boomers (those born between 1946 and 1964) 8 account for more than half of domestic chronic hepa- 9 titis C cases. In addition, African-Americans, Latin- 10 Americans, and American Indian/Alaskan Natives 11 are among the groups which have disproportionately 12 high rates of HBV and/or HCV infections in the 13 United States. 14 (9) For both chronic HBV and chronic HCV, 15 behavioral changes can slow disease progression if 16 diagnosis is made early. Early diagnosis, which is 17 determined through simple blood tests, can reduce 18 the risk of transmission and disease progression 19 through education and vaccination of household 20 members and other susceptible persons at risk. 21 (10) For those chronically infected with HBV 22 or HCV, regular monitoring can lead to the early de- 23 tection of liver cancer at a stage where cure is still 24 possible. Liver cancer is the third deadliest cancer in 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00394 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 395 •HR 2954 IH the United States however, liver cancer has received 1 little funding for research, prevention, or treatment. 2 (11) Treatment for chronic HCV can eradicate 3 the disease in approximately 75 percent of those cur- 4 rently treated. The treatment of chronic HBV can 5 effectively suppress viral replication in the over- 6 whelming majority (>80%) of those treated thereby 7 reducing the risk of transmission and progression to 8 liver scarring or liver cancer even though a complete 9 cure is much less common than for HCV. 10 (12) To combat the HBV and HCV epidemics 11 in the United States, in May 2011, the Department 12 of Health and Human Services released Combating 13 the Silent Epidemic of Viral Hepatitis: Action Plan 14 for the Prevention, Care & Treatment of Viral Hepa- 15 titis (hereafter referred to as the HHS Action Plan). 16 The Institute of Medicine (IOM) of the National 17 Academies 2010 reported on the Federal response to 18 HBV and HCV titled: Hepatitis and Liver Cancer: 19 A National Strategy for Prevention and Control of 20 Hepatitis B and C. These recommendations and 21 guidelines provide a framework for HBV and HCV 22 prevention, education, control, research, and medical 23 management programs. 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00395 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 396 •HR 2954 IH (13) The annual health care costs attributable 1 to HBV and HCV in the United States are signifi- 2 cant. For HBV, it is estimated to be approximately 3 $1,000,000,000 to 2,000,000,000 ($1,000 to $2,000 4 per infected person). More than $1,000,000,000 is 5 spent each year for HBV-related hospitalizations. 6 The indirect costs of chronic HBV infection are 7 harder to measure, but include reduced physical and 8 emotional quality of life, reduced economic produc- 9 tivity, long-term disability, and premature death. 10 For HCV, medical costs for patients are expected to 11 increase from $30,000,000,000 in 2009 to over 12 $85,000,000,000 in 2024. Avoiding these costs by 13 screening and diagnosing individuals earlier—and 14 connecting them to appropriate treatment and care 15 will save lives and critical health care dollars. Cur- 16 rently, without a comprehensive screening, testing 17 and diagnosis program, most patients are diagnosed 18 too late when they need a liver transplant costing at 19 least $314,000 for uncomplicated cases or when they 20 have liver cancer or end stage liver disease which 21 costs $30,980 to $110,576 per hospital admission. 22 As health care costs continue to grow, it is critical 23 that the Federal Government invests in effective 24 mechanisms to avoid documented cost drivers. 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00396 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 397 •HR 2954 IH (14) According to the IOM report in 2010, 1 chronic HBV and HCV infections cause substantial 2 morbidity and mortality despite being preventable 3 and treatable. Deficiencies in the implementation of 4 established guidelines for the prevention, diagnosis, 5 and medical management of chronic HBV and HCV 6 infections perpetuate personal and economic bur- 7 dens. Existing grants are not sufficient for the scale 8 of the health burden presented by HBV and HCV. 9 (15) Screening and testing for HBV and HCV 10 is aligned with the Healthy People 2020 goal; In- 11 crease immunization rates and reduce preventable 12 infectious diseases. Awareness of disease and access 13 to prevention and treatment remain essential compo- 14 nents for reducing infectious disease transmission. 15 (16) Federal support is necessary to increase 16 knowledge and awareness of HBV and HCV and to 17 assist State and local prevention and control efforts 18 in reducing the morbidity and mortality of these 19 epidemics. 20 (c) BIENNIAL ASSESSMENT OF HHS HEPATITIS B 21 AND HEPATITIS C PREVENTION, EDUCATION, RESEARCH, 22 AND MEDICAL MANAGEMENT PLAN.—Title III of the 23 Public Health Service Act (42 U.S.C. 241 et seq.) is 24 amended— 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00397 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 398 •HR 2954 IH (1) by striking section 317N (42 U.S.C. 247b– 1 15); and 2 (2) by adding at the end the following: 3 ‘‘PART X—BIENNIAL ASSESSMENT OF HHS HEPA- 4 TITIS B AND HEPATITIS C PREVENTION, EDU- 5 CATION, RESEARCH, AND MEDICAL MANAGE- 6 MENT PLAN 7 ‘‘SEC. 399NN. BIENNIAL UPDATE OF THE PLAN. 8 ‘‘(a) IN GENERAL.—The Secretary shall conduct a bi- 9 ennial assessment of the Secretary’s plan for the preven- 10 tion, control, and medical management of, and education 11 and research relating to, hepatitis B and hepatitis C, for 12 the purposes of— 13 ‘‘(1) incorporating into such plan new knowl- 14 edge or observations relating to hepatitis B and hep- 15 atitis C (such as knowledge and observations that 16 may be derived from clinical, laboratory, and epide- 17 miological research and disease detection, preven- 18 tion, and surveillance outcomes); 19 ‘‘(2) addressing gaps in the coverage or effec- 20 tiveness of the plan; and 21 ‘‘(3) evaluating and, if appropriate, updating 22 recommendations, guidelines, or educational mate- 23 rials of the Centers for Disease Control and Preven- 24 tion or the National Institutes of Health for health 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00398 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 399 •HR 2954 IH care providers or the public on viral hepatitis in 1 order to be consistent with the plan. 2 ‘‘(b) PUBLICATION OF NOTICE OF ASSESSMENTS.— 3 Not later than October 1 of the first even-numbered year 4 beginning after the date of the enactment of this part, 5 and October 1 of each even-numbered year thereafter, the 6 Secretary shall publish in the Federal Register a notice 7 of the results of the assessments conducted under para- 8 graph (1). Such notice shall include— 9 ‘‘(1) a description of any revisions to the plan 10 referred to in subsection (a) as a result of the as- 11 sessment; 12 ‘‘(2) an explanation of the basis for any such 13 revisions, including the ways in which such revisions 14 can reasonably be expected to further promote the 15 original goals and objectives of the plan; and 16 ‘‘(3) in the case of a determination by the Sec- 17 retary that the plan does not need revision, an expla- 18 nation of the basis for such determination. 19 ‘‘SEC. 399NN–1. ELEMENTS OF PROGRAM. 20 ‘‘(a) EDUCATION AND AWARENESS PROGRAMS.—The 21 Secretary, acting through the Director of the Centers for 22 Disease Control and Prevention, the Administrator of the 23 Health Resources and Services Administration, and the 24 Administrator of the Substance Abuse and Mental Health 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00399 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 400 •HR 2954 IH Services Administration, and in accordance with the plan 1 referred to in section 399NN(a), shall implement pro- 2 grams to increase awareness and enhance knowledge and 3 understanding of hepatitis B and hepatitis C. Such pro- 4 grams shall include— 5 ‘‘(1) the conduct of culturally and language ap- 6 propriate health education in primary and secondary 7 schools, college campuses, public awareness cam- 8 paigns, and community outreach activities (especially 9 to the ethnic communities with high rates of chronic 10 hepatitis B and chronic hepatitis C and other high- 11 risk groups) to promote public awareness and knowl- 12 edge about the value of hepatitis A and hepatitis B 13 immunization, risk factors, the transmission and 14 prevention of hepatitis B and hepatitis C, the value 15 of screening for the early detection of hepatitis B 16 and hepatitis C, and options available for the treat- 17 ment of chronic hepatitis B and chronic hepatitis C; 18 ‘‘(2) the promotion of immunization programs 19 that increase awareness and access to hepatitis A 20 and hepatitis B vaccines for susceptible adults and 21 children; 22 ‘‘(3) the training of health care professionals 23 regarding the importance of vaccinating individuals 24 infected with hepatitis C and individuals who are at 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00400 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 401 •HR 2954 IH risk for hepatitis C infection against hepatitis A and 1 hepatitis B; 2 ‘‘(4) the training of health care professionals 3 regarding the importance of vaccinating individuals 4 chronically infected with hepatitis B and individuals 5 who are at risk for chronic hepatitis B infection 6 against the hepatitis A virus; 7 ‘‘(5) the training of health care professionals 8 and health educators to make them aware of the 9 high rates of chronic hepatitis B and chronic hepa- 10 titis C in certain adult ethnic populations, and the 11 importance of prevention, detection, and medical 12 management of hepatitis B and hepatitis C and of 13 liver cancer screening; 14 ‘‘(6) the development and distribution of health 15 education curricula (including information relating 16 to the special needs of individuals infected with hep- 17 atitis B and hepatitis C, such as the importance of 18 prevention and early intervention, regular moni- 19 toring, the recognition of psychosocial needs, appro- 20 priate treatment, and liver cancer screening) for in- 21 dividuals providing hepatitis B and hepatitis C coun- 22 seling; and 23 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00401 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 402 •HR 2954 IH ‘‘(7) support for the implementation curricula 1 described in paragraph (6) by State and local public 2 health agencies. 3 ‘‘(b) IMMUNIZATION, PREVENTION, AND CONTROL 4 PROGRAMS.— 5 ‘‘(1) IN GENERAL.—The Secretary, acting 6 through the Director of the Centers for Disease 7 Control and Prevention, shall support the integra- 8 tion of activities described in paragraph (2) into ex- 9 isting clinical and public health programs at State, 10 local, territorial, and tribal levels (including commu- 11 nity health clinics, programs for the prevention and 12 treatment of HIV/AIDS, sexually transmitted dis- 13 eases, and substance abuse, and programs for indi- 14 viduals in correctional settings). 15 ‘‘(2) ACTIVITIES.— 16 ‘‘(A) VOLUNTARY TESTING PROGRAMS.— 17 ‘‘(i) IN GENERAL.—The Secretary 18 shall establish a mechanism by which to 19 support and promote the development of 20 State, local, territorial, and tribal vol- 21 untary hepatitis B and hepatitis C testing 22 programs to screen the high-prevalence 23 populations to aid in the early identifica- 24 tion of chronically infected individuals. 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00402 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 403 •HR 2954 IH ‘‘(ii) CONFIDENTIALITY OF THE TEST 1 RESULTS.—The Secretary shall prohibit 2 the use of the results of a hepatitis B or 3 hepatitis C test conducted by a testing pro- 4 gram developed or supported under this 5 subparagraph for any of the following: 6 ‘‘(I) Issues relating to health in- 7 surance. 8 ‘‘(II) To screen or determine 9 suitability for employment. 10 ‘‘(III) To discharge a person 11 from employment. 12 ‘‘(B) COUNSELING REGARDING VIRAL HEP- 13 ATITIS.—The Secretary shall support State, 14 local, territorial, and tribal programs in a wide 15 variety of settings, including those providing 16 primary and specialty health care services in 17 nonprofit private and public sectors, to— 18 ‘‘(i) provide individuals with ongoing 19 risk factors for hepatitis B and hepatitis C 20 infection with client-centered education 21 and counseling which concentrates on— 22 ‘‘(I) promoting testing of individ- 23 uals that have been exposed to their 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00403 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 404 •HR 2954 IH blood, family members, and their sex- 1 ual partners; and 2 ‘‘(II) changing behaviors that 3 place individuals at risk for infection; 4 ‘‘(ii) provide individuals chronically in- 5 fected with hepatitis B or hepatitis C with 6 education, health information, and coun- 7 seling to reduce their risk of— 8 ‘‘(I) dying from end-stage liver 9 disease and liver cancer; and 10 ‘‘(II) transmitting viral hepatitis 11 to others; and 12 ‘‘(iii) provide women chronically in- 13 fected with hepatitis B or hepatitis C who 14 are pregnant or of childbearing age with 15 culturally and language appropriate health 16 information, such as how to prevent hepa- 17 titis B perinatal infection, and to alleviate 18 fears associated with pregnancy or raising 19 a family. 20 ‘‘(C) IMMUNIZATION.—The Secretary shall 21 support State, local, territorial, and tribal ef- 22 forts to expand the current vaccination pro- 23 grams to protect every child in the country and 24 all susceptible adults, particularly those infected 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00404 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 405 •HR 2954 IH with hepatitis C and high-prevalence ethnic 1 populations and other high-risk groups, from 2 the risks of acute and chronic hepatitis B infec- 3 tion by— 4 ‘‘(i) ensuring continued funding for 5 hepatitis B vaccination for all children 19 6 years of age or younger through the Vac- 7 cines for Children Program; 8 ‘‘(ii) ensuring that the recommenda- 9 tions of the Advisory Committee on Immu- 10 nization Practices are followed regarding 11 the birth dose of hepatitis B vaccinations 12 for newborns; 13 ‘‘(iii) requiring proof of hepatitis B 14 vaccination for entry into public or private 15 daycare, preschool, elementary school, sec- 16 ondary school, and institutions of higher 17 education; 18 ‘‘(iv) expanding the availability of 19 hepatitis B vaccination for all susceptible 20 adults to protect them from becoming 21 acutely or chronically infected, including 22 ethnic and other populations with high 23 prevalence rates of chronic hepatitis B in- 24 fection; 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00405 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 406 •HR 2954 IH ‘‘(v) expanding the availability of hep- 1 atitis B vaccination for all susceptible 2 adults, particularly those in their reproduc- 3 tive age (women and men less than 45 4 years of age), to protect them from the 5 risk of hepatitis B infection; 6 ‘‘(vi) ensuring the vaccination of indi- 7 viduals infected, or at risk for infection, 8 with hepatitis C against hepatitis A, hepa- 9 titis B, and other infectious diseases, as 10 appropriate, for which such individuals 11 may be at increased risk; and 12 ‘‘(vii) ensuring the vaccination of indi- 13 viduals infected, or at risk for infection, 14 with hepatitis B against hepatitis A virus 15 and other infectious diseases, as appro- 16 priate, for which such individuals may be 17 at increased risk. 18 ‘‘(D) MEDICAL REFERRAL.—The Secretary 19 shall support State, local, territorial, and tribal 20 programs that support— 21 ‘‘(i) referral of persons chronically in- 22 fected with hepatitis B or hepatitis C— 23 ‘‘(I) for medical evaluation to de- 24 termine the appropriateness for 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00406 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 407 •HR 2954 IH antiviral treatment to reduce the risk 1 of progression to cirrhosis and liver 2 cancer; and 3 ‘‘(II) for ongoing medical man- 4 agement including regular monitoring 5 of liver function and screening for 6 liver cancer; and 7 ‘‘(ii) referral of persons infected with 8 acute or chronic hepatitis B infection or 9 acute or chronic hepatitis C infection for 10 drug and alcohol abuse treatment where 11 appropriate. 12 ‘‘(3) INCREASED SUPPORT FOR ADULT VIRAL 13 HEPATITIS COORDINATORS.—The Secretary, acting 14 through the Director of the Centers for Disease 15 Control and Prevention, shall provide increased sup- 16 port to Adult Viral Hepatitis Coordinators in State, 17 local, territorial, and tribal health departments in 18 order to enhance the additional management, net- 19 working, and technical expertise needed to ensure 20 successful integration of hepatitis B and hepatitis C 21 prevention and control activities into existing public 22 health programs. 23 ‘‘(c) EPIDEMIOLOGICAL SURVEILLANCE.— 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00407 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 408 •HR 2954 IH ‘‘(1) IN GENERAL.—The Secretary, acting 1 through the Director of the Centers for Disease 2 Control and Prevention, shall support the establish- 3 ment and maintenance of a national chronic and 4 acute hepatitis B and hepatitis C surveillance pro- 5 gram, in order to identify— 6 ‘‘(A) trends in the incidence of acute and 7 chronic hepatitis B and acute and chronic hepa- 8 titis C; 9 ‘‘(B) trends in the prevalence of acute and 10 chronic hepatitis B and acute and chronic hepa- 11 titis C infection among groups that may be dis- 12 proportionately affected; and 13 ‘‘(C) trends in liver cancer and end-stage 14 liver disease incidence and deaths, caused by 15 chronic hepatitis B and chronic hepatitis C in 16 the high-risk ethnic populations. 17 ‘‘(2) SEROPREVALENCE AND LIVER CANCER 18 STUDIES.—The Secretary, acting through the Direc- 19 tor of the Centers for Disease Control and Preven- 20 tion, shall prepare a report outlining the population- 21 based seroprevalence studies currently underway, fu- 22 ture planned studies, the criteria involved in deter- 23 mining which seroprevalence studies to conduct, 24 defer, or suspend, and the scope of those studies, the 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00408 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 409 •HR 2954 IH economic and clinical impact of hepatitis B and hep- 1 atitis C, and the impact of chronic hepatitis B and 2 chronic hepatitis C infections on the quality of life. 3 Not later than one year after the date of the enact- 4 ment of this part, the Secretary shall submit the re- 5 port to the Committee on Energy and Commerce of 6 the House of Representatives and the Committee on 7 Health, Education, Labor, and Pensions of the Sen- 8 ate. 9 ‘‘(3) CONFIDENTIALITY.—The Secretary shall 10 not disclose any individually identifiable information 11 identified under paragraph (1) or derived through 12 studies under paragraph (2). 13 ‘‘(d) RESEARCH.—The Secretary, acting through the 14 Director of the Centers for Disease Control and Preven- 15 tion, the Director of the National Cancer Institute, and 16 the Director of the National Institutes of Health, shall— 17 ‘‘(1) conduct epidemiologic and community- 18 based research to develop, implement, and evaluate 19 best practices for hepatitis B and hepatitis C pre- 20 vention especially in the ethnic populations with high 21 rates of chronic hepatitis B and chronic hepatitis C 22 and other high-risk groups; 23 ‘‘(2) conduct research on hepatitis B and hepa- 24 titis C natural history, pathophysiology, improved 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00409 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 410 •HR 2954 IH treatments and prevention (such as the hepatitis C 1 vaccine), and noninvasive tests that help to predict 2 the risk of progression to liver cirrhosis and liver 3 cancer; 4 ‘‘(3) conduct research that will lead to better 5 noninvasive or blood tests to screen for liver cancer, 6 and more effective treatments of liver cancer caused 7 by chronic hepatitis B and chronic hepatitis C; and 8 ‘‘(4) conduct research comparing the effective- 9 ness of screening, diagnostic, management, and 10 treatment approaches for chronic hepatitis B, chron- 11 ic hepatitis C, and liver cancer in the affected com- 12 munities. 13 ‘‘(e) UNDERSERVED AND DISPROPORTIONATELY AF- 14 FECTED POPULATIONS.—In carrying out this section, the 15 Secretary shall provide expanded support for individuals 16 with limited access to health education, testing, and health 17 care services and groups that may be disproportionately 18 affected by hepatitis B and hepatitis C. 19 ‘‘(f) EVALUATION OF PROGRAM.—The Secretary 20 shall develop benchmarks for evaluating the effectiveness 21 of the programs and activities conducted under this sec- 22 tion and make determinations as to whether such bench- 23 marks have been achieved. 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00410 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 411 •HR 2954 IH ‘‘SEC. 399NN–2. GRANTS. 1 ‘‘(a) IN GENERAL.—The Secretary may award grants 2 to, or enter into contracts or cooperative agreements with, 3 States, political subdivisions of States, territories, Indian 4 tribes, or nonprofit entities that have special expertise re- 5 lating to hepatitis B, hepatitis C, or both, to carry out 6 activities under this part. 7 ‘‘(b) APPLICATION.—To be eligible for a grant, con- 8 tract, or cooperative agreement under subsection (a), an 9 entity shall prepare and submit to the Secretary an appli- 10 cation at such time, in such manner, and containing such 11 information as the Secretary may require. 12 ‘‘SEC. 399NN–3. AUTHORIZATION OF APPROPRIATIONS. 13 ‘‘There are authorized to be appropriated to carry out 14 this part $90,000,000 for fiscal year 2012, $90,000,000 15 for fiscal year 2013, $110,000,000 for fiscal year 2014, 16 $130,000,000 for fiscal year 2015, and $150,000,000 for 17 fiscal year 2016.’’. 18 (d) ENHANCING SAMHSA’S ROLE IN HEPATITIS AC- 19 TIVITIES.—Paragraph (6) of section 501(d) of the Public 20 Health Service Act (42 U.S.C. 290aa(d)) is amended by 21 striking ‘‘HIV or tuberculosis’’ and inserting ‘‘HIV, tuber- 22 culosis, or hepatitis’’. 23 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00411 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 412 •HR 2954 IH Subtitle C—Acquired Bone Marrow 1 Failure Diseases 2 SEC. 721. ACQUIRED BONE MARROW FAILURE DISEASES. 3 (a) SHORT TITLE.—This subtitle may be cited as the 4 ‘‘Bone Marrow Failure Disease Research and Treatment 5 Act of 2011’’. 6 (b) FINDINGS.—The Congress finds the following: 7 (1) Between 20,000 and 30,000 Americans are 8 diagnosed each year with myelodysplastic syndromes, 9 aplastic anemia, paroxysmal nocturnal hemo- 10 globinuria, and other acquired bone marrow failure 11 diseases. 12 (2) Acquired bone marrow failure diseases have 13 a debilitating and often fatal impact on those diag- 14 nosed with these diseases. 15 (3) While some treatments for acquired bone 16 marrow failure diseases can prolong and improve the 17 quality of patients’ lives, there is no single cure for 18 these diseases. 19 (4) The prevalence of acquired bone marrow 20 failure diseases in the United States will continue to 21 grow as the general public ages. 22 (5) Evidence exists suggesting that acquired 23 bone marrow failure diseases occur more often in 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00412 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 413 •HR 2954 IH minority populations, particularly in Asian-American 1 and Hispanic/Latin-American populations. 2 (6) The National Heart, Lung, and Blood Insti- 3 tute and the National Cancer Institute have con- 4 ducted important research into the causes of and 5 treatments for acquired bone marrow failure dis- 6 eases. 7 (7) The National Marrow Donor Program Reg- 8 istry has made significant contributions to the fight 9 against bone marrow failure diseases by connecting 10 millions of potential marrow donors with individuals 11 and families suffering from these conditions. 12 (8) Despite these advances, a more comprehen- 13 sive Federal strategic effort among numerous Fed- 14 eral agencies is needed to discover a cure for ac- 15 quired bone marrow failure disorders. 16 (9) Greater Federal surveillance of acquired 17 bone marrow failure diseases is needed to gain a bet- 18 ter understanding of the causes of acquired bone 19 marrow failure diseases. 20 (10) The Federal Government should increase 21 its research support for and engage with public and 22 private organizations in developing a comprehensive 23 approach to combat and cure acquired bone marrow 24 failure diseases. 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00413 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 414 •HR 2954 IH (c) NATIONAL ACQUIRED BONE MARROW FAILURE 1 DISEASE REGISTRY.—Part B of the Public Health Service 2 Act (42 U.S.C. 311 et seq.) is amended by inserting after 3 section 317W, as added, the following: 4 ‘‘SEC. 317X. NATIONAL ACQUIRED BONE MARROW FAILURE 5 DISEASE REGISTRY. 6 ‘‘(a) ESTABLISHMENT OF REGISTRY.— 7 ‘‘(1) IN GENERAL.—Not later than 6 months 8 after the date of the enactment of this section, the 9 Secretary, acting through the Director of the Cen- 10 ters for Disease Control and Prevention, shall— 11 ‘‘(A) develop a system to collect data on 12 acquired bone marrow failure diseases; and 13 ‘‘(B) establish and maintain a national and 14 publicly available registry, to be known as the 15 National Acquired Bone Marrow Failure Dis- 16 ease Registry, in accordance with paragraph 17 (3). 18 ‘‘(2) RECOMMENDATIONS OF ADVISORY COM- 19 MITTEE.—In carrying out this subsection, the Sec- 20 retary shall take into consideration the recommenda- 21 tions of the Advisory Committee on Acquired Bone 22 Marrow Failure Diseases established under sub- 23 section (b). 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00414 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 415 •HR 2954 IH ‘‘(3) PURPOSES OF REGISTRY.—The National 1 Acquired Bone Marrow Failure Disease Registry— 2 ‘‘(A) shall identify the incidence and preva- 3 lence of acquired bone marrow failure diseases 4 in the United States; 5 ‘‘(B) shall be used to collect and store data 6 on acquired bone marrow failure diseases, in- 7 cluding data concerning— 8 ‘‘(i) the age, race or ethnicity, general 9 geographic location, sex, and family history 10 of individuals who are diagnosed with ac- 11 quired bone marrow failure diseases, and 12 any other characteristics of such individ- 13 uals determined appropriate by the Sec- 14 retary; 15 ‘‘(ii) the genetic and environmental 16 factors that may be associated with devel- 17 oping acquired bone marrow failure dis- 18 eases; 19 ‘‘(iii) treatment approaches for deal- 20 ing with acquired bone marrow failure dis- 21 eases; 22 ‘‘(iv) outcomes for individuals treated 23 for acquired bone marrow failure diseases, 24 including outcomes for recipients of stem 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00415 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 416 •HR 2954 IH cell therapeutic products as contained in 1 the database established pursuant to sec- 2 tion 379A; and 3 ‘‘(v) any other factors pertaining to 4 acquired bone marrow failure diseases de- 5 termined appropriate by the Secretary; and 6 ‘‘(C) shall be made available— 7 ‘‘(i) to the general public; and 8 ‘‘(ii) to researchers to facilitate fur- 9 ther research into the causes of, and treat- 10 ments for, acquired bone marrow failure 11 diseases in accordance with standard prac- 12 tices of the Centers for Disease Control 13 and Preventions. 14 ‘‘(b) ADVISORY COMMITTEE.— 15 ‘‘(1) ESTABLISHMENT.—Not later than 6 16 months after the date of the enactment of this sec- 17 tion, the Secretary, acting through the Director of 18 the Centers for Disease Control and Prevention, 19 shall establish an advisory committee, to be known 20 as the Advisory Committee on Acquired Bone Mar- 21 row Failure Diseases. 22 ‘‘(2) MEMBERS.—The members of the Advisory 23 Committee on Acquired Bone Marrow Failure Dis- 24 eases shall be appointed by the Secretary, acting 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00416 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 417 •HR 2954 IH through the Director of the Centers for Disease 1 Control and Prevention, and shall include at least 2 one representative from each of the following: 3 ‘‘(A) A national patient advocacy organiza- 4 tion with experience advocating on behalf of pa- 5 tients suffering from acquired bone marrow 6 failure diseases. 7 ‘‘(B) The National Institutes of Health, in- 8 cluding at least one representative from each 9 of— 10 ‘‘(i) the National Cancer Institute; 11 ‘‘(ii) the National Heart, Lung, and 12 Blood Institute; and 13 ‘‘(iii) the Office of Rare Diseases. 14 ‘‘(C) The Centers for Disease Control and 15 Prevention. 16 ‘‘(D) Clinicians with experience in— 17 ‘‘(i) diagnosing or treating acquired 18 bone marrow failure diseases; and 19 ‘‘(ii) medical data registries. 20 ‘‘(E) Epidemiologists who have experience 21 with data registries. 22 ‘‘(F) Publicly or privately funded research- 23 ers who have experience researching acquired 24 bone marrow failure diseases. 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00417 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 418 •HR 2954 IH ‘‘(G) The entity operating the C.W. Bill 1 Young Cell Transplantation Program estab- 2 lished pursuant to section 379 and the entity 3 operating the C.W. Bill Young Cell Transplan- 4 tation Program Outcomes Database. 5 ‘‘(3) RESPONSIBILITIES.—The Advisory Com- 6 mittee on Acquired Bone Marrow Failure Diseases 7 shall provide recommendations to the Secretary on 8 the establishment and maintenance of the National 9 Acquired Bone Marrow Failure Disease Registry, in- 10 cluding recommendations on the collection, mainte- 11 nance, and dissemination of data. 12 ‘‘(4) PUBLIC AVAILABILITY.—The Secretary 13 shall make the recommendations of the Advisory 14 Committee on Acquired Bone Marrow Failure Dis- 15 ease publicly available. 16 ‘‘(c) GRANTS.—The Secretary, acting through the 17 Director of the Centers for Disease Control and Preven- 18 tion, may award grants to, and enter into contracts and 19 cooperative agreements with, public or private nonprofit 20 entities for the management of, as well as the collection, 21 analysis, and reporting of data to be included in, the Na- 22 tional Acquired Bone Marrow Failure Disease Registry. 23 ‘‘(d) DEFINITION.—In this section, the term ‘ac- 24 quired bone marrow failure disease’ means— 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00418 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 419 •HR 2954 IH ‘‘(1) myelodysplastic syndromes (MDS); 1 ‘‘(2) aplastic anemia; 2 ‘‘(3) paroxysmal nocturnal hemoglobinuria 3 (PNH); 4 ‘‘(4) pure red cell aplasia; 5 ‘‘(5) acute myeloid leukemia that has pro- 6 gressed from myelodysplastic syndromes; or 7 ‘‘(6) large granular lymphocytic leukemia. 8 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 9 is authorized to be appropriated to carry out this section 10 $3,000,000 for each of fiscal years 2012 through 2016.’’. 11 (d) PILOT STUDIES THROUGH THE AGENCY FOR 12 TOXIC SUBSTANCES AND DISEASE REGISTRY.— 13 (1) PILOT STUDIES.—The Secretary of Health 14 and Human Services, acting through the Adminis- 15 trator of the Agency for Toxic Substances and Dis- 16 ease Registry, shall conduct pilot studies to deter- 17 mine which environmental factors, including expo- 18 sure to toxins, may cause acquired bone marrow fail- 19 ure diseases. 20 (2) COLLABORATION WITH THE RADIATION IN- 21 JURY TREATMENT NETWORK.—In carrying out the 22 directives of this section, the Secretary may collabo- 23 rate with the Radiation Injury Treatment Network 24 of the C.W. Bill Young Cell Transplantation Pro- 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00419 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 420 •HR 2954 IH gram established pursuant to section 379 of the 1 Public Health Service Act (42 U.S.C. 274j) to— 2 (A) augment data for the pilot studies au- 3 thorized by this section; 4 (B) access technical assistance that may be 5 provided by the Radiation Injury Treatment 6 Network; or 7 (C) perform joint research projects. 8 (3) AUTHORIZATION OF APPROPRIATIONS.— 9 There is authorized to be appropriated to carry out 10 this section $1,000,000 for each of fiscal years 2012 11 through 2016. 12 (e) MINORITY-FOCUSED PROGRAMS ON ACQUIRED 13 BONE MARROW FAILURE DISEASES.—Title XVII of the 14 Public Health Service Act (42 U.S.C. 300u et seq.) is 15 amended by inserting after section 1707A the following: 16 ‘‘MINORITY-FOCUSED PROGRAMS ON ACQUIRED BONE 17 MARROW FAILURE DISEASES 18 ‘‘SEC. 1707B. (a) INFORMATION AND REFERRAL 19 SERVICES.— 20 ‘‘(1) IN GENERAL.—Not later than 6 months 21 after the date of the enactment of this section, the 22 Secretary, acting through the Deputy Assistant Sec- 23 retary for Minority Health, shall establish and co- 24 ordinate outreach and informational programs tar- 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00420 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 421 •HR 2954 IH geted to minority populations affected by acquired 1 bone marrow failure diseases. 2 ‘‘(2) PROGRAM REQUIREMENTS.—Minority-fo- 3 cused outreach and informational programs author- 4 ized by this section— 5 ‘‘(A) shall make information about treat- 6 ment options and clinical trials for acquired 7 bone marrow failure diseases publicly available, 8 and 9 ‘‘(B) shall provide referral services for 10 treatment options and clinical trials, 11 at the national minority health resource center sup- 12 ported under section 1707(b)(8) (including by means 13 of the center’s Web site, through appropriate loca- 14 tions such as the center’s knowledge center, and 15 through appropriate programs such as the center’s 16 resource persons network) and through minority 17 health consultants located at each Department of 18 Health and Human Services regional office. 19 ‘‘(b) HISPANIC AND ASIAN-AMERICAN AND PACIFIC 20 ISLANDER OUTREACH.— 21 ‘‘(1) IN GENERAL.—The Secretary, acting 22 through the Deputy Assistant Secretary for Minority 23 Health, shall undertake a coordinated outreach ef- 24 fort to connect Hispanic, Asian-American, and Pa- 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00421 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 422 •HR 2954 IH cific Islander communities with comprehensive serv- 1 ices focused on treatment of, and information about, 2 acquired bone marrow failure diseases. 3 ‘‘(2) COLLABORATION.—In carrying out this 4 subsection, the Secretary may collaborate with public 5 health agencies, nonprofit organizations, community 6 groups, and online entities to disseminate informa- 7 tion about treatment options and clinical trials for 8 acquired bone marrow failure diseases. 9 ‘‘(c) GRANTS AND COOPERATIVE AGREEMENTS.— 10 ‘‘(1) IN GENERAL.—Not later than 6 months 11 after the date of the enactment of this section, the 12 Secretary, acting through the Deputy Assistant Sec- 13 retary for Minority Health, shall award grants to, or 14 enter into cooperative agreements with, entities to 15 perform research on acquired bone marrow failure 16 diseases. 17 ‘‘(2) REQUIREMENT.—Grants and cooperative 18 agreements authorized by this subsection shall be 19 awarded or entered into on a competitive, peer-re- 20 viewed basis. 21 ‘‘(3) SCOPE OF RESEARCH.—Research funded 22 under this section shall examine factors affecting the 23 incidence of acquired bone marrow failure diseases 24 in minority populations. 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00422 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 423 •HR 2954 IH ‘‘(d) DEFINITION.—In this section, the term ‘ac- 1 quired bone marrow failure disease’ has the meaning given 2 to such term in section 317X(d). 3 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 4 is authorized to be appropriated to carry out this section 5 $2,000,000 for each of fiscal years 2012 through 2016.’’. 6 (f) DIAGNOSIS AND QUALITY OF CARE FOR AC- 7 QUIRED BONE MARROW FAILURE DISEASES.— 8 (1) GRANTS.—The Secretary of Health and 9 Human Services, acting through the Director of the 10 Agency for Healthcare Research and Quality, shall 11 award grants to entities to improve diagnostic prac- 12 tices and quality of care with respect to patients 13 with acquired bone marrow failure diseases. 