Text of US HB 5294 (2014)

I 113TH CONGRESS 2D SESSION H. R. 5294 To improve the health of minority individuals, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JULY 30, 2014 Ms. ROYBAL-ALLARD (for herself, Ms. LEE of California, Mrs. CHRISTENSEN, Ms. BORDALLO, Ms. BROWN of Florida, Mr. BUTTERFIELD, Ms. CHU, Ms. CLARKE of New York, Mr. CA´RDENAS, Mr. CARSON of Indiana, Ms. CASTOR of Florida, Mr. CONYERS, Mr. CROWLEY, Mr. CUMMINGS, Mr. DANNY K. DAVIS of Illinois, Ms. DEGETTE, Ms. DELAURO, Ms. EDWARDS, Mr. ELLISON, Mr. FALEOMAVAEGA, Mr. FARR, Mr. FATTAH, Ms. FUDGE, Mr. GARCIA, Mr. GRIJALVA, Ms. MICHELLE LUJAN GRIS- HAM of New Mexico, Mr. GUTIE´RREZ, Ms. HAHN, Mr. HINOJOSA, Mr. HONDA, Ms. JACKSON LEE, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. JOHNSON of Georgia, Mr. LEWIS, Ms. LOFGREN, Mrs. LOWEY, Mr. BEN RAY LUJA´N of New Mexico, Ms. MATSUI, Ms. MCCOLLUM, Mr. MCGOVERN, Mrs. NEGRETE MCLEOD, Mr. MEEKS, Ms. MENG, Mrs. NAPOLITANO, Ms. NORTON, Mr. PASTOR of Arizona, Mr. PIERLUISI, Mr. RANGEL, Mr. RICHMOND, Mr. RUSH, Mr. SABLAN, Ms. LINDA T. SA´NCHEZ of California, Ms. LORETTA SANCHEZ of California, Ms. SCHA- KOWSKY, Mr. SCHIFF, Mr. DAVID SCOTT of Georgia, Mr. SCOTT of Vir- ginia, Mr. SERRANO, Mr. SIRES, Ms. SLAUGHTER, Mr. TAKANO, Mr. TONKO, Mr. VARGAS, Mr. VELA, Ms. VELA´ZQUEZ, and Ms. WATERS) in- troduced the following bill; which was referred to the Committee on En- ergy and Commerce, and in addition to the Committees on Ways and Means, Agriculture, Education and the Workforce, the Budget, Veterans’ Affairs, Armed Services, the Judiciary, and Natural Resources, for a pe- riod to be subsequently determined by the Speaker, in each case for con- sideration of such provisions as fall within the jurisdiction of the com- mittee concerned VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 2 •HR 5294 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 2014’’. 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 primary language data collected by the Federal Government. 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. Standards for measuring socioeconomic status in collection of health data. Sec. 112. Safety and effectiveness of drugs with respect to racial and ethnic background. Sec. 113. Improving health data regarding Native Hawaiians and other Pacific Islanders. Sec. 114. Clarification of simplified administrative reporting requirement. TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE Sec. 201. Definitions. VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 3 •HR 5294 IH Sec. 202. Amendment to the Public Health Service Act. Sec. 203. Pilot program for improvement and development of State medical in- terpreting services. Sec. 204. Training tomorrow’s doctors for culturally and linguistically appro- priate care: graduate medical education. Sec. 205. Federal reimbursement for culturally and linguistically appropriate services under the Medicare, Medicaid, and State Children’s Health Insurance Programs. Sec. 206. Increasing understanding of and improving health literacy. Sec. 207. Assurances for receiving Federal funds. Sec. 208. Report on Federal efforts to provide culturally and linguistically ap- propriate health care services. Sec. 209. English for speakers of other languages. Sec. 210. Implementation. Sec. 211. 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. Sense of Congress on the mission of the National Health Care Work- force Commission. Sec. 306. Scholarship and fellowship programs. Sec. 307. McNair Postbaccalaureate Achievement Program. Sec. 308. Rules for determination of full-time equivalent residents for cost-re- porting periods. Sec. 309. Developing and implementing strategies for local health equity. Sec. 310. Loan forgiveness for mental and behavioral health social workers. Sec. 311. Health Professions Workforce Fund. Sec. 312. Findings; sense of Congress relating to graduate medical education. Sec. 313. Career support for skilled internationally educated health profes- sionals. 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 citizenship and immigration barriers to access to affordable health care under the ACA. Sec. 413. Study on the uninsured. VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6211 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 4 •HR 5294 IH Sec. 414. Medicaid payment parity for the territories. Sec. 415. Extension of Medicare secondary payer. Sec. 416. Border health grants. Sec. 417. Removing Medicare barrier to health care. Sec. 418. 100 percent FMAP for medical assistance provided by urban Indian health centers. Sec. 419. 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. Indian defined in PPACA. Sec. 434. Study of DSH payments to ensure hospital access for low-income pa- tients. Sec. 435. Assistant Secretary of the Indian Health Service. Sec. 436. Reauthorization of the Native Hawaiian Health Care Improvement Act. 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 unintended teenage pregnancies. Sec. 509. Gestational diabetes. Sec. 510. Emergency contraception education and information programs. Sec. 511. Supporting healthy adolescent development. Sec. 512. Compassionate assistance for rape emergencies. Sec. 513. Access to birth control duties of pharmacies to ensure provision of FDA-approved contraception. Sec. 514. Additional focus area for the Office on Women’s Health. Sec. 515. Interagency coordinating committee on the promotion of optimal ma- ternity outcomes. VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6211 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 5 •HR 5294 IH Sec. 516. Consumer education campaign. Sec. 517. Bibliographic database of systematic reviews for care of childbearing women and newborns. Sec. 518. Maternity care health professional shortage areas. Sec. 519. Expansion of CDC prevention research centers program to include centers on optimal maternity outcomes. Sec. 520. Expanding models allowed to be tested by Center for Medicare and Medicaid Innovation to include maternity care models. Sec. 521. Development of interprofessional maternity care educational models and tools. Sec. 522. Including within inpatient hospital services under Medicare services furnished by certain students, interns, and residents supervised by certified nurse midwives. Sec. 523. Grants to professional organizations to increase diversity in maternity care professionals. TITLE VI—MENTAL HEALTH Sec. 601. Coverage of marriage and family therapist services, mental health counselor services, and substance abuse counselor services under part B of the Medicare program. Sec. 602. Minority Fellowship Program. Sec. 603. Integrated Health Care Demonstration Program. Sec. 604. Addressing racial and ethnic minority mental health disparities re- search gaps. Sec. 605. Health professions competencies to address racial and ethnic minority mental health disparities. TITLE VII—ADDRESSING HIGH IMPACT MINORITY DISEASES Subtitle A—Cancer Sec. 701. Lung cancer mortality reduction. 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. CDC Wisewoman Screening Program. Sec. 733. Report on cardiovascular care for women and minorities. Sec. 734. Coverage of comprehensive tobacco cessation services in Medicaid. Sec. 735. Clinical research funding for oral health. Sec. 736. Participation by Medicaid beneficiaries in approved clinical trials. VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6211 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 6 •HR 5294 IH Subtitle E—HIV/AIDS Sec. 741. Statement of policy. Sec. 742. Findings. Sec. 743. Additional funding for AIDS drug assistance program treatments. Sec. 744. Enhancing the national HIV surveillance system. Sec. 745. Evidence-based strategies for improving linkage to and retention in appropriate care. Sec. 746. Improving entry into and retention in care and antiretroviral adher- ence for persons with HIV. Sec. 747. Services to reduce HIV/AIDS in racial and ethnic minority commu- nities. Sec. 748. Minority AIDS initiative. Sec. 749. Health care professionals treating individuals with HIV/AIDS. Sec. 750. HIV/AIDS provider loan repayment program. Sec. 751. Dental education loan repayment program. Sec. 752. Reducing new HIV infections among injecting drug users. Sec. 753. Support for expansion of comprehensive sexual health and education programs. Sec. 754. Elimination of abstinence-only education program. Sec. 755. Report on impact of HIV/AIDS in vulnerable populations. Sec. 756. National HIV/AIDS observance days. Sec. 757. Review of all Federal and State laws, policies, and regulations regard- ing the criminal prosecution of individuals for HIV-related of- fenses. Sec. 758. Repeal of limitation against use of funds for education or information designed to promote or encourage, directly, homosexual or het- erosexual activity or intravenous substance abuse. Sec. 759. Expanding support for condoms in prisons. Sec. 760. Automatic reinstatement or enrollment in Medicaid for people who test positive for HIV before reentering communities. Sec. 761. Stop AIDS in prison. Sec. 762. Support data system review and indicators for monitoring HIV care. Sec. 763. Transfer of funds for implementation of national HIV/AIDS strategy. Sec. 764. HIV integrated services delivery model demonstration. Sec. 765. Report on the implementation of goal 4 (improved coordination) of the national HIV/AIDS strategy. Subtitle F—Diabetes Sec. 771. Research, treatment, and education. Sec. 772. Research, education, and other activities. Sec. 773. Research, education, and other activities. Sec. 774. Research, education, and other activities. Sec. 775. Updated report on health disparities. Subtitle G—Lung Disease Sec. 776. Expansion of the National Asthma Education and Prevention Pro- gram. Sec. 777. Asthma-related activities of the Centers for Disease Control and Pre- vention. Sec. 778. Influenza and pneumonia vaccination campaign. Sec. 779. Chronic obstructive pulmonary disease action plan. Subtitle H—Osteoarthritis and Musculoskeletal Diseases VerDate Mar 15 2010 01:02 Aug 07, 2014 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6211 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 7 •HR 5294 IH Sec. 781. Findings. Sec. 782. Osteoarthritis and other musculoskeletal health-related activities of the Centers for Disease Control and Prevention. Subtitle I—Sleep and Circadian Rhythm Disorders Sec. 791. Short title; findings. Sec. 792. Sleep and circadian rhythm disorders research activities of the Na- tional Institutes of Health. Sec. 793. Sleep and circadian rhythm health disparities-related activities of the Centers for Disease Control and Prevention. TITLE VIII—HEALTH INFORMATION TECHNOLOGY Sec. 800. Definitions. 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. Sec. 814. Authorization of appropriations. Subtitle C—Additional Research and Studies Sec. 831. Data collection and assessments conducted in coordination with mi- nority-serving institutions. Sec. 832. 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 rehabilitation facili- ties, long-term care facilities, 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, marital status, familial status, sexual orientation, gen- der identity, or disability status. Sec. 902. Treatment of Medicare payments under title VI of the Civil Rights Act of 1964. VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6211 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 8 •HR 5294 IH 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. TITLE X—ADDRESSING SOCIAL DETERMINANTS AND IMPROVING ENVIRONMENTAL JUSTICE Sec. 1001. Definitions. Sec. 1002. Findings. Sec. 1003. Health impact assessments. Sec. 1004. Implementation of recommendations by Environmental Protection Agency. Sec. 1005. Grant program to conduct environmental health improvement activi- ties and to improve social determinants of health. Sec. 1006. Additional research on the relationship between the built environ- ment and the health of community residents. Sec. 1007. Environment and public health restoration. Sec. 1008. 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 VerDate Mar 15 2010 01:02 Aug 07, 2014 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 9 •HR 5294 IH gender identity, socioeconomic status, or disability 1 status—that directly and indirectly affect the health, 2 health care, and wellness of individuals and commu- 3 nities. 4 (3) By 2020, the Nation will face a shortage of 5 health care providers and allied health workers and 6 this shortage disproportionately affects health pro- 7 fessional shortage areas where many racial and eth- 8 nic minority populations reside. 9 (4) All efforts to reduce health disparities and 10 barriers to quality health services require better and 11 more consistent data. 12 (5) A full range of culturally and linguistically 13 appropriate health care and public health services 14 must be available and accessible in every community. 15 (6) Racial and ethnic minorities and under- 16 served populations must be included early and equi- 17 tably in health reform innovations. 18 (7) Efforts to improve minority health have 19 been limited by inadequate resources in funding, 20 staffing, stewardship, and accountability. Targeted 21 investments that are focused on disparities elimi- 22 nation must be made in providing care and services 23 that are community-based, including prevention and 24 policies addressing social determinants of health. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 10 •HR 5294 IH (8) In 2011, the Department of Health and 1 Human Services developed the HHS Action Plan to 2 Reduce Racial and Ethnic Health Disparities and 3 the National Stakeholder Strategy for Achieving 4 Health Equity, two strategic plans that represent 5 the country’s first coordinated roadmap to reducing 6 health disparities. Along with the National Preven- 7 tion Strategy, Healthy People 2020, and the Na- 8 tional Health Care Quality Strategy, as well as crit- 9 ical resources such as the 2012 National Healthcare 10 Quality and Disparities Reports, these comprehen- 11 sive plans will work to increase the number of Amer- 12 icans who are healthy at every stage of life. 13 (9) The Department of Health and Human 14 Services also developed other strategic planning doc- 15 uments to combat disease disparities with a high im- 16 pact on minority populations including the National 17 HIV/AIDS Strategy, and the Action Plan for the 18 Prevention, Care and Treatment of Viral Hepatitis. 19 (10) The Patient Protection and Affordable 20 Care Act, as amended by the Health Care and Edu- 21 cation Reconciliation Act, represents the biggest ad- 22 vancement for minority health in the last 40 years. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 11 •HR 5294 IH TITLE I—DATA COLLECTION 1 AND REPORTING 2 SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE 3 ACT. 4 (a) PURPOSE.—It is the purpose of this section to 5 promote data collection, analysis, and reporting by race, 6 ethnicity, sex, primary language, sexual orientation, dis- 7 ability status, gender identity, and socioeconomic status 8 among federally supported health programs. 9 (b) AMENDMENT.—Title XXXIV of the Public 10 Health Service Act, as amended by titles II and III of 11 this Act, is further amended by inserting after subtitle A 12 the following: 13 ‘‘Subtitle B—Strengthening Data 14 Collection, Improving Data 15 Analysis, and Expanding Data 16 Reporting 17 ‘‘SEC. 3431. HEALTH DISPARITY DATA. 18 ‘‘(a) REQUIREMENTS.— 19 ‘‘(1) IN GENERAL.—Each health-related pro- 20 gram operated by or that receives funding or reim- 21 bursement, in whole or in part, either directly or in- 22 directly from the Department of Health and Human 23 Services shall— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 12 •HR 5294 IH ‘‘(A) require the collection, by the agency 1 or program involved, of data on the race, eth- 2 nicity, sex, primary language, sexual orienta- 3 tion, disability status, gender identity, and so- 4 cioeconomic status of each applicant for and re- 5 cipient of health-related assistance under such 6 program— 7 ‘‘(i) using, at a minimum, the stand- 8 ards for data collection on race, ethnicity, 9 sex, primary language, sexual orientation, 10 disability status, gender identity, and so- 11 cioeconomic status developed under section 12 3101; 13 ‘‘(ii) collecting data for additional 14 population groups if such groups can be 15 aggregated into the race and ethnicity cat- 16 egories outlined by the standards developed 17 under section 3101; 18 ‘‘(iii) additionally referring, where 19 practicable, to the standards developed by 20 the Institute of Medicine in ‘Race, Eth- 21 nicity, and Language Data: Standardiza- 22 tion for Health Care Quality Improve- 23 ment’; and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 13 •HR 5294 IH ‘‘(iv) where practicable, through self- 1 reporting; 2 ‘‘(B) with respect to the collection of the 3 data described in subparagraph (A), for appli- 4 cants and recipients who are minors, require 5 communication assistance in speech or writing, 6 and for applicants and recipients who are other- 7 wise legally incapacitated, require that— 8 ‘‘(i) such data be collected from the 9 parent or legal guardian of such an appli- 10 cant or recipient; and 11 ‘‘(ii) the primary language of the par- 12 ent or legal guardian of such an applicant 13 or recipient be collected; 14 ‘‘(C) systematically analyze such data 15 using the smallest appropriate units of analysis 16 feasible to detect racial and ethnic disparities, 17 as well as disparities along the lines of primary 18 language, sex, disability status, sexual orienta- 19 tion, gender identity, and socioeconomic status 20 in health and health care, and report the results 21 of such analysis to the Secretary, the Director 22 of the Office for Civil Rights, each agency listed 23 in section 3101(c)(1), the Committee on 24 Health, Education, Labor, and Pensions and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 14 •HR 5294 IH the Committee on Finance of the Senate, and 1 the Committee on Energy and Commerce and 2 the Committee on Ways and Means of the 3 House of Representatives; 4 ‘‘(D) provide such data to the Secretary on 5 at least an annual basis; and 6 ‘‘(E) ensure that the provision of assist- 7 ance to an applicant or recipient of assistance 8 is not denied or otherwise adversely affected be- 9 cause of the failure of the applicant or recipient 10 to provide race, ethnicity, primary language, 11 sex, sexual orientation, disability status, gender 12 identity, and socioeconomic status data. 13 ‘‘(2) RULES OF CONSTRUCTION.—Nothing in 14 this subsection shall be construed to— 15 ‘‘(A) permit the use of information col- 16 lected under this subsection in a manner that 17 would adversely affect any individual providing 18 any such information; or 19 ‘‘(B) diminish existing or future require- 20 ments on health care providers to collect data. 21 ‘‘(3) NO COMPELLED DISCLOSURE OF DATA.— 22 This title does not authorize any health care pro- 23 vider, Federal official, or other entity to compel the 24 disclosure of any data collected under this title. The 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 15 •HR 5294 IH disclosure of any such data by an individual pursu- 1 ant to this title shall be strictly voluntary. 2 ‘‘(b) PROTECTION OF DATA.—The Secretary shall 3 ensure (through the promulgation of regulations or other- 4 wise) that all data collected pursuant to subsection (a) are 5 protected— 6 ‘‘(1) under the same privacy protections as the 7 Secretary applies to other health data under the reg- 8 ulations promulgated under section 264(c) of the 9 Health Insurance Portability and Accountability Act 10 of 1996 (Public Law 104–191; 110 Stat. 2033) re- 11 lating to the privacy of individually identifiable 12 health information and other protections; and 13 ‘‘(2) from all inappropriate internal use by any 14 entity that collects, stores, or receives the data, in- 15 cluding use of such data in determinations of eligi- 16 bility (or continued eligibility) in health plans, and 17 from other inappropriate uses, as defined by the 18 Secretary. 19 ‘‘(c) NATIONAL PLAN OF THE DATA COUNCIL.—The 20 Secretary shall develop and implement a national plan to 21 ensure the collection of data in a culturally appropriate 22 and competent manner, to improve the collection, analysis, 23 and reporting of racial, ethnic, sex, primary language, sex- 24 ual orientation, disability status, gender identity, and so- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 16 •HR 5294 IH cioeconomic status data at the Federal, State, territorial, 1 tribal, and local levels, including data to be collected under 2 subsection (a), and to ensure that data collection activities 3 carried out under this section are in compliance with the 4 standards developed under section 3101. The Data Coun- 5 cil of the Department of Health and Human Services, in 6 consultation with the National Committee on Vital Health 7 Statistics, the Office of Minority Health, Office on Wom- 8 en’s Health, and other appropriate public and private enti- 9 ties, shall make recommendations to the Secretary con- 10 cerning the development, implementation, and revision of 11 the national plan. Such plan shall include recommenda- 12 tions on how to— 13 ‘‘(1) implement subsection (a) while minimizing 14 the cost and administrative burdens of data collec- 15 tion and reporting; 16 ‘‘(2) expand awareness among Federal agencies, 17 States, territories, Indian tribes, health providers, 18 health plans, health insurance issuers, and the gen- 19 eral public that data collection, analysis, and report- 20 ing by race, ethnicity, primary language, sexual ori- 21 entation, disability status, gender identity, and socio- 22 economic status is legal and necessary to assure eq- 23 uity and nondiscrimination in the quality of health 24 care services; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 17 •HR 5294 IH ‘‘(3) ensure that future patient record systems 1 have data code sets for racial, ethnic, primary lan- 2 guage, sexual orientation, disability status, gender 3 identity, and socioeconomic status identifiers and 4 that such identifiers can be retrieved from clinical 5 records, including records transmitted electronically; 6 ‘‘(4) improve health and health care data collec- 7 tion and analysis for more population groups if such 8 groups can be aggregated into the minimum race 9 and ethnicity categories, including exploring the fea- 10 sibility of enhancing collection efforts in States for 11 racial and ethnic groups that comprise a significant 12 proportion of the population of the State; 13 ‘‘(5) provide researchers with greater access to 14 racial, ethnic, primary language, sexual orientation, 15 disability status, gender identity, and socioeconomic 16 status data, subject to privacy and confidentiality 17 regulations; and 18 ‘‘(6) safeguard and prevent the misuse of data 19 collected under subsection (a). 20 ‘‘(d) COMPLIANCE WITH STANDARDS.—Data col- 21 lected under subsection (a) shall be obtained, maintained, 22 and presented (including for reporting purposes) in ac- 23 cordance with the standards developed under section 24 3101. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 18 •HR 5294 IH ‘‘(e) TECHNICAL ASSISTANCE FOR THE COLLECTION 1 AND REPORTING OF DATA.— 2 ‘‘(1) IN GENERAL.—The Secretary may, either 3 directly or through grant or contract, provide tech- 4 nical assistance to enable a health care program or 5 an entity operating under such program to comply 6 with the requirements of this section. 7 ‘‘(2) TYPES OF ASSISTANCE.—Assistance pro- 8 vided under this subsection may include assistance 9 to— 10 ‘‘(A) enhance or upgrade computer tech- 11 nology that will facilitate racial, ethnic, primary 12 language, sexual orientation, disability status, 13 gender identity, and socioeconomic status data 14 collection and analysis; 15 ‘‘(B) improve methods for health data col- 16 lection and analysis, including additional popu- 17 lation groups if such groups can be aggregated 18 into the race and ethnicity categories outlined 19 by the standards developed under section 3101; 20 ‘‘(C) develop mechanisms for submitting 21 collected data subject to existing privacy and 22 confidentiality regulations; and 23 ‘‘(D) develop educational programs to in- 24 form health insurance issuers, health plans, 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 19 •HR 5294 IH health providers, health-related agencies, and 1 the general public that data collection and re- 2 porting by race, ethnicity, primary language, 3 sexual orientation, disability status, gender 4 identity, and socioeconomic status are legal and 5 essential for eliminating health and health care 6 disparities. 7 ‘‘(f) ANALYSIS OF HEALTH DISPARITY DATA.—The 8 Secretary, acting through the Director of the Agency for 9 Healthcare Research and Quality and in coordination with 10 the Administrator of the Centers for Medicare & Medicaid 11 Services, shall provide technical assistance to agencies of 12 the Department of Health and Human Services in meeting 13 Federal standards for health disparity data collection and 14 for analysis of racial and ethnic disparities in health and 15 health care in public programs by— 16 ‘‘(1) identifying appropriate quality assurance 17 mechanisms to monitor for health disparities; 18 ‘‘(2) specifying the clinical, diagnostic, or thera- 19 peutic measures which should be monitored; 20 ‘‘(3) developing new quality measures relating 21 to racial and ethnic disparities and their overlap 22 with other disparity factors in health and health 23 care; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 20 •HR 5294 IH ‘‘(4) identifying the level at which data analysis 1 should be conducted; and 2 ‘‘(5) sharing data with external organizations 3 for research and quality improvement purposes. 4 ‘‘(g) PRIMARY LANGUAGE.—References in this sec- 5 tion— 6 ‘‘(1) to primary language data, include spoken 7 and written primary language data; and 8 ‘‘(2) to primary language data collection activi- 9 ties, include identifying, collecting, storing, tracking, 10 and analyzing primary language data and informa- 11 tion on the methods used to meet the language ac- 12 cess needs of limited-English-proficient individuals. 13 ‘‘(h) DEFINITION.—In this section, the term ‘health- 14 related program’ mean a program— 15 ‘‘(1) under the Social Security Act (42 U.S.C. 16 301 et seq.) that pays for health care and services; 17 and 18 ‘‘(2) under this Act that provides Federal finan- 19 cial assistance for health care, biomedical research, 20 or health services research and or is designed to im- 21 prove the public’s health. 22 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 23 are authorized to be appropriated to carry out this section 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 21 •HR 5294 IH such sums as may be necessary for each of fiscal years 1 2015 through 2020. 2 ‘‘SEC. 3432. PROVISIONS RELATING TO NATIVE AMERICANS. 3 ‘‘(a) ESTABLISHMENT OF EPIDEMIOLOGY CEN- 4 TERS.—The Secretary shall establish an epidemiology cen- 5 ter in each service area to carry out the functions de- 6 scribed in subsection (b). Any new center established after 7 the date of the enactment of the Health Equity and Ac- 8 countability Act of 2014 may be operated under a grant 9 authorized by subsection (d), but funding under such a 10 grant shall not be divisible. 11 ‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 12 and upon the request of Indian tribes, tribal organizations, 13 and urban Indian organizations, each service area epide- 14 miology center established under this subsection shall, 15 with respect to such service area— 16 ‘‘(1) collect data relating to, and monitor 17 progress made toward meeting, each of the health 18 status objectives of the service, the Indian tribes, 19 tribal organizations, and urban Indian organizations 20 in the service area; 21 ‘‘(2) evaluate existing delivery systems, data 22 systems, and other systems that impact the improve- 23 ment of Indian health; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 22 •HR 5294 IH ‘‘(3) assist Indian tribes, tribal organizations, 1 and urban Indian organizations in identifying their 2 highest priority health status objectives and the 3 services needed to achieve such objectives, based on 4 epidemiological data; 5 ‘‘(4) make recommendations for the targeting 6 of services needed by the populations served; 7 ‘‘(5) make recommendations to improve health 8 care delivery systems for Indians and urban Indians; 9 ‘‘(6) provide requested technical assistance to 10 Indian tribes, tribal organizations, and urban Indian 11 organizations in the development of local health 12 service priorities and incidence and prevalence rates 13 of disease and other illness in the community; and 14 ‘‘(7) provide disease surveillance and assist In- 15 dian tribes, tribal organizations, and urban Indian 16 organizations to promote public health. 17 ‘‘(c) TECHNICAL ASSISTANCE.—The Director of the 18 Centers for Disease Control and Prevention shall provide 19 technical assistance to the centers in carrying out the re- 20 quirements of this subsection. 21 ‘‘(d) GRANTS FOR STUDIES.— 22 ‘‘(1) IN GENERAL.—The Secretary may make 23 grants to Indian tribes, tribal organizations, urban 24 Indian organizations, and eligible intertribal con- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 23 •HR 5294 IH sortia to conduct epidemiological studies of Indian 1 communities. 2 ‘‘(2) ELIGIBLE INTERTRIBAL CONSORTIA.—An 3 intertribal consortium is eligible to receive a grant 4 under this subsection if— 5 ‘‘(A) the intertribal consortium is incor- 6 porated for the primary purpose of improving 7 Indian health; and 8 ‘‘(B) the intertribal consortium is rep- 9 resentative of the Indian tribes or urban Indian 10 communities in which the intertribal consortium 11 is located. 12 ‘‘(3) APPLICATIONS.—An application for a 13 grant under this subsection shall be submitted in 14 such manner and at such time as the Secretary shall 15 prescribe. 16 ‘‘(4) REQUIREMENTS.—An applicant for a 17 grant under this subsection shall— 18 ‘‘(A) demonstrate the technical, adminis- 19 trative, and financial expertise necessary to 20 carry out the functions described in paragraph 21 (5); 22 ‘‘(B) consult and cooperate with providers 23 of related health and social services in order to 24 avoid duplication of existing services; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 24 •HR 5294 IH ‘‘(C) demonstrate cooperation from Indian 1 tribes or urban Indian organizations in the area 2 to be served. 3 ‘‘(5) USE OF FUNDS.—A grant awarded under 4 paragraph (1) may be used— 5 ‘‘(A) to carry out the functions described 6 in subsection (b); 7 ‘‘(B) to provide information to and consult 8 with tribal leaders, urban Indian community 9 leaders, and related health staff on health care 10 and health service management issues; and 11 ‘‘(C) in collaboration with Indian tribes, 12 tribal organizations, and urban Indian commu- 13 nities, to provide the service with information 14 regarding ways to improve the health status of 15 Indians. 16 ‘‘(e) ACCESS TO INFORMATION.—An epidemiology 17 center operated by a grantee pursuant to a grant awarded 18 under subsection (d) shall be treated as a public health 19 authority for purposes of the Health Insurance Portability 20 and Accountability Act of 1996 (Public Law 104–191; 110 21 Stat. 2033), as such entities are defined in part 164.501 22 of title 45, Code of Federal Regulations (or a successor 23 regulation). The Secretary shall grant such grantees ac- 24 cess to and use of data, data sets, monitoring systems, 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 25 •HR 5294 IH delivery systems, and other protected health information 1 in the possession of the Secretary.’’. 2 SEC. 102. ELIMINATION OF PREREQUISITE OF DIRECT AP- 3 PROPRIATIONS FOR DATA COLLECTION AND 4 ANALYSIS. 5 Section 3101 of the Public Health Service Act (42 6 U.S.C. 300kk) is amended— 7 (1) by striking subsection (h); and 8 (2) by redesignating subsection (i) as subsection 9 (h). 10 SEC. 103. COLLECTION OF RACE AND ETHNICITY DATA BY 11 THE SOCIAL SECURITY ADMINISTRATION. 12 Part A of title XI of the Social Security Act (42 13 U.S.C. 1301 et seq.) is amended by adding at the end 14 the following: 15 ‘‘SEC. 1150C. COLLECTION OF RACE AND ETHNICITY DATA 16 BY THE SOCIAL SECURITY ADMINISTRATION. 17 ‘‘(a) REQUIREMENT.—The Commissioner of Social 18 Security, in consultation with the Administrator of the 19 Centers for Medicare & Medicaid Services, shall— 20 ‘‘(1) require the collection of data on the race, 21 ethnicity, primary language, and disability status of 22 all applicants for Social Security account numbers or 23 benefits under title II or part A of title XVIII and 24 all individuals with respect to whom the Commis- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 26 •HR 5294 IH sioner maintains records of wages and self-employ- 1 ment income in accordance with reports received by 2 the Commissioner or the Secretary of the Treas- 3 ury— 4 ‘‘(A) using, at a minimum, the standards 5 for data collection on race, ethnicity, primary 6 language, and disability status developed under 7 section 3101 of the Public Health Service Act; 8 ‘‘(B) where practicable, collecting data for 9 additional population groups if such groups can 10 be aggregated into the race and ethnicity cat- 11 egories outlined by the standards developed 12 under section 3101 of the Public Health Service 13 Act; and 14 ‘‘(C) additionally referring, where prac- 15 ticable, to the standards developed by the Insti- 16 tute of Medicine in ‘Race, Ethnicity, and Lan- 17 guage Data: Standardization for Health Care 18 Quality Improvement’ (released August 31, 19 2009); 20 ‘‘(2) with respect to the collection of the data 21 described in paragraph (1) for applicants who are 22 under 18 years of age or otherwise legally incapaci- 23 tated, require that— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 27 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 28 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 29 •HR 5294 IH such sums as may be necessary for each of fiscal years 1 2015 through 2020.’’. 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 30 •HR 5294 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 ‘‘2020’’; 10 (2) in paragraph (2), in the first sentence, by 11 striking ‘‘2003’’ and inserting ‘‘2020’’; and 12 (3) in paragraph (3), by striking ‘‘2002’’ and 13 inserting ‘‘2020’’. 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 31 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 32 •HR 5294 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 2015 through 2020.’’. 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 33 •HR 5294 IH (2) submit a report to the Congress on the re- 1 sults of such study. 2 SEC. 108. RACIAL, ETHNIC, AND PRIMARY LANGUAGE DATA 3 COLLECTED 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 primary language data during the pre- 9 ceding calendar year shall submit such data to the Sec- 10 retary of Health and Human Services. 11 (b) ANALYSIS; PUBLIC AVAILABILITY; REPORTING.— 12 Not later than April 30, 2015, 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 primary language data submitted under subsection 19 (a) for 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 34 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 35 •HR 5294 IH (3) in paragraph (2)(B), by inserting ‘‘sexual 1 orientation, gender identity,’’ before ‘‘and disability 2 status’’. 3 SEC. 111. 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. 112. 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 505E the following: 19 ‘‘SEC. 505F. 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 36 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 37 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 38 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 39 •HR 5294 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 ‘‘(cc) 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 505F.’’. 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 505F’’. 17 SEC. 113. IMPROVING HEALTH DATA REGARDING NATIVE 18 HAWAIIANS AND OTHER PACIFIC ISLANDERS. 19 Part B of title III of the Public Health Service Act 20 (42 U.S.C. 243 et seq.) is amended by inserting after sec- 21 tion 317U, as added, the following: 22 ‘‘SEC. 317V. NATIVE HAWAIIAN AND OTHER PACIFIC IS- 23 LANDER HEALTH DATA. 24 ‘‘(a) DEFINITIONS.—In this section: 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 40 •HR 5294 IH ‘‘(1) COMMUNITY GROUP.—The term ‘commu- 1 nity group’ means a group of NHOPI who are orga- 2 nized at the community level, and may include a 3 church group, social service group, national advocacy 4 organization, or cultural group. 5 ‘‘(2) NONPROFIT, NONGOVERNMENTAL ORGANI- 6 ZATION.—The term ‘nonprofit, nongovernmental or- 7 ganization’ means a group of NHOPI with a dem- 8 onstrated history of addressing NHOPI issues, in- 9 cluding a NHOPI coalition. 10 ‘‘(3) DESIGNATED ORGANIZATION.—The term 11 ‘designated organization’ means an entity estab- 12 lished to represent NHOPI populations and which 13 has statutory responsibilities to provide, or has com- 14 munity support for providing, health care. 15 ‘‘(4) GOVERNMENT REPRESENTATIVES.—The 16 term ‘government representatives’ means representa- 17 tives from Hawaii, American Samoa, the Common- 18 wealth of the Northern Mariana Islands, the Fed- 19 erated States of Micronesia, Guam, the Republic of 20 Palau, and the Republic of the Marshall Islands. 21 ‘‘(5) NATIVE HAWAIIANS AND OTHER PACIFIC 22 ISLANDERS (NHOPI).—The term ‘Native Hawaiians 23 and Other Pacific Islanders’ or ‘NHOPI’ means peo- 24 ple having origins in any of the original peoples of 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 41 •HR 5294 IH American Samoa, the Commonwealth of the North- 1 ern Mariana Islands, the Federated States of Micro- 2 nesia, Guam, Hawaii, the Republic of the Marshall 3 Islands, the Republic of Palau, or any other Pacific 4 island. 5 ‘‘(6) INSULAR AREA.—The term ‘insular area’ 6 means Guam, the Commonwealth of Northern Mar- 7 iana Islands, American Samoa, the United States 8 Virgin Islands, the Federated States of Micronesia, 9 the Republic of Palau, or the Republic of the Mar- 10 shall Islands. 11 ‘‘(b) NATIONAL STRATEGY.— 12 ‘‘(1) IN GENERAL.—The Secretary, acting 13 through the Director of the National Center for 14 Health Statistics (referred to in this section as 15 ‘NCHS’) of the Centers for Disease Control and 16 Prevention, and other agencies within the Depart- 17 ment of Health and Human Services as the Sec- 18 retary determines appropriate, shall develop and im- 19 plement an ongoing and sustainable national strat- 20 egy for identifying and evaluating the health status 21 and health care needs of NHOPI populations living 22 in the continental United States, Hawaii, American 23 Samoa, the Commonwealth of the Northern Mariana 24 Islands, the Federated States of Micronesia, Guam, 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 42 •HR 5294 IH the Republic of Palau, and the Republic of the Mar- 1 shall Islands. 2 ‘‘(2) CONSULTATION.—In developing and imple- 3 menting a national strategy, as described in para- 4 graph (1), not later than 180 days after the date of 5 enactment of the Health Equity and Accountability 6 Act of 2014, the Secretary— 7 ‘‘(A) shall consult with representatives of 8 community groups, designated organizations, 9 and nonprofit, nongovernmental organizations 10 and with government representatives of NHOPI 11 populations; and 12 ‘‘(B) may solicit the participation of rep- 13 resentatives from other Federal departments. 14 ‘‘(c) PRELIMINARY HEALTH SURVEY.— 15 ‘‘(1) IN GENERAL.—The Secretary, acting 16 through the Director of NCHS, shall conduct a pre- 17 liminary health survey in order to identify the major 18 areas and regions in the continental United States, 19 Hawaii, American Samoa, the Commonwealth of the 20 Northern Mariana Islands, the Federated States of 21 Micronesia, Guam, the Republic of Palau, and the 22 Republic of the Marshall Islands in which NHOPI 23 people reside. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 43 •HR 5294 IH ‘‘(2) CONTENTS.—The health survey described 1 in paragraph (1) shall include health data and any 2 other data the Secretary determines to be— 3 ‘‘(A) useful in determining health status 4 and health care needs; or 5 ‘‘(B) required for developing or imple- 6 menting a national strategy. 7 ‘‘(3) METHODOLOGY.—Methodology for the 8 health survey described in paragraph (1), including 9 plans for designing questions, implementation, sam- 10 pling, and analysis, shall be developed in consulta- 11 tion with community groups, designated organiza- 12 tions, nonprofit, nongovernmental organizations, and 13 government representatives of NHOPI populations, 14 as determined by the Secretary. 15 ‘‘(4) TIMEFRAME.—The survey required under 16 this subsection shall be completed not later than 18 17 months after the date of enactment of the Health 18 Equity and Accountability Act of 2014. 19 ‘‘(d) PROGRESS REPORT.—Not later than 2 years 20 after the date of enactment of the Health Equity and Ac- 21 countability Act of 2014, the Secretary shall submit to 22 Congress a progress report, which shall include the na- 23 tional strategy described in subsection (b)(1). 24 ‘‘(e) STUDY AND REPORT BY THE IOM.— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 44 •HR 5294 IH ‘‘(1) IN GENERAL.—The Secretary shall enter 1 into an agreement with the Institute of Medicine to 2 conduct a study, with input from stakeholders in in- 3 sular areas, on the following: 4 ‘‘(A) The standards and definitions of 5 health care applied to health care systems in in- 6 sular areas and the appropriateness of such 7 standards and definitions. 8 ‘‘(B) The status and performance of health 9 care systems in insular areas, evaluated based 10 upon standards and definitions, as the Sec- 11 retary determines. 12 ‘‘(C) The effectiveness of donor aid in ad- 13 dressing health care needs and priorities in in- 14 sular areas. 15 ‘‘(D) The progress toward implementation 16 of recommendations of the Committee on 17 Health Care Services in the United States—As- 18 sociated Pacific Basin of the Institute of Medi- 19 cine that are set forth in the 1998 report, ‘Pa- 20 cific Partnerships for Health: Charting a New 21 Course for the 21st Century’. 22 ‘‘(2) REPORT.—An agreement described in 23 paragraph (1) shall require the Institute of Medicine 24 to submit to the Secretary and to Congress, not 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 45 •HR 5294 IH later than 2 years after the date of the enactment 1 of the Health Equity and Accountability Act of 2 2014, a report containing a description of the results 3 of the study conducted under paragraph (1), includ- 4 ing the conclusions and recommendations of the In- 5 stitute of Medicine for each of the items described 6 in subparagraphs (A) through (D) of such para- 7 graph. 8 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—To 9 carry out this section, there are authorized to be appro- 10 priated such sums as may be necessary for fiscal years 11 2015 through 2020.’’. 12 SEC. 114. CLARIFICATION OF SIMPLIFIED ADMINISTRATIVE 13 REPORTING REQUIREMENT. 14 Section 11(a) of the Food and Nutrition Act of 2008 15 (7 U.S.C. 2020(a)) is amended by adding at the end the 16 following: 17 ‘‘(5) SIMPLIFIED ADMINISTRATIVE REPORTING 18 REQUIREMENT.—The administrative notification re- 19 quirement under section 421(e)(2) of the Personal 20 Responsibility and Work Opportunity Reconciliation 21 Act of 1996 (8 U.S.C. 1631(e)(2)) shall be satisfied 22 by the submission by an agency of a report on the 23 aggregate number of exceptions granted under such 24 section by such agency in each year.’’. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 46 •HR 5294 IH TITLE II—CULTURALLY AND LIN- 1 GUISTICALLY APPROPRIATE 2 HEALTH CARE 3 SEC. 201. DEFINITIONS. 4 In this title, the definitions contained in section 3400 5 of the Public Health Service Act, as added by section 202, 6 shall apply. 7 SEC. 202. AMENDMENT TO THE PUBLIC HEALTH SERVICE 8 ACT. 9 (a) FINDINGS.—Congress finds the following: 10 (1) Effective communication is essential to 11 meaningful access to quality physical and mental 12 health care. 13 (2) Research indicates that the lack of appro- 14 priate language services creates language barriers 15 that result in increased risk of misdiagnosis, ineffec- 16 tive treatment plans and poor health outcomes for 17 limited-English-proficient individuals and individuals 18 with communication disabilities such as hearing, vi- 19 sion, or print impairments. 20 (3) The number of limited-English-speaking 21 residents in the United States who speak English 22 less than very well and, therefore, cannot effectively 23 communicate with health and social service providers 24 continues to increase significantly. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 47 •HR 5294 IH (4) The responsibility to fund language services 1 in the provision of health care and health-care-re- 2 lated services to limited-English-proficient individ- 3 uals and individuals with communication disabilities 4 such as hearing, vision, or print impairments is a so- 5 cietal one that cannot fairly be visited solely upon 6 the health care, public health, or social services com- 7 munity. 8 (5) Title VI of the Civil Rights Act of 1964 9 prohibits discrimination based on the grounds of 10 race, color, or national origin by any entity receiving 11 Federal financial assistance. In order to avoid dis- 12 crimination on the grounds of national origin, all 13 programs or activities administered by the Depart- 14 ment must take adequate steps to ensure that their 15 policies and procedures do not deny or have the ef- 16 fect of denying limited-English-proficient individuals 17 with equal access to benefits and services for which 18 such persons qualify. 19 (6) Linguistic diversity in the health care and 20 health-care-related-services workforce is important 21 for providing all patients the environment most con- 22 ducive to positive health outcomes. 23 (7) All members of the health care and health- 24 care-related-services community should continue to 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 48 •HR 5294 IH educate their staff and constituents about limited- 1 English-proficient and disability communication 2 issues and help them identify resources to improve 3 access to quality care for limited-English-proficient 4 individuals and individuals with communication dis- 5 abilities such as hearing, vision, or print impair- 6 ments. 7 (8) Access to English as a second language and 8 sign language instructions is an important mecha- 9 nism for ensuring effective communication and elimi- 10 nating the language barriers that impede access to 11 health care. 12 (9) Competent language services in health care 13 settings should be available as a matter of course. 14 (b) AMENDMENT.—The Public Health Service Act 15 (42 U.S.C. 201 et seq.) is amended by adding at the end 16 the following: 17 ‘‘TITLE XXXIV—CULTURALLY 18 AND LINGUISTICALLY APPRO- 19 PRIATE HEALTH CARE 20 ‘‘SEC. 3400. DEFINITIONS. 21 ‘‘In this title: 22 ‘‘(1) BILINGUAL.—The term ‘bilingual’ with re- 23 spect to an individual means a person who has suffi- 24 cient degree of proficiency in two languages. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 49 •HR 5294 IH ‘‘(2) COMMUNITY HEALTH WORKER.—The term 1 ‘community health worker’ includes a community 2 health advocate, a lay health educator, a community 3 health representative, a peer health promoter, a 4 community health outreach worker, and in Spanish, 5 promotores de salud. 6 ‘‘(3) COMPETENT INTERPRETER SERVICES.— 7 The term ‘competent interpreter services’ means a 8 translanguage rendition of a spoken or signed mes- 9 sage in which the interpreter— 10 ‘‘(A) comprehends the source language and 11 can communicate comprehensively in the target 12 language to convey the meaning intended in the 13 source language; and 14 ‘‘(B) knows health and health-related ter- 15 minology and provides accurate interpretations 16 by choosing equivalent expressions that convey 17 the best matching and meaning to the source 18 language and capture, to the greatest possible 19 extent, all nuances intended in the source mes- 20 sage. 21 ‘‘(4) COMPETENT TRANSLATION SERVICES.— 22 The term ‘competent translation services’ means a 23 translanguage rendition of a written document in 24 which the translator— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 50 •HR 5294 IH ‘‘(A) comprehends the source language and 1 can write or sign comprehensively in the target 2 language to convey the meaning intended in the 3 source language; and 4 ‘‘(B) knows health and health-related ter- 5 minology and provides accurate translations by 6 choosing equivalent expressions that convey the 7 best matching and meaning to the source lan- 8 guage and capture, to the greatest possible ex- 9 tent, all nuances intended in the source docu- 10 ment. 11 ‘‘(5) CULTURAL COMPETENCE.—The term ‘cul- 12 tural competence’ means a set of congruent behav- 13 iors, attitudes, and policies that come together in a 14 system, agency, or among professionals that enables 15 effective work in cross-cultural situations. In the 16 preceding sentence— 17 ‘‘(A) the term ‘cultural’ refers to inte- 18 grated patterns of human behavior that include 19 the language, thoughts, communications, ac- 20 tions, customs, beliefs, values, and institutions 21 of racial, ethnic, religious, or social groups, in- 22 cluding lesbian, gay, bisexual, transgender, and 23 intersex individuals, and individuals with phys- 24 ical and mental disabilities; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 51 •HR 5294 IH ‘‘(B) the term ‘competence’ implies having 1 the capacity to function effectively as an indi- 2 vidual and an organization within the context of 3 the cultural beliefs, behaviors, and needs pre- 4 sented by consumers and their communities. 5 ‘‘(6) EFFECTIVE COMMUNICATION.—The term 6 ‘effective communication’ means an exchange of in- 7 formation between the provider of health care or 8 health-care-related services and the recipient of such 9 services who is limited in English proficiency, or has 10 a communication impairment such as a hearing, vi- 11 sion, or learning impairment, that enables access, 12 understanding, and benefit from health care or 13 health-care-related services, and full participation in 14 the development of their treatment plan. 15 ‘‘(7) GRIEVANCE RESOLUTION PROCESS.—The 16 term ‘grievance resolution process’ means all aspects 17 of dispute resolution including filing complaints, 18 grievance and appeal procedures, and court action. 19 ‘‘(8) HEALTH CARE GROUP.—The term ‘health 20 care group’ means a group of physicians organized, 21 at least in part, for the purposes of providing physi- 22 cians’ services under the Medicaid, SCHIP, or Medi- 23 care programs and may include a hospital and any 24 other individual or entity furnishing services covered 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 52 •HR 5294 IH under the Medicaid, SCHIP, or Medicare programs 1 that is affiliated with the health care group. 2 ‘‘(9) HEALTHCARE SERVICES.—The term 3 ‘health care services’ means services that address 4 physical as well as mental health conditions in all 5 care settings. 6 ‘‘(10) HEALTH-CARE-RELATED SERVICES.—The 7 term ‘health-care-related services’ means human or 8 social services programs or activities that provide ac- 9 cess, referrals or links to health care. 10 ‘‘(11) INDIAN TRIBE.—The term ‘Indian tribe’ 11 means any Indian tribe, band, nation, or other orga- 12 nized group or community, including any Alaska Na- 13 tive village or group or regional or village corpora- 14 tion as defined in or established pursuant to the 15 Alaska Native Claims Settlement Act (85 Stat. 688) 16 (43 U.S.C. 1601 et seq.), which is recognized as eli- 17 gible for the special programs and services provided 18 by the United States to Indians because of their sta- 19 tus as Indians. 20 ‘‘(12) INTEGRATED HEALTH CARE DELIVERY 21 SYSTEM.—The term ‘integrated health care delivery 22 system’ means an interdisciplinary system that 23 brings together providers from the primary health, 24 mental health, substance use and related disciplines 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 53 •HR 5294 IH to improve the health outcomes of an individual. 1 Providers may include but are not limited to hos- 2 pitals, health, mental health or substance use clinics 3 and providers, home health agencies, ambulatory 4 surgery centers, skilled nursing facilities, rehabilita- 5 tion centers, and employed, independent, or con- 6 tracted physicians. 7 ‘‘(13) INTERPRETING/INTERPRETATION.—The 8 terms ‘interpreting’ and ‘interpretation’ mean the 9 transmission of a spoken, written, or signed message 10 from one language or format into another, faithfully, 11 accurately, and objectively. 12 ‘‘(14) LANGUAGE ACCESS.—The term ‘language 13 access’ means the provision of language services to 14 an LEP individual or individual with communication 15 disabilities designed to enhance that individual’s ac- 16 cess to, understanding of, or benefit from health 17 care or health-care-related services. 18 ‘‘(15) LANGUAGE OR LANGUAGE ACCESS SERV- 19 ICES.—The term ‘language or language access serv- 20 ices’ means provision of health care services directly 21 in a non-English language, interpretation, trans- 22 lation, signage, video recording, and English or non- 23 English alternative formats. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 54 •HR 5294 IH ‘‘(16) LEP.—The term ‘LEP’ means limited- 1 English-proficient. 2 ‘‘(17) MEDICARE, MEDICAID, AND SCHIP.—The 3 terms ‘Medicare’, ‘Medicaid’, and ‘SCHIP’ mean the 4 respective programs under titles XVIII, XIX, and 5 XXI of the Social Security Act. 6 ‘‘(18) MINORITY.— 7 ‘‘(A) IN GENERAL.—The terms ‘minority’ 8 and ‘minorities’ refer to individuals from a mi- 9 nority group. 10 ‘‘(B) POPULATIONS.—The term ‘minority’, 11 with respect to populations, refers to racial and 12 ethnic minority groups. 13 ‘‘(19) MINORITY GROUP.—The term ‘minority 14 group’ has the meaning given the term ‘racial and 15 ethnic minority group’. 16 ‘‘(20) RACIAL AND ETHNIC MINORITY GROUP.— 17 The term ‘racial and ethnic minority group’ means 18 American Indians and Alaska Natives, African- 19 Americans (including Caribbean Blacks, Africans, 20 and other Blacks), Asian-Americans, Hispanics (in- 21 cluding Latinos), and Native Hawaiians and other 22 Pacific Islanders. 23 ‘‘(21) ONSITE INTERPRETATION.—The term 24 ‘onsite interpretation’ means a method of inter- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 55 •HR 5294 IH preting or interpretation for which the interpreter is 1 in the physical presence of the provider of health 2 care or health-care-related services and the recipient 3 of such services who is limited in English proficiency 4 or has a communication impairment such as hear- 5 ing, vision, or learning. 6 ‘‘(22) SECRETARY.—The term ‘Secretary’ 7 means the Secretary of Health and Human Services. 8 ‘‘(23) SIGHT TRANSLATION.—The term ‘sight 9 translation’ means the transmission of a written 10 message in one language into a spoken or signed 11 message in another language, or an alternative for- 12 mat in English or another language. 13 ‘‘(24) STATE.—The term ‘State’ means each of 14 the several States, the District of Columbia, the 15 Commonwealth of Puerto Rico, the Indian tribes, 16 the United States Virgin Islands, Guam, American 17 Samoa, and the Commonwealth of the Northern 18 Mariana Islands. 19 ‘‘(25) TELEPHONIC INTERPRETATION.—The 20 term ‘telephonic interpretation’ (also known as over 21 the phone interpretation or OPI) means a method of 22 interpreting/interpretation for which the interpreter 23 is not in the physical presence of the provider of 24 health care or related services and the limited- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00055 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 56 •HR 5294 IH English-proficient recipient of such services but is 1 connected via telephone. 2 ‘‘(26) TRANSLATION.—The term ‘translation’ 3 means the transmission of a written message in one 4 language into a written or signed message in an- 5 other language, and includes translation into an- 6 other language or alternative format, such as large 7 print font, Braille, audio recording, or CD. 8 ‘‘(27) VIDEO INTERPRETATION.—The term 9 ‘video interpretation’ means a method of inter- 10 preting/interpretation for which the interpreter is 11 not in the physical presence of the provider of health 12 care or related services and the limited-English-pro- 13 ficient recipient of such services but is connected via 14 a video hook-up that includes both audio and video 15 transmission. 16 ‘‘(28) VITAL DOCUMENT.—The term ‘vital doc- 17 ument’ includes but is not limited to applications for 18 government programs that provide health care serv- 19 ices, medical or financial consent forms, financial as- 20 sistance documents, letters containing important in- 21 formation regarding patient instructions (such as 22 prescriptions, referrals to other providers, and dis- 23 charge plans) and participation in a program (such 24 as a Medicaid managed care program), notices per- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 57 •HR 5294 IH taining to the reduction, denial, or termination of 1 services or benefits, notices of the right to appeal 2 such actions, and notices advising limited-English- 3 proficient individuals and individuals with commu- 4 nication disabilities of the availability of free lan- 5 guage services, alternative formats, and other out- 6 reach materials. 7 ‘‘SEC. 3401. IMPROVING ACCESS TO SERVICES FOR INDIVID- 8 UALS WITH LIMITED ENGLISH PROFICIENCY. 9 ‘‘(a) PURPOSE.—As provided in Executive Order 10 13166, it is the purpose of this section— 11 ‘‘(1) to improve Federal agency performance re- 12 garding access to federally conducted and federally 13 assisted programs and activities for individuals who 14 are limited in their English proficiency; 15 ‘‘(2) to require each Federal agency to examine 16 the services it provides and develop and implement 17 a system by which limited-English-proficient individ- 18 uals can obtain cultural competence and meaningful 19 access to those services consistent with, and without 20 substantially burdening, the fundamental mission of 21 the agency; 22 ‘‘(3) to require each Federal agency to ensure 23 that recipients of Federal financial assistance pro- 24 vide cultural competence and meaningful access to 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 58 •HR 5294 IH their limited-English-proficient applicants and bene- 1 ficiaries; 2 ‘‘(4) to ensure that recipients of Federal finan- 3 cial assistance take reasonable steps, consistent with 4 the guidelines set forth in the Limited English Pro- 5 ficient Guidance of the Department of Justice (as 6 issued on June 12, 2002), to ensure cultural com- 7 petence and meaningful access to their programs 8 and activities by limited-English-proficient individ- 9 uals; and 10 ‘‘(5) to ensure compliance with title VI of the 11 Civil Rights Act of 1964 and that health care pro- 12 viders and organizations do not discriminate in the 13 provision of services. 14 ‘‘(b) FEDERALLY CONDUCTED PROGRAMS AND AC- 15 TIVITIES.— 16 ‘‘(1) IN GENERAL.—Not later than 120 days 17 after the date of enactment of this title, each Fed- 18 eral agency that carries out health-care-related ac- 19 tivities shall prepare a plan to improve access cul- 20 tural competence to the federally conducted, health- 21 care-related programs and activities of the agency by 22 limited-English-proficient individuals. Not later than 23 one year after the date of enactment of this title, 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 59 •HR 5294 IH each such Federal agency shall ensure that such 1 plan is fully implemented. 2 ‘‘(2) PLAN REQUIREMENT.—Each plan under 3 paragraph (1) shall include— 4 ‘‘(A) the steps the agency will take to en- 5 sure that limited-English-proficient individuals 6 have access to the agency’s federally conducted 7 health care and health-care-related programs 8 and activities; 9 ‘‘(B) the policies and procedures for identi- 10 fying, assessing, and meeting the language 11 needs and cultural competence needs of its lim- 12 ited-English-proficient beneficiaries served by 13 federally conducted programs and activities; 14 ‘‘(C) the steps the agency will take for its 15 federally conducted programs and activities to 16 improve cultural competence to provide a range 17 of language assistance options, notice to lim- 18 ited-English-proficient individuals of the right 19 to competent language services, periodic train- 20 ing of staff, monitoring and quality assessment 21 of the language services and, in appropriate cir- 22 cumstances, the translation of written mate- 23 rials; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 60 •HR 5294 IH ‘‘(D) the steps the agency will take to en- 1 sure that applications, forms, and other rel- 2 evant documents for its federally conducted pro- 3 grams and activities are competently translated 4 into the primary language of a limited-English- 5 proficient client where such materials are need- 6 ed to improve access to federally conducted and 7 federally assisted programs and activities for 8 such a limited-English-proficient individual; 9 ‘‘(E) the resources the agency will provide 10 to improve cultural competence to assist recipi- 11 ents of Federal funds to improve access to 12 health care or health-care-related programs and 13 activities for limited-English-proficient individ- 14 uals; 15 ‘‘(F) the resources the agency will provide 16 to ensure that competent language assistance is 17 provided to limited-English-proficient patients 18 by interpreters or trained bilingual staff; and 19 ‘‘(G) the resources the agency will provide 20 to ensure that family, particularly minor chil- 21 dren, and friends are not used to provide inter- 22 pretation services, except— 23 ‘‘(i) in the case of a medical emer- 24 gency where delay directly associated with 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 61 •HR 5294 IH obtaining a competent interpreter would 1 jeopardize the health of the patient; or 2 ‘‘(ii) on request of the patient, who 3 has been informed in his or her preferred 4 language of the availability of free inter- 5 pretation services, if the health care serv- 6 ices provider has determined that the fam- 7 ily or friend can provide competent inter- 8 preter services as defined in section 3400. 9 ‘‘(3) SUBMISSION OF PLAN TO DOJ.—Each 10 agency that is required to prepare a plan under 11 paragraph (1) shall send a copy of such plan to the 12 Department of Justice, which shall serve as the cen- 13 tral repository of such plans. 14 ‘‘(4) RULE OF CONSTRUCTION.—Paragraph 15 (2)(G)(i) shall not be construed to mean that emer- 16 gency rooms or similar entities that regularly pro- 17 vide health care services in medical emergencies are 18 exempt from legal or regulatory requirements related 19 to competent interpreter services. 20 ‘‘(c) FEDERALLY ASSISTED PROGRAMS AND ACTIVI- 21 TIES.— 22 ‘‘(1) IN GENERAL.—Not later than 120 days 23 after the date of enactment of this title, each Fed- 24 eral agency providing health-care-related Federal fi- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 62 •HR 5294 IH nancial assistance shall ensure that the guidance for 1 recipients of Federal financial assistance developed 2 by the agency to ensure compliance with title VI of 3 the Civil Rights Act of 1964 (42 U.S.C. 2000d et 4 seq.) is specifically tailored to the recipients of such 5 assistance. Each agency shall send a copy of such 6 guidance to the Department of Justice which shall 7 serve as the central repository of the agency’s plans. 8 After approval by the Department of Justice, each 9 agency shall publish its guidance document in the 10 Federal Register for public comment. 11 ‘‘(2) REQUIREMENTS.—The agency-specific 12 guidance developed under paragraph (1) shall take 13 into account the types of health care services pro- 14 vided by the recipients, the individuals served by the 15 recipients, and other factors set out in such stand- 16 ards. 17 ‘‘(3) EXISTING GUIDANCES.—A Federal agency 18 that has developed a guidance for purposes of title 19 VI of the Civil Rights Act of 1964 shall examine 20 such existing guidance, as well as the programs and 21 activities to which such guidance applies, to deter- 22 mine if modification of such guidance is necessary to 23 comply with this subsection. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00062 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 63 •HR 5294 IH ‘‘(4) CONSULTATION.—Each Federal agency 1 shall consult with the Department of Justice in es- 2 tablishing the guidances under this subsection. 3 ‘‘(d) CONSULTATIONS.— 4 ‘‘(1) IN GENERAL.—In carrying out this sec- 5 tion, each Federal agency that carriers out health 6 care and health-care-related activities shall ensure 7 that stakeholders, such as limited-English-proficient 8 individuals and their representative organizations, 9 recipients of Federal assistance, and other appro- 10 priate individuals or entities, have an adequate op- 11 portunity to provide input with respect to the actions 12 of the agency. 13 ‘‘(2) EVALUATION.—Each Federal agency de- 14 scribed in paragraph (1) shall evaluate the— 15 ‘‘(A) particular needs of the limited- 16 English-proficient individuals served by the 17 agency; 18 ‘‘(B) particular needs of the limited- 19 English-proficient individuals served by the 20 agency’s recipients of Federal financial assist- 21 ance; and 22 ‘‘(C) burdens of compliance with the agen- 23 cy guidance and this section for the agency and 24 its recipients. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 64 •HR 5294 IH ‘‘SEC. 3402. NATIONAL STANDARDS FOR CULTURALLY AND 1 LINGUISTICALLY APPROPRIATE SERVICES IN 2 HEALTH CARE. 3 ‘‘(a) APPLICABILITY.—This section applies to any 4 health program or activity, any part of which is receiving 5 Federal financial assistance, including credits, subsidies, 6 or contracts of insurance, or any program or activity that 7 is administered by an executive agency or any entity estab- 8 lished under title I of the Patient Protection and Afford- 9 able Care Act (or amendments made thereby), as such 10 programs, activities, agencies, and entities are described 11 in section 1557(a) of the Patient Protection and Afford- 12 able Care Act. 13 ‘‘(b) STANDARDS.—The programs, activities, agen- 14 cies, and entities described in subsection (a) shall— 15 ‘‘(1) implement strategies to recruit, retain, and 16 promote individuals at all levels to maintain a di- 17 verse staff and leadership that can provide culturally 18 and linguistically appropriate health care to patient 19 populations of the service area of the programs, ac- 20 tivities, agencies, and entities; 21 ‘‘(2) educate and train governance, leadership, 22 and workforce at all levels and across all disciplines 23 of the programs, activities, agencies, and entities in 24 culturally and linguistically appropriate policies and 25 practices on an ongoing basis; 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 65 •HR 5294 IH ‘‘(3) offer and provide language assistance, in- 1 cluding trained bilingual staff and interpreter serv- 2 ices, to individuals who have limited-English pro- 3 ficiency or other communication needs, at no cost to 4 them at all points of contact, and during all hours 5 of operation, to facilitate timely access to all health 6 care and services; 7 ‘‘(4) notify patients, in a culturally appropriate 8 manner, of their right to receive language assistance 9 services in their primary language, verbally and in 10 writing; 11 ‘‘(5) ensure the competence of language assist- 12 ance provided to limited-English-proficient patients 13 by interpreters and bilingual staff, and ensure that 14 family, particularly minor children, and friends are 15 not used to provide interpretation services— 16 ‘‘(A) except in case of emergency; or 17 ‘‘(B) except on request of the patient, who 18 has been informed in his or her preferred lan- 19 guage of the availability of free interpretation 20 services if the health care services provider has 21 determined that the family or friend can pro- 22 vide competent interpreter services as defined in 23 section 3400; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 66 •HR 5294 IH ‘‘(6) for each eligible LEP language group that 1 constitutes 5 percent or 500 individuals, whichever 2 is less, of the population of persons eligible to be 3 served or likely to be affected or encountered in the 4 service area of the organization, make available— 5 ‘‘(A) easily understood patient-related ma- 6 terials, including print and multimedia mate- 7 rials; 8 ‘‘(B) information or notices about termi- 9 nation of benefits; and 10 ‘‘(C) signage; 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 and in- 15 fuse them throughout the organization’s planning 16 and operations; 17 ‘‘(8) conduct initial and ongoing organizational 18 assessments of culturally and linguistically appro- 19 priate services-related activities and integrate valid 20 linguistic, competence-related National Standards 21 for Culturally and Linguistically Appropriate Serv- 22 ices (CLAS) measures into the internal audits, per- 23 formance improvement programs, patient satisfac- 24 tion assessments, continuous quality improvement 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 67 •HR 5294 IH activities, and outcomes-based evaluations of the or- 1 ganization and develop ways to standardize the as- 2 sessments; 3 ‘‘(9) ensure that, consistent with the privacy 4 protections provided for under the regulations pro- 5 mulgated under section 264(c) of the Health Insur- 6 ance Portability and Accountability Act of 1996, 7 data on an individual required to be collected pursu- 8 ant to section 3101, including the individual’s alter- 9 native format preferences and policy modification 10 needs, are— 11 ‘‘(A) collected in health records; 12 ‘‘(B) integrated into the organization’s 13 management information systems; and 14 ‘‘(C) periodically updated; 15 ‘‘(10) maintain a current demographic, cultural, 16 and epidemiological profile of the community, con- 17 duct regular assessments of community health assets 18 and needs, and use the results to accurately plan for 19 and implement services that respond to the cultural 20 and linguistic characteristics of the service area of 21 the organization; 22 ‘‘(11) develop participatory, collaborative part- 23 nerships with communities and utilize a variety of 24 formal and informal mechanisms to facilitate com- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 68 •HR 5294 IH munity and patient involvement in designing, imple- 1 menting, and evaluating policies and practices to en- 2 sure culturally and linguistically appropriate service- 3 related activities; 4 ‘‘(12) ensure that conflict and grievance resolu- 5 tion processes are culturally and linguistically sen- 6 sitive and capable of identifying, preventing, and re- 7 solving cross-cultural conflicts or complaints by pa- 8 tients; 9 ‘‘(13) regularly make available to the public in- 10 formation about their progress and successful inno- 11 vations in implementing the standards under this 12 section and provide public notice in their commu- 13 nities about the availability of this information; and 14 ‘‘(14) if requested, regularly make available to 15 the head of each Federal entity from which Federal 16 funds are received, information about their progress 17 and successful innovations in implementing the 18 standards under this section as required by the head 19 of such entity. 