14 (2) AUTHORIZATION OF APPROPRIATIONS.— 15 There is authorized to be appropriated to carry out 16 this section $2,000,000 for each of fiscal years 2012 17 through 2016. 18 (g) DEFINITION.—In this section, the term ‘‘acquired 19 bone marrow failure disease’’ means— 20 (1) myelodysplastic syndromes (MDS); 21 (2) aplastic anemia; 22 (3) paroxysmal nocturnal hemoglobinuria 23 (PNH); 24 (4) pure red cell aplasia; 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00423 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 424 •HR 2954 IH (5) acute myeloid leukemia that progressed 1 from myelodysplastic syndromes; or 2 (6) large granular lymphocytic leukemia. 3 Subtitle D—Cardiovascular Dis- 4 ease, Chronic Disease, and 5 Other Disease Issues 6 SEC. 731. GUIDELINES FOR DISEASE SCREENING FOR MI- 7 NORITY PATIENTS. 8 (a) IN GENERAL.—The Secretary, acting through the 9 Director of the Agency for Healthcare Research and Qual- 10 ity, shall convene a series of meetings to develop guidelines 11 for disease screening for minority patient populations 12 which have a higher than average risk for many chronic 13 diseases and cancers. 14 (b) PARTICIPANTS.—In convening meetings under 15 subsection (a), the Secretary shall ensure that meeting 16 participants include representatives of— 17 (1) professional societies and associations; 18 (2) minority health organizations; 19 (3) health care researchers and providers, in- 20 cluding those with expertise in minority health; 21 (4) Federal health agencies, including the Of- 22 fice of Minority Health, the National Institute on 23 Minority Health and Health Disparities, and the 24 National Institutes of Health; and 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00424 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 425 •HR 2954 IH (5) other experts determined appropriate by the 1 Secretary. 2 (c) DISEASES.—Screening guidelines for minority 3 populations shall be developed as appropriate under sub- 4 section (a) for— 5 (1) hypertension; 6 (2) hypercholesterolemia; 7 (3) diabetes; 8 (4) cardiovascular disease; 9 (5) cancers, including breast, prostate, colon, 10 cervical, and lung cancer; 11 (6) asthma; 12 (7) diabetes; 13 (8) kidney diseases; 14 (9) eye diseases and disorders, including glau- 15 coma; 16 (10) HIV/AIDS and sexually transmitted dis- 17 eases; 18 (11) uterine fibroids; 19 (12) autoimmune disease; 20 (13) mental health conditions; 21 (14) dental health conditions and oral diseases; 22 (15) environmental and related health illnesses 23 and conditions; 24 (16) Sickle cell disease; 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00425 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 426 •HR 2954 IH (17) violence and injury prevention and control; 1 (18) genetic and related conditions; 2 (19) heart disease and stroke; 3 (20) tuberculosis; 4 (21) chronic obstructive pulmonary disease; and 5 (22) other diseases determined appropriate by 6 the Secretary. 7 (d) DISSEMINATION.—Not later than 24 months 8 after the date of enactment of this title, the Secretary 9 shall publish and disseminate to health care provider orga- 10 nizations the guidelines developed under subsection (a). 11 (e) AUTHORIZATION OF APPROPRIATIONS.—There 12 are authorized to be appropriated to carry out this section, 13 such sums as may be necessary for each of fiscal years 14 2012 through 2016. 15 SEC. 732. COVERAGE OF THE SHINGLES VACCINE UNDER 16 THE MEDICARE PROGRAM. 17 (a) IN GENERAL.—Section 1861 of the Social Secu- 18 rity Act (42 U.S.C. 1395x) is amended— 19 (1) in subsection (s)(10)(A), by inserting ‘‘, 20 shingles vaccine and its administration,’’ before 21 ‘‘and, subject to’’; and 22 (2) in subsection (ww)(2)(A), by inserting 23 ‘‘shingles,’’ after ‘‘Pneumococcal,’’. 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00426 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 427 •HR 2954 IH (b) EFFECTIVE DATE.—The amendments made by 1 subsection (a) shall apply to shingles vaccine furnished on 2 or after January 1 of the first calendar year beginning 3 more than 60 days after the date of the enactment of this 4 Act. 5 SEC. 733. CDC WISEWOMAN SCREENING PROGRAM. 6 Section 1509 of the Public Health Service Act (42 7 U.S.C. 300n–4a) is amended— 8 (1) in subsection (a)— 9 (A) by striking the heading and inserting 10 ‘‘IN GENERAL.—’’; and 11 (B) in the matter preceding paragraph (1), 12 by striking ‘‘may make grants’’ and all that fol- 13 lows through ‘‘purpose’’ and inserting the fol- 14 lowing: ‘‘may make grants to such States for 15 the purpose’’; and 16 (2) in subsection (d)(1), by striking ‘‘there are 17 authorized’’ and all that follows through the period 18 and inserting ‘‘there are authorized to be appro- 19 priated $23,000,000 for fiscal year 2012, 20 $25,300,000 for fiscal year 2013, $27,800,000 for 21 fiscal year 2014, $30,800,000 for fiscal year 2015, 22 and $34,000,000 for fiscal year 2016.’’. 23 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00427 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 428 •HR 2954 IH SEC. 734. REPORT ON CARDIOVASCULAR CARE FOR WOMEN 1 AND MINORITIES. 2 Part P of title III of the Public Health Service Act 3 (42 U.S.C. 280g et seq.) is amended by adding at the end 4 the following: 5 ‘‘SEC. 399V–5. REPORT ON CARDIOVASCULAR CARE FOR 6 WOMEN AND MINORITIES. 7 ‘‘Not later than September 30, 2014, and annually 8 thereafter, the Secretary shall prepare and submit to the 9 Congress a report on the quality of and access to care 10 for women and minorities with heart disease, stroke, and 11 other cardiovascular diseases. The report shall contain rec- 12 ommendations for eliminating disparities in, and improv- 13 ing the treatment of, heart disease, stroke, and other car- 14 diovascular diseases in women, racial and ethnic minori- 15 ties, those for whom English is not their primary lan- 16 guage, and individuals with disabilities.’’. 17 SEC. 735. COVERAGE OF COMPREHENSIVE TOBACCO CES- 18 SATION SERVICES IN MEDICAID. 19 (a) REQUIRING COVERAGE OF COUNSELING AND 20 PHARMACOTHERAPY FOR CESSATION OF TOBACCO 21 USE.—Section 1905 of the Social Security Act (42 U.S.C. 22 1396d) is amended— 23 (1) in subsection (a)(4)(D) is amended by strik- 24 ing ‘‘by pregnant women’’; and 25 (2) in subsection (bb)— 26 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00428 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 429 •HR 2954 IH (A) by striking ‘‘by pregnant women’’ each 1 place it appears; 2 (B) in paragraph (1), in the matter before 3 subparagraph (A), by inserting ‘‘by individuals’’ 4 before ‘‘who use tobacco’’; and 5 (C) in paragraph (2)(A), by striking ‘‘with 6 respect to pregnant women’’. 7 (b) EXCEPTION FROM OPTIONAL RESTRICTION 8 UNDER MEDICAID PRESCRIPTION DRUG COVERAGE.— 9 Section 1927(d)(2)(F) of the Social Security Act (42 10 U.S.C. 1396r–8(d)(2)(F)) is amended by striking ‘‘in the 11 case of pregnant women’’. 12 (c) REMOVAL OF COST SHARING FOR COUNSELING 13 AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO 14 USE.— 15 (1) GENERAL COST SHARING LIMITATIONS.— 16 Section 1916 of the Social Security Act (42 U.S.C. 17 1396o) is amended— 18 (A) in subsections (a)(2)(B) and (b)(2)(B), 19 by striking ‘‘and counseling and pharmacother- 20 apy for cessation of tobacco use by pregnant 21 women (as defined in section 1905(bb)) and 22 covered outpatient drugs (as defined in sub- 23 section (k)(2) of section 1927 and including 24 nonprescription drugs described in subsection 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00429 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 430 •HR 2954 IH (d)(2) of such section) that are prescribed for 1 purposes of promoting, and when used to pro- 2 mote, tobacco cessation by pregnant women in 3 accordance with the Guideline referred to in 4 section 1905(bb)(2)(A)’’ each place it appears; 5 and 6 (B) in each of subsections (a)(2)(D) and 7 (b)(2)(D) by inserting ‘‘and counseling and 8 pharmacotherapy for cessation of tobacco use 9 (as defined in section 1905(bb)) and covered 10 outpatient drugs (as defined in subsection 11 (k)(2) of section 1927 and including non- 12 prescription drugs described in subsection 13 (d)(2) of such section) that are prescribed for 14 purposes of promoting, and when used to pro- 15 mote, tobacco cessation in accordance with the 16 Guideline referred to in section 17 1905(bb)(2)(A),’’ after ‘‘section 18 1905(a)(4)(C),’’. 19 (2) APPLICATION TO ALTERNATIVE 20 COSTSHARING.—Section 1916A(b)(3)(B) of such Act 21 (42 U.S.C. 1396o–1(b)(3)(B)) is amended— 22 (A) in clause (iii), by striking ‘‘, and coun- 23 seling and pharmacotherapy for cessation of to- 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00430 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 431 •HR 2954 IH bacco use by pregnant women (as defined in 1 section 1905(bb))’’; and 2 (B) by adding at the end the following: 3 ‘‘(xi) Counseling and 4 pharmacotherapy for cessation of tobacco 5 use (as defined in section 1905(bb)) and 6 covered outpatient drugs (as defined in 7 subsection (k)(2) of section 1927 and in- 8 cluding nonprescription drugs described in 9 subsection (d)(2) of such section) that are 10 prescribed for purposes of promoting, and 11 when used to promote, tobacco cessation in 12 accordance with the Guideline referred to 13 in section 1905(bb)(2)(A).’’. 14 (d) EFFECTIVE DATE.—The amendments made by 15 this section shall take effect on October 1, 2012. 16 SEC. 736. CLINICAL RESEARCH FUNDING FOR ORAL 17 HEALTH. 18 (a) IN GENERAL.—The Secretary of Health and 19 Human Services shall expand and intensify the conduct 20 and support of the research activities of the National In- 21 stitutes of Health and the National Institute of Dental 22 and Craniofacial Research to improve the oral health of 23 the population through the prevention and management 24 of oral diseases and conditions. 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00431 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 432 •HR 2954 IH (b) INCLUDED RESEARCH ACTIVITIES.—Research 1 activities under subsection (a) shall include— 2 (1) comparative effectiveness research and clin- 3 ical disease management research addressing early 4 childhood caries and oral cancer; and 5 (2) awarding of grants and contracts to support 6 the training and development of health services re- 7 searchers, comparative effectiveness researchers, and 8 clinical researchers whose research improves the oral 9 health of the population. 10 Subtitle E—HIV/AIDS 11 SEC. 741. FINDINGS. 12 The Congress finds the following: 13 (1) Over one million people are estimated to be 14 living with HIV in the United States according to 15 the Centers for Disease Control and Prevention. 16 (2) Annually there are over 17,000 deaths in 17 people with an HIV diagnoses in 40 States and 5 18 dependent areas of the United States. 19 (3) The Centers for Disease Control and Pre- 20 vention estimates that in 2009 there were approxi- 21 mately 48,100 people newly infected with HIV. 22 Though this number seems to be staying relatively 23 stable, the number of new infections is rapidly in- 24 creasing among certain populations especially among 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00432 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 433 •HR 2954 IH young African-American men who have sex with men 1 who had an overall 48 percent increase in new infec- 2 tions from 2006 to 2009. 3 (4) HIV disproportionately affects certain popu- 4 lations in the United States. Though African-Ameri- 5 cans represent less than 13 percent of the popu- 6 lation, African-Americans account for almost half 7 (46 percent) of all people living with HIV in the 8 United States. Men who have sex with men (MSM) 9 make up approximately 2 percent of the population, 10 but account for over half (53 percent) of individuals 11 living with HIV and are the only risk group in which 12 HIV infections continue to increase. 13 (5) Disparities exist among Latin-Americans; 14 they make up 15 percent of US population and 17 15 percent of new infections (2006). 16 (6) Though American Indians/Alaska Natives 17 represent less than 1 percent of the total number of 18 HIV/AIDS cases, American Indians and Alaska Na- 19 tives rank third in rates of HIV/AIDS diagnosis, 20 after African-Americans and Latin-Americans. 21 (7) While Asian-Americans, Native Hawaiians, 22 and Pacific Islanders HIV/AIDS cases account for 23 approximately 1 percent of cases nationally, Asian 24 Americans and Pacific Islanders were the only ra- 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00433 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 434 •HR 2954 IH cial/ethnic groups with a statistically significant in- 1 crease in new HIV diagnoses between 2001 and 2 2008. 3 (8) The limited data available on transgender 4 individuals point to a disproportionate burden of 5 HIV infection. 6 (9) Stigma and discrimination contribute to 7 these disparities. 8 (10) For HIV, early detection and treatment 9 can have huge effects. New research suggests that 10 treatment of individuals not only slows disease pro- 11 gression, but can also greatly reduce the risk of 12 transmission to other individuals. 13 (11) To combat the HIV epidemic in the United 14 States, the National HIV/AIDS Strategy (NHAS) 15 from the White House Office of National AIDS Pol- 16 icy provides a framework of increasing access to 17 care, reducing new infections, and eliminating HIV- 18 related health disparities. The vision of NHAS is 19 ‘‘The United States will become a place where new 20 HIV infections are rare and when they do occur, 21 every person, regardless of age, gender, race/eth- 22 nicity, sexual orientation, gender identity, or socio- 23 economic circumstance, will have unfettered access 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00434 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 435 •HR 2954 IH to high quality, life extending care, free from stigma 1 and discrimination.’’. 2 (12) Although the cost of education, treatment 3 and care, and research are not inconsequential, they 4 are substantially less than the annual health care 5 cost attributable to HIV in the United States. The 6 lifetime cost of HIV care and treatment in 2004 was 7 estimated to be $405,000 to $648,000 dollars annu- 8 ally. Preventing 40,000 new infections in the United 9 States each year would save $12.8 billion annually. 10 SEC. 742. ADDRESSING HIV/AIDS IN COMMUNITIES OF 11 COLOR. 12 (a) NATIONAL OBSERVANCE DAYS.—It is the sense 13 of the Congress that national observance days highlighting 14 the impact of HIV/AIDS on communities of color include 15 the following: 16 (1) National Black HIV/AIDS Awareness Day. 17 (2) National Latino AIDS Awareness Day. 18 (3) National Asian and Pacific Islander HIV/ 19 AIDS Awareness Day. 20 (4) National Native HIV/AIDS Awareness Day. 21 (5) Caribbean American HIV/AIDS Awareness 22 Day. 23 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00435 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 436 •HR 2954 IH (b) CALL TO ACTION.—It is the sense of the Con- 1 gress that the President should call on members of com- 2 munities of color— 3 (1) to become involved at the local community 4 level in HIV/AIDS testing, policy, and advocacy; 5 (2) to become aware, engaged, and empowered 6 on the HIV/AIDS epidemic within their commu- 7 nities; and 8 (3) to urge members of their communities to re- 9 duce risk factors, practice safe sex and other preven- 10 tive measures, be tested for HIV/AIDS, and seek 11 care when appropriate. 12 SEC. 743. HIV/AIDS REDUCTION IN RACIAL AND ETHNIC MI- 13 NORITY COMMUNITIES. 14 (a) EXPANDED FUNDING.—The Secretary, in col- 15 laboration with the Deputy Assistant Secretary for Minor- 16 ity Health, the Director of the Centers for Disease Control 17 and Prevention, the Administrator of the Health Re- 18 sources and Services Administration, and the Adminis- 19 trator of the Substance Abuse and Mental Health Services 20 Administration, shall provide funds and carry out activi- 21 ties to expand the Minority HIV/AIDS Initiative. 22 (b) USE OF FUNDS.—The additional funds made 23 available under this section may be used, through the Mi- 24 nority AIDS Initiative, to support the following activities: 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00436 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 437 •HR 2954 IH (1) Providing technical assistance and infra- 1 structure support to reduce HIV/AIDS in minority 2 populations. 3 (2) Increasing minority populations’ access to 4 HIV/AIDS prevention and care services. 5 (3) Building strong community programs and 6 partnerships to address HIV prevention and the 7 health care needs of specific racial and ethnic minor- 8 ity populations. 9 (c) PRIORITY INTERVENTIONS.—Within the racial 10 and ethnic minority populations referred to in subsection 11 (b), priority in conducting intervention services shall be 12 given to— 13 (1) women; 14 (2) youth; 15 (3) men who have sex with men; 16 (4) persons who engage in intravenous drug 17 abuse; 18 (5) homeless individuals; and 19 (6) individuals incarcerated or in the penal sys- 20 tem. 21 (d) AUTHORIZATION OF APPROPRIATIONS.—For car- 22 rying out this section, there are authorized to be appro- 23 priated $610,000,0000 for fiscal year 2012 and such sums 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00437 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 438 •HR 2954 IH as may be necessary for each of fiscal years 2013 through 1 2016. 2 SEC. 744. REPEALING INEFFECTIVE AND INCOMPLETE AB- 3 STINENCE-ONLY EDUCATION PROGRAM. 4 (a) IN GENERAL.—Title V of the Social Security Act 5 (42 U.S.C. 701 et seq.) is amended by striking section 6 510. 7 (b) RESCISSION.—Amounts appropriated for each of 8 fiscal years 2010 and 2011 under section 510(d) of the 9 Social Security Act (42 U.S.C. 710(d)) (as in effect on 10 the day before the date of enactment of this Act) that are 11 unobligated as of the date of enactment of this Act are 12 rescinded. 13 (c) REPROGRAM OF ELIMINATED ABSTINENCE-ONLY 14 FUNDS FOR THE PERSONAL RESPONSIBILITY EDUCATION 15 PROGRAM (PREP).—Section 513(f) of the Social Security 16 Act (42 U.S.C. 713(f)) is amended by striking ‘‘for each 17 of fiscal years 2010 through 2014’’ and inserting ‘‘for fis- 18 cal year 2010, $75,000,000 increased by an amount equal 19 to the unobligated portion of funds appropriated for each 20 of fiscal years 2010 and 2011 under section 510(d) that 21 are rescinded under subsection (b), and $125,000,000 for 22 each of fiscal years 2012 through 2014’’. 23 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00438 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 439 •HR 2954 IH SEC. 745. DENTAL EDUCATION LOAN REPAYMENT PRO- 1 GRAM. 2 (a) IN GENERAL.—The Secretary of Health and 3 Human Services may enter into an agreement with any 4 dentist under which— 5 (1) the dentist agrees to serve as a dentist for 6 a period of not less than 2 years at a facility with 7 a critical shortage of dentists (as determined by the 8 Secretary) in an area with a high incidence of HIV/ 9 AIDS; and 10 (2) the Secretary agrees to make payments in 11 accordance with subsection (b) on the dental edu- 12 cation loans of the dentist. 13 (b) MANNER OF PAYMENTS.—The payments de- 14 scribed in subsection (a) shall be made by the Secretary 15 as follows: 16 (1) Upon completion by the dentist for whom 17 the payments are to be made of the first year of the 18 service specified in the agreement entered into with 19 the Secretary under subsection (a), the Secretary 20 shall pay 30 percent of the principal of and the in- 21 terest on the dental education loans of the dentist. 22 (2) Upon completion by the dentist of the sec- 23 ond year of such service, the Secretary shall pay an- 24 other 30 percent of the principal of and the interest 25 on such loans. 26 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00439 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 440 •HR 2954 IH (3) Upon completion by that individual of a 1 third year of such service, the Secretary shall pay 2 another 25 percent of the principal of and the inter- 3 est on such loans. 4 (c) APPLICABILITY OF CERTAIN PROVISIONS.—The 5 provisions of subpart III of part D of title III of the Public 6 Health Service Act (42 U.S.C. 254l et seq.) shall, except 7 as inconsistent with this section, apply to the program car- 8 ried out under this section in the same manner and to 9 the same extent as such provisions apply to the National 10 Health Service Corps Loan Repayment Program. 11 (d) REPORTS.—Not later than 18 months after the 12 date of the enactment of this Act, and annually thereafter, 13 the Secretary shall prepare and submit to the Congress 14 a report describing the program carried out under this sec- 15 tion, including statements regarding the following: 16 (1) The number of dentists enrolled in the pro- 17 gram. 18 (2) The number and amount of loan repay- 19 ments. 20 (3) The placement location of loan repayment 21 recipients at facilities described in subsection (a)(1). 22 (4) The default rate and actions required. 23 (5) The amount of outstanding default funds. 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00440 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 441 •HR 2954 IH (6) To the extent that it can be determined, the 1 reason for the default. 2 (7) The demographics of individuals partici- 3 pating in the program. 4 (8) An evaluation of the overall costs and bene- 5 fits of the program. 6 (e) DEFINITIONS.—In this section: 7 (1) The term ‘‘dental education loan’’— 8 (A) means a loan that is incurred for the 9 cost of attendance (including tuition, other rea- 10 sonable educational expenses, and reasonable 11 living costs) at a school of dentistry; and 12 (B) includes only the portion of the loan 13 that is outstanding on the date the dentist in- 14 volved begins the service specified in the agree- 15 ment under subsection (a). 16 (2) The term ‘‘dentist’’ means a graduate of a 17 school of dentistry who has completed postgraduate 18 training in general or pediatric dentistry. 19 (3) The term ‘‘HIV/AIDS’’ means human im- 20 munodeficiency virus and acquired immune defi- 21 ciency syndrome. 22 (4) The term ‘‘school of dentistry’’ has the 23 meaning given to that term in section 799B of the 24 Public Health Service Act (42 U.S.C. 295p). 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00441 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 442 •HR 2954 IH (5) The term ‘‘Secretary’’ means the Secretary 1 of Health and Human Services. 2 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 3 out this section, there are authorized to be appropriated 4 such sums as may be necessary for each of fiscal years 5 2012 through 2016. 6 SEC. 746. REPORT ON THE IMPLEMENTATION OF THE NA- 7 TIONAL HIV/AIDS STRATEGY. 8 (a) REPORT REQUIRED.—Not later than 6 months 9 after the date of the enactment of this Act, the President, 10 in consultation with the heads of all relevant agencies in- 11 cluding the Department of Education, the Department of 12 Health and Human Services, the Department of Housing 13 and Urban Development, the Department of Justice, the 14 Department of Labor, the Department of Veterans Af- 15 fairs, and the Social Security Administration, shall trans- 16 mit to the Congress and make publicly available a report 17 on the status of the implementation of the National HIV/ 18 AIDS Strategy. 19 (b) CONTENTS.—The report required by subsection 20 (a) shall include a description, analysis, and evaluation 21 of— 22 (1) key steps taken by the Federal Government 23 towards the achievement of the goals of the National 24 HIV/AIDS Strategy, including the goals of— 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00442 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 443 •HR 2954 IH (A) reducing the number of people who be- 1 come infected with HIV; 2 (B) increasing access to care and opti- 3 mizing health outcomes for people living with 4 HIV; and 5 (C) reducing HIV-related health dispari- 6 ties; 7 (2) the extent to which the National HIV/AIDS 8 Strategy has improved coordination of efforts to 9 maximize the effective delivery of HIV/AIDS preven- 10 tion, care, and treatment services at the community 11 level, including coordination— 12 (A) within and among Federal agencies 13 and departments; 14 (B) between the Federal Government and 15 State and local governments and health depart- 16 ments; 17 (C) between the Federal Government and 18 nonprofit foundations and civil society organiza- 19 tions, including community- and faith-based or- 20 ganizations focused on addressing the issue of 21 HIV/AIDS; and 22 (D) between the Federal Government and 23 private businesses; 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00443 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 444 •HR 2954 IH (3) efforts by the Federal Government to edu- 1 cate, involve, and establish and strengthen partner- 2 ships with civil society organizations, including 3 community- and faith-based organizations, in order 4 to implement the National HIV/AIDS Strategy and 5 achieve its goals; 6 (4) how Federal resources are being deployed to 7 implement the Strategy, including— 8 (A) the amount of funding used to date, by 9 each Federal agency and department, to imple- 10 ment the National HIV/AIDS Strategy; 11 (B) a brief summary for each Federal 12 agency and department of the number and 13 function of all Federal employees assisting in 14 implementing the Strategy; and 15 (C) an estimate of the amount of funding 16 necessary to implement the National HIV/AIDS 17 Strategy, by each Federal agency and depart- 18 ment, for the next fiscal year; and 19 (5) what additional steps, if any, are necessary 20 to fully implement the National HIV/AIDS Strategy, 21 including— 22 (A) whether any existing statutory laws, 23 policies, or regulations are impeding the imple- 24 mentation of the National HIV/AIDS Strategy, 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00444 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 445 •HR 2954 IH at the Federal, State, or local level, and wheth- 1 er any changes to such laws, policies, or regula- 2 tions are necessary or recommended; and 3 (B) whether any Federal agencies or de- 4 partments require additional statutory authority 5 to effectively carry out their duties as part of 6 the National HIV/AIDS Strategy. 7 (c) USE OF PREVIOUSLY APPROPRIATED FUNDS.— 8 Funding for the report required under subsection (a) shall 9 derive from discretionary funds of the departments and 10 agencies specified in such subsection. 11 SEC. 747. ADDRESSING HIV/AIDS IN THE AFRICAN-AMER- 12 ICAN COMMUNITY. 13 (a) SENSE OF CONGRESS ON NATIONAL BLACK 14 CLERGY HIV/AIDS AWARENESS SUNDAY.—It is the 15 sense of Congress that— 16 (1) there should be established a National 17 Black Clergy HIV/AIDS Awareness Sunday on 18 which the Congress and the President call on mem- 19 bers of the Black clergy— 20 (A) to become involved at the local commu- 21 nity level in HIV/AIDS testing, policy, and ad- 22 vocacy; 23 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00445 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 446 •HR 2954 IH (B) to discuss the HIV/AIDS epidemic 1 with their congregations and the community at- 2 large; and 3 (C) to urge members of their congregations 4 to reduce risk factors, practice safe sex and 5 other preventive measures, be tested for HIV/ 6 AIDS, and seek care when appropriate; and 7 (2) an appropriate Sunday should be selected 8 for this occasion. 9 (b) SENSE OF CONGRESS ON FEDERAL AGENCIES 10 WITH RESPONSIBILITY FOR PREVENTING, TESTING FOR, 11 AND TREATING HIV/AIDS.—It is the sense of Congress 12 that all Federal agencies with a responsibility for pre- 13 venting, testing for, and treating HIV/AIDS should— 14 (1) adopt policies for prevention, testing, and 15 treatment that are consistent with the guidelines 16 issued in 2006 by the Centers for Disease Control 17 and Prevention, entitled ‘‘Revised Recommendations 18 for HIV Testing of Adults, Adolescents, and Preg- 19 nant Women in Health-Care Settings’’; and 20 (2) begin a systemic, aggressive approach to im- 21 plementing voluntary, routine testing as part of all 22 health exams, including in emergency rooms, clinics, 23 and private physician offices. 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00446 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 447 •HR 2954 IH (c) SENSE OF CONGRESS ON FEDERAL BUREAU OF 1 PRISONS PROCEDURES FOR INMATES WITH HIV.—It is 2 the sense of Congress that the Federal Bureau of Prisons 3 should implement procedures for— 4 (1) voluntary HIV testing as a routine compo- 5 nent of inmate care; and 6 (2) referral to care as a routine component of 7 release planning for inmates with HIV/AIDS, includ- 8 ing referral to community-based care and faith-based 9 institutions. 10 SEC. 748. NATIONAL BLACK CLERGY FOR THE ELIMI- 11 NATION OF HIV/AIDS. 12 (a) SHORT TITLE.—This section may be cited as the 13 ‘‘National Black Clergy for the Elimination of HIV/AIDS 14 Act of 2011’’. 15 (b) FINDINGS.—Congress finds the following: 16 (1) It has been estimated that more than 17 1,200,000 people in the United States are living 18 with HIV/AIDS, and approximately 500,000 of them 19 are Black. Blacks are 8 times more likely to have 20 AIDS than their White counterparts. Within the 21 Black community, the subpopulation most dispropor- 22 tionately impacted by HIV/AIDS is Black men who 23 have sex with men (MSM) with prevalence rates 24 twice those of White MSM. Black women account 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00447 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 448 •HR 2954 IH for the majority of new AIDS cases among women 1 and are 23 times more likely to be living with AIDS 2 than White women and 4 times more likely than 3 Latinas. 4 (2) On October 7–8, 2007, 186 Black clergy, 5 consisting of Baptist, COGIC, Methodist, Protes- 6 tant, AME, and Pentecostal, together with, medical, 7 policy, and AIDS leaders, were brought together by 8 the National Black Leadership Commission on 9 AIDS (NBLCA), the oldest and largest Black AIDS 10 organization of its kind in America, hosted by Time 11 Warner, Inc., with other foundation support, to par- 12 ticipate in the National Black Clergy Conclave On 13 HIV/AIDS Policy. 14 (3) The attendees included faith leaders across 15 traditional, mega, and activist churches representing 16 millions of congregants: the National Medical Asso- 17 ciation (NMA) representing 30,000 African-Amer- 18 ican physicians; the National Conference of Black 19 Mayors; the National Caucus of Black State Legisla- 20 tors; and the Health Brain Trust of the Congres- 21 sional Black Caucus and key African-American HIV/ 22 AIDS advocates from across the United States. This 23 group developed a plan of action that has become 24 the National Black Clergy for the Elimination of 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00448 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 449 •HR 2954 IH HIV/AIDS Act of 2011 to respond to the ‘‘on the 1 ground’’ emergency in prevention, care, and treat- 2 ment for AIDS in Black America. 3 (4) In August 2007, the NMA, the oldest and 4 largest organization representing 30,000 African- 5 American physicians, released a consensus report en- 6 titled ‘‘Addressing The HIV/AIDS Crisis In The Af- 7 rican American Community: Fact, Fiction and Pol- 8 icy’’; and specifically called on the next President of 9 the United States to declare HIV/AIDS in African- 10 American communities a public health emergency 11 and worked with NBLCA to organize clergy to advo- 12 cate for the specific needs of Black physicians, their 13 patients, and those at risk in African-American com- 14 munities; and have pledged to advocate and work 15 with clergy to develop, execute, and implement these 16 initiatives as a part of their rightful role of leader- 17 ship in African-American communities and culture. 18 (5) The National Conference of Black Mayors 19 has pledged to work with clergy, medical, and com- 20 munity leaders to develop and support these initia- 21 tives on a local level and to help them to continue 22 to develop a policy agenda leading to the elimination 23 of HIV/AIDS. 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00449 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 450 •HR 2954 IH (6) The National Caucus of Black State Legis- 1 lators pledged to take the initiatives herein to their 2 body and develop plans of action for Black State 3 Legislators to work with local clergy, health depart- 4 ments, and CBOs to adopt and implement these ini- 5 tiatives on a national level. 6 (7) At their April 2008 annual meeting, the 7 National Policy Alliance (NPA), consisting of the 8 Joint Center For Political and Economic Studies 9 (secretariat) and the National Black Caucus of 10 School Board Members, National Black Caucus of 11 Local Elected Officials; the Judicial Council of the 12 National Bar Association; the National Association 13 of Black County Officials; Blacks in Government 14 and the CBC; NCBM; WCM, voted unanimously to 15 support, endorse, and encourage the passage of the 16 National Black Clergy for the Elimination of HIV/ 17 AIDS Act of 2011 and to organize their respective 18 members to endorse and support the passage of this 19 bill. 20 (8) The World Conference of Black Mayors has 21 ratified its support of these initiatives and legisla- 22 tion, and pledged to assist the clergy to take them 23 internationally. 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00450 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 451 •HR 2954 IH (9) The National Black Leadership Commission 1 on AIDS, the Balm in Gilead, and the Black AIDS 2 Institute have been recognized by the clergy for their 3 tradition and history of service and will work with 4 clergy to conduct community and policy develop- 5 ment, linkages to local departments of health and 6 other services, infrastructure development, education 7 media, and fund development activities. 8 (10) Bishop T.D. Jakes of the Potters House 9 in Dallas, Texas, and Rev. Calvin O. Butts of the 10 Abyssinian Baptist Church in Harlem, New York, 11 and chairman of the National Black Leadership 12 Commission on AIDS have been recognized as the 13 organizers of this group and will help guide and lead 14 the development efforts of fellow clergy through this 15 process. 16 (11) The National Conclave on HIV/AIDS for 17 Black Clergy calls upon the President, Congress, 18 and corporate America to declare the HIV/AIDS cri- 19 sis in the African-American community a ‘‘public 20 health emergency’’. 21 (12) The Black clergy will aggressively seek to 22 have every person under the sphere of their influence 23 tested for HIV in order to know the person’s status. 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00451 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 452 •HR 2954 IH (13) The Black clergy will promote HIV/AIDS 1 awareness to ensure that all Black clergy serving in 2 their denominations and other congregations are 3 equipped to address issues related to this disease in 4 a factual and scientifically sound manner. 5 (14) The Black clergy will use the ABC/D 6 model as a behavioral guideline for prevention initia- 7 tives: 8 (A) A–Abstain. 9 (B) B–Be Faithful. 10 (C) C–Use Condoms. 11 (D) D–Don’t Engage in Risky Behaviors. 12 (c) DEFINITIONS APPLICABLE THROUGHOUT SEC- 13 TION.—In this section— 14 (1) the terms ‘‘HIV’’ and ‘‘HIV/AIDS’’ have 15 the meanings given to such terms in section 2689 of 16 the Public Health Service Act (42 U.S.C. 300ff–88); 17 and 18 (2) the term ‘‘Secretary’’ means the Secretary 19 of Health and Human Services. 20 (d) SERVICES TO REDUCE HIV/AIDS IN THE AFRI- 21 CAN-AMERICAN COMMUNITY.— 22 (1) IN GENERAL.—For the purpose of reducing 23 HIV/AIDS in the African-American community, the 24 Secretary, acting through the Deputy Assistant Sec- 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00452 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 453 •HR 2954 IH retary for Minority Health, may make grants to 1 public health agencies and faith-based organizations 2 to conduct— 3 (A) outreach activities related to HIV/ 4 AIDS prevention and testing activities; 5 (B) HIV/AIDS prevention activities; and 6 (C) HIV/AIDS testing activities. 7 (2) AUTHORIZATION OF APPROPRIATIONS.—To 8 carry out this section, there are authorized to be ap- 9 propriated $50,000,000 for fiscal year 2012, and 10 such sums as may be necessary for fiscal years 2013 11 through 2016. 12 (e) GRANTS FOR SUBSTANCE ABUSE AND MENTAL 13 HEALTH SERVICES TO PUBLIC HEALTH AGENCIES AND 14 FAITH-BASED ORGANIZATIONS.— 15 (1) IN GENERAL.—The Secretary, acting 16 through the Administrator of the Substance Abuse 17 and Mental Health Services Administration, may 18 make grants to public health agencies and faith- 19 based organizations to— 20 (A) conduct HIV/AIDS and sexually trans- 21 mitted disease outreach, prevention, and testing 22 activities that are targeted to the African-Amer- 23 ican community; and 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00453 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 454 •HR 2954 IH (B) in connection with such activities, pro- 1 vide substance abuse testing and mental health 2 services to members of such community. 3 (2) AUTHORIZATION OF APPROPRIATIONS.—To 4 carry out this section, there are authorized to be ap- 5 propriated $90,000,000 for fiscal year 2012 and 6 such sums as may be necessary for fiscal years 2013 7 through 2016. 8 (f) SERVICES FOR HIV/AIDS AFFECTED YOUTH 9 WHO ARE SEPARATED FROM THEIR FAMILIES.— 10 (1) IN GENERAL.—The Secretary, acting 11 through the Administrator of the Substance Abuse 12 and Mental Health Services Administration, may 13 make grants to faith- and community-based organi- 14 zations to provide family reunification services, men- 15 tal health counseling, HIV/AIDS and sexually trans- 16 mitted disease testing, and substance abuse testing 17 and treatment to youth who— 18 (A)(i) have run away from home; 19 (ii) are homeless; or 20 (iii) reside in a detention center or foster 21 care; and 22 (B) are HIV positive or at risk for HIV/ 23 AIDS, including young men who have sex with 24 men. 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00454 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 455 •HR 2954 IH (2) AUTHORIZATION OF APPROPRIATIONS.—To 1 carry out this section, there are authorized to be ap- 2 propriated $5,000,000 for fiscal year 2012, and such 3 sums as may be necessary for fiscal years 2013 4 through 2016. 5 (g) PUBLIC HEALTH INTERVENTION AND PREVEN- 6 TION ACTIVITIES.— 7 (1) IN GENERAL.—For the purpose of reducing 8 HIV/AIDS, sexually transmitted diseases, tuber- 9 culosis, and viral hepatitis in African-American com- 10 munities, the Secretary, acting through the Director 11 of the Centers for Disease Control and Prevention, 12 may make grants to faith-based organizations for 13 public health intervention and prevention activities, 14 including the use of rapid testing in traditional and 15 nontraditional settings to increase the number of in- 16 dividuals who know their status at the point of care 17 and are put into treatment. 18 (2) PARTNERSHIPS.—In carrying out this sec- 19 tion, the Secretary shall encourage grantees to enter 20 into partnerships with public health agencies. 21 (3) AUTHORIZATION OF APPROPRIATIONS.—To 22 carry out this section, there are authorized to be ap- 23 propriated $100,000,000 for fiscal year 2012, and 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00455 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 456 •HR 2954 IH such sums as may be necessary for fiscal years 2013 1 through 2016. 2 (h) HIV/AIDS PREVENTION AND EDUCATION.— 3 (1) PREVENTION ACTIVITIES.—The Secretary, 4 acting through the Director of the Centers for Dis- 5 ease Control and Prevention, shall expand and inten- 6 sify HIV/AIDS prevention activities in African- 7 American communities. Such activities— 8 (A) shall be targeted to specific popu- 9 lations; 10 (B) shall be comprehensive and accurately 11 based on science and research; and 12 (C) shall include information on absti- 13 nence, the proper use of condoms, risks associ- 14 ated with unprotected sex, and the value of sex- 15 ual delay particularly among young adolescents 16 and teenagers. 17 (2) EDUCATION.—The Secretary, acting 18 through the Director of the Centers for Disease 19 Control and Prevention, shall expand and intensify 20 HIV/AIDS educational activities targeting Black 21 women, youth, and men who have sex with men. 22 (3) COORDINATION.—The Secretary shall carry 23 out this section in coordination with public schools 24 of all levels, Black organizations, historically Black 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00456 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 457 •HR 2954 IH colleges and universities, and faith-based organiza- 1 tions and institutions. 2 (4) AUTHORIZATION OF APPROPRIATIONS.—To 3 carry out this section, there are authorized to be ap- 4 propriated $90,000,000 for fiscal year 2012, and 5 such sums as may be necessary for fiscal years 2013 6 through 2016. 7 (i) BUILDING CAPACITY OF COMMUNITIES.— 8 (1) IN GENERAL.—The Secretary, acting 9 through the Director of the Centers for Disease 10 Control and Prevention, shall expand funding to eli- 11 gible entities to build the capacity of African-Amer- 12 ican communities to respond to HIV/AIDS. 13 (2) EMPHASIS.—In carrying out this section, 14 the Secretary shall emphasize the provision of fund- 15 ing for policy development, education, technical as- 16 sistance, and training— 17 (A) to national and local faith-based orga- 18 nizations; and 19 (B) to organizations with a significant his- 20 tory of working within the African-American 21 community on HIV/AIDS issues, an inter- 22 denominational center of seminaries specializing 23 in the training of African-American clergy, and 24 historically Black colleges and universities. 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00457 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 458 •HR 2954 IH (3) DEFINITION.—In this section, the term ‘‘el- 1 igible entity’’ means a national or community-based 2 organization with a history and tradition of service 3 to African-American communities. 4 (4) AUTHORIZATION OF APPROPRIATIONS.—To 5 carry out this section, there are authorized to be ap- 6 propriated $25,000,000 for fiscal year 2012, and 7 such sums as may be necessary for fiscal years 2013 8 through 2016. 9 (j) NATIONAL MEDIA OUTREACH CAMPAIGN.— 10 (1) IN GENERAL.—The Secretary, acting 11 through the Director of the Centers for Disease 12 Control and Prevention, shall implement a national 13 media outreach campaign that urges all sexually ac- 14 tive individuals to be tested for and know their HIV/ 15 AIDS status. 16 (2) REQUIREMENTS.—The national media out- 17 reach campaign under this subsection shall— 18 (A) be science-driven and targeted to Afri- 19 can-American men, women, and youth; and 20 (B) give special emphasis to Black women 21 and men who have sex with men. 22 (3) COORDINATION; CONSULTATION.—The Sec- 23 retary shall carry out this subsection— 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00458 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 459 •HR 2954 IH (A) in coordination with Black media out- 1 lets for print, electronic, and Web-based media 2 and Black media associations, including the Na- 3 tional Association of Black Owned Broadcasters 4 and the National Newspaper Publishers Asso- 5 ciation; and 6 (B) in consultation with an advisory board 7 including representatives of the National Med- 8 ical Association, faith leaders, elected and ap- 9 pointed officials, social marketing experts, and 10 business and community stakeholders. 11 (4) AUTHORIZATION OF APPROPRIATIONS.—To 12 carry out this subsection, there are authorized to be 13 appropriated $10,000,000 for fiscal year 2012, and 14 such sums as may be necessary for fiscal years 2013 15 through 2016. 16 (k) RESEARCH TO DEVELOP BEHAVIORAL STRATE- 17 GIES TO REDUCE TRANSMISSION OF HIV/AIDS.— 18 (1) IN GENERAL.—The Secretary, acting 19 through the Director of the National Institutes of 20 Health, may conduct or support culturally competent 21 research to develop evidence-based behavioral strate- 22 gies to reduce the transmission of HIV/AIDS within 23 the African-American community. 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00459 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 460 •HR 2954 IH (2) PRIORITY.—In carrying out this section, the 1 Secretary shall prioritize research that focuses on 2 populations within the African-American community 3 that are at increased risk for HIV/AIDS, includ- 4 ing— 5 (A) men who have sex with men; and 6 (B) women. 7 (3) AUTHORIZATION OF APPROPRIATIONS.—To 8 carry out this section, there are authorized to be ap- 9 propriated $10,000,000 for fiscal year 2012, and 10 such sums as may be necessary for fiscal years 2013 11 through 2016. 12 (l) STUDY OF BIOLOGICAL AND BEHAVIORAL FAC- 13 TORS.— 14 (1) IN GENERAL.—The Secretary, acting 15 through the Director of the National Institute on 16 Minority Health and Health Disparities, may make 17 grants for— 18 (A) the study of biological and behavioral 19 factors that lead to increased HIV/AIDS preva- 20 lence in the African-American community, to be 21 conducted by researchers with a history and 22 tradition of service to Black communities; and 23 (B) behavioral and structural network re- 24 search and interventions, in collaboration with 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00460 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 461 •HR 2954 IH other institutes and centers of the National In- 1 stitutes of Health, indigenous faith and national 2 and community-based organizations with a his- 3 tory and tradition of conducting such research 4 for Black communities, with a special emphasis 5 on Black women and Black men who have sex 6 with men. 7 (2) AUTHORIZATION OF APPROPRIATIONS.—To 8 carry out this subsection, there are authorized to be 9 appropriated $100,000,000 for fiscal year 2012, and 10 such sums as may be necessary for fiscal years 2013 11 through 2016. 12 (m) HEALTH CARE PROFESSIONALS TREATING INDI- 13 VIDUALS WITH HIV/AIDS.—Part E of title VII of the 14 Public Health Service Act (42 U.S.C. 294n et seq.) is 15 amended by adding at the end the following: 16 ‘‘Subpart 4—Health Care Professionals Treating 17 Individuals With HIV/AIDS 18 ‘‘SEC. 781. BETTER CARE FOR INDIVIDUALS WITH HIV/AIDS. 19 ‘‘(a) IN GENERAL.—The Secretary, acting through 20 the Administrator of the Health Resources and Services 21 Administration and in consultation with the African- 22 American church community, may award grants for any 23 of the following: 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00461 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 462 •HR 2954 IH ‘‘(1) Development of curricula for training pri- 1 mary care providers in HIV/AIDS prevention and 2 care. 3 ‘‘(2) Training health care professionals with ex- 4 pertise in HIV/AIDS to provide care to individuals 5 with HIV/AIDS. 6 ‘‘(3) Development by grant recipients under 7 title XXVI and other persons of policies for pro- 8 viding culturally relevant and sensitive treatment to 9 individuals with HIV/AIDS, with particular empha- 10 sis on treatment to African-Americans and children 11 with HIV/AIDS. 12 ‘‘(4) Development and implementation of pro- 13 grams to increase the use of telemedicine to respond 14 to HIV/AIDS-specific health care needs in rural and 15 minority communities, with particular emphasis 16 given to medically underserved communities and the 17 southern States. 18 ‘‘(5) Creation of faith- and community-based 19 certification programs for providers in HIV/AIDS 20 care and support services. 21 ‘‘(6) Establishment of comfort care centers that 22 provide mental, emotional, and psychosocial coun- 23 seling for people with HIV/AIDS and implement ad- 24 ditional protocols to be carried out in the centers 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00462 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 463 •HR 2954 IH that address the needs of children and young adults 1 who are infected with the disease and are 2 transitioning from childhood to adulthood. 3 ‘‘(7) Incentive payments to health care pro- 4 viders supported by the Health Resources and Serv- 5 ices Administration to implement HIV/AIDS testing 6 consistent with the guidelines issued in 2006 by the 7 Centers for Disease Control and Prevention entitled 8 ‘Revised Recommendations for HIV Testing of 9 Adults, Adolescents, and Pregnant Women in 10 Health-Care Settings’. 11 ‘‘(b) DEFINITION.—In this section, the term ‘HIV/ 12 AIDS’ has the meaning given to such term in section 13 2689. 14 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 15 carry out this section, there are authorized to be appro- 16 priated $100,000,000 for fiscal year 2012, and such sums 17 as may be necessary for fiscal years 2013 through 2016.’’. 18 (n) REPORT ON IMPACT OF HIV/AIDS IN THE AFRI- 19 CAN-AMERICAN COMMUNITY.— 20 (1) IN GENERAL.—The Secretary shall submit 21 to Congress and the President an annual report on 22 the impact of HIV/AIDS in the African-American 23 community. 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00463 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 464 •HR 2954 IH (2) CONTENTS.—The report under subsection 1 (a) shall include information on the— 2 (A) progress that has been made in reduc- 3 ing the impact of HIV/AIDS in such commu- 4 nity; 5 (B) opportunities that exist to make addi- 6 tional progress in reducing the impact of HIV/ 7 AIDS in such community; 8 (C) challenges that may impede such addi- 9 tional progress; and 10 (D) Federal funding necessary to achieve 11 substantial reductions in HIV/AIDS in the Afri- 12 can-American community. 13 SEC. 749. REDUCING THE SPREAD OF SEXUALLY TRANS- 14 MITTED INFECTIONS IN CORRECTIONAL FA- 15 CILITIES. 16 (a) SHORT TITLE.—This section may be cited as the 17 ‘‘Justice for the Unprotected Against Sexually Trans- 18 mitted Infections among the Confined and Exposed Act’’ 19 or the ‘‘JUSTICE Act’’. 20 (b) FINDINGS.—The Congress makes the following 21 findings: 22 (1) According to the Bureau of Justice Statis- 23 tics (BJS), 2,292,133 persons were incarcerated in 24 the United States as of the end of 2009. Between 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00464 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 465 •HR 2954 IH 1998 and 2008, the number of persons incarcerated 1 in Federal or State correctional facilities increased 2 by an average of 2.4 percent per year. One in every 3 32 United States residents was on probation, in jail 4 or prison, or on parole at the end of 2009. 5 (2) As of 2009, 66.8 percent of incarcerated 6 persons were racial or ethnic minorities. Based on 7 current incarceration rates, BJS estimates that Afri- 8 can-American males are 6 times more likely to be 9 held in custody than White males, while Hispanic 10 males are a little more than 2 times more likely to 11 be held in custody. Across all age categories, Afri- 12 can-American males were incarcerated at higher 13 rates than Hispanic or White males. 14 (3) There is a disproportionately high rate of 15 HIV/AIDS among incarcerated persons, especially 16 among minorities. Approximately 25 percent of the 17 HIV-positive population of the United States passes 18 through correctional facilities each year. BJS has 19 determined that the rate of confirmed AIDS cases is 20 2.4 times higher among incarcerated persons than in 21 the general population. Minorities account for the 22 majority of AIDS-related deaths among incarcerated 23 persons, with African-American incarcerated persons 24 2.8 times more likely than White incarcerated per- 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00465 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 466 •HR 2954 IH sons and 1.4 times more likely than Hispanic incar- 1 cerated persons to die from AIDS-related causes. 2 Nearly two-thirds of AIDS-related deaths are among 3 Black, non-Hispanic males. 4 (4) Studies suggest that other sexually trans- 5 mitted infections (STIs), such as gonorrhea, 6 chlamydia, syphilis, genital herpes, viral hepatitis, 7 and human papillomavirus, also exist at a higher 8 rate among incarcerated persons than in the general 9 population. For instance, researchers have estimated 10 that the rate of hepatitis C (HCV) infection among 11 incarcerated persons is somewhere between 8 and 20 12 times higher than that of the general population. 13 (5) Correctional facilities lack a uniform system 14 of STI testing and reporting. Establishing a uniform 15 data collection system would assist in developing and 16 targeting counseling and treatment programs for in- 17 carcerated persons. Better developed and targeted 18 programs may reduce the spread of STIs. 19 (6) Although Congress has acted to reduce the 20 spread of sexual violence in correctional facilities by 21 enacting the National Prison Rape Elimination Act 22 (PREA) of 2003, BJS reported that approximately 23 4.4 percent of incarcerated persons in prisons and 24 3.1 percent of persons in jail reported experiencing 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00466 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 467 •HR 2954 IH one or more incidents of sexual victimization by an- 1 other incarcerated person or correctional facility 2 staff in the previous year. 3 (7) Approximately 95 percent of all incarcer- 4 ated persons eventually return to society. According 5 to one study, every year approximately 100,000 per- 6 sons infected with both HIV and HCV are released 7 from correctional facilities. These individuals com- 8 prise approximately 50 percent of all persons with 9 both infections in the United States. 10 (8) According to the Centers for Disease Con- 11 trol and Prevention (CDC), latex condoms, when 12 used consistently and correctly, are highly effective 13 in preventing the transmission of HIV. Latex 14 condoms also reduce the risk of other STIs. Despite 15 the effectiveness of condoms in reducing the spread 16 of STIs, the Bureau of Prisons does not recommend 17 their use in correctional facilities. 18 (9) The distribution of condoms in correctional 19 facilities is currently legal in certain parts of the 20 United States and the world. The States of Vermont 21 and Mississippi and the District of Columbia allow 22 condom distribution programs in their correctional 23 facilities. The cities of New York, San Francisco, 24 Los Angeles, Washington DC, and Philadelphia also 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00467 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 468 •HR 2954 IH allow condom distribution in their correctional facili- 1 ties. However, these States and cities operate fewer 2 than 1 percent of all correctional facilities. 3 (10) A 2007 report by the Massachusetts Gen- 4 eral Hospital Division of Infectious Diseases and the 5 University of California, San Francisco, found that 6 the proportion of European prison systems allowing 7 condoms rose from 53 percent in 1989 to 81 percent 8 in 1997. The same report also found that no prison 9 system allowing the distribution of condoms had re- 10 versed their decision, and no prison system reported 11 an increase in sexual activity among incarcerated 12 persons as a result of a decision to allow condom 13 distribution. 14 (11) In 2000 and 2001, researchers surveyed 15 300 incarcerated persons and 100 correctional offi- 16 cers at the Central Detention Facility, a correctional 17 facility operated by the District of Columbia at 18 which condoms are available. Researchers found that 19 both incarcerated persons and correctional officers 20 generally supported the condom distribution pro- 21 gram and considered it to be important. Further- 22 more, the researchers determined that the program 23 had not caused any major security infractions. In 24 Canada, the Expert Committee on AIDS and Pris- 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00468 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 469 •HR 2954 IH ons surveyed more than 400 correctional officers in 1 the Federal prison system of Canada in 1995 and 2 reported that 82 percent of those responding indi- 3 cated that the availability of condoms had created no 4 problems at their facility. 5 (12) The American Public Health Association, 6 the United Nations Joint Program on HIV/AIDS, 7 and the World Health Organization have endorsed 8 the effectiveness of condom distribution programs in 9 correctional facilities. 10 (13) Many correctional facilities in the United 11 States do not provide comprehensive testing and 12 treatment programs to reduce the spread of STIs. 13 According to BJS surveys from 2005, only 996 of 14 the 1,821 Federal and State correctional facilities 15 (i.e. 54.7 percent) provided HIV/AIDS counseling 16 programs. 17 (14) Individuals who are enrolled in Medicaid 18 prior to incarceration face a suspension of their ben- 19 efits upon incarceration, and in some States a termi- 20 nation of their Medicaid eligibility. The Federal Gov- 21 ernment encourages States to automatically re-enroll 22 incarcerated persons on Medicaid upon their release 23 from a correctional facility, unless the State reaches 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00469 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 470 •HR 2954 IH a determination that the individual is no longer eligi- 1 ble for reasons other than their prior incarceration. 2 (15) Formerly incarcerated individuals who are 3 newly released from correctional facilities often face 4 delays in the resumption of their Medicaid benefits 5 which may exacerbate any health issues which they 6 face. 7 (16) Incarcerated individuals living with HIV/ 8 AIDS who are eligible for Medicaid would benefit 9 from prompt and automatic enrollment upon their 10 release in order to ensure their continued ability to 11 access health services, including antiretroviral treat- 12 ment. 13 (c) AUTHORITY TO ALLOW COMMUNITY ORGANIZA- 14 TIONS TO PROVIDE STI COUNSELING, STI PREVENTION 15 EDUCATION, AND SEXUAL BARRIER PROTECTION DE- 16 VICES IN FEDERAL CORRECTIONAL FACILITIES.— 17 (1) DIRECTIVE TO ATTORNEY GENERAL.—Not 18 later than 30 days after the date of enactment of 19 this Act, the Attorney General shall direct the Bu- 20 reau of Prisons to allow community organizations to 21 distribute sexual barrier protection devices and to 22 engage in STI counseling and STI prevention edu- 23 cation in Federal correctional facilities. These activi- 24 ties shall be subject to all relevant Federal laws and 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00470 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 471 •HR 2954 IH regulations which govern visitation in correctional 1 facilities. 2 (2) INFORMATION REQUIREMENT.—Any com- 3 munity organization permitted to distribute sexual 4 barrier protection devices under paragraph (1) must 5 ensure that the persons to whom the devices are dis- 6 tributed are informed about the proper use and dis- 7 posal of sexual barrier protection devices in accord- 8 ance with established public health practices. Any 9 community organization conducting STI counseling 10 or STI prevention education under paragraph (1) 11 must offer comprehensive sexuality education. 12 (3) POSSESSION OF DEVICE PROTECTED.—No 13 Federal correctional facility may, because of the pos- 14 session or use of a sexual barrier protection device— 15 (A) take adverse action against an incar- 16 cerated person; or 17 (B) consider possession or use as evidence 18 of prohibited activity for the purpose of any 19 Federal correctional facility administrative pro- 20 ceeding. 21 (4) IMPLEMENTATION.—The Attorney General 22 and Bureau of Prisons shall implement this section 23 according to established public health practices in a 24 manner that protects the health, safety, and privacy 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00471 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 472 •HR 2954 IH of incarcerated persons and of correctional facility 1 staff. 2 (d) SENSE OF CONGRESS REGARDING DISTRIBUTION 3 OF SEXUAL BARRIER PROTECTION DEVICES IN STATE 4 PRISON SYSTEMS.—It is the sense of Congress that States 5 should allow for the legal distribution of sexual barrier 6 protection devices in State correctional facilities to reduce 7 the prevalence and spread of STIs in those facilities. 8 (e) AUTOMATIC REINSTATEMENT OF MEDICAID BEN- 9 EFITS.— 10 (1) IN GENERAL.—Section 1902(e) of the So- 11 cial Security Act (42 U.S.C. 1396a(e)) is amended 12 by adding at the end the following: 13 ‘‘(15) ENROLLMENT OF EX-OFFENDERS.— 14 ‘‘(A) AUTOMATIC ENROLLMENT OR REIN- 15 STATEMENT.— 16 ‘‘(i) IN GENERAL.—The State plan 17 shall provide for the automatic enrollment 18 or reinstatement of enrollment of an eligi- 19 ble individual if— 20 ‘‘(I) such individual is scheduled 21 to be released from a public institu- 22 tion due to the completion of sen- 23 tence, not less than 30 days prior to 24 the scheduled date of the release; and 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00472 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 473 •HR 2954 IH ‘‘(II) such individual is to be re- 1 leased from a public institution on pa- 2 role or on probation, as soon as pos- 3 sible after the date on which the de- 4 termination to release such individual 5 was made, and before the date such 6 individual is released. 7 ‘‘(ii) EXCEPTION.—If a State makes a 8 determination that an individual is not eli- 9 gible to be enrolled under the State plan— 10 ‘‘(I) on or before the date by 11 which the individual would be enrolled 12 under clause (i), such clause shall not 13 apply to such individual; or 14 ‘‘(II) after such date, the State 15 may terminate the enrollment of such 16 individual. 17 ‘‘(B) RELATIONSHIP OF ENROLLMENT TO 18 PAYMENT FOR SERVICES.— 19 ‘‘(i) IN GENERAL.—Subject to sub- 20 paragraph (A)(ii), an eligible individual 21 who is enrolled, or whose enrollment is re- 22 instated under subparagraph (A), shall be 23 eligible for medical assistance that is pro- 24 vided after the date that the eligible indi- 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00473 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 474 •HR 2954 IH vidual is released from the public institu- 1 tion 2 ‘‘(ii) RELATIONSHIP TO PAYMENT 3 PROHIBITION FOR INMATES.—No provision 4 of this paragraph may be construed to per- 5 mit payment for care or services for which 6 payment is excluded under the subpara- 7 graph (A), following paragraph (29), of 8 section 1905(a). 9 ‘‘(C) TREATMENT OF CONTINUOUS ELIGI- 10 BILITY.— 11 ‘‘(i) SUSPENSION FOR INMATES.—Any 12 period of continuous eligibility under this 13 title shall be suspended on the date an in- 14 dividual enrolled under this title becomes 15 an inmate of a public institution (except as 16 a patient of a medical institution). 17 ‘‘(ii) DETERMINATION OF REMAINING 18 PERIOD.—Notwithstanding any changes to 19 State law related to continuous eligibility 20 during the time that an individual is an in- 21 mate of a public institution (except as a 22 patient of a medical institution), subject to 23 clause (iii), with respect to an eligible indi- 24 vidual who was subject to a suspension 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00474 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 475 •HR 2954 IH under subclause (I), on the date that such 1 individual is released from a public institu- 2 tion the suspension of continuous eligibility 3 under such subclause shall be lifted for a 4 period that is equal to the time remaining 5 in the period of continuous eligibility for 6 such individual on the date that such pe- 7 riod was suspended under such subclause. 8 ‘‘(iii) EXCEPTION.—If a State makes 9 a determination that an individual is not 10 eligible to be enrolled under the State 11 plan— 12 ‘‘(I) on or before the date that 13 the suspension of continuous eligibility 14 is lifted under clause (ii), such clause 15 shall not apply to such individual; or 16 ‘‘(II) after such date, the State 17 may terminate the enrollment of such 18 individual. 19 ‘‘(D) AUTOMATIC ENROLLMENT OR REIN- 20 STATEMENT OF ENROLLMENT DEFINED.—For 21 purposes of this paragraph, the term ‘automatic 22 enrollment or reinstatement of enrollment’ 23 means that the State determines eligibility for 24 medical assistance under the State plan without 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00475 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 476 •HR 2954 IH a program application from, or on behalf of, the 1 eligible individual, but an individual can only be 2 automatically enrolled in the State Medicaid 3 plan if the individual affirmatively consents to 4 being enrolled through affirmation in writing, 5 by telephone, orally, through electronic signa- 6 ture, or through any other means specified by 7 the Secretary. 8 ‘‘(E) ELIGIBLE INDIVIDUAL DEFINED.— 9 For purposes of this paragraph, the term ‘eligi- 10 ble individual’ means an individual who is an 11 inmate of a public institution (except as a pa- 12 tient in a medical institution)— 13 ‘‘(i) who was enrolled under the State 14 plan for medical assistance immediately be- 15 fore becoming an inmate of such an insti- 16 tution; or 17 ‘‘(ii) is diagnosed with human im- 18 munodeficiency virus.’’. 19 (2) SUPPLEMENTAL FUNDING FOR STATE IM- 20 PLEMENTATION OF AUTOMATIC REINSTATEMENT OF 21 MEDICAID BENEFITS.— 22 (A) IN GENERAL.—Subject to paragraph 23 (6), for each State for which the Secretary of 24 Health and Human Services has approved an 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00476 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 477 •HR 2954 IH application under paragraph (3), the Federal 1 matching payments (including payments based 2 on the Federal medical assistance percentage) 3 made to such State under section 1903 of the 4 Social Security Act (42 U.S.C. 1396b) shall be 5 increased by 5.0 percentage points for pay- 6 ments to the State for the activities permitted 7 under paragraph (2) for a period of one year. 8 (B) USE OF FUNDS.—A State may only 9 use increased matching payments authorized 10 under paragraph (1)— 11 (i) to strengthen the State’s enroll- 12 ment and administrative resources for the 13 purpose of improving processes for enroll- 14 ing (or reinstating the enrollment of) eligi- 15 ble individuals (as such term is defined in 16 section 1902(e)(15)(E) of the Social Secu- 17 rity Act); and 18 (ii) for medical assistance (as such 19 term is defined in section 1905(a) of the 20 Social Security Act) provided to such eligi- 21 ble individuals. 22 (C) APPLICATION AND AGREEMENT.—The 23 Secretary may only make payments to a State 24 in the increased amount if— 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00477 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 478 •HR 2954 IH (i) the State has amended the State 1 plan under section 1902 of the Social Se- 2 curity Act to incorporate the requirements 3 of subsection (e)(15) of such section; 4 (ii) the State has submitted an appli- 5 cation to the Secretary that includes a plan 6 for implementing the requirements of sec- 7 tion 1902(e)(15) of the Social Security Act 8 under the State’s amended State plan be- 9 fore the end of the 90-day period begin- 10 ning on the date that the State receives in- 11 creased matching payments under para- 12 graph (1); 13 (iii) the State’s application meets the 14 satisfaction of the Secretary; and 15 (iv) the State enters an agreement 16 with the Secretary that states that— 17 (I) the State will only use the in- 18 creased matching funds for the uses 19 permitted under paragraph (2); and 20 (II) at the end of the period 21 under paragraph (1), the State will 22 submit to the Secretary, and make 23 publicly available, a report that con- 24 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00478 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 479 •HR 2954 IH tains the information required under 1 paragraph (4). 2 (D) REQUIRED REPORT INFORMATION.— 3 The information that is required in the report 4 under paragraph (3)(D)(ii) includes— 5 (i) the results of an evaluation of the 6 impact of the implementation of the re- 7 quirements of section 1902(e)(15) of the 8 Social Security Act on improving the 9 State’s processes for enrolling of individ- 10 uals who are released for public institu- 11 tions into the Medicaid program; 12 (ii) the number of individuals who 13 were automatically enrolled (or whose en- 14 rollment is reinstated) under such section 15 1902(e)(15) during the period under para- 16 graph (1); and 17 (iii) any other information that is re- 18 quired by the Secretary. 19 (E) INCREASE IN CAP ON MEDICAID PAY- 20 MENTS TO TERRITORIES.—Subject to para- 21 graph (6), the amounts otherwise determined 22 for Puerto Rico, the United States Virgin Is- 23 lands, Guam, the Commonwealth of the North- 24 ern Mariana Islands, and American Samoa 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00479 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 480 •HR 2954 IH under subsections (f) and (g) of section 1108 of 1 the Social Security Act (42 U.S.C. 1308) shall 2 each be increased by the necessary amount to 3 allow for the increase in the Federal matching 4 payments under paragraph (1), but only for the 5 period under such paragraph for such State. In 6 the case of such an increase for a territory, sub- 7 section (a)(1) of such section 1108 shall be ap- 8 plied without regard to any increase in payment 9 made to the territory under part E of title IV 10 of such Act that is attributable to the increase 11 in Federal medical assistance percentage ef- 12 fected under paragraph (1) for the territory. 13 (F) LIMITATIONS.— 14 (i) TIMING.—With respect to a State, 15 at the end of the period under paragraph 16 (1), no increased matching payments may 17 be made to such State under this sub- 18 section. 19 (ii) MAINTENANCE OF ELIGIBILITY.— 20 (I) IN GENERAL.—Subject to 21 clause (ii), a State is not eligible for 22 an increase in its Federal matching 23 payments under paragraph (1), or an 24 increase in a cap amount under para- 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00480 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 481 •HR 2954 IH graph (5), if eligibility standards, 1 methodologies, or procedures under its 2 State plan under title XIX of the So- 3 cial Security Act (including any waiv- 4 er under such title or under section 5 1115 of such Act (42 U.S.C. 1315)) 6 are more restrictive than the eligibility 7 standards, methodologies, or proce- 8 dures, respectively, under such plan 9 (or waiver) as in effect on the date of 10 enactment of this Act. 11 (II) STATE REINSTATEMENT OF 12 ELIGIBILITY PERMITTED.—A State 13 that has restricted eligibility stand- 14 ards, methodologies, or procedures 15 under its State plan under title XIX 16 of the Social Security Act (including 17 any waiver under such title or under 18 section 1115 of such Act (42 U.S.C. 19 1315)) after the date of enactment of 20 this Act, is no longer ineligible under 21 clause (i) beginning with the first cal- 22 endar quarter in which the State has 23 reinstated eligibility standards, meth- 24 odologies, or procedures that are no 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00481 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 482 •HR 2954 IH more restrictive than the eligibility 1 standards, methodologies, or proce- 2 dures, respectively, under such plan 3 (or waiver) as in effect on such date. 4 (iii) NO WAIVER AUTHORITY.—The 5 Secretary may not waive the application of 6 this subsection under section 1115 of the 7 Social Security Act or otherwise. 8 (iv) LIMITATION OF MATCHING PAY- 9 MENTS TO 100 PERCENT.—In no case shall 10 an increase in Federal matching payments 11 under this subsection result in Federal 12 matching payments that exceed 100 per- 13 cent. 14 (3) EFFECTIVE DATE.— 15 (A) IN GENERAL.—Except as provided in 16 paragraph (2), the amendments made by sub- 17 section (a) shall take effect 180 days after the 18 date of the enactment of this Act and shall 19 apply to services furnished on or after such 20 date. 21 (B) RULE FOR CHANGES REQUIRING 22 STATE LEGISLATION.—In the case of a State 23 plan for medical assistance under title XIX of 24 the Social Security Act which the Secretary of 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00482 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 483 •HR 2954 IH Health and Human Services determines re- 1 quires State legislation (other than legislation 2 appropriating funds) in order for the plan to 3 meet the additional requirement imposed by the 4 amendments made by this subsection, the State 5 plan shall not be regarded as failing to comply 6 with the requirements of such title solely on the 7 basis of its failure to meet this additional re- 8 quirement before the first day of the first cal- 9 endar quarter beginning after the close of the 10 first regular session of the State legislature that 11 begins after the date of the enactment of this 12 Act. For purposes of the previous sentence, in 13 the case of a State that has a 2-year legislative 14 session, each year of such session shall be 15 deemed to be a separate regular session of the 16 State legislature. 