20 ‘‘SEC. 3403. ROBERT T. MATSUI CENTER FOR CULTURAL 21 AND LINGUISTIC COMPETENCE IN HEALTH 22 CARE. 23 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 24 through the Director of the Agency for Healthcare Re- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00068 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 69 •HR 5294 IH search and Quality, shall establish and support a center 1 to be known as the ‘Robert T. Matsui Center for Cultural 2 and Linguistic Competence in Health Care’ (referred to 3 in this section as the ‘Center’) to carry out the following 4 activities: 5 ‘‘(1) INTERPRETATION SERVICES.—The Center 6 shall provide resources via the Internet to identify 7 and link health care providers to competent inter- 8 preter and translation services. 9 ‘‘(2) TRANSLATION OF WRITTEN MATERIAL.— 10 ‘‘(A) The Center shall provide, directly or 11 through contract, vital documents from com- 12 petent translation services for providers of 13 health care and health-care-related services at 14 no cost to such providers. Materials may be 15 submitted for translation into non-English lan- 16 guages. Translation services shall be provided 17 in a timely and reasonable manner. The quality 18 of such translation services shall be monitored 19 and reported publicly. 20 ‘‘(B) For each form developed or revised 21 by the Secretary that will be used by LEP indi- 22 viduals in health care or health-care-related set- 23 tings, the Center shall translate the form, at a 24 minimum, into the top 15 non-English lan- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 70 •HR 5294 IH guages in the United States according to the 1 most recent data from the American Commu- 2 nity Survey or its replacement. The translation 3 must be completed within 45 days of the Sec- 4 retary receiving final approval of the form from 5 the Office of Management and Budget. 6 ‘‘(3) TOLL-FREE CUSTOMER SERVICE TELE- 7 PHONE NUMBER.—The Center shall provide, 8 through a toll-free number, a customer service line 9 for LEP individuals— 10 ‘‘(A) to obtain information about federally 11 conducted or funded health programs, including 12 Medicare, Medicaid, and SCHIP; 13 ‘‘(B) to obtain assistance with applying for 14 or accessing these programs and understanding 15 Federal notices written in English; and 16 ‘‘(C) to learn how to access language serv- 17 ices. 18 ‘‘(4) HEALTH INFORMATION CLEARING- 19 HOUSE.— 20 ‘‘(A) IN GENERAL.—The Center shall de- 21 velop and maintain an information clearing- 22 house to facilitate the provision of language 23 services by providers of health care and health- 24 care-related services to reduce medical errors, 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 71 •HR 5294 IH improve medical outcomes, to improve cultural 1 competence, reduce health care costs caused by 2 miscommunication with individuals with lim- 3 ited-English proficiency, and reduce or elimi- 4 nate the duplication of effort to translate mate- 5 rials. The clearinghouse shall make such infor- 6 mation available on the Internet and in print. 7 Such information shall include the information 8 described in the succeeding provisions of this 9 paragraph. 10 ‘‘(B) DOCUMENT TEMPLATES.—The Cen- 11 ter shall collect and evaluate for accuracy, de- 12 velop, and make available templates for stand- 13 ard documents that are necessary for patients 14 and consumers to access and make educated de- 15 cisions about their health care, including the 16 following: 17 ‘‘(i) Administrative and legal docu- 18 ments, including— 19 ‘‘(I) intake forms; 20 ‘‘(II) Medicare, Medicaid, and 21 SCHIP forms, including eligibility in- 22 formation; 23 ‘‘(III) forms informing patient of 24 HIPAA compliance and consent; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00071 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 72 •HR 5294 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.—In 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00072 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 73 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 74 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 75 •HR 5294 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) AVAILABILITY OF LANGUAGE ACCESS.—The Di- 7 rector shall collaborate with the Deputy Assistant Sec- 8 retary for Minority Health, the Administrator of the Cen- 9 ters for Medicare & Medicaid Services, and the Adminis- 10 trator of the Health Resources and Services Administra- 11 tion to notify health care providers and health care organi- 12 zations about the availability of language access services 13 by the Center. 14 ‘‘(d) EDUCATION.—The Secretary, directly or 15 through contract, shall undertake a national education 16 campaign to inform providers, LEP individuals, health 17 professionals, graduate schools, and community health 18 centers about— 19 ‘‘(1) Federal and State laws and guidelines gov- 20 erning access to language services; 21 ‘‘(2) the value of using trained interpreters and 22 the risks associated with using family members, 23 friends, minors, and untrained bilingual staff; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 76 •HR 5294 IH ‘‘(3) funding sources for developing and imple- 1 menting language services; and 2 ‘‘(4) promising practices to effectively provide 3 language services. 4 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—In ad- 5 dition to the amounts authorized under subsection 6 (e)(8)(F), there are authorized to be appropriated to carry 7 out this section such sums as may be necessary for each 8 of fiscal years 2015 through 2019. 9 ‘‘SEC. 3404. INNOVATIONS IN CULTURAL AND LINGUISTIC 10 COMPETENCE GRANTS. 11 ‘‘(a) IN GENERAL.—The Secretary, acting through 12 the Director of the Agency for Healthcare Research and 13 Quality, shall award grants to eligible entities to enable 14 such entities to design, implement, and evaluate innova- 15 tive, cost-effective programs to improve cultural com- 16 petence and language access in health care for individuals 17 with limited-English proficiency. The Director of the 18 Agency for Healthcare Research and Quality shall coordi- 19 nate with, and ensure the participation of, other agencies 20 including the Health Resources and Services Administra- 21 tion, the Center on Minority Health and Health Dispari- 22 ties at the National Institutes of Health, and the Office 23 of Minority Health, regarding the design and evaluation 24 of the grants program. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 77 •HR 5294 IH ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 1 under subsection (a) an entity shall— 2 ‘‘(1) be— 3 ‘‘(A) a city, county, Indian tribe, State, 4 territory, or subdivision thereof; 5 ‘‘(B) an organization described in section 6 501(c)(3) of the Internal Revenue Code of 1986 7 and exempt from tax under section 501(a) of 8 such Code; 9 ‘‘(C) a community health, mental health, 10 or substance use center or clinic; 11 ‘‘(D) a solo or group physician practice; 12 ‘‘(E) an integrated health care delivery 13 system; 14 ‘‘(F) a public hospital; 15 ‘‘(G) a health care group, university, or 16 college; or 17 ‘‘(H) other entity designated by the Sec- 18 retary; and 19 ‘‘(2) prepare and submit to the Secretary an 20 application, at such time, in such manner, and ac- 21 companied by such additional information as the 22 Secretary may require. 23 ‘‘(c) USE OF FUNDS.—An entity shall use funds re- 24 ceived under a grant under this section to— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 78 •HR 5294 IH ‘‘(1) develop, implement, and evaluate models of 1 providing competent interpretation services through 2 onsite interpretation, telephonic interpretation, or 3 video interpretation; 4 ‘‘(2) implement strategies to recruit, retain, and 5 promote individuals at all levels of the organization 6 to maintain a diverse staff and leadership that can 7 promote and provide language services to patient 8 populations of the service area of the organization; 9 ‘‘(3) develop and maintain a needs assessment 10 that identifies the current demographic, cultural, 11 and epidemiological profile of the community to ac- 12 curately plan for and implement language services 13 needed in service area of the organization; 14 ‘‘(4) develop a strategic plan to implement lan- 15 guage services; 16 ‘‘(5) develop participatory, collaborative part- 17 nerships with communities encompassing the LEP 18 patient populations being served to gain input in de- 19 signing and implementing language services; 20 ‘‘(6) develop and implement grievance resolu- 21 tion processes that are culturally and linguistically 22 sensitive and capable of identifying, preventing, and 23 resolving complaints by LEP individuals; or 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 79 •HR 5294 IH ‘‘(7) develop short-term medical mental health 1 interpretation training courses and incentives for bi- 2 lingual health care staff who are asked to interpret 3 in the workplace; 4 ‘‘(8) develop formal training programs, includ- 5 ing continued professional development and edu- 6 cation programs as well as supervision, for individ- 7 uals interested in becoming dedicated health care in- 8 terpreters and culturally competent providers; 9 ‘‘(9) provide staff language training instruction, 10 which shall include information on the practical limi- 11 tations of such instruction for non-native speakers; 12 ‘‘(10) develop policies that address compensa- 13 tion in salary for staff who receive training to be- 14 come either a staff interpreter or bilingual provider; 15 ‘‘(11) develop other language assistance services 16 as determined appropriate by the Secretary; 17 ‘‘(12) develop, implement, and evaluate models 18 of improving cultural competence; and 19 ‘‘(13) ensure that, consistent with the privacy 20 protections provided for under the regulations pro- 21 mulgated under section 264(c) of the Health Insur- 22 ance Portability and Accountability Act of 1996 (42 23 U.S.C. 1320d–2 note) and any applicable State pri- 24 vacy laws, data on the individual patient or recipi- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 80 •HR 5294 IH ent’s race, ethnicity, and primary language are col- 1 lected (and periodically updated) in health records 2 and integrated into the organization’s information 3 management systems or any similar system used to 4 store and retrieve data. 5 ‘‘(d) PRIORITY.—In awarding grants under this sec- 6 tion, the Secretary shall give priority to entities that pri- 7 marily engage in providing direct care and that have devel- 8 oped partnerships with community organizations or with 9 agencies with experience in improving language access. 10 ‘‘(e) EVALUATION.— 11 ‘‘(1) BY GRANTEES.—An entity that receives a 12 grant under this section shall submit to the Sec- 13 retary an evaluation that describes, in the manner 14 and to the extent required by the Secretary, the ac- 15 tivities carried out with funds received under the 16 grant, and how such activities improved access to 17 health and health-care-related services and the qual- 18 ity of health care for individuals with limited-English 19 proficiency. Such evaluation shall be collected and 20 disseminated through the Robert T. Matsui Center 21 for Cultural and Linguistic Competence in Health 22 Care established under section 3403. The Director 23 of the Agency for Healthcare Research and Quality 24 shall notify grantees of the availability of technical 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 81 •HR 5294 IH assistance for the evaluation and provide such assist- 1 ance upon request. 2 ‘‘(2) BY SECRETARY.—The Director of the 3 Agency for Healthcare Research and Quality shall 4 evaluate or arrange with other individuals or organi- 5 zations to evaluate projects funded under this sec- 6 tion. 7 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 8 is authorized to be appropriated to carry out this section, 9 $5,000,000 for each of fiscal years 2015 through 2019. 10 ‘‘SEC. 3405. RESEARCH ON CULTURAL AND LANGUAGE COM- 11 PETENCE. 12 ‘‘(a) IN GENERAL.—The Secretary, acting through 13 the Director of the Agency for Healthcare Research and 14 Quality, shall expand research concerning language access 15 in the provision of health care. 16 ‘‘(b) ELIGIBILITY.—The Director of the Agency for 17 Healthcare Research and Quality may conduct the re- 18 search described in subsection (a) or enter into contracts 19 with other individuals or organizations to do so. 20 ‘‘(c) USE OF FUNDS.—Research under this section 21 shall be designed to do one or more of the following: 22 ‘‘(1) To identify the barriers to mental and be- 23 havioral services that are faced by LEP individuals. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 82 •HR 5294 IH ‘‘(2) To identify health care providers’ and 1 health administrators’ attitudes, knowledge, and 2 awareness of the barriers to quality health care serv- 3 ices that are faced by LEP individuals. 4 ‘‘(3) To identify optimal approaches for deliv- 5 ering language access. 6 ‘‘(4) To identify best practices for data collec- 7 tion, including— 8 ‘‘(A) the collection by providers of health 9 care and health-care-related services of data on 10 the race, ethnicity, and primary language of re- 11 cipients of such services, taking into account ex- 12 isting research conducted by the Government or 13 private sector; 14 ‘‘(B) the development and implementation 15 of data collection and reporting systems; and 16 ‘‘(C) effective privacy safeguards for col- 17 lected data. 18 ‘‘(5) To develop a minimum data collection set 19 for primary language. 20 ‘‘(6) To evaluate the most effective ways in 21 which the Department can create or coordinate, and 22 then subsidize or otherwise fund telephonic interpre- 23 tation providers for health care providers, taking 24 into consideration, among other factors, the flexi- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 83 •HR 5294 IH bility necessary for such a system to accommodate 1 variations in— 2 ‘‘(A) provider type; 3 ‘‘(B) languages needed and their frequency 4 of use; 5 ‘‘(C) type of encounter; 6 ‘‘(D) time of encounter, including regular 7 business hours and after hours; and 8 ‘‘(E) location of encounter. 9 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 10 are authorized to be appropriated to carry out this section 11 such sums as may be necessary for each of fiscal years 12 2015 through 2019.’’. 13 SEC. 203. PILOT PROGRAM FOR IMPROVEMENT AND DE- 14 VELOPMENT OF STATE MEDICAL INTER- 15 PRETING SERVICES. 16 (a) GRANTS AUTHORIZED.—The Secretary shall 17 award one grant in accordance with this section to each 18 of three States to assist each such State in designing, im- 19 plementing, and evaluating a statewide program to provide 20 onsite interpreter services under Medicaid. 21 (b) GRANT PERIOD.—A grant awarded under this 22 section is authorized for a period of three fiscal years be- 23 ginning on October 1, 2014. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00083 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 84 •HR 5294 IH (c) PREFERENCE.—In awarding a grant under this 1 section, the Secretary shall give preference to a State— 2 (1) that has a high proportion of qualified LEP 3 enrollees, as determined by the Secretary; 4 (2) that has a large number of qualified LEP 5 enrollees, as determined by the Secretary; 6 (3) that has a high growth rate of the popu- 7 lation of LEP individuals, as determined by the Sec- 8 retary; and 9 (4) that has a population of qualified LEP en- 10 rollees that is linguistically diverse, requiring inter- 11 preter services in at least 200 non-English lan- 12 guages. 13 (d) USE OF FUNDS.—A State receiving a grant under 14 this section shall use the grant funds to— 15 (1) ensure that all health care providers in the 16 State participating in the State plan under Medicaid 17 have access to onsite interpreter services, for the 18 purpose of enabling effective communication between 19 such providers and qualified LEP enrollees during 20 the furnishing of items and services and administra- 21 tive interactions; 22 (2) establish, expand, procure, or contract for— 23 (A) a statewide health care information 24 technology system that is designed to achieve 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00084 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 85 •HR 5294 IH efficiencies and economies of scale with respect 1 to onsite interpreter services provided to health 2 care providers in the State participating in the 3 State plan under Medicaid; and 4 (B) an entity to administer such system, 5 the duties of which shall include— 6 (i) procuring and scheduling inter- 7 preter services for qualified LEP enrollees; 8 (ii) procuring and scheduling inter- 9 preter services for LEP individuals seeking 10 to enroll in the State plan under Medicaid; 11 (iii) ensuring that interpreters receive 12 payment for interpreter services rendered 13 under the system; and 14 (iv) consulting regularly with organi- 15 zations representing consumers, inter- 16 preters, and health care providers; and 17 (3) develop mechanisms to establish, improve, 18 and strengthen the competency of the medical inter- 19 pretation workforce that serves qualified LEP enroll- 20 ees in the State, including a national certification 21 process that is valid, credible, and vendor-neutral. 22 (e) APPLICATION.—To receive a grant under this sec- 23 tion, a State shall submit an application at such time and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 86 •HR 5294 IH containing such information as the Secretary may require, 1 which shall include the following: 2 (1) A description of the language access needs 3 of individuals in the State enrolled in the State plan 4 under Medicaid. 5 (2) A description of the extent to which the 6 program will— 7 (A) use the grant funds for the purposes 8 described in subsection (d); 9 (B) meet the health care needs of rural 10 populations of the State; and 11 (C) collect information that accurately 12 tracks the language services requested by con- 13 sumers as compared to the language services 14 provided by health care providers in the State 15 participating in the State plan under Medicaid. 16 (3) A description of how the program will be 17 evaluated, including a proposal for collaboration with 18 organizations representing interpreters, consumers, 19 and LEP individuals. 20 (f) DEFINITIONS.—In this section: 21 (1) QUALIFIED LEP ENROLLEE.—The term 22 ‘‘qualified LEP enrollee’’ means an individual— 23 (A) who is limited-English-proficient; and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00086 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 87 •HR 5294 IH (B) who is enrolled in a State plan under 1 Medicaid. 2 (2) STATE.—The term ‘‘State’’ has the mean- 3 ing given the term in section 1101(a)(1) of the So- 4 cial Security Act (42 U.S.C. 1301(a)(1)), for pur- 5 poses of title XIX of such Act. 6 (3) UNITED STATES.—The term ‘‘United 7 States’’ has the meaning given the term in section 8 1101(a)(2) of the Social Security Act (42 U.S.C. 9 1301(a)(2)), for purposes of title XIX of such Act. 10 (g) FUNDING.— 11 (1) AUTHORIZATION OF APPROPRIATIONS.— 12 There is authorized to be appropriated $5,000,000 13 to carry out this section. 14 (2) AVAILABILITY OF FUNDS.—The funds au- 15 thorized by paragraph (1) shall be available without 16 fiscal year limitation. 17 (3) INCREASED FEDERAL FINANCIAL PARTICI- 18 PATION.—Section 1903(a)(2)(E) of the Social Secu- 19 rity Act (42 U.S.C. 1396b(a)(2)(E)), as amended by 20 section 205(d)(1) of this Act, is further amended by 21 inserting ‘‘(or, in the case of a State receiving a 22 grant under section 203 of the Health Equity and 23 Accountability Act of 2014, 100 percent for each 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00087 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 88 •HR 5294 IH quarter occurring during the grant period)’’ after 1 ‘‘90 percent’’. 2 (h) LIMITATION.—No Federal funds under this sec- 3 tion may be used to provide interpreter services from a 4 location outside the United States. 5 SEC. 204. TRAINING TOMORROW’S DOCTORS FOR CUL- 6 TURALLY AND LINGUISTICALLY APPRO- 7 PRIATE CARE: GRADUATE MEDICAL EDU- 8 CATION. 9 (a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec- 10 tion 1886(h)(4) of the Social Security Act (42 U.S.C. 11 1395ww(h)(4)) is amended by adding at the end the fol- 12 lowing new subparagraph: 13 ‘‘(L) TREATMENT OF CULTURALLY COM- 14 PETENCY TRAINING.—In determining a hos- 15 pital’s number of full-time equivalent residents 16 for purposes of this subsection, all the time that 17 is spent by an intern or resident in an approved 18 medical residency training program for edu- 19 cation and training in cultural competency and 20 linguistically appropriate service delivery shall 21 be counted toward the determination of full- 22 time equivalency.’’. 23 (b) INDIRECT MEDICAL EDUCATION.—Section 24 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 89 •HR 5294 IH 1395ww(d)(5)(B)) is amended by adding at the end the 1 following new clause: 2 ‘‘(xii) The provisions of subparagraph (L) 3 of subsection (h)(4) shall apply under this sub- 4 paragraph in the same manner as they apply 5 under such subsection.’’. 6 (c) EFFECTIVE DATE.—The amendments made by 7 subsections (a) and (b) shall apply with respect to pay- 8 ments made to hospitals on or after the date that is one 9 year after the date of the enactment of this Act. 10 SEC. 205. FEDERAL REIMBURSEMENT FOR CULTURALLY 11 AND LINGUISTICALLY APPROPRIATE SERV- 12 ICES UNDER THE MEDICARE, MEDICAID, AND 13 STATE CHILDREN’S HEALTH INSURANCE 14 PROGRAMS. 15 (a) LANGUAGE ACCESS GRANTS FOR MEDICARE 16 PROVIDERS.— 17 (1) ESTABLISHMENT.— 18 (A) IN GENERAL.—Not later than 6 19 months after the date of the enactment of this 20 Act, the Secretary of Health and Human Serv- 21 ices, acting through the Centers for Medicare & 22 Medicaid Services and in consultation with the 23 Center for Medicare and Medicaid Innovation, 24 shall establish a demonstration program under 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00089 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 90 •HR 5294 IH which the Secretary shall award grants to eligi- 1 ble Medicare service providers to improve com- 2 munication between such providers and limited- 3 English-proficient Medicare beneficiaries, in- 4 cluding beneficiaries who live in diverse and un- 5 derserved communities. 6 (B) APPLICATION OF INNOVATION 7 RULES.—The demonstration project under sub- 8 paragraph (A) shall be conducted in a manner 9 that is consistent with the applicable provisions 10 of subsections (b), (c), and (d) of section 1115A 11 of the Social Security Act (42 U.S.C. 1315a). 12 (C) NUMBER OF GRANTS.—To the extent 13 practicable, the Secretary shall award not less 14 than 24 grants under this subsection. 15 (D) GRANT PERIOD.—Except as provided 16 under paragraph (2)(D), each grant awarded 17 under this subsection shall be for a 3-year pe- 18 riod. 19 (2) ELIGIBILITY REQUIREMENTS.—To be eligi- 20 ble for a grant under this subsection, an entity must 21 meet the following requirements: 22 (A) MEDICARE PROVIDER.—The entity 23 must be— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00090 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 91 •HR 5294 IH (i) a provider of services under part A 1 of title XVIII of the Social Security Act; 2 (ii) a provider of services under part 3 B of such title; 4 (iii) a Medicare Advantage organiza- 5 tion offering a Medicare Advantage plan 6 under part C of such title; or 7 (iv) a PDP sponsor offering a pre- 8 scription drug plan under part D of such 9 title. 10 (B) UNDERSERVED COMMUNITIES.—The 11 entity must serve a community that, with re- 12 spect to necessary language services for improv- 13 ing access and utilization of health care among 14 limited-English-proficient individuals, is 15 disproportionally underserved. 16 (C) APPLICATION.—The entity must pre- 17 pare and submit to the Secretary an applica- 18 tion, at such time, in such manner, and accom- 19 panied by such additional information as the 20 Secretary may require. 21 (D) REPORTING.—In the case of a grantee 22 that received a grant under this subsection in 23 a previous year, such grantee is only eligible for 24 continued payments under a grant under this 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 92 •HR 5294 IH subsection if the grantee met the reporting re- 1 quirements under paragraph (9) for such year. 2 If a grantee fails to meet the requirement of 3 such paragraph for the first year of a grant, the 4 Secretary may terminate the grant and solicit 5 applications from new grantees to participate in 6 the demonstration program. 7 (3) DISTRIBUTION.—To the extent feasible, the 8 Secretary shall award— 9 (A) at least 6 grants to providers of serv- 10 ices described in paragraph (2)(A)(i); 11 (B) at least 6 grants to service providers 12 described in paragraph (2)(A)(ii); 13 (C) at least 6 grants to organizations de- 14 scribed in paragraph (2)(A)(iii); and 15 (D) at least 6 grants to sponsors described 16 in paragraph (2)(A)(iv). 17 (4) CONSIDERATIONS IN AWARDING GRANTS.— 18 (A) VARIATION IN GRANTEES.—In award- 19 ing grants under this subsection, the Secretary 20 shall select grantees to ensure the following: 21 (i) The grantees provide many dif- 22 ferent types of language services. 23 (ii) The grantees serve Medicare bene- 24 ficiaries who speak different languages, 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 93 •HR 5294 IH and who, as a population, have differing 1 needs for language services. 2 (iii) The grantees serve Medicare 3 beneficiaries in both urban and rural set- 4 tings. 5 (iv) The grantees serve Medicare 6 beneficiaries in at least two geographic re- 7 gions, as defined by the Secretary. 8 (v) The grantees serve Medicare bene- 9 ficiaries in at least two large metropolitan 10 statistical areas with racial, ethnic, and 11 economically diverse populations. 12 (B) PRIORITY FOR PARTNERSHIPS WITH 13 COMMUNITY ORGANIZATIONS AND AGENCIES.— 14 In awarding grants under this subsection, the 15 Secretary shall give priority to eligible entities 16 that have a partnership with— 17 (i) a community organization; or 18 (ii) a consortia of community organi- 19 zations, State agencies, and local agencies, 20 that has experience in providing language serv- 21 ices. 22 (5) USE OF FUNDS FOR COMPETENT LANGUAGE 23 SERVICES.— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00093 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 94 •HR 5294 IH (A) IN GENERAL.—Subject to subpara- 1 graph (E), a grantee may only use grant funds 2 received under this subsection to pay for the 3 provision of competent language services to 4 Medicare beneficiaries who are limited-English- 5 proficient. 6 (B) COMPETENT LANGUAGE SERVICES DE- 7 FINED.—For purposes of this subsection, the 8 term ‘‘competent language services’’ means— 9 (i) interpreter and translation services 10 that— 11 (I) subject to the exceptions 12 under subparagraph (C)— 13 (aa) if the grantee operates 14 in a State that has statewide 15 health care interpreter standards, 16 meet the State standards cur- 17 rently in effect; or 18 (bb) if the grantee operates 19 in a State that does not have 20 statewide health care interpreter 21 standards, utilizes competent in- 22 terpreters who follow the Na- 23 tional Council on Interpreting in 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00094 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 95 •HR 5294 IH Health Care’s Code of Ethics and 1 Standards of Practice; and 2 (II) that, in the case of inter- 3 preter services, are provided 4 through— 5 (aa) onsite interpretation; 6 (bb) telephonic interpreta- 7 tion; or 8 (cc) video interpretation; 9 and 10 (ii) the direct provision of health care 11 or health-care-related services by a com- 12 petent bilingual health care provider. 13 (C) EXCEPTIONS.—The requirements of 14 subparagraph (B)(i)(I) do not apply, with re- 15 spect to interpreter and translation services and 16 a grantee— 17 (i) in the case of a Medicare bene- 18 ficiary who is limited-English-proficient 19 if— 20 (I) such beneficiary has been in- 21 formed, in the beneficiary’s primary 22 language, of the availability of free in- 23 terpreter and translation services and 24 the beneficiary instead requests that a 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 96 •HR 5294 IH family member, friend, or other per- 1 son provide such services; and 2 (II) the grantee documents such 3 request in the beneficiary’s medical 4 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) MEDICARE ADVANTAGE ORGANIZA- 19 TIONS AND PDP SPONSORS.—If a grantee is a 20 Medicare Advantage organization offering a 21 Medicare Advantage plan under part C of title 22 XVIII of the Social Security Act or a PDP 23 sponsor offering a prescription drug plan under 24 part D of such title, such entity must provide 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00096 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 97 •HR 5294 IH at least 50 percent of the grant funds that the 1 entity receives under this subsection directly to 2 the entity’s network providers (including all 3 health providers and pharmacists) for the pur- 4 pose of providing support for such providers to 5 provide competent language services to Medi- 6 care beneficiaries who are limited-English-pro- 7 ficient. 8 (E) ADMINISTRATIVE AND REPORTING 9 COSTS.—A grantee may use up to 10 percent of 10 the grant funds to pay for administrative costs 11 associated with the provision of competent lan- 12 guage services and for reporting required under 13 paragraph (9). 14 (6) DETERMINATION OF AMOUNT OF GRANT 15 PAYMENTS.— 16 (A) IN GENERAL.—Payments to grantees 17 under this subsection shall be calculated based 18 on the estimated numbers of limited-English- 19 proficient Medicare beneficiaries in a grantee’s 20 service area utilizing— 21 (i) data on the numbers of limited- 22 English-proficient individuals who speak 23 English less than ‘‘very well’’ from the 24 most recently available data from the Bu- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00097 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 98 •HR 5294 IH reau of the Census or other State-based 1 study the Secretary determines likely to 2 yield accurate data regarding the number 3 of such individuals in such service area; or 4 (ii) data provided by the grantee, if 5 the grantee routinely collects data on the 6 primary language of the Medicare bene- 7 ficiaries that the grantee serves and the 8 Secretary determines that the data is accu- 9 rate and shows a greater number of lim- 10 ited-English-proficient individuals than 11 would be estimated using the data under 12 clause (i). 13 (B) DISCRETION OF SECRETARY.—Subject 14 to subparagraph (C), the amount of payment 15 made to a grantee under this subsection may be 16 modified annually at the discretion of the Sec- 17 retary, based on changes in the data under sub- 18 paragraph (A) with respect to the service area 19 of a grantee for the year. 20 (C) LIMITATION ON AMOUNT.—The 21 amount of a grant made under this subsection 22 to a grantee may not exceed $500,000 for the 23 period under paragraph (1)(D). 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00098 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 99 •HR 5294 IH (7) ASSURANCES.—Grantees under this sub- 1 section shall, as a condition of receiving a grant 2 under this subsection— 3 (A) ensure that clinical and support staff 4 receive appropriate ongoing education and 5 training in linguistically appropriate service de- 6 livery; 7 (B) ensure the linguistic competence of bi- 8 lingual providers; 9 (C) offer and provide appropriate language 10 services at no additional charge to each patient 11 with limited-English proficiency for all points of 12 contact between the patient and the grantee, in 13 a timely manner during all hours of operation; 14 (D) notify Medicare beneficiaries of their 15 right to receive language services in their pri- 16 mary language; 17 (E) post signage in the primary languages 18 commonly used by the patient population in the 19 service area of the organization; and 20 (F) ensure that— 21 (i) primary language data are col- 22 lected for recipients of language services 23 and such data are consistent with stand- 24 ards developed under title XXXIV of the 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 100 •HR 5294 IH Public Health Service Act, as added by 1 section 202 of this Act, to the extent such 2 standards are available upon the initiation 3 of the demonstration program; and 4 (ii) consistent with the privacy protec- 5 tions provided under the regulations pro- 6 mulgated pursuant to section 264(c) of the 7 Health Insurance Portability and Account- 8 ability Act of 1996 (42 U.S.C. 1320d–2 9 note), if the recipient of language services 10 is a minor or is incapacitated, primary lan- 11 guage data are collected on the parent or 12 legal guardian of such recipient. 13 (8) NO COST-SHARING.—Limited-English-pro- 14 ficient Medicare beneficiaries shall not have to pay 15 cost-sharing or co-payments for competent language 16 services provided under this demonstration program. 17 (9) REPORTING REQUIREMENTS FOR GRANT- 18 EES.—Not later than the end of each calendar year, 19 a grantee that receives funds under this subsection 20 in such year shall submit to the Secretary a report 21 that includes the following information: 22 (A) The number of Medicare beneficiaries 23 to whom competent language services are pro- 24 vided. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 101 •HR 5294 IH (B) The primary languages of those Medi- 1 care beneficiaries. 2 (C) The types of language services pro- 3 vided to such beneficiaries. 4 (D) Whether such language services were 5 provided by employees of the grantee or 6 through a contract with external contractors or 7 agencies. 8 (E) The types of interpretation services 9 provided to such beneficiaries, and the approxi- 10 mate length of time such service is provided to 11 such beneficiaries. 12 (F) The costs of providing competent lan- 13 guage services. 14 (G) An account of the training or accredi- 15 tation of bilingual staff, interpreters, and trans- 16 lators providing services funded by the grant 17 under this subsection. 18 (10) EVALUATION AND REPORT TO CON- 19 GRESS.—Not later than 1 year after the completion 20 of a 3-year grant under this subsection, the Sec- 21 retary shall conduct an evaluation of the demonstra- 22 tion program under this subsection and shall submit 23 to the Congress a report that includes the following: 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00101 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 102 •HR 5294 IH (A) An analysis of the patient outcomes 1 and the costs of furnishing care to the limited- 2 English-proficient Medicare beneficiaries par- 3 ticipating in the project as compared to such 4 outcomes and costs for limited-English-pro- 5 ficient Medicare beneficiaries not participating, 6 based on the data provided under paragraph (9) 7 and any other information available to the Sec- 8 retary. 9 (B) The effect of delivering language serv- 10 ices on— 11 (i) Medicare beneficiary access to care 12 and utilization of services; 13 (ii) the efficiency and cost effective- 14 ness of health care delivery; 15 (iii) patient satisfaction; 16 (iv) health outcomes; and 17 (v) the provision of culturally appro- 18 priate services provided to such bene- 19 ficiaries. 20 (C) The extent to which bilingual staff, in- 21 terpreters, and translators providing services 22 under such demonstration were trained or ac- 23 credited and the nature of accreditation or 24 training needed by type of provider, service, or 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00102 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 103 •HR 5294 IH other category as determined by the Secretary 1 to ensure the provision of high-quality interpre- 2 tation, translation, or other language services to 3 Medicare beneficiaries if such services are ex- 4 panded pursuant to subsection (c) of section 5 1907 of this Act. 6 (D) Recommendations, if any, regarding 7 the extension of such project to the entire Medi- 8 care program, subject to the provisions of sec- 9 tion 1115A(c) of the Social Security Act. 10 (11) APPROPRIATIONS.—There is appropriated 11 to carry out this subsection, in equal parts from the 12 Federal Hospital Insurance Trust Fund under sec- 13 tion 1817 of the Social Security Act (42 U.S.C. 14 1395i) and the Federal Supplementary Medical In- 15 surance Trust Fund under section 1841 of such Act 16 (42 U.S.C. 1395t), $16,000,000 for each fiscal year 17 of the demonstration program. 18 (b) LANGUAGE SERVICES UNDER THE MEDICARE 19 PROGRAM.— 20 (1) INCLUSION AS RURAL HEALTH CLINIC 21 SERVICES.—Section 1861 of the Social Security Act 22 (42 U.S.C. 1395x) is amended— 23 (A) in subsection (aa)(1)— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00103 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 104 •HR 5294 IH (i) in subparagraph (B), by striking 1 the ‘‘and’’ at the end; 2 (ii) in subparagraph (C), by inserting 3 ‘‘and’’ after the comma at the end; and 4 (iii) by inserting after subparagraph 5 (C) the following: 6 ‘‘(D) language services as defined in sub- 7 section (iii)(1),’’; and 8 (B) by adding at the end the following new 9 subsection: 10 ‘‘Language Services and Related Terms 11 ‘‘(iii)(1) LANGUAGE SERVICES DEFINED.—The term 12 ‘language services’ has the same meaning given ‘language 13 or language access services’ in section 3400 of the Public 14 Health Service Act. 15 ‘‘(2) INTERPRETER SERVICES DEFINED.—For the 16 purposes of this subsection, the term ‘interpreter services’ 17 has the meaning given ‘competent interpreter services’ 18 under section 3400(3) of the Public Health Service Act. 19 ‘‘(3) INTERPRETER DEFINED.—The term ‘inter- 20 preter’— 21 ‘‘(A) means an individual— 22 ‘‘(i) who faithfully, accurately, and objec- 23 tively transmits a spoken message from one lan- 24 guage into another language; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00104 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 105 •HR 5294 IH ‘‘(ii) who knows health and health-related 1 terminology in both languages; and 2 ‘‘(B) includes individuals who provide in-person, 3 telephonic, and video interpretation. 4 ‘‘(4) TRANSLATION DEFINED.—The term ‘trans- 5 lation’ means the transmission of a written message in one 6 language into a written message in another language that 7 retains the intended meaning of the original message. 8 ‘‘(5) LIMITED-ENGLISH-PROFICIENT AND LEP DE- 9 FINED.—The terms ‘limited-English-proficient’ and ‘LEP’ 10 have the meaning given the term ‘limited english pro- 11 ficient’ under section 9101(25) of the Elementary and 12 Secondary Education Act of 1965, except that subpara- 13 graphs (A), (B), and (D) of such section not apply.’’. 14 (2) COVERAGE.—Section 1832(a)(2) of such 15 Act (42 U.S.C. 1395k(a)(2)) is amended— 16 (A) by striking ‘‘and’’ at the end of sub- 17 paragraph (I); 18 (B) by striking the period at the end of 19 subparagraph (J) and inserting ‘‘; and’’; and 20 (C) by adding at the end of subparagraph 21 (J) the following: 22 ‘‘(K) language services (as defined in para- 23 graph (1) of section 1861(iii)) furnished by an 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 106 •HR 5294 IH interpreter (as defined in paragraph (3) of such 1 section) or translator.’’. 2 (3) PAYMENT.—Section 1833(a) of the Social 3 Security Act (42 U.S.C. 1395l(a)) is amended— 4 (A) by striking ‘‘and’’ at the end of para- 5 graph (8); 6 (B) by redesignating paragraph (9) as 7 paragraph (10); and 8 (C) by inserting after paragraph (8) the 9 following new paragraph: 10 ‘‘(9) in the case of language services described 11 in section 1861(iii)(1), 100 percent of the reasonable 12 charges for such services, as determined in consulta- 13 tion with the Medicare Payment Advisory Commis- 14 sion; and’’. 15 (4) WAIVER OF BUDGET NEUTRALITY.—For 16 the 3-year period beginning on the date of enact- 17 ment of this section, the budget neutrality provision 18 of section 1848(c)(2)(B)(ii) of the Social Security 19 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 20 apply with respect to language services (as such 21 term is defined in section 1861(iii)(1) of such Act). 22 (c) MEDICARE PARTS C AND D.— 23 (1) IN GENERAL.—Medicare Advantage plans 24 under part C of the Social Security Act and pre- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00106 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 107 •HR 5294 IH scription drug plans under part D of such Act shall 1 comply with title VI of the Civil Rights Act of 1964 2 and section 1557 of the Patient Protection and Af- 3 fordable Care Act to provide effective language serv- 4 ices to enrollees of such plans. 5 (2) MEDICARE ADVANTAGE PLANS AND PRE- 6 SCRIPTION DRUG PLANS REPORTING REQUIRE- 7 MENT.—Section 1857(e) of the Social Security Act 8 (42 U.S.C. 1395w–27(e)) is amended by adding at 9 the end the following new paragraph: 10 ‘‘(5) REPORTING REQUIREMENTS RELATING TO 11 EFFECTIVE LANGUAGE SERVICES.—A contract under 12 this part shall require a Medicare Advantage organi- 13 zation (and, through application of section 1860D– 14 12(b)(3)(D), a contract under section 1860D–12 15 shall require a PDP sponsor) to annually submit 16 (for each year of the contract) a report that contains 17 information on the plan’s internal policies and proce- 18 dures related to recruitment and retention efforts di- 19 rected to workforce diversity and linguistically and 20 culturally appropriate provision of services in each of 21 the following contexts: 22 ‘‘(A) The collection of data in a manner 23 that meets the requirements of title I of the 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 108 •HR 5294 IH Health Equity and Accountability Act of 2014, 1 regarding the enrollee population. 2 ‘‘(B) Education of staff and contractors 3 who have routine contact with enrollees regard- 4 ing the various needs of the diverse enrollee 5 population. 6 ‘‘(C) Evaluation of the health plan’s lan- 7 guage services programs and services with re- 8 spect to the plan’s enrollee population, such as 9 through analysis of complaints or satisfaction 10 survey results. 11 ‘‘(D) Methods by which the plan provides 12 to the Secretary information regarding the eth- 13 nic diversity of the plan’s enrollee population. 14 ‘‘(E) The periodic provision of educational 15 information to plan enrollees on the plan’s lan- 16 guage services and programs.’’. 17 (d) IMPROVING LANGUAGE SERVICES IN MEDICAID 18 AND CHIP.— 19 (1) PAYMENTS TO STATES.—Section 20 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 21 1396b(a)(2)(E)) is amended by— 22 (A) striking ‘‘75’’ and inserting ‘‘90’’; 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00108 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 109 •HR 5294 IH (B) striking ‘‘translation or interpretation 1 services’’ and inserting ‘‘language services’’; 2 and 3 (C) striking ‘‘children of families’’ and in- 4 serting ‘‘individuals’’. 5 (2) STATE PLAN REQUIREMENTS.—Section 6 1902(a)(10)(A) of the Social Security Act (42 7 U.S.C. 1396a(a)(10)(A)) is amended by striking 8 ‘‘and (28)’’ and inserting ‘‘(28), and (29)’’. 9 (3) DEFINITION OF MEDICAL ASSISTANCE.— 10 Section 1905(a) of the Social Security Act (42 11 U.S.C. 1396d(a)) is amended by— 12 (A) in paragraph (28), by striking ‘‘and’’ 13 at the end; 14 (B) by redesignating paragraph (29) as 15 paragraph (30); and 16 (C) by inserting after paragraph (28) the 17 following new paragraph: 18 ‘‘(29) language services, as such term is defined 19 in section 1861(iii)(1), provided in a timely manner 20 to limited-English-proficient individuals who need 21 such services; and’’. 22 (4) USE OF DEDUCTIONS AND COST SHAR- 23 ING.—Section 1916(a)(2) of the Social Security Act 24 (42 U.S.C. 1396o(2)) is amended by— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 110 •HR 5294 IH (A) by striking ‘‘or’’ at the end of subpara- 1 graph (D); 2 (B) by striking ‘‘; and’’ at the end of sub- 3 paragraph (E) and inserting ‘‘, or’’; and 4 (C) by adding at the end the following new 5 subparagraph: 6 ‘‘(F) language services described in section 7 1905(a)(29); and’’. 8 (5) CHIP COVERAGE REQUIREMENTS.—Section 9 2103 of the Social Security Act (42 U.S.C. 1397cc) 10 is amended— 11 (A) in subsection (a), in the matter before 12 paragraph (1), by striking ‘‘and (7)’’ and in- 13 serting ‘‘(7), and (9)’’; and 14 (B) in subsection (c), by adding at the end 15 the following new paragraph: 16 ‘‘(9) LANGUAGE SERVICES.—The child health 17 assistance provided to a targeted low-income child 18 shall include coverage of language services, as such 19 term is defined in section 1861(iii)(1), provided in a 20 timely manner to limited-English-proficient individ- 21 uals who need such services.’’; and 22 (C) in subsection (e)(2)— 23 (i) in the heading, by striking ‘‘PRE- 24 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00110 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 111 •HR 5294 IH (ii) by inserting ‘‘, subsection (c)(9),’’ 1 after ‘‘subsection (c)(1)(C)’’. 2 (6) DEFINITION OF CHILD HEALTH ASSIST- 3 ANCE.—Section 2110(a)(27) of the Social Security 4 Act (42 U.S.C. 1397jj) is amended by striking 5 ‘‘translation’’ and inserting ‘‘language services as 6 described in section 2103(c)(9)’’. 7 (7) STATE DATA COLLECTION.—Pursuant to 8 the reporting requirement described in section 9 2107(b)(1) of the Social Security Act (42 U.S.C. 10 1397gg(b)(1)), the Secretary of Health and Human 11 Services shall require that States collect data on— 12 (A) the primary language of individuals re- 13 ceiving child health assistance under title XXI 14 of the Social Security Act; and 15 (B) in the case of such individuals who are 16 minors or incapacitated, the primary language 17 of the individual’s parent or guardian. 18 (8) CHIP PAYMENTS TO STATES.—Section 19 2105 of the Social Security Act (42 U.S.C. 20 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00111 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 112 •HR 5294 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 eligible entity’s eligible costs for 15 such services for the quarter. 16 (B) FUNDING.—Out of any funds in the 17 Treasury not otherwise appropriated, there are 18 appropriated to the Secretary of Health and 19 Human Services such sums as may be nec- 20 essary for each of fiscal years 2012 through 21 2016. 22 (C) RELATION TO MEDICAID DSH.—Pay- 23 ments under this subsection shall not offset or 24 reduce payments under section 1923 of the So- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00112 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 113 •HR 5294 IH cial Security Act, nor shall payments under 1 such section be considered when determining 2 uncompensated costs associated with the provi- 3 sion of language services. 4 (2) METHODOLOGY FOR PAYMENT OF 5 CLAIMS.— 6 (A) IN GENERAL.—The Secretary shall es- 7 tablish a methodology to determine the average 8 per person cost of language services. 9 (B) DIFFERENT ENTITIES.—In estab- 10 lishing such methodology, the Secretary may es- 11 tablish different methodologies for different 12 types of eligible entities. 13 (C) NO INDIVIDUAL CLAIMS.—The Sec- 14 retary may not require eligible entities to sub- 15 mit individual claims for language services for 16 individual patients as a requirement for pay- 17 ment under this subsection. 18 (3) DATA COLLECTION INSTRUMENT.—For pur- 19 poses of this subsection, the Secretary shall create a 20 standard data collection instrument that is con- 21 sistent with any existing reporting requirements by 22 the Secretary or relevant accrediting organizations 23 regarding the number of individuals to whom lan- 24 guage access are provided. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00113 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 114 •HR 5294 IH (4) GUIDELINES.—Not later than 6 months 1 after the date of enactment of this Act, the Sec- 2 retary of Health and Human Services shall establish 3 and distribute guidelines concerning the implementa- 4 tion of this subsection. 5 (5) REPORTING REQUIREMENTS.— 6 (A) REPORT TO SECRETARY.—Entities re- 7 ceiving payment under this subsection shall pro- 8 vide the Secretary with a quarterly report on 9 how the entity used such funds. Such report 10 shall contain aggregate (and may not contain 11 individualized) data collected using the instru- 12 ment under paragraph (3) and shall otherwise 13 be in a form and manner determined by the 14 Secretary. 15 (B) REPORT TO CONGRESS.—Not later 16 than 2 years after the date of enactment of this 17 Act, and every 2 years thereafter, the Secretary 18 shall submit a report to Congress concerning 19 the implementation of this subsection. 20 (6) DEFINITIONS.—In this subsection: 21 (A) ELIGIBLE COSTS.—The term ‘‘eligible 22 costs’’ means, with respect to an eligible entity 23 that provides language services to limited- 24 English-proficient individuals, the product of— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00114 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 115 •HR 5294 IH (i) the average per person cost of lan- 1 guage services, determined according to 2 the methodology devised under paragraph 3 (2); and 4 (ii) the number of limited-English-pro- 5 ficient individuals who are provided lan- 6 guage services by the entity and for whom 7 no reimbursement is available for such 8 services under the amendments made by 9 subsections (a), (b), (c), or (d) or by pri- 10 vate health insurance. 11 (B) ELIGIBLE ENTITY.—The term ‘‘eligible 12 entity’’ means an entity that— 13 (i) is a Medicaid provider that is— 14 (I) a physician; 15 (II) a hospital with a low-income 16 utilization rate (as defined in section 17 1923(b)(3) of the Social Security Act 18 (42 U.S.C. 1396r–4(b)(3))) of greater 19 than 25 percent; or 20 (III) a federally qualified health 21 center (as defined in section 22 1905(l)(2)(B) of the Social Security 23 Act (42 U.S.C. 1396d(l)(2)(B))); 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00115 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 116 •HR 5294 IH (ii) provide language services to at 1 least 8 percent of the entity’s total number 2 of patients, not later than 6 months after 3 the date of the enactment of the Act; and 4 (iii) prepare and submit an applica- 5 tion to the Secretary, at such time, in such 6 manner, and accompanied by such infor- 7 mation as the Secretary may require to as- 8 certain the entity’s eligibility for funding 9 under this subsection. 10 (C) LANGUAGE SERVICES.—The term 11 ‘‘language services’’ has the meaning given such 12 term in section 1861(iii)(1) of the Social Secu- 13 rity Act. 14 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964 AND 15 OTHER LAWS.—Nothing in this section shall be construed 16 to limit otherwise existing obligations of recipients of Fed- 17 eral financial assistance under title VI of the Civil Rights 18 Act of 1964 (42 U.S.C. 2000(d) et seq.) or other laws 19 that protect the civil rights of individuals. 20 (g) EFFECTIVE DATE.— 21 (1) IN GENERAL.—Except as otherwise pro- 22 vided and subject to paragraph (2), the amendments 23 made by this section shall take effect on January 1, 24 2013. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00116 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 117 •HR 5294 IH (2) EXCEPTION IF STATE LEGISLATION RE- 1 QUIRED.—In the case of a State plan for medical as- 2 sistance under title XIX of the Social Security Act 3 which the Secretary of Health and Human Services 4 determines requires State legislation (other than leg- 5 islation appropriating funds) in order for the plan to 6 meet the additional requirement imposed by the 7 amendments made by this section, the State plan 8 shall not be regarded as failing to comply with the 9 requirements of such title solely on the basis of its 10 failure to meet this additional requirement before 11 the first day of the first calendar quarter beginning 12 after the close of the first regular session of the 13 State legislature that begins after the date of the en- 14 actment of this Act. For purposes of the previous 15 sentence, in the case of a State that has a 2-year 16 legislative session, each year of such session shall be 17 deemed to be a separate regular session of the State 18 legislature. 19 SEC. 206. INCREASING UNDERSTANDING OF AND IMPROV- 20 ING HEALTH LITERACY. 21 (a) IN GENERAL.—The Secretary, acting through the 22 Director of the Agency for Healthcare Research and Qual- 23 ity and the Administrator of the Health Resources and 24 Services Administration, in consultation with the Director 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00117 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 118 •HR 5294 IH of the National Institute on Minority Health and Health 1 Disparities and the Office of Minority Health, shall award 2 grants to eligible entities to improve health care for pa- 3 tient populations that have low functional health literacy. 4 (b) ELIGIBILITY.—To be eligible to receive a grant 5 under subsection (a), an entity shall— 6 (1) be a hospital, health center or clinic, health 7 plan, or other health entity (including a nonprofit 8 minority health organization or association); and 9 (2) prepare and submit to the Secretary an ap- 10 plication at such time, in such manner, and con- 11 taining such information as the Secretary may re- 12 quire. 13 (c) USE OF FUNDS.— 14 (1) AGENCY FOR HEALTHCARE RESEARCH AND 15 QUALITY.—Grants awarded under subsection (a) 16 through the Agency for Healthcare Research and 17 Quality shall be used— 18 (A) to define and increase the under- 19 standing of health literacy; 20 (B) to investigate the correlation between 21 low health literacy and health and health care; 22 (C) to clarify which aspects of health lit- 23 eracy have an effect on health outcomes; and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 119 •HR 5294 IH (D) for any other activity determined ap- 1 propriate by the Director of the Agency. 2 (2) HEALTH RESOURCES AND SERVICES ADMIN- 3 ISTRATION.—Grants awarded under subsection (a) 4 through the Health Resources and Services Adminis- 5 tration shall be used to conduct demonstration 6 projects for interventions for patients with low 7 health literacy that may include— 8 (A) the development of new disease man- 9 agement programs for patients with low health 10 literacy; 11 (B) the tailoring of existing disease man- 12 agement programs addressing mental, physical, 13 oral, and behavioral health conditions for pa- 14 tients with low health literacy; 15 (C) the translation of written health mate- 16 rials for patients with low health literacy; 17 (D) the identification, implementation, and 18 testing of low health literacy screening tools; 19 (E) the conduct of educational campaigns 20 for patients and providers about low health lit- 21 eracy; and 22 (F) other activities determined appropriate 23 by the Administrator of the Health Resources 24 and Services Administration. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00119 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 120 •HR 5294 IH (d) DEFINITIONS.—In this section, the term ‘‘low 1 health literacy’’ means the inability of an individual to ob- 2 tain, process, and understand basic health information 3 and services needed to make appropriate health decisions. 4 (e) 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 2015 through 2019. 8 SEC. 207. ASSURANCES FOR RECEIVING FEDERAL FUNDS. 9 (a) IN GENERAL.—Any health program or activity, 10 any part of which is receiving Federal financial assistance, 11 including credits, subsidies, or contracts of insurance, and 12 any program or activity that is administered by an execu- 13 tive agency or any entity established under title I of the 14 Patient Protection and Affordable Care Act (or amend- 15 ments made thereby), as such programs, activities, agen- 16 cies, and entities are described in section 1557(a) of the 17 Patient Protection and Affordable Care Act (42 U.S.C. 18 18116), in order to ensure the right of LEP individuals 19 to receive access to quality health care, shall— 20 (1) ensure that appropriate clinical and support 21 staff receive ongoing education and training in lin- 22 guistically appropriate service delivery; 23 (2) offer and provide appropriate language serv- 24 ices at no additional charge to each patient with lim- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00120 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 121 •HR 5294 IH ited-English-proficiency at all points of contact, in a 1 timely manner during all hours of operation; 2 (3) notify patients of their right to receive lan- 3 guage services in their primary language; and 4 (4) utilize only competent interpreter or trans- 5 lation services, as defined in section 3400 of the 6 Public Health Service Act. 7 (b) EXEMPTIONS.—The requirements of subsection 8 (a)(4) shall not apply as follows: 9 (1) When a patient (who has been informed in 10 his or her primary language of the availability of 11 free interpreter and translation services) requests 12 the use of family, friends, or other persons untrained 13 in interpretation or translation if the following con- 14 ditions are met: 15 (A) The interpreter requested by the pa- 16 tient is over the age of 18. 17 (B) The recipient informs the patient that 18 he or she has the option of having the recipient 19 provide an interpreter for him or her without 20 charge, or of using his or her own interpreter. 21 (C) The recipient informs the patient that 22 the recipient may not require an LEP person to 23 use a family member or friend as an inter- 24 preter. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00121 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 122 •HR 5294 IH (D) The recipient evaluates whether the 1 person the patient wishes to use as an inter- 2 preter is competent. If the recipient has reason 3 to believe that the interpreter is not competent, 4 the recipient provides the recipient’s own inter- 5 preter to protect the recipient from liability if 6 the patient’s interpreter is later found not com- 7 petent. 8 (E) If the recipient has reason to believe 9 that there is a conflict of interest between the 10 interpreter and patient, the recipient may not 11 use the patient’s interpreter. 12 (F) The recipient has the patient sign a 13 waiver, witnessed by at least 1 individual not 14 related to the patient, that includes the infor- 15 mation stated in subparagraphs (A) through 16 (E) and is translated into the patient’s lan- 17 guage. 18 (2) When a medical emergency exists and the 19 delay directly associated with obtaining competent 20 interpreter or translation services would jeopardize 21 the health of the patient, but only until a competent 22 interpreter or translation service is available. 23 (c) RULE OF CONSTRUCTION.—Subsection (b)(2) 24 shall not be construed to mean that emergency rooms or 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 123 •HR 5294 IH similar entities that regularly provide health care services 1 in medical emergencies are exempt from legal or regu- 2 latory requirements related to competent interpreter serv- 3 ices. 4 SEC. 208. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL- 5 TURALLY AND LINGUISTICALLY APPRO- 6 PRIATE HEALTH CARE SERVICES. 7 (a) REPORT.—Not later than 1 year after the date 8 of enactment of this Act and annually thereafter, the Sec- 9 retary of Health and Human Services shall enter into a 10 contract with the Institute of Medicine for the preparation 11 and publication of a report that describes Federal efforts 12 to ensure that all individuals with limited-English pro- 13 ficiency have meaningful access culturally competent to 14 health care and health-care-related services. Such report 15 shall include— 16 (1) a description and evaluation of the activities 17 carried out under this Act; 18 (2) a description and analysis of best practices, 19 model programs, guidelines, and other effective 20 strategies for providing access to culturally and lin- 21 guistically appropriate health care services; 22 (3) recommendations on the development and 23 implementation of policies and practices by providers 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00123 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 124 •HR 5294 IH of health care and health-care-related services for 1 limited-English-proficient individuals; 2 (4) a description of the effect of providing lan- 3 guage services on quality of health care and access 4 to care; and 5 (5) a description of the costs associated with or 6 savings related to the provision of language services. 7 (b) 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 2015 through 2019. 11 SEC. 209. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES. 12 (a) GRANTS AUTHORIZED.—The Secretary of Edu- 13 cation is authorized to provide grants to eligible entities 14 for the provision of English as a second language (here- 15 after referred to as ‘‘ESL’’) instruction and shall deter- 16 mine, after consultation with appropriate stakeholders, the 17 mechanism for administering and distributing such 18 grants. 19 (b) ELIGIBLE ENTITY DEFINED.—For purposes of 20 this section, the term ‘‘eligible entity’’ means a State or 21 community-based organization that employs, and serves, 22 minority populations. 23 (c) APPLICATION.—An eligible entity may apply for 24 a grant under this section by submitting such information 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00124 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 125 •HR 5294 IH as the Secretary may require and in such form and man- 1 ner as the Secretary may require. 2 (d) USE OF GRANT.—As a condition of receiving a 3 grant under this section, an eligible entity shall— 4 (1) develop and implement a plan for assuring 5 the availability of ESL instruction that effectively 6 integrates information about the nature of the 7 United States health care system, how to access 8 care, and any special language skills that may be re- 9 quired for them to access and regularly negotiate the 10 system effectively; 11 (2) develop a plan, including, where appro- 12 priate, public-private partnerships, for making ESL 13 instruction progressively available to all individuals 14 seeking instruction; and 15 (3) maintain current ESL instruction efforts by 16 using the additional funds to supplement rather 17 than supplant any funds expended for ESL instruc- 18 tion in the State as of January 1, 2015. 19 (e) ADDITIONAL DUTIES OF THE SECRETARY.—The 20 Secretary of Education shall— 21 (1) collect and publicize annual data on how 22 much Federal, State, and local governments spend 23 on ESL instruction; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00125 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 126 •HR 5294 IH (2) collect data from State and local govern- 1 ments to identify the unmet needs of English lan- 2 guage learners for appropriate ESL instruction, in- 3 cluding— 4 (A) the preferred written and spoken lan- 5 guage of such English language learners; 6 (B) the extent of waiting lists including 7 how many programs maintain waiting lists and, 8 for programs that do not have waiting lists, the 9 reasons why not; 10 (C) the availability of programs to geo- 11 graphically isolated communities; 12 (D) the impact of course enrollment poli- 13 cies, including open enrollment, on the avail- 14 ability of ESL instruction; 15 (E) the number individuals in the State 16 and each participating locality; 17 (F) the effectiveness of the instruction in 18 meeting the needs of individuals receiving in- 19 struction and those needing instruction; 20 (G) as assessment of the need for pro- 21 grams that integrate job training and ESL in- 22 struction, to assist individuals to obtain better 23 jobs; and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00126 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 127 •HR 5294 IH (H) the availability of ESL slots by State 1 and locality; 2 (3) determine the cost and most appropriate 3 methods of making ESL instruction available to all 4 English language learners seeking instruction; and 5 (4) within 1 year of the date of enactment of 6 this Act, issue a report to Congress that assesses the 7 information collected in paragraphs (1), (2), and (3) 8 and makes recommendations on steps that should be 9 taken to progressively realize the goal of making 10 ESL instruction available to all English language 11 learners seeking instruction. 12 (f) AUTHORIZATION OF APPROPRIATIONS.—There 13 are authorized to be appropriated to the Secretary of Edu- 14 cation for each of fiscal years 2015 through 2018 15 $250,000,000 to carry out this section. 16 SEC. 210. IMPLEMENTATION. 17 (a) GENERAL PROVISIONS.— 18 (1) A State shall not be immune under the 19 Eleventh Amendment of the Constitution of the 20 United States from suit in Federal court for failing 21 to provide the language access funded pursuant to 22 this title. 23 (2) In a suit against a State for a violation of 24 this title, remedies (including remedies at both at 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00127 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 128 •HR 5294 IH law and in equity) are available for such a violation 1 to the same extent as such remedies are available for 2 such a violation in the suit against any public or pri- 3 vate entity other than a State. 4 (b) RULE OF CONSTRUCTION.—Nothing in this title 5 shall be construed to limit otherwise existing obligations 6 of recipients of Federal financial assistance under title VI 7 of the Civil Rights Act of 1964 (42 U.S.C. 2000(d) et 8 seq.) or any other statute. 9 SEC. 211. LANGUAGE ACCESS SERVICES. 10 (a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 11 the Patient Protection and Affordable Care Act (42 12 U.S.C. 18022(b)(1)) is amended by adding at the end the 13 following: 14 ‘‘(K) Language access services, including 15 oral interpretation and written translations.’’. 16 (b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL 17 COVERAGE.—Section 36B(c)(2)(C) of the Internal Rev- 18 enue Code of 1986 is amended by adding at the end the 19 following: 20 ‘‘(v) COVERAGE MUST INCLUDE LAN- 21 GUAGE ACCESS AND SERVICES.—Except as 22 provided in clause (iii), an employee shall 23 not be treated as eligible for minimum es- 24 sential coverage if such coverage consists 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00128 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 129 •HR 5294 IH of an eligible employer-sponsored plan (as 1 defined in section 5000A(f)(2)) and the 2 plan does not provide coverage for lan- 3 guage access services, including oral inter- 4 pretation and written translations.’’. 5 (c) QUALITY REPORTING.—Section 2717(a)(1) of the 6 Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 7 amended— 8 (1) by striking ‘‘and’’ at the end of subpara- 9 graph (C); 10 (2) by striking the period at the end of sub- 11 paragraph (D) and inserting ‘‘; and’’; and 12 (3) by adding at the end the following new sub- 13 paragraph: 14 ‘‘(E) reduce health disparities through the 15 provision of language access services, including 16 oral interpretation and written translations.’’. 17 (d) REGULATIONS REGARDING INTERNAL CLAIMS 18 AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR 19 HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 20 The Secretary of the Treasury, the Secretary of Labor, 21 and the Secretary of Health and Human Services shall 22 amend the regulations in section 54.9815–2719T(e) of 23 title 26, Code of Federal Regulations, section 2590.715– 24 2719(e) of title 29, Code of Federal Regulations, and sec- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00129 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 130 •HR 5294 IH tion 147.136(e) of title 45, Code of Federal Regulations, 1 respectively, to require group health plans and health in- 2 surance issuers offering group or individual health insur- 3 ance coverage to which such sections apply— 4 (1) to provide oral interpretation services with- 5 out any threshold requirements; 6 (2) to provide in the English versions of all no- 7 tices a statement prominently displayed in not less 8 than 15 non-English languages clearly indicating 9 how to access the language services provided by the 10 plan or issuer; and 11 (3) with respect to written translations of no- 12 tices, to apply a threshold that 5 percent of the pop- 13 ulation or at least 500 individuals per service area 14 are literate only in the same non-English language 15 in lieu of 10 percent or more residing in a county. 