17 (f) SURVEY OF AND REPORT ON CORRECTIONAL FA- 18 CILITY PROGRAMS AIMED AT REDUCING THE SPREAD OF 19 STIS.— 20 (1) SURVEY.—The Attorney General, after con- 21 sulting with the Secretary of Health and Human 22 Services, State officials, and community organiza- 23 tions, shall, to the maximum extent practicable, con- 24 duct a survey of all Federal and State correctional 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00483 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 484 •HR 2954 IH facilities, no later than 180 days after the date of 1 enactment of this Act and annually thereafter for 5 2 years, to determine the following: 3 (A) PREVENTION EDUCATION OFFERED.— 4 The type of prevention education, information, 5 or training offered to incarcerated persons and 6 correctional facility staff regarding sexual vio- 7 lence and the spread of STIs, including whether 8 such education, information, or training— 9 (i) constitutes comprehensive sexuality 10 education; 11 (ii) is compulsory for new incarcerated 12 persons and for new staff; and 13 (iii) is offered on an ongoing basis. 14 (B) ACCESS TO SEXUAL BARRIER PROTEC- 15 TION DEVICES.—Whether incarcerated persons 16 can— 17 (i) possess sexual barrier protection 18 devices; 19 (ii) purchase sexual barrier protection 20 devices; 21 (iii) purchase sexual barrier protection 22 devices at a reduced cost; and 23 (iv) obtain sexual barrier protection 24 devices without cost. 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00484 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 485 •HR 2954 IH (C) INCIDENCE OF SEXUAL VIOLENCE.— 1 The incidence of sexual violence and assault 2 committed by incarcerated persons and by cor- 3 rectional facility staff. 4 (D) COUNSELING, TREATMENT, AND SUP- 5 PORTIVE SERVICES.—Whether the correctional 6 facility requires incarcerated persons to partici- 7 pate in counseling, treatment, and supportive 8 services related to STIs, or whether it offers 9 such programs to incarcerated persons. 10 (E) STI TESTING.—Whether the correc- 11 tional facility tests incarcerated persons for 12 STIs or gives them the option to undergo such 13 testing— 14 (i) at intake; 15 (ii) on a regular basis; and 16 (iii) prior to release. 17 (F) STI TEST RESULTS.—The number of 18 incarcerated persons who are tested for STIs 19 and the outcome of such tests at each correc- 20 tional facility, disaggregated to include results 21 for— 22 (i) the type of sexually transmitted in- 23 fection tested for; 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00485 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 486 •HR 2954 IH (ii) the race and/or ethnicity of indi- 1 viduals tested; 2 (iii) the age of individuals tested; and 3 (iv) the gender of individuals tested. 4 (G) PRE-RELEASE REFERRAL POLICY.— 5 Whether incarcerated persons are informed 6 prior to release about STI-related services or 7 other health services in their communities, in- 8 cluding free and low-cost counseling and treat- 9 ment options. 10 (H) PRE-RELEASE REFERRALS MADE.— 11 The number of referrals to community-based 12 organizations or public health facilities offering 13 STI-related or other health services provided to 14 incarcerated persons prior to release, and the 15 type of counseling or treatment for which the 16 referral was made. 17 (I) REINSTATEMENT OF MEDICAID BENE- 18 FITS.—Whether the correctional facility assists 19 incarcerated persons that were enrolled in the 20 State Medicaid program prior to their incarcer- 21 ation, in reinstating their enrollment upon re- 22 lease and whether such individuals receive refer- 23 rals as provided by paragraph (8) to entities 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00486 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 487 •HR 2954 IH that accept the State Medicaid program, includ- 1 ing if applicable— 2 (i) the number of such individuals, in- 3 cluding those diagnosed with the human 4 immunodeficiency virus, that have been re- 5 instated; 6 (ii) a list of obstacles to reinstating 7 enrollment or to making determinations of 8 eligibility for reinstatement, if any; and 9 (iii) the number of individuals denied 10 enrollment. 11 (J) OTHER ACTIONS TAKEN.—Whether the 12 correctional facility has taken any other action, 13 in conjunction with community organizations or 14 otherwise, to reduce the prevalence and spread 15 of STIs in that facility. 16 (2) PRIVACY.—In conducting the survey, the 17 Attorney General shall not request or retain the 18 identity of any person who has sought or been of- 19 fered counseling, treatment, testing, or prevention 20 education information regarding an STI (including 21 information about sexual barrier protection devices), 22 or who has tested positive for an STI. 23 (3) REPORT.—The Attorney General shall 24 transmit to Congress and make publicly available 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00487 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 488 •HR 2954 IH the results of the survey required under paragraph 1 (1), both for the Nation as a whole and 2 disaggregated as to each State and each correctional 3 facility. To the maximum extent possible, the Attor- 4 ney General shall issue the first report no later than 5 1 year after the date of enactment of this Act and 6 shall issue reports annually thereafter for 5 years. 7 (g) STRATEGY.— 8 (1) DIRECTIVE TO ATTORNEY GENERAL.—The 9 Attorney General, in consultation with the Secretary 10 of Health and Human Services, State officials, and 11 community organizations, shall develop and imple- 12 ment a 5-year strategy to reduce the prevalence and 13 spread of STIs in Federal and State correctional fa- 14 cilities. To the maximum extent possible, the strat- 15 egy shall be developed, transmitted to Congress, and 16 made publicly available no later than 180 days after 17 the transmission of the first report required under 18 subsection (h)(3). 19 (2) CONTENTS OF STRATEGY.—The strategy 20 shall include the following: 21 (A) PREVENTION EDUCATION.—A plan for 22 improving prevention education, information, 23 and training offered to incarcerated persons 24 and correctional facility staff, including infor- 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00488 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 489 •HR 2954 IH mation and training on sexual violence and the 1 spread of STIs, and comprehensive sexuality 2 education. 3 (B) SEXUAL BARRIER PROTECTION DEVICE 4 ACCESS.—A plan for expanding access to sexual 5 barrier protection devices in correctional facili- 6 ties. 7 (C) SEXUAL VIOLENCE REDUCTION.—A 8 plan for reducing the incidence of sexual vio- 9 lence among incarcerated persons and correc- 10 tional facility staff, developed in consultation 11 with the National Prison Rape Elimination 12 Commission. 13 (D) COUNSELING AND SUPPORTIVE SERV- 14 ICES.—A plan for expanding access to coun- 15 seling and supportive services related to STIs in 16 correctional facilities. 17 (E) TESTING.—A plan for testing incarcer- 18 ated persons for STIs during intake, during 19 regular health exams, and prior to release, and 20 that— 21 (i) is conducted in accordance with 22 guidelines established by the Centers for 23 Disease Control and Prevention; 24 (ii) includes pre-test counseling; 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00489 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 490 •HR 2954 IH (iii) requires that incarcerated persons 1 are notified of their option to decline test- 2 ing at any time; 3 (iv) requires that incarcerated persons 4 are confidentially notified of their test re- 5 sults in a timely manner; and 6 (v) ensures that incarcerated persons 7 testing positive for STIs receive post-test 8 counseling, care, treatment, and supportive 9 services. 10 (F) TREATMENT.—A plan for ensuring 11 that correctional facilities have the necessary 12 medicine and equipment to treat and monitor 13 STIs and for ensuring that incarcerated per- 14 sons living with or testing positive for STIs re- 15 ceive and have access to care and treatment 16 services. 17 (G) STRATEGIES FOR DEMOGRAPHIC 18 GROUPS.—A plan for developing and imple- 19 menting culturally appropriate, sensitive, and 20 specific strategies to reduce the spread of STIs 21 among demographic groups heavily impacted by 22 STIs. 23 (H) LINKAGES WITH COMMUNITIES AND 24 FACILITIES.—A plan for establishing and 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00490 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 491 •HR 2954 IH strengthening linkages to local communities and 1 health facilities that— 2 (i) provide counseling, testing, care, 3 and treatment services; 4 (ii) may receive persons recently re- 5 leased from incarceration who are living 6 with STIs; and 7 (iii) accept payment through the State 8 Medicaid program. 9 (I) ENROLLMENT IN STATE MEDICAID 10 PROGRAMS.—Plans to ensure that incarcerated 11 persons who were— 12 (i) enrolled in their State Medicaid 13 program prior to incarceration in a correc- 14 tional facility are automatically re-enrolled 15 in such program upon their release; and 16 (ii) not enrolled in their State Med- 17 icaid program prior to incarceration, but 18 who are diagnosed with the human im- 19 munodeficiency virus while incarcerated in 20 a correctional facility, are automatically 21 enrolled in such program upon their re- 22 lease. 23 (J) OTHER PLANS.—Any other plans de- 24 veloped by the Attorney General for reducing 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00491 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 492 •HR 2954 IH the spread of STIs or improving the quality of 1 health care in correctional facilities. 2 (K) MONITORING SYSTEM.—A monitoring 3 system that establishes performance goals re- 4 lated to reducing the prevalence and spread of 5 STIs in correctional facilities and which, where 6 feasible, expresses such goals in quantifiable 7 form. 8 (L) MONITORING SYSTEM PERFORMANCE 9 INDICATORS.—Performance indicators that 10 measure or assess the achievement of the per- 11 formance goals described in subparagraph (I). 12 (M) COST ESTIMATE.—A detailed estimate 13 of the funding necessary to implement the 14 strategy at the Federal and State levels for all 15 5 years, including the amount of funds required 16 by community organizations to implement the 17 parts of the strategy in which they take part. 18 (3) REPORT.—The Attorney General shall 19 transmit to Congress and make publicly available an 20 annual progress report regarding the implementation 21 and effectiveness of the strategy described in sub- 22 section (a). The progress report shall include an 23 evaluation of the implementation of the strategy 24 using the monitoring system and performance indi- 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00492 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 493 •HR 2954 IH cators provided for in subparagraphs (I) and (J) of 1 paragraph (2). 2 (h) APPROPRIATIONS.— 3 (1) IN GENERAL.—There are authorized to be 4 appropriated such sums as may be necessary to 5 carry out this section for each of the fiscal years 6 2012 through 2018. 7 (2) AVAILABILITY OF FUNDS.—Amounts made 8 available under subsection (a) are authorized to re- 9 main available until expended. 10 (i) DEFINITIONS.—For the purposes of this section: 11 (1) COMMUNITY ORGANIZATION.—The term 12 ‘‘community organization’’ means a public health 13 care facility or a nonprofit organization which pro- 14 vides health- or STI-related services according to es- 15 tablished public health standards. 16 (2) COMPREHENSIVE SEXUALITY EDUCATION.— 17 The term ‘‘comprehensive sexuality education’’ 18 means sexuality education that includes information 19 about abstinence and about the proper use and dis- 20 posal of sexual barrier protection devices and which 21 is— 22 (A) evidence-based; 23 (B) medically accurate; 24 (C) age and developmentally appropriate; 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00493 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 494 •HR 2954 IH (D) gender and identity sensitive; 1 (E) culturally and linguistically appro- 2 priate; and 3 (F) structured to promote critical thinking, 4 self-esteem, respect for others, and the develop- 5 ment of healthy attitudes and relationships. 6 (3) CORRECTIONAL FACILITY.—The term ‘‘cor- 7 rectional facility’’ means any prison, penitentiary, 8 adult detention facility, juvenile detention facility, 9 jail, or other facility to which persons may be sent 10 after conviction of a crime or act of juvenile delin- 11 quency within the United States. 12 (4) INCARCERATED PERSON.—The term ‘‘incar- 13 cerated person’’ means any person who is serving a 14 sentence in a correctional facility after conviction of 15 a crime. 16 (5) SEXUALLY TRANSMITTED INFECTION.—The 17 term ‘‘sexually transmitted infection’’ or ‘‘STI’’ 18 means any disease or infection that is commonly 19 transmitted through sexual activity, including HIV/ 20 AIDS, gonorrhea, chlamydia, syphilis, genital her- 21 pes, viral hepatitis, and human papillomavirus. 22 (6) SEXUAL BARRIER PROTECTION DEVICE.— 23 The term ‘‘sexual barrier protection device’’ means 24 any FDA-approved physical device which has not 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00494 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 495 •HR 2954 IH been tampered with and which reduces the prob- 1 ability of STI transmission or infection between sex- 2 ual partners, including female condoms, male 3 condoms, and dental dams. 4 (7) STATE.—The term ‘‘State’’ includes the 5 District of Columbia, American Samoa, the Com- 6 monwealth of the Northern Mariana Islands, Guam, 7 Puerto Rico, and the United States Virgin Islands. 8 SEC. 750. STOP AIDS IN PRISON. 9 (a) SHORT TITLE.—This section may be cited as the 10 ‘‘Stop AIDS in Prison Act of 2011’’. 11 (b) COMPREHENSIVE HIV/AIDS POLICY.— 12 (1) IN GENERAL.—The Bureau of Prisons 13 (hereinafter in this section referred to as the ‘‘Bu- 14 reau’’) shall develop a comprehensive policy to pro- 15 vide HIV testing, treatment, and prevention for in- 16 mates within the correctional setting and upon re- 17 entry. 18 (2) PURPOSE.—The purposes of such policy are 19 the following: 20 (A) To stop the spread of HIV/AIDS 21 among inmates. 22 (B) To protect prison guards and other 23 personnel from HIV/AIDS infection. 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00495 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 496 •HR 2954 IH (C) To provide comprehensive medical 1 treatment to inmates who are living with HIV/ 2 AIDS. 3 (D) To promote HIV/AIDS awareness and 4 prevention among inmates. 5 (E) To encourage inmates to take personal 6 responsibility for their health. 7 (F) To reduce the risk that inmates will 8 transmit HIV/AIDS to other persons in the 9 community following their release from prison. 10 (3) CONSULTATION.—The Bureau shall consult 11 with appropriate officials of the Department of 12 Health and Human Services, the Office of National 13 Drug Control Policy, the Office of National AIDS 14 Policy, and the Centers for Disease Control regard- 15 ing the development of such policy. 16 (4) TIME LIMIT.—The Bureau shall draft ap- 17 propriate regulations to implement such policy not 18 later than 1 year after the date of the enactment of 19 this Act. 20 (c) REQUIREMENTS FOR POLICY.—The policy cre- 21 ated under subsection (b) shall provide for the following: 22 (1) TESTING AND COUNSELING UPON IN- 23 TAKE.— 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00496 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 497 •HR 2954 IH (A)(i) Subject to clause (ii), health care 1 personnel shall provide routine HIV testing to 2 all inmates as a part of a comprehensive med- 3 ical examination immediately following admis- 4 sion to a facility. 5 (ii) Health care personnel shall not be re- 6 quired to provide routine HIV testing to an in- 7 mate who is transferred to a facility from an- 8 other facility if the inmate’s medical records are 9 transferred with the inmate and indicate that 10 the inmate has been tested previously. 11 (B) To all inmates admitted to a facility 12 prior to the effective date of this policy, health 13 care personnel shall provide routine HIV testing 14 within no more than 6 months. HIV testing for 15 these inmates may be performed in conjunction 16 with other health services provided to these in- 17 mates by health care personnel. 18 (C) All HIV tests under this paragraph 19 shall comply with paragraph (9). 20 (2) PRE-TEST AND POST-TEST COUNSELING.— 21 Health care personnel shall provide confidential pre- 22 test and post-test counseling to all inmates who are 23 tested for HIV. Counseling may be included with 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00497 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 498 •HR 2954 IH other general health counseling provided to inmates 1 by health care personnel. 2 (3) HIV/AIDS PREVENTION EDUCATION.— 3 (A) Health care personnel shall improve 4 HIV/AIDS awareness through frequent edu- 5 cational programs for all inmates. HIV/AIDS 6 educational programs may be provided by com- 7 munity based organizations, local health depart- 8 ments, and inmate peer educators. Such HIV/ 9 AIDS educational programs shall include infor- 10 mation on modes of transmission, including 11 transmission through tattooing, sexual contact, 12 and intravenous drug use; prevention methods; 13 treatment; and disease progression. HIV/AIDS 14 educational programs shall be culturally sen- 15 sitive, conducted in a variety of languages, and 16 present scientifically accurate information in a 17 clear and understandable manner. 18 (B) HIV/AIDS educational materials shall 19 be made available to all inmates at orientation, 20 at health care clinics, at regular educational 21 programs, and prior to release. Both written 22 and audio-visual materials shall be made avail- 23 able to all inmates. These materials shall be 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00498 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 499 •HR 2954 IH culturally sensitive, written for low literacy lev- 1 els, and available in a variety of languages. 2 (4) HIV TESTING UPON REQUEST.— 3 (A) Health care personnel shall allow in- 4 mates to obtain HIV tests upon request once 5 per year or whenever an inmate has a reason to 6 believe the inmate may have been exposed to 7 HIV. Health care personnel shall, both orally 8 and in writing, inform inmates, during orienta- 9 tion and periodically throughout incarceration, 10 of their right to obtain HIV tests. 11 (B) Health care personnel shall encourage 12 inmates to request HIV tests if the inmate is 13 sexually active, has been raped, uses intra- 14 venous drugs, receives a tattoo, or if the inmate 15 is concerned that the inmate may have been ex- 16 posed to HIV/AIDS. 17 (C) An inmate’s request for an HIV test 18 shall not be considered an indication that the 19 inmate has put himself or herself at risk of in- 20 fection or committed a violation of prison rules. 21 (5) HIV TESTING OF PREGNANT WOMAN.— 22 (A) Health care personnel shall provide 23 routine HIV testing to all inmates who become 24 pregnant. 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00499 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 500 •HR 2954 IH (B) All HIV tests under this paragraph 1 shall comply with paragraph (9). 2 (6) COMPREHENSIVE TREATMENT.— 3 (A) Health care personnel shall provide all 4 inmates who test positive for HIV— 5 (i) timely, comprehensive medical 6 treatment; 7 (ii) confidential counseling on man- 8 aging their medical condition and pre- 9 venting its transmission to other persons; 10 and 11 (iii) voluntary partner notification 12 services. 13 (B) Medical care provided under this para- 14 graph shall be consistent with current Depart- 15 ment of Health and Human Services guidelines 16 and standard medical practice. Health care per- 17 sonnel shall discuss treatment options, the im- 18 portance of adherence to antiretroviral therapy, 19 and the side effects of medications with inmates 20 receiving treatment. 21 (C) Health care personnel and pharmacy 22 personnel shall ensure that the facility for- 23 mulary contains all Food and Drug Administra- 24 tion-approved medications necessary to provide 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00500 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 501 •HR 2954 IH comprehensive treatment for inmates living with 1 HIV/AIDS, and that the facility maintains ade- 2 quate supplies of such medications to meet in- 3 mates’ medical needs. Health care personnel 4 and pharmacy personnel shall also develop and 5 implement automatic renewal systems for these 6 medications to prevent interruptions in care. 7 (D) Correctional staff, health care per- 8 sonnel, and pharmacy personnel shall develop 9 and implement distribution procedures to en- 10 sure timely and confidential access to medica- 11 tions. 12 (7) PROTECTION OF CONFIDENTIALITY.— 13 (A) Health care personnel shall develop 14 and implement procedures to ensure the con- 15 fidentiality of inmate tests, diagnoses, and 16 treatment. Health care personnel and correc- 17 tional staff shall receive regular training on the 18 implementation of these procedures. Penalties 19 for violations of inmate confidentiality by health 20 care personnel or correctional staff shall be 21 specified and strictly enforced. 22 (B) HIV testing, counseling, and treat- 23 ment shall be provided in a confidential setting 24 where other routine health services are provided 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00501 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 502 •HR 2954 IH and in a manner that allows the inmate to re- 1 quest and obtain these services as routine med- 2 ical services. 3 (8) TESTING, COUNSELING, AND REFERRAL 4 PRIOR TO REENTRY.— 5 (A)(i) Subject to clauses (ii) and (iii), 6 health care personnel shall provide routine HIV 7 testing to all inmates no more than 3 months 8 prior to their release and reentry into the com- 9 munity. 10 (ii) Inmates who are already known to be 11 infected shall not be required to be tested 12 again. 13 (iii) The requirement under clause (i) may 14 be waived if an inmate’s release occurs without 15 sufficient notice to the Bureau to allow health 16 care personnel to perform a routine HIV test 17 and notify the inmate of the results. 18 (B) All HIV tests under this paragraph 19 shall comply with paragraph (9). 20 (C) To all inmates who test positive for 21 HIV and all inmates who already are known to 22 have HIV/AIDS, health care personnel shall 23 provide— 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00502 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 503 •HR 2954 IH (i) confidential prerelease counseling 1 on managing their medical condition in the 2 community, accessing appropriate treat- 3 ment and services in the community, and 4 preventing the transmission of their condi- 5 tion to family members and other persons 6 in the community; 7 (ii) referrals to appropriate health 8 care providers and social service agencies 9 in the community that meet the inmate’s 10 individual needs, including voluntary part- 11 ner notification services and prevention 12 counseling services for people living with 13 HIV/AIDS; and 14 (iii) a 30-day supply of any medically 15 necessary medications the inmate is cur- 16 rently receiving. 17 (9) OPT-OUT PROVISION.—Inmates shall have 18 the right to refuse routine HIV testing. Inmates 19 shall be informed both orally and in writing of this 20 right. Oral and written disclosure of this right may 21 be included with other general health information 22 and counseling provided to inmates by health care 23 personnel. If an inmate refuses a routine test for 24 HIV, health care personnel shall make a note of the 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00503 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 504 •HR 2954 IH inmate’s refusal in the inmate’s confidential medical 1 records. However, the inmate’s refusal shall not be 2 considered a violation of prison rules or result in dis- 3 ciplinary action. 4 (10) EXCLUSION OF TESTS PERFORMED UNDER 5 SECTION 4014(b) FROM THE DEFINITION OF ROU- 6 TINE HIV TESTING.—HIV testing of an inmate 7 under section 4014(b) of title 18, United States 8 Code, is not routine HIV testing for the purposes of 9 paragraph (9). Health care personnel shall document 10 the reason for testing under section 4014(b) of title 11 18, United States Code, in the inmate’s confidential 12 medical records. 13 (11) TIMELY NOTIFICATION OF TEST RE- 14 SULTS.—Health care personnel shall provide timely 15 notification to inmates of the results of HIV tests. 16 (d) CHANGES IN EXISTING LAW.— 17 (1) SCREENING IN GENERAL.—Section 4014(a) 18 of title 18, United States Code, is amended— 19 (A) by striking ‘‘for a period of 6 months 20 or more’’; 21 (B) by striking ‘‘, as appropriate,’’; and 22 (C) by striking ‘‘if such individual is deter- 23 mined to be at risk for infection with such virus 24 in accordance with the guidelines issued by the 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00504 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 505 •HR 2954 IH Bureau of Prisons relating to infectious disease 1 management’’ and inserting ‘‘unless the indi- 2 vidual declines. The Attorney General shall also 3 cause such individual to be so tested before re- 4 lease unless the individual declines.’’. 5 (2) INADMISSIBILITY OF HIV TEST RESULTS IN 6 CIVIL AND CRIMINAL PROCEEDINGS.—Section 7 4014(d) of title 18, United States Code, is amended 8 by inserting ‘‘or under the Stop AIDS in Prison Act 9 of 2011’’ after ‘‘under this section’’. 10 (3) SCREENING AS PART OF ROUTINE SCREEN- 11 ING.—Section 4014(e) of title 18, United States 12 Code, is amended by adding at the end the fol- 13 lowing: ‘‘Such rules shall also provide that the initial 14 test under this section be performed as part of the 15 routine health screening conducted at intake.’’. 16 (e) REPORTING REQUIREMENTS.— 17 (1) REPORT ON HEPATITIS AND OTHER DIS- 18 EASES.—Not later than 1 year after the date of the 19 enactment of this Act, the Bureau shall provide a re- 20 port to the Congress on Bureau policies and proce- 21 dures to provide testing, treatment, and prevention 22 education programs for hepatitis and other diseases 23 transmitted through sexual activity and intravenous 24 drug use. The Bureau shall consult with appropriate 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00505 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 506 •HR 2954 IH officials of the Department of Health and Human 1 Services, the Office of National Drug Control Policy, 2 the Office of National AIDS Policy, and the Centers 3 for Disease Control and Prevention regarding the 4 development of this report. 5 (2) ANNUAL REPORTS.— 6 (A) GENERALLY.—Not later than 2 years 7 after the date of the enactment of this Act, and 8 then annually thereafter, the Bureau shall re- 9 port to Congress on the incidence among in- 10 mates of diseases transmitted through sexual 11 activity and intravenous drug use. 12 (B) MATTERS PERTAINING TO VARIOUS 13 DISEASES.—Reports under subparagraph (A) 14 shall discuss— 15 (i) the incidence among inmates of 16 HIV/AIDS, hepatitis, and other diseases 17 transmitted through sexual activity and in- 18 travenous drug use; and 19 (ii) updates on Bureau testing, treat- 20 ment, and prevention education programs 21 for these diseases. 22 (C) MATTERS PERTAINING TO HIV/AIDS 23 ONLY.—Reports under subparagraph (A) shall 24 also include— 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00506 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 507 •HR 2954 IH (i) the number of inmates who tested 1 positive for HIV upon intake; 2 (ii) the number of inmates who tested 3 positive prior to reentry; 4 (iii) the number of inmates who were 5 not tested prior to reentry because they 6 were released without sufficient notice; 7 (iv) the number of inmates who opted- 8 out of taking the test; 9 (v) the number of inmates who were 10 tested under section 4014(b) of title 18, 11 United States Code; and 12 (vi) the number of inmates under 13 treatment for HIV/AIDS. 14 (D) CONSULTATION.—The Bureau shall 15 consult with appropriate officials of the Depart- 16 ment of Health and Human Services, the Office 17 of National Drug Control Policy, the Office of 18 National AIDS Policy, and the Centers for Dis- 19 ease Control and Prevention regarding the de- 20 velopment of reports under subparagraph (A). 21 SEC. 751. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND 22 ETHNIC MINORITY COMMUNITIES. 23 (a) IN GENERAL.—For the purpose of reducing HIV/ 24 AIDS in racial and ethnic minority communities, the Sec- 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00507 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 508 •HR 2954 IH retary, acting through the Deputy Assistant Secretary for 1 Minority Health, may make grants to public health agen- 2 cies and faith-based organizations to conduct— 3 (1) outreach activities related to HIV/AIDS 4 prevention and testing activities; 5 (2) HIV/AIDS prevention activities; and 6 (3) HIV/AIDS testing activities. 7 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 8 out this section, there are authorized to be appropriated 9 $50,000,000 for fiscal year 2012, and such sums as may 10 be necessary for fiscal years 2013 through 2016. 11 SEC. 752. HEALTH CARE PROFESSIONALS TREATING INDI- 12 VIDUALS WITH HIV/AIDS. 13 Part E of title VII of the Public Health Service Act 14 (42 U.S.C. 294n et seq.) is amended by adding at the end 15 the following: 16 ‘‘Subpart 5—Health Care Professionals Treating 17 Individuals With HIV/AIDS 18 ‘‘SEC. 785. HEALTH CARE PROFESSIONALS TREATING INDI- 19 VIDUALS WITH HIV/AIDS. 20 ‘‘(a) IN GENERAL.—The Secretary, acting through 21 the Administrator of the Health Resources and Services 22 Administration and in consultation with racial and ethnic 23 minority community organizations, may award grants for 24 any of the following: 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00508 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 509 •HR 2954 IH ‘‘(1) Development of curricula for training pri- 1 mary care providers in HIV/AIDS prevention and 2 care. 3 ‘‘(2) Training health care professionals with ex- 4 pertise in HIV/AIDS to provide care to individuals 5 with HIV/AIDS. 6 ‘‘(3) Development by grant recipients under 7 title XXVI and other persons of policies for pro- 8 viding culturally relevant and sensitive treatment to 9 individuals with HIV/AIDS, with particular empha- 10 sis on treatment to racial and ethnic minorities, men 11 who have sex with men, and women and children 12 with HIV/AIDS. 13 ‘‘(4) Development and implementation of pro- 14 grams to increase the use of telemedicine to respond 15 to HIV/AIDS-specific health care needs in rural and 16 minority communities, with particular emphasis 17 given to medically underserved communities and in- 18 sular areas. 19 ‘‘(5) Creation of faith- and community-based 20 certification programs for providers in HIV/AIDS 21 care and support services. 22 ‘‘(6) Establishment of comfort care centers that 23 provide mental, emotional, and psychosocial coun- 24 seling for people with HIV/AIDS and implement ad- 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00509 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 510 •HR 2954 IH ditional protocols to be carried out in the centers 1 that address the needs of children and young adults 2 who are infected with the disease and are 3 transitioning from childhood to adulthood. 4 ‘‘(7) Incentive payments to health care pro- 5 viders supported by the Health Resources and Serv- 6 ices Administration to implement HIV/AIDS testing 7 consistent with the guidelines issued in 2006 by the 8 Centers for Disease Control and Prevention entitled 9 ‘Revised Recommendations for HIV Testing of 10 Adults, Adolescents, and Pregnant Women in 11 Health-Care Settings’. 12 ‘‘(b) DEFINITION.—In this section, the term ‘HIV/ 13 AIDS’ has the meaning given to such term in section 14 2689. 15 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 16 carry out this section, there are authorized to be appro- 17 priated $100,000,000 for fiscal year 2012, and such sums 18 as may be necessary for fiscal years 2013 through 2016.’’. 19 SEC. 753. REPORT ON IMPACT OF HIV/AIDS IN RACIAL AND 20 ETHNIC MINORITY COMMUNITIES. 21 (a) IN GENERAL.—The Secretary shall submit to the 22 Congress and the President an annual report on the im- 23 pact of HIV/AIDS in racial and ethnic minority commu- 24 nities. 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00510 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 511 •HR 2954 IH (b) CONTENTS.—The report under subsection (a) 1 shall include information on the— 2 (1) progress that has been made in reducing 3 the impact of HIV/AIDS in such communities; 4 (2) opportunities that exist to make additional 5 progress in reducing the impact of HIV/AIDS in 6 such communities; 7 (3) challenges that may impede such additional 8 progress; and 9 (4) Federal funding necessary to achieve sub- 10 stantial reductions in HIV/AIDS in racial and ethnic 11 minority communities. 12 SEC. 754. STUDY ON STATUS OF HIV/AIDS EPIDEMIC AMONG 13 AFRICAN-AMERICANS. 14 (a) IN GENERAL.—The Secretary shall— 15 (1) seek to enter into an agreement with the In- 16 stitute of Medicine to document, in collaboration 17 with an academic organization which specializes in 18 the identification and reduction of health disparities 19 within the African-American community, all aspects 20 of the HIV/AIDS epidemic among African-Ameri- 21 cans, including the role that historical racial or eth- 22 nic barriers play in sustaining the epidemic among 23 African-Americans; 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00511 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 512 •HR 2954 IH (2) submit a report to the President, the Direc- 1 tor of the Office of National AIDS Policy Coordina- 2 tion, the Director of the White House Domestic Pol- 3 icy Council, the Director of White House Office of 4 Faith-Based and Neighborhood Partnerships, key 5 Federal agencies, and the relevant committees of the 6 Congress on the status of the HIV/AIDS epidemic 7 among African-Americans in the United States; and 8 (3) include in such report— 9 (A) specific recommendations on the imple- 10 mentation of Federal policies to reduce the bur- 11 den of HIV/AIDS in the African-American com- 12 munity; and 13 (B) a special focus on the Black clergy and 14 the church as a unique resource in the African- 15 American community. 16 (b) AUTHORIZATION OF APPROPRIATIONS.— 17 (1) IN GENERAL.—To carry out this section, 18 there is authorized to be appropriated $2,000,000 19 for each of fiscal years 2012 and 2013. 20 (2) SPECIAL RULE.—Of the amount of funds 21 appropriated to carry out this section for a fiscal 22 year— 23 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00512 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 513 •HR 2954 IH (A) 45 percent shall be allocated to the In- 1 stitutes of Medicine pursuant to the agreement 2 entered into under subsection (a)(1); 3 (B) 45 percent shall be allocated to an 4 academic organization which specializes in the 5 identification and reduction of health disparities 6 within the African-American community pursu- 7 ant to such agreement; and 8 (C) 10 percent shall be allocated for ad- 9 ministrative costs and other activities under 10 this subsection. 11 Subtitle F—Diabetes 12 SEC. 755. TREATMENT OF DIABETES IN MINORITY COMMU- 13 NITIES. 14 (a) SHORT TITLE.—This subtitle may be cited as the 15 ‘‘Minority Diabetes Initiative Act’’. 16 (b) GRANTS REGARDING TREATMENT OF DIABETES 17 IN MINORITY COMMUNITIES.—Part D of title III of the 18 Public Health Service Act (42 U.S.C. 254b et seq.) is 19 amended by inserting after section 330L the following: 20 ‘‘SEC. 330M. GRANTS REGARDING TREATMENT OF DIABE- 21 TES IN MINORITY COMMUNITIES. 22 ‘‘(a) IN GENERAL.—The Secretary may make grants 23 to public and nonprofit private health care providers for 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00513 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 514 •HR 2954 IH the purpose of providing treatment for diabetes in minor- 1 ity communities. 2 ‘‘(b) RECIPIENTS OF GRANTS.—The public and non- 3 profit private health care providers to whom grants may 4 be made under subsection (a) include physicians, podia- 5 trists, community-based organizations, health care organi- 6 zations, community health centers, and State, local, and 7 tribal health departments. 8 ‘‘(c) SCOPE OF TREATMENT ACTIVITIES.—The Sec- 9 retary shall ensure that grants under subsection (a) cover 10 a variety of diabetes-related health care services, including 11 routine care for diabetic patients, public education on dia- 12 betes prevention and control, eye care, foot care, and 13 treatment for kidney disease and other complications of 14 diabetes. 15 ‘‘(d) APPROPRIATE CULTURAL CONTEXT.—A condi- 16 tion for the receipt of a grant under subsection (a) is that 17 the applicant involved agrees that, in the program carried 18 out with the grant, services will be provided in the lan- 19 guages most appropriate for, and with consideration for 20 the cultural backgrounds of, the individuals for whom the 21 services are provided. 22 ‘‘(e) OUTREACH SERVICES.—A condition for the re- 23 ceipt of a grant under subsection (a) is that the applicant 24 involved agrees to provide outreach activities to inform the 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00514 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 515 •HR 2954 IH public of the services of the program, and to provide offsite 1 information on diabetes. 2 ‘‘(f) APPLICATION FOR GRANT.—A grant may be 3 made under subsection (a) only if an application for the 4 grant is submitted to the Secretary and the application 5 is in such form, is made in such manner, and contains 6 such agreements, assurances, and information as the Sec- 7 retary determines to be necessary to carry out this section. 8 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—For the 9 purpose of carrying out this section, there are authorized 10 to be appropriated such sums as may be necessary for 11 each of the fiscal years 2012 through 2017.’’. 12 SEC. 756. ELIMINATING DISPARITIES IN DIABETES PREVEN- 13 TION ACCESS AND CARE. 14 (a) RESEARCH, TREATMENT, AND EDUCATION.— 15 (1) IN GENERAL.—Subpart 3 of part C of title 16 IV of the Public Health Service Act (42 U.S.C. 285c 17 et seq.) is amended by adding at the end the fol- 18 lowing new section: 19 ‘‘SEC. 434B. DIABETES IN MINORITY POPULATIONS. 20 ‘‘(a) IN GENERAL.—The Director of the National In- 21 stitutes of Health shall expand, intensify, and support on- 22 going research and other activities with respect to pre-dia- 23 betes and diabetes, particularly type 2, in minority popu- 24 lations, including research to identify clinical, socio- 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00515 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 516 •HR 2954 IH economic, geographical, cultural, and organizational fac- 1 tors that contribute to type 2 diabetes in such populations. 2 ‘‘(b) CERTAIN ACTIVITIES.—Activities under sub- 3 section (a) regarding type 2 diabetes in minority popu- 4 lations shall include the following: 5 ‘‘(1) Continuing research on behavior and obe- 6 sity, including through the obesity research center 7 that is sponsored by the National Institutes of 8 Health. 9 ‘‘(2) Research on environmental factors that 10 may contribute to the increase in type 2 diabetes. 11 ‘‘(3) Support for new methods to identify envi- 12 ronmental triggers and genetic interactions that lead 13 to the development of type 2 diabetes in minority 14 newborns. Such research should follow the newborns 15 through puberty, an increasingly high-risk period for 16 developing type 2 diabetes. 17 ‘‘(4) Research to identify genes that predispose 18 individuals to the onset of developing type 1 and 19 type 2 diabetes and to the development of complica- 20 tions. 21 ‘‘(5) Research to prevent complications in indi- 22 viduals who have already developed diabetes, such as 23 research that attempts to identify the genes that 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00516 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 517 •HR 2954 IH predispose individuals with diabetes to the develop- 1 ment of complications. 2 ‘‘(6) Research methods and alternative thera- 3 pies to control blood glucose. 4 ‘‘(7) Support of ongoing research efforts exam- 5 ining the level of glycemia at which adverse out- 6 comes develop during pregnancy and to address the 7 many clinical issues associated with minority moth- 8 ers and fetuses during diabetic and gestational dia- 9 betic pregnancies. 10 ‘‘(c) EDUCATION.—The Director of the National In- 11 stitutes of Health shall— 12 ‘‘(1) through the National Institute on Minority 13 Health and Health Disparities and the National Di- 14 abetes Education Program— 15 ‘‘(A) make grants to programs funded 16 under section 485F (relating to centers of ex- 17 cellence) for the purpose of establishing a men- 18 toring program for health care professionals to 19 be more involved in weight counseling, obesity 20 research, and nutrition; and 21 ‘‘(B) provide for the participation of mi- 22 nority health professionals in diabetes-focused 23 research programs; and 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00517 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 518 •HR 2954 IH ‘‘(2) make grants for programs to establish a 1 pipeline from high school to professional school that 2 will increase minority representation in diabetes-fo- 3 cused health fields by expanding Minority Access to 4 Research Careers (MARC) program internships and 5 mentoring opportunities for recruitment. 6 ‘‘(d) DEFINITION.—For purposes of this section, the 7 term ‘minority population’ means a racial and ethnic mi- 8 nority group, as defined in section 1707(g). 9 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the 10 purpose of carrying out this section, there are authorized 11 to be appropriated such sums as are necessary for fiscal 12 year 2012 and each subsequent fiscal year.’’. 13 (2) DIABETES MELLITUS INTERAGENCY CO- 14 ORDINATING COMMITTEE.—Section 429 of the Pub- 15 lic Health Service Act (42 U.S.C. 285c–3) is amend- 16 ed by adding at the end the following new sub- 17 section: 18 ‘‘(c)(1) The Diabetes Mellitus Interagency Coordi- 19 nating Committee shall submit to the Secretary a biennial 20 report that shall include an assessment of the Federal ac- 21 tivities and programs related to diabetes in minority popu- 22 lations. Such assessment shall— 23 ‘‘(A) compile the current activities of all current 24 Federal health programs to allow for the assessment 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00518 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 519 •HR 2954 IH of their adequacy as a systemic method of address- 1 ing the impact of diabetes mellitus on minority pop- 2 ulations; 3 ‘‘(B) develop strategic planning activities to de- 4 velop an effective and comprehensive Federal plan to 5 address diabetes mellitus within minority popu- 6 lations which will involve all appropriate Federal 7 health programs and shall— 8 ‘‘(i) include steps to address issues includ- 9 ing type 1 and type 2 diabetes in children and 10 the disproportionate impact of diabetes mellitus 11 on minority populations; and 12 ‘‘(ii) remain consistent with the programs 13 and activities identified in section 399O, as well 14 as remaining consistent with the intent of the 15 Eliminating Disparities in Diabetes Prevention 16 Access and Care Act of 2010; and 17 ‘‘(C) assess the implementation of such a plan 18 throughout Federal health programs. 19 ‘‘(2) For the purposes of this subsection, the term 20 ‘minority population’ means a racial and ethnic minority 21 group, as defined in section 1707(g). 22 ‘‘(3) For the purpose of carrying out this subsection, 23 there are authorized to be appropriated such sums as are 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00519 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 520 •HR 2954 IH necessary for fiscal year 2012 and each subsequent fiscal 1 year.’’. 2 (b) RESEARCH, EDUCATION, AND OTHER ACTIVI- 3 TIES.—Part B of title III of the Public Health Service 4 Act (42 U.S.C. 243 et seq.) is amended by inserting after 5 section 317T the following section: 6 ‘‘SEC. 317U. DIABETES IN MINORITY POPULATIONS. 7 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 8 ‘‘(1) IN GENERAL.—The Secretary, acting 9 through the Director of the Centers for Disease 10 Control and Prevention, shall conduct and support 11 research and other activities with respect to diabetes 12 in minority populations. 13 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 14 paragraph (1) regarding diabetes in minority popu- 15 lations shall include the following: 16 ‘‘(A) Expanding the National Diabetes 17 Laboratory capacity for translational research 18 and the identification of genetic and 19 immunological risk factors associated with dia- 20 betes. 21 ‘‘(B) Improving the understanding of dia- 22 betes prevalence among Asian-American, Native 23 Hawaiian and other Pacific Islanders by en- 24 hancing data in the National Health and Nutri- 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00520 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 521 •HR 2954 IH tion Examination Survey by oversampling these 1 populations in appropriate geographic areas, or 2 by another method determined appropriate to 3 collect this data. 4 ‘‘(C) Within the Division of Diabetes 5 Translation, providing for prevention research 6 to better understand how to influence health 7 care systems changes to improve quality of care 8 being delivered to such populations, and within 9 the Division of Diabetes Translation, carrying 10 out model demonstration projects to design, im- 11 plement, and evaluate effective diabetes preven- 12 tion and control intervention for such popu- 13 lations. 14 ‘‘(D) Through the Division of Diabetes 15 Translation, carrying out culturally appropriate 16 community-based interventions designed to ad- 17 dress issues and problems experienced by such 18 populations. 19 ‘‘(E) Conducting applied research within 20 the Division of Diabetes Translation to reduce 21 health disparities within such populations with 22 diabetes. 23 ‘‘(F) Conducting applied research on pri- 24 mary prevention within the Division of Diabetes 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00521 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 522 •HR 2954 IH Translation to specifically focus on such popu- 1 lations with pre-diabetes. 2 ‘‘(b) EDUCATION.— 3 ‘‘(1) IN GENERAL.—The Secretary, acting 4 through the Director of the Centers for Disease 5 Control and Prevention, shall direct the Division of 6 Diabetes Translation to conduct and support pro- 7 grams to educate the public on the causes and ef- 8 fects of diabetes in minority populations. 9 ‘‘(2) CERTAIN ACTIVITIES.—Programs under 10 paragraph (1) regarding education on diabetes in 11 minority populations shall include carrying out pub- 12 lic awareness campaigns directed toward such popu- 13 lations to aggressively emphasize the importance and 14 impact of physical activity and diet in regard to dia- 15 betes and diabetes-related complications through the 16 National Diabetes Education Program. 17 ‘‘(c) DIABETES; HEALTH PROMOTION, PREVENTION 18 ACTIVITIES, AND ACCESS.— 19 ‘‘(1) IN GENERAL.—The Secretary, acting 20 through the Director of the Centers for Disease 21 Control and Prevention, shall carry out culturally 22 appropriate diabetes health promotion and preven- 23 tion programs for minority populations. 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00522 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 523 •HR 2954 IH ‘‘(2) CERTAIN ACTIVITIES.—Activities regard- 1 ing culturally appropriate diabetes health promotion 2 and prevention programs for minority populations 3 shall include the following: 4 ‘‘(A) Expanding the Diabetes Prevention 5 and Control Program (currently existing in all 6 the States and territories) and providing funds 7 for education and community outreach on dia- 8 betes. 9 ‘‘(B) Providing funds for an expansion of 10 the Diabetes Prevention Program Initiative that 11 focuses on physical inactivity and diet and its 12 relation to type 2 diabetes within such popu- 13 lations. 14 ‘‘(C) Providing funds to strengthen exist- 15 ing surveillance systems to improve the quality, 16 accuracy, and timeliness of morbidity and mor- 17 tality diabetes data for such populations. 18 ‘‘(d) DEFINITION.—For purposes of this section, the 19 term ‘minority population’ means a racial and ethnic mi- 20 nority group, as defined in section 1707(g). 21 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the 22 purpose of carrying out this section, there are authorized 23 to be appropriated such sums as are necessary for fiscal 24 year 2012 and each subsequent fiscal year.’’. 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00523 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 524 •HR 2954 IH (c) RESEARCH, EDUCATION, AND OTHER ACTIVI- 1 TIES.—Part P of title III of the Public Health Service 2 Act is amended— 3 (1) by redesignating the section 399R inserted 4 by section 2 of Public Law 110–373 as section 5 399S; 6 (2) by redesignating the section 399R inserted 7 by section 3 of Public Law 110–374 as section 8 399T; and 9 (3) by adding at the end the following new sec- 10 tion: 11 ‘‘SEC. 399V–6. PROGRAMS TO EDUCATE HEALTH PRO- 12 VIDERS ON THE CAUSES AND EFFECTS OF DI- 13 ABETES IN MINORITY POPULATIONS. 14 ‘‘(a) IN GENERAL.—The Secretary, acting through 15 the Director of the Health Resources and Services Admin- 16 istration, shall conduct and support programs described 17 in subsection (b) to educate health professionals on the 18 causes and effects of diabetes in minority populations. 19 ‘‘(b) PROGRAMS.—Programs described in this sub- 20 section, with respect to education on diabetes in minority 21 populations, shall include the following: 22 ‘‘(1) Making grants for diabetes-focused edu- 23 cation classes or training programs on cultural sen- 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00524 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 525 •HR 2954 IH sitivity and patient care within such populations for 1 health care providers. 2 ‘‘(2) Providing funds to community health cen- 3 ters for programs that provide diabetes services and 4 screenings. 5 ‘‘(3) Providing additional funds for the Health 6 Careers Opportunity Program, Centers for Excel- 7 lence, and the Minority Faculty Fellowship Program 8 to partner with the Office of Minority Health under 9 section 1707 and the National Institutes of Health 10 to strengthen programs for career opportunities 11 within minority populations focused on diabetes 12 treatment and care. 13 ‘‘(4) Developing a diabetes focus within, and 14 providing additional funds for, the National Health 15 Service Corps Scholarship program to place individ- 16 uals in areas that are disproportionately affected by 17 diabetes and to provide health care services to such 18 areas. 19 ‘‘(5) Establishing a diabetes ambassador pro- 20 gram for recruitment efforts to increase the number 21 of underrepresented minorities currently serving in 22 student, faculty, or administrative positions in insti- 23 tutions of higher learning, hospitals, and community 24 health centers. 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00525 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 526 •HR 2954 IH ‘‘(6) Establishing a loan repayment program 1 that focuses on diabetes care and prevention in mi- 2 nority populations.’’. 3 (d) RESEARCH, EDUCATION, AND OTHER ACTIVI- 4 TIES.—Part P of title III of the Public Health Service 5 Act (42 U.S.C. 280g et seq.), as amended by subsection 6 (c), is further amended by adding at the end the following 7 section: 8 ‘‘SEC. 399V–7. RESEARCH, EDUCATION, AND OTHER ACTIVI- 9 TIES REGARDING DIABETES IN MINORITY 10 POPULATIONS. 11 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 12 ‘‘(1) IN GENERAL.—In addition to activities 13 under sections 317U and 434B, the Secretary shall 14 conduct and support research and other activities 15 with respect to diabetes within minority populations. 16 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 17 paragraph (1) regarding diabetes in minority popu- 18 lations shall include the following: 19 ‘‘(A) Through the National Center on Mi- 20 nority Health and Health Disparities, the Office 21 of Minority Health under section 1707, the 22 Health Resources and Services Administration, 23 the Centers for Disease Control and Prevention, 24 and the Indian Health Service, establishing 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00526 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 527 •HR 2954 IH partnerships within minority populations to 1 conduct studies on cultural, familial, and social 2 factors that may influence health promotion, di- 3 abetes management, and prevention. 4 ‘‘(B) Through the Indian Health Service, 5 in collaboration with other appropriate Federal 6 agencies, coordinating the collection of data on 7 ethnic and culturally appropriate diabetes treat- 8 ment, care, prevention, and services by health 9 care professionals to the American Indian popu- 10 lation. 11 ‘‘(3) PROGRAMS RELATING TO CLINICAL RE- 12 SEARCH.— 13 ‘‘(A) EDUCATION REGARDING CLINICAL 14 TRIALS.—The Secretary shall carry out edu- 15 cation and awareness programs designed to in- 16 crease participation of minority populations in 17 clinical trials. 18 ‘‘(B) MINORITY RESEARCHERS.—The Sec- 19 retary shall carry out mentorship programs for 20 minority researchers who are conducting or in- 21 tend to conduct research on diabetes in minor- 22 ity populations. 23 ‘‘(C) SUPPLEMENTING CLINICAL RE- 24 SEARCH REGARDING CHILDREN.—The Sec- 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00527 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 528 •HR 2954 IH retary shall make grants to supplement clinical 1 research programs to assist such programs in 2 obtaining the services of health professionals 3 and other resources to provide specialized care 4 for children with type 1 and type 2 diabetes. 5 ‘‘(4) ADDITIONAL PROGRAMS.—Activities under 6 paragraph (1) regarding education on diabetes shall 7 include providing funds for new and existing diabe- 8 tes-focused education grants and programs for 9 present and future students and clinicians in the 10 medical field from minority populations, including 11 for the following: 12 ‘‘(A) For Federal and State loan repay- 13 ment programs for health profession students 14 within communities of color. 15 ‘‘(B) For the Office of Minority Health 16 under section 1707 for training health profes- 17 sion students to focus on diabetes within such 18 populations. 19 ‘‘(b) DEFINITION.—For purposes of this section, the 20 term ‘minority population’ means a racial and ethnic mi- 21 nority group as defined in section 1707(g). 22 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the 23 purpose of carrying out this section, there are authorized 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00528 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 529 •HR 2954 IH to be appropriated such sums as are necessary for fiscal 1 year 2012 and each subsequent fiscal year.’’. 2 (e) SENSE OF THE CONGRESS.—It is the sense of the 3 Congress that States and localities are encourage to recog- 4 nize established times of diabetes awareness, such as 5 American Diabetes Month (November), American Diabe- 6 tes Alert Day (annually on the 4th Tuesday of March), 7 and World Diabetes Day (November 14th). 8 Subtitle G—Lung Disease 9 SEC. 761. EXPANSION OF THE NATIONAL ASTHMA EDU- 10 CATION AND PREVENTION PROGRAM. 11 (a) IN GENERAL.—Not later than 2 years after the 12 date of the enactment of this Act, the Secretary of Health 13 and Human Services shall convene a working group com- 14 prised of patient groups, nonprofit organizations, medical 15 societies, and other relevant governmental and nongovern- 16 mental entities, including those that participate in the Na- 17 tional Asthma Education and Prevention Program, to de- 18 velop a report to Congress that— 19 (1) catalogs, with respect to asthma prevention, 20 management, and surveillance— 21 (A) the activities of the Federal Govern- 22 ment, including identifying all Federal pro- 23 grams that carry out asthma-related activities, 24 as well as assessment of the progress of the 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00529 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 530 •HR 2954 IH Federal Government and States, with respect to 1 achieving the goals of the Healthy People 2020 2 initiative; and 3 (B) the activities of other entities that par- 4 ticipate in the program, including nonprofit or- 5 ganizations, patient advocacy groups, and med- 6 ical societies; and 7 (2) makes recommendations for the future di- 8 rection of asthma activities, in consultation with re- 9 searchers from the National Institutes of Health and 10 other member bodies of the National Asthma Edu- 11 cation and Prevention Program who are qualified to 12 review and analyze data and evaluate interventions, 13 including— 14 (A) description of how the Federal Govern- 15 ment may better coordinate and improve its re- 16 sponse to asthma including identifying any bar- 17 riers that may exist; 18 (B) description of how the Federal Govern- 19 ment may continue, expand, and improve its 20 private-public partnerships with respect to asth- 21 ma including identifying any barriers that may 22 exist; 23 (C) identification of steps that may be 24 taken to reduce the— 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00530 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 531 •HR 2954 IH (i) morbidity, mortality, and overall 1 prevalence of asthma; 2 (ii) financial burden of asthma on so- 3 ciety; 4 (iii) burden of asthma on dispropor- 5 tionately affected areas, particularly those 6 in medically underserved populations (as 7 defined in section 330(b)(3) of the Public 8 Health Service Act (42 U.S.C. 9 254b(b)(3)); and 10 (iv) burden of asthma as a chronic 11 disease; 12 (D) identification of programs and policies 13 that have achieved the steps described in sub- 14 paragraph (C), and steps that may be taken to 15 expand such programs and policies to benefit 16 larger populations; and 17 (E) recommendations for future research 18 and interventions. 19 (b) REPORT TO CONGRESS.—At the end of the 5-year 20 period following the submission of the report under sub- 21 section (a), the National Asthma Education and Preven- 22 tion Program shall evaluate the analyses and rec- 23 ommendations under such report and determine whether 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00531 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 532 •HR 2954 IH a new report to the Congress is necessary, and make ap- 1 propriate recommendations to the Congress. 2 SEC. 762. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 3 FOR DISEASE CONTROL AND PREVENTION. 4 Section 317I of the Public Health Service Act (42 5 U.S.C. 247b–10) is amended to read as follows: 6 ‘‘SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 7 FOR DISEASE CONTROL AND PREVENTION. 8 ‘‘(a) PROGRAM FOR PROVIDING INFORMATION AND 9 EDUCATION TO THE PUBLIC.—The Secretary, acting 10 through the Director of the Centers for Disease Control 11 and Prevention, shall collaborate with State and local 12 health departments to conduct activities, including the 13 provision of information and education to the public re- 14 garding asthma including— 15 ‘‘(1) deterring the harmful consequences of un- 16 controlled asthma; and 17 ‘‘(2) disseminating health education and infor- 18 mation regarding prevention of asthma episodes and 19 strategies for managing asthma. 20 ‘‘(b) DEVELOPMENT OF STATE ASTHMA PLANS.— 21 The Secretary, acting through the Director of the Centers 22 for Disease Control and Prevention, shall collaborate with 23 State and local health departments to develop State plans 24 incorporating public health responses to reduce the burden 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00532 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 533 •HR 2954 IH of asthma, particularly regarding disproportionately af- 1 fected populations. 2 ‘‘(c) COMPILATION OF DATA.—The Secretary, acting 3 through the Director of the Centers for Disease Control 4 and Prevention, shall, in cooperation with State and local 5 public health officials— 6 ‘‘(1) conduct asthma surveillance activities to 7 collect data on the prevalence and severity of asth- 8 ma, the effectiveness of public health asthma inter- 9 ventions, and the quality of asthma management, in- 10 cluding— 11 ‘‘(A) collection of household data on the 12 local burden of asthma; 13 ‘‘(B) surveillance of health care facilities; 14 and 15 ‘‘(C) collection of data not containing indi- 16 vidually identifiable information from electronic 17 health records or other electronic communica- 18 tions; 19 ‘‘(2) compile and annually publish data regard- 20 ing the prevalence and incidence of childhood asth- 21 ma, the child mortality rate, and the number of hos- 22 pital admissions and emergency department visits by 23 children associated with asthma nationally and in 24 each State and at the county level by age, sex, race, 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00533 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 534 •HR 2954 IH and ethnicity, as well as lifetime and current preva- 1 lence; and 2 ‘‘(3) compile and annually publish data regard- 3 ing the prevalence and incidence of adult asthma, 4 the adult mortality rate, and the number of hospital 5 admissions and emergency department visits by 6 adults associated with asthma nationally and in each 7 State and at the county level by age, sex, race, eth- 8 nicity, industry, and occupation, as well as lifetime 9 and current prevalence. 10 ‘‘(d) COORDINATION OF DATA COLLECTION.—The 11 Director of the Centers for Disease Control and Preven- 12 tion, in conjunction with State and local health depart- 13 ments, shall coordinate data collection activities under 14 subsection (c)(2) so as to maximize comparability of re- 15 sults. 16 ‘‘(e) COLLABORATION.—The Centers for Disease 17 Control and Prevention are encouraged to collaborate with 18 national, State, and local nonprofit organizations to pro- 19 vide information and education about asthma, and to 20 strengthen such collaborations when possible. 21 ‘‘(f) ADDITIONAL FUNDING.—In addition to any 22 other authorization of appropriations that is available to 23 the Centers for Disease Control and Prevention for the 24 purpose of carrying out this section, there are authorized 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00534 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 535 •HR 2954 IH to be appropriated to such Centers such sums as may be 1 necessary for each of fiscal years 2012 through 2016 for 2 the purpose of carrying out this section.’’. 3 SEC. 763. INFLUENZA AND PNEUMONIA VACCINATION CAM- 4 PAIGN. 5 (a) IN GENERAL.—The Secretary of Health and 6 Human Services shall— 7 (1) enhance the annual campaign by the De- 8 partment of Health and Human Services to increase 9 the number of people vaccinated each year for influ- 10 enza and pneumonia; and 11 (2) include in such campaign the use of written 12 educational materials, public service announcements, 13 physician education, and any other means which the 14 Secretary deems effective. 15 (b) MATERIALS AND ANNOUNCEMENTS.—In carrying 16 out the annual campaign described in subsection (a), the 17 Secretary of Health and Human Services shall ensure 18 that— 19 (1) educational materials and public service an- 20 nouncements are readily and widely available in 21 communities experiencing disparities in the incidence 22 and mortality rates of influenza and pneumonia; and 23 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00535 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 536 •HR 2954 IH (2) the campaign uses targeted, culturally ap- 1 propriate messages and messengers to reach under- 2 served communities. 3 (c) AUTHORIZATION OF APPROPRIATIONS.—There 4 are authorized to be appropriated to carry out this section 5 such sums as may be necessary for each of fiscal years 6 2012 through 2016. 7 SEC. 764. CHRONIC OBSTRUCTIVE PULMONARY DISEASE 8 ACTION PLAN. 9 (a) IN GENERAL.—The Director of the Centers for 10 Disease Control and Prevention shall conduct, support, 11 and expand public health strategies, prevention, diagnosis, 12 surveillance, and public and professional awareness activi- 13 ties regarding chronic obstructive pulmonary disease. 14 (b) NATIONAL ACTION PLAN.— 15 (1) DEVELOPMENT.—Not later than 2 years 16 after the date of the enactment of this Act, the Di- 17 rector of the National Heart, Lung, and Blood Insti- 18 tute, in consultation with the Director of the Centers 19 for Disease Control and Prevention, shall develop a 20 national action plan to address chronic obstructive 21 pulmonary disease in the United States with partici- 22 pation from patients, caregivers, health profes- 23 sionals, patient advocacy organizations, researchers, 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00536 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 537 •HR 2954 IH providers, public health professionals, and other 1 stakeholders. 2 (2) CONTENTS.—At a minimum, such plan 3 shall include recommendations for— 4 (A) public health interventions for the pur- 5 pose of implementation of the national plan; 6 (B) biomedical, health services, and public 7 health research on chronic obstructive pul- 8 monary disease; and 9 (C) inclusion of chronic obstructive pul- 10 monary disease in the health data collections of 11 all Federal agencies. 12 (3) CONSIDERATION.—In developing such plan, 13 the Director of the National Heart, Lung, and Blood 14 Institute shall consider the recommendations and 15 findings of the Institute of Medicine in the report 16 entitled ‘‘A Nationwide Framework for Surveillance 17 of Cardiovascular and Chronic Lung Diseases’’ (July 18 22, 2011). 19 (c) CHRONIC DISEASE PREVENTION PROGRAMS.— 20 The Director of the National Heart, Lung, and Blood In- 21 stitute shall carry out the following: 22 (1) Conduct public education and awareness ac- 23 tivities with patient and professional organizations 24 to stimulate earlier diagnosis and improve patient 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00537 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 538 •HR 2954 IH outcomes from treatment of chronic obstructive pul- 1 monary disease. To the extent known and relevant, 2 such public education and awareness activities shall 3 reflect differences in chronic obstructive pulmonary 4 disease by cause (tobacco, environmental, occupa- 5 tional, biological, and genetic) and include a focus 6 on outreach to undiagnosed and, as appropriate, mi- 7 nority populations. 8 (2) Supplement and expand upon the activities 9 of the National Heart, Lung, and Blood Institute by 10 making grants to nonprofit organizations, State and 11 local jurisdictions, and Indian tribes for the purpose 12 of reducing the burden of chronic obstructive pul- 13 monary disease, especially in disproportionately im- 14 pacted communities, through public health interven- 15 tions and related activities. 16 (3) Coordinate with the Centers for Disease 17 Control and Prevention, the Indian Health Service, 18 the Health Resources and Services Administration, 19 and the Department of Veterans Affairs to develop 20 pilot programs to demonstrate best practices for the 21 diagnosis and management of chronic obstructive 22 pulmonary disease. 23 (4) Develop improved techniques and identify 24 best practices, in coordination with the Secretary of 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00538 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 539 •HR 2954 IH Veterans Affairs, for assisting chronic obstructive 1 pulmonary disease patients to successfully stop 2 smoking, including identification of subpopulations 3 with different needs. Initiatives under this para- 4 graph may include research to determine whether 5 successful smoking cessation strategies are different 6 for chronic obstructive pulmonary disease patients 7 compared to such strategies for patients with other 8 chronic diseases. 9 (d) ENVIRONMENTAL AND OCCUPATIONAL HEALTH 10 PROGRAMS.—The Director of the Centers for Disease 11 Control and Prevention shall— 12 (1) support research into the environmental and 13 occupational causes and biological mechanisms that 14 contribute to chronic obstructive pulmonary disease; 15 and 16 (2) develop and disseminate public health inter- 17 ventions that will lessen the impact of environmental 18 and occupational causes of chronic obstructive pul- 19 monary disease. 20 (e) DATA COLLECTION.—Not later than 180 days 21 after the enactment of this Act, the Director of the Na- 22 tional Heart, Lung, and Blood Institute and the Director 23 of the Centers for Disease Control and Prevention, acting 24 jointly, shall assess the depth and quality of information 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00539 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 540 •HR 2954 IH on chronic obstructive pulmonary disease that is collected 1 in surveys and population studies conducted by the Cen- 2 ters for Disease Control and Prevention, including wheth- 3 er there are additional opportunities for information to be 4 collected in the National Health and Nutrition Examina- 5 tion Survey, the National Health Interview Survey, and 6 the Behavioral Risk Factors Surveillance System surveys. 7 The Director of the National Heart, Lung, and Blood In- 8 stitute shall include the results of such assessment in the 9 national action plan under subsection (b). 10 (f) AUTHORIZATION OF APPROPRIATIONS.—There 11 are authorized to be appropriated to carry out this section 12 such sums as may be necessary for each of fiscal years 13 2012 through 2016. 14 TITLE VIII—HEALTH 15 INFORMATION TECHNOLOGY 16 Subtitle A—Reducing Health 17 Disparities Through Health IT 18 SEC. 801. HRSA ASSISTANCE TO HEALTH CENTERS FOR 19 PROMOTION OF HEALTH IT. 20 The Secretary of Health and Human Services, acting 21 through the Administrator of the Health Resources and 22 Services Administration, shall expand and intensify the 23 programs and activities of the Administration (directly or 24 through grants or contracts) to provide technical assist- 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00540 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 541 •HR 2954 IH ance and resources to health centers (as defined in section 1 330(a) of the Public Health Service Act (42 U.S.C. 2 254b(a)) to adopt and meaningfully use certified EHR 3 technology (as defined in section 3000(1) of such Act (42 4 U.S.C. 300jj(1)) for the management of chronic diseases 5 and health conditions. 6 SEC. 802. ASSESSMENT OF IMPACT OF HEALTH IT ON RA- 7 CIAL AND ETHNIC MINORITY COMMUNITIES; 8 OUTREACH AND ADOPTION OF HEALTH IT IN 9 SUCH COMMUNITIES. 10 Section 3001(c)(6)(C) of the Public Health Service 11 Act (42 U.S.C. 300jj–11(c)(6)(C)) is amended— 12 (1) in the heading by inserting ‘‘, RACIAL AND 13 ETHNIC MINORITY COMMUNITIES,’’ after ‘‘HEALTH 14 DISPARITIES’’; 15 (2) by inserting ‘‘, in communities with a high 16 proportion of individuals from racial and ethnic mi- 17 nority groups (as defined in section 1707(g)),’’ after 18 ‘‘communities with health disparities’’; and 19 (3) by adding at the end the following new sen- 20 tence: ‘‘In any publication under the previous sen- 21 tence, the National Coordinator shall include best 22 practices for encouraging partnerships between the 23 Federal Government and private entities to expand 24 outreach for and the adoption of such technology in 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00541 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 542 •HR 2954 IH communities with a high proportion of individuals 1 from racial and ethnic minority groups (as so de- 2 fined), while also maintaining the accessibility re- 3 quirements of section 508 of the Rehabilitation Act 4 to encourage patient involvement in their own health 5 care. The National Coordinator shall— 6 ‘‘(i) not later than 6 months after the 7 submission to the Congress of the reports 8 required by sections 832 and 833 of the 9 Health Equity and Accountability Act of 10 2011, establish criteria for evaluating the 11 impact of health information technology on 12 communities with a high proportion of in- 13 dividuals from racial and ethnic minority 14 groups (as so defined) taking into account 15 the findings in such reports; and 16 ‘‘(ii) not later than 12 months after 17 the submission to the Congress of such re- 18 ports, conduct and publish the results of 19 an evaluation of such impact.’’. 