16 (e) DATA COLLECTION AND REPORTING.—The Sec- 17 retary of Health and Human Services shall— 18 (1) amend the single streamlined application 19 form developed pursuant to section 1413 of the Pa- 20 tient Protection and Affordable Care Act (42 U.S.C. 21 18083) to collect the preferred spoken and written 22 language for each household member applying for 23 coverage under a qualified health plan through an 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00130 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 131 •HR 5294 IH Exchange under title I of the Patient Protection and 1 Affordable Care Act; 2 (2) require navigators, certified application 3 counselors, and other enrollment assisters to collect 4 and report requests for language assistance; and 5 (3) require the Federal and State call centers 6 established pursuant to section 1311(d)(4)(b) of the 7 Patient Protection and Affordable Care Act (42 8 U.S.C. 18031(d)(4)(b)) to submit an annual report 9 documenting the number of language assistance re- 10 quests, the types of languages requested, the range 11 and average wait time for a consumer to speak with 12 an interpreter, and any steps the call center and lan- 13 guage line have taken to actively address some of 14 the consumer complaints. 15 (f) EFFECTIVE DATE.—The amendments made by 16 this section shall apply to plan years beginning after the 17 date of the enactment of this Act. 18 TITLE III—HEALTH WORKFORCE 19 DIVERSITY 20 SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 21 ACT. 22 Title XXXIV of the Public Health Service Act, as 23 added by section 202, is amended by adding at the end 24 the following: 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00131 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 132 •HR 5294 IH ‘‘Subtitle A—Diversifying the 1 Health Care Workplace 2 ‘‘SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE 3 DIVERSITY. 4 ‘‘(a) IN GENERAL.—The Secretary, acting through 5 the Bureau of Health Workforce within the Health Re- 6 sources and Services Administration, shall award a grant 7 to an entity determined appropriate by the Secretary for 8 the establishment of a national working group on work- 9 force diversity. 10 ‘‘(b) REPRESENTATION.—In establishing the national 11 working group under subsection (a): 12 ‘‘(1) The grantee shall ensure that the group 13 has representatives of the following: 14 ‘‘(A) The Health Resources and Services 15 Administration. 16 ‘‘(B) The Department of Health and 17 Human Services Data Council. 18 ‘‘(C) The Office of Minority Health of the 19 Department of Health and Human Services. 20 ‘‘(D) The Substance Abuse and Mental 21 Health Services Administration. 22 ‘‘(E) The Bureau of Labor Statistics of 23 the Department of Labor. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00132 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 133 •HR 5294 IH ‘‘(F) The Public Health Practice Program 1 Office—Office of Workforce Policy and Plan- 2 ning. 3 ‘‘(G) The National Institute on Minority 4 Health and Health Disparities. 5 ‘‘(H) The Agency for Healthcare Research 6 and Quality. 7 ‘‘(I) The Institute of Medicine Study Com- 8 mittee for the 2004 workforce diversity report. 9 ‘‘(J) The Indian Health Service. 10 ‘‘(K) Minority-serving academic institu- 11 tions. 12 ‘‘(L) Consumer organizations. 13 ‘‘(M) Health professional associations, in- 14 cluding those that represent underrepresented 15 minority populations. 16 ‘‘(N) Researchers in the area of health 17 workforce. 18 ‘‘(O) Health workforce accreditation enti- 19 ties. 20 ‘‘(P) Private foundations that have spon- 21 sored workforce diversity initiatives. 22 ‘‘(Q) Local and State health departments. 23 ‘‘(R) Representatives of community mem- 24 bers to be included on admissions committees 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00133 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 134 •HR 5294 IH for health profession schools pursuant to sub- 1 section (c)(8). 2 ‘‘(S) Other entities determined appropriate 3 by the Secretary. 4 ‘‘(2) The grantee shall ensure that, in addition 5 to the representatives under paragraph (1), the 6 group has not less than 5 health professions stu- 7 dents representing various health profession fields 8 and levels of training. 9 ‘‘(c) ACTIVITIES.—The working group established 10 under subsection (a) shall convene at least twice each year 11 to complete the following activities: 12 ‘‘(1) Review current public and private health 13 workforce diversity initiatives. 14 ‘‘(2) Identify successful health workforce diver- 15 sity programs and practices. 16 ‘‘(3) Examine challenges relating to the devel- 17 opment and implementation of health workforce di- 18 versity initiatives. 19 ‘‘(4) Draft a national strategic work plan for 20 health workforce diversity, including recommenda- 21 tions for public and private sector initiatives. 22 ‘‘(5) Develop a framework and methods for the 23 evaluation of current and future health workforce di- 24 versity initiatives. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00134 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 135 •HR 5294 IH ‘‘(6) Develop recommended standards for work- 1 force diversity that could be applicable to all health 2 professions programs and programs funded under 3 this Act. 4 ‘‘(7) Develop guidelines to train health profes- 5 sionals to care for a diverse population. 6 ‘‘(8) Develop a strategy for the inclusion of 7 community members on admissions committees for 8 health profession schools. 9 ‘‘(9) Other activities determined appropriate by 10 the Secretary. 11 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 12 the establishment of the working group under subsection 13 (a), and annually thereafter, the working group shall pre- 14 pare and make available to the general public for com- 15 ment, an annual report on the activities of the working 16 group. Such report shall include the recommendations of 17 the working group for improving health workforce diver- 18 sity. 19 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 20 is authorized to be appropriated to carry out this section 21 such sums as may be necessary for each of fiscal years 22 2015 through 2020. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00135 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 136 •HR 5294 IH ‘‘SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH 1 WORKFORCE DIVERSITY. 2 ‘‘(a) IN GENERAL.—The Secretary, acting through 3 the Deputy Assistant Secretary for Minority Health, and 4 in collaboration with the Bureau of Health Workforce 5 within the Health Resources and Services Administration, 6 the National Institute on Minority Health and Health Dis- 7 parities, shall establish a technical clearinghouse on health 8 workforce diversity within the Office of Minority Health 9 and coordinate current and future clearinghouses. 10 ‘‘(b) INFORMATION AND SERVICES.—The clearing- 11 house established under subsection (a) shall offer the fol- 12 lowing information and services: 13 ‘‘(1) Information on the importance of health 14 workforce diversity. 15 ‘‘(2) Statistical information relating to under- 16 represented minority representation in health and al- 17 lied health professions and occupations. 18 ‘‘(3) Model health workforce diversity practices 19 and programs, including integrated models of care. 20 ‘‘(4) Admissions policies that promote health 21 workforce diversity and are in compliance with Fed- 22 eral and State laws. 23 ‘‘(5) Retainment policies that promote comple- 24 tion of health profession degrees for underserved 25 populations. 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00136 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 137 •HR 5294 IH ‘‘(6) Lists of scholarship, loan repayment, and 1 loan cancellation grants as well as fellowship infor- 2 mation for underserved populations for health pro- 3 fessions schools. 4 ‘‘(7) Foundation and other large organizational 5 initiatives relating to health workforce diversity. 6 ‘‘(c) CONSULTATION.—In carrying out this section, 7 the Secretary shall consult with non-Federal entities which 8 may include minority health professional associations and 9 minority sections of major health professional associations 10 to ensure the adequacy and accuracy of information. 11 ‘‘(d) 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 2015 through 2020. 15 ‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO 16 WORKFORCE DIVERSITY. 17 ‘‘(a) IN GENERAL.—The Secretary, acting through 18 the Administrator of the Health Resources and Services 19 Administration and the Centers for Disease Control and 20 Prevention, shall award grants to eligible entities that 21 demonstrate a commitment to health workforce diversity. 22 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 23 under subsection (a), an entity shall— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00137 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 138 •HR 5294 IH ‘‘(1) be an educational institution or entity that 1 historically produces or trains meaningful numbers 2 of underrepresented minority health professionals, 3 including— 4 ‘‘(A) historically Black colleges and univer- 5 sities; 6 ‘‘(B) Hispanic-serving health professions 7 schools; 8 ‘‘(C) Hispanic-serving institutions; 9 ‘‘(D) tribal colleges and universities; 10 ‘‘(E) Asian-American, Native American, 11 and Pacific Islander-serving institutions; 12 ‘‘(F) institutions that have programs to re- 13 cruit and retain underrepresented minority 14 health professionals, in which a significant 15 number of the enrolled participants are under- 16 represented minorities; 17 ‘‘(G) health professional associations, 18 which may include underrepresented minority 19 health professional associations; and 20 ‘‘(H) institutions— 21 ‘‘(i) located in communities with pre- 22 dominantly underrepresented minority pop- 23 ulations; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00138 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 139 •HR 5294 IH ‘‘(ii) with whom partnerships have 1 been formed for the purpose of increasing 2 workforce diversity; and 3 ‘‘(iii) in which at least 20 percent of 4 the enrolled participants are underrep- 5 resented minorities; 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.—Amounts received under a 10 grant under subsection (a) shall be used to expand existing 11 workforce diversity programs, implement new workforce 12 diversity programs, or evaluate existing or new workforce 13 diversity programs, including with respect to mental 14 health care professions. Such programs shall enhance di- 15 versity by considering minority status as part of an indi- 16 vidualized consideration of qualifications. Possible activi- 17 ties may include— 18 ‘‘(1) educational outreach programs relating to 19 opportunities in the health professions; 20 ‘‘(2) scholarship, fellowship, grant, loan repay- 21 ment, and loan cancellation programs; 22 ‘‘(3) postbaccalaureate programs; 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00139 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 140 •HR 5294 IH ‘‘(4) academic enrichment programs, particu- 1 larly targeting those who would not be competitive 2 for health professions schools; 3 ‘‘(5) kindergarten through 12th grade and 4 other health pipeline programs; 5 ‘‘(6) mentoring programs; 6 ‘‘(7) internship or rotation programs involving 7 hospitals, health systems, health plans, and other 8 health entities; 9 ‘‘(8) community partnership development for 10 purposes relating to workforce diversity; or 11 ‘‘(9) leadership training. 12 ‘‘(d) REPORTS.—Not later than 1 year after receiving 13 a grant under this section, and annually for the term of 14 the grant, a grantee shall submit to the Secretary a report 15 that summarizes and evaluates all activities conducted 16 under the grant. 17 ‘‘(e) DEFINITION.—In this section, the term ‘Asian- 18 American, Native American, and Pacific Islander-serving 19 institutions’ has the same meaning as the term ‘Asian 20 American and Native American Pacific Islander-serving 21 institution’ as defined in section 371(c) of the Higher 22 Education Act of 1965 (20 U.S.C. 1067q(c)). 23 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 24 is authorized to be appropriated to carry out this section, 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00140 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 141 •HR 5294 IH such sums as may be necessary for each of fiscal years 1 2015 through 2020. 2 ‘‘SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND 3 RESEARCHERS. 4 ‘‘(a) IN GENERAL.—The Secretary, acting through 5 the Director of the National Institutes of Health, the Di- 6 rector of the Centers for Disease Control and Prevention, 7 the Commissioner of Food and Drugs, the Director of the 8 Agency for Healthcare Research and Quality, and the Ad- 9 ministrator of the Health Resources and Services Admin- 10 istration, shall award grants that expand existing opportu- 11 nities for scientists and researchers and promote the inclu- 12 sion of underrepresented minorities in the health profes- 13 sions. 14 ‘‘(b) RESEARCH FUNDING.—The head of each entity 15 within the Department of Health and Human Services 16 shall establish or expand existing programs to provide re- 17 search funding to scientists and researchers in training. 18 Under such programs, the head of each such entity shall 19 give priority in allocating research funding to support 20 health research in traditionally underserved communities, 21 including underrepresented minority communities, and re- 22 search classified as community or participatory. 23 ‘‘(c) DATA COLLECTION.—The head of each entity 24 within the Department of Health and Human Services 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00141 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 142 •HR 5294 IH shall collect data on the number (expressed as an absolute 1 number and a percentage) of underrepresented minority 2 and nonminority applicants who receive and are denied 3 agency funding at every stage of review. Such data shall 4 be reported annually to the Secretary and the appropriate 5 committees of Congress. 6 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec- 7 retary shall establish a student loan reimbursement pro- 8 gram to provide student loan reimbursement assistance to 9 researchers who focus on racial and ethnic disparities in 10 health. The Secretary shall promulgate regulations to de- 11 fine the scope and procedures for the program under this 12 subsection. 13 ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec- 14 retary shall establish a student loan cancellation program 15 to provide student loan cancellation assistance to research- 16 ers who focus on racial and ethnic disparities in health. 17 Students participating in the program shall make a min- 18 imum 5-year commitment to work at an accredited health 19 profession school. The Secretary shall promulgate addi- 20 tional regulations to define the scope and procedures for 21 the program under this subsection. 22 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 23 is authorized to be appropriated to carry out this section, 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00142 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 143 •HR 5294 IH such sums as may be necessary for each of fiscal years 1 2015 through 2020. 2 ‘‘SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH 3 PROFESSIONALS. 4 ‘‘(a) IN GENERAL.—The Secretary, acting through 5 the Director of the Centers for Disease Control and Pre- 6 vention, the Administrator of the Substance Abuse and 7 Mental Health Services Administration, the Administrator 8 of the Health Resources and Services Administration, and 9 the Administrator of the Centers for Medicare & Medicaid 10 Services, shall establish a program to award grants to eli- 11 gible individuals for career support in nonresearch-related 12 health and wellness professions. 13 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 14 under subsection (a), an individual shall— 15 ‘‘(1) be a student in a health professions school, 16 a graduate of such a school who is working in a 17 health profession, an individual working in a health 18 or wellness profession (including mental and behav- 19 ioral health), or a faculty member of such a school; 20 and 21 ‘‘(2) 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 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00143 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 144 •HR 5294 IH ‘‘(c) USE OF FUNDS.—An individual shall use 1 amounts received under a grant under this section to— 2 ‘‘(1) support the individual’s health activities or 3 projects that involve underserved communities, in- 4 cluding racial and ethnic minority communities; 5 ‘‘(2) support health-related career advancement 6 activities; 7 ‘‘(3) to pay, or as reimbursement for payments 8 of, student loans or training or credentialing costs 9 for individuals who are health professionals and are 10 focused on health issues affecting underserved com- 11 munities, including racial and ethnic minority com- 12 munities; and 13 ‘‘(4) to establish and promote leadership train- 14 ing programs to decrease health disparities and to 15 increase cultural competence with the goal of in- 16 creasing diversity in leadership positions. 17 ‘‘(d) DEFINITION.—In this section, the term ‘career 18 in nonresearch-related health and wellness professions’ 19 means employment or intended employment in the field 20 of public health, health policy, health management, health 21 administration, medicine, nursing, pharmacy, psychology, 22 social work, psychiatry, other mental and behavioral 23 health, allied health, community health, social work, or 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00144 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 145 •HR 5294 IH other fields determined appropriate by the Secretary, 1 other than in a position that involves research. 2 ‘‘(e) 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 2015 through 2020. 6 ‘‘SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DI- 7 VERSITY ON QUALITY. 8 ‘‘(a) IN GENERAL.—The Director of the Agency for 9 Healthcare Research and Quality, in collaboration with 10 the Deputy Assistant Secretary for Minority Health and 11 the Director of the National Institute on Minority Health 12 and Health Disparities, shall award grants to eligible enti- 13 ties to expand research on the link between health work- 14 force diversity and quality health care. 15 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 16 under subsection (a), an entity shall— 17 ‘‘(1) be a clinical, public health, or health serv- 18 ices research entity or other entity determined ap- 19 propriate by the Director; 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 awarded under subsection (a) shall be used to sup- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00145 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 146 •HR 5294 IH port research that investigates the effect of health work- 1 force diversity on— 2 ‘‘(1) language access; 3 ‘‘(2) cultural competence; 4 ‘‘(3) patient satisfaction; 5 ‘‘(4) timeliness of care; 6 ‘‘(5) safety of care; 7 ‘‘(6) effectiveness of care; 8 ‘‘(7) efficiency of care; 9 ‘‘(8) patient outcomes; 10 ‘‘(9) community engagement; 11 ‘‘(10) resource allocation; 12 ‘‘(11) organizational structure; 13 ‘‘(12) compliance of care; or 14 ‘‘(13) other topics determined appropriate by 15 the Director. 16 ‘‘(d) PRIORITY.—In awarding grants under sub- 17 section (a), the Director shall give individualized consider- 18 ation to all relevant aspects of the applicant’s background. 19 Consideration of prior research experience involving the 20 health of underserved communities shall be such a factor. 21 ‘‘(e) 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 2015 through 2020. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00146 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 147 •HR 5294 IH ‘‘SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM. 1 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 2 through the National Institute on Minority Health and 3 Health Disparities and in collaboration with the Office of 4 Minority Health, the Office for Civil Rights, the Centers 5 for Disease Control and Prevention, the Centers for Medi- 6 care & Medicaid Services, the Health Resources and Serv- 7 ices Administration, and other appropriate public and pri- 8 vate entities, shall establish and coordinate a health and 9 health care disparities education program to support, de- 10 velop, and implement educational initiatives and outreach 11 strategies that inform health care professionals and the 12 public about the existence of and methods to reduce racial 13 and ethnic disparities in health and health care. 14 ‘‘(b) ACTIVITIES.—The Secretary, through the edu- 15 cation program established under subsection (a), shall, 16 through the use of public awareness and outreach cam- 17 paigns targeting the general public and the medical com- 18 munity at large— 19 ‘‘(1) disseminate scientific evidence for the ex- 20 istence and extent of racial and ethnic disparities in 21 health care, including disparities that are not other- 22 wise attributable to known factors such as access to 23 care, patient preferences, or appropriateness of 24 intervention, as described in the 2002 Institute of 25 Medicine Report entitled ‘Unequal Treatment: Con- 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00147 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 148 •HR 5294 IH fronting Racial and Ethnic Disparities in Health 1 Care’, as well as the impact of disparities related to 2 age, disability status, socioeconomic status, sex, gen- 3 der identity, and sexual orientation on racial and 4 ethnic minorities; 5 ‘‘(2) disseminate new research findings to 6 health care providers and patients to assist them in 7 understanding, reducing, and eliminating health and 8 health care disparities; 9 ‘‘(3) disseminate information about the impact 10 of linguistic and cultural barriers on health care 11 quality and the obligation of health providers who 12 receive Federal financial assistance to ensure that 13 people with limited-English proficiency have access 14 to language access services; 15 ‘‘(4) disseminate information about the impor- 16 tance and legality of racial, ethnic, disability status, 17 socioeconomic status, sex, gender identity, and sex- 18 ual orientation, and primary language data collec- 19 tion, analysis, and reporting; 20 ‘‘(5) design and implement specific educational 21 initiatives to health care providers relating to health 22 and health care disparities; and 23 ‘‘(6) assess the impact of the programs estab- 24 lished under this section in raising awareness of 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00148 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 149 •HR 5294 IH health and health care disparities and providing in- 1 formation on available resources. 2 ‘‘(c) 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 2015 through 2020.’’. 6 SEC. 302. HISPANIC-SERVING HEALTH PROFESSIONS 7 SCHOOLS. 8 Part B of title VII of the Public Health Service Act 9 (42 U.S.C. 293 et seq.) is amended by adding at the end 10 the following: 11 ‘‘SEC. 742. HISPANIC-SERVING HEALTH PROFESSIONS 12 SCHOOLS. 13 ‘‘(a) IN GENERAL.—The Secretary, acting through 14 the Administrator of the Health Resources and Services 15 Administration, shall award grants to Hispanic-serving 16 health professions schools for the purpose of carrying out 17 programs to recruit Hispanic individuals to enroll in and 18 graduate from such schools, which may include providing 19 scholarships and other financial assistance as appropriate. 20 ‘‘(b) ELIGIBILITY.—In subsection (a), the term ‘His- 21 panic-serving health professions school’ means an entity 22 that— 23 ‘‘(1) is a school or program under section 24 799B; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00149 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 150 •HR 5294 IH ‘‘(2) has an enrollment of full-time equivalent 1 students that is made up of at least 9 percent His- 2 panic students; 3 ‘‘(3) has been effective in carrying out pro- 4 grams to recruit Hispanic individuals to enroll in 5 and graduate from the school; 6 ‘‘(4) has been effective in recruiting and retain- 7 ing Hispanic faculty members; 8 ‘‘(5) has a significant number of graduates who 9 are providing health services to medically under- 10 served populations or to individuals in health profes- 11 sional shortage areas; and 12 ‘‘(6) is a Regional Hispanic Center of Excel- 13 lence.’’. 14 SEC. 303. LOAN REPAYMENT PROGRAM OF CENTERS FOR 15 DISEASE CONTROL AND PREVENTION. 16 Section 317F(c) of the Public Health Service Act (42 17 U.S.C. 247b–7(c)) is amended— 18 (1) by striking ‘‘and’’ after ‘‘1994,’’; and 19 (2) by inserting before the period at the end the 20 following: ‘‘$750,000 for fiscal year 2015, and such 21 sums as may be necessary for each of the fiscal 22 years 2016 through 2020’’. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00150 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 151 •HR 5294 IH SEC. 304. COOPERATIVE AGREEMENTS FOR ONLINE DE- 1 GREE PROGRAMS AT SCHOOLS OF PUBLIC 2 HEALTH AND SCHOOLS OF ALLIED HEALTH. 3 Part B of title VII of the Public Health Service Act 4 (42 U.S.C. 293 et seq.), as amended by section 302, is 5 further amended by adding at the end the following: 6 ‘‘SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DE- 7 GREE PROGRAMS. 8 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 9 acting through the Administrator of the Health Resources 10 and Services Administration, in consultation with the Di- 11 rector of the Centers for Disease Control and Prevention, 12 the Director of the Agency for Healthcare Research and 13 Quality, and the Deputy Assistant Secretary for Minority 14 Health, shall award cooperative agreements to schools of 15 public health and schools of allied health to design and 16 implement online degree programs. 17 ‘‘(b) PRIORITY.—In awarding cooperative agreements 18 under this section, the Secretary shall give priority to any 19 school of public health or school of allied health that has 20 an established track record of serving medically under- 21 served communities. 22 ‘‘(c) REQUIREMENTS.—Recipients of cooperative 23 agreements under this section shall design and implement 24 an online degree program that meets the following restric- 25 tions: 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00151 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 152 •HR 5294 IH ‘‘(1) Enrollment of individuals who have ob- 1 tained a secondary school diploma or its recognized 2 equivalent. 3 ‘‘(2) Maintaining a significant enrollment of 4 underrepresented minority or disadvantaged stu- 5 dents. 6 ‘‘(3) Achieving a high completion rate of en- 7 rolled underrepresented minority or disadvantaged 8 students. 9 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 10 are authorized to be appropriated to carry out this section 11 such sums as may be necessary for each of fiscal years 12 2015 through 2020.’’. 13 SEC. 305. SENSE OF CONGRESS ON THE MISSION OF THE 14 NATIONAL HEALTH CARE WORKFORCE COM- 15 MISSION. 16 It is the sense of Congress that the National Health 17 Care Workforce Commission established by section 5101 18 of the Patient Protection and Affordable Care Act (42 19 U.S.C. 294q) should, in carrying out its assigned duties 20 under that section, give attention to the needs of racial 21 and ethnic minorities, individuals with lower socio- 22 economic status, individuals with mental, developmental, 23 and physical disabilities, lesbian, gay, bisexual, and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00152 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 153 •HR 5294 IH transgender populations, and individuals who are members 1 of multiple minority or special population groups. 2 SEC. 306. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 3 Subtitle A of title XXXIV of the Public Health Serv- 4 ice Act, as added by section 301, is further amended by 5 inserting after section 3417 the following: 6 ‘‘SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH 7 SERVICES CORPS. 8 ‘‘(a) IN GENERAL.—The Administrator of the Health 9 Resources and Services Administration and the Director 10 of the Centers for Disease Control and Prevention, in col- 11 laboration with the Deputy Assistant Secretary for Minor- 12 ity Health, shall award grants to eligible entities to in- 13 crease awareness among postprimary and postsecondary 14 students of career opportunities in the health professions. 15 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 16 under subsection (a), an entity shall— 17 ‘‘(1) be a clinical, public health, or health serv- 18 ices organization, community-based or nonprofit en- 19 tity, or other entity determined appropriate by the 20 Director of the Centers for Disease Control and Pre- 21 vention; 22 ‘‘(2) serve a health professional shortage area, 23 as determined by the Secretary; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00153 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 154 •HR 5294 IH ‘‘(3) work with students, including those from 1 racial and ethnic minority backgrounds, that have 2 expressed an interest in the health professions; and 3 ‘‘(4) 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.—Grant awards under sub- 7 section (a) shall be used to support internships that will 8 increase awareness among students of non-research-based, 9 career opportunities in the following health professions: 10 ‘‘(1) Medicine. 11 ‘‘(2) Nursing. 12 ‘‘(3) Public Health. 13 ‘‘(4) Pharmacy. 14 ‘‘(5) Health administration and management. 15 ‘‘(6) Health policy. 16 ‘‘(7) Psychology. 17 ‘‘(8) Dentistry. 18 ‘‘(9) International health. 19 ‘‘(10) Social work. 20 ‘‘(11) Allied health. 21 ‘‘(12) Psychiatry. 22 ‘‘(13) Hospice care. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00154 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 155 •HR 5294 IH ‘‘(14) Other professions deemed appropriate by 1 the Director of the Centers for Disease Control and 2 Prevention. 3 ‘‘(d) PRIORITY.—In awarding grants under sub- 4 section (a), the Director of the Centers for Disease Con- 5 trol and Prevention shall give priority to those entities 6 that— 7 ‘‘(1) serve a high proportion of individuals from 8 disadvantaged backgrounds; 9 ‘‘(2) have experience in health disparity elimi- 10 nation programs; 11 ‘‘(3) facilitate the entry of disadvantaged indi- 12 viduals into institutions of higher education; and 13 ‘‘(4) provide counseling or other services de- 14 signed to assist disadvantaged individuals in success- 15 fully completing their education at the postsecondary 16 level. 17 ‘‘(e) STIPENDS.—The Secretary may approve sti- 18 pends under this section for individuals for any period of 19 education in student-enhancement programs (other than 20 regular courses) at health professions schools, programs, 21 or entities, except that such a stipend may not be provided 22 to an individual for more than 6 months, and such a sti- 23 pend may not exceed $20 per day (notwithstanding any 24 other provision of law regarding the amount of stipends). 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00155 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 156 •HR 5294 IH ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 1 is authorized to be appropriated to carry out this section 2 such sums as may be necessary for each of fiscal years 3 2015 through 2020. 4 ‘‘SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS 5 PROGRAM. 6 ‘‘(a) IN GENERAL.—The Director of the Centers for 7 Disease Control and Prevention, in collaboration with the 8 Deputy Assistant Secretary for Minority Health, shall 9 award scholarships to postsecondary students who seek a 10 career in public health. 11 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol- 12 arship under subsection (a), an individual shall— 13 ‘‘(1) have interest, knowledge, or skill in public 14 health research or public health practice, or other 15 health professions as determined appropriate by the 16 Director of the Centers for Disease Control and Pre- 17 vention; 18 ‘‘(2) reside in a health professional shortage 19 area as determined by the Secretary; 20 ‘‘(3) demonstrate promise for becoming a leader 21 in public health; 22 ‘‘(4) secure admission to a 4-year institution of 23 higher education; 24 ‘‘(5) comply with subsection (e); and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00156 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 157 •HR 5294 IH ‘‘(6) submit to the Secretary an application at 1 such time, in such manner, and containing such in- 2 formation as the Secretary may require. 3 ‘‘(c) USE OF FUNDS.—Amounts received under an 4 award under subsection (a) shall be used to support oppor- 5 tunities for students to become public health professionals. 6 ‘‘(d) PRIORITY.—In awarding grants under sub- 7 section (a), the Director shall give priority to those stu- 8 dents that— 9 ‘‘(1) are from disadvantaged backgrounds; 10 ‘‘(2) have secured admissions to a minority- 11 serving institution; and 12 ‘‘(3) have identified a health professional as a 13 mentor at their school or institution and an aca- 14 demic advisor to assist in the completion of their 15 baccalaureate degree. 16 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 17 payment of scholarships under this section for such indi- 18 viduals for any period of education in student under- 19 graduate tenure, except that such a scholarship may not 20 be provided to an individual for more than 4 years, and 21 such scholarships may not exceed $10,000 per academic 22 year (notwithstanding any other provision of law regard- 23 ing the amount of scholarship). 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00157 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 158 •HR 5294 IH ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 1 is authorized to be appropriated to carry out this section 2 such sums as may be necessary for each of fiscal years 3 2015 through 2020. 4 ‘‘SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH 5 FELLOWSHIP PROGRAM. 6 ‘‘(a) IN GENERAL.—The Director of the Centers for 7 Disease Control and Prevention, in collaboration with the 8 Deputy Assistant Secretary for Minority Health, the Ad- 9 ministrator of the Substance Abuse and Mental Health 10 Services Administration, and the Director of the Indian 11 Health Services, shall award research fellowships to post- 12 baccalaureate students to conduct research that will exam- 13 ine gender and health disparities and to pursue a career 14 in the health professions. 15 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 16 ship under subsection (a) an individual shall— 17 ‘‘(1) have experience in health research or pub- 18 lic health practice; 19 ‘‘(2) reside in a health professional shortage 20 area as determined by the Secretary; 21 ‘‘(3) have expressed an interest in the health 22 professions; 23 ‘‘(4) demonstrate promise for becoming a leader 24 in the field of women’s health; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00158 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 159 •HR 5294 IH ‘‘(5) secure admission to a health professions 1 school or graduate program with an emphasis in 2 gender studies; 3 ‘‘(6) comply with subsection (f); and 4 ‘‘(7) submit to the Secretary an application at 5 such time, in such manner, and containing such in- 6 formation as the Secretary may require. 7 ‘‘(c) USE OF FUNDS.—Amounts received under an 8 award under subsection (a) shall be used to support oppor- 9 tunities for students to become researchers and advance 10 the research base on the intersection between gender and 11 health. 12 ‘‘(d) PRIORITY.—In awarding grants under sub- 13 section (a), the Director of the Centers for Disease Con- 14 trol and Prevention shall give priority to those applicants 15 that— 16 ‘‘(1) are from disadvantaged backgrounds; and 17 ‘‘(2) have identified a mentor and academic ad- 18 visor who will assist in the completion of their grad- 19 uate or professional degree and have secured a re- 20 search assistant position with a researcher working 21 in the area of gender and health. 22 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 23 Disease Control and Prevention may approve fellowships 24 for individuals under this section for any period of edu- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00159 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 160 •HR 5294 IH cation in the student’s graduate or health profession ten- 1 ure, except that such a fellowship may not be provided 2 to an individual for more than 3 years, and such a fellow- 3 ship may not exceed $18,000 per academic year (notwith- 4 standing any other provision of law regarding the amount 5 of fellowship). 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 2015 through 2020. 10 ‘‘SEC. 3420A. PAUL DAVID WELLSTONE INTERNATIONAL 11 HEALTH FELLOWSHIP PROGRAM. 12 ‘‘(a) IN GENERAL.—The Director of the Agency for 13 Healthcare Research and Quality, in collaboration with 14 the Deputy Assistant Secretary for Minority Health, shall 15 award research fellowships to college students or recent 16 graduates to advance their understanding of international 17 health. 18 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 19 ship under subsection (a) an individual shall— 20 ‘‘(1) have educational experience in the field of 21 international health; 22 ‘‘(2) reside in a health professional shortage 23 area as determined by the Secretary; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00160 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 161 •HR 5294 IH ‘‘(3) demonstrate promise for becoming a leader 1 in the field of international health; 2 ‘‘(4) be a college senior or recent graduate of 3 a four-year higher education institution; 4 ‘‘(5) comply with subsection (e); and 5 ‘‘(6) submit to the Secretary an application at 6 such time, in such manner, and containing such in- 7 formation as the Secretary may require. 8 ‘‘(c) USE OF FUNDS.—Amounts received under an 9 award under subsection (a) shall be used to support oppor- 10 tunities for students to become health professionals and 11 to advance their knowledge about international issues re- 12 lating to health care access and quality. 13 ‘‘(d) PRIORITY.—In awarding grants under sub- 14 section (a), the Director shall give priority to those appli- 15 cants that— 16 ‘‘(1) are from a disadvantaged background; and 17 ‘‘(2) have identified a mentor at a health pro- 18 fessions school or institution, an academic advisor to 19 assist in the completion of their graduate or profes- 20 sional degree, and an advisor from an international 21 health non-governmental organization, private volun- 22 teer organization, or other international institution 23 or program that focuses on increasing health care 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00161 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 162 •HR 5294 IH access and quality for residents in developing coun- 1 tries. 2 ‘‘(e) FELLOWSHIPS.—The Secretary shall approve 3 fellowships for college seniors or recent graduates, except 4 that such a fellowship may not be provided to an indi- 5 vidual for more than 6 months, may not be awarded to 6 a graduate that has not been enrolled in school for more 7 than 1 year, and may not exceed $4,000 per academic year 8 (notwithstanding any other provision of law regarding the 9 amount of fellowship). 10 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 11 is authorized to be appropriated to carry out this section, 12 such sums as may be necessary for each of fiscal years 13 2015 through 2020. 14 ‘‘SEC. 3420B. EDWARD R. ROYBAL HEALTH SCHOLAR PRO- 15 GRAM. 16 ‘‘(a) IN GENERAL.—The Director of the Agency for 17 Healthcare Research and Quality, the Director of the Cen- 18 ters for Medicare and Medicaid Services, and the Adminis- 19 trator for Health Resources and Services Administration, 20 in collaboration with the Deputy Assistant Secretary for 21 Minority Health, shall award grants to eligible entities to 22 expose entering graduate students to the health profes- 23 sions. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00162 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 163 •HR 5294 IH ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 1 under subsection (a), an entity shall— 2 ‘‘(1) be a clinical, public health, or health serv- 3 ices organization, community-based, academic, or 4 nonprofit entity, or other entity determined appro- 5 priate by the Director of the Agency for Healthcare 6 Research and Quality; 7 ‘‘(2) serve in a health professional shortage 8 area as determined by the Secretary; 9 ‘‘(3) work with students obtaining a degree in 10 the health professions; and 11 ‘‘(4) submit to the Secretary an application at 12 such time, in such manner, and containing such in- 13 formation as the Secretary may require. 14 ‘‘(c) USE OF FUNDS.—Amounts received under a 15 grant awarded under subsection (a) shall be used to sup- 16 port opportunities that expose students to non-research- 17 based health professions, including— 18 ‘‘(1) public health policy; 19 ‘‘(2) health care and pharmaceutical policy; 20 ‘‘(3) health care administration and manage- 21 ment; 22 ‘‘(4) health economics; and 23 ‘‘(5) other professions determined appropriate 24 by the Director of the Agency for Healthcare Re- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00163 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 164 •HR 5294 IH search and Quality, the Director of the Centers for 1 Medicare and Medicaid Services, and the Adminis- 2 trator for Health Resources and Services Adminis- 3 tration. 4 ‘‘(d) PRIORITY.—In awarding grants under sub- 5 section (a), the Director of the Agency for Healthcare Re- 6 search and Quality shall give priority to those entities 7 that— 8 ‘‘(1) have experience with health disparity elimi- 9 nation programs; 10 ‘‘(2) facilitate training in the fields described in 11 subsection (c); and 12 ‘‘(3) provide counseling or other services de- 13 signed to assist such individuals in successfully com- 14 pleting their education at the postsecondary level. 15 ‘‘(e) STIPENDS.—The Secretary may approve the 16 payment of stipends for individuals under this section for 17 any period of education in student-enhancement programs 18 (other than regular courses) at health professions schools 19 or entities, except that such a stipend may not be provided 20 to an individual for more than 2 months, and such a sti- 21 pend may not exceed $100 per day (notwithstanding any 22 other provision of law regarding the amount of stipends). 23 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 24 is authorized to be appropriated to carry out this section 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00164 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 165 •HR 5294 IH such sums as may be necessary for each of fiscal years 1 2015 through 2020.’’. 2 SEC. 307. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 3 PROGRAM. 4 Section 402E of the Higher Education Act of 1965 5 (20 U.S.C. 1070a–15) is amended by striking subsection 6 (g) and inserting the following: 7 ‘‘(g) COLLABORATION IN HEALTH PROFESSION DI- 8 VERSITY TRAINING PROGRAMS.—The Secretary shall co- 9 ordinate with the Secretary of Health and Human Serv- 10 ices to ensure that there is collaboration between the goals 11 of the program under this section and programs of the 12 Health Resources and Services Administration that pro- 13 mote health workforce diversity. The Secretary of Edu- 14 cation shall take such measures as may be necessary to 15 encourage students participating in projects assisted 16 under this section to consider health profession careers. 17 ‘‘(h) FUNDING.—From amounts appropriated pursu- 18 ant to the authority of section 402A(g), the Secretary 19 shall, to the extent practicable, allocate funds for projects 20 authorized by this section in an amount which is not less 21 than $31,000,000 for each of the fiscal years 2015 22 through 2021.’’. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00165 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 166 •HR 5294 IH SEC. 308. RULES FOR DETERMINATION OF FULL-TIME 1 EQUIVALENT RESIDENTS FOR COST-REPORT- 2 ING PERIODS. 3 (a) DGME DETERMINATIONS.—Section 1886(h)(4) 4 of the Social Security Act (42 U.S.C. 1395ww(h)(4)) is 5 amended— 6 (1) in subparagraph (E), by striking ‘‘Subject 7 to subparagraphs (J) and (K), such rules’’ and in- 8 serting ‘‘Subject to subparagraphs (J), (K), and (L), 9 such rules’’; 10 (2) in subparagraph (J), by striking ‘‘Such 11 rules’’ and inserting ‘‘Subject to subparagraph (L), 12 such rules’’; 13 (3) in subparagraph (K), by striking ‘‘In deter- 14 mining’’ and inserting ‘‘Subject to subparagraph 15 (L), in determining’’; and 16 (4) by adding at the end the following new sub- 17 paragraph: 18 ‘‘(L) For purposes of cost-reporting peri- 19 ods beginning on or after October 1, 2014, in 20 determining the hospital’s number of full-time 21 equivalent residents for purposes of this para- 22 graph, all the time spent by an intern or resi- 23 dent in an approved medical residency training 24 program shall be counted toward the determina- 25 tion of full-time equivalency if the hospital— 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00166 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 167 •HR 5294 IH ‘‘(i) is recognized as a subsection (d) 1 hospital; 2 ‘‘(ii) is recognized as a subsection (d) 3 Puerto Rico hospital; 4 ‘‘(iii) is reimbursed under a reim- 5 bursement system authorized under section 6 1814(b)(3); or 7 ‘‘(iv) is a provider-based hospital out- 8 patient department.’’. 9 (b) IME DETERMINATIONS.—Section 10 1886(d)(5)(B)(x) of the Social Security Act (42 U.S.C. 11 1395ww(d)(5)(B)(x)) is amended— 12 (1) in subclause (II), by striking ‘‘In deter- 13 mining’’ and inserting ‘‘Subject to subclause (x)(IV), 14 in determining’’; 15 (2) in subclause (III), by striking ‘‘In deter- 16 mining’’ and inserting ‘‘Subject to subclause (x)(IV), 17 in determining’’; and 18 (3) by adding at the end the following new sub- 19 clause: 20 ‘‘(IV) The provisions of subpara- 21 graph (L) of subsection (h)(4) shall 22 apply under this subparagraph in the 23 same manner as they apply under 24 such subsection.’’. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00167 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 168 •HR 5294 IH SEC. 309. DEVELOPING AND IMPLEMENTING STRATEGIES 1 FOR LOCAL HEALTH EQUITY. 2 (a) GRANTS.—The Secretaries of Health and Human 3 Services, Education, and Labor, acting jointly, shall make 4 grants to academic institutions for the purposes of— 5 (1) in accordance with subsection (b), devel- 6 oping capacity— 7 (A) to build an evidence base for successful 8 strategies for increasing local health equity; and 9 (B) to serve as national models of driving 10 local health equity; 11 (2) in accordance with subsection (c), devel- 12 oping a strategic partnership with the community in 13 which the academic institution is located; and 14 (3) collecting data on, and periodically evalu- 15 ating, the effectiveness of the institution’s programs 16 funded through this section to enable the institution 17 to adapt accordingly for maximum efficiency and 18 success. 19 (b) DEVELOPING CAPACITY FOR INCREASING LOCAL 20 HEALTH EQUITY.—As a condition on receipt of a grant 21 under subsection (a), an academic institution shall agree 22 to use the grant to build an evidence base for successful 23 strategies for increasing local health equity, and to serve 24 as a national model of driving local health equity, by sup- 25 porting— 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00168 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 169 •HR 5294 IH (1) resources to strengthen institutional metrics 1 and capacity to execute institutionwide health work- 2 force goals that can serve as models for increasing 3 health equity in communities across the country; 4 (2) collaborations among a cohort of institu- 5 tions in implementing systemic change, partnership 6 development, and programmatic efforts supportive of 7 health equity goals across disciplines and popu- 8 lations; and 9 (3) enhanced or newly developed data systems 10 and research infrastructure capable of informing 11 current and future workforce efforts and building a 12 foundation for a broader research agenda targeting 13 urban health disparities. 14 (c) STRATEGIC PARTNERSHIPS.—As a condition on 15 receipt of a grant under subsection (a), an academic insti- 16 tution shall agree to use the grant to develop a strategic 17 partnership with the community in which the institution 18 is located for the purposes of— 19 (1) strengthening connections between the insti- 20 tution and the community— 21 (A) to improve evaluation of and address 22 the community’s health and health workforce 23 needs; and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00169 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 170 •HR 5294 IH (B) to engage the community in health 1 workforce development; 2 (2) developing, enhancing, or accelerating inno- 3 vative undergraduate and graduate programs in the 4 biomedical sciences and health professions; and 5 (3) strengthening pipeline programs in the bio- 6 medical sciences and health professions, including by 7 developing partnerships between institutions of high- 8 er education and elementary and secondary schools 9 to recruit the next generation of health professionals 10 earlier in the pipeline to a health care career. 11 SEC. 310. LOAN FORGIVENESS FOR MENTAL AND BEHAV- 12 IORAL HEALTH SOCIAL WORKERS. 13 Section 455 of the Higher Education Act of 1965 (20 14 U.S.C. 1087e) is amended by adding at the end the fol- 15 lowing new subsection: 16 ‘‘(r) REPAYMENT PLAN FOR MENTAL AND BEHAV- 17 IORAL HEALTH SOCIAL WORKERS.— 18 ‘‘(1) IN GENERAL.—The Secretary shall cancel 19 the balance of interest and principal due on any eli- 20 gible Federal Direct Loan not in default for a bor- 21 rower who— 22 ‘‘(A) has made 120 monthly payments on 23 the eligible Federal Direct Loan after October 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00170 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 171 •HR 5294 IH 1, 2014, pursuant to any one or a combination 1 of the following— 2 ‘‘(i) payments under an income-based 3 repayment plan under section 493C; 4 ‘‘(ii) payments under a standard re- 5 payment plan under subsection (d)(1)(A), 6 based on a 10-year repayment period; 7 ‘‘(iii) monthly payments under a re- 8 payment plan under subsection (d)(1) or 9 (g) of not less than the monthly amount 10 calculated under subsection (d)(1)(A), 11 based on a 10-year repayment period; or 12 ‘‘(iv) payments under an income con- 13 tingent repayment plan under subsection 14 (d)(1)(D); and 15 ‘‘(B)(i) is employed as a mental health or 16 behavioral health social worker, as defined by 17 the Secretary by regulation, at the time of such 18 forgiveness; and 19 ‘‘(ii) has been employed as such a mental 20 health or behavioral health social worker during 21 the period in which the borrower makes each of 22 the 120 payments as described in subparagraph 23 (A). 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00171 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 172 •HR 5294 IH ‘‘(2) LOAN CANCELLATION AMOUNT.—After the 1 conclusion of the employment period described in 2 paragraph (1), the Secretary shall cancel the obliga- 3 tion to repay the balance of principal and interest 4 due as of the time of such cancellation, on the eligi- 5 ble Federal Direct Loans made to the borrower 6 under this part. 7 ‘‘(3) INELIGIBILITY FOR DOUBLE BENEFITS.— 8 No borrower may, for the same employment as a 9 mental heath or behavioral health social worker, re- 10 ceive a reduction of loan obligations under both this 11 subsection and section 455(m), 428J, 428K, 428L, 12 or 460. 13 ‘‘(4) DEFINITION OF ELIGIBLE FEDERAL DI- 14 RECT LOAN.—In this subsection, the term ‘eligible 15 Federal Direct Loan’ means a Federal Direct Staf- 16 ford Loan, Federal Direct PLUS Loan, Federal Di- 17 rect Unsubsidized Stafford Loan, or a Federal Di- 18 rect Consolidation Loan.’’. 19 SEC. 311. HEALTH PROFESSIONS WORKFORCE FUND. 20 (a) PURPOSE.—It is the purpose of this section to 21 establish a Health Professions Workforce Fund to be ad- 22 ministered through the Health Resources and Services Ad- 23 ministration within the Department of Health and Human 24 Services to provide for expanded and sustained national 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00172 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 173 •HR 5294 IH investment in the health professions and nursing work- 1 force development programs under title VII and title VIII 2 of the Public Health Service Act. 3 (b) ESTABLISHING THE HEALTH PROFESSIONS 4 WORKFORCE FUND.—There is authorized to be appro- 5 priated, and there is appropriated, out of any monies in 6 the Treasury not otherwise appropriated, to the Health 7 Professions Workforce Fund— 8 (1) $355,000,000 for fiscal year 2015; 9 (2) $375,000,000 for fiscal year 2016; 10 (3) $392,000,000 for fiscal year 2017; 11 (4) $412,000,000 for fiscal year 2018; 12 (5) $432,000,000 for fiscal year 2019; 13 (6) $454,000,000 for fiscal year 2020; 14 (7) $476,000,000 for fiscal year 2021; 15 (8) $500,000,000 for fiscal year 2022; 16 (9) $525,000,000 for fiscal year 2023; and 17 (10) $552,000,000 for fiscal year 2024. 18 (c) FUNDING.— 19 (1) For the purpose of carrying out health pro- 20 fessions education programs authorized under title 21 VII of the Public Health Service Act, in addition to 22 any other amounts authorized to be appropriated for 23 such purpose, there is authorized to be appropriated 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00173 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 174 •HR 5294 IH out of any monies in the Health Professions Work- 1 force Fund, the following: 2 (A) $240,000,000 for fiscal year 2015. 3 (B) $253,000,000 for fiscal year 2016. 4 (C) $265,000,000 for fiscal year 2017. 5 (D) $278,000,000 for fiscal year 2018. 6 (E) $292,000,000 for fiscal year 2019. 7 (F) $307,000,000 for fiscal year 2020. 8 (G) $322,000,000 for fiscal year 2021. 9 (H) $338,000,000 for fiscal year 2022. 10 (I) $355,000,000 for fiscal year 2023. 11 (J) $373,000,000 for fiscal year 2024. 12 (2) For the purpose of carrying out nursing 13 workforce development programs authorized under 14 Title VIII of the Public Health Service Act, in addi- 15 tion to any other amounts authorized to be appro- 16 priated for such purpose, there is authorized to be 17 appropriated out of any monies in the Health Pro- 18 fessions Workforce Fund, the following: 19 (A) $115,000,000 for fiscal year 2015. 20 (B) $122,000,000 for fiscal year 2016. 21 (C) $127,000,000 for fiscal year 2017. 22 (D) $134,000,000 for fiscal year 2018. 23 (E) $140,000,000 for fiscal year 2019. 24 (F) $147,000,000 for fiscal year 2020. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00174 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 175 •HR 5294 IH (G) $154,000,000 for fiscal year 2021. 1 (H) $162,000,000 for fiscal year 2022. 2 (I) $170,000,000 for fiscal year 2023. 3 (J) $179,000,000 for fiscal year 2024. 4 SEC. 312. FINDINGS; SENSE OF CONGRESS RELATING TO 5 GRADUATE MEDICAL EDUCATION. 6 (a) FINDINGS.—Congress finds the following: 7 (1) Projections by the Association of American 8 Medical Colleges (AAMC) and other expert entities, 9 such as the Health Resources and Services Adminis- 10 tration (HRSA), have indicated a nationwide short- 11 age of up to 130,600 physicians, split evenly be- 12 tween primary care and specialists, by 2025. 13 (2) The coverage of an additional 25 million 14 uninsured Americans under the Patient Protection 15 and Affordable Care Act is expected to increase the 16 projected shortage by 25 percent. 17 (3) The United States Census projects that the 18 Nation’s population will grow from 310 million in 19 2010 to 400 million in 2044, with the Nation be- 20 coming majority-minority in 2043, and the number 21 of Medicare beneficiaries increasing from 50.7 mil- 22 lion in 2012 to 90 million in 2045. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00175 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 176 •HR 5294 IH (4) One-third of currently practicing physicians 1 are over 55 years of age and likely to retire in the 2 next 20 years. 3 (5) A nationwide physician shortage will result 4 in many Americans waiting longer and traveling far- 5 ther for health care; seeking nonemergent care in 6 emergency departments; and delaying treatment 7 until their health care needs become more serious, 8 complex, and costly. 9 (6) Changing demographics (such as an aging 10 population), new health care delivery models (such 11 as medical homes), and other factors (such as dis- 12 aster preparedness) are contributing to a shortage of 13 both generalist and specialist physicians. 14 (7) These shortages will have the most severe 15 impact on vulnerable and underserved populations, 16 including racial/ethnic minorities and the approxi- 17 mately 20 percent of Americans who live in rural or 18 inner-city locations designated as health professional 19 shortage areas. 20 (8) United States medical schools have com- 21 mitted to and have initiated a 30 percent increase 22 in enrollment by 2017 to help reduce the Nation’s 23 shortage of quality physicians. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00176 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 177 •HR 5294 IH (9) An increase in United States medical school 1 graduates must be accompanied by an increase of 2 4,000 graduate medical education (GME) training 3 positions each year. 4 (10) Graduate medical education programs and 5 teaching hospitals provide venues in which the next 6 generation of physicians learns to work collabo- 7 ratively with other physicians and health profes- 8 sionals, adopt more efficient care delivery models 9 (such as care coordination and medical homes), in- 10 corporate health information technology and elec- 11 tronic health records in every aspect of their work, 12 apply new methods of assuring quality and safety, 13 and participate in groundbreaking clinical and public 14 health research. 15 (11) The Medicare Program under title XVIII 16 of the Social Security Act (having more beneficiaries 17 than any other health care program), supports its 18 ‘‘fair share’’ of the costs associated with graduate 19 medical education (GME). 20 (12) In general, the level of support of graduate 21 medical education by the Medicare Program has 22 been capped since 1997 and has not been increased 23 to support the expansion of graduate medical edu- 24 cation programs needed to avert the projected physi- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00177 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 178 •HR 5294 IH cian shortage or to accommodate the increase in 1 United States medical school graduates. 2 (b) SENSE OF CONGRESS.—It is the sense of Con- 3 gress that eliminating the limit of the number of residency 4 positions that receive some level of Medicare support 5 under section 1886(h) of the Social Security Act (42 6 U.S.C. 1395ww(h)), also referred to as the Medical grad- 7 uate medical education cap, is critical to— 8 (1) ensuring an appropriate supply of physi- 9 cians to meet the Nation’s health care needs; 10 (2) facilitating equitable access for all who seek 11 health care; and 12 (3) mitigating disparities in health and health 13 care. 14 SEC. 313. CAREER SUPPORT FOR SKILLED INTERNATION- 15 ALLY EDUCATED HEALTH PROFESSIONALS. 16 (a) FINDINGS.—Congress finds the following: 17 (1) According to the Association of Schools of 18 Public Health, projections indicate a nationwide 19 shortage of up to 250,000 public health workers 20 needed by 2020. 21 (2) Similar trends are projected for other health 22 professions indicating shortages across disciplines, 23 including within the fields of nursing, dentistry, 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00178 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 179 •HR 5294 IH pharmacy, mental and behavioral health, primary 1 care, and community and allied health. 2 (3) A nationwide health workforce shortage will 3 result in serious health threats and more severe and 4 costly health care needs, due to, in part, a delayed 5 response to food-borne outbreaks, emerging infec- 6 tious diseases, and natural disasters, fewer cancer 7 screenings and delayed treatment. 8 (4) Vulnerable and underserved populations and 9 health professional shortage areas will be most se- 10 verely impacted by the health workforce shortage. 11 (5) According to the Migration Policy Institute, 12 over 2 million college-educated immigrants in the 13 United States today are unemployed or under- 14 employed in low- or semi-skilled jobs that fail to 15 draw on their education and expertise. 16 (6) Approximately two out of every five inter- 17 nationally educated immigrants are unemployed or 18 underemployed. 19 (7) According to Drexel University Center for 20 Labor Markets and Policy, underemployment for 21 internationally educated immigrant women is 28 per- 22 cent higher than for their male counterparts. 23 (8) According to the Drexel University Center 24 for Labor Markets and Policy, the mean annual 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00179 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 180 •HR 5294 IH earnings of underemployed immigrants were 1 $32,000, or 43 percent less than U.S.-born college 2 graduates employed in the college labor market. 3 (9) According to Upwardly Global and the Wel- 4 come Back Initiative, with proper guidance and sup- 5 port underemployed skilled immigrants typically in- 6 crease their income by 215 percent to 900 percent. 7 (10) According to the Brookings Institution and 8 the Partnership for a New American Economy, im- 9 migrants working in the health workforce are, on av- 10 erage, better-educated than U.S.-born workers in the 11 health workforce. 12 (b) GRANTS TO ELIGIBLE ENTITIES.— 13 (1) AUTHORITY TO PROVIDE GRANTS.—The 14 Secretary of Health and Human Services, acting 15 through the Bureau of Health Workforce within the 16 Health Resources and Services Administration, the 17 National Institute on Minority Health and Health 18 Disparities, or the Office of Minority Health (in this 19 section referred to as the ‘‘Secretary’’), may award 20 grants to eligible entities to carry out activities de- 21 scribed in subsection (c). 22 (2) ELIGIBILITY.—To be eligible to receive a 23 grant under this section, an entity shall— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00180 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 181 •HR 5294 IH (A) be a clinical, public health, or health 1 services organization, a community-based or 2 nonprofit entity, an academic institution, a 3 faith-based organization, a State, county, or 4 local government, a National Area Health Edu- 5 cation Center, or another entity determined ap- 6 propriate by the Secretary; and 7 (B) submit to the Secretary an application 8 at such time, in such manner, and containing 9 such information as the Secretary may require. 10 (c) AUTHORIZED ACTIVITIES.—A grant awarded 11 under this section shall be used— 12 (1) to provide services to assist unemployed and 13 underemployed skilled immigrants, residing in the 14 United States, who have legal, permanent work au- 15 thorization and who are internationally educated 16 health professions, enter into the American health 17 workforce with employment matching their health 18 professional skills and education, and advance in em- 19 ployment to positions that better match their health 20 professional education and expertise; 21 (2) to reduce disparities in incomes between 22 skilled health professional immigrants and other 23 workers in the health workforce; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00181 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 182 •HR 5294 IH (3) to reduce barriers to entry and advance- 1 ment in the health workforce for internationally edu- 2 cated skilled immigrants; and 3 (4) to educate employers regarding the abilities 4 and capacities of internationally educated health 5 professionals. 6 (d) DEFINITIONS.—In this section: 7 (1) The term ‘‘health professional’’ means an 8 individual trained for employment or intended em- 9 ployment in the field of public health, health man- 10 agement, dentistry, health administration, medicine, 11 nursing, pharmacy, psychology, social work, psychi- 12 atry, other mental and behavioral health, allied 13 health, community health, social work, or wellness 14 work, including fitness and nutrition, or other fields 15 as determined appropriate by the Secretary. 16 (2) The term ‘‘underemployed’’ means being 17 employed at less skilled tasks than an employee’s 18 training or abilities would otherwise permit. 19 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 20 authorized to be appropriated to carry out this section 21 such sums as may be necessary for each of fiscal years 22 2015 through 2019. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00182 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 183 •HR 5294 IH TITLE IV—IMPROVEMENT OF 1 HEALTH CARE SERVICES 2 Subtitle A—Health Empowerment 3 Zones 4 SEC. 401. SHORT TITLE. 5 This subtitle may be cited as the ‘‘Health Empower- 6 ment Zone Act of 2014’’. 7 SEC. 402. FINDINGS. 8 The Congress finds the following: 9 (1) Numerous studies and reports, including 10 the 2012 National Healthcare Disparities Report of 11 the Administration on Healthcare Research and 12 Quality and the 2002 Unequal Treatment Report of 13 the Institute of Medicine, document the extensive- 14 ness to which health disparities exist across the 15 country. 16 (2) These studies have found that, on average, 17 racial and ethnic minorities are disproportionately 18 afflicted with chronic and acute conditions—such as 19 cancer, diabetes, musculoskeletal disease, obesity, 20 and hypertension—and suffer worse health out- 21 comes, worse health status, and higher mortality 22 rates than their White counterparts. 23 (3) Several recent studies also show that health 24 disparities are a function of not only access to health 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00183 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 184 •HR 5294 IH care, but also the social determinants of health—in- 1 cluding the environment, the physical structure of 2 communities, nutrition and food options, educational 3 attainment, employment, race, ethnicity, geography, 4 and language preference—that directly and indi- 5 rectly affect the health, health care, and wellness of 6 individuals and communities. 7 (4) Integrally involving and fully supporting the 8 communities most affected by health inequities in 9 the assessment, planning, launch, and evaluation of 10 health disparity elimination efforts are among the 11 leading recommendations made to adequately ad- 12 dress and ultimately reduce health disparities. 13 (5) Recommendations also include supporting 14 the efforts of community stakeholders from a broad 15 cross section—including, but not limited to local 16 businesses, local departments of commerce, edu- 17 cation, labor, urban planning, and transportation, 18 and community-based and other nonprofit organiza- 19 tions—to find areas of common ground around 20 health disparity elimination and collaborate to im- 21 prove the overall health and wellness of a community 22 and its residents. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00184 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 185 •HR 5294 IH SEC. 403. DESIGNATION OF HEALTH EMPOWERMENT 1 ZONES. 2 (a) IN GENERAL.—At the request of an eligible com- 3 munity partnership, the Secretary may designate an eligi- 4 ble area as a health empowerment zone. 5 (b) ELIGIBILITY CRITERIA.— 6 (1) ELIGIBLE COMMUNITY PARTNERSHIP.—A 7 community partnership is eligible to submit a re- 8 quest under this section if the partnership— 9 (A) demonstrates widespread public sup- 10 port from key individuals and entities in the eli- 11 gible area, including members of the target 12 community, State and local governments, non- 13 profit organizations, and community and indus- 14 try leaders, for designation of the eligible area 15 as a health empowerment zone; and 16 (B) includes representatives of— 17 (i) a broad cross section of stake- 18 holders and residents from communities in 19 the eligible area experiencing dispropor- 20 tionate disparities in health status and 21 health care; and 22 (ii) organizations, facilities, and insti- 23 tutions that have a history of working 24 within and serving such communities. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00185 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 186 •HR 5294 IH (2) ELIGIBLE AREA.—An area is eligible to be 1 designated as a health empowerment zone under this 2 section if one or more communities in the area expe- 3 rience disproportionate disparities in health status 4 and health care. In determining whether a commu- 5 nity experiences such disparities, the Secretary shall 6 consider the data collected by the Department of 7 Health and Human Services focusing on the fol- 8 lowing areas: 9 (A) Access to affordable, high-quality 10 health services. 11 (B) The prevalence of disproportionate 12 rates of certain illnesses or diseases including 13 the following: 14 (i) Arthritis, osteoporosis, chronic 15 back conditions, and other musculoskeletal 16 diseases. 17 (ii) Cancer. 18 (iii) Chronic kidney disease. 19 (iv) Diabetes. 20 (v) Injury (intentional and uninten- 21 tional). 22 (vi) Violence (intimate and non- 23 intimate). 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00186 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 187 •HR 5294 IH (vii) Maternal and paternal illnesses 1 and diseases. 2 (viii) Infant mortality. 3 (ix) Mental illness and other disabil- 4 ities. 5 (x) Substance abuse treatment and 6 prevention, including underage drinking. 