20 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00542 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 543 •HR 2954 IH Subtitle B—Modifications to 1 Achieve Parity in Existing Pro- 2 grams 3 SEC. 811. EXTENDING FUNDING TO STRENGTHEN THE 4 HEALTH IT INFRASTRUCTURE IN RACIAL 5 AND ETHNIC MINORITY COMMUNITIES. 6 Section 3011 of the Public Health Service Act (42 7 U.S.C. 300jj–31) is amended— 8 (1) in subsection (a), by adding at the end the 9 following new paragraph: 10 ‘‘(8) Activities described in the previous para- 11 graphs of this subsection with respect to commu- 12 nities with a high proportion of individuals from ra- 13 cial and ethnic minority groups (as defined in sec- 14 tion 1707(g)).’’; and 15 (2) by adding at the end the following new sub- 16 section: 17 ‘‘(e) ANNUAL REPORT ON EXPENDITURES.—The 18 National Coordinator shall report annually to the Con- 19 gress on activities and expenditures under this section.’’. 20 SEC. 812. PRIORITIZING REGIONAL EXTENSION CENTER AS- 21 SISTANCE TO RACIAL AND ETHNIC MINORITY 22 GROUPS. 23 (a) IN GENERAL.—Section 3012(c)(4)(C) of the Pub- 24 lic Health Service Act (42 U.S.C. 300jj–32(c)(4)(C)) is 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00543 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 544 •HR 2954 IH amended by inserting ‘‘or individuals from racial and eth- 1 nic minority groups (as defined in section 1707(g))’’ after 2 ‘‘medically underserved individuals’’. 3 (b) BIENNIAL EVALUATION.—Section 3012(c)(8) of 4 such Act (42 U.S.C. 300jj–32(c)(8)) is amended— 5 (1) by inserting: ‘‘Each evaluation panel shall 6 include at least one consumer advocate from a racial 7 and ethnic minority community served by the center 8 involved and at least one representative of a minor- 9 ity-serving institution.’’ after ‘‘ ‘and of Federal offi- 10 cials.’’; and 11 (2) by inserting ‘‘and shall determine the de- 12 gree to which such center provides outreach and as- 13 sistance to providers predominantly serving racial 14 and ethnic minority groups (as defined in section 15 1707(g))’’ after ‘‘specified in paragraph (3)’’. 16 SEC. 813. EXTENDING COMPETITIVE GRANTS FOR THE DE- 17 VELOPMENT OF LOAN PROGRAMS TO FACILI- 18 TATE ADOPTION OF CERTIFIED EHR TECH- 19 NOLOGY BY PROVIDERS SERVING RACIAL 20 AND ETHNIC MINORITY GROUPS. 21 Section 3014(e) of the Public Health Service Act (42 22 U.S.C. 300jj–34(e)) is amended— 23 (1) in paragraph (3), by striking at the end 24 ‘‘or’’; 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00544 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 545 •HR 2954 IH (2) in paragraph (4), by striking the period at 1 the end and inserting ‘‘; or’’; and 2 (3) by adding at the end the following new 3 paragraph: 4 ‘‘(5) carry out any of the activities described in 5 a previous paragraph of this subsection with respect 6 to communities with a high proportion of individuals 7 from racial and ethnic minority groups (as defined 8 in section 1707(g)).’’. 9 Subtitle C—Additional Research 10 and Studies 11 SEC. 831. DATA COLLECTION AND ASSESSMENTS CON- 12 DUCTED IN COORDINATION WITH MINORITY- 13 SERVING INSTITUTIONS. 14 Section 3001(c)(6) of the Public Health Service Act 15 (42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 16 end the following new subparagraph: 17 ‘‘(F) DATA COLLECTION AND ASSESS- 18 MENTS CONDUCTED IN COORDINATION WITH 19 MINORITY-SERVING INSTITUTIONS.— 20 ‘‘(i) IN GENERAL.—In carrying out 21 subparagraph (C) with respect to commu- 22 nities with a high proportion of individuals 23 from racial and ethnic minority groups (as 24 defined in section 1707(g)), the National 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00545 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 546 •HR 2954 IH Coordinator shall, to the greatest extent 1 possible, coordinate with an entity de- 2 scribed in clause (ii). 3 ‘‘(ii) MINORITY-SERVING INSTITU- 4 TIONS.—For purposes of clause (i), an en- 5 tity described in this clause is a historically 6 Black college or university, an Hispanic- 7 serving institution, a tribal college or uni- 8 versity, or an Asian-American-, Native 9 American-, and Pacific Islander-serving in- 10 stitution with an accredited public health, 11 health policy, or health services research 12 program.’’. 13 SEC. 832. IOM STUDY AND REPORT ON PRIVACY CONCERNS 14 OF CERTAIN MINORITY POPULATIONS. 15 (a) IN GENERAL.—The Secretary of Health and 16 Human Services shall seek to enter into an agreement 17 with the Institute of Medicine of the National Academies 18 to— 19 (1) complete a study— 20 (A) on the privacy concerns, relating to the 21 exchange of health information, of individuals 22 described in subsection (b); 23 (B) on how such concerns may create bar- 24 riers for such individuals to access health care 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00546 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 547 •HR 2954 IH or participate in the exchange of health infor- 1 mation; and 2 (C) including recommendations for over- 3 coming such barriers for such individuals; and 4 (2) not later than 24 months after the date of 5 the enactment of this Act, submit to Congress a re- 6 port on the results of such study. 7 If such Institute declines to conduct the study and submit 8 the report, the Secretary shall enter into an agreement 9 with another appropriate public or nonprofit private entity 10 to conduct the study and submit the report. 11 (b) INDIVIDUALS DESCRIBED.—For purposes of sub- 12 section (a), the individuals described in this subsection are 13 individuals from racial and ethnic minority groups (as de- 14 fined in section 1707(g)), including such individuals 15 who— 16 (1) are immigrants, as well as citizens living 17 within immigrant households (‘‘mixed-status’’ house- 18 holds) in the United States; 19 (2) are lesbian, gay, bisexual, or transgender; or 20 (3) have a mental health disability or a record 21 of a mental health disability or treatment for a men- 22 tal health disability. 23 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00547 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 548 •HR 2954 IH SEC. 833. STUDY OF HEALTH INFORMATION TECHNOLOGY 1 IN MEDICALLY UNDERSERVED COMMU- 2 NITIES. 3 (a) STUDY.—The Secretary of Health and Human 4 Services shall seek to enter into an agreement with the 5 Institute of Medicine of the National Academies to con- 6 duct a study on the development and implementation of 7 health information technology in communities with a high 8 proportion of individuals from racial and ethnic minority 9 groups (as defined in section 1707(g)) and submit the re- 10 port under subsection (b). The study shall— 11 (1) identify barriers to successful implementa- 12 tion of health information technology in these com- 13 munities; 14 (2) examine the impact of health information 15 technology on providing quality care and reducing 16 the cost of care to these communities; 17 (3) examine urban and rural community health 18 systems and determine the impact that health infor- 19 mation technology may have on the capacity of pri- 20 mary health providers; 21 (4) identify specific best practices for using 22 health information technology to foster the con- 23 sistent provision of physical accessibility and reason- 24 able policy accommodations in health care to individ- 25 uals with disabilities in these communities; and 26 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00548 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 549 •HR 2954 IH (5) assess the feasibility and the costs of associ- 1 ated with the use of health information technology 2 in these communities. 3 If such Institute declines to conduct the study, the Sec- 4 retary shall enter into an agreement with another appro- 5 priate public or nonprofit private entity to conduct the 6 study. 7 (b) REPORT.—The Secretary shall ensure that, not 8 later than 24 months after the date of the enactment of 9 this Act, the study required under subsection (a) is com- 10 pleted and a report on the study is submitted to Congress, 11 including any recommendations for legislation or adminis- 12 trative action. 13 Subtitle D—Closing Gaps in 14 Funding To Adopt Certified EHRs 15 SEC. 841. APPLICATION OF MEDICARE HITECH PAYMENTS 16 TO HOSPITALS IN PUERTO RICO. 17 (a) IN GENERAL.—Subsection (n)(6)(B) of section 18 1886 of the Social Security Act (42 U.S.C. 1395ww) is 19 amended by striking ‘‘subsection (d) hospital’’ and insert- 20 ing ‘‘hospital that is a subsection (d) hospital or a sub- 21 section (d) Puerto Rico hospital’’. 22 (b) OFFSETTING REDUCTION.—Subsection (n)(2) of 23 such section is amended by adding at the end the following 24 new subparagraph: 25 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00549 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 550 •HR 2954 IH ‘‘(H) BUDGET NEUTRALITY ADJUST- 1 MENT.—The Secretary shall reduce the applica- 2 ble amounts that would otherwise be deter- 3 mined under this subsection with respect to— 4 ‘‘(i) the first fiscal year to which this 5 subparagraph applies by an amount that 6 the Secretary estimates would ensure that 7 estimated aggregate payments under this 8 subsection for such fiscal year are not in- 9 creased as a result of the amendments 10 made by subsection (a) of section 841 of 11 the Health Equity and Accountability Act 12 of 2011; or 13 ‘‘(ii) a succeeding fiscal year by an 14 amount that the Secretary estimates would 15 ensure that estimated aggregate payments 16 under this subsection for such fiscal year 17 are not increased as a result of the amend- 18 ments made by subsections (a) and (c) of 19 such section.’’. 20 (c) CONFORMING AMENDMENTS.—(1) Subsection 21 (b)(3)(B)(ix) of such section is amended— 22 (A) in subclause (I), by striking ‘‘(n)(6)(A)’’ 23 and inserting ‘‘(n)(6)(B)’’; and 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00550 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 551 •HR 2954 IH (B) in subclause (II), by striking ‘‘subsection 1 (d) hospital’’ and inserting ‘‘an eligible hospital’’. 2 (2) Paragraphs (2) and (4)(A) of section 1853(m) of 3 the Social Security Act (42 U.S.C. 1395w–23(m)) are 4 each amended by striking ‘‘1886(n)(6)(A)’’ and inserting 5 ‘‘1886(n)(6)(B)’’. 6 (d) IMPLEMENTATION.—Notwithstanding any other 7 provision of law, the Secretary of Health and Human 8 Services may implement the amendments made by sub- 9 sections (a), (b) and (c) by program instruction or other- 10 wise. 11 (e) EFFECTIVE DATE.—The amendments made by 12 this section shall apply to payments for payment years for 13 fiscal years beginning after the date of the enactment of 14 this Act. 15 SEC. 842. EXTENDING MEDICAID EHR INCENTIVE PAY- 16 MENTS TO LONG-TERM CARE FACILITIES AND 17 HOME HEALTH AGENCIES. 18 Section 1903(t)(2)(B) of the Social Security Act (42 19 U.S.C. 1396b(t)(2)(B)) is amended— 20 (1) in clause (i), by striking ‘‘, or’’ and insert- 21 ing a semicolon; 22 (2) in clause (ii), by striking the period at the 23 end and inserting a semicolon; and 24 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00551 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 552 •HR 2954 IH (3) by adding at the end the following new 1 clauses: 2 ‘‘(iii) a long-term care facility; or 3 ‘‘(iv) a home health agency (as defined in 4 section 1861(o)).’’. 5 SEC. 843. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 6 FOR MEDICAID ELECTRONIC HEALTH 7 RECORD INCENTIVE PAYMENTS. 8 (a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 9 Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 10 amended by striking ‘‘insofar as the assistant is prac- 11 ticing’’ and all that follows through ‘‘so led’’. 12 (b) EFFECTIVE DATE.—The amendment made by 13 subsection (a) shall apply with respect to amounts ex- 14 pended under 1903(a)(3)(F) of the Social Security Act 15 (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters begin- 16 ning on or after the date of the enactment of this Act. 17 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00552 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 553 •HR 2954 IH TITLE IX—ACCOUNTABILITY 1 AND EVALUATION 2 SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL 3 ASSISTED HEALTH CARE SERVICES AND RE- 4 SEARCH PROGRAMS ON THE BASIS OF SEX, 5 RACE, COLOR, NATIONAL ORIGIN, SEXUAL 6 ORIENTATION, GENDER IDENTITY, OR DIS- 7 ABILITY STATUS. 8 No person in the United States shall, on the basis 9 of sex, race, color, national origin, sexual orientation, gen- 10 der identity, or disability status, be excluded from partici- 11 pation in, be denied the benefits of, or be subjected to dis- 12 crimination under any health care service or research pro- 13 gram or activity receiving Federal financial assistance. 14 SEC. 902. TREATMENT OF MEDICARE PAYMENTS UNDER 15 TITLE VI OF THE CIVIL RIGHTS ACT OF 1964. 16 A payment to a provider of services, physician, or 17 other supplier under part B, C, or D of title XVIII of 18 the Social Security Act shall be deemed a grant, and not 19 a contract of insurance or guaranty, for the purposes of 20 title VI of the Civil Rights Act of 1964. 21 VerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00553 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 554 •HR 2954 IH SEC. 903. ACCOUNTABILITY AND TRANSPARENCY WITHIN 1 THE DEPARTMENT OF HEALTH AND HUMAN 2 SERVICES. 3 Title XXXIV of the Public Health Service Act, as 4 amended by titles I, II, and III of this Act, is further 5 amended by inserting after subtitle B the following: 6 ‘‘Subtitle C—Strengthening 7 Accountability 8 ‘‘SEC. 3441. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 9 ‘‘(a) IN GENERAL.—The Secretary shall establish 10 within the Office for Civil Rights an Office of Health Dis- 11 parities, which shall be headed by a director to be ap- 12 pointed by the Secretary. 13 ‘‘(b) PURPOSE.—The Office of Health Disparities 14 shall ensure that the health programs, activities, and oper- 15 ations of health entities which receive Federal financial as- 16 sistance are in compliance with title VI of the Civil Rights 17 Act, which prohibits discrimination on the basis of race, 18 color, or national origin. The activities of the Office shall 19 include the following: 20 ‘‘(1) The development and implementation of 21 an action plan to address racial and ethnic health 22 care disparities, which shall address concerns relat- 23 ing to the Office for Civil Rights as released by the 24 United States Commission on Civil Rights in the re- 25 port entitled ‘Health Care Challenge: Acknowledging 26 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00554 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 555 •HR 2954 IH Disparity, Confronting Discrimination, and Ensur- 1 ing Equity’ (September 1999) in conjunction with 2 the reports by the Institute of Medicine entitled ‘Un- 3 equal Treatment: Confronting Racial and Ethnic 4 Disparities in Health Care’, ‘Crossing the Quality 5 Chasm: A New Health System for the 21st Cen- 6 tury’, and ‘In the Nation’s Compelling Interest: En- 7 suring Diversity in the Health Care Workforce’, and 8 ‘The National Partnership for Action to End Health 9 Disparities’, and other related reports by the Insti- 10 tute of Medicine. This plan shall be publicly dis- 11 closed for review and comment and the final plan 12 shall address any comments or concerns that are re- 13 ceived by the Office. 14 ‘‘(2) Investigative and enforcement actions 15 against intentional discrimination and policies and 16 practices that have a disparate impact on minorities. 17 ‘‘(3) The review of racial, ethnic, and primary 18 language health data collected by Federal health 19 agencies to assess health care disparities related to 20 intentional discrimination and policies and practices 21 that have a disparate impact on minorities. 22 ‘‘(4) Outreach and education activities relating 23 to compliance with title VI of the Civil Rights Act. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00555 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 556 •HR 2954 IH ‘‘(5) The provision of technical assistance for 1 health entities to facilitate compliance with title VI 2 of the Civil Rights Act. 3 ‘‘(6) Coordination and oversight of activities of 4 the civil rights compliance offices established under 5 section 3442. 6 ‘‘(7) Ensuring compliance with the 1997 Office 7 of Management and Budget Standards for Maintain- 8 ing, Collecting, and Presenting Federal Data on 9 Race, Ethnicity and the available language stand- 10 ards. 11 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en- 12 sure the effectiveness of the Office of Health Disparities 13 by ensuring that the Office is provided with— 14 ‘‘(1) adequate funding to enable the Office to 15 carry out its duties under this section; and 16 ‘‘(2) staff with expertise in— 17 ‘‘(A) epidemiology; 18 ‘‘(B) statistics; 19 ‘‘(C) health quality assurance; 20 ‘‘(D) minority health and health dispari- 21 ties; 22 ‘‘(E) cultural and linguistic competency; 23 and 24 ‘‘(F) civil rights. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00556 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 557 •HR 2954 IH ‘‘(d) REPORT.—Not later than December 31, 2012, 1 and annually thereafter, the Secretary, in collaboration 2 with the Director of the Office for Civil Rights and the 3 Deputy Assistant Secretary for Minority Health, shall 4 submit a report to the Committee on Health, Education, 5 Labor, and Pensions of the Senate and the Committee on 6 Energy and Commerce of the House of Representatives 7 that includes— 8 ‘‘(1) the number of cases filed, broken down by 9 category; 10 ‘‘(2) the number of cases investigated and 11 closed by the office; 12 ‘‘(3) the outcomes of cases investigated; 13 ‘‘(4) the staffing levels of the office including 14 staff credentials; 15 ‘‘(5) the number of other lingering and emerg- 16 ing cases in which civil rights inequities can be dem- 17 onstrated; and 18 ‘‘(6) the number of cases remaining open and 19 an explanation for their open status. 20 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 21 are authorized to be appropriated to carry out this section, 22 such sums as may be necessary for each of fiscal years 23 2012 through 2017. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00557 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 558 •HR 2954 IH ‘‘SEC. 3442. ESTABLISHMENT OF HEALTH PROGRAM OF- 1 FICES FOR CIVIL RIGHTS WITHIN FEDERAL 2 HEALTH AND HUMAN SERVICES AGENCIES. 3 ‘‘(a) IN GENERAL.—The Secretary shall establish 4 civil rights compliance offices in each agency within the 5 Department of Health and Human Services that admin- 6 isters health programs. 7 ‘‘(b) PURPOSE OF OFFICES.—Each office established 8 under subsection (a) shall ensure that recipients of Fed- 9 eral financial assistance under Federal health programs 10 administer their programs, services, and activities in a 11 manner that— 12 ‘‘(1) does not discriminate, either intentionally 13 or in effect, on the basis of race, national origin, lan- 14 guage, ethnicity, sex, age, disability, sexual orienta- 15 tion, and gender identity; and 16 ‘‘(2) promotes the reduction and elimination of 17 disparities in health and health care based on race, 18 national origin, language, ethnicity, sex, age, dis- 19 ability, sexual orientation, and gender identity. 20 ‘‘(c) POWERS AND DUTIES.—The offices established 21 in subsection (a) shall have the following powers and du- 22 ties: 23 ‘‘(1) The establishment of compliance and pro- 24 gram participation standards for recipients of Fed- 25 eral financial assistance under each program admin- 26 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00558 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 559 •HR 2954 IH istered by an agency within the Department of 1 Health and Human Services including the establish- 2 ment of disparity reduction standards to encompass 3 disparities in health and health care related to race, 4 national origin, language, ethnicity, sex, age, dis- 5 ability, sexual orientation, and gender identity. 6 ‘‘(2) The development and implementation of 7 program-specific guidelines that interpret and apply 8 Department of Health and Human Services guid- 9 ance under title VI of the Civil Rights Act of 1964 10 and section 1557 of the Patient Protection and Af- 11 fordable Care Act to each Federal health program 12 administered by the agency. 13 ‘‘(3) The development of a disparity-reduction 14 impact analysis methodology that shall be applied to 15 every rule issued by the agency and published as 16 part of the formal rulemaking process under sections 17 555, 556, and 557 of title 5, United States Code. 18 ‘‘(4) Oversight of data collection, analysis, and 19 publication requirements for all recipients of Federal 20 financial assistance under each Federal health pro- 21 gram administered by the agency, and compliance 22 with the 1997 Office of Management and Budget 23 Standards for Maintaining, Collecting, and Pre- 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00559 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 560 •HR 2954 IH senting Federal Data on Race and Ethnicity and the 1 available language standards. 2 ‘‘(5) The conduct of publicly available studies 3 regarding discrimination within Federal health pro- 4 grams administered by the agency as well as dis- 5 parity reduction initiatives by recipients of Federal 6 financial assistance under Federal health programs. 7 ‘‘(6) Annual reports to the Committee on 8 Health, Education, Labor, and Pensions and the 9 Committee on Finance of the Senate and the Com- 10 mittee on Energy and Commerce and the Committee 11 on Ways and Means of the House of Representatives 12 on the progress in reducing disparities in health and 13 health care through the Federal programs adminis- 14 tered by the agency. 15 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS 16 IN THE DEPARTMENT OF JUSTICE.— 17 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN 18 SERVICES.—The Office for Civil Rights in the De- 19 partment of Health and Human Services shall pro- 20 vide standard-setting and compliance review inves- 21 tigation support services to the Civil Rights Compli- 22 ance Office for each agency. 23 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 24 for Civil Rights in the Department of Justice shall 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00560 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 561 •HR 2954 IH continue to maintain the power to institute formal 1 proceedings when an agency Office for Civil Rights 2 determines that a recipient of Federal financial as- 3 sistance is not in compliance with the disparity re- 4 duction standards of the agency. 5 ‘‘(e) DEFINITION.—In this section, the term ‘Federal 6 health programs’ mean programs— 7 ‘‘(1) under the Social Security Act (42 U.S.C. 8 301 et seq.) that pay for health care and services; 9 and 10 ‘‘(2) under this Act that provide Federal finan- 11 cial assistance for health care, biomedical research, 12 health services research, and programs designed to 13 improve the public’s health.’’. 14 SEC. 904. UNITED STATES COMMISSION ON CIVIL RIGHTS. 15 (a) COORDINATION WITHIN DEPARTMENT OF JUS- 16 TICE OF ACTIVITIES REGARDING HEALTH DISPARI- 17 TIES.—Section 3 of the Civil Rights Commission Act of 18 1983 (42 U.S.C. 1975a) is amended— 19 (1) in paragraph (1), by striking ‘‘and’’ at the 20 end; 21 (2) in paragraph (2), by striking the period at 22 the end and inserting ‘‘; and’’; and 23 (3) by adding at the end the following: 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00561 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 562 •HR 2954 IH ‘‘(3) shall, with respect to activities carried out 1 in health care and correctional facilities toward the 2 goal of eliminating health disparities between the 3 general population and members of racial or ethnic 4 minority groups, coordinate such activities of— 5 ‘‘(A) the Office for Civil Rights within the 6 Department of Justice; 7 ‘‘(B) the Office of Justice Programs within 8 the Department of Justice; 9 ‘‘(C) the Office for Civil Rights within the 10 Department of Health and Human Services; 11 and 12 ‘‘(D) the Office of Minority Health within 13 the Department of Health and Human Services 14 (headed by the Deputy Assistant Secretary for 15 Minority Health).’’. 16 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 17 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 18 1975c) is amended by striking the first sentence and in- 19 serting the following: ‘‘For the purpose of carrying out 20 this Act, there are authorized to be appropriated 21 $30,000,000 for fiscal year 2012, and such sums as may 22 be necessary for each of the fiscal years 2013 through 23 2017.’’. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00562 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 563 •HR 2954 IH SEC. 905. SENSE OF CONGRESS CONCERNING FULL FUND- 1 ING OF ACTIVITIES TO ELIMINATE RACIAL 2 AND ETHNIC HEALTH DISPARITIES. 3 (a) FINDINGS.—Congress makes the following find- 4 ings: 5 (1) The health status of the American populace 6 is declining and the United States currently ranks 7 below most industrialized nations in health status 8 measured by longevity, sickness, and mortality. 9 (2) Racial and ethnic minority populations tend 10 have the poorest health status and face substantial 11 cultural, social, and economic barriers to obtaining 12 quality health care. 13 (3) Efforts to improve minority health have 14 been limited by inadequate resources (funding, staff- 15 ing, and stewardship) and accountability. 16 (b) SENSE OF CONGRESS.—It is the sense of Con- 17 gress that— 18 (1) funding should be doubled by fiscal year 19 2013 for the National Institute for Minority Health 20 Disparities, the Office of Civil Rights in the Depart- 21 ment of Health and Human Services, the National 22 Institute of Nursing Research, and the Office of Mi- 23 nority Health; 24 (2) adequate funding by fiscal year 2013, and 25 subsequent funding increases, should be provided for 26 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00563 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 564 •HR 2954 IH health professions training programs, the Racial and 1 Ethnic Approaches to Community Health (REACH) 2 at the Centers for Disease Control and Prevention, 3 the Minority HIV/AIDS Initiative, and the Excel- 4 lence Centers to Eliminate Ethnic/Racial Disparities 5 (EXCEED) Program at the Agency for Healthcare 6 Research and Quality; 7 (3) funding should be restored to the Racial 8 and Ethnic Approaches to Community Health 9 (REACH) program at the Centers for Disease Con- 10 trol and Prevention, which has been a successful 11 program at the community health level; 12 (4) current and newly created health disparity 13 elimination incentives, programs, agencies, and de- 14 partments under this Act (and the amendments 15 made by this Act) should receive adequate staffing 16 and funding by fiscal year 2013; and 17 (5) stewardship and accountability should be 18 provided to the Congress and the President for 19 measurable and sustainable progress toward health 20 disparity elimination. 21 SEC. 906. GAO AND NIH REPORTS. 22 (a) GAO REPORT ON NIH GRANT RACIAL AND ETH- 23 NIC DIVERSITY.— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00564 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 565 •HR 2954 IH (1) IN GENERAL.—The Comptroller General of 1 the United States shall conduct a study on the racial 2 and ethnic diversity among the following groups: 3 (A) All applicants for grants, contracts, 4 and cooperative agreements awarded by the Na- 5 tional Institutes of Health during the period be- 6 ginning January 1, 1990, and ending December 7 31, 2011. 8 (B) All recipients of such grants, con- 9 tracts, and cooperative agreements. 10 (C) All members of the peer review panels 11 of such applicants and recipients, respectively. 12 (2) REPORT.—Not later than six months after 13 the date of the enactment of this Act, the Comp- 14 troller General shall complete the study under para- 15 graph (1) and submit to Congress a report con- 16 taining the results of such study. 17 (b) NIH REPORT ON CERTAIN AUTHORITY OF NA- 18 TIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH 19 DISPARITIES.—Not later than six months after the date 20 of the enactment of this Act, and biennially thereafter, the 21 Director of the National Institutes of Health, in collabora- 22 tion with the Director of the National Institute on Minor- 23 ity Health and Health Disparities, shall submit to Con- 24 gress a report that details and evaluates— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00565 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 566 •HR 2954 IH (1) the steps taken during the applicable report 1 period by the Director of the National Institutes of 2 Health to enforce the expanded planning, coordina- 3 tion, review, and evaluation authority provided the 4 National Institute on Minority Health and Health 5 Disparities under section 464z–3(h) of the Public 6 Health Service Act (42 U.S.C. 285(h)), as added by 7 section 10334(c) of the Patient Protection and Af- 8 fordable Care Act, over all minority health and 9 health disparity research that is conducted or sup- 10 ported by the Institutes and Centers at the National 11 Institutes of Health; and 12 (2) the outcomes of such steps. 13 (c) GAO REPORT RELATED TO RECIPIENTS OF 14 PPACA FUNDING.—Not later than one year after the 15 date of the enactment of this Act and biennially thereafter 16 until 2020, the Comptroller General of the United States 17 shall submit to Congress a report that identifies, with re- 18 spect to minority community-based organizations that ap- 19 plied during the applicable report period for Federal fund- 20 ing provided pursuant to the provisions of (and amend- 21 ments made by) the Patient Protection and Affordable 22 Care Act for purposes of achieving health equity and elimi- 23 nating health disparities, the percentage of such organiza- 24 tions that were awarded such funding. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00566 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 567 •HR 2954 IH (d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL 1 INSTITUTE ON MINORITY HEALTH AND HEALTH DIS- 2 PARITIES.—The Director of the National Institute on Mi- 3 nority Health and Health Disparities shall prepare an an- 4 nual report on the activities carried out or to be carried 5 out by the Institute, and shall submit each such report 6 to the Committee on Health, Education, Labor, and Pen- 7 sions of the Senate, the Committee on Energy and Com- 8 merce of the House of Representatives, the Secretary of 9 Health and Human Services, and the Director of the Na- 10 tional Institutes of Health. With respect to the fiscal year 11 involved, the report shall— 12 (1) describe and evaluate the progress made in 13 health disparities research conducted or supported 14 by institutes and centers of the National Institutes 15 of Health; 16 (2) summarize and analyze expenditures made 17 for activities with respect to health disparities re- 18 search conducted or supported by the National Insti- 19 tutes of Health; 20 (3) include a separate statement applying the 21 requirements of paragraphs (1) and (2) specifically 22 to minority health disparities research; and 23 (4) contain such recommendations as the Direc- 24 tor of the Institute considers appropriate. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00567 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 568 •HR 2954 IH TITLE X—ADDRESSING SOCIAL 1 DETERMINANTS AND IM- 2 PROVING ENVIRONMENTAL 3 JUSTICE 4 SEC. 1001. CODIFICATION OF EXECUTIVE ORDER 12898. 5 (a) IN GENERAL.—The President of the United 6 States is authorized and directed to execute, administer, 7 and enforce as a matter of Federal law the provisions of 8 Executive Order 12898, dated February 11, 1994 (‘‘Fed- 9 eral Actions To Address Environmental Justice In Minor- 10 ity Populations and Low-Income Populations’’), with such 11 modifications as are provided in this section. 12 (b) DEFINITION OF ENVIRONMENTAL JUSTICE.—For 13 purposes of carrying out the provisions of Executive Order 14 12898, the following definitions shall apply: 15 (1) The term ‘‘environmental justice’’ means 16 the fair treatment and meaningful involvement of all 17 people regardless of race, color, national origin, edu- 18 cational level, or income with respect to the develop- 19 ment, implementation, and enforcement of environ- 20 mental laws and regulations in order to ensure 21 that— 22 (A) minority and low-income communities 23 have access to public information relating to 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00568 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 569 •HR 2954 IH human health and environmental planning, reg- 1 ulations, and enforcement; and 2 (B) no minority or low-income population 3 is forced to shoulder a disproportionate burden 4 of the negative human health and environ- 5 mental impacts of pollution or other environ- 6 mental hazard. 7 (2) The term ‘‘fair treatment’’ means policies 8 and practices that ensure that no group of people, 9 including racial, ethnic, or socioeconomic groups 10 bear disproportionately high and adverse human 11 health or environmental effects resulting from Fed- 12 eral agency programs, policies, and activities. 13 (c) JUDICIAL REVIEW AND RIGHTS OF ACTION.— 14 The provisions of section 6–609 of Executive Order 12898 15 shall not apply for purposes of this Act. 16 SEC. 1002. IMPLEMENTATION OF RECOMMENDATIONS BY 17 ENVIRONMENTAL PROTECTION AGENCY. 18 (a) INSPECTOR GENERAL RECOMMENDATIONS.—The 19 Administrator of the Environmental Protection Agency 20 shall, as promptly as practicable, carry out each of the 21 following recommendations of the Inspector General of the 22 agency as set forth in Report No. 2006–P–00034 entitled 23 ‘‘EPA needs to conduct environmental justice reviews of 24 its programs, policies and activities’’: 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00569 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 570 •HR 2954 IH (1) The recommendation that the Agency’s pro- 1 gram and regional offices identify which programs, 2 policies, and activities need environmental justice re- 3 views and require these offices to establish a plan to 4 complete the necessary reviews. 5 (2) The recommendation that the Administrator 6 of the Agency ensure that these reviews determine 7 whether the programs, policies, and activities may 8 have a disproportionately high and adverse health or 9 environmental impact on minority and low-income 10 populations. 11 (3) The recommendation that each program 12 and regional office develop specific environmental 13 justice review guidance for conducting environmental 14 justice reviews. 15 (4) The recommendation that the Administrator 16 designate a responsible office to compile results of 17 environmental justice reviews and recommend appro- 18 priate actions. 19 (b) GAO RECOMMENDATIONS.—In developing rules 20 under laws administered by the Environmental Protection 21 Agency, the Administrator of the Agency shall, as prompt- 22 ly as practicable, carry out each of the following rec- 23 ommendations of the Comptroller General of the United 24 States as set forth in GAO Report numbered GAO–05– 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00570 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 571 •HR 2954 IH 289 entitled ‘‘EPA Should Devote More Attention to En- 1 vironmental Justice when Developing Clean Air Rules’’: 2 (1) The recommendation that the Administrator 3 ensure that workgroups involved in developing a rule 4 devote attention to environmental justice while draft- 5 ing and finalizing the rule. 6 (2) The recommendation that the Administrator 7 enhance the ability of such workgroups to identify 8 potential environmental justice issues through such 9 steps as providing workgroup members with guid- 10 ance and training to helping them identify potential 11 environmental justice problems and involving envi- 12 ronmental justice coordinators in the workgroups 13 when appropriate. 14 (3) The recommendation that the Administrator 15 improve assessments of potential environmental jus- 16 tice impacts in economic reviews by identifying the 17 data and developing the modeling techniques needed 18 to assess such impacts. 19 (4) The recommendation that the Administrator 20 direct appropriate Agency officers and employees to 21 respond fully when feasible to public comments on 22 environmental justice, including improving the Agen- 23 cy’s explanation of the basis for its conclusions, to- 24 gether with supporting data. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00571 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 572 •HR 2954 IH (c) 2004 INSPECTOR GENERAL REPORT.—The Ad- 1 ministrator of the Environmental Protection Agency shall, 2 as promptly as practicable, carry out each of the following 3 recommendations of the Inspector General of the Agency 4 as set forth in the report entitled ‘‘EPA Needs to Consist- 5 ently Implement the Intent of the Executive Order on En- 6 vironmental Justice’’ (Report No. 2004–P–00007): 7 (1) The recommendation that the Agency clear- 8 ly define the mission of the Office of Environmental 9 Justice (OEJ) and provide Agency staff with an un- 10 derstanding of the roles and responsibilities of the 11 Office. 12 (2) The recommendation that the Agency estab- 13 lish (through issuing guidance or a policy statement 14 from the Administrator) specific time frames for the 15 development of definitions, goals, and measurements 16 regarding environmental justice and provide the re- 17 gions and program offices a standard and consistent 18 definition for a minority and low-income community, 19 with instructions on how the Agency will implement 20 and operationalize environmental justice into the 21 Agency’s daily activities. 22 (3) The recommendation that the Agency en- 23 sure the comprehensive training program currently 24 under development includes standard and consistent 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00572 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 573 •HR 2954 IH definitions of the key environmental justice concepts 1 (such as ‘‘low-income’’, ‘‘minority’’, and ‘‘dispropor- 2 tionately impacted’’) and instructions for implemen- 3 tation of those concepts. 4 The Administrator shall submit an initial report to Con- 5 gress within 6 months after the enactment of this Act re- 6 garding the Administrator’s strategy for implementing the 7 recommendations referred to in paragraphs (1), (2), and 8 (3). Thereafter, the Administrator shall provide semi- 9 annual reports to Congress regarding the Administrator’s 10 progress in implementing such recommendations and 11 modifying the Administrator’s emergency management 12 procedures to incorporate environmental justice in the 13 Agency’s Incident Command Structure (in accordance 14 with the December 18, 2006, letter from the Deputy Ad- 15 ministrator to the Acting Inspector General of the Agen- 16 cy). 17 (d) FEDERAL ACTION PLAN FOR SAVING LIVES, 18 PROTECTING PEOPLE AND THEIR FAMILIES FROM 19 RADON.— 20 (1) IN GENERAL.—Because radon is a naturally 21 occurring radioactive gas that is recognized as the 22 leading cause of lung cancer among nonsmokers and 23 is a particular environmental threat for low-income 24 and minority individuals because of the lack of infor- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00573 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 574 •HR 2954 IH mation about radon levels in their own homes, the 1 Administrator of the Environmental Protection 2 Agency shall within 6 months after the date of the 3 enactment of this Act, implement the action plan en- 4 titled ‘‘Protecting People and Families from Radon: 5 A Federal Action Plan for Saving Lives’’ (June 20, 6 2011), working with the Secretary of Health and 7 Human Services acting through the Director of the 8 Centers for Disease Control and Prevention, and 9 with the other Federal agencies mentioned in and as 10 set forth in the action plan. 11 (2) SPECIFIC STEPS.—In carrying out para- 12 graph (1), the Administrator shall take steps to 13 achieve each of the following: 14 (A) The recommendation that the 15 workgroup comprised of the Federal agencies 16 participating in the development of the action 17 plan referred to in paragraph (1) implement 18 specific steps within the current authority and 19 activities of each Federal agency to reduce ex- 20 posure to radon. 21 (B) The recommendation that such 22 workgroup meet on the 1-year anniversary of 23 the plan to assess and recognize achievements 24 of the plan. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00574 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 575 •HR 2954 IH (3) REPORT.—The Administrator shall report 1 to the Congress on the 1-year assessment of the 2 plan’s implementation, including the challenges re- 3 maining and the progress in reducing radon expo- 4 sure particularly to low-income and minority fami- 5 lies. 6 SEC. 1003. GRANT PROGRAM. 7 (a) DEFINITIONS.—In this section: 8 (1) DIRECTOR.—The term ‘‘Director’’ means 9 the Director of the Centers for Disease Control and 10 Prevention, acting in collaboration with the Adminis- 11 trator of the Environmental Protection Agency and 12 the Director of the National Institute of Environ- 13 mental Health Sciences. 14 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti- 15 ty’’ means a State or local community that— 16 (A) bears a disproportionate burden of ex- 17 posure to environmental health hazards; 18 (B) has established a coalition— 19 (i) with not less than 1 community- 20 based organization; and 21 (ii) with not less than 1— 22 (I) public health entity; 23 (II) health care provider organi- 24 zation; or 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00575 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 576 •HR 2954 IH (III) academic institution, includ- 1 ing any minority-serving institution 2 (including an Hispanic-serving institu- 3 tion, a historically Black college or 4 university, and a tribal college or uni- 5 versity); 6 (C) ensures planned activities and funding 7 streams are coordinated to improve community 8 health; and 9 (D) submits an application in accordance 10 with subsection (c). 11 (b) ESTABLISHMENT.—The Director shall establish a 12 grant program under which eligible entities shall receive 13 grants to conduct environmental health improvement ac- 14 tivities. 15 (c) APPLICATION.—To receive a grant under this sec- 16 tion, an eligible entity shall submit an application to the 17 Director at such time, in such manner, and accompanied 18 by such information as the Director may require. 19 (d) COOPERATIVE AGREEMENTS.—An eligible entity 20 may use a grant under this section— 21 (1) to promote environmental health; and 22 (2) to address environmental health disparities. 23 (e) AMOUNT OF COOPERATIVE AGREEMENT.— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00576 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 577 •HR 2954 IH (1) IN GENERAL.—The Director shall award 1 grants to eligible entities at the 2 different funding 2 levels described in this subsection. 3 (2) LEVEL 1 COOPERATIVE AGREEMENTS.— 4 (A) IN GENERAL.—An eligible entity 5 awarded a grant under this paragraph shall use 6 the funds to identify environmental health prob- 7 lems and solutions by— 8 (i) establishing a planning and 9 prioritizing council in accordance with sub- 10 paragraph (B); and 11 (ii) conducting an environmental 12 health assessment in accordance with sub- 13 paragraph (C). 14 (B) PLANNING AND PRIORITIZING COUN- 15 CIL.— 16 (i) IN GENERAL.—A prioritizing and 17 planning council established under sub- 18 paragraph (A)(i) (referred to in this para- 19 graph as a ‘‘PPC’’) shall assist the envi- 20 ronmental health assessment process and 21 environmental health promotion activities 22 of the eligible entity. 23 (ii) MEMBERSHIP.—Membership of a 24 PPC shall consist of representatives from 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00577 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 578 •HR 2954 IH various organizations within public health, 1 planning, development, and environmental 2 services and shall include stakeholders 3 from vulnerable groups such as children, 4 the elderly, disabled, and minority ethnic 5 groups that are often not actively involved 6 in democratic or decisionmaking processes. 7 (iii) DUTIES.—A PPC shall— 8 (I) identify key stakeholders and 9 engage and coordinate potential part- 10 ners in the planning process; 11 (II) establish a formal advisory 12 group to plan for the establishment of 13 services; 14 (III) conduct an in-depth review 15 of the nature and extent of the need 16 for an environmental health assess- 17 ment, including a local epidemiological 18 profile, an evaluation of the service 19 provider capacity of the community, 20 and a profile of any target popu- 21 lations; and 22 (IV) define the components of 23 care and form essential programmatic 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00578 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 579 •HR 2954 IH linkages with related providers in the 1 community. 2 (C) ENVIRONMENTAL HEALTH ASSESS- 3 MENT.— 4 (i) IN GENERAL.—A PPC shall carry 5 out an environmental health assessment to 6 identify environmental health concerns. 7 (ii) ASSESSMENT PROCESS.—The 8 PPC shall— 9 (I) define the goals of the assess- 10 ment; 11 (II) generate the environmental 12 health issue list; 13 (III) analyze issues with a sys- 14 tems framework; 15 (IV) develop appropriate commu- 16 nity environmental health indicators; 17 (V) rank the environmental 18 health issues; 19 (VI) set priorities for action; 20 (VII) develop an action plan; 21 (VIII) implement the plan; and 22 (IX) evaluate progress and plan- 23 ning for the future. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00579 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 580 •HR 2954 IH (D) EVALUATION.—Each eligible entity 1 that receives a grant under this paragraph shall 2 evaluate, report, and disseminate program find- 3 ings and outcomes. 4 (E) TECHNICAL ASSISTANCE.—The Direc- 5 tor may provide such technical and other non- 6 financial assistance to eligible entities as the 7 Director determines to be necessary. 8 (3) LEVEL 2 COOPERATIVE AGREEMENTS.— 9 (A) ELIGIBILITY.— 10 (i) IN GENERAL.—The Director shall 11 award grants under this paragraph to eli- 12 gible entities that have already— 13 (I) established broad-based col- 14 laborative partnerships; and 15 (II) completed environmental as- 16 sessments. 17 (ii) NO LEVEL 1 REQUIREMENT.—To 18 be eligible to receive a grant under this 19 paragraph, an eligible entity is not re- 20 quired to have successfully completed a 21 Level 1 Cooperative Agreement (as de- 22 scribed in paragraph (2)). 23 (B) USE OF GRANT FUNDS.—An eligible 24 entity awarded a grant under this paragraph 25 VerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00580 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 581 •HR 2954 IH shall use the funds to further activities to carry 1 out environmental health improvement activi- 2 ties, including— 3 (i) addressing community environ- 4 mental health priorities in accordance with 5 paragraph (2)(C)(ii), including— 6 (I) air quality; 7 (II) water quality; 8 (III) solid waste; 9 (IV) land use; 10 (V) housing; 11 (VI) food safety; 12 (VII) crime; 13 (VIII) injuries; and 14 (IX) health care services; 15 (ii) building partnerships between 16 planning, public health, and other sectors, 17 to address how the built environment im- 18 pacts food availability and access and 19 physical activity to promote healthy behav- 20 iors and lifestyles and reduce overweight 21 and obesity, asthma, respiratory condi- 22 tions, dental, oral and mental health condi- 23 tions, poverty, and related co-morbidities; 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00581 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 582 •HR 2954 IH (iii) establishing programs to ad- 1 dress— 2 (I) how environmental and social 3 conditions of work and living choices 4 influence physical activity and dietary 5 intake; or 6 (II) how those conditions influ- 7 ence the concerns and needs of people 8 who have impaired mobility and use 9 assistance devices, including wheel- 10 chairs and lower limb prostheses; and 11 (iv) convening intervention programs 12 that examine the role of the social environ- 13 ment in connection with the physical and 14 chemical environment in— 15 (I) determining access to nutri- 16 tional food; and 17 (II) improving physical activity to 18 reduce morbidity and increase quality 19 of life. 20 (f) AUTHORIZATION OF APPROPRIATIONS.—There 21 are authorized to be appropriated to carry out this sec- 22 tion— 23 (1) $25,000,000 for fiscal year 2012; and 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00582 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 583 •HR 2954 IH (2) such sums as may be necessary for fiscal 1 years 2013 through 2016. 2 SEC. 1004. ADDITIONAL RESEARCH ON THE RELATIONSHIP 3 BETWEEN THE BUILT ENVIRONMENT AND 4 THE HEALTH OF COMMUNITY RESIDENTS. 5 (a) DEFINITION OF ELIGIBLE INSTITUTION.—In this 6 section, the term ‘‘eligible institution’’ means a public or 7 private nonprofit institution that submits to the Secretary 8 of Health and Human Services (in this section referred 9 to as the ‘‘Secretary’’) and the Administrator of the Envi- 10 ronmental Protection Agency (in this section referred to 11 as the ‘‘Administrator’’) an application for a grant under 12 the grant program authorized under subsection (b)(2) at 13 such time, in such manner, and containing such agree- 14 ments, assurances, and information as the Secretary and 15 Administrator may require. 16 (b) RESEARCH GRANT PROGRAM.— 17 (1) DEFINITION OF HEALTH.—In this section, 18 the term ‘‘health’’ includes— 19 (A) levels of physical activity; 20 (B) consumption of nutritional foods; 21 (C) rates of crime; 22 (D) air, water, and soil quality; 23 (E) risk of injury; 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00583 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 584 •HR 2954 IH (F) accessibility to health care services; 1 and 2 (G) other indicators as determined appro- 3 priate by the Secretary. 4 (2) GRANTS.—The Secretary, in collaboration 5 with the Administrator, shall provide grants to eligi- 6 ble institutions to conduct and coordinate research 7 on the built environment and its influence on indi- 8 vidual and population-based health. 9 (3) RESEARCH.—The Secretary shall support 10 research that— 11 (A) investigates and defines the causal 12 links between all aspects of the built environ- 13 ment and the health of residents; 14 (B) examines— 15 (i) the extent of the impact of the 16 built environment (including the various 17 characteristics of the built environment) on 18 the health of residents; 19 (ii) the variance in the health of resi- 20 dents by— 21 (I) location (such as inner cities, 22 inner suburbs, and outer suburbs); 23 and 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00584 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 585 •HR 2954 IH (II) population subgroup (such as 1 children, the elderly, the disadvan- 2 taged); or 3 (iii) the importance of the built envi- 4 ronment to the total health of residents, 5 which is the primary variable of interest 6 from a public health perspective; 7 (C) is used to develop— 8 (i) measures to address health and the 9 connection of health to the built environ- 10 ment; and 11 (ii) efforts to link the measures to 12 travel and health databases; and 13 (D) distinguishes carefully between per- 14 sonal attitudes and choices and external influ- 15 ences on observed behavior to determine how 16 much an observed association between the built 17 environment and the health of residents, versus 18 the lifestyle preferences of the people that 19 choose to live in the neighborhood, reflects the 20 physical characteristics of the neighborhood; 21 and 22 (E)(i) identifies or develops effective inter- 23 vention strategies to promote better health 24 among residents with a focus on behavioral 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00585 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 586 •HR 2954 IH interventions and enhancements of the built en- 1 vironment that promote increased use by resi- 2 dents; and 3 (ii) in developing the intervention strate- 4 gies under clause (i), ensures that the interven- 5 tion strategies will reach out to high-risk popu- 6 lations, including racial and ethnic minorities 7 and low-income urban and rural communities. 8 (4) PRIORITY.—In providing assistance under 9 the grant program authorized under paragraph (2), 10 the Secretary and the Administrator shall give pri- 11 ority to research that incorporates— 12 (A) minority-serving institutions as grant- 13 ees; 14 (B) interdisciplinary approaches; or 15 (C) the expertise of the public health, 16 physical activity, urban planning, and transpor- 17 tation research communities in the United 18 States and abroad. 19 SEC. 1005. ENVIRONMENT AND PUBLIC HEALTH RESTORA- 20 TION. 21 (a) FINDINGS.— 22 (1) GENERAL FINDINGS.—The Congress finds 23 as follows: 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00586 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 587 •HR 2954 IH (A) As human beings, we share our envi- 1 ronment with a wide variety of habitats and 2 ecosystems that nurture and sustain a diversity 3 of species. 4 (B) The abundance of natural resources in 5 our environment forms the basis for our econ- 6 omy and has greatly contributed to human de- 7 velopment throughout history. 8 (C) The accelerated pace of human devel- 9 opment over the last several hundred years has 10 significantly impacted our natural environment 11 and its resources, the health and diversity of 12 plant and animal wildlife, the availability of 13 critical habitats, the quality of our air and our 14 water, and our global climate. 15 (D) The intervention of the Federal Gov- 16 ernment is necessary to minimize and mitigate 17 human impact on the environment for the ben- 18 efit of public health, to maintain air quality and 19 water quality, to sustain the diversity of plants 20 and animals, to combat global climate change, 21 and to protect the environment. 22 (E) Laws and regulations in the United 23 States have been created and promulgated to 24 minimize and mitigate human impact on the en- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00587 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 588 •HR 2954 IH vironment for the benefit of public health, to 1 maintain air quality and water quality, to sus- 2 tain wildlife, and to protect the environment. 3 (F) Such laws include the Antiquities Act 4 of 1906 (16 U.S.C. 431 et seq.) initiated by 5 President Theodore Roosevelt to create the na- 6 tional park system, the National Environmental 7 Policy Act of 1969 (42 U.S.C. 4321 et seq.), 8 the Clean Air Act (42 U.S.C. 7401 et seq.), the 9 Federal Water Pollution Control Act (33 U.S.C. 10 1251 et seq.), the Comprehensive Environ- 11 mental Response, Compensation, and Liability 12 Act of 1980 (Public Law 96–510), the Endan- 13 gered Species Act of 1973 (Public Law 93– 14 205), and the National Forest Management Act 15 of 1976 (Public Law 94–588). 16 (G) Attempts to repeal or weaken key envi- 17 ronmental safeguards pose dangers to the pub- 18 lic health, air quality, water quality, wildlife, 19 and the environment. 20 (2) FINDINGS ON CHANGES AND PROPOSED 21 CHANGES IN LAW.—The Congress finds that, since 22 2001, the following changes and proposed changes 23 to existing law or regulations have negatively im- 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00588 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 589 •HR 2954 IH pacted or will negatively impact the environment and 1 public health: 2 (A) CLEAN WATER.— 3 (i) On May 9, 2002, the Environ- 4 mental Protection Agency (EPA) and the 5 Army Corps of Engineers put forth a final 6 rule that reconciled regulations imple- 7 menting section 404 of the Federal Water 8 Pollution Control Act by redefining the 9 term ‘‘fill material’’ and amending the def- 10 inition of the term ‘‘discharge of fill mate- 11 rial’’, reversing a 25-year-old regulation. 12 The new rule fails to restrict the dumping 13 of hardrock mining waste, construction de- 14 bris, and other industrial wastes into riv- 15 ers, streams, lakes, and wetlands. The rule 16 further allows destructive mountaintop re- 17 moval coal mining companies to dump 18 waste into streams and lakes, polluting the 19 surrounding natural habitat and poisoning 20 plants and animals that depend on those 21 water sources. 22 (ii) On February 12, 2003, the Envi- 23 ronmental Protection Agency published the 24 rule ‘‘National Pollutant Discharge Elimi- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00589 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 590 •HR 2954 IH nation System Permit Regulation and Ef- 1 fluent Limitation Guidelines and Stand- 2 ards for Concentrated Animal Feeding Op- 3 erations’’, new livestock waste regulations 4 that aimed to control factory farm pollu- 5 tion but which would severely undermine 6 existing protections under the Federal 7 Water Pollution Control Act. This regula- 8 tion allows large-scale animal factories to 9 foul the Nation’s waters with animal 10 waste, allows livestock owners to draft 11 their own pollution-management plans and 12 avoid ground water monitoring, legalizes 13 the discharge of contaminated runoff water 14 rich in nitrogen, phosphorus, bacteria, and 15 metals, and ensures that large factory 16 farms are not held liable for the environ- 17 mental damage they cause. In a 2005 Fed- 18 eral court decision (‘‘Waterkeeper Alliance, 19 et al. v. Enviromental Protection Agency’’, 20 399 F.3d 486 (2nd Cir. 2005)), major 21 parts of the rule were upheld, others va- 22 cated, and still others remanded back to 23 the EPA. On November 20, 2008, the En- 24 vironmental Protection Agency published a 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00590 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 591 •HR 2954 IH revised final rule which undermines envi- 1 ronmental protection provisions by remov- 2 ing mandatory permitting requirements 3 and allowing large animal farms to self- 4 certify the absence of pollutant discharge 5 activity. 6 (iii) On March 19, 2003, the Environ- 7 mental Protection Agency published a new 8 rule regarding the Total Maximum Daily 9 Load program of the Federal Water Pollu- 10 tion Control Act that regulates the max- 11 imum amount of a particular pollutant 12 that can be present in a body of water and 13 still meet water quality standards. The new 14 rule withdrew the existing regulation put 15 forth on July 13, 2000, and halted mo- 16 mentum in cleaning up polluted waterways 17 throughout the Nation. By abandoning the 18 existing rule, the Environmental Protection 19 Agency is undermining the effectiveness of 20 clean-up plans and is allowing States to 21 avoid cleaning polluted waters entirely by 22 dropping them from their clean-up lists. 23 Waterways play a crucial role in the lives 24 of the people of the United States and are 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00591 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 592 •HR 2954 IH critical to the livelihood of fish and wildlife. 1 The result of dropping the July 2000 rule 2 is that the restoration of polluted rivers, 3 shorelines, and lakes will be delayed, harm- 4 ing more fish and wildlife and worsening 5 the quality of drinking water. 6 (iv) On December 2, 2008, the Envi- 7 ronmental Protection Agency and the 8 Army Corps of Engineers jointly issued a 9 guidance document in the form of a legal 10 memorandum, titled ‘‘Clean Water Act Ju- 11 risdiction Following the U.S. Supreme 12 Court’s Decision in Rapanos v. United 13 States & Carabell v. United States’’. This 14 new guidance dictates enforcement actions 15 under the Federal Water Pollution Control 16 Act and calls for a complicated ‘‘case-by- 17 case’’ analysis to determine jurisdiction for 18 waterways that do not flow all year. Such 19 actions endanger small streams and wet- 20 lands that serve as important habitats for 21 aquatic life, which play a fundamental role 22 in safeguarding sources of clean drinking 23 water and mitigate the risks and effects of 24 floods and droughts. Further, the defini- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00592 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 593 •HR 2954 IH tion provided therein for ‘‘waters of the 1 United States’’ is applicable to the Federal 2 Water Pollution Control Act as a whole, 3 potentially affecting programs that control 4 industrial pollution and sewage levels, pre- 5 vent oil spills, and set water quality stand- 6 ards for all waters in the United States 7 protected under the Federal Water Pollu- 8 tion Control Act. 9 (B) FORESTS AND LAND MANAGEMENT.— 10 (i) On December 3, 2003, the Presi- 11 dent signed into law the Healthy Forests 12 Restoration Act of 2003 (Public Law 108– 13 148; 16 U.S.C. 6501 et seq.). Although the 14 law attempts to reduce the risk of cata- 15 strophic forest fires, it provides a boon to 16 timber companies by accelerating the ag- 17 gressive thinning of backcountry forests 18 that are far from at-risk communities. The 19 law allows for increased logging of large, 20 fire-resistant trees that are not in close 21 proximity of homes and communities; it 22 undermines critical protections for endan- 23 gered species by exempting Federal land 24 management agencies from consulting with 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00593 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 594 •HR 2954 IH the United States Fish and Wildlife Serv- 1 ice before approving any action that could 2 harm endangered plants or wildlife; and it 3 limits public participation by reducing the 4 number of environmental project reviews. 5 (ii) On April 21, 2008, the Depart- 6 ment of Agriculture issued a Final Plan- 7 ning Rule and Record of Decision for Na- 8 tional Forest System Land Management 9 Planning. Similar to rules enacted by the 10 Administration on January 5, 2005, later 11 remanded back to the agency in Federal 12 district court for violating the National 13 Environmental Policy Act of 1969, the En- 14 dangered Species Act of 1973, and the Ad- 15 ministrative Procedure Act (‘‘Citizens for 16 Better Forestry v. United States Depart- 17 ment of Agriculture’’, 481 F. Supp. 2d 18 1059 (N.D. Cal. 2007)), this revised rule 19 eliminates strict forest planning standards 20 established in 1982, and opens millions of 21 acres of public lands to damaging and 22 invasive logging, mining, and drilling oper- 23 ations. These regulations would reverse 24 more than 20 years of protection for wild- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00594 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 595 •HR 2954 IH life and national forests by removing the 1 overall goal of ensuring ecological sustain- 2 ability in managing the national forest sys- 3 tem, weakening the National Forest Man- 4 agement Act of 1976, and effectively end- 5 ing the review of forest management plans 6 under the National Environmental Policy 7 Act of 1969. 8 (iii) On September 20, 2006, the Dis- 9 trict Court for the Northern District of 10 California vacated the Protection of Inven- 11 toried Roadless Areas rule, enacted on May 12 13, 2005, which gave State Governors 18 13 months to petition the Federal Government 14 to either restore the previous rule for their 15 States, or submit a new management and 16 development plan for national forest areas 17 inventoried under the rule. Despite the 18 enjoinment of the Administration’s 2005 19 rule, and the subsequent restoration of the 20 original Roadless Area Conservation Rule, 21 the U.S. Forest Service has continued to 22 allow States to petition for a special rule 23 under the authority of the Administrative 24 Procedure Act, publishing a final special 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00595 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 596 •HR 2954 IH rule for Idaho on October 16, 2008. As a 1 result, 58.5 million acres of wild national 2 forests are still vulnerable to logging, road 3 building, and other developments that may 4 fragment natural habitats and negatively 5 impact fish and wildlife. 6 (iv) On November 17, 2008, the De- 7 partment of the Interior’s Bureau of Land 8 Management (BLM) signed the Record of 9 Decision (ROD) amending 12 resource 10 management plans in Colorado, Utah, and 11 Wyoming, opening 2,000,000 acres of pub- 12 lic lands to commercial tar sands and oil 13 shale exploration and development. On No- 14 vember 18, 2008, the BLM published a 15 final rule for Oil Shale Management set- 16 ting the policies and procedures for a com- 17 mercial leasing program for the manage- 18 ment of federally owned oil shale in those 19 three States. Previously barred by a con- 20 gressional moratorium on the commercial 21 leasing regulations for oil shale until Sep- 22 tember 30, 2008, the development of oil 23 shale on public lands poses a serious threat 24 to land conservation, endangered and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00596 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 597 •HR 2954 IH threatened species, and critical habitat. 1 Domestic shale oil production allowed by 2 these regulations is highly water and en- 3 ergy intensive, the impacts of which will in- 4 tensify existing water scarcity in the arid 5 Western Region and potentially degrade 6 air and water quality for surrounding pop- 7 ulations. 8 (C) SCIENTIFIC REVIEW.—On December 9 16, 2008, the United States Fish and Wildlife 10 Service of the Department of the Interior and 11 the National Oceanic and Atmospheric Admin- 12 istration of the Department of Commerce joint- 13 ly issued a new rule amending regulations gov- 14 erning interagency cooperation under section 7 15 of the Endangered Species Act of 1973 (ESA). 16 This rule undermines the intention of the ESA 17 to protect species and the ecosystems upon 18 which they depend by allowing Federal agencies 19 to carry out, permit, or fund an action without 20 proper environmental review and expert third- 21 party consultation from Federal wildlife ex- 22 perts. Under this new rule, Federal agencies 23 can unilaterally circumvent the formal review 24 process, eliminating longstanding and scientif- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00597 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 598 •HR 2954 IH ically grounded safeguards that serve to protect 1 the biodiversity of our Nation’s ecosystems and 2 avert harm to thousands of endangered and 3 threatened species. 4 (b) STATEMENT OF POLICY.—It is the policy of the 5 United States Government to work in conjunction with 6 States, territories, tribal governments, international orga- 7 nizations, and foreign governments in order to act as a 8 steward of the environment for the benefit of public 9 health, to maintain air quality and water quality, to sus- 10 tain the diversity of plant and animal species, to combat 11 global climate change, and to protect the environment for 12 future generations to enjoy. 13 (c) STUDY AND REPORT ON PUBLIC HEALTH OR EN- 14 VIRONMENTAL IMPACT OF REVISED RULES, REGULA- 15 TIONS, LAWS, OR PROPOSED LAWS.— 16 (1) STUDY.—Not later than 30 days after the 17 date of enactment of this Act, the President shall 18 enter into an arrangement under which the National 19 Academy of Sciences will conduct a study to deter- 20 mine the impact on public health, air quality, water 21 quality, wildlife, and the environment of the fol- 22 lowing regulations, laws, and proposed laws: 23 (A) CLEAN WATER.— 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00598 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 599 •HR 2954 IH (i) Final revisions to the Federal 1 Water Pollution Control Act regulatory 2 definitions of ‘‘fill material’’ and ‘‘dis- 3 charge of fill material’’, finalized and pub- 4 lished in the Federal Register on May 9, 5 2002 (67 FR 31129), amending part 232 6 of title 40, Code of Federal Regulations. 7 (ii) Revised National Pollutant Dis- 8 charge Elimination System Permit Regula- 9 tion and Effluent Limitation Guidelines 10 and Standards for Concentrated Animal 11 Feeding Operations in response to the 12 ‘‘Waterkeeper Alliance, et al. v. 13 Enviromental Protection Agency’’ decision, 14 finalized and published in the Federal Reg- 15 ister on November 20, 2008 (73 FR 225), 16 amending parts 9, 122, and 412 of title 17 40, Code of Federal Regulations. 18 (iii) A March 19, 2003, rule published 19 in the Federal Register (68 FR 13608) 20 withdrawing a July 13, 2000, rule revising 21 the Total Maximum Daily Load program 22 of the Federal Water Pollution Control Act 23 (65 FR 43586), amending parts 9, 122, 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00599 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 600 •HR 2954 IH 123, 124, and 130 of title 40, Code of 1 Federal Regulations. 2 (iv) Official Guidance Document, 3 ‘‘Clean Water Act Jurisdiction Following 4 the United States Supreme Court’s Deci- 5 sion in Rapanos v. United States & 6 Carabell v. United States’’, issued on De- 7 cember 2, 2008, relating to jurisdiction 8 under section 404 of the Federal Water 9 Pollution Control Act. 10 (B) FORESTS AND LAND MANAGEMENT.— 11 (i) Healthy Forests Restoration Act of 12 2003, signed into law on December 3, 13 2003 (Public Law 108–148; 16 U.S.C. 14 6501 et seq.). 15 (ii) National Forest System Land 16 Management Planning Rule, finalized and 17 published in the Federal Register on April 18 21, 2008 (73 FR 21468), replacing the 19 2005 final rule (70 FR 1022, Jan. 5, 20 2005), as amended March 3, 2006 (71 FR 21 10837) and the 2000 final rule adopted on 22 November 9, 2000 (65 FR 67514) as 23 amended on September 29, 2004 (69 FR 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00600 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 601 •HR 2954 IH 58055), amending title 36, Code of Fed- 1 eral Regulations, part 219. 2 (iii) The application of the Adminis- 3 trative Procedure Act (5 U.S.C. 551 to 4 559, 701 to 706, et seq.), such that States 5 may petition for a special rule for the 6 roadless areas in all or part of said State. 7 (iv) Record of Decision, ‘‘Oil Shale 8 and Tar Sands Resources Resource Man- 9 agement Plan Amendments’’, issued on 10 November 17, 2008, along with the Final 11 Rule, Oil Shale Management-General, pub- 12 lished in the Federal Register on Novem- 13 ber 18, 2008 (73 FR 223), amending title 14 43, Code of Federal Regulations, parts 15 3900, 3910, 3920, and 3930. 16 (C) SCIENTIFIC REVIEW.—Final Rule, 17 Interagency Cooperation Under the Endangered 18 Species Act, published in the Federal Register 19 on December 16, 2008, amending title 50, Code 20 of Federal Regulations, part 402. 21 (2) METHOD.—In conducting the study under 22 paragraph (1), the National Academy of Sciences 23 may utilize and compare existing scientific studies 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00601 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 602 •HR 2954 IH regarding the regulations, laws, and proposed laws 1 listed in paragraph (1). 2 (3) REPORT.—Under the arrangement entered 3 into under paragraph (1), not later than 270 days 4 after the date on which such arrangement is entered 5 into, the National Academy of Sciences shall make 6 publicly available and shall submit to the Congress 7 and to the head of each department and agency of 8 the Federal Government that issued, implements, or 9 would implement a regulation, law, or proposed law 10 listed in paragraph (1), a report containing— 11 (A) a description of the impact of all such 12 regulations, laws, and proposed laws on public 13 health, air quality, water quality, wildlife, and 14 the environment, compared to the impact of 15 preexisting regulations, or laws in effect, includ- 16 ing— 17 (i) any negative impacts to air quality 18 or water quality; 19 (ii) any negative impacts to wildlife; 20 (iii) any delays in hazardous waste 21 cleanup that are projected to be hazardous 22 to public health; and 23 (iv) any other negative impact on pub- 24 lic health or the environment; and 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00602 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 603 •HR 2954 IH (B) any recommendations that the Na- 1 tional Academy of Sciences considers appro- 2 priate to maintain, restore, or improve in whole 3 or in part protections for public health, air 4 quality, water quality, wildlife, and the environ- 5 ment for each of the regulations, laws, and pro- 6 posed laws listed in paragraph (1), which may 7 include recommendations for the adoption of 8 any regulation or law in place or proposed prior 9 to January 1, 2001. 10 (d) DEPARTMENT AND AGENCY REVISION OF EXIST- 11 ING RULES, REGULATIONS, OR LAWS.