7 (xi) Nutrition, obesity, and overweight 8 conditions. 9 (xii) Heart disease. 10 (xiii) Hypertension. 11 (xiv) Cerebrovascular disease or 12 stroke. 13 (xv) Tuberculosis. 14 (xvi) HIV/AIDS and other sexually 15 transmitted diseases. 16 (xvii) Viral hepatitis. 17 (xviii) Asthma. 18 (xix) Tooth decay and other oral 19 health issues. 20 (C) Within the target community, the his- 21 torical and persistent presence of conditions 22 that have been found to contribute to health 23 disparities including any such conditions re- 24 specting the following: 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00187 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 188 •HR 5294 IH (i) Poverty. 1 (ii) Educational status and the quality 2 of community schools. 3 (iii) Income. 4 (iv) Access to high-quality affordable 5 health care. 6 (v) Work and work environment. 7 (vi) Environmental conditions in the 8 community, including with respect to clean 9 water, clean air, and the presence or ab- 10 sence of pollutants. 11 (vii) Language and English pro- 12 ficiency. 13 (viii) Access to affordable healthy 14 food. 15 (ix) Access to ethnically and culturally 16 diverse health and human service providers 17 and practitioners. 18 (x) Access to culturally and linguis- 19 tically competent health and human serv- 20 ices and health and human service pro- 21 viders. 22 (xi) Health-supporting infrastructure. 23 (xii) Health insurance that is ade- 24 quate and affordable. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00188 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 189 •HR 5294 IH (xiii) Race, racism, and bigotry (con- 1 scious and unconscious). 2 (xiv) Sexual orientation. 3 (xv) Health literacy. 4 (xvi) Place of residence (such as 5 urban areas, rural areas, and tribal res- 6 ervations). 7 (xvii) Stress. 8 (c) PROCEDURE.— 9 (1) REQUEST.—A request under subsection (a) 10 shall— 11 (A) describe the bounds of the area to be 12 designated as a health empowerment zone and 13 the process used to select those bounds; 14 (B) demonstrate that the partnership sub- 15 mitting the request is an eligible community 16 partnership described in subsection (b)(1); 17 (C) demonstrate that the area is an eligible 18 area described in subsection (b)(2); 19 (D) include a comprehensive assessment of 20 disparities in health status and health care ex- 21 perience by one or more communities in the 22 area; 23 (E) set forth— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00189 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 190 •HR 5294 IH (i) a vision and a set of values for the 1 area; and 2 (ii) a comprehensive and holistic set of 3 goals to be achieved in the area through 4 designation as a health empowerment zone; 5 and 6 (F) include a strategic plan and an action 7 plan for achieving the goals described in sub- 8 paragraph (E)(ii). 9 (2) APPROVAL.—Not later than 60 days after 10 the receipt of a request for designation of an area 11 as a health empowerment zone under this section, 12 the Secretary shall approve or disapprove the re- 13 quest. 14 (d) MINIMUM NUMBER.—The Secretary— 15 (1) shall designate not more than 110 health 16 empowerment zones under this section; and 17 (2) shall designate at least one health empower- 18 ment zone in each of the several States, the District 19 of Columbia, and each territory or possession of the 20 United States. 21 SEC. 404. ASSISTANCE TO THOSE SEEKING DESIGNATION. 22 At the request of any organization or entity seeking 23 to submit a request under section 403(a), the Secretary 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00190 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 191 •HR 5294 IH shall provide technical assistance, and may award a grant, 1 to assist such organization or entity— 2 (1) to form an eligible community partnership 3 described in section 403(b)(1); 4 (2) to complete a health assessment, including 5 an assessment of health disparities under section 6 403(c)(1)(D); or 7 (3) to prepare and submit a request, including 8 a strategic plan, in accordance with section 403. 9 SEC. 405. BENEFITS OF DESIGNATION. 10 (a) PRIORITY.—In awarding any competitive grant, 11 a Federal official shall give priority to any applicant 12 that— 13 (1) meets the eligibility criteria for the grant; 14 (2) proposes to use the grant for activities in a 15 health empowerment zone; and 16 (3) demonstrates that such activities will di- 17 rectly and significantly further the goals of the stra- 18 tegic plan approved for such zone under section 403. 19 (b) GRANTS FOR INITIAL IMPLEMENTATION OF 20 STRATEGIC PLAN.— 21 (1) IN GENERAL.—Upon designating an eligible 22 area as a health empowerment zone at the request 23 of an eligible community partnership, the Secretary 24 shall, subject to the availability of appropriations, 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00191 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 192 •HR 5294 IH make a grant to the community partnership for im- 1 plementation of the strategic plan for such zone. 2 (2) GRANT PERIOD.—A grant under paragraph 3 (1) for a health empowerment zone shall be for a pe- 4 riod of 2 years and may be renewed, except that the 5 total period of grants under paragraph (1) for such 6 zone may not exceed 10 years. 7 (3) LIMITATION.—In awarding grants under 8 this subsection, the Secretary shall not give less pri- 9 ority to an applicant or reduce the amount of a 10 grant because the Secretary rendered technical as- 11 sistance or made a grant to the same applicant 12 under section 404. 13 (4) REPORTING.—The Secretary shall require 14 each recipient of a grant under this subsection to re- 15 port to the Secretary not less than every 6 months 16 on the progress in implementing the strategic plan 17 for the health empowerment zone. 18 SEC. 406. DEFINITION. 19 In this subtitle, the term ‘‘Secretary’’ means the Sec- 20 retary of Health and Human Services, acting through the 21 Administrator of the Health Resources and Services Ad- 22 ministration and the Deputy Assistant Secretary for Mi- 23 nority Health, and in cooperation with the Director of the 24 Office of Community Services and the Director of the Na- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00192 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 193 •HR 5294 IH tional Institute for Minority Health and Health Dispari- 1 ties. 2 SEC. 407. AUTHORIZATION OF APPROPRIATIONS. 3 To carry out this subtitle, there is authorized to be 4 appropriated $100,000,000 for fiscal year 2015. 5 Subtitle B—Other Improvements of 6 Health Care Services 7 CHAPTER 1—EXPANSION OF COVERAGE 8 SEC. 411. AMENDMENT TO THE PUBLIC HEALTH SERVICE 9 ACT. 10 Title XXXIV of the Public Health Service Act, as 11 amended by titles I, II, III, and IX of this Act, is further 12 amended by inserting after subtitle C the following: 13 ‘‘Subtitle D—Reconstruction and 14 Improvement Grants for Public 15 Health Care Facilities Serving 16 Pacific Islanders and the Insu- 17 lar Areas 18 ‘‘SEC. 3451. GRANT SUPPORT FOR QUALITY IMPROVEMENT 19 INITIATIVES. 20 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 21 with the Administrator of the Health Resources and Serv- 22 ices Administration, the Director of the Agency for 23 Healthcare Research and Quality, and the Administrator 24 of the Centers for Medicare & Medicaid Services, shall 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00193 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 194 •HR 5294 IH award grants to eligible entities for the conduct of dem- 1 onstration projects to improve the quality of and access 2 to health care. 3 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 4 under subsection (a), an entity shall— 5 ‘‘(1) be a health center, hospital, health plan, 6 health system, community clinic. or other health en- 7 tity determined appropriate by the Secretary— 8 ‘‘(A) that, by legal mandate or explicitly 9 adopted mission, provides patients with access 10 to services regardless of their ability to pay; 11 ‘‘(B) that provides care or treatment for a 12 substantial number of patients who are unin- 13 sured, are receiving assistance under a State 14 program under title XIX of the Social Security 15 Act, or are members of vulnerable populations, 16 as determined by the Secretary; and 17 ‘‘(C)(i) with respect to which, not less than 18 50 percent of the entity’s patient population is 19 made up of racial and ethnic minorities; or 20 ‘‘(ii) that— 21 ‘‘(I) serves a disproportionate percent- 22 age of local, minority racial and ethnic pa- 23 tients, or that has a patient population, at 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00194 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 195 •HR 5294 IH least 50 percent of which is limited- 1 English-proficient; and 2 ‘‘(II) provides an assurance that 3 amounts received under the grant will be 4 used only to support quality improvement 5 activities in the racial and ethnic popu- 6 lation served; and 7 ‘‘(2) prepare and submit to the Secretary an 8 application at such time, in such manner, and con- 9 taining such information as the Secretary may re- 10 quire. 11 ‘‘(c) PRIORITY.—In awarding grants under sub- 12 section (a), the Secretary shall give priority to applicants 13 under subsection (b)(2) that— 14 ‘‘(1) demonstrate an intent to operate as part 15 of a health care partnership, network, collaborative, 16 coalition, or alliance where each member entity con- 17 tributes to the design, implementation, and evalua- 18 tion of the proposed intervention; or 19 ‘‘(2) intend to use funds to carry out system- 20 wide changes with respect to health care quality im- 21 provement, including— 22 ‘‘(A) improved systems for data collection 23 and reporting; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00195 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 196 •HR 5294 IH ‘‘(B) innovative collaborative or similar 1 processes; 2 ‘‘(C) group programs with behavioral or 3 self-management interventions; 4 ‘‘(D) case management services; 5 ‘‘(E) physician or patient reminder sys- 6 tems; 7 ‘‘(F) educational interventions; or 8 ‘‘(G) other activities determined appro- 9 priate by the Secretary. 10 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 11 received under a grant under subsection (a) to support 12 the implementation and evaluation of health care quality 13 improvement activities or minority health and health care 14 disparity reduction activities that include— 15 ‘‘(1) with respect to health care systems, activi- 16 ties relating to improving— 17 ‘‘(A) patient safety; 18 ‘‘(B) timeliness of care; 19 ‘‘(C) effectiveness of care; 20 ‘‘(D) efficiency of care; 21 ‘‘(E) patient centeredness; and 22 ‘‘(F) health information technology; and 23 ‘‘(2) with respect to patients, activities relating 24 to— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00196 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 197 •HR 5294 IH ‘‘(A) staying healthy; 1 ‘‘(B) getting well, mentally and physically; 2 ‘‘(C) living effectively with illness or dis- 3 ability; and 4 ‘‘(D) coping with end-of-life issues. 5 ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 6 provide financial and other technical assistance to grant- 7 ees under this section for the development of common data 8 systems. 9 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 10 are authorized to be appropriated to carry out this section 11 such sums as may be necessary for each of fiscal years 12 2015 through 2020. 13 ‘‘SEC. 3452. CENTERS OF EXCELLENCE. 14 ‘‘(a) IN GENERAL.—The Secretary, acting through 15 the Administrator of the Health Resources and Services 16 Administration, shall designate centers of excellence at 17 public hospitals, and other health systems serving large 18 numbers of minority patients, that— 19 ‘‘(1) meet the requirements of section 20 3451(b)(1); 21 ‘‘(2) demonstrate excellence in providing care to 22 minority populations; and 23 ‘‘(3) demonstrate excellence in reducing dispari- 24 ties in health and health care. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00197 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 198 •HR 5294 IH ‘‘(b) REQUIREMENTS.—A hospital or health system 1 that serves as a center of excellence under subsection (a) 2 shall— 3 ‘‘(1) design, implement, and evaluate programs 4 and policies relating to the delivery of care in ra- 5 cially, ethnically, and linguistically diverse popu- 6 lations; 7 ‘‘(2) provide training and technical assistance 8 to other hospitals and health systems relating to the 9 provision of quality health care to minority popu- 10 lations; and 11 ‘‘(3) develop activities for graduate or con- 12 tinuing medical education that institutionalize a 13 focus on cultural competence training for health care 14 providers. 15 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 16 are authorized to be appropriated to carry out this section, 17 such sums as may be necessary for each of fiscal years 18 2015 through 2020. 19 ‘‘SEC. 3453. RECONSTRUCTION AND IMPROVEMENT GRANTS 20 FOR PUBLIC HEALTH CARE FACILITIES SERV- 21 ING PACIFIC ISLANDERS AND THE INSULAR 22 AREAS. 23 ‘‘(a) IN GENERAL.—The Secretary shall provide di- 24 rect financial assistance to designated health care pro- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00198 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 199 •HR 5294 IH viders and community health centers in American Samoa, 1 Guam, the Commonwealth of the Northern Mariana Is- 2 lands, the United States Virgin Islands, Puerto Rico, and 3 Hawaii for the purposes of reconstructing and improving 4 health care facilities and services in a culturally competent 5 and sustainable manner. 6 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi- 7 nancial assistance under subsection (a), an entity shall be 8 a public health facility or community health center located 9 in American Samoa, Guam, the Commonwealth of the 10 Northern Mariana Islands, the United States Virgin Is- 11 lands, Puerto Rico, or Hawaii that— 12 ‘‘(1) is owned or operated by— 13 ‘‘(A) the Government of American Samoa, 14 Guam, the Commonwealth of the Northern 15 Mariana Islands, the United States Virgin Is- 16 lands, Puerto Rico, or Hawaii or a unit of local 17 government; or 18 ‘‘(B) a nonprofit organization; and 19 ‘‘(2)(A) provides care or treatment for a sub- 20 stantial number of patients who are uninsured, re- 21 ceiving assistance under a State program under a 22 title XVIII of the Social Security Act, or a State 23 program under title XIX of such Act, or who are 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00199 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 200 •HR 5294 IH members of a vulnerable population, as determined 1 by the Secretary; or 2 ‘‘(B) serves a disproportionate percentage of 3 local, minority racial and ethnic patients. 4 ‘‘(c) REPORT.—Not later than 180 days after the 5 date of enactment of this title and annually thereafter, the 6 Secretary shall submit to the Congress and the President 7 a report that includes an assessment of health resources 8 and facilities serving populations in American Samoa, 9 Guam, the Commonwealth of the Northern Mariana Is- 10 lands, the United States Virgin Islands, Puerto Rico, and 11 Hawaii. In preparing such report, the Secretary shall— 12 ‘‘(1) consult with and obtain information on all 13 health care facilities needs from the entities de- 14 scribed in subsection (b); 15 ‘‘(2) include all amounts of Federal assistance 16 received by each entity in the preceding fiscal year; 17 ‘‘(3) review the total unmet needs of each juris- 18 diction for health care facilities, including needs for 19 renovation and expansion of existing facilities; 20 ‘‘(4) include a strategic plan for addressing the 21 needs of each jurisdiction identified in the report; 22 and 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00200 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 201 •HR 5294 IH ‘‘(5) evaluate the effectiveness of the care pro- 1 vided by measuring patient outcomes and cost meas- 2 ures. 3 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 4 are authorized to be appropriated such sums as necessary 5 to carry out this section.’’. 6 SEC. 412. REMOVING CITIZENSHIP AND IMMIGRATION BAR- 7 RIERS TO ACCESS TO AFFORDABLE HEALTH 8 CARE UNDER THE ACA. 9 (a) IN GENERAL.— 10 (1) PREMIUM TAX CREDITS.—Section 36B of 11 the Internal Revenue Code of 1986 is amended— 12 (A) in subsection (c)(1)(B)— 13 (i) by amending the subparagraph 14 heading to read as follows: ‘‘SPECIAL RULE 15 FOR CERTAIN INDIVIDUALS INELIGIBLE 16 FOR MEDICAID DUE TO STATUS’’, and 17 (ii) in clause (ii), by striking ‘‘lawfully 18 present in the United States, but’’ and in- 19 serting ‘‘who’’, and 20 (B) by striking subsection (e). 21 (2) COST-SHARING REDUCTIONS.—Section 1402 22 of the Patient Protection and Affordable Care Act 23 (42 U.S.C. 18071) is amended by striking sub- 24 section (e). 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00201 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 202 •HR 5294 IH (3) PREEXISTING CONDITION INSURANCE 1 PLAN.—Section 1101(d) of the Patient Protection 2 and Affordable Care Act (42 U.S.C. 18001(d)) is 3 amended by striking paragraph (1) and redesig- 4 nating paragraphs (2) and (3) as paragraphs (1) 5 and (2), respectively. 6 (4) BASIC HEALTH PROGRAM ELIGIBILITY.— 7 Section 1331(e)(1)(B) of the Patient Protection and 8 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 9 amended by striking ‘‘lawfully present in the United 10 States,’’. 11 (5) RESTRICTIONS ON FEDERAL PAYMENTS.— 12 Section 1412 of the Patient Protection and Afford- 13 able Care Act (42 U.S.C. 18082) is amended by 14 striking subsection (d). 15 (6) REQUIREMENT TO MAINTAIN MINIMUM ES- 16 SENTIAL COVERAGE.—Subsection (d) of section 17 5000A of the Internal Revenue Code of 1986 is 18 amended by striking paragraph (3) and by redesig- 19 nating paragraph (4) as paragraph (3). 20 (b) CONFORMING AMENDMENT.— 21 (1) Section 1411(a) of the Patient Protection 22 and Affordable Care Act (42 U.S.C. 18081(a)) is 23 amended by striking paragraph (1) and redesig- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00202 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 203 •HR 5294 IH nating paragraphs (2), (3), and (4) as paragraphs 1 (1), (2), and (3), respectively. 2 (2) Section 1312(f) of the Patient Protection 3 and Affordable Care Act (42 U.S.C. 18032(f)) is 4 amended— 5 (A) in the subsection heading, by striking 6 ‘‘employers;’’ and all that follows through ‘‘resi- 7 dents’’; and 8 (B) by striking paragraph (3). 9 SEC. 413. STUDY ON THE UNINSURED. 10 (a) IN GENERAL.—The Secretary of Health and 11 Human Services (in this section referred to as the ‘‘Sec- 12 retary’’) shall— 13 (1) conduct a study, in accordance with the 14 standards under section 3101 of the Public Health 15 Service Act (42 U.S.C. 300kk), on the demographic 16 characteristics of the population of individuals who 17 do not have health insurance coverage; and 18 (2) predict, based on such study, the demo- 19 graphic characteristics of the population of individ- 20 uals who would remain without health insurance cov- 21 erage after the end of open enrollment or any special 22 enrollment period. 23 (b) REPORTING REQUIREMENTS.— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00203 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 204 •HR 5294 IH (1) IN GENERAL.—Not later than 12 months 1 after the date of the enactment of this Act, the Sec- 2 retary shall submit to the Congress the results of 3 the study under subsection (a)(1) and the prediction 4 made under subsection (a)(2). 5 (2) REPORTING OF DEMOGRAPHIC CHARACTER- 6 ISTICS.—The Secretary shall report the demographic 7 characteristics under paragraphs (1) and (2) of sub- 8 section (a) on the basis of racial and ethnic group, 9 and shall stratify the reporting on each racial and 10 ethnic group by other demographic characteristics 11 that can impact access to health insurance coverage, 12 such as sexual orientation, gender identity, primary 13 language, disability status, sex, socioeconomic sta- 14 tus, age group, and citizenship and immigration sta- 15 tus, in a manner consistent with title I of this Act. 16 SEC. 414. MEDICAID PAYMENT PARITY FOR THE TERRI- 17 TORIES. 18 (a) ELIMINATION OF FUNDING LIMITATIONS FOR 19 PUERTO RICO, THE UNITED STATES VIRGIN ISLANDS, 20 GUAM, THE COMMONWEALTH OF THE NORTHERN MAR- 21 IANA ISLANDS, AND AMERICAN SAMOA.— 22 (1) IN GENERAL.—Section 1108 of the Social 23 Security Act (42 U.S.C. 1308) is amended— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00204 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 205 •HR 5294 IH (A) in subsection (f), in the matter pre- 1 ceding paragraph (1), by striking ‘‘subsection 2 (g)’’ and inserting ‘‘subsections (g) and (h)’’; 3 (B) in subsection (g)(2), in the matter pre- 4 ceding subparagraph (A)— 5 (i) by striking ‘‘Notwithstanding sub- 6 section (f) and subject to and’’ and insert- 7 ing ‘‘Notwithstanding subsection (f) and 8 subject to’’; and 9 (ii) by striking ‘‘paragraphs (3) and 10 (5)’’ and inserting ‘‘, paragraphs (3) and 11 (5) of this subsection, and subsection (h)’’. 12 (C) by adding at the end the following new 13 subsection: 14 ‘‘(h) SUNSET OF FUNDING LIMITATIONS FOR PUER- 15 TO RICO, THE UNITED STATES VIRGIN ISLANDS, GUAM, 16 THE COMMONWEALTH OF THE NORTHERN MARIANA IS- 17 LANDS, AND AMERICAN SAMOA.—Subsections (f) and (g) 18 shall not apply to Puerto Rico, the United States Virgin 19 Islands, Guam, the Commonwealth of the Northern Mar- 20 iana Islands, and American Samoa for any fiscal year 21 after fiscal year 2015.’’. 22 (2) CONFORMING AMENDMENT.—Section 23 1903(u) of such Act (42 U.S.C. 1396c(u)) is amend- 24 ed by striking paragraph (4). 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00205 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 206 •HR 5294 IH (3) EFFECTIVE DATE.—The amendments made 1 by this subsection shall apply beginning with fiscal 2 year 2016. 3 (b) PARITY IN FMAP.— 4 (1) IN GENERAL.—Section 1905(b) of such Act 5 (42 U.S.C. 1396d(b)) is amended by inserting after 6 ‘‘and American Samoa shall be 55 percent,’’ the fol- 7 lowing: ‘‘(except that, beginning with fiscal year 8 2018, the Federal medical assistance percentage for 9 Puerto Rico, the United States Virgin Islands, 10 Guam, the Commonwealth of the Northern Mariana 11 Islands, and American Samoa shall be the Federal 12 medical assistance percentage determined by the 13 Secretary in consultation (for the United States Vir- 14 gin Islands, Guam, the Commonwealth of the North- 15 ern Mariana Islands, and American Samoa) with the 16 Secretary of the Interior)’’. 17 (2) 2-FISCAL-YEAR TRANSITION.—Notwith- 18 standing any other provision of law, during fiscal 19 years 2016 and 2017, the Federal medical assist- 20 ance percentage established under section 1905(b) of 21 the Social Security Act (42 U.S.C. 1396d(b)) for 22 Puerto Rico, the United States Virgin Islands, 23 Guam, the Commonwealth of the Northern Mariana 24 Islands, and American Samoa shall be the highest 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00206 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 207 •HR 5294 IH such Federal medical assistance percentage applica- 1 ble to any of the 50 States or the District of Colum- 2 bia for the fiscal year involved. 3 (3) PER CAPITA INCOME DATA.— 4 (A) REPORT TO CONGRESS.—Not later 5 than October 1, 2016, the Secretary of Health 6 and Human Services shall submit to Congress 7 a report that describes the per capita income 8 data used to promulgate the Federal medical 9 assistance percentage in the territories and how 10 such data differ from the per capita income 11 data used to promulgate Federal medical assist- 12 ance percentages for the 50 States and the Dis- 13 trict of Columbia. The report should include 14 recommendations on how the Federal medical 15 assistance percentages can be calculated for the 16 territories to ensure parity with the 50 States 17 and the District of Columbia. 18 (B) APPLICATION.—Section 1101(a)(8)(B) 19 of the Social Security Act (42 U.S.C. 20 1308(a)(8)(B)) is amended— 21 (i) by striking ‘‘(other than Puerto 22 Rico, the United States Virgin Islands, and 23 Guam)’’ and inserting ‘‘(including Puerto 24 Rico, the United States Virgin Islands, 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00207 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 208 •HR 5294 IH Guam, the Commonwealth of the Northern 1 Mariana Islands, and American Samoa)’’; 2 and 3 (ii) by inserting ‘‘(or, if such satisfac- 4 tory data are not available in the case of 5 the United States Virgin Islands, Guam, 6 the Northern Mariana Islands, or Amer- 7 ican Samoa, satisfactory data available 8 from the Department of the Interior for 9 the same period, or if such satisfactory 10 data are not available in the case of Puerto 11 Rico, satisfactory data available from the 12 government of the Commonwealth of Puer- 13 to Rico for the same period)’’ after ‘‘De- 14 partment of Commerce’’. 15 SEC. 415. EXTENSION OF MEDICARE SECONDARY PAYER. 16 (a) IN GENERAL.—Section 1862(b)(1)(C) of the So- 17 cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend- 18 ed— 19 (1) in the last sentence, by inserting ‘‘, and be- 20 fore January 1, 2015’’ after ‘‘prior to such date)’’; 21 and 22 (2) by adding at the end the following new sen- 23 tence: ‘‘Effective for items and services furnished on 24 or after January 1, 2015 (with respect to periods 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00208 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 209 •HR 5294 IH beginning on or after the date that is 42 months 1 prior to such date), clauses (i) and (ii) shall be ap- 2 plied by substituting ‘42-month’ for ‘12-month’ each 3 place it appears in the first sentence.’’. 4 (b) EFFECTIVE DATE.—The amendments made by 5 this section shall take effect on the date of enactment of 6 this Act. For purposes of determining an individual’s sta- 7 tus under section 1862(b)(1)(C) of the Social Security Act 8 (42 U.S.C. 1395y(b)(1)(C)), as amended by subsection 9 (a), an individual who is within the coordinating period 10 as of the date of enactment of this Act shall have that 11 period extended to the full 42 months described in the last 12 sentence of such section, as added by the amendment 13 made by subsection (a)(2). 14 SEC. 416. BORDER HEALTH GRANTS. 15 (a) ELIGIBLE ENTITY DEFINED.—In this section, 16 the term ‘‘eligible entity’’ means a State, public institution 17 of higher education, local government, tribal government, 18 nonprofit health organization, community health center, or 19 community clinic receiving assistance under section 330 20 of the Public Health Service Act (42 U.S.C. 254b), that 21 is located in the border area. 22 (b) AUTHORIZATION.—From funds appropriated 23 under subsection (f), the Secretary of Health and Human 24 Services (in this section referred to as the ‘‘Secretary’’), 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00209 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 210 •HR 5294 IH acting through the United States members of the United 1 States-Mexico Border Health Commission, shall award 2 grants to eligible entities to address priorities and rec- 3 ommendations to improve the health of border area resi- 4 dents that are established by— 5 (1) the United States members of the United 6 States-Mexico Border Health Commission; 7 (2) the State border health offices; and 8 (3) the Secretary. 9 (c) APPLICATION.—An eligible entity that desires a 10 grant under subsection (b) shall submit an application to 11 the Secretary at such time, in such manner, and con- 12 taining such information as the Secretary may require. 13 (d) USE OF FUNDS.—An eligible entity that receives 14 a grant under subsection (b) shall use the grant funds 15 for— 16 (1) programs relating to— 17 (A) maternal and child health; 18 (B) primary care and preventative health; 19 (C) public health and public health infra- 20 structure; 21 (D) musculoskeletal health and obesity; 22 (E) health education and promotion; 23 (F) oral health; 24 (G) mental and behavioral health; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00210 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 211 •HR 5294 IH (H) substance abuse; 1 (I) health conditions that have a high prev- 2 alence in the border area; 3 (J) medical and health services research; 4 (K) workforce training and development; 5 (L) community health workers or 6 promotoras; 7 (M) health care infrastructure problems in 8 the border area (including planning and con- 9 struction grants); 10 (N) health disparities in the border area; 11 (O) environmental health; and 12 (P) outreach and enrollment services with 13 respect to Federal programs (including pro- 14 grams authorized under titles XIX and XXI of 15 the Social Security Act (42 U.S.C. 1396 and 16 1397aa)); and 17 (2) other programs determined appropriate by 18 the Secretary. 19 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro- 20 vided to an eligible entity awarded a grant under sub- 21 section (b) shall be used to supplement and not supplant 22 other funds available to the eligible entity to carry out the 23 activities described in subsection (d). 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00211 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 212 •HR 5294 IH (f) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated to carry out this section, 2 $200,000,000 for fiscal year 2015, and such sums as may 3 be necessary for each succeeding fiscal year. 4 SEC. 417. REMOVING MEDICARE BARRIER TO HEALTH 5 CARE. 6 (a) PART A.—Section 1818(a)(3) of the Social Secu- 7 rity Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking 8 ‘‘(B)’’ and all that follows through ‘‘under this section’’ 9 and inserting ‘‘(B) an individual who is lawfully present 10 in the United States’’. 11 (b) PART B.—Section 1836(2) of the Social Security 12 Act (42 U.S.C. 1395o(2)) is amended by striking ‘‘(B)’’ 13 and all that follows through ‘‘under this part’’ and insert- 14 ing ‘‘(B) an individual who is lawfully present in the 15 United States’’. 16 SEC. 418. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 17 PROVIDED BY URBAN INDIAN HEALTH CEN- 18 TERS. 19 (a) IN GENERAL.—The third sentence of section 20 1905(b) of the Social Security Act (42 U.S.C. 1396(b)), 21 as amended by section 415(c), is further amended by in- 22 serting ‘‘or are received through a program operated by 23 an urban Indian organization through a grant or contract 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00212 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 213 •HR 5294 IH under title V of such Act’’ after ‘‘(as defined in section 1 4 of the Indian Health Care Improvement Act)’’. 2 (b) EFFECTIVE DATE.—The amendment made by 3 this section shall apply to medical assistance provided on 4 or after the date of enactment of this Act. 5 SEC. 419. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 6 PROVIDED TO A NATIVE HAWAIIAN THROUGH 7 A FEDERALLY QUALIFIED HEALTH CENTER 8 OR A NATIVE HAWAIIAN HEALTH CARE SYS- 9 TEM UNDER THE MEDICAID PROGRAM. 10 (a) IN GENERAL.—The third sentence of section 11 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), 12 as amended by section 419, is amended by inserting ‘‘; 13 and, with respect to medical assistance provided to a Na- 14 tive Hawaiian (as defined in section 12(2) of the Native 15 Hawaiian Health Care Improvement Act) through a feder- 16 ally qualified health center or a Native Hawaiian health 17 care system (as defined in section 12(6) of such Act), 18 whether directly, by referral, or under contract or other 19 arrangement between such federally qualified health cen- 20 ter or Native Hawaiian health care system and another 21 health care provider’’ before the period. 22 (b) EFFECTIVE DATE.—The amendment made by 23 this section shall apply to medical assistance provided on 24 or after the date of enactment of this Act. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00213 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 214 •HR 5294 IH CHAPTER 2—EXPANSION OF ACCESS 1 SEC. 421. GRANTS FOR RACIAL AND ETHNIC APPROACHES 2 TO COMMUNITY HEALTH. 3 (a) PURPOSE.—It is the purpose of this section to 4 provide for the awarding of grants to assist communities 5 in mobilizing and organizing resources in support of effec- 6 tive and sustainable programs that will reduce or eliminate 7 disparities in health and health care experienced by racial 8 and ethnic minority individuals. 9 (b) AUTHORITY TO AWARD GRANTS.—The Secretary 10 of Health and Human Services, acting through the Ad- 11 ministrator of the Health Resources and Services Admin- 12 istration, shall award grants to eligible entities to assist 13 in designing, implementing, and evaluating culturally and 14 linguistically appropriate, science-based, and community- 15 driven sustainable strategies to eliminate racial and ethnic 16 health and health care disparities. 17 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 18 grant under this section, an entity shall— 19 (1) represent a coalition— 20 (A) whose principal purpose is to develop 21 and implement interventions to reduce or elimi- 22 nate a health or health care disparity in a tar- 23 geted racial or ethnic minority group in the 24 community served by the coalition; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00214 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 215 •HR 5294 IH (B) that includes— 1 (i) members selected from among— 2 (I) public health departments; 3 (II) community-based organiza- 4 tions; 5 (III) university and research or- 6 ganizations; 7 (IV) American Indian tribal or- 8 ganizations, national American Indian 9 organizations, Indian Health Service, 10 or organizations serving Alaska Na- 11 tives; and 12 (V) interested public or private 13 health care providers or organizations 14 as deemed appropriate by the Sec- 15 retary; and 16 (ii) at least 1 member from a commu- 17 nity-based organization that represents the 18 targeted racial or ethnic minority group; 19 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, which shall 23 include— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00215 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 216 •HR 5294 IH (A) a description of the targeted racial or 1 ethnic populations in the community to be 2 served under the grant; 3 (B) a description of at least 1 health dis- 4 parity that exists in the racial or ethnic tar- 5 geted populations, including health issues such 6 as infant mortality, breast and cervical cancer 7 screening and management, musculoskeletal 8 diseases and obesity, prostate cancer screening 9 and management, cardiovascular disease, diabe- 10 tes, child and adult immunization levels, or 11 other health priority areas as designated by the 12 Secretary; and 13 (C) a demonstration of a proven record of 14 accomplishment of the coalition members in 15 serving and working with the targeted commu- 16 nity. 17 (d) SUSTAINABILITY.—The Secretary shall give pri- 18 ority to an eligible entity under this section if the entity 19 agrees that, with respect to the costs to be incurred by 20 the entity in carrying out the activities for which the grant 21 was awarded, the entity (and each of the participating 22 partners in the coalition represented by the entity) will 23 maintain its expenditures of non-Federal funds for such 24 activities at a level that is not less than the level of such 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00216 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 217 •HR 5294 IH expenditures during the fiscal year immediately preceding 1 the first fiscal year for which the grant is awarded. 2 (e) NONDUPLICATION.—Funds provided through this 3 grant program should supplement, not supplant, existing 4 Federal funding, and the funds should not be used to du- 5 plicate the activities of the other health disparity grant 6 programs in this Act. 7 (f) TECHNICAL ASSISTANCE.—The Secretary may, 8 either directly or by grant or contract, provide any entity 9 that receives a grant under this section with technical and 10 other nonfinancial assistance necessary to meet the re- 11 quirements of this section. 12 (g) DISSEMINATION.—The Secretary shall encourage 13 and enable grantees to share best practices, evaluation re- 14 sults, and reports with communities not affiliated with 15 grantees using the Internet, conferences, and other perti- 16 nent information regarding the projects funded by this 17 section, including the outreach efforts of the Office of Mi- 18 nority Health and Health Disparity Elimination and the 19 Centers for Disease Control and Prevention. 20 (h) ADMINISTRATIVE BURDENS.—The Secretary 21 shall make every effort to minimize duplicative or unneces- 22 sary administrative burdens on grantees. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00217 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 218 •HR 5294 IH (i) DEFINITION.—In this section, the term ‘‘Sec- 1 retary’’ means the Secretary of Health and Human Serv- 2 ices. 3 (j) AUTHORIZATION OF APPROPRIATIONS.—There 4 are authorized to be appropriated such sums as may be 5 necessary to carry out this section. 6 SEC. 422. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 7 (a) ELIMINATION OF ISOLATION TEST FOR COST- 8 BASED AMBULANCE REIMBURSEMENT.— 9 (1) IN GENERAL.—Section 1834(l)(8) of the 10 Social Security Act (42 U.S.C. 1395m(l)(8)) is 11 amended— 12 (A) in subparagraph (B)— 13 (i) by striking ‘‘owned and’’; and 14 (ii) by inserting ‘‘(including when 15 such services are provided by the entity 16 under an arrangement with the hospital)’’ 17 after ‘‘hospital’’; and 18 (B) by striking the comma at the end of 19 subparagraph (B) and all that follows and in- 20 serting a period. 21 (2) EFFECTIVE DATE.—The amendments made 22 by this subsection shall apply to services furnished 23 on or after January 1, 2015. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00218 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 219 •HR 5294 IH (b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE 1 TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT 2 REQUIREMENT.— 3 (1) IN GENERAL.—Section 1820(c)(2) of the 4 Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 5 amended— 6 (A) in subparagraph (B)(iii), by striking 7 ‘‘provides not more than’’ and inserting ‘‘sub- 8 ject to subparagraph (F), provides not more 9 than’’; and 10 (B) by adding at the end the following new 11 subparagraph: 12 ‘‘(F) ALTERNATIVE TO 25 INPATIENT BED 13 LIMIT REQUIREMENT.— 14 ‘‘(i) IN GENERAL.—A State may elect 15 to treat a facility, with respect to the des- 16 ignation of the facility for a cost-reporting 17 period, as satisfying the requirement of 18 subparagraph (B)(iii) relating to a max- 19 imum number of acute care inpatient beds 20 if the facility elects, in accordance with a 21 method specified by the Secretary and be- 22 fore the beginning of the cost reporting pe- 23 riod, to meet the requirement under clause 24 (ii). 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00219 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 220 •HR 5294 IH ‘‘(ii) ALTERNATE REQUIREMENT.— 1 The requirement under this clause, with 2 respect to a facility and a cost-reporting 3 period, is that the total number of inpa- 4 tient bed days described in subparagraph 5 (B)(iii) during such period will not exceed 6 7,300. For purposes of this subparagraph, 7 an individual who is an inpatient in a bed 8 in the facility for a single day shall be 9 counted as one inpatient bed day. 10 ‘‘(iii) WITHDRAWAL OF ELECTION.— 11 The option described in clause (i) shall not 12 apply to a facility for a cost-reporting pe- 13 riod if the facility (for any two consecutive 14 cost-reporting periods during the previous 15 5 cost-reporting periods) was treated under 16 such option and had a total number of in- 17 patient bed days for each of such two cost- 18 reporting periods that exceeded the num- 19 ber specified in such clause.’’. 20 (2) EFFECTIVE DATE.—The amendments made 21 by paragraph (1) shall apply to cost-reporting peri- 22 ods beginning on or after the date of the enactment 23 of this Act. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00220 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 221 •HR 5294 IH SEC. 423. ESTABLISHMENT OF RURAL COMMUNITY HOS- 1 PITAL (RCH) PROGRAM. 2 (a) IN GENERAL.—Section 1861 of the Social Secu- 3 rity Act (42 U.S.C. 1395x), as amended by section 4 203(b)(1), is amended by adding at the end of the fol- 5 lowing new subsection: 6 ‘‘Rural Community Hospital; Rural Community Hospital 7 Services 8 ‘‘(jjj)(1) The term ‘rural community hospital’ means 9 a hospital (as defined in subsection (e)) that— 10 ‘‘(A) is located in a rural area (as defined in 11 section 1886(d)(2)(D)) or treated as being so lo- 12 cated pursuant to section 1886(d)(8)(E); 13 ‘‘(B) subject to paragraph (2), has less than 51 14 acute care inpatient beds, as reported in its most re- 15 cent cost report; 16 ‘‘(C) makes available 24-hour emergency care 17 services; 18 ‘‘(D) subject to paragraph (3), has a provider 19 agreement in effect with the Secretary and is open 20 to the public as of January 1, 2010; and 21 ‘‘(E) applies to the Secretary for such designa- 22 tion. 23 ‘‘(2) For purposes of paragraph (1)(B), beds in a 24 psychiatric or rehabilitation unit of the hospital which is 25 a distinct part of the hospital shall not be counted. 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00221 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 222 •HR 5294 IH ‘‘(3) Paragraph (1)(D) shall not be construed to pro- 1 hibit any of the following from qualifying as a rural com- 2 munity hospital: 3 ‘‘(A) A replacement facility (as defined by the 4 Secretary in regulations in effect on January 1, 5 2012) with the same service area (as defined by the 6 Secretary in regulations in effect on such date). 7 ‘‘(B) A facility obtaining a new provider num- 8 ber pursuant to a change of ownership. 9 ‘‘(C) A facility which has a binding written 10 agreement with an outside, unrelated party for the 11 construction, reconstruction, lease, rental, or financ- 12 ing of a building as of January 1, 2012. 13 ‘‘(4) Nothing in this subsection shall be construed as 14 prohibiting a critical access hospital from qualifying as a 15 rural community hospital if the critical access hospital 16 meets the conditions otherwise applicable to hospitals 17 under subsection (e) and section 1866. 18 ‘‘(5) Nothing in this subsection shall be construed as 19 prohibiting a rural community hospital participating in 20 the demonstration program under section 410A of the 21 Medicare Prescription Drug, Improvement, and Mod- 22 ernization Act of 2003 (Public Law 108–173; 117 Stat. 23 2313) from qualifying as a rural community hospital if 24 the rural community hospital meets the conditions other- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00222 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 223 •HR 5294 IH wise applicable to hospitals under subsection (e) and sec- 1 tion 1866.’’. 2 (b) PAYMENT.— 3 (1) INPATIENT HOSPITAL SERVICES.—Section 4 1814 of the Social Security Act (42 U.S.C. 1395f) 5 is amended by adding at the end the following new 6 subsection: 7 ‘‘Payment for Inpatient Services Furnished in Rural 8 Community Hospitals 9 ‘‘(m) The amount of payment under this part for in- 10 patient hospital services furnished in a rural community 11 hospital, other than such services furnished in a psy- 12 chiatric or rehabilitation unit of the hospital which is a 13 distinct part, is, at the election of the hospital in the appli- 14 cation referred to in section 1861(jjj)(1)(E)— 15 ‘‘(1) 101 percent of the reasonable costs of pro- 16 viding such services, without regard to the amount 17 of the customary or other charge, or 18 ‘‘(2) the amount of payment provided for under 19 the prospective payment system for inpatient hos- 20 pital services under section 1886(d).’’. 21 (2) OUTPATIENT SERVICES.—Section 1834 of 22 such Act (42 U.S.C. 1395m) is amended by adding 23 at the end the following new subsection: 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00223 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 224 •HR 5294 IH ‘‘(p) PAYMENT FOR OUTPATIENT SERVICES FUR- 1 NISHED IN RURAL COMMUNITY HOSPITALS.—The 2 amount of payment under this part for outpatient services 3 furnished in a rural community hospital is, at the election 4 of the hospital in the application referred to in section 5 1861(jjj)(1)(E)— 6 ‘‘(1) 101 percent of the reasonable costs of pro- 7 viding such services, without regard to the amount 8 of the customary or other charge and any limitation 9 under section 1861(v)(1)(U), or 10 ‘‘(2) the amount of payment provided for under 11 the prospective payment system for covered OPD 12 services under section 1833(t).’’. 13 (3) EXEMPTION FROM 30-PERCENT REDUCTION 14 IN REIMBURSEMENT FOR BAD DEBT.—Section 15 1861(v)(1)(T) of such Act (42 U.S.C. 16 1395x(v)(1)(T)) is amended by inserting ‘‘(other 17 than for a rural community hospital)’’ after ‘‘In de- 18 termining such reasonable costs for hospitals’’. 19 (c) BENEFICIARY COST-SHARING FOR OUTPATIENT 20 SERVICES.—Section 1834(p) of such Act (as added by 21 subsection (b)(2)) is amended— 22 (1) by redesignating paragraphs (1) and (2) as 23 subparagraphs (A) and (B), respectively; 24 (2) by inserting ‘‘(1)’’ after ‘‘(p)’’; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00224 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 225 •HR 5294 IH (3) by adding at the end the following: 1 ‘‘(2) The amounts of beneficiary cost-sharing for out- 2 patient services furnished in a rural community hospital 3 under this part shall be as follows: 4 ‘‘(A) For items and services that would have 5 been paid under section 1833(t) if provided by a 6 hospital, the amount of cost-sharing determined 7 under paragraph (8) of such section. 8 ‘‘(B) For items and services that would have 9 been paid under section 1833(h) if furnished by a 10 provider or supplier, no cost-sharing shall apply. 11 ‘‘(C) For all other items and services, the 12 amount of cost-sharing that would apply to the item 13 or service under the methodology that would be used 14 to determine payment for such item or service if pro- 15 vided by a physician, provider, or supplier, as the 16 case may be.’’. 17 (d) CONFORMING AMENDMENTS.— 18 (1) PART A PAYMENT.—Section 1814(b) of 19 such Act (42 U.S.C. 1395f(b)) is amended in the 20 matter preceding paragraph (1) by inserting ‘‘other 21 than inpatient hospital services furnished by a rural 22 community hospital,’’ after ‘‘critical access hospital 23 services,’’. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00225 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 226 •HR 5294 IH (2) PART B PAYMENT.—Section 1833(a) of 1 such Act (42 U.S.C. 1395l(a)), as amended by sec- 2 tion 203(b)(2), is amended— 3 (A) in paragraph (2), in the matter before 4 subparagraph (A), by striking ‘‘and (I)’’ and in- 5 serting ‘‘(I), and (K)’’; 6 (B) by striking ‘‘and’’ at the end of para- 7 graph (9); 8 (C) by striking the period at the end of 9 paragraph (10) and inserting ‘‘; and’’; and 10 (D) by adding at the end the following: 11 ‘‘(11) in the case of outpatient services fur- 12 nished by a rural community hospital, the amounts 13 described in section 1834(p).’’. 14 (3) TECHNICAL AMENDMENTS.— 15 (A) CONSULTATION WITH STATE AGEN- 16 CIES.—Section 1863 of such Act (42 U.S.C. 17 1395z) is amended by striking ‘‘and (dd)(2)’’ 18 and inserting ‘‘(dd)(2), (mm)(1), and (jjj)(1)’’. 19 (B) PROVIDER AGREEMENTS.—Section 20 1866(a)(2)(A) of such Act (42 U.S.C. 21 1395cc(a)(2)(A)) is amended by inserting ‘‘sec- 22 tion 1834(p)(2),’’ after ‘‘section 1833(b),’’. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00226 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 227 •HR 5294 IH (e) EFFECTIVE DATE.—The amendments made by 1 this section shall apply to items and services furnished on 2 or after October 1, 2014. 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00227 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 228 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00228 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 229 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00229 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 230 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00230 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 231 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00231 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 232 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00232 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 233 •HR 5294 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 Healthcare 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00233 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 234 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00234 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 235 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00235 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 236 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00236 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 237 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00237 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 238 •HR 5294 IH priated to the Secretary to carry out this section 1 $30,000,000 for the period of fiscal years 2015 2 through 2019. 3 (2) AVAILABILITY.— 4 (A) IN GENERAL.—Funds appropriated 5 under paragraph (1) shall remain available for 6 expenditure through fiscal year 2019. 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 2020. 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00238 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 239 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00239 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 240 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00240 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 241 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00241 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 242 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00242 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 243 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00243 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 244 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00244 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 245 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00245 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 246 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00246 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 247 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00247 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 248 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00248 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 249 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00249 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 250 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00250 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 251 •HR 5294 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, 2016, 24 the Secretary shall prepare and submit to the appropriate 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00251 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 252 •HR 5294 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 2015, and such sums as may 14 be necessary for each of fiscal years 2016 through 2019.’’. 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.—Nothing in this sec- 23 tion shall be construed to prevent a community 24 health center from contracting with a federally cer- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00252 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 253 •HR 5294 IH tified rural health clinic (as defined by section 1 1861(aa)(2) of the Social Security Act) for the deliv- 2 ery of primary health care and other mental, dental, 3 and physical health services that are available at the 4 rural health clinic to individuals who would other- 5 wise be eligible for free or reduced cost care if that 6 individual were able to obtain that care at the com- 7 munity health center. Such services may be limited 8 in scope to those primary health care and other 9 mental, dental, and physical health services available 10 in that rural health clinic. 11 ‘‘(2) ENABLING SERVICES.—To the extent pos- 12 sible, enabling services such as transportation and 13 translation assistance shall be provided by rural 14 health clinics described in paragraph (1). 15 ‘‘(3) ASSURANCES.—In order for a rural health 16 clinic to receive funds under this section through a 17 contract with a community health center for the de- 18 livery of primary health care and other services de- 19 scribed in paragraph (1), such rural health clinic 20 shall establish policies to ensure— 21 ‘‘(A) nondiscrimination based upon the 22 ability of a patient to pay; 23 ‘‘(B) the establishment of a sliding fee 24 scale for low-income patients; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00253 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 254 •HR 5294 IH ‘‘(C) any such services should be subject to 1 full reimbursement according to the Prospective 2 Payment System scale.’’. 3 SEC. 428. FACILITATING THE PROVISION OF TELEHEALTH 4 SERVICES ACROSS STATE LINES. 5 (a) IN GENERAL.—For purposes of expediting the 6 provision of telehealth services, for which payment is made 7 under the Medicare Program, across State lines, the Sec- 8 retary of Health and Human Services shall, in consulta- 9 tion with representatives of States, physicians, health care 10 practitioners, and patient advocates, encourage and facili- 11 tate the adoption of provisions allowing for multistate 12 practitioner practice across State lines. 13 (b) DEFINITIONS.—In subsection (a): 14 (1) TELEHEALTH SERVICE.—The term ‘‘tele- 15 health service’’ has the meaning given that term in 16 subparagraph (F) of section 1834(m)(4) of the So- 17 cial Security Act (42 U.S.C. 1395m(m)(4)). 18 (2) PHYSICIAN, PRACTITIONER.—The terms 19 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 20 given those terms in subparagraphs (D) and (E), re- 21 spectively, of such section. 22 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 23 Program’’ means the program of health insurance 24 administered by the Secretary of Health and Human 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00254 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 255 •HR 5294 IH Services under title XVIII of the Social Security Act 1 (42 U.S.C. 1395 et seq.). 2 SEC. 429. SCORING OF PREVENTIVE HEALTH SAVINGS. 3 Section 202 of the Congressional Budget and Im- 4 poundment Control Act of 1974 (2 U.S.C. 602) is amend- 5 ed by adding at the end the following new subsection: 6 ‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 7 ‘‘(1) DETERMINATION BY THE DIRECTOR.— 8 Upon a request by the chairman or ranking minority 9 member of the Committee on the Budget of the Sen- 10 ate, or by the chairman or ranking minority member 11 of the Committee on the Budget of the House of 12 Representatives, the Director shall determine if a 13 proposed measure would result in reductions in 14 budget outlays in budgetary outyears through the 15 use of preventive health and preventive health serv- 16 ices. 17 ‘‘(2) PROJECTIONS.—If the Director determines 18 that a measure would result in substantial reduc- 19 tions in budget outlays as described in paragraph 20 (1), the Director— 21 ‘‘(A) shall include, in any projection pre- 22 pared by the Director, a description and esti- 23 mate of the reductions in budget outlays in the 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00255 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 256 •HR 5294 IH budgetary outyears and a description of the 1 basis for such conclusions; and 2 ‘‘(B) may prepare a budget projection that 3 includes some or all of the budgetary outyears, 4 notwithstanding the time periods for projections 5 described in subsection (e) and sections 308, 6 402, and 424. 7 ‘‘(3) DEFINITIONS.—As used in this sub- 8 section— 9 ‘‘(A) the term ‘preventive health’ means an 10 action that focuses on the health of the public, 11 individuals, and defined populations in order to 12 protect, promote, and maintain health, wellness, 13 and functional ability, and prevent disease, dis- 14 ability, and premature death that is dem- 15 onstrated by credible and publicly available epi- 16 demiological projection models, incorporating 17 clinical trials or observational studies in hu- 18 mans, to avoid future health care costs; and 19 ‘‘(B) the term ‘budgetary outyears’ means 20 the 2 consecutive 10-year periods beginning 21 with the first fiscal year that is 10 years after 22 the budget year provided for in the most re- 23 cently agreed to concurrent resolution on the 24 budget.’’. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00256 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 257 •HR 5294 IH SEC. 430. SENSE OF CONGRESS. 1 It is the sense of the Congress that— 2 (1) the maintenance of effort provisions added 3 to sections 1902 and 2105(d) of the Social Security 4 Act by sections 2001(b) and 2101(b) of the Patient 5 Protection and Affordable Care Act were written to 6 maintain the eligibility standards for the Medicaid 7 program under title XIX of the Social Security Act 8 and Children’s Health Insurance Program under 9 title XXI of such Act until the American Health 10 Benefit Exchanges in the States are fully oper- 11 ational; 12 (2) it is imperative that the maintenance of ef- 13 fort provisions are enforced to the strict standard in- 14 tended by the Congress; 15 (3) waiving the maintenance of effort provisions 16 should not be permitted, except in the case of a re- 17 quest for a waiver that meets the explicit non- 18 application requirements; 19 (4) the maintenance of effort provisions ensure 20 the continued success of the Medicaid program and 21 Children’s Health Insurance Program and were writ- 22 ten deliberately to specifically protect vulnerable and 23 disabled individuals, children, and senior citizens, 24 many of whom are also members of communities of 25 color; and 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00257 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 258 •HR 5294 IH (5) the maintenance of effort provisions must 1 be strictly enforced and proposals to weaken the 2 maintenance of effort provisions must not be consid- 3 ered. 4 SEC. 431. REPEAL OF REQUIREMENT FOR DOCUMENTA- 5 TION EVIDENCING CITIZENSHIP OR NATION- 6 ALITY UNDER THE MEDICAID PROGRAM. 7 (a) REPEAL.—Subsections (i)(22) and (x) of section 8 1903 of the Social Security Act (42 U.S.C. 1396b) are 9 each repealed. 10 (b) CONFORMING AMENDMENTS.— 11 (1) Section 1902 of the Social Security Act (42 12 U.S.C. 1396a) is amended— 13 (A) by amending paragraph (46) of sub- 14 section (a) to read as follows: 15 ‘‘(46) provide that information is requested and 16 exchanged for purposes of income and eligibility 17 verification in accordance with a State system which 18 meets the requirements of section 1137 of this 19 Act;’’; 20 (B) in subsection (e)(13)(A)(i)— 21 (i) in the matter preceding subclause 22 (I), by striking ‘‘sections 1902(a)(46)(B) 23 and 1137(d)’’ and inserting ‘‘section 24 1137(d)’’; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00258 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 259 •HR 5294 IH (ii) in subclause (IV), by striking 1 ‘‘1902(a)(46)(B) or’’; and 2 (C) by striking subsection (ee). 3 (2) Section 1903 of the Social Security Act (42 4 U.S.C. 1396b) is amended— 5 (A) in subsection (i), by redesignating 6 paragraphs (23) through (26) as paragraphs 7 (22) through (25), respectively; and 8 (B) by redesignating subsections (y) and 9 (z) as subsections (x) and (y), respectively. 10 (3) Subsection (c) of section 6036 of the Deficit 11 Reduction Act of 2005 (42 U.S.C. 1396b note) is re- 12 pealed. 13 (c) EFFECTIVE DATE.—The repeals and amend- 14 ments made by this section shall take effect as if included 15 in the enactment of the Deficit Reduction Act of 2005. 16 SEC. 432. OFFICE OF MINORITY HEALTH IN VETERANS 17 HEALTH ADMINISTRATION OF DEPARTMENT 18 OF VETERANS AFFAIRS. 19 (a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 20 I of chapter 73 of title 38, United States Code, is amended 21 by adding at the end the following new section: 22 ‘‘§ 7310. Office of Minority Health 23 ‘‘(a) ESTABLISHMENT.—There is established in the 24 Department within the Office of the Under Secretary for 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00259 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 260 •HR 5294 IH Health an office to be known as the ‘Office of Minority 1 Health’ (in this section referred to as the ‘Office’). 2 ‘‘(b) HEAD.—The Director of the Office of Minority 3 Health shall be the head of the Office. The Director of 4 the Office of Minority Health shall be appointed by the 5 Under Secretary of Health from among individuals quali- 6 fied to perform the duties of the position. 7 ‘‘(c) FUNCTIONS.—The functions of the Office are as 8 follows: 9 ‘‘(1) To establish short-range and long-range 10 goals and objectives and coordinate all other activi- 11 ties within the Veterans Health Administration that 12 relate to disease prevention, health promotion, health 13 care services delivery, and health care research con- 14 cerning veterans who are members of a racial or eth- 15 nic minority group. 16 ‘‘(2) To support research, demonstrations, and 17 evaluations to test new and innovative models for 18 the discharge of activities described in paragraph 19 (1). 20 ‘‘(3) To increase knowledge and understanding 21 of health risk factors for veterans who are members 22 of a racial or ethnic minority group. 23 ‘‘(4) To develop mechanisms that support bet- 24 ter health care information dissemination, education, 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00260 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 261 •HR 5294 IH prevention, and services delivery to veterans from 1 disadvantaged backgrounds, including veterans who 2 are members of a racial or ethnic minority group. 3 ‘‘(5) To enter into contracts or agreements with 4 appropriate public and nonprofit private entities to 5 develop and carry out programs to provide bilingual 6 or interpretive services to assist veterans who are 7 members of a racial or ethnic minority group and 8 who lack proficiency in speaking the English lan- 9 guage in accessing and receiving health care services 10 through the Veterans Health Administration. 11 ‘‘(6) To carry out programs to improve access 12 to health care services through the Veterans Health 13 Administration for veterans with limited proficiency 14 in speaking the English language, including the de- 15 velopment and evaluation of demonstration and pilot 16 projects for that purpose. 17 ‘‘(7) To advise the Under Secretary of Health 18 on matters relating to the development, implementa- 19 tion, and evaluation of health professions education 20 in decreasing disparities in health care outcomes be- 21 tween veterans who are members of a racial or eth- 22 nic minority group and other veterans, including cul- 23 tural competency as a method of eliminating such 24 health disparities. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00261 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 262 •HR 5294 IH ‘‘(8) To perform such other functions and du- 1 ties as the Secretary or the Under Secretary for 2 Health considers appropriate. 3 ‘‘(d) DEFINITIONS.—In this section: 4 ‘‘(1) The term ‘racial or ethnic minority group’ 5 means the following: 6 ‘‘(A) American Indians (including Alaska 7 Natives, Eskimos, and Aleuts). 8 ‘‘(B) Asian-Americans. 9 ‘‘(C) Native Hawaiians and other Pacific 10 Islanders. 11 ‘‘(D) Blacks. 12 ‘‘(E) Hispanics. 13 ‘‘(2) The term ‘Hispanic’ means individuals 14 whose origin is Mexican, Puerto Rican, Cuban, Cen- 15 tral or South American, or any other Spanish-speak- 16 ing country.’’. 17 (b) CLERICAL AMENDMENT.—The table of sections 18 at the beginning of such chapter is amended by inserting 19 after the item relating to section 7309 the following new 20 item: 21 ‘‘7310. Office of Minority Health.’’. SEC. 433. INDIAN DEFINED IN PPACA. 22 (a) DEFINITION OF INDIAN.—Section 1304 of the 23 Patient Protection and Affordable Care Act (42 U.S.C. 24 18024) is amended by adding at the end the following: 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00262 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 263 •HR 5294 IH ‘‘(f) INDIAN.— 1 ‘‘(1) IN GENERAL.—In this title, the term ‘In- 2 dian’ means any individual— 3 ‘‘(A) described in paragraph (13) or (28) 4 of section 4 of the Indian Health Care Improve- 5 ment Act (25 U.S.C. 1603); 6 ‘‘(B) who is eligible for health services pro- 7 vided by the Indian Health Service under sec- 8 tion 809 of the Indian Health Care Improve- 9 ment Act (25 U.S.C. 1679); 10 ‘‘(C) who is of Indian descent and belongs 11 to the Indian community served by the local fa- 12 cilities and program of the Indian Health Serv- 13 ice; or 14 ‘‘(D) who is described in paragraph (2). 15 ‘‘(2) INCLUDED INDIVIDUALS.—The following 16 individuals shall be considered to be an ‘Indian’: 17 ‘‘(A) A member of a federally recognized 18 Indian tribe. 19 ‘‘(B) A resident of an urban center who 20 meets 1 or more of the following 4 criteria: 21 ‘‘(i) Membership in a tribe, band, or 22 other organized group of Indians, including 23 those tribes, bands, or groups terminated 24 since 1940 and those recognized as of the 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00263 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 264 •HR 5294 IH date of enactment of the Health Equity 1 and Accountability Act of 2014 or later by 2 the State in which they reside, or being a 3 descendant, in the first or second degree, 4 of any such member. 5 ‘‘(ii) Is an Eskimo or Aleut or other 6 Alaska Native. 7 ‘‘(iii) Is considered by the Secretary of 8 the Interior to be an Indian for any pur- 9 pose. 10 ‘‘(iv) Is determined to be an Indian 11 under regulations promulgated by the Sec- 12 retary. 13 ‘‘(C) An individual who is considered by 14 the Secretary of the Interior to be an Indian for 15 any purpose. 16 ‘‘(D) An individual who is considered by 17 the Secretary to be an Indian for purposes of 18 eligibility for Indian health care services, includ- 19 ing as a California Indian, Eskimo, Aleut, or 20 other Alaska Native.’’. 21 (b) CONFORMING AMENDMENTS.— 22 (1) AFFORDABLE CHOICES HEALTH BENEFIT 23 PLANS.—Section 1311(c)(6)(D) of the Patient Pro- 24 tection and Affordable Care Act (42 U.S.C. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00264 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 265 •HR 5294 IH 18031(c)(6)(D)) is amended by striking ‘‘section 4 1 of the Indian Health Care Improvement Act’’ and 2 inserting ‘‘section 1304(f)’’. 3 (2) REDUCED COST-SHARING FOR INDIVIDUALS 4 ENROLLING IN QUALIFIED HEALTH PLANS.—Section 5 1402(d) of the Patient Protection and Affordable 6 Care Act (42 U.S.C. 18071(d)) is amended— 7 (A) in paragraph (1), in the matter pre- 8 ceding subparagraph (A), by striking ‘‘section 9 4(d) of the Indian Self-Determination and Edu- 10 cation Assistance Act (25 U.S.C. 450b(d))’’ and 11 inserting ‘‘section 1304(f)’’; and 12 (B) in paragraph (2), in the matter pre- 13 ceding subparagraph (A), by striking ‘‘(as so 14 defined)’’ and inserting ‘‘(as defined in section 15 1304(f))’’. 16 (3) EXEMPTION FROM PENALTY FOR NOT 17 MAINTAINING MINIMUM ESSENTIAL COVERAGE.— 18 Section 5000A(e) of the Internal Revenue Code of 19 1986 is amended by striking paragraph (3) and in- 20 serting the following: 21 ‘‘(3) INDIANS.—Any applicable individual who 22 is an Indian (as defined in section 1304(f) of the 23 Patient Protection and Affordable Care Act).’’. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00265 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 266 •HR 5294 IH SEC. 434. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL 1 ACCESS FOR LOW-INCOME PATIENTS. 2 (a) IN GENERAL.—Not later than January 1, 2016, 3 the Comptroller General of the United States shall con- 4 duct a study on how certain amendments made by the Pa- 5 tient Protection and Affordable Care Act (Public Law 6 111–148) to titles XVIII and XIX of the Social Security 7 Act affect the timely access to health care services for low- 8 income patients. Such study shall— 9 (1) evaluate and examine whether States elect- 10 ing to make medical assistance available under sec- 11 tion 1902(a)(10)(A)(i)(VIII) of the Social Security 12 Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) (including 13 States making such an election through a waiver of 14 the State plan) to individuals described in such sec- 15 tion mitigates the need for payments to dispropor- 16 tionate share hospitals under section 1886(d)(5)(F) 17 of the Social Security Act (42 U.S.C. 18 1395ww(d)(5)(F)) and section 1923 of such Act (42 19 U.S.C. 1396r–4), including the impact of such 20 States electing to make medical assistance available 21 to such individuals on— 22 (A) the number of individuals in the 23 United States who are without health insurance 24 and the distribution of such individuals in rela- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00266 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 267 •HR 5294 IH tion to areas primarily served by dispropor- 1 tionate share hospitals; and 2 (B) the low-income utilization rate of such 3 hospitals and the resulting fiscal sustainability 4 of such hospitals; 5 (2) evaluate the appropriate level and distribu- 6 tion of such payments among disproportionate hos- 7 pitals for purposes of— 8 (A) sufficiently accounting for the level of 9 uncompensated care provided by such hospitals 10 to low-income patients; and 11 (B) providing timely access to health serv- 12 ices for individuals in medically underserved 13 areas; and 14 (3) assess, with respect to disproportionate hos- 15 pitals— 16 (A) the role played by such hospitals in 17 providing critical access to emergency, inpa- 18 tient, and outpatient health services, as well as 19 the location of such hospitals in relation to 20 medically underserved areas; and 21 (B) the extent to which such hospitals sat- 22 isfy the requirements established for charitable 23 hospital organizations under section 501(r) of 24 the Internal Revenue Code of 1986 with respect 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00267 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 268 •HR 5294 IH to community health needs assessments, finan- 1 cial assistance policy requirements, limitations 2 on charges, and billing and collection require- 3 ments. 