—Not later than 12 180 days after the date on which the report is submitted 13 pursuant to subsection (c)(3), the head of each depart- 14 ment and agency that has issued or implemented a regula- 15 tion or law listed in subsection (c)(1) shall submit to the 16 Congress a plan describing the steps such department or 17 such agency will take, or has taken, to restore or improve 18 protections for public health and the environment in whole 19 or in part that were in existence prior to the issuance of 20 such regulation or law. 21 SEC. 1006. HEALTHY FOOD FINANCING INITIATIVE. 22 (a) IN GENERAL.—Subtitle D of the Department of 23 Agriculture Reorganization Act of 1994 (7 U.S.C. 6951) 24 is amended by adding at the end the following: 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00603 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 604 •HR 2954 IH ‘‘SEC. 242. HEALTHY FOOD FINANCING INITIATIVE. 1 ‘‘(a) PURPOSE.—The purpose of this section is to es- 2 tablish a program to improve access to healthy foods in 3 underserved areas, to create and preserve quality jobs, and 4 to revitalize low-income communities by providing loans 5 and grants to eligible fresh, healthy food retailers to over- 6 come the higher costs and initial barriers to entry in un- 7 derserved, urban, suburban, and rural areas. 8 ‘‘(b) DEFINITIONS.—In this section: 9 ‘‘(1) COMMUNITY DEVELOPMENT FINANCIAL IN- 10 STITUTION.—The term ‘community development fi- 11 nancial institution’ has the meaning given the term 12 in section 103 of the Community Development 13 Banking and Financial Institutions Act of 1994 (12 14 U.S.C. 4702). 15 ‘‘(2) FOOD ACCESS ORGANIZATION.—The term 16 ‘food access organization’ means a nonprofit organi- 17 zation with expertise in improving access to healthy 18 food in underserved communities. 19 ‘‘(3) INITIATIVE.—The term ‘Initiative’ means 20 the Healthy Food Financing Initiative established in 21 the Department by subsection (c)(1). 22 ‘‘(4) LOCAL FUNDS.—The term ‘local funds’ 23 means the allocation of national funds and any other 24 forms of financial assistance (including grants, 25 loans, and equity investments) that are raised by 26 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00604 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 605 •HR 2954 IH partnerships to carry out the purposes of this sec- 1 tion. 2 ‘‘(5) NATIONAL FUNDS.—The term ‘national 3 funds’ means any Federal appropriation made to 4 carry out this section and any other forms of finan- 5 cial assistance (including grants, loans, and equity 6 investments) that are raised by the national fund 7 manager to carry out the purposes of this section. 8 ‘‘(6) NATIONAL FUND MANAGER.—The term 9 ‘national fund manager’ means a community devel- 10 opment financial institution in existence as of the 11 date of enactment of this section and certified by the 12 Community Development Financial Institutions 13 Fund of the Department of the Treasury that is des- 14 ignated by the Secretary to manage the Initiative for 15 purposes of— 16 ‘‘(A) raising private capital; 17 ‘‘(B) providing financial and technical as- 18 sistance to partnerships; and 19 ‘‘(C) funding eligible projects directly at 20 the request of partnerships to attract fresh, 21 healthy food retailers to underserved urban, 22 suburban, and rural areas, in accordance with 23 this section. 24 ‘‘(7) PARTNERSHIP.— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00605 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 606 •HR 2954 IH ‘‘(A) IN GENERAL.—The term ‘partner- 1 ship’ means a regional, State, or local public 2 and private partnership that is organized to im- 3 prove access to fresh, healthy foods by pro- 4 viding financial and technical assistance to eli- 5 gible projects. 6 ‘‘(B) INCLUSIONS.—The term ‘partnership’ 7 includes— 8 ‘‘(i) an unit of State, local, or tribal 9 government or a quasi-public State or local 10 government agency; 11 ‘‘(ii) a food access or community 12 health organization committed to improv- 13 ing access to healthy foods; 14 ‘‘(iii) a community development finan- 15 cial institution or other organization that 16 is capable of administering a loan and 17 grant program in accordance with this sec- 18 tion; and 19 ‘‘(iv) other organizations interested in 20 improving access to healthy foods in under- 21 served areas. 22 ‘‘(c) ESTABLISHMENT.— 23 ‘‘(1) IN GENERAL.—There is established in the 24 Department a Healthy Food Financing Initiative. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00606 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 607 •HR 2954 IH ‘‘(2) MANAGEMENT.—Not later than 1 year 1 after the date of enactment of this section, the Sec- 2 retary shall select and enter into a grant agreement 3 with a national fund manager who shall be respon- 4 sible for the management of the Initiative nationally. 5 ‘‘(3) ELIGIBLE PROJECTS.— 6 ‘‘(A) IN GENERAL.—Subject to the re- 7 quirements of this paragraph, the national fund 8 manager shall establish the eligibility criteria 9 for projects to be assisted by the Initiative. 10 ‘‘(B) REQUIREMENTS.—To be eligible to 11 receive assistance through the Initiative, a 12 project shall— 13 ‘‘(i) include a supermarket, grocery 14 store, farmers market, or other fresh, 15 healthy food retailer; 16 ‘‘(ii) consist of a for-profit business 17 enterprise, a member- or worker-owned co- 18 operative, or a nonprofit organization; 19 ‘‘(iii) meet the eligibility criteria es- 20 tablished under this section; 21 ‘‘(iv) continue to be a viable business 22 enterprise with a financial viability plan; 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00607 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 608 •HR 2954 IH ‘‘(v) require an investment of public 1 funding to move forward and be competi- 2 tive; 3 ‘‘(vi) operate on a self-service basis; 4 ‘‘(vii) in accordance with subpara- 5 graph (C), expand or preserve the avail- 6 ability of healthy, fresh, high quality un- 7 prepared and unprocessed foods, particu- 8 larly fresh fruits and vegetables, in under- 9 served areas; and 10 ‘‘(viii) agree to accept benefits under 11 the supplemental nutrition assistance pro- 12 gram established under the Food and Nu- 13 trition Act of 2008 (7 U.S.C. 2011 et 14 seq.). 15 ‘‘(C) REQUIREMENTS.— 16 ‘‘(i) DEFINITIONS.—In this subpara- 17 graph: 18 ‘‘(I) PERISHABLE FOOD.— 19 ‘‘(aa) IN GENERAL.—The 20 term ‘perishable food’ means food 21 that is fresh, refrigerated, or fro- 22 zen. 23 ‘‘(bb) EXCLUSION.—The 24 term ‘perishable food’ does not 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00608 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 609 •HR 2954 IH include packaged or canned 1 goods. 2 ‘‘(II) STAPLE FOOD.— 3 ‘‘(aa) IN GENERAL.—The 4 term ‘staple food’ means food 5 that is a basic dietary item, in- 6 cluding bread, flour, fruits, vege- 7 tables, and meat. 8 ‘‘(bb) EXCLUSIONS.—The 9 term ‘staple food’ does not in- 10 clude snack or accessory food 11 (such as chips, soda, coffee, con- 12 diments, and spices) or ready-to- 13 eat, prepared food. 14 ‘‘(III) VARIETY.—The term ‘vari- 15 ety’ means an assortment of different 16 types of food items. 17 ‘‘(ii) IN GENERAL.—For purposes of 18 subparagraph (B)(vii), to expand or pre- 19 serve the availability of fresh fruits and 20 vegetables in underserved areas shall 21 mean, with respect to a project, that the 22 project maintains a store that— 23 ‘‘(I) carries a full line of fresh 24 produce, as defined by the national 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00609 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 610 •HR 2954 IH fund manager to reflect differences in 1 project size and overall store size; 2 ‘‘(II) sells food for home prepara- 3 tion and consumption; and 4 ‘‘(III) at a minimum— 5 ‘‘(aa) offers for sale at least 6 3 different varieties of food in 7 each of the 4 staple food groups 8 (bread and grains, dairy, fruits 9 and vegetables, and meat, poul- 10 try, and fish), with perishable 11 food in at least 2 categories, on 12 a daily basis; or 13 ‘‘(bb) has a store at which 14 at least 50 percent of the total 15 sales of the store (including food 16 and nonfood items or services) 17 are from the sale of eligible sta- 18 ple food. 19 ‘‘(D) INCOME CRITERIA.—Each eligible 20 project shall be located in— 21 ‘‘(i) a low- or moderate-income census 22 tract, as determined by the Bureau of the 23 Census of the Department of Commerce; 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00610 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 611 •HR 2954 IH ‘‘(ii) a population census tract that is 1 treated as a low-income community under 2 section 45D(e) of the Internal Revenue 3 Code of 1986; or 4 ‘‘(iii) an area that significantly serves 5 an adjacent area that meets the criteria 6 described in clause (i) or (ii), as approved 7 by the national fund manager. 8 ‘‘(E) UNDERSERVED CRITERIA.— 9 ‘‘(i) IN GENERAL.—Each eligible 10 project shall be located in an underserved 11 area, as determined by the partnerships 12 according to criteria established by the na- 13 tional fund manager. 14 ‘‘(ii) FACTORS.—In determining 15 whether an area is an underserved area, 16 the following factors shall be taken into 17 consideration: 18 ‘‘(I) Population density. 19 ‘‘(II) Below average supermarket 20 density or sales. 21 ‘‘(III) Car ownership. 22 ‘‘(IV) Geographical or physical 23 barriers, such as highways, moun- 24 tains, major parks, or bodies of water. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00611 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 612 •HR 2954 IH ‘‘(iii) LOCATIONS.—On an annual 1 basis, the national fund manager shall col- 2 lect data and publish maps that show the 3 location of underserved areas. 4 ‘‘(4) PRIORITY PROJECTS.— 5 ‘‘(A) IN GENERAL.—Priority shall be given 6 to projects that— 7 ‘‘(i) are located in severely distressed 8 low-income communities, as defined by the 9 Community Development Financial Insti- 10 tutions Fund of the Department of the 11 Treasury; and 12 ‘‘(ii) include 1 or more of the fol- 13 lowing characteristics: 14 ‘‘(I) The project will create or re- 15 tain quality jobs in the community, as 16 determined in accordance with sub- 17 paragraph (B). 18 ‘‘(II) The project has community 19 support in terms of store quality, af- 20 fordability, site location, and coordina- 21 tion with local community plans or 22 other programs promoting community 23 and economic development. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00612 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 613 •HR 2954 IH ‘‘(III) The project supports re- 1 gional food systems and locally grown 2 foods, to the extent available. 3 ‘‘(IV) In major metropolitan 4 areas, the project is associated with a 5 transit-oriented development project. 6 ‘‘(V) In areas with public transit, 7 the project is accessible by public 8 transit. 9 ‘‘(VI) The project involves the 10 reuse of a building that is listed in or 11 eligible for the National Register of 12 Historic Places. 13 ‘‘(VII) The project involves a 14 brownfield or grayfield (as those 15 terms are used in the Comprehensive 16 Environmental Response, Compensa- 17 tion, and Liability Act of 1980 (42 18 U.S.C. 9601 et seq.)). 19 ‘‘(VIII) The estimated energy 20 consumption of the project, calculated 21 using building energy software ap- 22 proved by the Department of Energy, 23 will qualify the project for designation 24 under the Energy Star program estab- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00613 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 614 •HR 2954 IH lished by section 324A of the Energy 1 Policy and Conservation Act (42 2 U.S.C. 6294a). 3 ‘‘(IX) The project involves 4 women- and minority-owned busi- 5 nesses. 6 ‘‘(B) QUALITY JOBS.—For purposes of 7 subparagraph (A)(ii)(I), a quality job is a job 8 that— 9 ‘‘(i) provides wages that are com- 10 parable to or better than similar positions 11 in existing businesses of similar size in 12 similar local economies; 13 ‘‘(ii) offers benefits that are com- 14 parable to or better than what is offered 15 for similar positions in existing local busi- 16 nesses of similar size in similar local econo- 17 mies; and 18 ‘‘(iii) is targeted for residents of 19 neighborhoods with a high proportion of 20 persons of low income (as that term is de- 21 fined in section 102(a) of the Housing and 22 Community Development Act of 1974 (42 23 U.S.C. 5302(a))) through local targeted 24 hiring programs. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00614 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 615 •HR 2954 IH ‘‘(d) DUTIES OF THE SECRETARY.— 1 ‘‘(1) IN GENERAL.—The Secretary shall— 2 ‘‘(A) designate a national fund manager to 3 manage national funds; 4 ‘‘(B) oversee the Initiative nationally; 5 ‘‘(C) work closely with the designated na- 6 tional fund manager— 7 ‘‘(i) to ensure that funds are used ap- 8 propriately and in the most effective man- 9 ner practicable; and 10 ‘‘(ii) to develop the program strategy 11 into a detailed work plan, program, and 12 operating budget; 13 ‘‘(D) review and approve the operating 14 budget for the national fund manager to ensure 15 that the administrative costs are— 16 ‘‘(i) reasonable (not more than 5 per- 17 cent of the total budget); 18 ‘‘(ii) connected to the costs of oper- 19 ations; and 20 ‘‘(iii) reflect efficient operations by the 21 national fund manager; and 22 ‘‘(E) make available to the public an an- 23 nual report, using data obtained from the De- 24 partment of Agriculture, the Department of 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00615 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 616 •HR 2954 IH Health and Human Services, and the Commu- 1 nity Development Financial Institutions, that 2 describes the impacts of the Initiative, including 3 tracking health and economic development indi- 4 cators at the local, State, and national levels to 5 determine the impacts of individual projects 6 and the collective impact in local areas and 7 statewide of funded projects and the Initiative 8 overall. 9 ‘‘(2) NATIONAL FUND MANAGER.—The Sec- 10 retary shall— 11 ‘‘(A) select the national fund manager 12 through a competitive process from among com- 13 munity development financial institutions that 14 have a proven and recent track record of suc- 15 cess and effectiveness in— 16 ‘‘(i) attracting private capital; 17 ‘‘(ii) developing and managing pro- 18 grams that provide grants and loans to 19 support supermarkets and other fresh, 20 healthy food retail business enterprises in 21 low- and moderate-income communities, in- 22 cluding the development of grocery stores, 23 farmers markets, and other fresh, healthy 24 food retail models; 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00616 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 617 •HR 2954 IH ‘‘(iii) making and servicing loans that 1 are similar to loans proposed in the Initia- 2 tive or having a record of otherwise suc- 3 cessfully investing in fresh, healthy food 4 retail development projects; 5 ‘‘(iv) effectively managing multiple 6 contracts and subcontractors; 7 ‘‘(v) effectively managing large capital 8 pools, of at least $100,000,000; and 9 ‘‘(vi) providing or contracting for the 10 provision of technical assistance; and 11 ‘‘(B) administer the Initiative by approving 12 the disbursement of funds to the national fund 13 manager in a manner that facilitates the imple- 14 mentation of the overall Initiative. 15 ‘‘(3) COORDINATION.— 16 ‘‘(A) IN GENERAL.—Not later than 45 17 days after the date of receipt of an award, the 18 national fund manager shall develop, with guid- 19 ance from and in consultation with the Sec- 20 retary, and submit to the Secretary, a detailed 21 work plan. 22 ‘‘(B) APPROVAL REQUIRED.—The Sec- 23 retary shall review and approve the work plan, 24 program budget, and administrative costs under 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00617 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 618 •HR 2954 IH subsection (e)(4)(C) prior to entering into an 1 agreement with the national fund manager to 2 administer the Initiative. 3 ‘‘(4) PERFORMANCE TARGETS.— 4 ‘‘(A) IN GENERAL.—The Secretary shall 5 conduct financial audits of, and establish per- 6 formance targets for, the national fund man- 7 ager, which shall include, at a minimum, the re- 8 quirements described in this paragraph. 9 ‘‘(B) GEOGRAPHIC SPREAD.—Partnerships 10 funded by the Initiative shall be geographically 11 diverse and representative of the underserved 12 areas across the United States. 13 ‘‘(C) FOCUS ON LOW-INCOME COMMU- 14 NITIES.—A substantial portion of the projects 15 funded by partnerships shall serve very low- 16 and low-income communities, as defined by the 17 Bureau of the Census of the Department of 18 Commerce. 19 ‘‘(D) FINANCIAL EFFECTIVENESS OF THE 20 NATIONAL FUND MANAGER.—The national fund 21 manager and any local financial institution in- 22 volved in a partnership shall demonstrate on- 23 going capacity and timeliness in raising private 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00618 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 619 •HR 2954 IH capital and disbursing funds as required under 1 the Initiative. 2 ‘‘(E) TECHNICAL ASSISTANCE EFFECTIVE- 3 NESS OF THE NATIONAL FUND MANAGER.—The 4 provision of technical assistance by the national 5 fund manager shall be evaluated based on— 6 ‘‘(i) the responsiveness of the national 7 fund manager to requests for assistance; 8 and 9 ‘‘(ii) the ability of the national fund 10 manager to craft programs that develop 11 needed new capacities in partnerships. 12 ‘‘(F) IMPACT.—Performance targets shall 13 address the allocation of funds by the national 14 fund manager to partnerships and the tracking 15 and reporting of the impacts of the funds in im- 16 proving access to fresh, healthy foods and in 17 achieving other related impacts. 18 ‘‘(e) DUTIES OF THE NATIONAL FUND MANAGER.— 19 ‘‘(1) ALLOCATION OF FUNDS.— 20 ‘‘(A) IN GENERAL.—The national fund 21 manager shall— 22 ‘‘(i) allocate at least 70 percent of any 23 Federal appropriation made to carry out 24 this section to partnerships that are se- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00619 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 620 •HR 2954 IH lected based on the criteria described in 1 paragraph (3); and 2 ‘‘(ii) retain not more than 30 percent 3 of any Federal appropriation made to 4 carry out this section to undertake financ- 5 ing activities described in subparagraph 6 (C), including a reasonable amount for ad- 7 ministrative costs (not to exceed 5 percent) 8 approved by the Secretary in accordance 9 with paragraph (4)(C). 10 ‘‘(B) USE OF THE NATIONAL FUNDS BY 11 PARTNERSHIP PROGRAMS.— 12 ‘‘(i) IN GENERAL.—As a condition on 13 the receipt of funds, each partnership shall 14 use— 15 ‘‘(I) the national funds received 16 from the national fund manager under 17 subparagraph (A)(i) to create 1 or 18 more revolving loan programs or other 19 revolving pools of capital or other 20 products to facilitate financing of local 21 projects as determined by the agree- 22 ment between the partnership and the 23 national fund manager; and 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00620 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 621 •HR 2954 IH ‘‘(II) any remaining funds for 1 grants, or, as approved, for innovative 2 financing mechanisms. 3 ‘‘(ii) LIMITATIONS.— 4 ‘‘(I) IN GENERAL.—Use of funds 5 for administrative costs and other 6 purposes shall be— 7 ‘‘(aa) limited in accordance 8 with the terms of the agreement 9 negotiated between the national 10 fund manager and partnerships; 11 ‘‘(bb) based on whether ad- 12 ministrative costs are reasonable, 13 connected to the costs of oper- 14 ation, and reflect efficient oper- 15 ations by the partnership; and 16 ‘‘(cc) determined using cri- 17 teria including geographic cov- 18 erage, program duration, and 19 total funding amount. 20 ‘‘(II) GOAL.—The goal of this 21 clause to limit administrative costs to 22 the maximum extent practicable, but 23 in no case may the amount used for 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00621 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 622 •HR 2954 IH administrative costs exceed 10 percent 1 of the Federal funds allocated. 2 ‘‘(C) USE OF THE NATIONAL FUNDS BY 3 THE NATIONAL FUND MANAGER.—The national 4 fund manager shall use national funds de- 5 scribed in subparagraph (A)(ii) to undertake fi- 6 nancing and other activities to enhance and 7 maximize the effectiveness of the Initiative, as 8 determined by the agreement with the Sec- 9 retary, including— 10 ‘‘(i) attracting other forms of financial 11 assistance to match or leverage the na- 12 tional funds; 13 ‘‘(ii) awarding national funds to part- 14 nerships in accordance with paragraph (3); 15 ‘‘(iii) creating and managing pools of 16 grant or loan capital that blend or leverage 17 national funds with other forms of finan- 18 cial assistance, including capital in the 19 form of tax credits under section 45D of 20 the Internal Revenue Code of 1986, for the 21 benefit of partnerships; 22 ‘‘(iv) creating and managing pools of 23 grant or loan capital that blend or leverage 24 the national funds with other forms of fi- 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00622 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 623 •HR 2954 IH nancial assistance, including capital in the 1 form of tax credits under section 45D of 2 the Internal Revenue Code of 1986, to fi- 3 nance eligible local projects identified by 4 partnerships or the national fund manager 5 that have special or unique characteristics; 6 ‘‘(v) providing loans or grants directly 7 to eligible local projects as matching funds 8 if requested by a partnership; 9 ‘‘(vi) providing credit enhancement or 10 other financial products and instruments 11 for the benefit of partnerships or eligible 12 local projects; 13 ‘‘(vii) providing technical assistance; 14 and 15 ‘‘(viii) funding reasonable administra- 16 tive costs approved by the Secretary in ac- 17 cordance with paragraph (4)(C). 18 ‘‘(2) RESPONSIBILITIES OF THE NATIONAL 19 FUND MANAGER.—The designated national fund 20 manager shall— 21 ‘‘(A) raise other forms of financial assist- 22 ance to match or leverage the national funds; 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00623 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 624 •HR 2954 IH ‘‘(B) use administrative funds to develop 1 appropriate training programs and offer tech- 2 nical assistance services to— 3 ‘‘(i) partnerships; 4 ‘‘(ii) State, local, and tribal govern- 5 ments; 6 ‘‘(iii) the food retail industry; and 7 ‘‘(iv) food access and health advocacy 8 organizations to augment local capacities; 9 ‘‘(C) develop financial products such as 10 loans, grants, and credit enhancement tools 11 that can be used by partnerships to incentivize 12 and support the development and retention of 13 supermarkets and other fresh, healthy food re- 14 tail in underserved areas; 15 ‘‘(D) award Initiative funds to eligible 16 partnerships through an annual competitive 17 process in accordance with paragraph (3); 18 ‘‘(E) contract with a national food access 19 organization to assist in the review of applica- 20 tions from partnerships and to provide technical 21 assistance to local food access organizations in 22 the proposed partnerships; 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00624 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 625 •HR 2954 IH ‘‘(F) award and disburse funds to partner- 1 ships or eligible local projects in a timely man- 2 ner; 3 ‘‘(G) create and meet performance bench- 4 marks and reporting guidelines, as approved by 5 the Secretary, including for— 6 ‘‘(i) the amount of capital raised and 7 leveraged from financial institutions, part- 8 nerships, and other resources; 9 ‘‘(ii) the geographic diversity of part- 10 nerships; and 11 ‘‘(iii) the proportion of projects fund- 12 ed by the partnership that are in severely 13 distressed low-income communities; 14 ‘‘(H) develop program guidelines and oper- 15 ating procedures for the Initiative, including— 16 ‘‘(i) maximum grant and loan 17 amounts for projects; 18 ‘‘(ii) eligible uses of funds; 19 ‘‘(iii) prudent underwriting criteria; 20 ‘‘(iv) performance targets; 21 ‘‘(v) reporting guidelines; 22 ‘‘(vi) limits on administrative costs; 23 and 24 ‘‘(vii) implementation milestones; 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00625 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 626 •HR 2954 IH ‘‘(I) monitor the performance of partner- 1 ships; and 2 ‘‘(J) collect data, compile information, and 3 conduct such research studies as the national 4 fund manager determines to be relevant to the 5 successful implementation of the Initiative, in- 6 cluding— 7 ‘‘(i) to assess national and local mar- 8 ket conditions; 9 ‘‘(ii) to determine barriers to market 10 entry; and 11 ‘‘(iii) to identify opportunities for the 12 development or retention of supermarkets 13 and other fresh, healthy food retail enter- 14 prises in underserved communities. 15 ‘‘(3) CRITERIA FOR AWARDING NATIONAL 16 FUNDS TO PARTNERSHIPS.— 17 ‘‘(A) IN GENERAL.—The national fund 18 manager shall award national funds to partner- 19 ships through a competitive process on an an- 20 nual basis. 21 ‘‘(B) FIRST ROUND PRIORITY.—In the 22 first round of funding, the national fund man- 23 ager shall give priority to existing partnerships 24 that have demonstrable capacity to implement 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00626 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 627 •HR 2954 IH fresh food financing programs in underserved 1 areas quickly. 2 ‘‘(C) ADDITIONAL ROUNDS.—Additional 3 rounds shall be designed to promote geographic 4 diversity. 5 ‘‘(D) CRITERIA.—In awarding national 6 funds to partnerships, the national fund man- 7 ager shall consider— 8 ‘‘(i) the amount of funds and other 9 resources pledged by a partnership to 10 match or leverage national funds; 11 ‘‘(ii) the degree of State, local, or trib- 12 al government support of the partnership 13 as evidenced by matching grant and loan 14 funds or other types of support, such as al- 15 location of tax-exempt bonds, loan guaran- 16 tees, and coordination of resources from 17 other State or local economic development 18 programs; 19 ‘‘(iii) the capacity of the partnership 20 to successfully develop and manage loan 21 and grant programs; 22 ‘‘(iv) the lack of supermarkets and 23 other fresh, healthy food retail enterprises 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00627 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 628 •HR 2954 IH in low- and moderate-income areas that 1 would be served by the partnership; 2 ‘‘(v) the experience of the food access 3 or community health organization of the 4 partnership in outreach about access to 5 healthy foods and local healthy food access 6 issues; 7 ‘‘(vi) the degree of community engage- 8 ment and support in the development and 9 retention of supermarkets and other fresh, 10 healthy food retail enterprises; and 11 ‘‘(vii) the contribution of the program 12 of the partnership to the overall geographic 13 diversity of the Initiative. 14 ‘‘(4) ADMINISTRATIVE COSTS.— 15 ‘‘(A) IN GENERAL.—Not later than 45 16 days after the date of receipt of an award, the 17 national fund manager shall submit to the Sec- 18 retary for approval a 3-year program and oper- 19 ating budget and detailed work plan that shall 20 include— 21 ‘‘(i) costs for research and evaluation, 22 technical assistance, and training; and 23 ‘‘(ii) program and operating costs. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00628 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 629 •HR 2954 IH ‘‘(B) EARNED REVENUES.—Earned reve- 1 nues from loan fees and interest may be ex- 2 pended on program and operating costs in ac- 3 cordance with the budget approved by the Sec- 4 retary. 5 ‘‘(C) BASIS OF REVIEW.—The Secretary 6 shall base the review under subparagraph (A) 7 on— 8 ‘‘(i) the likelihood of the plan and ex- 9 penditures to further the purposes of this 10 section; and 11 ‘‘(ii) whether the administrative costs 12 are reasonable, connected to the costs of 13 operation, and reflect efficient operations 14 by the national fund manager. 15 ‘‘(f) PARTNERSHIPS.— 16 ‘‘(1) IN GENERAL.—Each partnership that re- 17 ceives assistance through the Initiative shall provide 18 financial and technical assistance to eligible fresh, 19 healthy food retail projects in underserved areas 20 within the defined communities of the partnership. 21 ‘‘(2) ADMINISTRATION.—Each partnership shall 22 designate a community development financial insti- 23 tution or other organization that is capable of ad- 24 ministering a loan and grant program— 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00629 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 630 •HR 2954 IH ‘‘(A) to execute grant agreements with the 1 national fund manager; and 2 ‘‘(B) to serve as the manager of local 3 funds. 4 ‘‘(3) RESPONSIBILITIES OF PARTNERSHIPS.—A 5 partnership shall— 6 ‘‘(A) raise other forms of financial assist- 7 ance to match the national funds received by 8 the partnership; 9 ‘‘(B) provide marketing and outreach to 10 communities, the supermarket industry, other 11 fresh, healthy food retailers, State and local 12 government officials, and civic and public inter- 13 est organizations— 14 ‘‘(i) to solicit applications from under- 15 served areas from across the State or local- 16 ity to be served by the partnership; and 17 ‘‘(ii) to inform the communities and 18 other persons about the availability of 19 grants, loans, training, and technical as- 20 sistance; 21 ‘‘(C) review and underwrite projects to de- 22 termine whether— 23 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00630 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 631 •HR 2954 IH ‘‘(i) a proposed project meets the cri- 1 teria for eligible projects under subsection 2 (c)(3); and 3 ‘‘(ii) a proposed project meets the cri- 4 teria for priority projects under subsection 5 (c)(4); 6 ‘‘(D) provide technical assistance services 7 to eligible fresh, healthy food retail operators 8 and developers; 9 ‘‘(E) track and report outcomes, includ- 10 ing— 11 ‘‘(i) the number of jobs created or re- 12 tained; 13 ‘‘(ii) the quantity of fresh, healthy 14 food retail space created or retained; and 15 ‘‘(iii) such other health and economic 16 indicators as are required by the national 17 fund manager; 18 ‘‘(F) monitor and audit funded projects to 19 ensure compliance with the Initiative, the na- 20 tional fund manager, and partnership program 21 requirements for a period of at least 3 years; 22 ‘‘(G) submit an annual report to the na- 23 tional fund manager that describes— 24 ‘‘(i) the activities of the partnership; 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00631 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 632 •HR 2954 IH ‘‘(ii) the expenditure of local funds; 1 and 2 ‘‘(iii) success in meeting performance 3 targets and satisfying such other terms 4 and conditions as are specified in the 5 agreement between the partnership and the 6 national fund manager; and 7 ‘‘(H) coordinate with the national fund 8 manager for the smooth operation of the Initia- 9 tive. 10 ‘‘(4) ADMINISTRATIVE COSTS.— 11 ‘‘(A) IN GENERAL.—As a condition on the 12 receipt of assistance under this section, each 13 partnership shall submit to the national fund 14 manager for approval a 3-year budget and plan 15 for all program and operating costs, includ- 16 ing— 17 ‘‘(i) costs for research and evaluation, 18 technical assistance, and training; and 19 ‘‘(ii) administrative and operating 20 costs. 21 ‘‘(B) EARNED REVENUES.—Earned reve- 22 nues from loan fees and interest may be ex- 23 pended on program and operating costs in ac- 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00632 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 633 •HR 2954 IH cordance with the budget approved by the na- 1 tional fund manager. 2 ‘‘(C) BASIS OF REVIEW.—The national 3 fund manager shall base the review under sub- 4 paragraph (A) on the likelihood of the budget 5 and plan to further the purposes of this section. 6 ‘‘(g) EVALUATION AND MONITORING.— 7 ‘‘(1) IN GENERAL.—Program evaluation and fi- 8 nancial audits shall occur at all levels of the Initia- 9 tive to ensure that— 10 ‘‘(A) national and local funds are used 11 properly; and 12 ‘‘(B) the objectives of the Initiative are 13 met. 14 ‘‘(2) PROGRAM EVALUATION AND FINANCIAL 15 AUDITS.— 16 ‘‘(A) IN GENERAL.—The Secretary shall— 17 ‘‘(i) conduct periodic program evalua- 18 tions and financial audits of the national 19 fund manager, partnerships, and projects 20 funded by the Initiative; and 21 ‘‘(ii) share with the national fund 22 manager the results of the evaluations and 23 audits. 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00633 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 634 •HR 2954 IH ‘‘(B) FUNDED PROJECTS.—The Secretary 1 or the national fund manager shall evaluate 2 partnerships to assess the health and economic 3 impacts of projects funded by the Initiative. 4 ‘‘(C) OTHER IMPACTS.— 5 ‘‘(i) SECRETARY OF HEALTH AND 6 HUMAN SERVICES.—The Secretary of 7 Health and Human Services shall conduct 8 research studies and evaluate the health 9 impacts of the Initiative. 10 ‘‘(ii) COMMUNITY DEVELOPMENT FI- 11 NANCIAL INSTITUTIONS.—Representatives 12 of the Community Development Financial 13 Institutions shall conduct research studies 14 and evaluate the economic impacts of the 15 Initiative. 16 ‘‘(D) PARTNERSHIPS.— 17 ‘‘(i) IN GENERAL.—Each partnership 18 shall— 19 ‘‘(I) conduct periodic administra- 20 tive and financial audits of projects 21 funded by the Initiative; and 22 ‘‘(II) share with the national 23 fund manager the results of the au- 24 dits. 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00634 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 635 •HR 2954 IH ‘‘(ii) FAILURE OF PARTNERSHIP.—In 1 a case in which a partnership fails, the na- 2 tional fund manager shall take over the 3 portfolio of the failed partnership. 4 ‘‘(h) ADMINISTRATIVE PROVISIONS.—Not later than 5 180 days after the date of enactment of this section, the 6 Secretary shall promulgate such regulations as may be 7 necessary to carry out this section, including regulations— 8 ‘‘(1) for the conduct of a performance evalua- 9 tion at the end of the initial 5-year period; 10 ‘‘(2) to terminate the contract for cause; and 11 ‘‘(3) to extend the contract for an additional 5- 12 year period. 13 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 14 authorized to be appropriated to the Secretary to carry 15 out this section $500,000,000, to remain available until 16 expended.’’. 17 (b) CONFORMING AMENDMENT.—Section 296(b) of 18 the Department of Agriculture Reorganization Act of 19 1994 (7 U.S.C. 7014(b)) is amended— 20 (1) in paragraph (6)(C), by striking ‘‘or’’ at the 21 end; 22 (2) in paragraph (7), by striking the period at 23 the end and inserting ‘‘; or’’; and 24 (3) by adding at the end the following: 25 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00635 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 636 •HR 2954 IH ‘‘(8) the authority of the Secretary to establish 1 in the Department the Healthy Food Financing Ini- 2 tiative in accordance with section 242.’’. 3 SEC. 1007. GAO REPORT ON HEALTH EFFECTS OF DEEP- 4 WATER HORIZON OIL RIG EXPLOSION IN THE 5 GULF COAST. 6 (a) STUDY.—The Comptroller General of the United 7 States shall conduct a study on the type and scope of 8 health care services administered through the Department 9 of Health and Human Services addressing the provision 10 of health care to racial and ethnic minorities (whether 11 residents, clean-up workers, or volunteers) affected by the 12 explosion of the mobile offshore drilling unit Deepwater 13 Horizon that occurred on April 20, 2010. 14 (b) SPECIFIC COMPONENTS; REPORTING.—In car- 15 rying out subsection (a), the Comptroller General shall— 16 (1) assess the type, size, and scope of programs 17 administered by the Department of Health and 18 Human Services that focus on provision of health 19 care to communities in the Gulf Coast; 20 (2) identify the merits and disadvantages asso- 21 ciated with each the programs; 22 (3) perform an analysis of the costs and bene- 23 fits of the programs; 24 VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00636 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS 637 •HR 2954 IH (4) determine whether there is any duplication 1 of programs; and 2 (5) not later than 180 days after the date of 3 the enactment of this Act, report findings and rec- 4 ommendations for improving access to health care 5 for racial and ethnic minorities to the Congress. 6 Æ VerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00637 Fmt 6652 Sfmt 6301 E:\BILLS\H2954.IH H2954 emcdonald on DSK5VPTVN1PROD with BILLS