4 (b) REPORTS.— 5 (1) REPORT TO CONGRESS.—Not later than 6 180 days after the date on which the study under 7 subsection (a) is completed, the Comptroller General 8 of the United States shall submit to the Committee 9 on Energy and Commerce of the House of Rep- 10 resentatives and the Committee on Health, Edu- 11 cation, Labor, and Pensions of the Senate a report 12 that contains— 13 (A) the results of the study; 14 (B) recommendations to Congress for any 15 legislative changes to the payments to dis- 16 proportionate share hospitals under section 17 1886(d)(5)(F) of the Social Security Act (42 18 U.S.C. 1395ww(d)(5)(F)) and section 1923 of 19 such Act (42 U.S.C. 1396r–4) that are needed 20 to ensure access to health services for low-in- 21 come patients that— 22 (i) are based on the number of indi- 23 viduals without health insurance, the 24 amount of uncompensated care provided by 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00268 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 269 •HR 5294 IH such hospitals, and the impact of reduced 1 payments levels on low-income commu- 2 nities; and 3 (ii) takes into account any reports 4 submitted by the Secretary of the Treas- 5 ury, in consultation with the Secretary of 6 Health and Human Services, to Congres- 7 sional committees regarding the costs in- 8 curred by charitable hospital organizations 9 for charity care, bad debt, nonreimbursed 10 expenses for services provided to individ- 11 uals under the Medicare Program under 12 title XVIII of the Social Security Act and 13 the Medicaid Program under title XIX of 14 such Act, and any community benefit ac- 15 tivities provided by such organizations. 16 (2) REPORT TO THE SECRETARY OF HEALTH 17 AND HUMAN SERVICES.—Not later than 180 days 18 after the date on which the study under subsection 19 (a) is completed, the Comptroller General of the 20 United States shall submit to the Secretary of 21 Health and Human Services a report that con- 22 tains— 23 (A) the results of the study; and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00269 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 270 •HR 5294 IH (B) any recommendations for purposes of 1 assisting in the development of the methodology 2 for the adjustment of payments to dispropor- 3 tionate share hospitals, as required under sec- 4 tion 1886(r) of the Social Security Act (42 5 U.S.C. 1395ww(r)) and the reduction of such 6 payments section 1923(f)(7) of such Act (42 7 U.S.C. 1396r–4(f)(7)), taking into account the 8 reports referred to in paragraph (1)(B)(ii). 9 SEC. 435. ASSISTANT SECRETARY OF THE INDIAN HEALTH 10 SERVICE. 11 (a) REFERENCES.—Any reference in a law, regula- 12 tion, document, paper, or other record of the United 13 States to the Director of the Indian Health Service shall 14 be deemed to be a reference to the Assistant Secretary 15 of the Indian Health Service. 16 (b) EXECUTIVE SCHEDULE.—Section 5315 of title 5, 17 United States Code, is amended in the matter relating to 18 the Assistant Secretaries of Health and Human Services 19 by striking ‘‘(6)’’ and inserting ‘‘(7), 1 of whom shall be 20 the Assistant Secretary of the Indian Health Service’’. 21 (c) CONFORMING AMENDMENT.—Section 5316 of 22 title 5, United States Code, is amended by striking ‘‘Direc- 23 tor, Indian Health Service, Department of Health and 24 Human Services.’’. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00270 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 271 •HR 5294 IH SEC. 436. REAUTHORIZATION OF THE NATIVE HAWAIIAN 1 HEALTH CARE IMPROVEMENT ACT. 2 (a) NATIVE HAWAIIAN HEALTH CARE SYSTEMS.— 3 Section 6(h)(1) of the Native Hawaiian Health Care Im- 4 provement Act (42 U.S.C. 11705(h)(1)) is amended by 5 striking ‘‘may be necessary for fiscal years 1993 through 6 2019’’ and inserting ‘‘are necessary’’. 7 (b) ADMINISTRATIVE GRANT FOR PAPA OLA 8 LOKAHI.—Section 7(b) of the Native Hawaiian Health 9 Care Improvement Act (42 U.S.C. 11706(b)) is amended 10 by striking ‘‘may be necessary for fiscal years 1993 11 through 2019’’ and inserting ‘‘are necessary’’. 12 (c) NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.— 13 Section 10(c) of the Native Hawaiian Health Care Im- 14 provement Act (42 U.S.C. 11709(c)) is amended by strik- 15 ing ‘‘may be necessary for fiscal years 1993 through 16 2019’’ and inserting ‘‘are necessary’’. 17 TITLE V—IMPROVING HEALTH 18 OUTCOMES FOR WOMEN, 19 CHILDREN, AND FAMILIES 20 SEC. 501. GRANTS TO PROMOTE POSITIVE HEALTH BEHAV- 21 IORS IN WOMEN AND CHILDREN. 22 Part Q of title III of the Public Health Service Act 23 (42 U.S.C. 280g et seq.) is amended by adding at the end 24 the following: 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00271 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 272 •HR 5294 IH ‘‘SEC. 399Z–2. GRANTS TO PROMOTE POSITIVE HEALTH BE- 1 HAVIORS IN WOMEN AND CHILDREN. 2 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col- 3 laboration with the Administrator of the Health Resources 4 and Services Administration and other Federal officials 5 determined appropriate by the Secretary, is authorized to 6 award grants to eligible entities to promote positive health 7 behaviors for women and children in target populations, 8 especially racial and ethnic minority women and children 9 in medically underserved communities. 10 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 11 subsection (a) may be used to support the activities of 12 community health workers, including such activities— 13 ‘‘(1) to educate and provide outreach regarding 14 enrollment in health insurance including the State 15 Children’s Health Insurance Program under title 16 XXI of the Social Security Act, Medicare under title 17 XVIII of such Act, and Medicaid under title XIX of 18 such Act; 19 ‘‘(2) to educate, guide, and provide outreach in 20 a community setting regarding health problems prev- 21 alent among women and children and especially 22 among racial and ethnic minority women and chil- 23 dren; 24 ‘‘(3) to educate, guide, and provide experiential 25 learning opportunities that target risk factors that 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00272 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 273 •HR 5294 IH impede achieving healthy behaviors and good health 1 outcomes, including— 2 ‘‘(A) poor nutrition; 3 ‘‘(B) physical inactivity; 4 ‘‘(C) being overweight or obese; 5 ‘‘(D) tobacco use; 6 ‘‘(E) alcohol and substance use; 7 ‘‘(F) injury and violence; 8 ‘‘(G) risky sexual behavior; 9 ‘‘(H) mental health problems; 10 ‘‘(I) musculoskeletal health and arthritis; 11 ‘‘(J) dental and oral health problems; 12 ‘‘(K) understanding informed consent; and 13 ‘‘(L) stigma; 14 ‘‘(4) to educate and guide regarding effective 15 strategies to promote positive health behaviors with- 16 in the family; 17 ‘‘(5) to promote community wellness and aware- 18 ness; and 19 ‘‘(6) to educate and refer target populations to 20 appropriate health care agencies and community- 21 based programs and organizations in order to in- 22 crease access to quality health care services, includ- 23 ing preventive health services. 24 ‘‘(c) APPLICATION.— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00273 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 274 •HR 5294 IH ‘‘(1) IN GENERAL.—Each eligible entity that 1 desires to receive a grant under subsection (a) shall 2 submit an application to the Secretary, at such time, 3 in such manner, and accompanied by such additional 4 information as the Secretary may require. 5 ‘‘(2) CONTENTS.—Each application submitted 6 pursuant to paragraph (1) shall— 7 ‘‘(A) describe the activities for which as- 8 sistance under this section is sought; 9 ‘‘(B) contain an assurance that, with re- 10 spect to each community health worker pro- 11 gram receiving funds under the grant awarded, 12 such program provides in-language training and 13 supervision to community health workers to en- 14 able such workers to provide authorized pro- 15 gram activities in (at least) the most commonly 16 used languages within a particular geographic 17 region; 18 ‘‘(C) contain an assurance that the appli- 19 cant will evaluate the effectiveness of commu- 20 nity health worker programs receiving funds 21 under the grant; 22 ‘‘(D) contain an assurance that each com- 23 munity health worker program receiving funds 24 under the grant will provide culturally com- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00274 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 275 •HR 5294 IH petent services in the linguistic context most 1 appropriate for the individuals served by the 2 program; 3 ‘‘(E) contain a plan to document and dis- 4 seminate project descriptions and results to 5 other States and organizations as identified by 6 the Secretary; and 7 ‘‘(F) describe plans to enhance the capac- 8 ity of individuals to utilize health services and 9 health-related social services under Federal, 10 State, and local programs by— 11 ‘‘(i) assisting individuals in estab- 12 lishing eligibility under the programs and 13 in receiving the services or other benefits 14 of the programs; and 15 ‘‘(ii) providing other services, as the 16 Secretary determines to be appropriate, 17 which may include transportation and 18 translation services. 19 ‘‘(d) PRIORITY.—In awarding grants under sub- 20 section (a), the Secretary shall give priority to those appli- 21 cants— 22 ‘‘(1) who propose to target geographic areas 23 that— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00275 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 276 •HR 5294 IH ‘‘(A)(i) have a high percentage of residents 1 who are uninsured or underinsured (if the tar- 2 geted geographic area is located in a State that 3 has elected to make medical assistance available 4 under section 1902(a)(10)(A)(i)(VIII) of the 5 Social Security Act to individuals described in 6 such section); or 7 ‘‘(ii) have a high percentage of under- 8 insured residents in a particular geographic 9 area (if the targeted geographic area is located 10 in a State that has not so elected); and 11 ‘‘(B) have a high percentage of families for 12 whom English is not their primary language or 13 including smaller limited-English-proficient 14 communities within the region that are not oth- 15 erwise reached by linguistically appropriate 16 health services; 17 ‘‘(2) with experience in providing health or 18 health-related social services to individuals who are 19 underserved with respect to such services; and 20 ‘‘(3) with documented community activity and 21 experience with community health workers. 22 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU- 23 TIONS.—The Secretary shall encourage community health 24 worker programs receiving funds under this section to col- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00276 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 277 •HR 5294 IH laborate with academic institutions, including minority- 1 serving institutions. Nothing in this section shall be con- 2 strued to require such collaboration. 3 ‘‘(f) QUALITY ASSURANCE AND COST EFFECTIVE- 4 NESS.—The Secretary shall establish guidelines for ensur- 5 ing the quality of the training and supervision of commu- 6 nity health workers under the programs funded under this 7 section and for ensuring the cost effectiveness of such pro- 8 grams. 9 ‘‘(g) MONITORING.—The Secretary shall monitor 10 community health worker programs identified in approved 11 applications and shall determine whether such programs 12 are in compliance with the guidelines established under 13 subsection (f). 14 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 15 provide technical assistance to community health worker 16 programs identified in approved applications with respect 17 to planning, developing, and operating programs under the 18 grant. 19 ‘‘(i) REPORT TO CONGRESS.— 20 ‘‘(1) IN GENERAL.—Not later than 4 years 21 after the date on which the Secretary first awards 22 grants under subsection (a), the Secretary shall sub- 23 mit to Congress a report regarding the grant 24 project. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00277 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 278 •HR 5294 IH ‘‘(2) CONTENTS.—The report required under 1 paragraph (1) shall include the following: 2 ‘‘(A) A description of the programs for 3 which grant funds were used. 4 ‘‘(B) The number of individuals served. 5 ‘‘(C) An evaluation of— 6 ‘‘(i) the effectiveness of these pro- 7 grams; 8 ‘‘(ii) the cost of these programs; and 9 ‘‘(iii) the impact of the project on the 10 health outcomes of the community resi- 11 dents. 12 ‘‘(D) Recommendations for sustaining the 13 community health worker programs developed 14 or assisted under this section. 15 ‘‘(E) Recommendations regarding training 16 to enhance career opportunities for community 17 health workers. 18 ‘‘(j) DEFINITIONS.—In this section: 19 ‘‘(1) COMMUNITY HEALTH WORKER.—The term 20 ‘community health worker’ means an individual who 21 promotes health or nutrition within the community 22 in which the individual resides— 23 ‘‘(A) by serving as a liaison between com- 24 munities and health care agencies; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00278 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 279 •HR 5294 IH ‘‘(B) by providing guidance and social as- 1 sistance to community residents; 2 ‘‘(C) by enhancing community residents’ 3 ability to effectively communicate with health 4 care providers; 5 ‘‘(D) by providing culturally and linguis- 6 tically appropriate health or nutrition edu- 7 cation; 8 ‘‘(E) by advocating for individual and com- 9 munity health, including dental, oral, mental, 10 and environmental health, or nutrition needs; 11 ‘‘(F) by taking into consideration the 12 needs of the communities served, including the 13 prevalence rates of risk factors that impede 14 achieving healthy behaviors and good health 15 outcomes among women and children, especially 16 among racial and ethnic minority women and 17 children; and 18 ‘‘(G) by providing referral and followup 19 services. 20 ‘‘(2) COMMUNITY SETTING.—The term ‘commu- 21 nity setting’ means a home or a community organi- 22 zation that serves a population. 23 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en- 24 tity’ means— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00279 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 280 •HR 5294 IH ‘‘(A) a unit of State, territorial, local, or 1 tribal government (including a federally recog- 2 nized tribe or Alaska Native village); or 3 ‘‘(B) a community-based organization. 4 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 5 The term ‘medically underserved community’ means 6 a community— 7 ‘‘(A) that has a substantial number of in- 8 dividuals who are members of a medically un- 9 derserved population, as defined by section 10 330(b)(3); 11 ‘‘(B) a significant portion of which is a 12 health professional shortage area as designated 13 under section 332; and 14 ‘‘(C) that includes populations that are lin- 15 guistically isolated, such as geographic areas 16 with a shortage of health professionals able to 17 provide linguistically appropriate services. 18 ‘‘(5) SUPPORT.—The term ‘support’ means the 19 provision of training, supervision, and materials 20 needed to effectively deliver the services described in 21 subsection (b), reimbursement for services, and 22 other benefits. 23 ‘‘(6) TARGET POPULATION.—The term ‘target 24 population’ means women of reproductive age, re- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00280 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 281 •HR 5294 IH gardless of their current childbearing status and 1 children under 21 years of age. 2 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 3 are authorized to be appropriated to carry out this section 4 $15,000,000 for each of fiscal years 2015 through 2019.’’. 5 SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NU- 6 TRITION ASSISTANCE FOR CHILDREN, PREG- 7 NANT WOMEN, AND LAWFULLY PRESENT IN- 8 DIVIDUALS. 9 (a) MEDICAID.—Section 1903(v) of the Social Secu- 10 rity Act (42 U.S.C. 1396b(v)) is amended by striking 11 paragraph (4) and inserting the following new paragraph: 12 ‘‘(4)(A) Notwithstanding sections 401(a), 13 402(b), 403, and 421 of the Personal Responsibility 14 and Work Opportunity Reconciliation Act of 1996 15 and paragraph (1), payment shall be made to a 16 State under this section for medical assistance fur- 17 nished to an alien under this title (including an alien 18 described in such paragraph) who meets any of the 19 following conditions: 20 ‘‘(i) The alien is otherwise eligible for such 21 assistance under the State plan approved under 22 this title (other than the requirement of the re- 23 ceipt of aid or assistance under title IV, supple- 24 mental security income benefits under title 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00281 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 282 •HR 5294 IH XVI, or a State supplementary payment) within 1 either or both of the following eligibility cat- 2 egories: 3 ‘‘(I) Children under 21 years of age, 4 including any optional targeted low-income 5 child (as such term is defined in section 6 1905(u)(2)(B)). 7 ‘‘(II) Pregnant women during preg- 8 nancy and during the 60-day period begin- 9 ning on the last day of the pregnancy. 10 ‘‘(ii) The alien is lawfully present in the 11 United States. 12 ‘‘(B) No debt shall accrue under an affidavit of 13 support against any sponsor of an alien who meets 14 the conditions specified in subparagraph (A) on the 15 basis of the provision of medical assistance to such 16 alien under this paragraph and the cost of such as- 17 sistance shall not be considered as an unreimbursed 18 cost.’’. 19 (b) SCHIP.—Subparagraph (J) of section 20 2107(e)(1) of the Social Security Act (42 U.S.C. 21 1397gg(e)(1)) is amended to read as follows: 22 ‘‘(J) Paragraph (4) of section 1903(v) (re- 23 lating to coverage of categories of children, 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00282 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 283 •HR 5294 IH pregnant women, and other lawfully present in- 1 dividuals).’’. 2 (c) SUPPLEMENTAL NUTRITION ASSISTANCE.—Not- 3 withstanding sections 401(a), 402(a), and 403(a) of the 4 Personal Responsibility and Work Opportunity Reconcili- 5 ation Act of 1996 (8 U.S.C. 1611(a); 1612(a); 1613(a)) 6 and section 6(f) of the Food and Nutrition Act of 2008 7 (7 U.S.C. 2015(f)), persons who are lawfully present in 8 the United States shall be not be ineligible for benefits 9 under the supplemental nutrition assistance program on 10 the basis of their immigration status or date of entry into 11 the United States. 12 (d) ELIGIBILITY FOR FAMILIES WITH CHILDREN.— 13 Section of the 421(d)(3) of the Personal Responsibility 14 and Work Opportunity Reconciliation Act of 1996 (8 15 U.S.C. 1631(d)(3)) is amended by striking ‘‘to the extent 16 that a qualified alien is eligible under section 17 402(a)(2)(J)’’ and inserting, ‘‘to the extent that a child 18 is a member of a household under the supplemental nutri- 19 tion assistance program’’. 20 (e) ENSURING PROPER SCREENING.—Section 21 11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 22 U.S.C. 2020(e)(2)(B)) is amended— 23 (1) by redesignating clauses (vi) and (vii) as 24 clauses (vii) and (viii); and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00283 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 284 •HR 5294 IH (2) by inserting after clause (v) the following: 1 ‘‘(vi) shall provide a method for imple- 2 menting section 421 of the Personal Re- 3 sponsibility and Work Opportunity Rec- 4 onciliation Act of 1996 (8 U.S.C. 1631) 5 that does not require any unnecessary in- 6 formation from persons who may be ex- 7 empt from that provision;’’. 8 SEC. 503. REPEAL OF DENIAL OF BENEFITS. 9 Section 115 of the Personal Responsibility and Work 10 Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) 11 is amended— 12 (1) in subsection (a) by striking paragraph (2); 13 (2) in subsection (b) by striking paragraph (2); 14 and 15 (3) in subsection (e) by striking paragraph (2). 16 SEC. 504. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 17 AND AWARENESS. 18 (a) IN GENERAL.—The Secretary shall establish and 19 implement a birth defects prevention and public awareness 20 program, consisting of the activities described in sub- 21 sections (c) and (d). 22 (b) DEFINITIONS.—In this section: 23 (1) The term ‘‘pregnancy and breastfeeding in- 24 formation services’’ includes only— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00284 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 285 •HR 5294 IH (A) information services to provide accu- 1 rate, evidence-based, clinical information re- 2 garding maternal exposures during pregnancy 3 that may be associated with birth defects or 4 other health risks, such as exposures to medica- 5 tions, chemicals, infections, foodborne patho- 6 gens, illnesses, nutrition, or lifestyle factors; 7 (B) information services to provide accu- 8 rate, evidence-based, clinical information re- 9 garding maternal exposures during breast- 10 feeding that may be associated with health risks 11 to a breast-fed infant, such as exposures to 12 medications, chemicals, infections, foodborne 13 pathogens, illnesses, nutrition, or lifestyle fac- 14 tors; 15 (C) the provision of accurate, evidence- 16 based information weighing risks of exposures 17 during breastfeeding against the benefits of 18 breastfeeding; and 19 (D) the provision of information described 20 in subparagraph (A), (B), or (C) through coun- 21 selors, Web sites, fact sheets, telephonic or elec- 22 tronic communication, community outreach ef- 23 forts, or other appropriate means. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00285 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 286 •HR 5294 IH (2) The term ‘‘Secretary’’ means the Secretary 1 of Health and Human Services, acting through the 2 Director of the Centers for Disease Control and Pre- 3 vention. 4 (c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 5 subsection (a), the Secretary shall conduct or support a 6 nationwide media campaign to increase awareness among 7 health care providers and at-risk populations about preg- 8 nancy and breastfeeding information services. 9 (d) GRANTS FOR PREGNANCY AND BREASTFEEDING 10 INFORMATION SERVICES.— 11 (1) IN GENERAL.—In carrying out subsection 12 (a), the Secretary shall award grants to State or re- 13 gional agencies or organizations for any of the fol- 14 lowing: 15 (A) INFORMATION SERVICES.—The provi- 16 sion of, or campaigns to increase awareness 17 about, pregnancy and breastfeeding information 18 services. 19 (B) SURVEILLANCE AND RESEARCH.—The 20 conduct or support of— 21 (i) surveillance of or research on— 22 (I) maternal exposures and ma- 23 ternal health conditions that may in- 24 fluence the risk of birth defects, pre- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00286 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 287 •HR 5294 IH maturity, or other adverse pregnancy 1 outcomes; and 2 (II) maternal exposures that may 3 influence health risks to a breastfed 4 infant; or 5 (ii) networking to facilitate surveil- 6 lance or research described in this sub- 7 paragraph. 8 (2) PREFERENCE FOR CERTAIN STATES.—The 9 Secretary, in making any grant under this sub- 10 section, shall give preference to States, otherwise 11 equally qualified, that have or had a pregnancy and 12 breastfeeding information service in place on or after 13 January 1, 2006. 14 (3) MATCHING FUNDS.—The Secretary may 15 only award a grant under this subsection to a State 16 or regional agency or organization that agrees, with 17 respect to the costs to be incurred in carrying out 18 the grant activities, to make available (directly or 19 through donations from public or private entities) 20 non-Federal funds toward such costs in an amount 21 equal to not less than 25 percent of the amount of 22 the grant. 23 (4) COORDINATION.—The Secretary shall en- 24 sure that activities funded through a grant under 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00287 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 288 •HR 5294 IH this subsection are coordinated, to the maximum ex- 1 tent practicable, with other birth defects prevention 2 and environmental health activities of the Federal 3 Government, including with respect to pediatric envi- 4 ronmental health specialty units and children’s envi- 5 ronmental health centers. 6 (e) EVALUATION.—In furtherance of the program 7 under subsection (a), the Secretary shall provide for an 8 evaluation of pregnancy and breastfeeding information 9 services to identify efficient and effective models of— 10 (1) providing information; 11 (2) raising awareness and increasing knowledge 12 about birth defects prevention measures and tar- 13 geting education to at-risk groups; 14 (3) modifying risk behaviors; or 15 (4) other outcome measures as determined ap- 16 propriate by the Secretary. 17 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 18 out this section, there are authorized to be appropriated 19 $5,000,000 for fiscal year 2015, $6,000,000 for fiscal year 20 2016, $7,000,000 for fiscal year 2017, $8,000,000 for fis- 21 cal year 2018, and $9,000,000 for fiscal year 2019. 22 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00288 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 289 •HR 5294 IH SEC. 505. UNIFORM STATE MATERNAL MORTALITY REVIEW 1 COMMITTEES ON PREGNANCY-RELATED 2 DEATHS. 3 (a) IN GENERAL.—Title V of the Social Security Act 4 (42 U.S.C. 701 et seq.) is amended by adding at the end 5 the following new section: 6 ‘‘SEC. 514. UNIFORM STATE MATERNAL MORTALITY RE- 7 VIEW COMMITTEES ON PREGNANCY-RE- 8 LATED DEATHS. 9 ‘‘(a) GRANTS.— 10 ‘‘(1) IN GENERAL.—Notwithstanding any other 11 provision of this title, for each of fiscal years 2015 12 through 2021, in addition to payments from allot- 13 ments for States under section 502 for such year, 14 the Secretary shall, subject to paragraph (3) and in 15 accordance with the criteria established under para- 16 graph (2), award grants to States to— 17 ‘‘(A) carry out the activities described in 18 subsection (b)(1); 19 ‘‘(B) establish a State maternal mortality 20 review committee, in accordance with subsection 21 (b)(2), to carry out the activities described in 22 subsection (b)(2)(A), and to establish the proc- 23 esses described in subsection (b)(1); 24 ‘‘(C) ensure the State department of 25 health carries out the applicable activities de- 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00289 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 290 •HR 5294 IH scribed in subsection (b)(3), with respect to 1 pregnancy-related deaths occurring within the 2 State during such fiscal year; 3 ‘‘(D) implement and use the comprehensive 4 case abstraction form developed under sub- 5 section (c), in accordance with such subsection; 6 and 7 ‘‘(E) provide for public disclosure of infor- 8 mation, in accordance with subsection (e). 9 ‘‘(2) CRITERIA.—The Secretary shall establish 10 criteria for determining eligibility for and the 11 amount of a grant awarded to a State under para- 12 graph (1). Such criteria shall provide that in the 13 case of a State that receives such a grant for a fiscal 14 year and is determined by the Secretary to have not 15 used such grant in accordance with this section, 16 such State shall not be eligible for such a grant for 17 any subsequent fiscal year. 18 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 19 For purposes of carrying out the grant program 20 under this section, including for administrative pur- 21 poses, there is authorized to be appropriated 22 $10,000,000 for each of fiscal years 2015 through 23 2021. 24 ‘‘(b) PREGNANCY-RELATED DEATH REVIEW.— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00290 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 291 •HR 5294 IH ‘‘(1) REVIEW OF PREGNANCY-RELATED DEATH 1 AND PREGNANCY-ASSOCIATED DEATH CASES.—For 2 purposes of subsection (a), with respect to a State 3 that receives a grant under subsection (a), the fol- 4 lowing shall apply: 5 ‘‘(A) MANDATORY REPORTING OF PREG- 6 NANCY-RELATED DEATHS.— 7 ‘‘(i) IN GENERAL.—The State shall, 8 through the State maternal mortality re- 9 view committee, develop a process, sepa- 10 rate from any reporting process established 11 by the State department of health prior to 12 the date of the enactment of this section, 13 that provides for mandatory and confiden- 14 tial case reporting by individuals and enti- 15 ties described in clause (ii) of pregnancy- 16 related deaths to the State department of 17 health. 18 ‘‘(ii) INDIVIDUALS AND ENTITIES DE- 19 SCRIBED.—Individuals and entities de- 20 scribed in this clause include each of the 21 following: 22 ‘‘(I) Health care providers. 23 ‘‘(II) Medical examiners. 24 ‘‘(III) Medical coroners. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00291 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 292 •HR 5294 IH ‘‘(IV) Hospitals. 1 ‘‘(V) Free-standing birth centers. 2 ‘‘(VI) Federally qualified health 3 centers. 4 ‘‘(VII) Other health care facili- 5 ties. 6 ‘‘(VIII) Any other individuals re- 7 sponsible for completing death certifi- 8 cates. 9 ‘‘(IX) Any other appropriate in- 10 dividuals or entities specified by the 11 Secretary. 12 ‘‘(B) VOLUNTARY REPORTING OF PREG- 13 NANCY-RELATED AND PREGNANCY-ASSOCIATED 14 DEATHS.— 15 ‘‘(i) The State shall, through the 16 State maternal mortality review committee, 17 develop a process for and encourage, sepa- 18 rate from any reporting process established 19 by the State department of health prior to 20 the date of the enactment of this section, 21 voluntary and confidential case reporting 22 by individuals described in clause (ii) of 23 pregnancy-associated deaths to the State 24 department of health. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00292 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 293 •HR 5294 IH ‘‘(ii) The State shall, through the 1 State maternal mortality review committee, 2 develop a process for voluntary and con- 3 fidential reporting by family members of 4 the deceased and by other individuals on 5 possible pregnancy-related and pregnancy- 6 associated deaths to the State department 7 of health. Such process shall include— 8 ‘‘(I) making publicly available on 9 the Internet Web site of the State de- 10 partment of health a telephone num- 11 ber, Internet Web link, and email ad- 12 dress for such reporting; and 13 ‘‘(II) publicizing to local profes- 14 sional organizations, community orga- 15 nizations, and social services agencies 16 the availability of the telephone num- 17 ber, Internet Web link, and email ad- 18 dress made available under subclause 19 (I). 20 ‘‘(C) DEVELOPMENT OF CASE-FINDING.— 21 The State, through the vital statistics unit of 22 the State, shall annually identify pregnancy-re- 23 lated and pregnancy-associated deaths occur- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00293 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 294 •HR 5294 IH ring in such State during the year involved 1 by— 2 ‘‘(i) matching all death records, with 3 respect to such year, for women of child- 4 bearing age to live birth certificates and in- 5 fant death certificates to identify deaths of 6 women that occurred during pregnancy 7 and within one year after the end of a 8 pregnancy; 9 ‘‘(ii) identifying deaths reported dur- 10 ing such year as having an underlying or 11 contributing cause of death related to 12 pregnancy, regardless of the time that has 13 passed between the end of the pregnancy 14 and the death; 15 ‘‘(iii) collecting data from medical ex- 16 aminer and coroner reports; and 17 ‘‘(iv) any other methods the States 18 may devise to identify maternal deaths, 19 such as through review of a random sam- 20 ple of reported deaths of women of child- 21 bearing age to ascertain cases of preg- 22 nancy-related and pregnancy-associated 23 deaths that are not discernable from a re- 24 view of death certificates alone. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00294 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 295 •HR 5294 IH When feasible and for purposes of effectively 1 collecting and obtaining data on pregnancy-re- 2 lated and pregnancy-associated deaths, the 3 State shall adopt the most recent standardized 4 birth and death certificates, as issued by the 5 National Center for Vital Health Statistics, in- 6 cluding the recommended checkbox section for 7 pregnancy on the death certificates. 8 ‘‘(D) CASE INVESTIGATION AND DEVELOP- 9 MENT OF CASE SUMMARIES.—Following receipt 10 of reports by the State department of health 11 pursuant to subparagraph (A) or (B) and col- 12 lection by the vital statistics unit of the State 13 of possible cases of pregnancy-related and preg- 14 nancy-associated deaths pursuant to subpara- 15 graph (C), the State, through the State mater- 16 nal mortality review committee established 17 under subsection (a), shall investigate each 18 case, utilizing the case abstraction form de- 19 scribed in subsection (c), and prepare de-identi- 20 fied case summaries, which shall be reviewed by 21 the committee and included in applicable re- 22 ports. For purposes of subsection (a), under the 23 processes established under subparagraphs (A), 24 (B), and (C), a State department of health or 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00295 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 296 •HR 5294 IH vital statistics unit of a State shall provide to 1 the State maternal mortality review committee 2 access to information collected pursuant to such 3 subparagraphs as necessary to carry out this 4 subparagraph. Data and information collected 5 for the case summary and review are for pur- 6 poses of public health activities, in accordance 7 with HIPAA privacy and security law (as de- 8 fined in section 3009(a)(2) of the Public Health 9 Service Act). Such case investigations shall in- 10 clude data and information obtained through— 11 ‘‘(i) medical examiner and autopsy re- 12 ports of the woman involved; 13 ‘‘(ii) medical records of the woman, 14 including such records related to health 15 care prior to pregnancy, prenatal and post- 16 natal care, labor and delivery care, emer- 17 gency room care, hospital discharge 18 records including immunization status and 19 screening status for prevalent diseases, and 20 any care delivered up until the time of 21 death of the woman for purposes of public 22 health activities, in accordance with 23 HIPAA privacy and security law (as de- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00296 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 297 •HR 5294 IH fined in section 3009(a)(2) of the Public 1 Health Service Act); 2 ‘‘(iii) oral and written interviews of in- 3 dividuals directly involved in the maternal 4 care of the woman during and immediately 5 following the pregnancy of the woman, in- 6 cluding health care, mental health, and so- 7 cial service providers in-language when 8 possible, as applicable; 9 ‘‘(iv) optional oral or written inter- 10 views of the family of the woman; 11 ‘‘(v) socioeconomic and other relevant 12 background information about the woman; 13 ‘‘(vi) information collected in subpara- 14 graph (C)(i); and 15 ‘‘(vii) other information on the cause 16 of death of the woman, such as social serv- 17 ices and child welfare reports, including ex- 18 periences with intimate partner violence. 19 ‘‘(2) STATE MATERNAL MORTALITY REVIEW 20 COMMITTEES.— 21 ‘‘(A) DUTIES.— 22 ‘‘(i) REQUIRED COMMITTEE ACTIVI- 23 TIES.—For purposes of subsection (a), a 24 maternal mortality review committee estab- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00297 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 298 •HR 5294 IH lished by a State pursuant to a grant 1 under such subsection shall carry out the 2 following pregnancy-related death and 3 pregnancy-associated death review activi- 4 ties and shall include all information rel- 5 evant to the death involved on the case ab- 6 straction form developed under subsection 7 (d): 8 ‘‘(I) With respect to a case of 9 pregnancy-related or pregnancy-asso- 10 ciated death of a woman, review the 11 case summaries prepared under sub- 12 paragraphs (A), (B), (C), and (D) of 13 paragraph (1). 14 ‘‘(II) Review aggregate statistical 15 reports developed by the vital statis- 16 tics unit of the State under paragraph 17 (1)(C) regarding pregnancy-related 18 and pregnancy-associated deaths to 19 identify trends, patterns, and dispari- 20 ties in adverse outcomes and address 21 medical, nonmedical, and system-re- 22 lated factors that may have contrib- 23 uted to such pregnancy-related and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00298 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 299 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00299 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 300 •HR 5294 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 multidisciplinary, consisting of 8 health care, behavioral health, and social 9 service providers, public health officials, 10 other persons with professional expertise 11 on maternal health and mortality, and pa- 12 tient and community advocates who rep- 13 resent those communities within such State 14 that are the most affected by maternal 15 mortality. Membership on such a com- 16 mittee of a State shall be reviewed annu- 17 ally by the State department of health to 18 ensure that membership representation re- 19 quirements are being fulfilled in accord- 20 ance with this paragraph. 21 ‘‘(ii) REQUIRED MEMBERSHIP.—Each 22 such review committee shall include— 23 ‘‘(I) representatives from medical 24 specialties providing care to pregnant 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00300 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 301 •HR 5294 IH and postpartum patients, including 1 obstetricians (including generalists 2 and maternal fetal medicine special- 3 ists), and family practice physicians; 4 ‘‘(II) representatives from mid- 5 wifery specialties (including certified 6 professional midwives and certified 7 midwives); 8 ‘‘(III) advanced practice nurses; 9 ‘‘(IV) hospital-based nurses; 10 ‘‘(V) representatives of the State 11 department of health maternal and 12 child health department; 13 ‘‘(VI) social service providers or 14 social workers; 15 ‘‘(VII) the chief medical exam- 16 iners or designees; 17 ‘‘(VIII) facility representatives, 18 such as from hospitals or free-stand- 19 ing birth centers; and 20 ‘‘(IX) community or patient ad- 21 vocates who represent those commu- 22 nities within the State that are the 23 most affected by maternal mortality. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00301 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 302 •HR 5294 IH ‘‘(iii) ADDITIONAL MEMBERS.—Each 1 such review committee may also include 2 representatives from other relevant aca- 3 demic, health, social service, or policy pro- 4 fessions, or community organizations, on 5 an ongoing basis, or as needed, as deter- 6 mined beneficial by the review committee, 7 including— 8 ‘‘(I) anesthesiologists; 9 ‘‘(II) emergency physicians; 10 ‘‘(III) pathologists; 11 ‘‘(IV) epidemiologists or biostat- 12 isticians; 13 ‘‘(V) intensivists; 14 ‘‘(VI) orthopedic surgeons and/or 15 orthopedic physicians; 16 ‘‘(VII) vital statistics officers; 17 ‘‘(VIII) nutritionists; 18 ‘‘(IX) mental health profes- 19 sionals; 20 ‘‘(X) substance abuse treatment 21 specialists; 22 ‘‘(XI) representatives of relevant 23 advocacy groups; 24 ‘‘(XII) academics; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00302 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 303 •HR 5294 IH ‘‘(XIII) representatives of bene- 1 ficiaries of the State plan under the 2 Medicaid Program under title XIX; 3 ‘‘(XIV) paramedics; 4 ‘‘(XV) lawyers; 5 ‘‘(XVI) risk management special- 6 ists; 7 ‘‘(XVII) representatives of the 8 departments of health or public health 9 of major cities in the State involved; 10 and 11 ‘‘(XVIII) policymakers. 12 ‘‘(iv) DIVERSE COMMUNITY MEMBER- 13 SHIP.—The composition of such a com- 14 mittee, with respect to a State, shall in- 15 clude— 16 ‘‘(I) representatives from diverse 17 communities, particularly those com- 18 munities within such State most se- 19 verely affected by pregnancy-related 20 deaths or pregnancy-associated deaths 21 and by a lack of access to relevant 22 maternal care services, from commu- 23 nity maternal child health organiza- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00303 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 304 •HR 5294 IH tions, and from minority advocacy 1 groups; 2 ‘‘(II) members, including health 3 care providers, from different geo- 4 graphic regions in the State, including 5 any rural, urban, and tribal areas; 6 and 7 ‘‘(III) health care and social serv- 8 ice providers who work in commu- 9 nities that are diverse with regard to 10 race, ethnicity, immigration status, in- 11 digenous status, and English pro- 12 ficiency. 13 ‘‘(v) MATERNAL MORTALITY REVIEW 14 STAFF.—Staff of each such review com- 15 mittee shall include— 16 ‘‘(I) vital health statisticians, ma- 17 ternal child health statisticians, or 18 epidemiologists; 19 ‘‘(II) a coordinator of the State 20 maternal mortality review committee, 21 to be designated by the State; and 22 ‘‘(III) administrative staff. 23 ‘‘(C) OPTION FOR STATES TO FORM RE- 24 GIONAL MATERNAL MORTALITY REVIEWS.— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00304 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 305 •HR 5294 IH States with a low rate of occurrence of preg- 1 nancy-associated or pregnancy-related deaths 2 may choose to partner with one or more neigh- 3 boring States to fulfill the activities described in 4 paragraph (1)(C). In such a case, with respect 5 to States in such a partnership, any require- 6 ment under this section relating to the report- 7 ing of information related to such activities 8 shall be deemed to be fulfilled by each such 9 State if a single such report is submitted for 10 the partnership. 11 ‘‘(3) STATE DEPARTMENT OF HEALTH ACTIVI- 12 TIES.—For purposes of subsection (a), a State de- 13 partment of health of a State receiving a grant 14 under such subsection shall— 15 ‘‘(A) in consultation with the maternal 16 mortality review committee of the State and in 17 conjunction with relevant professional organiza- 18 tions, develop a plan for ongoing health care 19 provider education, based on the findings and 20 recommendations of the committee, in order to 21 improve the quality of maternal care; and 22 ‘‘(B) take steps to widely disseminate the 23 findings and recommendations of the State ma- 24 ternal mortality review committees of the State 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00305 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 306 •HR 5294 IH and to implement the recommendations of such 1 committee. 2 ‘‘(c) CASE ABSTRACTION FORM.— 3 ‘‘(1) DEVELOPMENT.—The Director of the Cen- 4 ters for Disease Control and Prevention shall de- 5 velop a uniform, comprehensive case abstraction 6 form and make such form available to States for 7 State maternal mortality review committees for use 8 by such committees in order to— 9 ‘‘(A) ensure that the cases and information 10 collected and reviewed by such committees can 11 be pooled for review by the Department of 12 Health and Human Services and its agencies; 13 and 14 ‘‘(B) preserve the uniformity of the infor- 15 mation and its use for Federal public health 16 purposes. 17 ‘‘(2) PERMISSIBLE STATE MODIFICATION.— 18 Each State may modify the form developed under 19 paragraph (1) for implementation and use by such 20 State or by the State maternal mortality review com- 21 mittee of such State by including on such form addi- 22 tional information to be collected, but may not alter 23 the standard questions on such form, in order to en- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00306 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 307 •HR 5294 IH sure that the information can be collected and re- 1 viewed centrally at the Federal level. 2 ‘‘(d) TREATMENT AS PUBLIC HEALTH AUTHORITY 3 FOR PURPOSES OF HIPAA.—For purposes of applying 4 HIPAA privacy and security law (as defined in section 5 3009(a)(2) of the Public Health Service Act), a State ma- 6 ternal mortality review committee of a State established 7 pursuant to this section to carry out activities described 8 in subsection (b)(2)(A) shall be deemed to be a public 9 health authority described in section 164.501 (and ref- 10 erenced in section 164.512(b)(1)(i)) of title 45, Code of 11 Federal Regulations (or any successor regulation), car- 12 rying out public health activities and purposes described 13 in such section 164.512(b)(1)(i) (or any such successor 14 regulation). 15 ‘‘(e) PUBLIC DISCLOSURE OF INFORMATION.— 16 ‘‘(1) IN GENERAL.—For fiscal year 2015 or a 17 subsequent fiscal year, each State receiving a grant 18 under this section for such year shall, subject to 19 paragraph (3), provide for the public disclosure, and 20 submission to the information clearinghouse estab- 21 lished under paragraph (2), of the information in- 22 cluded in the report of the State under section 23 506(a)(2)(F) for such year (relating to the findings 24 for such year of the State maternal mortality review 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00307 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 308 •HR 5294 IH committee established by the State under this sec- 1 tion). 2 ‘‘(2) INFORMATION CLEARINGHOUSE.—The 3 Secretary of Health and Human Services shall es- 4 tablish an information clearinghouse, that shall be 5 administered by the Director of the Centers for Dis- 6 ease Control and Prevention, that will maintain find- 7 ings and recommendations submitted pursuant to 8 paragraph (1) and provide such findings and rec- 9 ommendations for public review and research pur- 10 poses by State health departments, maternal mor- 11 tality review committees, and health providers and 12 institutions. 13 ‘‘(3) CONFIDENTIALITY OF INFORMATION.—In 14 no case shall any individually identifiable health in- 15 formation be provided to the public, or submitted to 16 the information clearinghouse, under paragraph (1). 17 ‘‘(f) CONFIDENTIALITY OF REVIEW COMMITTEE 18 PROCEEDINGS.— 19 ‘‘(1) IN GENERAL.—All proceedings and activi- 20 ties of a State maternal mortality review committee 21 under this section, opinions of members of such a 22 committee formed as a result of such proceedings 23 and activities, and records obtained, created, or 24 maintained pursuant to this section, including 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00308 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 309 •HR 5294 IH records of interviews, written reports, and state- 1 ments procured by the Department of Health and 2 Human Services or by any other person, agency, or 3 organization acting jointly with the Department, in 4 connection with morbidity and mortality reviews 5 under this section, shall be confidential, and not sub- 6 ject to discovery, subpoena, or introduction into evi- 7 dence in any civil, criminal, legislative, or other pro- 8 ceeding. Such records shall not be open to public in- 9 spection. 10 ‘‘(2) TESTIMONY OF MEMBERS OF COM- 11 MITTEE.— 12 ‘‘(A) IN GENERAL.—Members of a State 13 maternal mortality review committee under this 14 section may not be questioned in any civil, 15 criminal, legislative, or other proceeding regard- 16 ing information presented in, or opinions 17 formed as a result of, a meeting or communica- 18 tion of the committee. 19 ‘‘(B) CLARIFICATION.—Nothing in this 20 subsection shall be construed to prevent a mem- 21 ber of such a committee from testifying regard- 22 ing information that was obtained independent 23 of such member’s participation on the com- 24 mittee, or that is public information. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00309 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 310 •HR 5294 IH ‘‘(3) AVAILABILITY OF INFORMATION FOR RE- 1 SEARCH PURPOSES.—Nothing in this subsection 2 shall prohibit the publishing by such a committee or 3 the Department of Health and Human Services of 4 statistical compilations and research reports that— 5 ‘‘(A) are based on confidential information, 6 relating to morbidity and mortality review; and 7 ‘‘(B) do not contain identifying informa- 8 tion or any other information that could be 9 used to ultimately identify the individuals con- 10 cerned. 11 ‘‘(g) DEFINITIONS.—For purposes of this section: 12 ‘‘(1) The term ‘pregnancy-associated death’ 13 means the death of a woman while pregnant or dur- 14 ing the one-year period following the date of the end 15 of pregnancy, irrespective of the cause of such death. 16 ‘‘(2) The term ‘pregnancy-related death’ means 17 the death of a woman while pregnant or during the 18 one-year period following the date of the end of 19 pregnancy, irrespective of the duration or site of the 20 pregnancy, from any cause related to or aggravated 21 by the pregnancy or its management, but not from 22 any accidental or incidental cause. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00310 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 311 •HR 5294 IH ‘‘(3) The term ‘woman of childbearing age’ 1 means a woman who is at least 10 years of age and 2 not more than 54 years of age.’’. 3 (b) INCLUSION OF FINDINGS OF REVIEW COMMIT- 4 TEES IN REQUIRED REPORTS.— 5 (1) STATE TRIENNIAL REPORTS.—Paragraph 6 (2) of section 506(a) of such Act (42 U.S.C. 706(a)) 7 is amended by inserting after subparagraph (E) the 8 following new subparagraph: 9 ‘‘(F) In the case of a State receiving a 10 grant under section 514, beginning for the first 11 fiscal year beginning after 3 years after the 12 date of establishment of the State maternal 13 mortality review committee established by the 14 State pursuant to such grant and once every 3 15 years thereafter, information containing the 16 findings and recommendations of such com- 17 mittee and information on the implementation 18 of such recommendations during the period in- 19 volved.’’. 20 (2) ANNUAL REPORTS TO CONGRESS.—Para- 21 graph (3) of such section is amended— 22 (A) in subparagraph (D), at the end, by 23 striking ‘‘and’’; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00311 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 312 •HR 5294 IH (B) in subparagraph (E), at the end, by 1 striking the period and inserting ‘‘; and’’; and 2 (C) by adding at the end the following new 3 subparagraph: 4 ‘‘(F) For fiscal year 2015 and each subse- 5 quent fiscal year, taking into account the find- 6 ings, recommendations, and implementation in- 7 formation submitted by States pursuant to 8 paragraph (2)(F), on the status of pregnancy- 9 related deaths and pregnancy-associated deaths 10 in the United States and including rec- 11 ommendations on methods to prevent such 12 deaths in the United States.’’. 13 SEC. 506. ELIMINATING DISPARITIES IN MATERNITY 14 HEALTH OUTCOMES. 15 Part B of title III of the Public Health Service Act 16 is amended by inserting after section 317V, as added, the 17 following new section: 18 ‘‘SEC. 317W. ELIMINATING DISPARITIES IN MATERNITY 19 HEALTH OUTCOMES. 20 ‘‘(a) IN GENERAL.—The Secretary (in consultation 21 with the Deputy Assistant Secretary for Minority Health, 22 the Director of the National Institutes of Health, the Di- 23 rector of the Centers for Disease Control and Prevention, 24 the Administrator of the Centers for Medicare & Medicaid 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00312 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 313 •HR 5294 IH Services, and the Administrator of the Agency for 1 Healthcare Research & Quality, and in consultation with 2 relevant national stakeholder organizations such as na- 3 tional medical specialty organizations, national maternal 4 child health organizations, national groups that represent 5 minority populations, and national health disparity organi- 6 zations) shall carry out the following activities to eliminate 7 disparities in maternal health outcomes: 8 ‘‘(1) Conduct research into the determinants 9 and the distribution of disparities in maternal care, 10 health risks, and health outcomes, and improve the 11 capacity of the performance measurement infrastruc- 12 ture to measure such disparities. 13 ‘‘(2) Expand access to services that have been 14 demonstrated to improve the quality and outcomes 15 of maternity care for vulnerable populations. 16 ‘‘(3) Establish a demonstration project to com- 17 pare the effectiveness of interventions to reduce dis- 18 parities in maternity services and outcomes, and im- 19 plement and assess effective interventions. 20 ‘‘(b) SCOPE AND SELECTION OF STATES FOR DEM- 21 ONSTRATION PROJECT.—The demonstration project 22 under subsection (a)(3) shall be conducted in no more 23 than 8 States, which shall be selected by the Secretary 24 based on— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00313 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 314 •HR 5294 IH ‘‘(1) applications submitted by States, which 1 specify which regions and populations the State in- 2 volved will serve under the demonstration project; 3 ‘‘(2) criteria designed by the Secretary to en- 4 sure that, as a whole, the demonstration project is, 5 to the greatest extent possible, representative of the 6 demographic and geographic composition of commu- 7 nities most affected by disparities; 8 ‘‘(3) criteria designed by the Secretary to en- 9 sure that a variety of types of models are tested 10 through the demonstration project and that such 11 models include interventions that have an existing 12 evidence base for effectiveness; and 13 ‘‘(4) criteria designed by the Secretary to as- 14 sure that the demonstration projects and models will 15 be carried out in consultation with local and regional 16 provider organizations, such as community health 17 centers, hospital systems, and medical societies rep- 18 resenting providers of maternity services. 19 ‘‘(c) DURATION OF DEMONSTRATION PROJECT.— 20 The demonstration project under subsection (a)(3) shall 21 begin on January 1, 2015, and end on December 31, 22 2019. 23 ‘‘(d) GRANTS FOR EVALUATION AND MONITORING.— 24 The Secretary may make grants to States and health care 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00314 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 315 •HR 5294 IH providers participating in the demonstration project under 1 subsection (a)(3) for the purpose of collecting data nec- 2 essary for the evaluation and monitoring of such project. 3 ‘‘(e) REPORTS.— 4 ‘‘(1) STATE REPORTS.—Each State that par- 5 ticipates in the demonstration project under sub- 6 section (a)(3) shall report to the Secretary, in a 7 time, form, and manner specified by the Secretary, 8 the data necessary to— 9 ‘‘(A) monitor the— 10 ‘‘(i) outcomes of the project; 11 ‘‘(ii) costs of the project; and 12 ‘‘(iii) quality of maternity care pro- 13 vided under the project; and 14 ‘‘(B) evaluate the rationale for the selec- 15 tion of the items and services included in any 16 bundled payment made by the State under the 17 project. 18 ‘‘(2) FINAL REPORT.—Not later than December 19 31, 2020, the Secretary shall submit to Congress a 20 report on the results of the demonstration project 21 under subsection (a)(3).’’. 22 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00315 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 316 •HR 5294 IH SEC. 507. DECREASING THE RISK FACTORS FOR SUDDEN 1 UNEXPECTED INFANT DEATH AND SUDDEN 2 UNEXPLAINED DEATH IN CHILDHOOD. 3 (a) ESTABLISHMENT.—The Secretary of Health and 4 Human Services, acting through the Administrator of the 5 Health Resources and Services Administration and in con- 6 sultation with the Director of the Centers for Disease Con- 7 trol and Prevention and the Director of the National Insti- 8 tutes of Health (in this section referred to as the ‘‘Sec- 9 retary’’), shall establish and implement a culturally com- 10 petent public health awareness and education campaign 11 to provide information that is focused on decreasing the 12 risk factors for sudden unexpected infant death and sud- 13 den unexplained death in childhood, including educating 14 individuals about safe sleep environments, sleep positions, 15 and reducing exposure to smoking during pregnancy and 16 after birth. 17 (b) TARGETED POPULATIONS.—The campaign under 18 subsection (a) shall be designed to reduce health dispari- 19 ties through the targeting of populations with high rates 20 of sudden unexpected infant death and sudden unex- 21 plained death in childhood. 22 (c) CONSULTATION.—In establishing and imple- 23 menting the campaign under subsection (a), the Secretary 24 shall consult with national organizations representing 25 health care providers, including nurses and physicians, 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00316 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 317 •HR 5294 IH parents, child care providers, children’s advocacy and safe- 1 ty organizations, maternal and child health programs, nu- 2 trition professionals focusing on women, infants, and chil- 3 dren, and other individuals and groups determined nec- 4 essary by the Secretary for such establishment and imple- 5 mentation. 6 (d) GRANTS.— 7 (1) IN GENERAL.—In carrying out the cam- 8 paign under subsection (a), the Secretary shall 9 award grants to national organizations, State and 10 local health departments, and community-based or- 11 ganizations for the conduct of education and out- 12 reach programs for nurses, parents, child care pro- 13 viders, public health agencies, and community orga- 14 nizations. 15 (2) APPLICATION.—To be eligible to receive a 16 grant under paragraph (1), an entity shall submit to 17 the Secretary an application at such time, in such 18 manner, and containing such information as the Sec- 19 retary may require. 20 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 21 authorized to be appropriated to carry out this section 22 such sums as may be necessary for each of fiscal years 23 2015 through 2019. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00317 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 318 •HR 5294 IH SEC. 508. REDUCING UNINTENDED TEENAGE PREG- 1 NANCIES. 2 Title III of the Public Health Service Act (42 U.S.C. 3 241 et seq.) is amended by adding at the end the following 4 new part: 5 ‘‘PART W—YOUTH PREGNANCY PREVENTION 6 PROGRAMS 7 ‘‘SEC. 399OO. PURPOSE. 8 ‘‘It is the purpose of this part to develop and carry 9 out research and demonstration projects on new and exist- 10 ing program interventions to provide youth in communities 11 at disproportionate risk for unintended teen pregnancy 12 (particularly youth in racial or ethnic minority or immi- 13 grant communities, youth in the foster care system, youth 14 in the juvenile justice system, rural youth, and LGBT 15 youth) the information and skills needed to prevent unin- 16 tended teenage pregnancies, build healthy relationships, 17 and improve overall health and well-being. 18 ‘‘SEC. 399OO–1. LIMITATION. 19 ‘‘No Federal funds provided under this Act may be 20 used for health education programs or media awareness 21 campaigns that— 22 ‘‘(1) deliberately withhold life-saving informa- 23 tion about the human immunodeficiency virus 24 (HIV); 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00318 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 319 •HR 5294 IH ‘‘(2) undermine young people’s confidence in 1 the effectiveness of contraception; 2 ‘‘(3) are medically inaccurate or have been sci- 3 entifically shown to be ineffective; 4 ‘‘(4) promote gender, racial, or ethnic stereo- 5 types; 6 ‘‘(5) are insensitive and unresponsive to the 7 needs of sexually active youth or LGBT youth; 8 ‘‘(6) are inconsistent with the ethical impera- 9 tives of medicine and public health; or 10 ‘‘(7) stigmatize and shame youth who are par- 11 enting or choose to parent. 12 ‘‘SEC. 399OO–2. DEMONSTRATION GRANTS TO REDUCE UN- 13 INTENDED TEENAGE PREGNANCIES. 14 ‘‘(a) IN GENERAL.—The Secretary shall award com- 15 petitive grants to eligible entities for establishing or ex- 16 panding programs to provide youth in communities at dis- 17 proportionate risk for unintended teen pregnancy (particu- 18 larly youth in racial or ethnic minority or immigrant com- 19 munities, youth in the foster care system, youth in the 20 juvenile justice system, rural youth, and LGBT youth) the 21 information and skills needed to prevent unintended teen- 22 age pregnancy and develop healthy relationships. 23 ‘‘(b) PRIORITY.—In awarding grants under this sec- 24 tion, the Secretary shall give priority to applicants— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00319 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 320 •HR 5294 IH ‘‘(1) proposing to carry out projects in commu- 1 nities at disproportionate risk for unintended teen 2 pregnancy (particularly youth in racial or ethnic mi- 3 nority or immigrant communities, youth in the foster 4 care system, youth in the juvenile justice system, 5 rural youth, and LGBT youth); 6 ‘‘(2) that have a demonstrated history of effec- 7 tively working with such targeted communities; 8 ‘‘(3) that have a demonstrated history of engag- 9 ing in a meaningful and significant partnership with 10 such targeted communities; or 11 ‘‘(4) that have an integrated approach that also 12 promotes the skills necessary to build healthy rela- 13 tionships and recognize abusive or unhealthy behav- 14 iors. 15 ‘‘(c) PROGRAM SETTINGS.—Programs funded 16 through a grant under subsection (a) shall be provided— 17 ‘‘(1) through classroom-based settings, such as 18 school health education, humanities, language arts, 19 or family and consumer science education; after- 20 school programs; community-based programs; work- 21 force development programs; and health care set- 22 tings, including community health centers; or 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00320 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 321 •HR 5294 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–6(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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00321 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 322 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00322 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 323 •HR 5294 IH munities or engaged in meaningful and significant 1 partnership with such communities. 2 ‘‘SEC. 399OO–3. MULTIMEDIA CAMPAIGNS TO REDUCE UNIN- 3 TENDED 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 unintended teenage 8 pregnancy and related social and emotional issues, such 9 as violence prevention. 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 communities 13 at disproportionate risk for unintended teen pregnancy 14 (particularly youth in racial or ethnic minority or immi- 15 grant communities, youth in the foster care system, youth 16 in the juvenile justice system, rural youth, and LGBT 17 youth). 18 ‘‘(c) INFORMATION TO BE PROVIDED.—As a condi- 19 tion of receipt of a grant under this section, an entity shall 20 agree to use the grant to carry out multimedia campaigns 21 described in subsection (a) that— 22 ‘‘(1) at a minimum, shall provide information 23 on— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00323 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 324 •HR 5294 IH ‘‘(A) the prevention of unintended teenage 1 pregnancy; and 2 ‘‘(B) healthy relationship development; and 3 ‘‘(2) may provide information on the prevention 4 of dating violence and sexual assault. 5 ‘‘SEC. 399OO–4. RESEARCH ON REDUCING UNINTENDED 6 TEENAGE PREGNANCIES AND TEENAGE DAT- 7 ING VIOLENCE AND IMPROVING HEALTHY 8 RELATIONSHIPS. 9 ‘‘(a) IN GENERAL.—The Secretary, acting through 10 the Director of the Centers for Disease Control and Pre- 11 vention, shall make grants to public and private entities 12 to conduct, support, or coordinate research on unintended 13 teenage pregnancy, dating violence, and healthy relation- 14 ships among racial or ethnic minority or immigrant com- 15 munities that— 16 ‘‘(1) improves data collection on— 17 ‘‘(A) sexual and reproductive health, in- 18 cluding unintended teenage pregnancies and 19 births, among all minority communities and 20 subpopulations in which such data are not col- 21 lected, including American Indian and Alaska 22 Native youth; 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00324 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 325 •HR 5294 IH ‘‘(B) sexual behavior, reproductive and sex- 1 ual coercion, and teenage contraceptive use pat- 2 terns at the State level, as appropriate; 3 ‘‘(C) unintended teenage pregnancies 4 among youth in and aging out of foster care or 5 juvenile justice systems and the underlying fac- 6 tors that lead to unintended teenage pregnancy 7 among youth in foster care or juvenile justice 8 systems; and 9 ‘‘(D) sexual and reproductive health, in- 10 cluding teenage pregnancies and births, sexual 11 behavior, reproductive and sexual coercion, and 12 teenage contraceptive use among— 13 ‘‘(i) LGBT youth; and 14 ‘‘(ii) rural youth; 15 ‘‘(2) investigates— 16 ‘‘(A) the variance in the rates of unin- 17 tended teenage pregnancy by— 18 ‘‘(i) racial and ethnic group (such as 19 Hispanic, Asian-American, African-Amer- 20 ican, Pacific Islander, American Indian, 21 and Alaska Native); and 22 ‘‘(ii) socioeconomic status, based on 23 the income of the family and education at- 24 tainment; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00325 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 326 •HR 5294 IH ‘‘(B) factors affecting the risk for youth of 1 unintended teenage pregnancy or dating vio- 2 lence, including the physical and social environ- 3 ment, level of acculturation, access to health 4 care, aspirations for the future, and history of 5 physical or sexual violence or abuse; 6 ‘‘(C) the role that violence and abuse play 7 in teenage sex, pregnancy, and childbearing; 8 ‘‘(D) strategies to address the dispropor- 9 tionate rates of unintended teenage pregnancies 10 and dating violence in racial or ethnic minority 11 or immigrant communities; 12 ‘‘(E) how effective interventions can be 13 replicated or adapted in other settings to serve 14 racial or ethnic minority or immigrant commu- 15 nities in a culturally appropriate manner; and 16 ‘‘(F) the effectiveness of media campaigns 17 in addressing healthy relationship development, 18 dating violence prevention, and unintended 19 teenage pregnancy; and 20 ‘‘(3) tests research-based strategies for address- 21 ing high rates of unintended teenage pregnancy 22 through programs that emphasize healthy relation- 23 ships and violence prevention. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00326 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 327 •HR 5294 IH ‘‘(b) PRIORITY.—In carrying out this section, the 1 Secretary shall give priority to research that incor- 2 porates— 3 ‘‘(1) interdisciplinary approaches; 4 ‘‘(2) a strong emphasis on community-based 5 participatory research; or 6 ‘‘(3) translational research. 7 ‘‘SEC. 399OO–5. HHS ADOLESCENT HEALTH WORK GROUP. 8 ‘‘(a) PURPOSE.—Not later than 30 days after the 9 date of the enactment of this part, the Secretary shall di- 10 rect the interagency adolescent health workgroup within 11 the Office of Adolescent Health of the Department of 12 Health and Human Services to— 13 ‘‘(1) include in the work of the group strategies 14 for teenage dating violence prevention and healthy 15 teenage relationships with a particular focus among 16 racial or ethnic minority or immigrant communities; 17 and 18 ‘‘(2) with respect to including such strategies, 19 consult, to the greatest extent possible, with the 20 Federal Interagency Workgroup on Teen Dating Vi- 21 olence formed under the leadership of the National 22 Institute of Justice of the Department of Justice. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00327 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 328 •HR 5294 IH ‘‘(b) REPORT REQUIREMENT.—The Secretary, 1 through the Office of Adolescent Health, shall periodically 2 submit to Congress a report that— 3 ‘‘(1) includes a review of the evidence-based 4 programs on preventing unintended teenage preg- 5 nancy, which are carried out and identified by the 6 Office; and 7 ‘‘(2) identifies the programs of the Department 8 of Health and Human Services that include teenage 9 dating violence prevention and the promotion of 10 healthy teenage relationships as part of a strategy to 11 prevent unintended teenage pregnancy. 12 ‘‘SEC. 399OO–6. GENERAL GRANT PROVISIONS. 13 ‘‘(a) APPLICATIONS.—To seek a grant under this 14 part, an entity shall submit an application to the Secretary 15 in such form, in such manner, and containing such agree- 16 ments, assurances, and information as the Secretary may 17 require. 18 ‘‘(b) ADDITIONAL REQUIREMENTS.—A grant may be 19 made under this part only if the applicant involved agrees 20 that information, activities, and services provided under 21 the grant— 22 ‘‘(1) will be evidence-based or evidence-in- 23 formed; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00328 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 329 •HR 5294 IH ‘‘(2) will be factually and medically accurate 1 and complete; and 2 ‘‘(3) if directed to a particular population 3 group, will be provided in an appropriate language 4 and cultural context. 5 ‘‘(c) TRAINING AND TECHNICAL ASSISTANCE.— 6 ‘‘(1) IN GENERAL.—Of the total amount made 7 available to carry out this part for a fiscal year, the 8 Secretary shall use 10 percent to provide, directly or 9 through a competitive grant process, training and 10 technical assistance to the grant recipients under 11 this part, including by disseminating research and 12 information regarding effective and promising prac- 13 tices, providing consultation and resources on a 14 broad array of teenage and unintended pregnancy 15 and violence prevention strategies, and developing 16 resources and materials. 17 ‘‘(2) COLLABORATION.—In carrying out this 18 subsection, the Secretary shall collaborate with enti- 19 ties that have expertise in the prevention of teenage 20 pregnancy, healthy relationship development, minor- 21 ity health and health disparities, and violence pre- 22 vention. 23 ‘‘SEC. 399OO–7. DEFINITIONS. 24 ‘‘In this part: 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00329 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 330 •HR 5294 IH ‘‘(1) MEDICALLY ACCURATE AND COMPLETE.— 1 The term ‘medically accurate and complete’ means, 2 with respect to information, activities, or services, 3 verified or supported by the weight of research con- 4 ducted in compliance with accepted scientific meth- 5 ods and— 6 ‘‘(A) published in peer-reviewed journals, 7 where applicable; or 8 ‘‘(B) comprising information that leading 9 professional organizations and agencies with 10 relevant expertise in the field recognize as accu- 11 rate, objective, and complete. 12 ‘‘(2) LGBT YOUTH.—The term ‘LGBT youth’ 13 means lesbian, gay, bisexual, and transgender youth. 14 ‘‘(3) RACIAL OR ETHNIC MINORITY OR IMMI- 15 GRANT COMMUNITIES.—The term ‘racial or ethnic 16 minority or immigrant communities’ means commu- 17 nities with a substantial number of residents who 18 are members of racial or ethnic minority groups or 19 who are immigrants. 20 ‘‘(4) REPRODUCTIVE AND SEXUAL COERCION.— 21 The term ‘reproductive and sexual coercion’— 22 ‘‘(A) means, with respect to a person, coer- 23 cive behavior that interferes with the ability of 24 such person to control the reproductive deci- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00330 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 331 •HR 5294 IH sionmaking of such person, such as inten- 1 tionally exposing such person to sexually trans- 2 mitted infections; in the case such person is a 3 female, attempting to impregnate such person 4 against her will; intentionally interfering with 5 the person’s birth control; or threatening or act- 6 ing violent if the person does not comply with 7 the perpetrator’s wishes regarding contracep- 8 tion or the decision whether to terminate or 9 continue a pregnancy; and 10 ‘‘(B) includes a range of behaviors that a 11 partner may use related to sexual decision-mak- 12 ing to pressure or coerce a person to have sex 13 without using physical force, such as repeatedly 14 pressuring a partner to have sex when he or she 15 does not want to; threatening to end a relation- 16 ship if a person does not have sex; and threat- 17 ening retaliation if notified of a positive sexu- 18 ally transmitted disease test result. 19 ‘‘(5) YOUTH.—The term ‘youth’ means individ- 20 uals who are 11 to 19 years of age. 21 ‘‘SEC. 399OO–8. REPORTS. 22 ‘‘(a) REPORT ON USE OF FUNDS.—Not later than 23 1 year after the date of the enactment of this part, the 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00331 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 332 •HR 5294 IH Secretary shall submit to Congress a report on the use 1 of funds provided pursuant to this part. 2 ‘‘(b) REPORT ON IMPACT OF PROGRAMS.—Not later 3 than March 1, 2019, the Secretary shall submit to Con- 4 gress a report on the impact of the programs under this 5 part on reducing unintended teenage pregnancies. 6 ‘‘SEC. 399OO–9. AUTHORIZATION OF APPROPRIATIONS. 7 ‘‘(a) IN GENERAL.—There are authorized to be ap- 8 propriated to carry out this part such sums as may be 9 necessary for each of the fiscal years 2015 through 2019. 10 ‘‘(b) AVAILABILITY.—Amounts appropriated pursu- 11 ant to subsection (a)— 12 ‘‘(1) are authorized to remain available until ex- 13 pended; and 14 ‘‘(2) are in addition to amounts otherwise made 15 available for such purposes.’’. 16 SEC. 509. GESTATIONAL DIABETES. 17 Part B of title III of the Public Health Service Act 18 (42 U.S.C. 243 et seq.) is amended by adding after section 19 317H the following: 20 ‘‘SEC. 317H–1. GESTATIONAL DIABETES. 21 ‘‘(a) UNDERSTANDING AND MONITORING GESTA- 22 TIONAL DIABETES.— 23 ‘‘(1) IN GENERAL.—The Secretary, acting 24 through the Director of the Centers for Disease 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00332 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 333 •HR 5294 IH Control and Prevention, in consultation with the Di- 1 abetes Mellitus Interagency Coordinating Committee 2 established under section 429 and representatives of 3 appropriate national health organizations, shall de- 4 velop a multisite gestational diabetes research 5 project within the diabetes program of the Centers 6 for Disease Control and Prevention to expand and 7 enhance surveillance data and public health research 8 on gestational diabetes. 9 ‘‘(2) AREAS TO BE ADDRESSED.—The research 10 project developed under paragraph (1) shall ad- 11 dress— 12 ‘‘(A) procedures to establish accurate and 13 efficient systems for the collection of gestational 14 diabetes data within each State and common- 15 wealth, territory, or possession of the United 16 States; 17 ‘‘(B) the progress of collaborative activities 18 with the National Vital Statistics System, the 19 National Center for Health Statistics, and 20 State health departments with respect to the 21 standard birth certificate, in order to improve 22 surveillance of gestational diabetes; 23 ‘‘(C) postpartum methods of tracking 24 women with gestational diabetes after delivery 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00333 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 334 •HR 5294 IH as well as targeted interventions proven to 1 lower the incidence of type 2 diabetes in that 2 population; 3 ‘‘(D) variations in the distribution of diag- 4 nosed and undiagnosed gestational diabetes, 5 and of impaired fasting glucose tolerance and 6 impaired fasting glucose, within and among 7 groups of women; and 8 ‘‘(E) factors and culturally sensitive inter- 9 ventions that influence risks and reduce the in- 10 cidence of gestational diabetes and related com- 11 plications during childbirth, including cultural, 12 behavioral, racial, ethnic, geographic, demo- 13 graphic, socioeconomic, and genetic factors. 14 ‘‘(3) REPORT.—Not later than 2 years after the 15 date of the enactment of this section, and annually 16 thereafter, the Secretary shall generate a report on 17 the findings and recommendations of the research 18 project including prevalence of gestational diabetes 19 in the multisite area and disseminate the report to 20 the appropriate Federal and non-Federal agencies. 21 ‘‘(b) EXPANSION OF GESTATIONAL DIABETES RE- 22 SEARCH.— 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00334 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 335 •HR 5294 IH ‘‘(1) IN GENERAL.—The Secretary shall expand 1 and intensify public health research regarding gesta- 2 tional diabetes. Such research may include— 3 ‘‘(A) developing and testing novel ap- 4 proaches for improving postpartum diabetes 5 testing or screening and for preventing type 2 6 diabetes in women with a history of gestational 7 diabetes; and 8 ‘‘(B) conducting public health research to 9 further understanding of the epidemiologic, 10 socioenvironmental, behavioral, translation, and 11 biomedical factors and health systems that in- 12 fluence the risk of gestational diabetes and the 13 development of type 2 diabetes in women with 14 a history of gestational diabetes. 15 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 16 There is authorized to be appropriated to carry out 17 this subsection $5,000,000 for each of fiscal years 18 2015 through 2019. 19 ‘‘(c) DEMONSTRATION GRANTS TO LOWER THE 20 RATE OF GESTATIONAL DIABETES.— 21 ‘‘(1) IN GENERAL.—The Secretary, acting 22 through the Director of the Centers for Disease 23 Control and Prevention, shall award grants, on a 24 competitive basis, to eligible entities for demonstra- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00335 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 336 •HR 5294 IH tion projects that implement evidence-based inter- 1 ventions to reduce the incidence of gestational diabe- 2 tes, the recurrence of gestational diabetes in subse- 3 quent pregnancies, and the development of type 2 di- 4 abetes in women with a history of gestational diabe- 5 tes. 6 ‘‘(2) PRIORITY.—In making grants under this 7 subsection, the Secretary shall give priority to 8 projects focusing on— 9 ‘‘(A) helping women who have 1 or more 10 risk factors for developing gestational diabetes; 11 ‘‘(B) working with women with a history of 12 gestational diabetes during a previous preg- 13 nancy; 14 ‘‘(C) providing postpartum care for women 15 with gestational diabetes; 16 ‘‘(D) tracking cases where women with a 17 history of gestational diabetes developed type 2 18 diabetes; 19 ‘‘(E) educating mothers with a history of 20 gestational diabetes about the increased risk of 21 their child developing diabetes; 22 ‘‘(F) working to prevent gestational diabe- 23 tes and prevent or delay the development of 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00336 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 337 •HR 5294 IH type 2 diabetes in women with a history of ges- 1 tational diabetes; and 2 ‘‘(G) achieving outcomes designed to assess 3 the efficacy and cost-effectiveness of interven- 4 tions that can inform decisions on long-term 5 sustainability, including third-party reimburse- 6 ment. 7 ‘‘(3) APPLICATION.—An eligible entity desiring 8 to receive a grant under this subsection shall submit 9 to the Secretary— 10 ‘‘(A) an application at such time, in such 11 manner, and containing such information as the 12 Secretary may require; and 13 ‘‘(B) a plan to— 14 ‘‘(i) lower the rate of gestational dia- 15 betes during pregnancy; or 16 ‘‘(ii) develop methods of tracking 17 women with a history of gestational diabe- 18 tes and develop effective interventions to 19 lower the incidence of the recurrence of 20 gestational diabetes in subsequent preg- 21 nancies and the development of type 2 dia- 22 betes. 23 ‘‘(4) USES OF FUNDS.—An eligible entity re- 24 ceiving a grant under this subsection shall use the 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00337 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 338 •HR 5294 IH grant funds to carry out demonstration projects de- 1 scribed in paragraph (1), including— 2 ‘‘(A) expanding community-based health 3 promotion education, activities, and incentives 4 focused on the prevention of gestational diabe- 5 tes and development of type 2 diabetes in 6 women with a history of gestational diabetes; 7 ‘‘(B) aiding State- and tribal-based diabe- 8 tes prevention and control programs to collect, 9 analyze, disseminate, and report surveillance 10 data on women with, and at risk for, gesta- 11 tional diabetes, the recurrence of gestational di- 12 abetes in subsequent pregnancies, and, for 13 women with a history of gestational diabetes, 14 the development of type 2 diabetes; and 15 ‘‘(C) training and encouraging health care 16 providers— 17 ‘‘(i) to promote risk assessment, high- 18 quality care, and self-management for ges- 19 tational diabetes and the recurrence of ges- 20 tational diabetes in subsequent preg- 21 nancies; and 22 ‘‘(ii) to prevent the development of 23 type 2 diabetes in women with a history of 24 gestational diabetes, and its complications 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00338 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 339 •HR 5294 IH in the practice settings of the health care 1 providers. 2 ‘‘(5) REPORT.—Not later than 4 years after the 3 date of the enactment of this section, the Secretary 4 shall prepare and submit to the Congress a report 5 concerning the results of the demonstration projects 6 conducted through the grants awarded under this 7 subsection. 8 ‘‘(6) DEFINITION OF ELIGIBLE ENTITY.—In 9 this subsection, the term ‘eligible entity’ means a 10 nonprofit organization (such as a nonprofit academic 11 center or community health center) or a State, trib- 12 al, or local health agency. 13 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 14 There is authorized to be appropriated to carry out 15 this subsection $5,000,000 for each of fiscal years 16 2015 through 2019. 17 ‘‘(d) POSTPARTUM FOLLOWUP REGARDING GESTA- 18 TIONAL DIABETES.—The Secretary, acting through the 19 Director of the Centers for Disease Control and Preven- 20 tion, shall work with the State- and tribal-based diabetes 21 prevention and control programs assisted by the Centers 22 to encourage postpartum followup after gestational diabe- 23 tes, as medically appropriate, for the purpose of reducing 24 the incidence of gestational diabetes, the recurrence of 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00339 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 340 •HR 5294 IH gestational diabetes in subsequent pregnancies, the devel- 1 opment of type 2 diabetes in women with a history of ges- 2 tational diabetes, and related complications.’’. 3 SEC. 510. EMERGENCY CONTRACEPTION EDUCATION AND 4 INFORMATION PROGRAMS. 5 (a) EMERGENCY CONTRACEPTION PUBLIC EDU- 6 CATION PROGRAM.— 7 (1) IN GENERAL.—The Secretary, acting 8 through the Director of the Centers for Disease 9 Control and Prevention, shall develop and dissemi- 10 nate to the public information on emergency contra- 11 ception. 12 (2) DISSEMINATION.—The Secretary may dis- 13 seminate information under paragraph (1) directly 14 or through arrangements with nonprofit organiza- 15 tions, consumer groups, institutions of higher edu- 16 cation, clinics, the media, and Federal, State, and 17 local agencies. 18 (3) INFORMATION.—The information dissemi- 19 nated under paragraph (1) shall include, at a min- 20 imum, a description of emergency contraception and 21 an explanation of the use, safety, efficacy, and avail- 22 ability of such contraception. 23 (b) EMERGENCY CONTRACEPTION INFORMATION 24 PROGRAM FOR HEALTH CARE PROVIDERS.— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00340 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 341 •HR 5294 IH (1) IN GENERAL.—The Secretary, acting 1 through the Administrator of the Health Resources 2 and Services Administration and in consultation 3 with major medical and public health organizations, 4 shall develop and disseminate to health care pro- 5 viders information on emergency contraception. 6 (2) INFORMATION.—The information dissemi- 7 nated under paragraph (1) shall include, at a min- 8 imum— 9 (A) information describing the use, safety, 10 efficacy, and availability of emergency contra- 11 ception; 12 (B) a recommendation regarding the use of 13 such contraception in appropriate cases; and 14 (C) information explaining how to obtain 15 copies of the information developed under sub- 16 section (a) for distribution to the patients of 17 the providers. 18 (c) DEFINITIONS.—In this section: 19 (1) EMERGENCY CONTRACEPTION.—The term 20 ‘‘emergency contraception’’ means a drug or device 21 (as the terms are defined in section 201 of the Fed- 22 eral Food, Drug, and Cosmetic Act (21 U.S.C. 321)) 23 or a drug regimen that— 24 (A) is used postcoitally; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00341 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 342 •HR 5294 IH (B) prevents pregnancy primarily by pre- 1 venting or delaying ovulation, and does not ter- 2 minate an established pregnancy; and 3 (C) is approved by the Food and Drug Ad- 4 ministration. 5 (2) HEALTH CARE PROVIDER.—The term 6 ‘‘health care provider’’ means an individual who is li- 7 censed or certified under State law to provide health 8 care services and who is operating within the scope 9 of such license. Such term shall include a phar- 10 macist. 11 (3) INSTITUTION OF HIGHER EDUCATION.—The 12 term ‘‘institution of higher education’’ has the same 13 meaning given such term in section 101(a) of the 14 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 15 (4) SECRETARY.—The term ‘‘Secretary’’ means 16 the Secretary of Health and Human Services. 17 (d) AUTHORIZATION OF APPROPRIATIONS.—There 18 are authorized to be appropriated to carry out this section 19 such sums as may be necessary for each of the fiscal years 20 2015 through 2019. 21 SEC. 511. SUPPORTING HEALTHY ADOLESCENT DEVELOP- 22 MENT. 23 (a) IN GENERAL.—The Secretary may award a grant 24 to each eligible State to conduct programs of sex education 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00342 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 343 •HR 5294 IH described in subsection (b), including education on both 1 abstinence and contraception for the prevention of teenage 2 pregnancy and sexually transmitted diseases, including 3 HIV/AIDS and viral hepatitis. 4 (b) REQUIREMENTS FOR SEX EDUCATION PRO- 5 GRAMS.—A program of sex education described in this 6 subsection is a program that— 7 (1) is age appropriate and medically accurate; 8 (2) stresses the value of abstinence while not ig- 9 noring those young people who have been or are sex- 10 ually active; 11 (3) includes information providing a factual un- 12 derstanding of male and female reproductive anat- 13 omy; 14 (4) provides information about the health bene- 15 fits and side effects of contraceptive and barrier 16 methods used— 17 (A) as a means to prevent pregnancy; and 18 (B) to reduce the risk of contracting sexu- 19 ally transmitted disease, including HIV/AIDS 20 and viral hepatitis; 21 (5) encourages family communication between 22 parent and child about sexuality; 23 (6) cultivates a respectful dialogue about sexu- 24 ality, including sexual orientation and gender iden- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00343 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 344 •HR 5294 IH tity, and embraces the principles of nondiscrimina- 1 tion based on sexual orientation and gender identity; 2 (7) counters the perpetuation of narrow gender 3 roles, including the sexualization of female children, 4 adolescents, and adults; 5 (8) teaches young people the skills to make re- 6 sponsible decisions about sexuality, including how to 7 avoid unwanted verbal, physical, and sexual ad- 8 vances and how to avoid making verbal, physical, 9 and sexual advances that are not wanted by the 10 other party; 11 (9) develops healthy relationships, including the 12 prevention of dating and sexual violence; 13 (10) teaches young people how alcohol and drug 14 use can affect responsible decisionmaking; and 15 (11) does not teach or promote religion. 16 (c) ADDITIONAL ACTIVITIES.—In carrying out a pro- 17 gram of sex education, a State may expend grant funds 18 awarded under subsection (a) to carry out educational and 19 motivational activities that help young people— 20 (1) gain knowledge about the physical, emo- 21 tional, biological, and hormonal changes of adoles- 22 cence and subsequent stages of human maturation; 23 (2) develop the knowledge and skills nec- 24 essary— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00344 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 345 •HR 5294 IH (A) to ensure and protect their sexual and 1 reproductive health from unintended pregnancy 2 and sexually transmitted disease, including 3 HIV/AIDS, throughout their lifespan; 4 (B) to be aware that certain racial and 5 ethnic groups are more affected by certain sex- 6 ually transmitted diseases; and 7 (C) to receive the education to prevent fur- 8 ther transmission; 9 (3) gain knowledge about the specific involve- 10 ment and responsibility of each individual in sexual 11 decisionmaking; 12 (4) develop healthy attitudes and values about 13 adolescent growth and development, body image, 14 gender roles, racial and ethnic diversity, sexual ori- 15 entation and gender identity, and other subjects; 16 (5) develop and practice healthy life skills in- 17 cluding goal-setting, decisionmaking, negotiation, 18 communication, and stress management; and 19 (6) promote self-esteem and positive inter- 20 personal skills focusing on relationship dynamics, in- 21 cluding friendships, dating, romantic involvement, 22 marriage, and family interactions. 23 (d) MATCHING FUNDS.—The Secretary may not 24 make payments to a State under this section in an amount 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00345 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 346 •HR 5294 IH exceeding Federal medical assistance percentage for such 1 State (as such term is defined in section 1905(b) of the 2 Social Security Act (42 U.S.C. 1396d(b))) of the costs of 3 the programs conducted by the State under this section. 4 (e) EVALUATION OF PROGRAMS.— 5 (1) IN GENERAL.—For the purpose of evalu- 6 ating the effectiveness of programs of sex education 7 carried out with a grant under this section, evalua- 8 tions shall be carried out in accordance with para- 9 graphs (2) and (3). 10 (2) NATIONAL EVALUATION.— 11 (A) METHOD.—The Secretary shall pro- 12 vide for a national evaluation of a representa- 13 tive sample of programs of sex education car- 14 ried out with grants under this section to deter- 15 mine— 16 (i) the effectiveness of such programs 17 in helping to delay the initiation of sexual 18 intercourse and other high-risk behaviors; 19 (ii) the effectiveness of such programs 20 in preventing adolescent pregnancy; 21 (iii) the effectiveness of such pro- 22 grams in preventing sexually transmitted 23 disease, including HIV/AIDS and viral 24 hepatitis; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00346 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 347 •HR 5294 IH (iv) the effectiveness of such programs 1 in increasing contraceptive knowledge and 2 contraceptive behaviors when sexual inter- 3 course occurs; and 4 (v) a list of best practices that— 5 (I) is based upon essential pro- 6 grammatic components of evaluated 7 programs that have led to success de- 8 scribed in clauses (i) through (iv); and 9 (II) documents the racial and 10 ethnic minority populations that are 11 recipients of grant funds under this 12 section or are served by programs of 13 sex education funded under this sec- 14 tion. 15 (B) GRANT CONDITION.—A condition for 16 the receipt of a grant to a State under this sec- 17 tion is that the State cooperate with the evalua- 18 tion under subparagraph (A). 19 (C) REPORT.—The Secretary shall submit 20 to the Congress— 21 (i) not later than the end of each fis- 22 cal year during the 5-year period beginning 23 with fiscal year 2015, an interim report on 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00347 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 348 •HR 5294 IH the national evaluation under subpara- 1 graph (A); and 2 (ii) not later than March 31, 2020, a 3 final report providing the results of such 4 national evaluation. 5 (3) INDIVIDUAL STATE EVALUATIONS.—A con- 6 dition for the receipt of a grant under this section 7 is that the State evaluate the programs of sex edu- 8 cation funded through such grant in accordance with 9 the following requirements: 10 (A) The evaluation will be conducted by an 11 external, independent entity. 12 (B) The purposes of the evaluation will be 13 the determination of— 14 (i) the effectiveness of such programs 15 in helping to delay the initiation of sexual 16 intercourse and other high-risk behaviors; 17 (ii) the effectiveness of such programs 18 in preventing adolescent pregnancy; 19 (iii) the effectiveness of such pro- 20 grams in preventing sexually transmitted 21 disease, including HIV/AIDS; and 22 (iv) the effectiveness of such programs 23 in increasing contraceptive and barrier 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00348 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 349 •HR 5294 IH method knowledge and contraceptive be- 1 haviors when sexual intercourse occurs. 2 (f) LIMITATIONS ON USE OF FUNDS.— 3 (1) LIMITATIONS ON SECRETARY.—Of the 4 amounts appropriated for a fiscal year for purposes 5 of this section, the Secretary may not use more 6 than— 7 (A) 7 percent of such amounts for admin- 8 istrative expenses related to carrying out this 9 section for that fiscal year; and 10 (B) 10 percent of such amounts for the 11 national evaluation under subsection (e)(2). 12 (2) LIMITATIONS TO STATES.—Of amounts pro- 13 vided to an eligible State under this subsection, the 14 State may not use more than 10 percent of the 15 grant to conduct any evaluation under subsection 16 (e)(3). 17 (g) NONDISCRIMINATION REQUIRED.—Programs 18 funded under this section shall not discriminate on the 19 basis of sex, race, ethnicity, national origin, disability, reli- 20 gion, marital status, familial status, sexual orientation, or 21 gender identity. Nothing in this section shall be construed 22 to invalidate or limit rights, remedies, procedures, or legal 23 standards available to victims of discrimination under any 24 other Federal law or any law of a State or a political sub- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00349 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 350 •HR 5294 IH division of a State, including title VI of the Civil Rights 1 Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the 2 Education Amendments of 1972 (20 U.S.C. 1681 et seq.), 3 section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 4 794), and the Americans with Disabilities Act of 1990 (42 5 U.S.C. 12101 et seq.). 6 (h) DEFINITIONS.—For purposes of this section: 7 (1) The term ‘‘age appropriate’’ means, with re- 8 spect to topics, messages, and teaching methods, 9 those suitable to particular ages or age groups of 10 children, adolescents, and adults, based on devel- 11 oping cognitive, emotional, and behavioral capacity 12 typical for the age or age group. 13 (2) The term ‘‘eligible State’’ means a State 14 that submits to the Secretary an application for a 15 grant under this section that is in such form, is 16 made in such manner, and contains such agree- 17 ments, assurances, and information as the Secretary 18 determines to be necessary to carry out this section. 19 (3) The term ‘‘HIV/AIDS’’ means the human 20 immunodeficiency virus, and includes acquired im- 21 mune deficiency syndrome. 22 (4) The term ‘‘medically accurate’’, with respect 23 to information, means information that is supported 24 by research, recognized as accurate and objective by 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00350 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 351 •HR 5294 IH leading medical, psychological, psychiatric, and pub- 1 lic health organizations and agencies, and, published 2 in journals that are peer reviewed. 3 (5) The term ‘‘State’’ means the 50 States, the 4 District of Columbia, the Commonwealth of Puerto 5 Rico, the Commonwealth of the Northern Mariana 6 Islands, American Samoa, Guam, the United States 7 Virgin Islands, and any other territory or possession 8 of the United States. 9 (i) AUTHORIZATION OF APPROPRIATIONS.—For the 10 purpose of carrying out this section, there is authorized 11 to be appropriated $50,000,000 for each of the fiscal years 12 2015 through 2019. 13 SEC. 512. COMPASSIONATE ASSISTANCE FOR RAPE EMER- 14 GENCIES. 15 (a) MEDICARE.— 16 (1) LIMITATION ON PAYMENT.—Section 17 1866(a)(1) of the Social Security Act (42 U.S.C. 18 1395cc(a)(1)) is amended— 19 (A) by striking ‘‘and’’ at the end of sub- 20 paragraph (V); 21 (B) in the subparagraph (W) added by sec- 22 tion 3005(1)(C) of Public Law 111–148— 23 (i) by striking the period at the end 24 and inserting a comma; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00351 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 352 •HR 5294 IH (ii) by moving the indentation 2 ems 1 to the left; and 2 (iii) by moving such subparagraph to 3 immediately follow subparagraph (V); 4 (C) in the subparagraph (W) added by sec- 5 tion 6406(b)(3) of Public Law 111–148— 6 (i) by striking the period at the end 7 and inserting ‘‘, and’’; 8 (ii) by moving the indentation 2 ems 9 to the left; 10 (iii) by redesignating such subpara- 11 graph as subparagraph (X); and 12 (iv) by moving such subparagraph to 13 immediately follow subparagraph (W), as 14 moved under paragraph (2)(C); and 15 (D) by inserting after the subparagraph 16 (X), as redesignated and moved under para- 17 graph (3), the following: 18 ‘‘(Y) in the case of a hospital or critical ac- 19 cess hospital, to adopt and enforce a policy to 20 ensure compliance with the requirements of 21 subsection (l) and to meet the requirements of 22 such subsection.’’. 23 (2) ASSISTANCE TO VICTIMS.—Section 1866 of 24 the Social Security Act (42 U.S.C. 1395cc) is 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00352 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 353 •HR 5294 IH amended by adding at the end the following new 1 subsection: 2 ‘‘(l) COMPASSIONATE ASSISTANCE FOR RAPE EMER- 3 GENCIES.— 4 ‘‘(1) IN GENERAL.—For purposes of section 5 1866(a)(1)(Y), a hospital meets the requirements of 6 this subsection if the hospital provides each of the 7 services described in paragraph (2) to each female 8 individual, whether or not eligible for benefits under 9 this title or under any other form of health insur- 10 ance. who comes to the hospital on or after January 11 1, 2015, and— 12 ‘‘(A) who states to hospital personnel that 13 she is a victim of sexual assault; 14 ‘‘(B) who is accompanied by an individual 15 who states to hospital personnel that the female 16 individual is a victim of sexual assault; or 17 ‘‘(C) whom hospital personnel, during the 18 course of treatment and care for the female in- 19 dividual, have reason to believe is a victim of 20 sexual assault. 21 ‘‘(2) REQUIRED SERVICES DESCRIBED.—For 22 purposes of paragraph (1), the services described in 23 this subparagraph are the following: 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00353 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 354 •HR 5294 IH ‘‘(A) Provision of medically and factually 1 accurate and unbiased written and oral infor- 2 mation about emergency contraception that— 3 ‘‘(i) is written in clear and concise 4 language; 5 ‘‘(ii) is readily comprehensible; 6 ‘‘(iii) includes an explanation that— 7 ‘‘(I) emergency contraception has 8 been approved by the Food and Drug 9 Administration as an over-the-counter 10 medication for female individuals, and 11 is a safe and effective way to prevent 12 pregnancy after unprotected inter- 13 course or contraceptive failure if 14 taken in a timely manner; 15 ‘‘(II) emergency contraception is 16 more effective the sooner it is taken; 17 and 18 ‘‘(III) emergency contraception 19 does not cause an abortion and cannot 20 interrupt an established pregnancy; 21 ‘‘(iv) meets such conditions regarding 22 the provision of such information in lan- 23 guages other than English as the Secretary 24 may establish; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00354 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 355 •HR 5294 IH ‘‘(v) is provided without regard to the 1 ability of the individual or her family to 2 pay costs associated with the provision of 3 such information to the individual. 4 ‘‘(B) Prompt offer to provide emergency 5 contraception to the individual, and in the case 6 that the individual accepts such offer, prompt 7 provision of such contraception to such indi- 8 vidual without regard to the inability of the in- 9 dividual or her family to pay costs associated 10 with the offer and provision of such contracep- 11 tion. 12 ‘‘(3) DEFINITIONS.—For purposes of this para- 13 graph: 14 ‘‘(A) The term ‘emergency contraception’ 15 means a drug or device (as such terms are de- 16 fined in section 201 of the Federal Food, Drug, 17 and Cosmetic Act (21 U.S.C. 321)) or a drug 18 regimen that— 19 ‘‘(i) is used postcoitally; 20 ‘‘(ii) prevents pregnancy primarily by 21 preventing or delaying ovulation, and does 22 not terminate an established pregnancy; 23 and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00355 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 356 •HR 5294 IH ‘‘(iii) is approved by the Food and 1 Drug Administration. 2 ‘‘(B) The term ‘hospital’ includes a critical 3 access hospital, as defined in section 4 1861(mm)(1). 5 ‘‘(C) The term ‘sexual assault’ means co- 6 itus in which the individual involved does not 7 consent or lacks the legal capacity to consent.’’. 8 (b) LIMITATION ON PAYMENT UNDER MEDICAID.— 9 Section 1903(i) of the Social Security Act (42 U.S.C. 10 1396b(i)) is amended by inserting after paragraph (11) 11 the following new paragraph: 12 ‘‘(12) with respect to any amount expended for 13 care or services furnished under the plan by a hos- 14 pital on or after January 1, 2015, unless such hos- 15 pital meets the requirements specified in section 16 1866(l) for purposes of title XVIII.’’. 17 SEC. 513. ACCESS TO BIRTH CONTROL DUTIES OF PHAR- 18 MACIES TO ENSURE PROVISION OF FDA-AP- 19 PROVED CONTRACEPTION. 20 Part B of title II of the Public Health Service Act 21 (42 U.S.C. 238 et seq.) is amended by adding at the end 22 the following: 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00356 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 357 •HR 5294 IH ‘‘SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION 1 OF FDA-APPROVED CONTRACEPTION. 2 ‘‘(a) IN GENERAL.—Subject to subsection (c), a 3 pharmacy that receives Food and Drug Administration- 4 approved drugs or devices in interstate commerce shall 5 maintain compliance with the following: 6 ‘‘(1) If a customer requests a contraceptive that 7 is in stock, the pharmacy shall ensure that the con- 8 traceptive is provided to the customer without delay. 9 ‘‘(2) If a customer requests a contraceptive that 10 is not in stock and the pharmacy in the normal 11 course of business stocks contraception, the phar- 12 macy shall immediately inform the customer that the 13 contraceptive is not in stock and without delay offer 14 the customer the following options: 15 ‘‘(A) If the customer prefers to obtain the 16 contraceptive through a referral or transfer, the 17 pharmacy shall— 18 ‘‘(i) locate a pharmacy of the cus- 19 tomer’s choice or the closest pharmacy 20 confirmed to have the contraceptive in 21 stock; and 22 ‘‘(ii) refer the customer or transfer 23 the prescription to that pharmacy. 24 ‘‘(B) If the customer prefers for the phar- 25 macy to order the contraceptive, the pharmacy 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00357 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 358 •HR 5294 IH shall obtain the contraceptive under the phar- 1 macy’s standard procedure for expedited order- 2 ing of medication and notify the customer when 3 the contraceptive arrives. 4 ‘‘(3) The pharmacy shall ensure that its em- 5 ployees do not— 6 ‘‘(A) intimidate, threaten, or harass cus- 7 tomers in the delivery of services relating to a 8 request for contraception; 9 ‘‘(B) interfere with or obstruct the delivery 10 of services relating to a request for contracep- 11 tion; 12 ‘‘(C) intentionally misrepresent or deceive 13 customers about the availability of contracep- 14 tion or its mechanism of action; 15 ‘‘(D) breach medical confidentiality with 16 respect to a request for contraception or threat- 17 en to breach such confidentiality; or 18 ‘‘(E) refuse to return a valid, lawful pre- 19 scription for contraception upon customer re- 20 quest. 21 ‘‘(b) CONTRACEPTIVES NOT ORDINARILY 22 STOCKED.—Nothing in subsection (a)(2) shall be con- 23 strued to require any pharmacy to comply with such sub- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00358 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 359 •HR 5294 IH section if the pharmacy does not ordinarily stock contra- 1 ceptives in the normal course of business. 2 ‘‘(c) REFUSALS PURSUANT TO STANDARD PHAR- 3 MACY PRACTICE.—This section does not prohibit a phar- 4 macy from refusing to provide a contraceptive to a cus- 5 tomer in accordance with any of the following: 6 ‘‘(1) If it is unlawful to dispense the contracep- 7 tive to the customer without a valid, lawful prescrip- 8 tion and no such prescription is presented. 9 ‘‘(2) If the customer is unable to pay for the 10 contraceptive. 11 ‘‘(3) If the employee of the pharmacy refuses to 12 provide the contraceptive on the basis of a profes- 13 sional clinical judgment. 14 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec- 15 tion shall be construed to invalidate or limit rights, rem- 16 edies, procedures, or legal standards under title VII of the 17 Civil Rights Act of 1964. 18 ‘‘(e) PREEMPTION.—This section does not preempt 19 any provision of State law or any professional obligation 20 made applicable by a State board or other entity respon- 21 sible for licensing or discipline of pharmacies or phar- 22 macists, to the extent that such State law or professional 23 obligation provides protections for customers that are 24 greater than the protections provided by this section. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00359 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 360 •HR 5294 IH ‘‘(f) ENFORCEMENT.— 1 ‘‘(1) CIVIL PENALTY.—A pharmacy that vio- 2 lates a requirement of subsection (a) is liable to the 3 United States for a civil penalty in an amount not 4 exceeding $1,000 per day of violation, not to exceed 5 $100,000 for all violations adjudicated in a single 6 proceeding. 7 ‘‘(2) PRIVATE CAUSE OF ACTION.—Any person 8 aggrieved as a result of a violation of a requirement 9 of subsection (a) may, in any court of competent ju- 10 risdiction, commence a civil action against the phar- 11 macy involved to obtain appropriate relief, including 12 actual and punitive damages, injunctive relief, and a 13 reasonable attorney’s fee and cost. 14 ‘‘(3) LIMITATIONS.—A civil action under para- 15 graph (1) or (2) may not be commenced against a 16 pharmacy after the expiration of the 5-year period 17 beginning on the date on which the pharmacy alleg- 18 edly engaged in the violation involved. 19 ‘‘(g) DEFINITIONS.—In this section: 20 ‘‘(1) The term ‘contraception’ or ‘contraceptive’ 21 means any drug or device approved by the Food and 22 Drug Administration to prevent pregnancy. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00360 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 361 •HR 5294 IH ‘‘(2) The term ‘employee’ means a person hired, 1 by contract or any other form of an agreement, by 2 a pharmacy. 3 ‘‘(3) The term ‘pharmacy’ means an entity 4 that— 5 ‘‘(A) is authorized by a State to engage in 6 the business of selling prescription drugs at re- 7 tail; and 8 ‘‘(B) employs one or more employees. 9 ‘‘(4) The term ‘product’ means a Food and 10 Drug Administration-approved drug or device. 11 ‘‘(5) The term ‘professional clinical judgment’ 12 means the use of professional knowledge and skills 13 to form a clinical judgment, in accordance with pre- 14 vailing medical standards. 15 ‘‘(6) The term ‘without delay’, with respect to 16 a pharmacy providing, providing a referral for, or 17 ordering contraception, or transferring the prescrip- 18 tion for contraception, means within the usual and 19 customary timeframe at the pharmacy for providing, 20 providing a referral for, or ordering other products, 21 or transferring the prescription for other products, 22 respectively. 23 ‘‘(h) EFFECTIVE DATE.—This section shall take ef- 24 fect on the 31st day after the date of the enactment of 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00361 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 362 •HR 5294 IH this section, without regard to whether the Secretary has 1 issued any guidance or final rule regarding this section.’’. 2 SEC. 514. ADDITIONAL FOCUS AREA FOR THE OFFICE ON 3 WOMEN’S HEALTH. 4 Section 229(b) of the Public Health Service Act (42 5 U.S.C. 237a(b)) is amended— 6 (1) in paragraph (6), at the end, by striking 7 ‘‘and’’; 8 (2) in paragraph (7), at the end, by striking the 9 period and inserting ‘‘; and’’; and 10 (3) by adding at the end the following new 11 paragraph: 12 ‘‘(8) facilitate policymakers, health system lead- 13 ers and providers, consumers, and other stake- 14 holders in understanding optimal maternity care and 15 support for the provision of such care, including the 16 priorities of— 17 ‘‘(A) protecting, promoting, and supporting 18 the innate capacities of childbearing women and 19 their newborns for childbirth, breastfeeding, 20 and attachment; 21 ‘‘(B) using obstetric interventions only 22 when such interventions are supported by 23 strong, high-quality evidence, and minimizing 24 overuse of maternity practices that have been 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00362 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 363 •HR 5294 IH shown to have benefit in limited situations and 1 that can expose women, infants, or both to risk 2 of harm if used routinely and indiscriminately, 3 including continuous electronic fetal monitoring, 4 labor induction, epidural analgesia, primary ce- 5 sarean section, and routine repeat cesarean 6 birth; 7 ‘‘(C) reliably incorporating noninvasive, 8 evidence-based practices that have documented 9 correlation with considerable improvement in 10 outcomes with no detrimental side effects, such 11 as smoking cessation programs in pregnancy 12 and proven models of group prenatal care that 13 integrate health assessment, education, and 14 support into a unified program; 15 ‘‘(D) a shared understanding of the quali- 16 fications of licensed providers of maternity care 17 and the best evidence about the safety, satisfac- 18 tion, outcomes, and costs of their care, and ap- 19 propriate deployment of such caregivers within 20 the maternity care workforce to address the 21 needs of childbearing women and newborns and 22 the growing shortage of maternity caregivers; 23 ‘‘(E) a shared understanding of the results 24 of the best available research comparing hos- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00363 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 364 •HR 5294 IH pital, birth center, and planned home births, in- 1 cluding information about each setting’s safety, 2 satisfaction, outcomes, and costs; and 3 ‘‘(F) high-quality, evidence-based child- 4 birth education that promotes a natural, 5 healthy, and safe approach to pregnancy, child- 6 birth, and early parenting; is taught by certified 7 educators, peer counselors, and health profes- 8 sionals; and promotes informed decisionmaking 9 by childbearing women.’’. 10 SEC. 515. INTERAGENCY COORDINATING COMMITTEE ON 11 THE PROMOTION OF OPTIMAL MATERNITY 12 OUTCOMES. 13 (a) IN GENERAL.—Part A of title II of the Public 14 Health Service Act (42 U.S.C. 202 et seq.) is amended 15 by adding at the end the following new section: 16 ‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 17 THE PROMOTION OF OPTIMAL MATERNITY 18 OUTCOMES. 19 ‘‘(a) IN GENERAL.—The Secretary of Health and 20 Human Services, acting through the Deputy Assistant 21 Secretary for Women’s Health under section 229 and in 22 collaboration with the Federal officials specified in sub- 23 section (b), shall establish the Interagency Coordinating 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00364 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 365 •HR 5294 IH Committee on the Promotion of Optimal Maternity Out- 1 comes (referred to in this subsection as the ‘ICCPOM’). 2 ‘‘(b) OTHER AGENCIES.—The officials specified in 3 this subsection are the Secretary of Labor, the Secretary 4 of Defense, the Secretary of Veterans Affairs, the Surgeon 5 General, the Director of the Centers for Disease Control 6 and Prevention, the Administrator of the Health Re- 7 sources and Services Agency, the Administrator of the 8 Centers for Medicare & Medicaid Services, the Director 9 of the Indian Health Service, the Administrator of the 10 Substance Abuse and Mental Health Services Administra- 11 tion, the Director of the National Institute on Child 12 Health and Development, the Director of the Agency for 13 Healthcare Research and Quality, the Assistant Secretary 14 for Children and Families, the Deputy Assistant Secretary 15 for Minority Health, the Director of the Office of Per- 16 sonnel Management, and such other Federal officials as 17 the Secretary of Health and Human Services determines 18 to be appropriate. 19 ‘‘(c) CHAIR.—The Deputy Assistant Secretary for 20 Women’s Health shall serve as the chair of the ICCPOM. 21 ‘‘(d) DUTIES.—The ICCPOM shall guide policy and 22 program development across the Federal Government with 23 respect to promotion of optimal maternity care, provided, 24 however, that nothing in this section shall be construed 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00365 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 366 •HR 5294 IH as transferring regulatory or program authority from an 1 agency to the ICCPOM. 2 ‘‘(e) CONSULTATIONS.—The ICCPOM shall actively 3 seek the input of, and shall consult with, all appropriate 4 and interested stakeholders, including State health depart- 5 ments, public health research and interest groups, founda- 6 tions, childbearing women and their advocates, and mater- 7 nity care professional associations and organizations, re- 8 flecting racially, ethnically, demographically, and geo- 9 graphically diverse communities. 10 ‘‘(f) ANNUAL REPORT.— 11 ‘‘(1) IN GENERAL.—The Secretary, on behalf of 12 the ICCPOM, shall annually submit to Congress a 13 report that summarizes— 14 ‘‘(A) all programs and policies of Federal 15 agencies (including the Medicare Program 16 under title XVIII of the Social Security Act and 17 the Medicaid program under title XIX of such 18 Act) designed to promote optimal maternity 19 care, focusing particularly on programs and 20 policies that support the adoption of evidence 21 based maternity care, as defined by timely, sci- 22 entifically sound systematic reviews; 23 ‘‘(B) all programs and policies of Federal 24 agencies (including the Medicare Program 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00366 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 367 •HR 5294 IH under title XVIII of the Social Security Act and 1 the Medicaid program under title XIX of such 2 Act) designed to address the problems of mater- 3 nal mortality and morbidity, infant mortality, 4 prematurity, and low birth weight, including 5 such programs and policies designed to address 6 racial and ethnic disparities with respect to 7 each of such problems; 8 ‘‘(C) the extent of progress in reducing 9 maternal mortality and infant mortality, low 10 birth weight, and prematurity at State and na- 11 tional levels; and 12 ‘‘(D) such other information regarding op- 13 timal maternity care as the Secretary deter- 14 mines to be appropriate. 15 The information specified in subparagraph (C) shall 16 be included in each such report in a manner that 17 disaggregates such information by race, ethnicity, 18 and indigenous status in order to determine the ex- 19 tent of progress in reducing racial and ethnic dis- 20 parities and disparities related to indigenous status. 21 ‘‘(2) CERTAIN INFORMATION.—Each report 22 under paragraph (1) shall include information 23 (disaggregated by race, ethnicity, and indigenous 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00367 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 368 •HR 5294 IH status, as applicable) on the following rates and 1 costs by State: 2 ‘‘(A) The rate of primary cesarean deliv- 3 eries and repeat cesarean deliveries. 4 ‘‘(B) The rate of vaginal births after cesar- 5 ean. 6 ‘‘(C) The rate of vaginal breech births. 7 ‘‘(D) The rate of induction of labor. 8 ‘‘(E) The rate of freestanding birth center 9 births. 10 ‘‘(F) The rate of planned and unplanned 11 home birth. 12 ‘‘(G) The rate of attended births by pro- 13 vider, including by an obstetrician-gynecologist, 14 family practice physician, obstetrician-gyne- 15 cologist physician assistant, certified nurse-mid- 16 wife, certified midwife, and certified profes- 17 sional midwife. 18 ‘‘(H) The cost of maternity care 19 disaggregated by place of birth and provider of 20 care, including— 21 ‘‘(i) uncomplicated vaginal birth; 22 ‘‘(ii) complicated vaginal birth; 23 ‘‘(iii) uncomplicated cesarean birth; 24 and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00368 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 369 •HR 5294 IH ‘‘(iv) complicated cesarean birth. 1 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 2 is authorized to be appropriated, in addition to such 3 amounts authorized to be appropriated under section 4 229(e), to carry out this section $1,000,000 for each of 5 the fiscal years 2015 through 2019.’’. 6 (b) CONFORMING AMENDMENTS.— 7 (1) INCLUSION AS DUTY OF HHS OFFICE ON 8 WOMEN’S HEALTH.—Section 229(b) of such Act (42 9 U.S.C. 237a(b)), as amended, is amended— 10 (A) in paragraph (7), at the end, by strik- 11 ing ‘‘and’’; 12 (B) in paragraph (8), at the end, by strik- 13 ing the period and inserting ‘‘; and’’; and 14 (C) by adding at the end the following new 15 paragraph: 16 ‘‘(9) establish the Interagency Coordinating 17 Committee on the Promotion of Optimal Maternity 18 Outcomes in accordance with section 229A.’’. 19 (2) TREATMENT OF BIENNIAL REPORTS.—Sec- 20 tion 229(d) of such Act (42 U.S.C. 237a(d)) is 21 amended by inserting ‘‘(other than under subsection 22 (b)(9))’’ after ‘‘under this section’’. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00369 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 370 •HR 5294 IH SEC. 516. CONSUMER EDUCATION CAMPAIGN. 1 Section 229 of the Public Health Service Act (42 2 U.S.C. 237a), as amended, is further amended in sub- 3 section (b)— 4 (1) in paragraph (8), at the end, by striking 5 ‘‘and’’; 6 (2) in paragraph (9), at the end, by striking the 7 period and inserting ‘‘; and’’; and 8 (3) by adding at the end the following new 9 paragraph: 10 ‘‘(10) not later than one year after the date of 11 the enactment of the Health Equity and Account- 12 ability Act of 2014, develop and implement a 4-year 13 culturally and linguistically appropriate multimedia 14 consumer education campaign that is designed to 15 promote understanding and acceptance of evidence- 16 based maternity practices and models of care for op- 17 timal maternity outcomes among women of child- 18 bearing ages and families of such women and that— 19 ‘‘(A) highlights the importance of pro- 20 tecting, promoting, and supporting the innate 21 capacities of childbearing women and their 22 newborns for childbirth, breastfeeding, and at- 23 tachment; 24 ‘‘(B) promotes understanding of the impor- 25 tance of using obstetric interventions when 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00370 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 371 •HR 5294 IH medically necessary and when supported by 1 strong, high-quality evidence; 2 ‘‘(C) highlights the widespread overuse of 3 maternity practices that have been shown to 4 have benefit when used appropriately in situa- 5 tions of medical necessity, but which can expose 6 women, infants, or both to risk of harm if used 7 routinely and indiscriminately, including contin- 8 uous fetal monitoring, labor induction, epidural 9 anesthesia, elective primary cesarean section, 10 and repeat cesarean delivery; 11 ‘‘(D) emphasizes the noninvasive maternity 12 practices that have strong proven correlation or 13 may be associated with considerable improve- 14 ment in outcomes with no detrimental side ef- 15 fects, and are significantly underused in the 16 United States, including smoking cessation pro- 17 grams in pregnancy, group model prenatal care, 18 continuous labor support, nonsupine positions 19 for birth, and external version to turn breech 20 babies at term; 21 ‘‘(E) educates consumers about the quali- 22 fications of licensed providers of maternity care 23 and the best evidence about their safety, satis- 24 faction, outcomes, and costs; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00371 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 372 •HR 5294 IH ‘‘(F) informs consumers about the best 1 available research comparing birth center 2 births, planned home births, and hospital 3 births, including information about each set- 4 ting’s safety, satisfaction, outcomes, and costs; 5 ‘‘(G) fosters participation in high-quality, 6 evidence-based childbirth education that pro- 7 motes a natural, healthy, and safe approach to 8 pregnancy, childbirth, and early parenting; is 9 taught by certified educators, peer counselors, 10 and health professionals; and promotes in- 11 formed decisionmaking by childbearing women; 12 and 13 ‘‘(H) is pilot tested for consumer com- 14 prehension, cultural sensitivity, and acceptance 15 of the messages across geographically, racially, 16 ethnically, and linguistically diverse popu- 17 lations.’’. 18 SEC. 517. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE- 19 VIEWS FOR CARE OF CHILDBEARING WOMEN 20 AND NEWBORNS. 21 (a) IN GENERAL.—Not later than one year after the 22 date of the enactment of this Act, the Secretary of Health 23 and Human Services, through the Agency for Healthcare 24 Research and Quality, shall— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00372 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 373 •HR 5294 IH (1) make publicly available an online biblio- 1 graphic database identifying systematic reviews, in- 2 cluding an explanation of the level and quality of 3 evidence, for care of childbearing women and 4 newborns; and 5 (2) initiate regular updates that incorporate 6 newly issued and updated systematic reviews. 7 (b) SOURCES.—To aim for a comprehensive inventory 8 of systematic reviews relevant to maternal and newborn 9 care, the database shall identify reviews from diverse 10 sources, including— 11 (1) scientific peer-reviewed journals; 12 (2) databases, including Cochrane Database of 13 Systematic Reviews, Clinical Evidence, and Data- 14 base of Abstracts of Reviews of Effects; and 15 (3) Internet Web sites of agencies and organi- 16 zations throughout the world that produce such sys- 17 tematic reviews. 18 (c) FEATURES.—The database shall— 19 (1) provide bibliographic citations for each 20 record within the database, and for each such cita- 21 tion include an explanation of the level and quality 22 of evidence; 23 (2) include abstracts, as available; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00373 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 374 •HR 5294 IH (3) provide reference to companion documents 1 as may exist for each review, such as evidence tables 2 and guidelines or consumer educational materials de- 3 veloped from the review; 4 (4) provide links to the source of the full review 5 and to any companion documents; 6 (5) provide links to the source of a previous 7 version or update of the review; 8 (6) be searchable by intervention or other topic 9 of the review, reported outcomes, author, title, and 10 source; and 11 (7) offer to users periodic electronic notification 12 of database updates relating to users’ topics of inter- 13 est. 14 (d) OUTREACH.—Not later than the first date the 15 database is made publicly available and periodically there- 16 after, the Secretary of Health and Human Services shall 17 publicize the availability, features, and uses of the data- 18 base under this section to the stakeholders described in 19 subsection (e). 20 (e) CONSULTATION.—For purposes of developing the 21 database under this section and maintaining and updating 22 such database, the Secretary of Health and Human Serv- 23 ices shall convene and consult with an advisory committee 24 composed of relevant stakeholders, including— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00374 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 375 •HR 5294 IH (1) Federal Medicaid administrators and State 1 agencies administrating State plans under title XIX 2 of the Social Security Act pursuant to section 3 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)); 4 (2) providers of maternity and newborn care 5 from both academic and community-based settings, 6 including obstetrician-gynecologists, family physi- 7 cians, certified nurse midwives, certified midwives, 8 certified professional midwives, physician assistants, 9 perinatal nurses, pediatricians, and nurse practi- 10 tioners; 11 (3) maternal-fetal medicine specialists; 12 (4) neonatologists; 13 (5) childbearing women and advocates for such 14 women, including childbirth educators certified by a 15 nationally accredited program, representing commu- 16 nities that are diverse in terms of race, ethnicity, in- 17 digenous status, and geographic area; 18 (6) employers and purchasers; 19 (7) health facility and system leaders, including 20 both hospital and birth center facilities; 21 (8) journalists; and 22 (9) bibliographic informatics specialists. 23 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 24 authorized to be appropriated $2,500,000 for each of the 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00375 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 376 •HR 5294 IH fiscal years 2015 through 2017 for the purpose of devel- 1 oping the database and such sums as may be necessary 2 for each subsequent fiscal year for updating the database 3 and providing outreach and notification to users, as de- 4 scribed in this section. 5 SEC. 518. MATERNITY CARE HEALTH PROFESSIONAL 6 SHORTAGE AREAS. 7 Section 332 of the Public Health Service Act (42 8 U.S.C. 254e) is amended by adding at the end the fol- 9 lowing new subsection: 10 ‘‘(k)(1) The Secretary, acting through the Adminis- 11 trator of the Health Resources and Services Administra- 12 tion, shall designate maternity care health professional 13 shortage areas in the States, publish a descriptive list of 14 the area’s population groups, medical facilities, and other 15 public facilities so designated, and at least annually review 16 and, as necessary, revise such designations. 17 ‘‘(2) For purposes of paragraph (1), a complete de- 18 scriptive list shall be published in the Federal Register not 19 later than one year after the date of the enactment of the 20 Health Equity and Accountability Act of 2014 and annu- 21 ally thereafter. 22 ‘‘(3) The provisions of subsections (b), (c), (e), (f), 23 (g), (h), (i), and (j) (other than (j)(1)(B)) of this section 24 shall apply to the designation of a maternity care health 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00376 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 377 •HR 5294 IH professional shortage area in a similar manner and extent 1 as such provisions apply to the designation of health pro- 2 fessional shortage areas, except in applying subsection 3 (b)(3), the reference in such subsection to ‘physicians’ 4 shall be deemed to be a reference to nationally certified 5 and State licensed obstetricians, family practice physicians 6 who practice full-scope maternity care, certified nurse 7 midwives, certified midwives, certified professional mid- 8 wives, and physician’s assistants who practice full scope 9 maternity care. 10 ‘‘(4) For purposes of this subsection, the term ‘ma- 11 ternity care health professional shortage area’ means— 12 ‘‘(A) an area in an urban or rural area (which 13 need not conform to the geographic boundaries of a 14 political subdivision and which is a rational area for 15 the delivery of health services) which the Secretary 16 determines has a shortage of providers of maternity 17 care health services including those referenced in 18 paragraph (3) or an urban or rural area that the 19 Secretary determines has lost a significant number 20 of such providers during the 10-year period begin- 21 ning with 2004 or has no obstetrical providers li- 22 censed to provide operative obstetrical services; 23 ‘‘(B) an area in an urban or rural area (which 24 need not conform to the geographic boundaries of a 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00377 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 378 •HR 5294 IH political subdivision and which is a rational area for 1 the delivery of health services) which the Secretary 2 determines has a shortage of hospital or labor and 3 delivery units, hospital birth center units, or free- 4 standing birth centers or an area that lost a signifi- 5 cant number of these units during the 10-year pe- 6 riod beginning with 2004; or 7 ‘‘(C) a population group which the Secretary 8 determines has such a shortage of providers or fa- 9 cilities.’’. 10 SEC. 519. EXPANSION OF CDC PREVENTION RESEARCH 11 CENTERS PROGRAM TO INCLUDE CENTERS 12 ON OPTIMAL MATERNITY OUTCOMES. 13 (a) IN GENERAL.—Not later than one year after the 14 date of the enactment of this Act, the Secretary of Health 15 and Human Services, shall support the establishment of 16 additional Prevention Research Centers under the Preven- 17 tion Research Center Program administered by the Cen- 18 ters for Disease Control and Prevention. Such additional 19 centers shall each be known as a Center for Excellence 20 on Optimal Maternity Outcomes. 21 (b) RESEARCH.—Each Center for Excellence on Opti- 22 mal Maternity Outcomes shall— 23 (1) conduct at least one focused program of re- 24 search to improve maternity outcomes, including the 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00378 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 379 •HR 5294 IH reduction of cesarean birth rates, elective inductions, 1 prematurity rates, and low birth weight rates within 2 an underserved population that has a disproportion- 3 ately large burden of suboptimal maternity out- 4 comes, including maternal mortality and morbidity, 5 infant mortality, prematurity, or low birth weight; 6 (2) work with partners on special interest 7 projects, as specified by the Centers for Disease 8 Control and Prevention and other relevant agencies 9 within the Department of Health and Human Serv- 10 ices, and on projects funded by other sources; and 11 (3) involve a minimum of two distinct birth set- 12 ting models, such as a hospital labor and delivery 13 model and freestanding birth center model; or a hos- 14 pital labor and delivery model and planned home 15 birth model. 16 (c) INTERDISCIPLINARY PROVIDERS.—Each Center 17 for Excellence on Optimal Maternity Outcomes shall in- 18 clude the following interdisciplinary providers of maternity 19 care: 20 (1) Obstetrician-gynecologists. 21 (2) At least two of the following providers: 22 (A) Family practice physicians. 23 (B) Nurse practitioners. 24 (C) Physician assistants. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00379 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 380 •HR 5294 IH (D) Certified professional midwives. 1 (d) SERVICES.—Research conducted by each Center 2 for Excellence on Optimal Maternity Outcomes shall in- 3 clude at least 2 (and preferably more) of the following sup- 4 portive provider services: 5 (1) Mental health. 6 (2) Doula labor support. 7 (3) Nutrition education. 8 (4) Childbirth education. 9 (5) Social work. 10 (6) Physical therapy or occupation therapy. 11 (7) Substance abuse services. 12 (8) Home visiting. 13 (e) COORDINATION.—The programs of research at 14 each of the two Centers of Excellence on Optimal Mater- 15 nity Outcomes shall compliment and not replicate the 16 work of the other. 17 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 18 authorized to be appropriated to carry out this section 19 $2,000,000 for each of the fiscal years 2015 through 20 2019. 21 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00380 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 381 •HR 5294 IH SEC. 520. EXPANDING MODELS ALLOWED TO BE TESTED BY 1 CENTER FOR MEDICARE AND MEDICAID IN- 2 NOVATION TO INCLUDE MATERNITY CARE 3 MODELS. 4 Section 1115A(b)(2)(B) of the Social Security Act 5 (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the 6 end the following new clause: 7 ‘‘(xxi) Promoting evidence-based mod- 8 els of care that have been associated with 9 reductions in maternal and infant health 10 disparities, including incorporating the use 11 of doula and promotoras support for preg- 12 nant and childbearing women into evi- 13 dence-based models of prenatal care, labor 14 and delivery, and postpartum care, and 15 supporting the appropriate use of out-of- 16 hospital birth models, including births at 17 home and in freestanding birth centers.’’. 18 SEC. 521. DEVELOPMENT OF INTERPROFESSIONAL MATER- 19 NITY CARE EDUCATIONAL MODELS AND 20 TOOLS. 21 (a) IN GENERAL.—Not later than 6 months after the 22 date of the enactment of this Act, the Secretary of Health 23 and Human Services, acting in conjunction with the Ad- 24 ministrator of Health Resources and Services Administra- 25 tion, shall convene, for a 1-year period, an Interprofes- 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00381 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 382 •HR 5294 IH sional Maternity Provider Education Commission to dis- 1 cuss and make recommendations for— 2 (1) a consensus standard physiologic maternity 3 care curriculum that takes into account the core 4 competencies for basic midwifery practice such as 5 those developed by the American College of Nurse 6 Midwives and the North American Registry of Mid- 7 wives, and the educational objectives for physicians 8 practicing in obstetrics and gynecology as deter- 9 mined by the Council on Resident Education in Ob- 10 stetrics and Gynecology; 11 (2) suggestions for multidisciplinary use of the 12 consensus physiologic curriculum; 13 (3) strategies to integrate and coordinate edu- 14 cation across maternity care disciplines, including 15 recommendations to increase medical and midwifery 16 student exposure to out-of-hospital birth; and 17 (4) pilot demonstrations of interprofessional 18 educational models. 19 (b) PARTICIPANTS.—The Commission shall include 20 maternity care educators, curriculum developers, service 21 leaders, certification leaders, and accreditation leaders 22 from the various professions that provide maternity care 23 in this country. Such professions shall include obstetrician 24 gynecologists, certified nurse midwives or certified mid- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00382 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 383 •HR 5294 IH wives, family practice physicians, nurse practitioners, phy- 1 sician assistants, certified professional midwives, and 2 perinatal nurses. Additionally, the Commission shall in- 3 clude representation from maternity care consumer advo- 4 cates. 5 (c) CURRICULUM.—The consensus standard physio- 6 logic maternity care curriculum described in subsection 7 (a)(1) shall— 8 (1) have a public health focus with a foundation 9 in health promotion and disease prevention; 10 (2) foster physiologic childbearing and woman 11 and family centered care; 12 (3) integrate strategies to reduce maternal and 13 infant morbidity and mortality; 14 (4) incorporate recommendations to ensure re- 15 spectful, safe, and seamless consultation, referral, 16 transport, and transfer of care when necessary; and 17 (5) include cultural sensitivity and strategies to 18 decrease disparities in maternity outcomes. 19 (d) REPORT.—Not later than 6 months after the final 20 meeting of the Commission, the Secretary of Health and 21 Human Services shall— 22 (1) submit to Congress a report containing the 23 recommendations made by the Commission under 24 this section; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00383 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 384 •HR 5294 IH (2) make such report publicly available. 1 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 2 authorized to be appropriated to carry out this section 3 $1,000,000 for each of the fiscal years 2015 and 2016, 4 and such sums as are necessary for each of the fiscal years 5 2017 through 2019. 6 SEC. 522. INCLUDING WITHIN INPATIENT HOSPITAL SERV- 7 ICES UNDER MEDICARE SERVICES FUR- 8 NISHED BY CERTAIN STUDENTS, INTERNS, 9 AND RESIDENTS SUPERVISED BY CERTIFIED 10 NURSE MIDWIVES. 11 (a) IN GENERAL.—Section 1861(b) of the Social Se- 12 curity Act (42 U.S.C. 1395x(b)) is amended— 13 (1) in paragraph (6), by striking ‘‘; or’’ and in- 14 serting ‘‘, or in the case of services in a hospital or 15 osteopathic hospital by a student midwife or an in- 16 tern or resident-in-training under a teaching pro- 17 gram previously described in this paragraph who is 18 in the field of obstetrics and gynecology, if such stu- 19 dent midwife, intern, or resident-in-training is super- 20 vised by a certified nurse-midwife to the extent per- 21 mitted under applicable State law and as may be au- 22 thorized by the hospital;’’; 23 (2) in paragraph (7), by striking the period at 24 the end and inserting ‘‘; or’’; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00384 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 385 •HR 5294 IH (3) by adding at the end the following new 1 paragraph: 2 ‘‘(8) a certified nurse-midwife where the hos- 3 pital has a teaching program approved as specified 4 in paragraph (6), if (A) the hospital elects to receive 5 any payment due under this title for reasonable 6 costs of such services, and (B) all certified nurse- 7 midwives in such hospital agree not to bill charges 8 for professional services rendered in such hospital to 9 individuals covered under the insurance program es- 10 tablished by this title.’’. 11 (b) EFFECTIVE DATE.—The amendments made by 12 subsection (a) shall apply to services furnished on or after 13 the date of the enactment of this Act. 14 SEC. 523. GRANTS TO PROFESSIONAL ORGANIZATIONS TO 15 INCREASE DIVERSITY IN MATERNITY CARE 16 PROFESSIONALS. 17 (a) IN GENERAL.—The Secretary of Health and 18 Human Services, through the Administrator of the Health 19 Resources and Services Administration, shall carry out a 20 grant program under which the Secretary may make to 21 eligible health professional organizations— 22 (1) for fiscal year 2015, planning grants de- 23 scribed in subsection (b); and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00385 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 386 •HR 5294 IH (2) for the subsequent 4-year period, implemen- 1 tation grants described in subsection (c). 2 (b) PLANNING GRANTS.— 3 (1) IN GENERAL.—Planning grants described in 4 this subsection are grants for the following purposes: 5 (A) To collect data and identify any work- 6 force disparities, with respect to a health pro- 7 fession, at each of the following areas along the 8 health professional continuum: 9 (i) Pipeline availability with respect to 10 students at the high school and college or 11 university levels considering and working 12 toward entrance in the profession. 13 (ii) Entrance into the training pro- 14 gram for the profession. 15 (iii) Graduation from such training 16 program. 17 (iv) Entrance into practice. 18 (v) Retention in practice for more 19 than a 5-year period. 20 (B) To develop one or more strategies to 21 address the workforce disparities within the 22 health profession, as identified under (and in 23 response to the findings pursuant to) subpara- 24 graph (A). 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00386 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 387 •HR 5294 IH (2) APPLICATION.—To be eligible to receive a 1 grant under this subsection, an eligible health pro- 2 fessional organization shall submit to the Secretary 3 of Health and Human Services an application in 4 such form and manner and containing such informa- 5 tion as specified by the Secretary. 6 (3) AMOUNT.—Each grant awarded under this 7 subsection shall be for an amount not to exceed 8 $300,000. 9 (4) REPORT.—Each recipient of a grant under 10 this subsection shall submit to the Secretary of 11 Health and Human Services a report containing— 12 (A) information on the extent and distribu- 13 tion of workforce disparities identified through 14 the grant; and 15 (B) reasonable objectives and strategies 16 developed to address such disparities within a 17 5-, 10-, and 25-year period. 18 (c) IMPLEMENTATION GRANTS.— 19 (1) IN GENERAL.—Implementation grants de- 20 scribed in this subsection are grants to implement 21 one or more of the strategies developed pursuant to 22 a planning grant awarded under subsection (b). 23 (2) APPLICATION.—To be eligible to receive a 24 grant under this subsection, an eligible health pro- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00387 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 388 •HR 5294 IH fessional organization shall submit to the Secretary 1 of Health and Human Services an application in 2 such form and manner as specified by the Secretary. 3 Each such application shall contain information on 4 the capability of the organization to carry out a 5 strategy described in paragraph (1), involvement of 6 partners or coalitions, plans for developing sustain- 7 ability of the efforts after the culmination of the 8 grant cycle, and any other information specified by 9 the Secretary. 10 (3) AMOUNT.—Each grant awarded under this 11 subsection shall be for an amount not to exceed 12 $500,000 each year during the 4-year period of the 13 grant. 14 (4) REPORTS.—For each of the first 3 years for 15 which an eligible health professional organization is 16 awarded a grant under this subsection, the organiza- 17 tion shall submit to the Secretary of Health and 18 Human Services a report on the activities carried 19 out by such organization through the grant during 20 such year and objectives for the subsequent year. 21 For the fourth year for which an eligible health pro- 22 fessional organization is awarded a grant under this 23 subsection, the organization shall submit to the Sec- 24 retary a report that includes an analysis of all the 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00388 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 389 •HR 5294 IH activities carried out by the organization through the 1 grant and a detailed plan for continuation of out- 2 reach efforts. 3 (d) ELIGIBLE HEALTH PROFESSIONAL ORGANIZA- 4 TION DEFINED.—For purposes of this section, the term 5 ‘‘eligible health professional organization’’ means a profes- 6 sional organization representing obstetrician-gyne- 7 cologists, certified nurse midwives, certified midwives, 8 family practice physicians, nurse practitioners whose scope 9 of practice includes maternity care, physician assistants 10 whose scope of practice includes obstetrical care, or cer- 11 tified professional midwives. 12 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 13 authorized to be appropriated to carry out this section 14 $2,000,000 for fiscal year 2015 and $3,000,000 for each 15 of the fiscal years 2016 through 2019. 16 TITLE VI—MENTAL HEALTH 17 SEC. 601. COVERAGE OF MARRIAGE AND FAMILY THERA- 18 PIST SERVICES, MENTAL HEALTH COUN- 19 SELOR SERVICES, AND SUBSTANCE ABUSE 20 COUNSELOR SERVICES UNDER PART B OF 21 THE MEDICARE PROGRAM. 22 (a) COVERAGE OF SERVICES.— 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00389 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 390 •HR 5294 IH (1) IN GENERAL.—Section 1861(s)(2) of the 1 Social Security Act (42 U.S.C. 1395x(s)(2)) is 2 amended— 3 (A) in subparagraph (EE), by striking 4 ‘‘and’’ at the end; 5 (B) in subparagraph (FF), by inserting 6 ‘‘and’’ at the end; and 7 (C) by adding at the end the following new 8 subparagraph: 9 ‘‘(GG) marriage and family therapist services 10 (as defined in subsection (kkk)(1)) and mental 11 health counselor services (as defined in subsection 12 (kkk)(3)) and substance abuse counselor services (as 13 defined in subsection (kkk)(5));’’. 14 (2) DEFINITIONS.—Section 1861 of such Act 15 (42 U.S.C. 1395x), as amended by sections 16 202(b)(1)(A) and 423(a), is amended by adding at 17 the end the following new subsection: 18 ‘‘Marriage and Family Therapist Services; Marriage and 19 Family Therapist; Mental Health Counselor Serv- 20 ices; Mental Health Counselor 21 ‘‘(kkk)(1) The term ‘marriage and family therapist 22 services’ means services performed by a marriage and 23 family therapist (as defined in paragraph (2)) for the diag- 24 nosis and treatment of mental illnesses, which the mar- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00390 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 391 •HR 5294 IH riage and family therapist is legally authorized to perform 1 under State law (or the State regulatory mechanism pro- 2 vided by State law) of the State in which such services 3 are performed, as would otherwise be covered if furnished 4 by a physician or as an incident to a physician’s profes- 5 sional service, but only if no facility or other provider 6 charges or is paid any amounts with respect to the fur- 7 nishing of such services. 8 ‘‘(2) The term ‘marriage and family therapist’ means 9 an individual who— 10 ‘‘(A) possesses a master’s or doctoral degree 11 which qualifies for licensure or certification as a 12 marriage and family therapist pursuant to State 13 law; 14 ‘‘(B) after obtaining such degree has performed 15 at least 2 years of clinical supervised experience in 16 marriage and family therapy; and 17 ‘‘(C) in the case of an individual performing 18 services in a State that provides for licensure or cer- 19 tification of marriage and family therapists, is li- 20 censed or certified as a marriage and family thera- 21 pist in such State. 22 ‘‘(3) The term ‘mental health counselor services’ 23 means services performed by a mental health counselor (as 24 defined in paragraph (4)) for the diagnosis and treatment 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00391 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 392 •HR 5294 IH of mental illnesses which the mental health counselor is 1 legally authorized to perform under State law (or the 2 State regulatory mechanism provided by the State law) of 3 the State in which such services are performed, as would 4 otherwise be covered if furnished by a physician or as inci- 5 dent to a physician’s professional service, but only if no 6 facility or other provider charges or is paid any amounts 7 with respect to the furnishing of such services. 8 ‘‘(4) The term ‘mental health counselor’ means an 9 individual who— 10 ‘‘(A) possesses a master’s or doctor’s degree in 11 mental health counseling or a related field; 12 ‘‘(B) after obtaining such a degree has per- 13 formed at least 2 years of supervised mental health 14 counselor practice; and 15 ‘‘(C) in the case of an individual performing 16 services in a State that provides for licensure or cer- 17 tification of mental health counselors or professional 18 counselors, is licensed or certified as a mental health 19 counselor or professional counselor in such State. 20 ‘‘(5) The term ‘substance abuse counselor services’ 21 means services performed by a substance abuse counselor 22 (as defined in paragraph (6)) for the diagnosis and treat- 23 ment of substance abuse and addiction which the sub- 24 stance abuse counselor is legally authorized to perform 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00392 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 393 •HR 5294 IH under State law (or the State regulatory mechanism pro- 1 vided by the State law) of the State in which such services 2 are performed, as would otherwise be covered if furnished 3 by a physician or as incident to a physician’s professional 4 service, but only if no facility or other provider charges 5 or is paid any amounts with respect to the furnishing of 6 such services. 7 ‘‘(6) The term ‘substance abuse counselor’ means an 8 individual who— 9 ‘‘(A) has performed at least 2 years of super- 10 vised substance abuse counselor practice; 11 ‘‘(B) in the case of an individual performing 12 services in a State that provides for licensure or cer- 13 tification of substance abuse counselors or profes- 14 sional counselors, is licensed or certified as a sub- 15 stance abuse counselor or professional counselor in 16 such State; or 17 ‘‘(C) the individual is a drug and alcohol coun- 18 selor as defined in section 40.281 of title 49, Code 19 of Federal Regulations.’’. 20 (3) PROVISION FOR PAYMENT UNDER PART 21 B.—Section 1832(a)(2)(B) of such Act (42 U.S.C. 22 1395k(a)(2)(B)) is amended by adding at the end 23 the following new clause: 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00393 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 394 •HR 5294 IH ‘‘(v) marriage and family therapist 1 services, mental health counselor services, 2 and substance abuse counselor services;’’. 3 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 4 of such Act (42 U.S.C. 1395l(a)(1)) is amended— 5 (A) by striking ‘‘and (Z)’’ and inserting 6 ‘‘(Z)’’; and 7 (B) by inserting before the semicolon at 8 the end the following: ‘‘, and (AA) with respect 9 to marriage and family therapist services, men- 10 tal health counselor services, and substance 11 abuse counselor services under section 12 1861(s)(2)(GG), the amounts paid shall be 80 13 percent of the lesser of the actual charge for 14 the services or 75 percent of the amount deter- 15 mined for payment of a psychologist under sub- 16 paragraph (L)’’. 17 (5) EXCLUSION OF MARRIAGE AND FAMILY 18 THERAPIST SERVICES AND MENTAL HEALTH COUN- 19 SELOR SERVICES FROM SKILLED NURSING FACILITY 20 PROSPECTIVE PAYMENT SYSTEM.—Section 21 1888(e)(2)(A)(ii) of such Act (42 U.S.C. 22 1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar- 23 riage and family therapist services (as defined in 24 section 1861(kkk)(1)), mental health counselor serv- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00394 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 395 •HR 5294 IH ices (as defined in section 1861(kkk)(3)),’’ after 1 ‘‘qualified psychologist services,’’. 2 (6) INCLUSION OF MARRIAGE AND FAMILY 3 THERAPISTS, MENTAL HEALTH COUNSELORS, AND 4 SUBSTANCE ABUSE COUNSELORS AS PRACTITIONERS 5 FOR ASSIGNMENT OF CLAIMS.—Section 6 1842(b)(18)(C) of such Act (42 U.S.C. 7 1395u(b)(18)(C)) is amended by adding at the end 8 the following new clauses: 9 ‘‘(vii) A marriage and family therapist (as de- 10 fined in section 1861(kkk)(2)). 11 ‘‘(viii) A mental health counselor (as defined in 12 section 1861(kkk)(4)). 13 ‘‘(ix) A substance abuse counselor (as defined 14 in section 1861 (kkk)(6)).’’. 15 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV- 16 ICES PROVIDED IN CERTAIN SETTINGS.— 17 (1) RURAL HEALTH CLINICS AND FEDERALLY 18 QUALIFIED HEALTH CENTERS.—Section 19 1861(aa)(1)(B) of the Social Security Act (42 20 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 21 by a clinical social worker (as defined in subsection 22 (hh)(1)),’’ and inserting ‘‘, by a clinical social worker 23 (as defined in subsection (hh)(1)), by a marriage 24 and family therapist (as defined in subsection 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00395 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 396 •HR 5294 IH (kkk)(2)), or by a mental health counselor (as de- 1 fined in subsection (kkk)(4)), or by a substance 2 abuse counselor (as defined in section 1861 3 (kkk)(6)).’’. 4 (2) HOSPICE PROGRAMS.—Section 5 1861(dd)(2)(B)(i)(III) of such Act (42 U.S.C. 6 1395x(dd)(2)(B)(i)(III)) is amended by inserting ‘‘or 7 one marriage and family therapist (as defined in 8 subsection (kkk)(2))’’ after ‘‘social worker’’. 9 (c) AUTHORIZATION OF MARRIAGE AND FAMILY 10 THERAPISTS TO DEVELOP DISCHARGE PLANS FOR POST- 11 HOSPITAL SERVICES.—Section 1861(ee)(2)(G) of the So- 12 cial Security Act (42 U.S.C. 1395x(ee)(2)(G)) is amended 13 by inserting ‘‘marriage and family therapist (as defined 14 in subsection (kkk)(2)),’’ after ‘‘social worker,’’. 15 (d) EFFECTIVE DATE.—The amendments made by 16 this section shall apply with respect to services furnished 17 on or after January 1, 2015. 18 SEC. 602. MINORITY FELLOWSHIP PROGRAM. 19 Title V of the Public Health Service Act is amended 20 by inserting after section 506B of such Act (42 U.S.C. 21 290aa–5b) the following: 22 ‘‘SEC. 506C. MINORITY FELLOWSHIP PROGRAM. 23 ‘‘(a) FELLOWSHIPS.—The Administrator shall main- 24 tain a program, to be known as the Minority Fellowship 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00396 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 397 •HR 5294 IH Program, under which the Administrator awards grants 1 or contracts to national associations or other appropriate 2 entities for the financial support of graduate students, 3 postdoctoral fellows, and residents in the professions of 4 psychology, psychiatry, social work, psychiatric advance- 5 practice nursing, marriage and family therapy, and profes- 6 sional counseling to students who demonstrate a commit- 7 ment to clinical or research careers focused on racial and 8 ethnic minority populations. 9 ‘‘(b) TERM OF FINANCIAL SUPPORT.—Financial sup- 10 port provided to an individual pursuant to subsection (a) 11 shall be for a term of not more than 12 months and may 12 be renewed thereafter. 13 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 14 carry out this section, there is authorized to be appro- 15 priated $10,000,000 for each of fiscal years 2015 through 16 2019.’’. 17 SEC. 603. INTEGRATED HEALTH CARE DEMONSTRATION 18 PROGRAM. 19 Part D of title V of the Public Health Service Act 20 (42 U.S.C. 290dd et seq.) is amended by adding at the 21 end the following: 22 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00397 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 398 •HR 5294 IH ‘‘SEC. 544. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 1 PROVISION OF BEHAVIORAL HEALTH CARE 2 IN PRIMARY CARE SETTINGS. 3 ‘‘(a) GRANTS.—The Secretary, acting through the 4 Deputy Assistant Secretary for Minority Health, shall 5 award grants to eligible entities for the purpose of pro- 6 viding technical assistance and training regarding the ef- 7 fective development and implementation of integrated 8 interprofessional health care teams that provide behavioral 9 health care. 10 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 11 a grant under this section, an entity shall be a federally 12 qualified health center (as defined in section 1861(aa) of 13 the Social Security Act) serving a high proportion of indi- 14 viduals from racial and ethnic minority groups (as defined 15 in section 1707(g)). 16 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 17 carry out this section, there is authorized to be appro- 18 priated $20,000,000 for each of fiscal years 2014 through 19 2016.’’. 20 SEC. 604. ADDRESSING RACIAL AND ETHNIC MINORITY 21 MENTAL HEALTH DISPARITIES RESEARCH 22 GAPS. 23 Not later than 6 months after the date of the enact- 24 ment of this Act, the Director of the National Institute 25 on Minority Health and Health Disparities shall enter into 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00398 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 399 •HR 5294 IH an arrangement with the Institute of Medicine (or, if the 1 Institute declines to enter into such an arrangement, an- 2 other appropriate entity)— 3 (1) to conduct a study with respect to mental 4 and behavioral health disparities in racial and ethnic 5 minority groups (as defined in section 1707(g) of 6 the Public Health Service Act (42 U.S.C. 300u– 7 6(g)); and 8 (2) to submit to the Congress a report on the 9 results of such study, including— 10 (A) a compilation of information on the dy- 11 namics of mental disorders in such racial and 12 ethnic minority groups; 13 (B) an identification of gaps in knowledge 14 and research needs; and 15 (C) recommendations for an interprofes- 16 sional research agenda at the National Insti- 17 tutes of Health aimed at reducing and ulti- 18 mately eliminating mental and behavioral health 19 disparities in such racial and ethnic minority 20 groups. 21 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00399 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 400 •HR 5294 IH SEC. 605. HEALTH PROFESSIONS COMPETENCIES TO AD- 1 DRESS RACIAL AND ETHNIC MINORITY MEN- 2 TAL HEALTH DISPARITIES. 3 (a) IN GENERAL.—The Secretary of Health and 4 Human Services, acting through the Administrator of the 5 Substance Abuse and Mental Health Services Administra- 6 tion, shall award grants to qualified national organizations 7 for the purpose of developing, and disseminating to health 8 professional educational programs, curricula or core com- 9 petencies addressing mental health disparities among ra- 10 cial and ethnic minority groups. 11 (b) USE OF FUNDS.—Organizations receiving funds 12 under subsection (a) shall use the funds to develop and 13 disseminate curricula or core competencies, as described 14 in such subsection, for use in the training of students in 15 the professions of social work, psychology, psychiatry, 16 marriage and family therapy, mental health counseling, 17 and substance abuse counseling. 18 (c) ALLOWABLE ACTIVITIES.—Organizations receiv- 19 ing funds under subsection (a) may use the funds to en- 20 gage in the following activities related to the development 21 and dissemination of curricula or core competencies: 22 (1) Formation of committees or working groups 23 comprised of experts from accredited health profes- 24 sions schools to identify core competencies relating 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00400 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 401 •HR 5294 IH to mental health disparities among racial and ethnic 1 minority groups. 2 (2) Planning of workshops in national fora to 3 allow for public input into the educational needs as- 4 sociated with mental health disparities among racial 5 and ethnic minority groups. 6 (3) Dissemination and promotion of the use of 7 curricula or core competencies in undergraduate and 8 graduate health professions training programs na- 9 tionwide. 10 (d) DEFINITIONS.—In this section: 11 (1) The term ‘‘qualified national organization’’ 12 means a national organization that focuses on the 13 education of students in programs of social work, 14 psychology, psychiatry, and marriage and family 15 therapy. 16 (2) The term ‘‘racial and ethnic minority 17 group’’ has the meaning given to such term in sec- 18 tion 1707(g) of the Public Health Service Act (42 19 U.S.C. 300u–6(g)). 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 2014 through 2018. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00401 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 402 •HR 5294 IH TITLE VII—ADDRESSING HIGH 1 IMPACT MINORITY DISEASES 2 Subtitle A—Cancer 3 SEC. 701. LUNG CANCER MORTALITY REDUCTION. 4 (a) SHORT TITLE.—This section may be cited as the 5 ‘‘Lung Cancer Mortality Reduction Act of 2014’’. 6 (b) FINDINGS.—Congress makes the following find- 7 ings: 8 (1) Lung cancer is the leading cause of cancer 9 death for both men and women, accounting for 28 10 percent of all cancer deaths. 11 (2) Lung cancer kills more people annually 12 than breast cancer, prostate cancer, colon cancer, 13 liver cancer, melanoma, and kidney cancer combined. 14 (3) Since the National Cancer Act of 1971 15 (Public Law 92–218; 85 Stat. 778), coordinated and 16 comprehensive research has raised the 5-year sur- 17 vival rates for breast cancer to 88 percent, for pros- 18 tate cancer to 99 percent, and for colon cancer to 19 64 percent. 20 (4) However, the 5-year survival rate for lung 21 cancer is still only 15 percent and a similar coordi- 22 nated and comprehensive research effort is required 23 to achieve increases in lung cancer survivability 24 rates. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00402 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 403 •HR 5294 IH (5) Sixty percent of lung cancer cases are now 1 diagnosed nonsmokers or former smokers. 2 (6) Two-thirds of nonsmokers diagnosed with 3 lung cancer are women. 4 (7) Certain minority populations, such as Afri- 5 can-American males, have disproportionately high 6 rates of lung cancer incidence and mortality, not- 7 withstanding their similar smoking rate. 8 (8) Members of the baby boomer generation are 9 entering their sixties, the most common age at which 10 people develop lung cancer. 11 (9) Tobacco addiction and exposure to other 12 lung cancer carcinogens such as Agent Orange and 13 other herbicides and battlefield emissions are serious 14 problems among military personnel and war vet- 15 erans. 16 (10) Significant and rapid improvements in 17 lung cancer mortality can be expected through great- 18 er use and access to lung cancer screening tests for 19 at-risk individuals. 20 (11) Additional strategies are necessary to fur- 21 ther enhance the existing tests and therapies avail- 22 able to diagnose and treat lung cancer in the future. 23 (12) The August 2001 Report of the Lung 24 Cancer Progress Review Group of the National Can- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00403 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 404 •HR 5294 IH cer Institute stated that funding for lung cancer re- 1 search was ‘‘far below the levels characterized for 2 other common malignancies and far out of propor- 3 tion to its massive health impact’’. 4 (13) The Report of the Lung Cancer Progress 5 Review Group identified as its ‘‘highest priority’’ the 6 creation of integrated, multidisciplinary, multi-insti- 7 tutional research consortia organized around the 8 problem of lung cancer rather than around specific 9 research disciplines. 10 (14) The United States must enhance its re- 11 sponse to the issues raised in the Report of the 12 Lung Cancer Progress Review Group, and this can 13 be accomplished through the establishment of a co- 14 ordinated effort designed to reduce the lung cancer 15 mortality rate by 50 percent by 2015 and targeted 16 funding to support this coordinated effort. 17 (c) SENSE OF CONGRESS CONCERNING INVESTMENT 18 IN LUNG CANCER RESEARCH.—It is the sense of the Con- 19 gress that— 20 (1) lung cancer mortality reduction should be 21 made a national public health priority; and 22 (2) a comprehensive mortality reduction pro- 23 gram coordinated by the Secretary of Health and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00404 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 405 •HR 5294 IH Human Services is justified and necessary to ade- 1 quately address and reduce lung cancer mortality. 2 (d) LUNG CANCER MORTALITY REDUCTION PRO- 3 GRAM.— 4 (1) IN GENERAL.—Subpart 1 of part C of title 5 IV of the Public Health Service Act (42 U.S.C. 285 6 et seq.) is amended by adding at the end the fol- 7 lowing: 8 ‘‘SEC. 417H. LUNG CANCER MORTALITY REDUCTION PRO- 9 GRAM. 10 ‘‘(a) IN GENERAL.—Not later than 6 months after 11 the date of the enactment of this section, the Secretary, 12 in consultation with the Secretary of Defense, the Sec- 13 retary of Veterans Affairs, the Director of the National 14 Institutes of Health, the Director of the Centers for Dis- 15 ease Control and Prevention, the Commissioner of Food 16 and Drugs, the Administrator of the Centers for Medicare 17 & Medicaid Services, the Director of the National Institute 18 on Minority Health and Health Disparities, and other 19 members of the Lung Cancer Advisory Board established 20 under section 701 of the Health Equity and Accountability 21 Act of 2014, shall implement a comprehensive program, 22 to be known as the Lung Cancer Mortality Reduction Pro- 23 gram, to achieve a reduction of at least 25 percent in the 24 mortality rate of lung cancer by 2020. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00405 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 406 •HR 5294 IH ‘‘(b) REQUIREMENTS.—The Program shall include at 1 least the following: 2 ‘‘(1) With respect to the National Institutes of 3 Health— 4 ‘‘(A) a strategic review and prioritization 5 by the National Cancer Institute of research 6 grants to achieve the goal of the Lung Cancer 7 Mortality Reduction Program in reducing lung 8 cancer mortality; 9 ‘‘(B) the provision of funds to enable the 10 Airway Biology and Disease Branch of the Na- 11 tional Heart, Lung, and Blood Institute to ex- 12 pand its research programs to include pre- 13 dispositions to lung cancer, the interrelationship 14 between lung cancer and other pulmonary and 15 cardiac disease, and the diagnosis and treat- 16 ment of these interrelationships; 17 ‘‘(C) the provision of funds to enable the 18 National Institute of Biomedical Imaging and 19 Bioengineering to expedite the development of 20 computer-assisted diagnostic, surgical, treat- 21 ment, and drug-testing innovations to reduce 22 lung cancer mortality, such as through expan- 23 sion of the Institute’s Quantum Grant Program 24 and Image-Guided Interventions programs; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00406 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 407 •HR 5294 IH ‘‘(D) the provision of funds to enable the 1 National Institute of Environmental Health 2 Sciences to implement research programs rel- 3 ative to the lung cancer incidence. 4 ‘‘(2) With respect to the Food and Drug Ad- 5 ministration— 6 ‘‘(A) activities under section 530 of the 7 Federal Food, Drug, and Cosmetic Act; and 8 ‘‘(B) activities under section 561 of the 9 Federal Food, Drug, and Cosmetic Act to ex- 10 pand access to investigational drugs and devices 11 for the diagnosis, monitoring, or treatment of 12 lung cancer. 13 ‘‘(3) With respect to the Centers for Disease 14 Control and Prevention, the establishment of an 15 early disease research and management program 16 under section 1511. 17 ‘‘(4) With respect to the Agency for Healthcare 18 Research and Quality, the conduct of a biannual re- 19 view of lung cancer screening, diagnostic, and treat- 20 ment protocols, and the issuance of updated guide- 21 lines. 22 ‘‘(5) The cooperation and coordination of all 23 minority and health disparity programs within the 24 Department of Health and Human Services to en- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00407 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 408 •HR 5294 IH sure that all aspects of the Lung Cancer Mortality 1 Reduction Program under this section adequately 2 address the burden of lung cancer on minority and 3 rural populations. 4 ‘‘(6) The cooperation and coordination of all to- 5 bacco control and cessation programs within agen- 6 cies of the Department of Health and Human Serv- 7 ices to achieve the goals of the Lung Cancer Mor- 8 tality Reduction Program under this section with 9 particular emphasis on the coordination of drug and 10 other cessation treatments with early detection pro- 11 tocols.’’. 12 (2) FEDERAL FOOD, DRUG, AND COSMETIC 13 ACT.—Subchapter B of chapter V of the Federal 14 Food, Drug, and Cosmetic Act (21 U.S.C. 360aaa et 15 seq.) is amended by adding at the end the following: 16 ‘‘DRUGS RELATING TO LUNG CANCER 17 ‘‘SEC. 530. (a) IN GENERAL.—The provisions of this 18 subchapter shall apply to a drug described in subsection 19 (b) to the same extent and in the same manner as such 20 provisions apply to a drug for a rare disease or condition. 21 ‘‘(b) QUALIFIED DRUGS.—A drug described in this 22 subsection is— 23 ‘‘(1) a chemoprevention drug for precancerous 24 conditions of the lung; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00408 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 409 •HR 5294 IH ‘‘(2) a drug for targeted therapeutic treat- 1 ments, including any vaccine, for lung cancer; and 2 ‘‘(3) a drug to curtail or prevent nicotine addic- 3 tion. 4 ‘‘(c) BOARD.—The Board established under the 5 Health Equity and Accountability Act of 2014 shall mon- 6 itor the program implemented under this section.’’. 7 (3) ACCESS TO UNAPPROVED THERAPIES.—Sec- 8 tion 561(e) of the Federal Food, Drug, and Cos- 9 metic Act (21 U.S.C. 360bbb(e)) is amended by in- 10 serting before the period the following: ‘‘and shall 11 include expanding access to drugs under section 12 530, with substantial consideration being given to 13 whether the totality of information available to the 14 Secretary regarding the safety and effectiveness of 15 an investigational drug, as compared to the risk of 16 morbidity and death from the disease, indicates that 17 a patient may obtain more benefit than risk if treat- 18 ed with the drug’’. 19 (4) CDC.—Title XV of the Public Health Serv- 20 ice Act (42 U.S.C. 300k et seq.) is amended by add- 21 ing at the end the following: 22 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00409 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 410 •HR 5294 IH ‘‘SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT 1 PROGRAM. 2 ‘‘The Secretary shall establish and implement an 3 early disease research and management program targeted 4 at the high incidence and mortality rates of lung cancer 5 among minority and low-income populations.’’. 6 (e) DEPARTMENT OF DEFENSE AND THE DEPART- 7 MENT OF VETERANS AFFAIRS.—The Secretary of Defense 8 and the Secretary of Veterans Affairs shall coordinate 9 with the Secretary of Health and Human Services— 10 (1) in the development of the Lung Cancer 11 Mortality Reduction Program under section 417H; 12 (2) in the implementation within the Depart- 13 ment of Defense and the Department of Veterans 14 Affairs of an early detection and disease manage- 15 ment research program for military personnel and 16 veterans whose smoking history and exposure to car- 17 cinogens during active duty service has increased 18 their risk for lung cancer; and 19 (3) in the implementation of coordinated care 20 programs for military personnel and veterans diag- 21 nosed with lung cancer. 22 (f) LUNG CANCER ADVISORY BOARD.— 23 (1) IN GENERAL.—The Secretary of Health and 24 Human Services shall convene a Lung Cancer Advi- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00410 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 411 •HR 5294 IH sory Board (referred to in this section as the 1 ‘‘Board’’)— 2 (A) to monitor the programs established 3 under this section (and the amendments made 4 by this section); and 5 (B) to provide annual reports to the Con- 6 gress concerning benchmarks, expenditures, 7 lung cancer statistics, and the public health im- 8 pact of such programs. 9 (2) COMPOSITION.—The Board shall be com- 10 posed of— 11 (A) the Secretary of Health and Human 12 Services; 13 (B) the Secretary of Defense; 14 (C) the Secretary of Veterans Affairs; and 15 (D) two representatives each from the 16 fields of clinical medicine focused on lung can- 17 cer, lung cancer research, imaging, drug devel- 18 opment, and lung cancer advocacy, to be ap- 19 pointed by the Secretary of Health and Human 20 Services. 21 (g) AUTHORIZATION OF APPROPRIATIONS.— 22 (1) IN GENERAL.—To carry out this section 23 (and the amendments made by this section), there 24 are authorized to be appropriated such sums as may 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00411 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 412 •HR 5294 IH be necessary for each of fiscal years 2015 through 1 2019. 2 (2) LUNG CANCER MORTALITY REDUCTION PRO- 3 GRAM.—Of the amounts authorized to be appro- 4 priated by subsection (a), there are authorized to be 5 appropriated— 6 (A) $25,000,000 for fiscal year 2015, and 7 such sums as may be necessary for each of fis- 8 cal years 2016 through 2019, for the activities 9 described in section 417H(b)(1)(B) of the Pub- 10 lic Health Service Act, as added by subsection 11 (d)(1); 12 (B) $25,000,000 for fiscal year 2015, and 13 such sums as may be necessary for each of fis- 14 cal years 2016 through 2019, for the activities 15 described in section 417H(b)(1)(C) of such Act; 16 (C) $10,000,000 for fiscal year 2015, and 17 such sums as may be necessary for each of fis- 18 cal years 2016 through 2019, for the activities 19 described in section 417H(b)(1)(D) of such Act; 20 and 21 (D) $15,000,000 for fiscal year 2015, and 22 such sums as may be necessary for each of fis- 23 cal years 2016 through 2019, for the activities 24 described in section 417H(b)(3) of such Act. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00412 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 413 •HR 5294 IH SEC. 702. EXPANDING PROSTATE CANCER RESEARCH, OUT- 1 REACH, SCREENING, TESTING, ACCESS, AND 2 TREATMENT EFFECTIVENESS. 3 (a) SHORT TITLE.—This section may be cited as the 4 ‘‘Prostate Research, Outreach, Screening, Testing, Access, 5 and Treatment Effectiveness Act of 2014’’ or the ‘‘PROS- 6 TATE Act’’. 7 (b) FINDINGS.—Congress makes the following find- 8 ings: 9 (1) Prostate cancer is the second leading cause 10 of cancer death among men. 11 (2) In 2010, more than 217,730 new patients 12 were diagnosed with prostate cancer and more than 13 32,000 men died from this disease. 14 (3) Roughly 2,000,000 Americans are living 15 with a diagnosis of prostate cancer and its con- 16 sequences. 17 (4) While prostate cancer generally affects older 18 individuals, younger men are also at risk for the dis- 19 ease, and when prostate cancer appears in early 20 middle age it frequently takes on a more aggressive 21 form. 22 (5) There are significant racial and ethnic dis- 23 parities that demand attention, namely African- 24 Americans have prostate cancer mortality rates that 25 are more than double those in the White population. 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00413 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 414 •HR 5294 IH (6) Underserved rural populations have higher 1 rates of mortality compared to their urban counter- 2 parts, and innovative and cost-efficient methods to 3 improve rural access to high quality care should take 4 advantage of advances in telehealth to diagnose and 5 treat prostate cancer when appropriate. 6 (7) Certain veterans populations may have 7 nearly twice the incidence of prostate cancer as the 8 general population of the United States. 9 (8) Urologists may constitute the specialists 10 who diagnose and treat the vast majority of prostate 11 cancer patients. 12 (9) Although much basic and translational re- 13 search has been completed and much is currently 14 known, there are still many unanswered questions. 15 For example, it is not fully understood how much of 16 known disparities are attributable to disease eti- 17 ology, access to care, or education and awareness in 18 the community. 19 (10) Causes of prostate cancer are not known. 20 There is not good information regarding how to dif- 21 ferentiate accurately, early on, between aggressive 22 and indolent forms of the disease. As a result, there 23 is significant overtreatment in prostate cancer. 24 There are no treatments that can durably arrest 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00414 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 415 •HR 5294 IH growth or cure prostate cancer once it has metasta- 1 sized. 2 (11) A significant proportion (roughly 23 to 54 3 percent) of cases may be clinically indolent and 4 ‘‘overdiagnosed’’, resulting in significant overtreat- 5 ment. More accurate tests will allow men and their 6 families to face less physical, psychological, financial, 7 and emotional trauma and billions of dollars could 8 be saved in private and public health care systems 9 in an area that has been identified by the Medicare 10 Program as one of eight high-volume, high-cost 11 areas in the Resource Utilization Report Program 12 authorized by Congress under the Medicare Im- 13 provements for Patients and Providers Act of 2008. 14 (12) Prostate cancer research and health care 15 programs across Federal agencies should be coordi- 16 nated to improve accountability and actively encour- 17 age the translation of research into practice, to iden- 18 tify and implement best practices, in order to foster 19 an integrated and consistent focus on effective pre- 20 vention, diagnosis, and treatment of this disease. 21 (c) PROSTATE CANCER COORDINATION AND EDU- 22 CATION.— 23 (1) INTERAGENCY PROSTATE CANCER COORDI- 24 NATION AND EDUCATION TASK FORCE.—Not later 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00415 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 416 •HR 5294 IH than 180 days after the date of the enactment of 1 this section, the Secretary of Veterans Affairs, in co- 2 operation with the Secretary of Defense and the Sec- 3 retary of Health and Human Services, shall estab- 4 lish an Interagency Prostate Cancer Coordination 5 and Education Task Force (in this section referred 6 to as the ‘‘Prostate Cancer Task Force’’). 7 (2) DUTIES.—The Prostate Cancer Task Force 8 shall— 9 (A) develop a summary of advances in 10 prostate cancer research supported or con- 11 ducted by Federal agencies relevant to the diag- 12 nosis, prevention, and treatment of prostate 13 cancer, including psychosocial impairments re- 14 lated to prostate cancer treatment, and compile 15 a list of best practices that warrant broader 16 adoption in health care programs; 17 (B) consider establishing, and advocating 18 for, a guidance to enable physicians to allow 19 screening of men who are over age 74, on a 20 case-by-case basis, taking into account quality 21 of life and family history of prostate cancer; 22 (C) share and coordinate information on 23 Federal research and health care program ac- 24 tivities, including activities related to— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00416 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 417 •HR 5294 IH (i) determining how to improve re- 1 search and health care programs, including 2 psychosocial impairments related to pros- 3 tate cancer treatment; 4 (ii) identifying any gaps in the overall 5 research inventory and in health care pro- 6 grams; 7 (iii) identifying opportunities to pro- 8 mote translation of research into practice; 9 and 10 (iv) maximizing the effects of Federal 11 efforts by identifying opportunities for col- 12 laboration and leveraging of resources in 13 research and health care programs that 14 serve those susceptible to or diagnosed 15 with prostate cancer; 16 (D) develop a comprehensive interagency 17 strategy and advise relevant Federal agencies in 18 the solicitation of proposals for collaborative, 19 multidisciplinary research and health care pro- 20 grams, including proposals to evaluate factors 21 that may be related to the etiology of prostate 22 cancer, that would— 23 (i) result in innovative approaches to 24 study emerging scientific opportunities or 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00417 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 418 •HR 5294 IH eliminate knowledge gaps in research to 1 improve the prostate cancer research port- 2 folio of the Federal Government; 3 (ii) outline key research questions, 4 methodologies, and knowledge gaps; and 5 (iii) ensure consistent action, as out- 6 lined by section 402(b) of the Public 7 Health Service Act; 8 (E) develop a coordinated message related 9 to screening and treatment for prostate cancer 10 to be reflected in educational and beneficiary 11 materials for Federal health programs as such 12 documents are updated; and 13 (F) not later than 2 years after the date 14 of the establishment of the Prostate Cancer 15 Task Force, submit to the Expert Advisory 16 Panel to be reviewed and returned within 30 17 days, and then within 90 days submitted to 18 Congress recommendations— 19 (i) regarding any appropriate changes 20 to research and health care programs, in- 21 cluding recommendations to improve the 22 research portfolio of the Department of 23 Veterans Affairs, Department of Defense, 24 National Institutes of Health, and other 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00418 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 419 •HR 5294 IH Federal agencies to ensure that scientif- 1 ically based strategic planning is imple- 2 mented in support of research and health 3 care program priorities; 4 (ii) designed to ensure that the re- 5 search and health care programs and ac- 6 tivities of the Department of Veterans Af- 7 fairs, the Department of Defense, the De- 8 partment of Health and Human Services, 9 and other Federal agencies are free of un- 10 necessary duplication; 11 (iii) regarding public participation in 12 decisions relating to prostate cancer re- 13 search and health care programs to in- 14 crease the involvement of patient advo- 15 cates, community organizations, and med- 16 ical associations representing a broad geo- 17 graphical area; 18 (iv) on how to best disseminate infor- 19 mation on prostate cancer research and 20 progress achieved by health care programs; 21 (v) about how to expand partnerships 22 between public entities, including Federal 23 agencies, and private entities to encourage 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00419 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 420 •HR 5294 IH collaborative, cross-cutting research and 1 health care delivery; 2 (vi) assessing any cost savings and ef- 3 ficiencies realized through the efforts iden- 4 tified and supported in this section and 5 recommending expansion of those efforts 6 that have proved most promising while also 7 ensuring against any conflicts in directives 8 from other congressional or statutory man- 9 dates or enabling statutes; 10 (vii) identifying key priority action 11 items from among the recommendations; 12 and 13 (viii) with respect to the level of fund- 14 ing needed by each agency to implement 15 the recommendations contained in the re- 16 port. 17 (3) MEMBERS OF THE PROSTATE CANCER TASK 18 FORCE.—The Prostate Cancer Task Force described 19 in subsection (a) shall be composed of representa- 20 tives from such Federal agencies, as each Secretary 21 determines necessary, to coordinate a uniform mes- 22 sage relating to prostate cancer screening and treat- 23 ment where appropriate, including representatives of 24 the following: 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00420 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 421 •HR 5294 IH (A) The Department of Veterans Affairs, 1 including representatives of each relevant pro- 2 gram areas of the Department of Veterans Af- 3 fairs. 4 (B) The Prostate Cancer Research Pro- 5 gram of the Congressionally Directed Medical 6 Research Program of the Department of De- 7 fense. 8 (C) The Department of Health and 9 Human Services, including at a minimum rep- 10 resentatives of the following: 11 (i) The National Institutes of Health. 12 (ii) National research institutes and 13 centers, including the National Cancer In- 14 stitute, the National Institute of Allergy 15 and Infectious Diseases, and the Office of 16 Minority Health. 17 (iii) The Centers for Medicare & Med- 18 icaid Services. 19 (iv) The Food and Drug Administra- 20 tion. 21 (v) The Centers for Disease Control 22 and Prevention. 23 (vi) The Agency for Healthcare Re- 24 search and Quality. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00421 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 422 •HR 5294 IH (vii) The Health Resources and Serv- 1 ices Administration. 2 (4) APPOINTING EXPERT ADVISORY PANELS.— 3 The Prostate Cancer Task Force shall appoint ex- 4 pert advisory panels, as determined appropriate, to 5 provide input and concurrence from individuals and 6 organizations from the medical, prostate cancer pa- 7 tient and advocate, research, and delivery commu- 8 nities with expertise in prostate cancer diagnosis, 9 treatment, and research, including practicing urolo- 10 gists, primary care providers, and others and indi- 11 viduals with expertise in education and outreach to 12 underserved populations affected by prostate cancer. 13 (5) MEETINGS.—The Prostate Cancer Task 14 Force shall convene not less than twice a year, or 15 more frequently as the Secretary determines to be 16 appropriate. 17 (6) SUBMISSION OF RECOMMENDATIONS TO 18 CONGRESS.—The Secretary of Veterans Affairs shall 19 submit to Congress any recommendations submitted 20 to the Secretary under paragraph (2)(E). 21 (7) FEDERAL ADVISORY COMMITTEE ACT.— 22 (A) IN GENERAL.—Except as provided in 23 subparagraph (B), the Federal Advisory Com- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00422 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 423 •HR 5294 IH mittee Act (5 U.S.C. App.) shall apply to the 1 Prostate Cancer Task Force. 2 (B) EXCEPTION.—Section 14(a)(2)(B) of 3 such Act (relating to the termination of advi- 4 sory committees) shall not apply to the Prostate 5 Cancer Task Force. 6 (8) SUNSET DATE.—The Prostate Cancer Task 7 Force shall terminate at the end of fiscal year 2019. 8 (d) PROSTATE CANCER RESEARCH.— 9 (1) RESEARCH COORDINATION.—The Secretary 10 of Veterans Affairs, in coordination with the Secre- 11 taries of Defense and of Health and Human Serv- 12 ices, shall establish and carry out a program to co- 13 ordinate and intensify prostate cancer research as 14 needed. Specifically, such research program shall— 15 (A) develop advances in diagnostic and 16 prognostic methods and tests, including bio- 17 markers and an improved prostate cancer 18 screening blood test, including improvements or 19 alternatives to the prostate specific antigen test 20 and additional tests to distinguish indolent from 21 aggressive disease; 22 (B) better understand the etiology of the 23 disease (including an analysis of lifestyle factors 24 proven to be involved in higher rates of prostate 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00423 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 424 •HR 5294 IH cancer, such as obesity and diet, and in dif- 1 ferent ethnic, racial, and socioeconomic groups, 2 such as the African-American, Latino or His- 3 panic, and American Indian populations and 4 men with a family history of prostate cancer) to 5 improve prevention efforts; 6 (C) expand basic research into prostate 7 cancer, including studies of fundamental molec- 8 ular and cellular mechanisms; 9 (D) identify and provide clinical testing of 10 novel agents for the prevention and treatment 11 of prostate cancer; 12 (E) establish clinical registries for prostate 13 cancer; 14 (F) use the National Institute of Bio- 15 medical Imaging and Bioengineering and the 16 National Cancer Institute for assessment of ap- 17 propriate imaging modalities; and 18 (G) address such other matters relating to 19 prostate cancer research as may be identified by 20 the Federal agencies participating in the pro- 21 gram under this section. 22 (2) PROSTATE CANCER ADVISORY BOARD.— 23 There is established in the Office of the Chief Sci- 24 entist of the Food and Drug Administration a Pros- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00424 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 425 •HR 5294 IH tate Cancer Scientific Advisory Board. Such board 1 shall be responsible for accelerating real-time shar- 2 ing of the latest research data and accelerating 3 movement of new medicines to patients. 4 (3) UNDERSERVED MINORITY GRANT PRO- 5 GRAM.—In carrying out such program, the Secretary 6 shall— 7 (A) award grants to eligible entities to 8 carry out components of the research outlined 9 in paragraph (1); 10 (B) integrate and build upon existing 11 knowledge gained from comparative effective- 12 ness research; and 13 (C) recognize and address— 14 (i) the racial and ethnic disparities in 15 the incidence and mortality rates of pros- 16 tate cancer and men with a family history 17 of prostate cancer; 18 (ii) any barriers in access to care and 19 participation in clinical trials that are spe- 20 cific to racial, ethnic, and other under- 21 served minorities and men with a family 22 history of prostate cancer; 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00425 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 426 •HR 5294 IH (iii) needed outreach and educational 1 efforts to raise awareness in these commu- 2 nities; and 3 (iv) appropriate access and utilization 4 of imaging modalities. 5 (e) TELEHEALTH AND RURAL ACCESS PILOT 6 PROJECT.— 7 (1) IN GENERAL.—The Secretary of Veterans 8 Affairs, the Secretary of Defense, and the Secretary 9 of Health and Human Services (in this section re- 10 ferred to as the ‘‘Secretaries’’) shall establish 4-year 11 telehealth pilot projects for the purpose of analyzing 12 the clinical outcomes and cost effectiveness associ- 13 ated with telehealth services in a variety of geo- 14 graphic areas that contain high proportions of medi- 15 cally underserved populations, including African- 16 Americans, Latino or Hispanic, American Indians/ 17 Alaska Natives, and those in rural areas. Such 18 projects shall promote efficient use of specialist care 19 through better coordination of primary care and 20 physician extender teams in underserved areas and 21 more effectively employ tumor boards to better coun- 22 sel patients. 23 (2) ELIGIBLE ENTITIES.— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00426 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 427 •HR 5294 IH (A) IN GENERAL.—The Secretaries shall 1 select eligible entities to participate in the pilot 2 projects under this section. 3 (B) PRIORITY.—In selecting eligible enti- 4 ties to participate in the pilot projects under 5 this section, the Secretaries shall give priority 6 to such entities located in medically under- 7 served areas, particularly those that include Af- 8 rican-Americans, Latinos and Hispanics, and 9 facilities of the Indian Health Service, including 10 Indian Health Service operated facilities, trib- 11 ally operated facilities, and Urban Indian Clin- 12 ics, and those in rural areas. 13 (3) EVALUATION.—The Secretaries shall, 14 through the pilot projects, evaluate— 15 (A) the effective and economic delivery of 16 care in diagnosing and treating prostate cancer 17 with the use of telehealth services in medically 18 underserved and tribal areas including collabo- 19 rative uses of health professionals and integra- 20 tion of the range of telehealth and other tech- 21 nologies; 22 (B) the effectiveness of improving the ca- 23 pacity of nonmedical providers and nonspecial- 24 ized medical providers to provide health services 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00427 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 428 •HR 5294 IH for prostate cancer in medically underserved 1 and tribal areas, including the exploration of in- 2 novative medical home models with collabora- 3 tion between urologists, other relevant medical 4 specialists, including oncologists, radiologists, 5 and primary care teams and coordination of 6 care through the efficient use of primary care 7 teams and physician extenders; and 8 (C) the effectiveness of using telehealth 9 services to provide prostate cancer treatment in 10 medically underserved areas, including the use 11 of tumor boards to facilitate better patient 12 counseling. 13 (4) REPORT.—Not later than 12 months after 14 the completion of the pilot projects under this sub- 15 section, the Secretaries shall submit to Congress a 16 report describing the outcomes of such pilot projects, 17 including any cost savings and efficiencies realized, 18 and providing recommendations, if any, for expand- 19 ing the use of telehealth services. 20 (f) EDUCATION AND AWARENESS.— 21 (1) IN GENERAL.—The Secretary of Veterans 22 Affairs shall develop a national education campaign 23 for prostate cancer. Such campaign shall involve the 24 use of written educational materials and public serv- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00428 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 429 •HR 5294 IH ice announcements consistent with the findings of 1 the Prostate Cancer Task Force under subsection 2 (c), that are intended to encourage men to seek 3 prostate cancer screening when appropriate. 4 (2) RACIAL DISPARITIES AND THE POPULATION 5 OF MEN WITH A FAMILY HISTORY OF PROSTATE 6 CANCER.—In developing the national campaign 7 under paragraph (1), the Secretary shall ensure that 8 such educational materials and public service an- 9 nouncements are more readily available in commu- 10 nities experiencing racial disparities in the incidence 11 and mortality rates of prostate cancer and by men 12 of any race classification with a family history of 13 prostate cancer. 14 (3) GRANTS.—In carrying out the national 15 campaign under this section, the Secretary shall 16 award grants to nonprofit private entities to enable 17 such entities to test alternative outreach and edu- 18 cation strategies. 19 (g) AUTHORIZATION OF APPROPRIATIONS.— 20 (1) IN GENERAL.—There is authorized to be 21 appropriated to carry out this section for the period 22 of fiscal years 2015 through 2019 an amount equal 23 to the savings described in paragraph (2). 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00429 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 430 •HR 5294 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 2015 through 2019 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 2015, 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), (3), 21 and (5) of this subsection) to such commonwealth or 22 territory for such fiscal year.’’. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00430 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 431 •HR 5294 IH (2) TECHNICAL AMENDMENT.—Such section is 1 further amended by striking ‘‘(3), and (4)’’ and in- 2 serting ‘‘(3), and (5)’’. 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 2014. 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00431 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 432 •HR 5294 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, appropriate use of items and 12 services covered under the Medicare Program 13 under title XVIII of the Social Security Act (42 14 U.S.C. 1395 et seq.), and referral patterns with 15 respect to target individuals with cancer; 16 (C) eliminate disparities in the rate of pre- 17 ventive cancer screening measures, such as Pap 18 smears, prostate cancer screenings, colon cancer 19 screenings, breast cancer screenings, and com- 20 puted tomography (CT) scans, for lung cancer 21 among target individuals; 22 (D) promote collaboration with community- 23 based organizations to ensure cultural com- 24 petency of health care professionals and lin- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00432 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 433 •HR 5294 IH guistic access for target individuals who are 1 persons with limited-English proficiency; and 2 (E) encourage the incorporation of commu- 3 nity health workers to increase the efficiency 4 and appropriateness of cancer screening pro- 5 grams. 6 (2) COMMUNITY HEALTH WORKER DEFINED.— 7 In this section, the term ‘‘community health worker’’ 8 includes a community health advocate, a lay health 9 worker, a community health representative, a peer 10 health promotor, a community health outreach work- 11 er, and a promotore de salud, who promotes health 12 or nutrition within the community in which the indi- 13 vidual resides. 14 (3) TARGET INDIVIDUAL DEFINED.—In this 15 section, the term ‘‘target individual’’ means an indi- 16 vidual of a racial and ethnic minority group, as de- 17 fined in section 1707(g)(1) of the Public Health 18 Service Act (42 U.S.C. 300u–6(g)(1)), who is enti- 19 tled to benefits under part A, and enrolled under 20 part B, of title XVIII of the Social Security Act. 21 (b) PROGRAM DESIGN.— 22 (1) INITIAL DESIGN.—Not later than 1 year 23 after the date of the enactment of this Act, the Sec- 24 retary shall evaluate best practices in the private 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00433 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 434 •HR 5294 IH sector, community programs, and academic research 1 of methods that reduce disparities among individuals 2 of racial and ethnic minority groups in the preven- 3 tion and treatment of cancer and shall design the 4 demonstration projects based on such evaluation. 5 (2) NUMBER AND PROJECT AREAS.—Not later 6 than 2 years after the date of the enactment of this 7 Act, the Secretary shall implement at least nine 8 demonstration projects, including the following: 9 (A) Two projects, each of which shall tar- 10 get different ethnic subpopulations, for each of 11 the four following major racial and ethnic mi- 12 nority groups: 13 (i) American Indians and Alaska Na- 14 tives, Eskimos and Aleuts. 15 (ii) Asian-Americans. 16 (iii) Blacks/African-Americans. 17 (iv) Latinos or Hispanics. 18 (v) Native Hawaiians and other Pa- 19 cific Islanders. 20 (B) One project within the Pacific Islands 21 or United States insular areas. 22 (C) At least one project each in a rural 23 area and inner-city area. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00434 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 435 •HR 5294 IH (3) EXPANSION OF PROJECTS; IMPLEMENTA- 1 TION OF DEMONSTRATION PROJECT RESULTS.—If 2 the initial report under subsection (c) contains an 3 evaluation that demonstration projects— 4 (A) reduce expenditures under the Medi- 5 care Program under title XVIII of the Social 6 Security Act (42 U.S.C. 1395 et seq.); or 7 (B) do not increase expenditures under the 8 Medicare Program and reduce racial and ethnic 9 health disparities in the quality of health care 10 services provided to target individuals and in- 11 crease satisfaction of Medicare beneficiaries and 12 health care providers; 13 the Secretary shall continue the existing demonstra- 14 tion projects and may expand the number of dem- 15 onstration projects. 16 (c) REPORT TO CONGRESS.— 17 (1) IN GENERAL.—Not later than 2 years after 18 the date the Secretary implements the initial dem- 19 onstration projects, and biannually thereafter, the 20 Secretary shall submit to Congress a report regard- 21 ing the demonstration projects. 22 (2) CONTENTS OF REPORT.—Each report under 23 paragraph (1) shall include the following: 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00435 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 436 •HR 5294 IH (A) A description of the demonstration 1 projects. 2 (B) An evaluation of— 3 (i) the cost effectiveness of the dem- 4 onstration projects; 5 (ii) the quality of the health care serv- 6 ices provided to target individuals under 7 the demonstration projects; and 8 (iii) beneficiary and health care pro- 9 vider satisfaction under the demonstration 10 projects. 11 (C) Any other information regarding the 12 demonstration projects that the Secretary de- 13 termines to be appropriate. 14 (d) WAIVER AUTHORITY.—The Secretary shall waive 15 compliance with the requirements of title XVIII of the So- 16 cial Security Act (42 U.S.C. 1395 et seq.) to such extent 17 and for such period as the Secretary determines is nec- 18 essary to conduct demonstration projects. 19 SEC. 705. REDUCING CANCER DISPARITIES WITHIN MEDI- 20 CARE. 21 (a) DEVELOPMENT OF MEASURES OF DISPARITIES 22 IN QUALITY OF CANCER CARE.— 23 (1) DEVELOPMENT OF MEASURES.—The Sec- 24 retary of Health and Human Services (in this sec- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00436 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 437 •HR 5294 IH tion referred to as the ‘‘Secretary’’) shall enter into 1 an agreement with an entity that specializes in de- 2 veloping quality measures for cancer care under 3 which the entity shall develop a uniform set of meas- 4 ures to evaluate disparities in the quality of cancer 5 care and annually update such set of measures. 6 (2) MEASURES TO BE INCLUDED.—Such set of 7 measures shall include, with respect to the treatment 8 of cancer, measures of patient outcomes, the process 9 for delivering medical care related to such treat- 10 ment, patient counseling and engagement in deci- 11 sionmaking, patient experience of care, resource use, 12 and practice capabilities, such as care coordination. 13 (b) ESTABLISHMENT OF REPORTING PROCESS.— 14 (1) IN GENERAL.—The Secretary shall establish 15 a reporting process that requires and provides for a 16 method for health care providers specified under 17 paragraph (2) to submit to the Secretary and make 18 public data on the performance of such providers 19 during each reporting period through use of the 20 measures developed pursuant to subsection (a). Such 21 data shall be submitted in a form and manner and 22 at a time specified by the Secretary. 23 (2) SPECIFICATION OF PROVIDERS TO REPORT 24 ON MEASURES.—The Secretary shall specify the 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00437 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 438 •HR 5294 IH classes of Medicare providers of services and sup- 1 pliers, including hospitals, cancer centers, physi- 2 cians, primary care providers, and specialty pro- 3 viders, that will be required under such process to 4 publicly report on the measures specified under sub- 5 section (a). 6 (3) ASSESSMENT OF CHANGES.—Under such 7 reporting process, the Secretary shall establish a for- 8 mat that assesses changes in both the absolute and 9 relative disparities in cancer care over time. These 10 measures shall be presented in an easily comprehen- 11 sible format, such as those presented in the final 12 publications relating to Healthy People 2010 or the 13 National Healthcare Disparities Report. 14 (4) INITIAL IMPLEMENTATION.—The Secretary 15 shall implement the reporting process under this 16 subsection for reporting periods beginning not later 17 than 6 months after the date that measures are first 18 established under subsection (a). 19 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00438 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 439 •HR 5294 IH Subtitle B—Viral Hepatitis and 1 Liver Cancer Control and Pre- 2 vention 3 SEC. 711. VIRAL HEPATITIS AND LIVER CANCER CONTROL 4 AND PREVENTION. 5 (a) SHORT TITLE.—This subtitle may be cited as the 6 ‘‘Viral Hepatitis and Liver Cancer Control and Prevention 7 Act of 2014’’. 8 (b) FINDINGS.—Congress finds the following: 9 (1) Approximately 5,300,000 Americans are 10 chronically infected with the hepatitis B virus (re- 11 ferred to in this section as ‘‘HBV’’), the hepatitis C 12 virus (referred to in this section as ‘‘HCV’’), or 13 both. 14 (2) In the United States, chronic HBV and 15 HCV are the most common cause of liver cancer, 16 one of the most lethal and fastest growing cancers 17 in this country. It is the most common cause of 18 chronic liver disease, liver cirrhosis, and the most 19 common indication for liver transplantation. At least 20 15,000 deaths per year in the United States can be 21 attributed to chronic HBV and HCV. Chronic HCV 22 is also a leading cause of death in Americans living 23 with HIV/AIDS, many of those living with HIV/ 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00439 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 440 •HR 5294 IH AIDS are coinfected with chronic HBV, chronic 1 HCV, or both. 2 (3) According to the Centers for Disease Con- 3 trol and Prevention (referred to in this section as 4 the ‘‘CDC’’), approximately 2 percent of the popu- 5 lation of the United States is living with chronic 6 HBV, chronic HCV, or both. The CDC has recog- 7 nized HCV as the Nation’s most common chronic 8 bloodborne virus infection and HBV as the deadliest 9 vaccine-preventable disease. 10 (4) HBV is easily transmitted and is 100 times 11 more infectious than HIV. According to the CDC, 12 HBV is transmitted through contact with infectious 13 blood, semen, or other body fluids. HCV is trans- 14 mitted by contact with infectious blood, particularly 15 through percutaneous exposures (i.e. puncture 16 through the skin). 17 (5) The CDC conservatively estimates that in 18 2010 approximately 17,000 Americans were newly 19 infected with HCV and more than 35,000 Americans 20 were newly infected with HBV. These estimates 21 could be much higher due to many reasons, includ- 22 ing lack of screening education and awareness, and 23 perceived marginalization of the populations at risk. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00440 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 441 •HR 5294 IH (6) In 2012, CDC released new guidelines rec- 1 ommending every person born between 1945 and 2 1965 receive a one-time test. Among the estimated 3 102 million (1.6 million chronically HCV-infected) 4 eligible for screening, birth-cohort screening leads to 5 84,000 fewer cases of decompensated cirrhosis, 6 46,000 fewer cases of hepatocellular carcinoma, 7 10,000 fewer liver transplants, and 78,000 fewer 8 HCV-related deaths gained versus risk-based screen- 9 ing. 10 (7) In 2013, the United States Preventive Task 11 Force (USPSTF) issued a Grade B rating for 12 screening for the hepatitis C virus (HCV) infection 13 in persons at high risk for infection and adults born 14 between 1945 and 1965. In 2014, the USPSTF 15 issued a Grade B for screening for the hepatitis B 16 virus (HBV) in persons at high-risk of hepatitis B 17 infection. In 2009, the USPSTF issued a Grade A 18 for screening pregnant women for the hepatitis B 19 virus (HBV) during their first prenatal visit. 20 (8) There were 35 outbreaks (19 of HBV, 16 21 of HCV) reported to CDC for investigation from 22 2008 through 2012 related to health care acquired 23 infection of HBV and HCV, 33 of which occurred in 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00441 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 442 •HR 5294 IH nonhospital settings. There were more than 99,975 1 patients potentially exposed to one of the viruses. 2 (9) Chronic HBV and chronic HCV usually do 3 not cause symptoms early in the course of the dis- 4 ease, but after many years of a clinically ‘‘silent’’ 5 phase, CDC estimates show more than 33 percent of 6 infected individuals will develop cirrhosis, end-stage 7 liver disease, or liver cancer. Since most individuals 8 with chronic HBV, HCV, or both are unaware of 9 their infection, they do not know to take precautions 10 to prevent the spread of their infection and can un- 11 knowingly exacerbate their own disease progression. 12 (10) HBV and HCV disproportionately affect 13 certain populations in the United States. Although 14 representing only 6 percent of the population, Asian- 15 Americans and Pacific Islanders account for over 16 half of the 1,400,000 domestic chronic HBV cases. 17 Baby boomers (those born between 1945 and 1965) 18 account for more than half of domestic chronic hepa- 19 titis C cases. In addition, African-Americans, 20 Latinos (Latinas), and American Indian/Native 21 Alaskans are among the groups which have dis- 22 proportionately high rates of HBV and/or HCV in- 23 fections in the United States. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00442 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 443 •HR 5294 IH (11) For both chronic HBV and chronic HCV, 1 behavioral changes can slow disease progression if 2 diagnosis is made early. Early diagnosis, which is 3 determined through simple blood tests, can reduce 4 the risk of transmission and disease progression 5 through education and vaccination of household 6 members and other susceptible persons at risk. 7 (12) Advancements have led to the development 8 of improved diagnostic tests for viral hepatitis. 9 These tests, including rapid, point of care testing 10 and others in development, can facilitate testing, no- 11 tification of results and post-test counseling, and re- 12 ferral to care at the time of the testing visit. In par- 13 ticular, these tests are also advantageous because 14 they can be used simultaneously with HIV rapid 15 testing for persons at risk for both HCV and HIV 16 infections. 17 (13) For those chronically infected with HBV 18 or HCV, regular monitoring can lead to the early de- 19 tection of liver cancer at a stage where a cure is still 20 possible. Liver cancer is the second deadliest cancer 21 in the United States; however, liver cancer has re- 22 ceived little funding for research, prevention, or 23 treatment. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00443 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 444 •HR 5294 IH (14) Treatment for chronic HCV can eradicate 1 the disease in approximately 75 percent of those cur- 2 rently treated. The treatment of chronic HBV can 3 effectively suppress viral replication in the over- 4 whelming majority (over 80 percent) of those treat- 5 ed, thereby reducing the risk of transmission and 6 progression to liver scarring or liver cancer, even 7 though a complete cure is much less common than 8 for HCV. 9 (15) To combat the viral hepatitis epidemic in 10 the United States, in May 2011, the Department of 11 Health and Human Services released ‘‘Combating 12 the Silent Epidemic of Viral Hepatitis: Action Plan 13 for the Prevention, Care & Treatment of Viral Hepa- 14 titis’’ (hereafter referred to as the HHS Action 15 Plan). The Institute of Medicine (IOM) of the Na- 16 tional Academies produced a 2010 report on the 17 Federal response to HBV and HCV titled: ‘‘Hepa- 18 titis and Liver Cancer: A National Strategy for Pre- 19 vention and Control of Hepatitis B and C’’. These 20 recommendations and guidelines provide a frame- 21 work for HBV and HCV prevention, education, con- 22 trol, research, and medical management programs. 23 (16) The annual health care costs attributable 24 to HBV and HCV in the United States are signifi- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00444 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 445 •HR 5294 IH cant. For HBV, it is estimated to be approximately 1 $2,500,000,000 ($2,000 per infected person). In 2 2000, the lifetime cost of HBV—-before the avail- 3 ability of most current therapies—-was approxi- 4 mately $80,000 per chronically infected person, to- 5 taling more than $100,000,000,000. For HCV, med- 6 ical costs for patients are expected to increase from 7 $30,000,000,000 in 2009 to over $85,000,000,000 8 in 2024. Avoiding these costs by screening and diag- 9 nosing individuals earlier—and connecting them to 10 appropriate treatment and care, will save lives and 11 critical health care dollars. Currently, without a 12 comprehensive screening, testing, and diagnosis pro- 13 gram, most patients are diagnosed too late when 14 they need a liver transplant costing at least 15 $314,000 for uncomplicated cases or when they have 16 liver cancer or end stage liver disease which costs 17 $30,980 to $110,576 per hospital admission. As 18 health care costs continue to grow, it is critical that 19 the Federal Government invests in effective mecha- 20 nisms to avoid documented cost drivers. 21 (17) According to the IOM report in 2010 (de- 22 scribed in paragraph (15)), chronic HBV and HCV 23 infections cause substantial morbidity and mortality 24 despite being preventable and treatable. Deficiencies 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00445 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 446 •HR 5294 IH in the implementation of established guidelines for 1 the prevention, diagnosis, and medical management 2 of chronic HBV and HCV infections perpetuate per- 3 sonal and economic burdens. Existing grants are not 4 sufficient for the scale of the health burden pre- 5 sented by HBV and HCV. 6 (18) Screening and testing for HBV and HCV 7 is aligned with the Healthy People 2020 goal to in- 8 crease immunization rates and reduce preventable 9 infectious diseases. Awareness of disease and access 10 to prevention and treatment remain essential compo- 11 nents for reducing infectious disease transmission. 12 (19) Federal support is necessary to increase 13 knowledge and awareness of HBV and HCV and to 14 assist State and local prevention and control efforts 15 in reducing the morbidity and mortality of these 16 epidemics. 17 (20) The Secretary of Health and Human Serv- 18 ices has the discretion to carry out this Act directly 19 and through whichever of the agencies of the Public 20 Health Service the Secretary determines to be ap- 21 propriate, which may (in the Secretary’s discretion) 22 include the Centers for Disease Control and Preven- 23 tion, the Health Resources and Services Administra- 24 tion, the Substance Abuse and Mental Health Serv- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00446 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 447 •HR 5294 IH ices Administration, the National Institutes of 1 Health (including the National Institute on Minority 2 Health and Health Disparities), and other agencies 3 of such Service. 4 (c) BIENNIAL ASSESSMENT OF HHS HEPATITIS B 5 AND HEPATITIS C PREVENTION, EDUCATION, RESEARCH, 6 AND MEDICAL MANAGEMENT PLAN.—Title III of the 7 Public Health Service Act (42 U.S.C. 241 et seq.) is 8 amended— 9 (1) by striking section 317N (42 U.S.C. 247b– 10 15); and 11 (2) by adding at the end the following: 12 ‘‘PART W—BIENNIAL ASSESSMENT OF HHS HEPA- 13 TITIS B AND HEPATITIS C PREVENTION, EDU- 14 CATION, RESEARCH, AND MEDICAL MANAGE- 15 MENT PLAN 16 ‘‘SEC. 399NN. BIENNIAL UPDATE OF THE PLAN. 17 ‘‘(a) IN GENERAL.—The Secretary shall conduct a bi- 18 ennial assessment of the Secretary’s plan for the preven- 19 tion, control, and medical management of, and education 20 and research relating to, hepatitis B and hepatitis C, for 21 the purposes of— 22 ‘‘(1) incorporating into such plan new knowl- 23 edge or observations relating to hepatitis B and hep- 24 atitis C (such as knowledge and observations that 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00447 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 448 •HR 5294 IH may be derived from clinical, laboratory, and epide- 1 miological research and disease detection, preven- 2 tion, and surveillance outcomes); 3 ‘‘(2) addressing gaps in the coverage or effec- 4 tiveness of the plan; and 5 ‘‘(3) evaluating and, if appropriate, updating 6 recommendations, guidelines, or educational mate- 7 rials of the Centers for Disease Control and Preven- 8 tion or the National Institutes of Health for health 9 care providers or the public on viral hepatitis in 10 order to be consistent with the plan. 11 ‘‘(b) PUBLICATION OF NOTICE OF ASSESSMENTS.— 12 Not later than October 1 of the first even-numbered year 13 beginning after the date of the enactment of this part, 14 and October 1 of each even-numbered year thereafter, the 15 Secretary shall publish in the Federal Register a notice 16 of the results of the assessments conducted under para- 17 graph (1). Such notice shall include— 18 ‘‘(1) a description of any revisions to the plan 19 referred to in subsection (a) as a result of the as- 20 sessment; 21 ‘‘(2) an explanation of the basis for any such 22 revisions, including the ways in which such revisions 23 can reasonably be expected to further promote the 24 original goals and objectives of the plan; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00448 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 449 •HR 5294 IH ‘‘(3) in the case of a determination by the Sec- 1 retary that the plan does not need revision, an expla- 2 nation of the basis for such determination. 3 ‘‘SEC. 399NN–1. ELEMENTS OF PROGRAM. 4 ‘‘(a) EDUCATION AND AWARENESS PROGRAMS.—The 5 Secretary, acting through the Director of the Centers for 6 Disease Control and Prevention, the Administrator of the 7 Health Resources and Services Administration, and the 8 Administrator of the Substance Abuse and Mental Health 9 Services Administration, and in accordance with the plan 10 referred to in section 399NN(a), shall implement pro- 11 grams to increase awareness and enhance knowledge and 12 understanding of hepatitis B and hepatitis C. Such pro- 13 grams shall include— 14 ‘‘(1) the conduct of culturally and language ap- 15 propriate health education in primary and secondary 16 schools, college campuses, public awareness cam- 17 paigns, and community outreach activities (especially 18 to the ethnic communities with high rates of chronic 19 hepatitis B and chronic hepatitis C and other high- 20 risk groups) to promote public awareness and knowl- 21 edge about the value of hepatitis A and hepatitis B 22 immunization, risk factors, the transmission and 23 prevention of hepatitis B and hepatitis C, the value 24 of screening for the early detection of hepatitis B 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00449 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 450 •HR 5294 IH and hepatitis C, and options available for the treat- 1 ment of chronic hepatitis B and chronic hepatitis C; 2 ‘‘(2) the promotion of immunization programs 3 that increase awareness and access to hepatitis A 4 and hepatitis B vaccines for susceptible adults and 5 children; 6 ‘‘(3) the training of health care professionals 7 regarding the importance of vaccinating individuals 8 infected with hepatitis C and individuals who are at 9 risk for hepatitis C infection against hepatitis A and 10 hepatitis B; 11 ‘‘(4) the training of health care professionals 12 regarding the importance of vaccinating individuals 13 chronically infected with hepatitis B and individuals 14 who are at risk for chronic hepatitis B infection 15 against the hepatitis A virus; 16 ‘‘(5) the training of health care professionals 17 and health educators to make them aware of the 18 high rates of chronic hepatitis B and chronic hepa- 19 titis C in certain adult ethnic populations, and the 20 importance of prevention, detection, and medical 21 management of hepatitis B and hepatitis C and of 22 liver cancer screening; 23 ‘‘(6) the development and distribution of health 24 education curricula (including information relating 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00450 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 451 •HR 5294 IH to the special needs of individuals infected with hep- 1 atitis B and hepatitis C, such as the importance of 2 prevention and early intervention, regular moni- 3 toring, the recognition of psychosocial needs, appro- 4 priate treatment, and liver cancer screening) for in- 5 dividuals providing hepatitis B and hepatitis C coun- 6 seling; and 7 ‘‘(7) support for the implementation curricula 8 described in paragraph (6) by State and local public 9 health agencies. 10 ‘‘(b) IMMUNIZATION, PREVENTION, AND CONTROL 11 PROGRAMS.— 12 ‘‘(1) IN GENERAL.—The Secretary, acting 13 through the Director of the Centers for Disease 14 Control and Prevention, shall support the integra- 15 tion of activities described in paragraph (3) into ex- 16 isting clinical and public health programs at State, 17 local, territorial, and tribal levels (including commu- 18 nity health clinics, programs for the prevention and 19 treatment of HIV/AIDS, sexually transmitted dis- 20 eases, and substance abuse, and programs for indi- 21 viduals in correctional settings). 22 ‘‘(2) COORDINATION OF DEVELOPMENT OF 23 FEDERAL SCREENING GUIDELINES.— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00451 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 452 •HR 5294 IH ‘‘(A) REFERENCES.—For purposes of this 1 subsection, the term ‘CDC Director’ means the 2 Director of the Centers for Disease Control and 3 Prevention, and the term ‘AHRQ Director’ 4 means the Director of the Agency for 5 Healthcare Research and Quality. 6 ‘‘(B) AGENCY FOR HEALTHCARE RE- 7 SEARCH AND QUALITY.—Due to the rapidly 8 evolving standard of care associated with diag- 9 nosing and treating viral hepatitis infection, the 10 AHRQ Director shall convene the Preventive 11 Services Task Force under section 915(a) of 12 the Public Health Service Act to review its rec- 13 ommendation for screening for HBV and HCV 14 infection every 3 years. 15 ‘‘(3) 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00452 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 453 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00453 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 454 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00454 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 455 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00455 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 456 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00456 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 457 •HR 5294 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 ‘‘(4) 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00457 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 458 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00458 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 459 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00459 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 460 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00460 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 461 •HR 5294 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 2015, $90,000,000 15 for fiscal year 2016, $110,000,000 for fiscal year 2017, 16 $130,000,000 for fiscal year 2018, and $150,000,000 for 17 fiscal year 2019.’’. 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00461 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 462 •HR 5294 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 2014’’. 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00462 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 463 •HR 5294 IH minority populations, particularly in Asian-American 1 and Latino or Hispanic 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00463 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 464 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00464 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 465 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00465 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 466 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00466 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 467 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00467 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 468 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00468 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 469 •HR 5294 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 2015 through 2019.’’. 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00469 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 470 •HR 5294 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 2015 11 through 2019. 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00470 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 471 •HR 5294 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 12 supported under section 1707(b)(8) (including by 13 means of the Center’s Web site, through appropriate 14 locations 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00471 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 472 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00472 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 473 •HR 5294 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 2015 through 2019.’’. 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 2015 17 through 2019. 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00473 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 474 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00474 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 475 •HR 5294 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 including oral cancer; 23 (15) environmental and related health illnesses 24 and conditions; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00475 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 476 •HR 5294 IH (16) Sickle cell disease; 1 (17) violence and injury prevention and control; 2 (18) genetic and related conditions; 3 (19) heart disease and stroke; 4 (20) tuberculosis; 5 (21) chronic obstructive pulmonary disease; 6 (22) musculoskeletal diseases, arthritis, and 7 obesity; and 8 (23) other diseases determined appropriate by 9 the Secretary. 10 (d) DISSEMINATION.—Not later than 24 months 11 after the date of enactment of this title, the Secretary 12 shall publish and disseminate to health care provider orga- 13 nizations the guidelines developed under subsection (a). 14 (e) 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 2015 through 2019. 18 SEC. 732. CDC WISEWOMAN SCREENING PROGRAM. 19 Section 1509 of the Public Health Service Act (42 20 U.S.C. 300n–4a) is amended— 21 (1) in subsection (a)— 22 (A) by striking the heading and inserting 23 ‘‘IN GENERAL.—’’; and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00476 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 477 •HR 5294 IH (B) in the matter preceding paragraph (1), 1 by striking ‘‘may make grants’’ and all that fol- 2 lows through ‘‘purpose’’ and inserting the fol- 3 lowing: ‘‘may make grants to such States for 4 the purpose’’; and 5 (2) in subsection (d)(1), by striking ‘‘there are 6 authorized’’ and all that follows through the period 7 and inserting ‘‘there are authorized to be appro- 8 priated $23,000,000 for fiscal year 2015, 9 $25,300,000 for fiscal year 2016, $27,800,000 for 10 fiscal year 2017, $30,800,000 for fiscal year 2018, 11 and $34,000,000 for fiscal year 2019.’’. 12 SEC. 733. REPORT ON CARDIOVASCULAR CARE FOR WOMEN 13 AND MINORITIES. 14 Part P of title III of the Public Health Service Act 15 (42 U.S.C. 280g et seq.) is amended by adding at the end 16 the following: 17 ‘‘SEC. 399V–6. REPORT ON CARDIOVASCULAR CARE FOR 18 WOMEN AND MINORITIES. 19 ‘‘Not later than September 30, 2015, and annually 20 thereafter, the Secretary shall prepare and submit to the 21 Congress a report on the quality of and access to care 22 for women and minorities with heart disease, stroke, and 23 other cardiovascular diseases. The report shall contain rec- 24 ommendations for eliminating disparities in, and improv- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00477 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 478 •HR 5294 IH ing the treatment of, heart disease, stroke, and other car- 1 diovascular diseases in women, racial and ethnic minori- 2 ties, those for whom English is not their primary lan- 3 guage, and individuals with disabilities.’’. 4 SEC. 734. COVERAGE OF COMPREHENSIVE TOBACCO CES- 5 SATION SERVICES IN MEDICAID. 6 (a) REQUIRING COVERAGE OF COUNSELING AND 7 PHARMACOTHERAPY FOR CESSATION OF TOBACCO 8 USE.—Section 1905 of the Social Security Act (42 U.S.C. 9 1396d) is amended— 10 (1) in subsection (a)(4)(D) is amended by strik- 11 ing ‘‘by pregnant women’’; and 12 (2) in subsection (bb)— 13 (A) by striking ‘‘by pregnant women’’ each 14 place it appears; 15 (B) in paragraph (1), in the matter before 16 subparagraph (A), by inserting ‘‘by individuals’’ 17 before ‘‘who use tobacco’’; and 18 (C) in paragraph (2)(A), by striking ‘‘with 19 respect to pregnant women’’. 20 (b) EXCEPTION FROM OPTIONAL RESTRICTION 21 UNDER MEDICAID PRESCRIPTION DRUG COVERAGE.— 22 Section 1927(d)(2)(F) of the Social Security Act (42 23 U.S.C. 1396r–8(d)(2)(F)) is amended by striking ‘‘in the 24 case of pregnant women’’. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00478 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 479 •HR 5294 IH (c) REMOVAL OF COST SHARING FOR COUNSELING 1 AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO 2 USE.— 3 (1) GENERAL COST SHARING LIMITATIONS.— 4 Section 1916 of the Social Security Act (42 U.S.C. 5 1396o) is amended— 6 (A) in subsections (a)(2)(B) and (b)(2)(B), 7 by striking ‘‘and counseling and 8 pharmacotherapy for cessation of tobacco use 9 by pregnant women (as defined in section 10 1905(bb)) and covered outpatient drugs (as de- 11 fined in subsection (k)(2) of section 1927 and 12 including nonprescription drugs described in 13 subsection (d)(2) of such section) that are pre- 14 scribed for purposes of promoting, and when 15 used to promote, tobacco cessation by pregnant 16 women in accordance with the Guideline re- 17 ferred to in section 1905(bb)(2)(A)’’ each place 18 it appears; and 19 (B) in each of subsections (a)(2)(D) and 20 (b)(2)(D) by inserting ‘‘and counseling and 21 pharmacotherapy for cessation of tobacco use 22 (as defined in section 1905(bb)) and covered 23 outpatient drugs (as defined in subsection 24 (k)(2) of section 1927 and including non- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00479 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 480 •HR 5294 IH prescription drugs described in subsection 1 (d)(2) of such section) that are prescribed for 2 purposes of promoting, and when used to pro- 3 mote, tobacco cessation in accordance with the 4 Guideline referred to in section 5 1905(bb)(2)(A),’’ after ‘‘section 6 1905(a)(4)(C),’’. 7 (2) APPLICATION TO ALTERNATIVE COST SHAR- 8 ING.—Section 1916A(b)(3)(B) of such Act (42 9 U.S.C. 1396o–1(b)(3)(B)42 U.S.C. 1396o– 10 1(b)(3)(B)) is amended— 11 (A) in clause (iii), by striking ‘‘, and coun- 12 seling and pharmacotherapy for cessation of to- 13 bacco use by pregnant women (as defined in 14 section 1905(bb))’’; and 15 (B) by adding at the end the following: 16 ‘‘(xi) Counseling and pharmacothera- 17 py for cessation of tobacco use (as defined 18 in section 1905(bb)) and covered out- 19 patient drugs (as defined in subsection 20 (k)(2) of section 1927 and including non- 21 prescription drugs described in subsection 22 (d)(2) of such section) that are prescribed 23 for purposes of promoting, and when used 24 to promote, tobacco cessation in accord- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00480 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 481 •HR 5294 IH ance with the Guideline referred to in sec- 1 tion 1905(bb)(2)(A).’’. 2 (d) EFFECTIVE DATE.—The amendments made by 3 this section shall take effect on October 1, 2014. 4 SEC. 735. CLINICAL RESEARCH FUNDING FOR ORAL 5 HEALTH. 6 (a) IN GENERAL.—The Secretary of Health and 7 Human Services shall expand and intensify the conduct 8 and support of the research activities of the National In- 9 stitutes of Health and the National Institute of Dental 10 and Craniofacial Research to improve the oral health of 11 the population through the prevention and management 12 of oral diseases and conditions. 13 (b) INCLUDED RESEARCH ACTIVITIES.—Research 14 activities under subsection (a) shall include— 15 (1) comparative effectiveness research and clin- 16 ical disease management research addressing early 17 childhood caries and oral cancer; and 18 (2) awarding of grants and contracts to support 19 the training and development of health services re- 20 searchers, comparative effectiveness researchers, and 21 clinical researchers whose research improves the oral 22 health of the population. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00481 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 482 •HR 5294 IH SEC. 736. PARTICIPATION BY MEDICAID BENEFICIARIES IN 1 APPROVED CLINICAL TRIALS. 2 (a) IN GENERAL.—Title XIX of the Social Security 3 Act (42 U.S.C. 1396 et seq.) is amended by inserting after 4 section 1943 the following new section: 5 ‘‘SEC. 1944. PARTICIPATION IN AN APPROVED CLINICAL 6 TRIAL. 7 ‘‘(a) COVERAGE OF ROUTINE PATIENT COSTS ASSO- 8 CIATED WITH APPROVED CLINICAL TRIALS.— 9 ‘‘(1) INCLUSION.—Subject to paragraph (2), 10 routine patient costs shall include all items and serv- 11 ices consistent with the medical assistance provided 12 under the State plan that would otherwise be pro- 13 vided to the individual under such State plan if such 14 individual was not enrolled in an approved clinical 15 trial, including any items or services related to the 16 prevention, detection, and treatment of any medical 17 complications that arise as a result of participation 18 in the approved clinical trial. 19 ‘‘(2) EXCLUSION.—For purposes of paragraph 20 (1), routine patient costs does not include— 21 ‘‘(A) the investigational item, device, or 22 service itself; 23 ‘‘(B) items and services that are provided 24 solely to satisfy data collection and analysis 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00482 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 483 •HR 5294 IH needs and that are not used in the direct clin- 1 ical management of the patient; or 2 ‘‘(C) a service that is clearly inconsistent 3 with widely accepted and established standards 4 of care for a particular diagnosis. 5 ‘‘(3) INFORMATION CONCERNING CLINICAL 6 TRIALS.— 7 ‘‘(A) IN GENERAL.—Subject to subpara- 8 graph (B), the Secretary, in consultation with 9 relevant stakeholders, shall develop a single 10 standardized electronic form for use by the indi- 11 vidual or the referring health care provider to 12 submit to the State agency administering the 13 State plan in order to verify that the clinical 14 trial meets the conditions established for an ap- 15 proved clinical trial (as defined in subsection 16 (c)). 17 ‘‘(B) EXCLUDED INFORMATION.—For pur- 18 poses of subparagraph (A) or any such request 19 by the State agency for information regarding 20 a clinical trial, an individual or referring health 21 care provider shall not be required to submit— 22 ‘‘(i) the clinical protocol document for 23 the clinical trial; or 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00483 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 484 •HR 5294 IH ‘‘(ii) subject to subparagraph (C), any 1 additional information other than such in- 2 formation as is required pursuant to the 3 form described in subparagraph (A). 4 ‘‘(C) OPTIONAL INFORMATION.—For pur- 5 poses of subparagraphs (A) and (B)(ii), the 6 form may include a requirement that the refer- 7 ring health care provider attest that the indi- 8 vidual is eligible to participate in the clinical 9 trial pursuant to the trial protocol and that 10 their participation in such trial would be appro- 11 priate. 12 ‘‘(D) REVIEW OF INFORMATION.— 13 ‘‘(i) IN GENERAL.—A State plan 14 under this title shall establish a process for 15 timely review by the State agency of the 16 form and information submitted pursuant 17 to subparagraph (A) and, not later than 18 48 hours after receipt of such form, con- 19 firmation that the information provided in 20 such form satisfies the requirements estab- 21 lished under such subparagraph, with such 22 process to include establishment and oper- 23 ation of a 24-hour, toll-free telephone num- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00484 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 485 •HR 5294 IH ber and e-mail address to provide for expe- 1 dited communication. 2 ‘‘(ii) FAILURE TO RESPOND.—If an 3 individual or the referring health care pro- 4 vider does not receive a response or re- 5 quest for additional information from the 6 State agency following the 48-hour period 7 described in clause (i), the information 8 provided in the form may be presumed to 9 satisfy the requirements established under 10 this paragraph. 11 ‘‘(b) ENCOURAGEMENT OF PARTICIPATION IN AP- 12 PROVED CLINICAL TRIALS.— 13 ‘‘(1) REASONABLY ACCESSIBLE PROVIDER.— 14 For purposes of participation in an approved clinical 15 trial by an individual eligible for medical assistance 16 under this title, the State agency administering the 17 State plan shall make reasonable efforts to ensure 18 that the individual is provided with access to a pro- 19 vider who is— 20 ‘‘(A) participating in the approved clinical 21 trial; 22 ‘‘(B) located not more than 25 miles from 23 the residence of the individual (or, if no such 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00485 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 486 •HR 5294 IH provider is available, as close as possible to the 1 residence of the individual); and 2 ‘‘(C) a participating provider under the 3 State plan or has been deemed to be a partici- 4 pating provider under the State plan for pur- 5 poses of providing medical assistance to the in- 6 dividual during their participation in the ap- 7 proved clinical trial. 8 ‘‘(2) INFORMATIONAL MATERIALS.—The State 9 agency administering the plan approved under this 10 title shall develop informational materials and pro- 11 grams to encourage participating providers to make 12 appropriate referrals to physicians and other appro- 13 priate health care professionals who can provide in- 14 dividuals with access to approved clinical trials. 15 ‘‘(c) DEFINITION OF APPROVED CLINICAL TRIAL.— 16 The term ‘approved clinical trial’ has the same meaning 17 as provided under section 2709(d) of the Public Health 18 Service Act.’’. 19 (b) CONFORMING AMENDMENT.—Section 1902(a) of 20 such Act (42 U.S.C. 1396a(a)) is amended by inserting 21 after paragraph (77) the following new paragraph: 22 ‘‘(78) provide that participation in an approved 23 clinical trial and coverage of routine patient costs 24 associated with such trial for an individual eligible 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00486 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 487 •HR 5294 IH for medical assistance under this title is conducted 1 in accordance with the requirements under section 2 1944;’’. 3 (c) EFFECTIVE DATE.— 4 (1) IN GENERAL.—Except as provided in para- 5 graph (2), the amendments made by this section 6 shall apply to calendar quarters beginning on or 7 after October 1, 2014. 8 (2) DELAY PERMITTED FOR STATE PLAN 9 AMENDMENT.—In the case of a State plan for med- 10 ical assistance under title XIX of the Social Security 11 Act which the Secretary of Health and Human Serv- 12 ices determines requires State legislation (other than 13 legislation appropriating funds) in order for the plan 14 to meet the additional requirements imposed by the 15 amendments made by this section, the State plan 16 shall not be regarded as failing to comply with the 17 requirements of such title solely on the basis of its 18 failure to meet these additional requirements before 19 the first day of the first calendar quarter beginning 20 after the close of the first regular session of the 21 State legislature that begins after the date of enact- 22 ment of this Act. For purposes of the previous sen- 23 tence, in the case of a State that has a 2-year legis- 24 lative session, each year of such session shall be 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00487 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 488 •HR 5294 IH deemed to be a separate regular session of the State 1 legislature. 2 Subtitle E—HIV/AIDS 3 SEC. 741. STATEMENT OF POLICY. 4 It is the policy of the United States to achieve an 5 AIDS-free generation, and to— 6 (1) expand access to lifesaving antiretroviral 7 therapy for people living with HIV/AIDS and imme- 8 diately link people to continuous and coordinated 9 high-quality care when they learn they are infected 10 with HIV; 11 (2) expand targeted efforts to prevent HIV in- 12 fection using a combination of effective, evidence- 13 based approaches, including routine HIV screening, 14 and universal access to HIV prevention tools in the 15 communities where HIV/AIDS is most heavily con- 16 centrated, particularly communities of color; 17 (3) ensure laws, policies, and regulations do not 18 impede access to prevention, treatment, and care for 19 people living with HIV/AIDS or at risk for acquiring 20 HIV; 21 (4) accelerate research for more efficacious HIV 22 prevention and treatments tools, a cure, and a vac- 23 cine; and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00488 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 489 •HR 5294 IH (5) respect the human rights and dignity of 1 persons living with HIV/AIDS. 2 SEC. 742. FINDINGS. 3 The Congress finds the following: 4 (1) Over one million people are estimated to be 5 living with HIV in the United States according to 6 the Centers for Disease Control and Prevention, 18 7 percent of whom are unaware of their HIV-positive 8 status. 9 (2) Annually there are over 50,000 new HIV in- 10 fections and 20,000 deaths in people with an HIV 11 diagnoses in 50 States and 6 dependent areas of the 12 United States. 13 (3) The Centers for Disease Control and Pre- 14 vention estimates that in 2011 there were approxi- 15 mately 50,199 people newly diagnosed with HIV. 16 Though this number seems to be staying relatively 17 stable, the number of new infections is rapidly in- 18 creasing among certain populations especially among 19 young African-American men who have sex with men 20 (MSM) who, in 2010, accounted for 45 percent of 21 new HIV infections among black MSM and 55 per- 22 cent of HIV infections among young MSM overall. 23 (4) HIV disproportionately affects certain popu- 24 lations in the United States. Though African-Ameri- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00489 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 490 •HR 5294 IH cans represent less than 13 percent of the popu- 1 lation, African-Americans account for almost half 2 (44 percent) of all people living with HIV in the 3 United States. Men who have sex with men (MSM) 4 make up approximately 4 percent of the population, 5 but account for 63 percent of all new HIV infections 6 and are the only risk group in which HIV infections 7 continue to increase. 8 (5) Disparities exist among Latinos/Hispanics; 9 they make up 16 percent of US population and 22 10 percent of new infections (2011). 11 (6) Though American Indians/Alaska Natives 12 represent less than 2 percent of the total number of 13 HIV/AIDS cases, American Indians and Alaska Na- 14 tives rank fifth in rates of HIV/AIDS diagnosis, still 15 higher than their White counterparts. 16 (7) While Asian-Americans, Native Hawaiians, 17 and Pacific Islanders HIV/AIDS cases account for 18 approximately 1 percent of cases nationally, between 19 2010 and 2011, the rate of new HIV diagnoses in- 20 creased for Asian-Americans by 22 percent. 21 (8) The latest data from the CDC (2013) indi- 22 cate that women account for 1 in 5 (20 percent) new 23 HIV infections in the United States women of color, 24 particularly Black women, have been especially hard 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00490 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 491 •HR 5294 IH hit and represent the majority of women living with 1 the disease and women newly infected. In addition, 2 Black women accounted for nearly two-thirds (64 3 percent) of all estimated new HIV infections among 4 women, while only accounting for 13 percent of the 5 female population; White women accounted for 18 6 percent and Latinas 15 percent of new infections. 7 (9) The history of HIV shows that culturally 8 relevant and gender-responsive supportive services, 9 including psychosocial support, treatment literacy, 10 case management, and transportation are necessary 11 strategies to reach and engage women and girls in 12 medical care. 13 (10) The limited data available on transgender 14 individuals point to a disproportionate burden of 15 HIV infection. 16 (11) Stigma and discrimination contribute to 17 these disparities. 18 (12) The Centers for Disease Control and Pre- 19 vention has determined that increasing the propor- 20 tion of people who know their HIV status is an es- 21 sential component of comprehensive HIV/AIDS 22 treatment and prevention efforts and that early di- 23 agnosis is critical in order for people with HIV/ 24 AIDS to receive life-extending therapy. Additionally, 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00491 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 492 •HR 5294 IH the Centers for Disease Control and Prevention rec- 1 ommend routine HIV screening in health care set- 2 tings for all patients aged 13 to 64, regardless of 3 risk. 4 (13) In 1998, Congress created the National 5 Minority AIDS Initiative to provide technical assist- 6 ance, build capacity, and strengthen outreach efforts 7 among local institutions and community-based orga- 8 nizations that serve racial and ethnic minorities liv- 9 ing with or vulnerable to HIV/AIDS. 10 (14) To combat the HIV epidemic in the United 11 States, the National HIV/AIDS Strategy (NHAS) 12 from the White House Office of National AIDS Pol- 13 icy provides a framework of increasing access to 14 care, reducing new infections, and eliminating HIV- 15 related health disparities. The vision of NHAS is 16 ‘‘The United States will become a place where new 17 HIV infections are rare and when they do occur, 18 every person, regardless of age, gender, race/eth- 19 nicity, gender identity, or socioeconomic cir- 20 cumstance, will have unfettered access to high qual- 21 ity, life-extending care, free from stigma and dis- 22 crimination.’’. 23 (15) In recent years, several thousand people 24 across the country were waiting to receive AIDS 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00492 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 493 •HR 5294 IH treatment through the AIDS Drug Assistance Pro- 1 gram authorized by the provisions popularly known 2 as the Ryan White CARE Act. 3 (16) At present, 34 States and 2 United States 4 territories have criminal statutes based on ‘‘expo- 5 sure’’ to HIV. Most of these laws were adopted be- 6 fore the availability of effective antiretroviral treat- 7 ment for HIV/AIDS. 8 (17) Although the cost of education, treatment 9 and care, and research are not inconsequential, they 10 are substantially less than the annual health care 11 cost attributable to HIV in the United States. The 12 lifetime cost of HIV care and treatment in 2004 was 13 estimated to be $405,000 to $648,000 annually. 14 Preventing 40,000 new infections in the United 15 States each year would save $12.8 billion annually. 16 (18) According to the Centers for Disease Con- 17 trol and Prevention (CDC), latex condoms, when 18 used consistently and correctly, are highly effective 19 in preventing the transmission of HIV. Latex 20 condoms also reduce the risk of other STIs. Despite 21 the effectiveness of condoms in reducing the spread 22 of STIs, the Bureau of Prisons does not recommend 23 their use in correctional facilities. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00493 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 494 •HR 5294 IH (19) The distribution of condoms in correctional 1 facilities is currently legal in certain parts of the 2 United States and the world. The States of Vermont 3 and Mississippi, the District of Columbia, and the 4 cities of New York, San Francisco, Los Angeles, 5 Washington, DC, and Philadelphia allow condom 6 distribution in their correctional facilities. However, 7 these States and cities operate fewer than 1 percent 8 of all correctional facilities. 9 (20) Many correctional facilities in the United 10 States do not provide comprehensive testing and 11 treatment programs to reduce the spread of STIs. 12 Fewer than half of correctional facilities provide 13 counseling to HIV-positive incarcerated persons. 14 (21) Incarcerated individuals living with HIV/ 15 AIDS who are eligible for Medicaid would benefit 16 from prompt and automatic enrollment upon their 17 release in order to ensure their continued ability to 18 access health services, including antiretroviral treat- 19 ment. 20 (22) Research shows that stable housing leads 21 to better health outcomes for those living with HIV. 22 Inadequate or unstable housing is not only a barrier 23 to effective treatment, but also increases the likeli- 24 hood of engaging in risky behaviors leading to HIV 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00494 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 495 •HR 5294 IH infection. Insecure housing puts people with HIV/ 1 AIDS at risk of premature death from exposure to 2 other diseases, poor nutrition, and lack of medical 3 care. 4 (23) Due to advances in treatment, many peo- 5 ple living with HIV/AIDS (PLWHA) today are liv- 6 ing healthy lives and have the ability and desire to 7 fully participate in all aspects of community life, in- 8 cluding employment. Research associates being em- 9 ployed with tremendous economic, social, and health 10 benefits for many people living with HIV/AIDS. 11 (24) The common benefits associated with em- 12 ployment include income, autonomy, productivity, 13 and status within society, daily structure, making a 14 contribution to one’s community, and increased skills 15 and self-esteem. Research also indicates that many 16 people with disabilities, including PLWHA, report 17 perceiving themselves as being less disabled or not 18 disabled at all, when working. Furthermore, some 19 studies link working with better physical and mental 20 health outcomes for PLWHA when compared to 21 those who are not working. Preliminary data also 22 suggest that transitioning to employment is associ- 23 ated with reduced HIV-related health risk behavior 24 for many people. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00495 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 496 •HR 5294 IH (25) On July 16, 2012, the Food and Drug Ad- 1 ministration approved the first drug to reduce the 2 risk of HIV infection in uninfected individuals who 3 are at high risk of HIV infection and who may en- 4 gage in sexual activity with HIV-infected partners. 5 SEC. 743. ADDITIONAL FUNDING FOR AIDS DRUG ASSIST- 6 ANCE PROGRAM TREATMENTS. 7 Section 2623 of the Public Health Service Act (42 8 U.S.C. 300ff–31b) is amended by adding at the end the 9 following: 10 ‘‘(c) ADDITIONAL FUNDING FOR AIDS DRUG AS- 11 SISTANCE PROGRAM TREATMENTS.—In addition to 12 amounts otherwise authorized to be appropriated for car- 13 rying out this subpart, there are authorized to be appro- 14 priated such sums as may be necessary to carry out sec- 15 tions 2612(b)(3)(B) and 2616 for each of fiscal years 16 2015 through 2017.’’. 17 SEC. 744. ENHANCING THE NATIONAL HIV SURVEILLANCE 18 SYSTEM. 19 (a) GRANTS.—The Secretary of Health and Human 20 Services, acting through the Director of the Centers for 21 Disease Control and Prevention, shall make grants to 22 States to support integration of public health surveillance 23 systems into all electronic health records in order to allow 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00496 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 497 •HR 5294 IH rapid communications between the clinical setting and 1 health departments, by means that include— 2 (1) providing technical assistance and policy 3 guidance to State and local health departments, clin- 4 ical providers, and other agencies serving individuals 5 with HIV to improve the interoperability of data sys- 6 tems relevant to monitoring HIV care and sup- 7 portive services; 8 (2) capturing longitudinal data pertaining to 9 the initiation and ongoing prescription or dispensing 10 of antiretroviral therapy for individuals diagnosed 11 with HIV (such as through pharmacy-based report- 12 ing); 13 (3) obtaining information— 14 (A) on a voluntary basis, on sexual orienta- 15 tion and gender identity; and 16 (B) on sources of coverage (or the lack 17 thereof) for medical treatment (including cov- 18 erage through Medicaid, Medicare, the program 19 under title XXVI of the Public Health Service 20 Act (42 U.S.C. 300ff–11 et seq.; commonly re- 21 ferred to as the ‘‘Ryan White HIV/AIDS Pro- 22 gram’’), other public funding, private insurance, 23 and health maintenance organizations); and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00497 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 498 •HR 5294 IH (4) obtaining and using current geographic 1 markers of residence (such as current address, zip 2 code, partial zip code, and census block). 3 (b) PRIVACY AND SECURITY SAFEGUARDS.—In car- 4 rying out this section, the Secretary of Health and Human 5 Services shall ensure that appropriate privacy and security 6 safeguards are met to prevent unauthorized disclosure of 7 protected health information and compliance with the 8 HIPAA privacy and security law (as defined in section 9 3009 of the Public Health Service Act (42 U.S.C. 300jj– 10 19)) and other relevant laws and regulations. 11 (c) PROHIBITION AGAINST IMPROPER USE OF 12 DATA.—No grant under this section may be used to allow 13 or facilitate the collection or use of surveillance or clinical 14 data or records— 15 (1) for punitive measures of any kind, civil or 16 criminal, against the subject of such data or records; 17 or 18 (2) for imposing any requirement or restriction 19 with respect to an individual without the individual’s 20 written consent. 21 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 22 out this section, there are authorized to be appropriated 23 such sums as may be necessary for each of fiscal years 24 2015 through 2019. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00498 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 499 •HR 5294 IH SEC. 745. EVIDENCE-BASED STRATEGIES FOR IMPROVING 1 LINKAGE TO AND RETENTION IN APPRO- 2 PRIATE CARE. 3 (a) STRATEGIES.—The Secretary of Health and 4 Human Services, in collaboration with the Director of the 5 Centers for Disease Control and Prevention, the Adminis- 6 trator of the Substance Abuse and Mental Health Services 7 Administration, the Director of the Office of AIDS Re- 8 search, the Administrator of the Health Resources and 9 Services Administration, and the Administrator of the 10 Centers for Medicare & Medicaid Services, shall— 11 (1) identify evidence-based strategies most ef- 12 fective at addressing the multifaceted issues that im- 13 pede disease status awareness and linkage to and re- 14 tention in appropriate care, taking into consideration 15 health care systems issues, clinic and provider 16 issues, and individual psychosocial, environmental, 17 and other contextual factors; 18 (2) support the wide-scale implementation of 19 the evidence-based strategies identified pursuant to 20 paragraph (1), including through incorporating such 21 strategies into health care coverage supported by the 22 Medicaid program under title XIX of the Social Se- 23 curity Act (42 U.S.C. 1396 et seq.), the program 24 under title XXVI of the Public Health Service Act 25 (42 U.S.C. 300ff–11 et seq.; commonly referred to 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00499 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 500 •HR 5294 IH as the ‘‘Ryan White HIV/AIDS Program’’), and 1 health plans purchased through an American Health 2 Benefit Exchange established pursuant to section 3 1311 of the Patient Protection and Affordable Care 4 Act (42 U.S.C. 18031); and 5 (3) not later than 12 months after the date of 6 the enactment of this Act, submit a report to the 7 Congress on the status of activities under para- 8 graphs (1) and (2). 9 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 10 out this section, there are authorized to be appropriated 11 such sums as may be necessary for fiscal years 2015 12 through 2019. 13 SEC. 746. IMPROVING ENTRY INTO AND RETENTION IN 14 CARE AND ANTIRETROVIRAL ADHERENCE 15 FOR PERSONS WITH HIV. 16 (a) SENSE OF CONGRESS.—It is the sense of the Con- 17 gress that AIDS research has led to scientific advance- 18 ments that have— 19 (1) saved the lives of millions of people with 20 HIV/AIDS; 21 (2) prevented millions of people from being in- 22 fected; and 23 (3) had broad benefits that extend far beyond 24 helping people at risk for or living with HIV. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00500 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 501 •HR 5294 IH (b) IN GENERAL.—The Secretary of Health and 1 Human Services, acting through the Director of the Na- 2 tional Institutes of Health, shall expand, intensify, and co- 3 ordinate operational and translational research and other 4 activities of the National Institutes of Health regarding 5 methods— 6 (1) to increase adoption of evidence-based ad- 7 herence strategies within HIV care and treatment 8 programs; 9 (2) to increase HIV testing and case detection 10 rates; 11 (3) to reduce HIV-related health disparities; 12 (4) to ensure that research to improve adher- 13 ence to HIV care and treatment programs address 14 the unique concerns of women; 15 (5) to integrate HIV/AIDS prevention and care 16 services with mental health and substance use pre- 17 vention and treatment delivery systems; and 18 (6) to increase knowledge on the implementa- 19 tion of preexposure prophylaxis (PrEP), including 20 with respect to— 21 (A) who can benefit most from PrEP; 22 (B) how to provide PrEP safely and effi- 23 ciently; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00501 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 502 •HR 5294 IH (C) how to integrate PrEP with other es- 1 sential prevention methods such as condoms; 2 and 3 (D) how to ensure high levels of adherence. 4 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 5 out this section, there are authorized to be appropriated 6 such sums as may be necessary for fiscal years 2015 7 through 2019. 8 SEC. 747. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND 9 ETHNIC MINORITY COMMUNITIES. 10 (a) IN GENERAL.—For the purpose of reducing HIV/ 11 AIDS in racial and ethnic minority communities, the Sec- 12 retary, acting through the Deputy Assistant Secretary for 13 Minority Health, may make grants to public health agen- 14 cies and faith-based organizations to conduct— 15 (1) outreach activities related to HIV/AIDS 16 prevention and testing activities; 17 (2) HIV/AIDS prevention activities; and 18 (3) HIV/AIDS testing activities. 19 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 20 out this section, there are authorized to be appropriated 21 $50,000,000 for fiscal year 2015, and such sums as may 22 be necessary for fiscal years 2016 through 2019. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00502 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 503 •HR 5294 IH SEC. 748. MINORITY AIDS INITIATIVE. 1 (a) EXPANDED FUNDING.—The Secretary, in col- 2 laboration with the Deputy Assistant Secretary for Minor- 3 ity Health, the Director of the Centers for Disease Control 4 and Prevention, the Administrator of the Health Re- 5 sources and Services Administration, and the Adminis- 6 trator of the Substance Abuse and Mental Health Services 7 Administration, shall provide funds and carry out activi- 8 ties to expand the Minority HIV/AIDS Initiative. 9 (b) USE OF FUNDS.—The additional funds made 10 available under this section may be used, through the Mi- 11 nority AIDS Initiative, to support the following activities: 12 (1) Providing technical assistance and infra- 13 structure support to reduce HIV/AIDS in minority 14 populations. 15 (2) Increasing minority populations’ access to 16 HIV/AIDS prevention and care services. 17 (3) Building strong community programs and 18 partnerships to address HIV prevention and the 19 health care needs of specific racial and ethnic minor- 20 ity populations. 21 (c) PRIORITY INTERVENTIONS.—Within the racial 22 and ethnic minority populations referred to in subsection 23 (b), priority in conducting intervention services shall be 24 given to— 25 (1) men who have sex with men; 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00503 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 504 •HR 5294 IH (2) youth; 1 (3) persons who engage in intravenous drug 2 abuse; 3 (4) women; 4 (5) homeless individuals; and 5 (6) individuals incarcerated or in the penal sys- 6 tem. 7 (d) AUTHORIZATION OF APPROPRIATIONS.—For car- 8 rying out this section, there are authorized to be appro- 9 priated $610,000,0000 for fiscal year 2015 and such sums 10 as may be necessary for each of fiscal years 2016 through 11 2019. 12 SEC. 749. HEALTH CARE PROFESSIONALS TREATING INDI- 13 VIDUALS WITH HIV/AIDS. 14 (a) IN GENERAL.—The Secretary of Health and 15 Human Services, acting through the Administrator of the 16 Health Resources and Services Administration, shall ex- 17 pand, intensify, and coordinate workforce initiatives of the 18 Health Resources and Services Administration to increase 19 the capacity of the health workforce focusing primarily on 20 HIV/AIDS to meet the demand for culturally competent 21 care, and may award grants for any of the following: 22 (1) Development of curricula for training pri- 23 mary care providers in HIV/AIDS prevention and 24 care, including routine HIV testing. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00504 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 505 •HR 5294 IH (2) Support to expand access to culturally and 1 linguistically accessible benefits counselors, trained 2 peer navigators, and mental and behavioral health 3 professionals with expertise in HIV/AIDS. 4 (3) Training health care professionals to pro- 5 vide care to individuals with HIV/AIDS. 6 (4) Development by grant recipients under title 7 XXVI of the Public Health Service Act (42 U.S.C. 8 300ff–11 et seq.; commonly referred to as the Ryan 9 White HIV/AIDS Program) and other persons, of 10 policies for providing culturally relevant and sen- 11 sitive treatment to individuals with HIV/AIDS, with 12 particular emphasis on treatment to racial and eth- 13 nic minorities, men who have sex with men, and 14 women, young people, and children with HIV/AIDS. 15 (5) Development and implementation of pro- 16 grams to increase the use of telehealth to respond to 17 HIV/AIDS-specific health care needs in rural and 18 minority communities, with particular emphasis 19 given to medically underserved communities and in- 20 sular areas. 21 (6) Evaluating interdisciplinary medical pro- 22 vider care team models that promote high quality 23 care, with particular emphasis on care to racial and 24 ethnic minorities. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00505 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 506 •HR 5294 IH (7) Training health care professionals to make 1 them aware of the high rates of chronic hepatitis B 2 and chronic hepatitis C in adult racial and ethnic 3 populations, and the importance of prevention, de- 4 tection, and medical management of hepatitis B and 5 hepatitis C and of liver cancer screening. 6 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 7 out this section, there are authorized to be appropriated 8 such sums as may be necessary for fiscal years 2015 9 through 2019. 10 SEC. 750. HIV/AIDS PROVIDER LOAN REPAYMENT PRO- 11 GRAM. 12 (a) IN GENERAL.—The Secretary may enter into an 13 agreement with any physician, nurse practitioner, or phy- 14 sician assistant under which— 15 (1) the physician, nurse practitioner, or physi- 16 cian assistant agrees to serve as a medical provider 17 for a period of not less than 2 years— 18 (A) at a Ryan White-funded or title X- 19 funded facility with a critical shortage of doc- 20 tors (as determined by the Secretary); or 21 (B) in an area with a high incidence of 22 HIV/AIDS; and 23 (2) the Secretary agrees to make payments in 24 accordance with subsection (b) on the professional 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00506 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 507 •HR 5294 IH education loans of the physician, nurse practitioner, 1 or physician assistant. 2 (b) MANNER OF PAYMENTS.—The payments de- 3 scribed in subsection (a) shall be made by the Secretary 4 as follows: 5 (1) Upon completion by the physician, nurse 6 practitioner, or physician assistant for whom the 7 payments are to be made of the first year of the 8 service specified in the agreement entered into with 9 the Secretary under subsection (a), the Secretary 10 shall pay 30 percent of the principal of and the in- 11 terest on the individual’s professional education 12 loans. 13 (2) Upon completion by the physician, nurse 14 practitioner, or physician assistant of the second 15 year of such service, the Secretary shall pay another 16 30 percent of the principal of and the interest on 17 such loans. 18 (3) Upon completion by that individual of a 19 third year of such service, the Secretary shall pay 20 another 25 percent of the principal of and the inter- 21 est on such loans. 22 (c) APPLICABILITY OF CERTAIN PROVISIONS.—The 23 provisions of subpart III of part D of title III of the Public 24 Health Service Act (42 U.S.C. 254l et seq.) shall, except 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00507 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 508 •HR 5294 IH as inconsistent with this section, apply to the program car- 1 ried out under this section in the same manner and to 2 the same extent as such provisions apply to the National 3 Health Service Corps Loan Repayment Program. 4 (d) REPORTS.—Not later than 18 months after the 5 date of the enactment of this Act, and annually thereafter, 6 the Secretary shall prepare and submit to the Congress 7 a report describing the program carried out under this sec- 8 tion, including statements regarding the following: 9 (1) The number of physicians, nurse practi- 10 tioners, and physician assistants enrolled in the pro- 11 gram. 12 (2) The number and amount of loan repay- 13 ments. 14 (3) The placement location of loan repayment 15 recipients at facilities described in subsection (a)(1). 16 (4) The default rate and actions required. 17 (5) The amount of outstanding default funds. 18 (6) To the extent that it can be determined, the 19 reason for the default. 20 (7) The demographics of individuals partici- 21 pating in the program. 22 (8) An evaluation of the overall costs and bene- 23 fits of the program. 24 (e) DEFINITIONS.—In this section: 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00508 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 509 •HR 5294 IH (1) The term ‘‘HIV/AIDS’’ means human im- 1 munodeficiency virus and acquired immune defi- 2 ciency syndrome. 3 (2) The term ‘‘nurse practitioner’’ means a reg- 4 istered nurse who has completed an accredited grad- 5 uate degree program in advanced nurse practice and 6 has successfully passed a national certification exam. 7 (3) The term ‘‘physician’’ means a graduate of 8 a school of medicine who has completed post- 9 graduate training in general or pediatric medicine. 10 (4) The term ‘‘physician assistant’’ means a 11 medical provider who completed an accredited physi- 12 cian assistant training program and successfully 13 passed the Physician Assistant National Certifying 14 Examination. 15 (5) The term ‘‘professional education loan’’— 16 (A) means a loan that is incurred for the 17 cost of attendance (including tuition, other rea- 18 sonable educational expenses, and reasonable 19 living costs) at a school of medicine, nursing, or 20 physician assistant training program; and 21 (B) includes only the portion of the loan 22 that is outstanding on the date the physician, 23 nurse practitioner, or physician assistant in- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00509 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 510 •HR 5294 IH volved begins the service specified in the agree- 1 ment under subsection (a). 2 (6) The term ‘‘Ryan White-funded’’ means, 3 with respect to a facility, receiving funds under title 4 XXVI of the Public Health Service Act (42 U.S.C. 5 300ff–11 et seq.). 6 (7) The term ‘‘Secretary’’ means the Secretary 7 of Health and Human Services. 8 (8) The term ‘‘school of medicine’’ has the 9 meaning given to that term in section 799B of the 10 Public Health Service Act (42 U.S.C. 295p). 11 (9) The term ‘‘title X-funded’’ means, with re- 12 spect to a facility, receiving funds under title X of 13 the Public Health Service Act (42 U.S.C. 300 et 14 seq.). 15 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 16 out this section, there are authorized to be appropriated 17 such sums as may be necessary for fiscal years 2015 18 through 2019. 19 SEC. 751. DENTAL EDUCATION LOAN REPAYMENT PRO- 20 GRAM. 21 (a) IN GENERAL.—The Secretary of Health and 22 Human Services may enter into an agreement with any 23 dentist under which— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00510 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 511 •HR 5294 IH (1) the dentist agrees to serve as a dentist for 1 a period of not less than 2 years at a facility with 2 a critical shortage of dentists (as determined by the 3 Secretary) in an area with a high incidence of HIV/ 4 AIDS; and 5 (2) the Secretary agrees to make payments in 6 accordance with subsection (b) on the dental edu- 7 cation loans of the dentist. 8 (b) MANNER OF PAYMENTS.—The payments de- 9 scribed in subsection (a) shall be made by the Secretary 10 as follows: 11 (1) Upon completion by the dentist for whom 12 the payments are to be made of the first year of the 13 service specified in the agreement entered into with 14 the Secretary under subsection (a), the Secretary 15 shall pay 30 percent of the principal of and the in- 16 terest on the dental education loans of the dentist. 17 (2) Upon completion by the dentist of the sec- 18 ond year of such service, the Secretary shall pay an- 19 other 30 percent of the principal of and the interest 20 on such loans. 21 (3) Upon completion by that individual of a 22 third year of such service, the Secretary shall pay 23 another 25 percent of the principal of and the inter- 24 est on such loans. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00511 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 512 •HR 5294 IH (c) APPLICABILITY OF CERTAIN PROVISIONS.—The 1 provisions of subpart III of part D of title III of the Public 2 Health Service Act (42 U.S.C. 254l et seq.) shall, except 3 as inconsistent with this section, apply to the program car- 4 ried out under this section in the same manner and to 5 the same extent as such provisions apply to the National 6 Health Service Corps Loan Repayment Program. 7 (d) REPORTS.—Not later than 18 months after the 8 date of the enactment of this Act, and annually thereafter, 9 the Secretary shall prepare and submit to the Congress 10 a report describing the program carried out under this sec- 11 tion, including statements regarding the following: 12 (1) The number of dentists enrolled in the pro- 13 gram. 14 (2) The number and amount of loan repay- 15 ments. 16 (3) The placement location of loan repayment 17 recipients at facilities described in subsection (a)(1). 18 (4) The default rate and actions required. 19 (5) The amount of outstanding default funds. 20 (6) To the extent that it can be determined, the 21 reason for the default. 22 (7) The demographics of individuals partici- 23 pating in the program. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00512 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 513 •HR 5294 IH (8) An evaluation of the overall costs and bene- 1 fits of the program. 2 (e) DEFINITIONS.—In this section: 3 (1) The term ‘‘dental education loan’’— 4 (A) means a loan that is incurred for the 5 cost of attendance (including tuition, other rea- 6 sonable educational expenses, and reasonable 7 living costs) at a school of dentistry; and 8 (B) includes only the portion of the loan 9 that is outstanding on the date the dentist in- 10 volved begins the service specified in the agree- 11 ment under subsection (a). 12 (2) The term ‘‘dentist’’ means a graduate of a 13 school of dentistry who has completed postgraduate 14 training in general or pediatric dentistry. 15 (3) The term ‘‘HIV/AIDS’’ means human im- 16 munodeficiency virus and acquired immune defi- 17 ciency syndrome. 18 (4) The term ‘‘school of dentistry’’ has the 19 meaning given to that term in section 799B of the 20 Public Health Service Act (42 U.S.C. 295p). 21 (5) The term ‘‘Secretary’’ means the Secretary 22 of Health and Human Services. 23 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 24 out this section, there are authorized to be appropriated 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00513 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 514 •HR 5294 IH such sums as may be necessary for each of fiscal years 1 2015 through 2019. 2 SEC. 752. REDUCING NEW HIV INFECTIONS AMONG INJECT- 3 ING DRUG USERS. 4 (a) SENSE OF CONGRESS.—It is the sense of the Con- 5 gress that providing sterile syringes and sterilized equip- 6 ment to injecting drug users substantially reduces risk of 7 HIV infection, increases the probability that they will ini- 8 tiate drug treatment, and does not increase drug use. 9 (b) IN GENERAL.—The Secretary of Health and 10 Human Services may provide grants and technical assist- 11 ance for the purpose of reducing the rate of HIV infections 12 among injecting drug users through a comprehensive 13 package of services for such users, including the provision 14 of sterile syringes, education and outreach, access to infec- 15 tious disease testing, overdose prevention, and treatment 16 for drug dependence. 17 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 18 out this section, there are authorized to be appropriated 19 such sums as may be necessary for fiscal years 2015 20 through 2019. 21 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00514 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 515 •HR 5294 IH SEC. 753. SUPPORT FOR EXPANSION OF COMPREHENSIVE 1 SEXUAL HEALTH AND EDUCATION PRO- 2 GRAMS. 3 (a) SENSE OF CONGRESS.—It is the sense of Con- 4 gress that— 5 (1) federally funded sex education programs 6 should aim to— 7 (A) reduce unintended pregnancy and sex- 8 ually transmitted infections, including HIV; 9 (B) promote safe and healthy relation- 10 ships; 11 (C) use, and be informed by, the best sci- 12 entific information available; 13 (D) be built on characteristics of effective 14 programs; 15 (E) expand the existing body of evidence 16 on comprehensive sex education programs 17 through program evaluation; 18 (F) expand training programs for teachers 19 of comprehensive sex education; 20 (G) build on the personal responsibility 21 education programs funded under section 513 22 of the Social Security Act (42 U.S.C. 713) and 23 the President’s Teen Pregnancy Prevention pro- 24 gram, funded under title II of the Consolidated 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00515 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 516 •HR 5294 IH Appropriations Act, 2010 (Public Law 111– 1 117; 123 Stat. 3253); and 2 (H) promote and uphold the rights of 3 young people to information in order to make 4 healthy and responsible decisions about their 5 sexual health; and 6 (2) no Federal funds should be used for health 7 education programs that— 8 (A) deliberately withhold life-saving infor- 9 mation about HIV; 10 (B) are medically inaccurate or have been 11 scientifically shown to be ineffective; 12 (C) promote gender stereotypes; 13 (D) are insensitive and unresponsive to the 14 needs of sexually active adolescents; 15 (E) are insensitive and unresponsive to the 16 needs of lesbian, gay, bisexual, or transgender 17 youth; or 18 (F) are inconsistent with the ethical im- 19 peratives of medicine and public health. 20 (b) GRANTS FOR COMPREHENSIVE SEX EDUCATION 21 FOR ADOLESCENTS.— 22 (1) PROGRAM AUTHORIZED.—The Secretary, in 23 coordination with the Director of the Office of Ado- 24 lescent Health, shall award grants, on a competitive 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00516 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 517 •HR 5294 IH basis, to eligible entities to enable such eligible enti- 1 ties to carry out programs that provide adolescents 2 with comprehensive sex education, as described in 3 paragraph (6). 4 (2) DURATION.—Grants awarded under this 5 subsection shall be for a period of 5 years. 6 (3) ELIGIBLE ENTITY.—In this subsection, the 7 term ‘‘eligible entity’’ means a public or private enti- 8 ty that focuses on adolescent health or education or 9 has experience working with adolescents, which may 10 include— 11 (A) a State educational agency; 12 (B) a local educational agency; 13 (C) a tribe or tribal organization, as de- 14 fined in section 4 of the Indian Self-Determina- 15 tion and Education Assistance Act (25 U.S.C. 16 450b); 17 (D) a State or local department of health; 18 (E) a State or local department of edu- 19 cation; 20 (F) a nonprofit organization; 21 (G) a nonprofit or public institution of 22 higher education; or 23 (H) a hospital. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00517 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 518 •HR 5294 IH (4) APPLICATIONS.—An eligible entity desiring 1 a grant under this subsection shall submit an appli- 2 cation to the Secretary at such time, in such man- 3 ner, and containing such information as the Sec- 4 retary may require, including the evaluation plan de- 5 scribed in paragraph (7)(A). 6 (5) PRIORITY.—In awarding grants under this 7 subsection, the Secretary shall give priority to eligi- 8 ble entities that— 9 (A) are State or local public entities, with 10 an additional priority for State or local edu- 11 cational agencies; and 12 (B) address health disparities among 13 young people that are at highest risk for not 14 less than 1 of the following: 15 (i) Unintended pregnancies. 16 (ii) Sexually transmitted infections, 17 including HIV. 18 (iii) Dating violence and sexual as- 19 sault. 20 (6) USE OF FUNDS.— 21 (A) IN GENERAL.—Each eligible entity 22 that receives a grant under this subsection shall 23 use grant funds to carry out a program that 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00518 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 519 •HR 5294 IH provides adolescents with comprehensive sex 1 education that— 2 (i) replicates evidence-based sex edu- 3 cation programs; 4 (ii) substantially incorporates ele- 5 ments of evidence-based sex education pro- 6 grams; or 7 (iii) creates a demonstration project 8 based on generally accepted characteristics 9 of effective sex education programs. 10 (B) CONTENTS OF SEX EDUCATION PRO- 11 GRAMS.—The sex education programs funded 12 under this subsection shall include curricula 13 and program materials that address— 14 (i) abstinence and delaying sexual ini- 15 tiation; 16 (ii) the health benefits and side effects 17 of all contraceptive and barrier methods as 18 a means to prevent pregnancy and sexually 19 transmitted infections, including HIV; 20 (iii) healthy relationships, including 21 the development of healthy attitudes and 22 skills necessary for understanding— 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00519 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 520 •HR 5294 IH (I) healthy relationships between 1 oneself and family, others, and soci- 2 ety; and 3 (II) the prevention of sexual 4 abuse, teen dating violence, bullying, 5 harassment, and suicide; 6 (iv) healthy life skills including goal- 7 setting, decisionmaking, interpersonal skills 8 (such as communication, assertiveness, and 9 peer refusal skills), critical thinking, self- 10 esteem and self-efficacy, and stress man- 11 agement; 12 (v) how to make responsible decisions 13 about sex and sexuality, including— 14 (I) how to avoid, and how to 15 avoid making, unwanted verbal, phys- 16 ical, and sexual advances; and 17 (II) how alcohol and drug use 18 can affect responsible decisionmaking; 19 (vi) the development of healthy atti- 20 tudes and values about such topics as ado- 21 lescent growth and development, body 22 image, gender roles and gender identity, 23 racial and ethnic diversity, and sexual ori- 24 entation; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00520 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 521 •HR 5294 IH (vii) referral services for local health 1 clinics and services where adolescents can 2 obtain additional information and services 3 related to sexual and reproductive health, 4 dating violence and sexual assault, and sui- 5 cide prevention. 6 (7) EVALUATION; REPORT.— 7 (A) INDEPENDENT EVALUATION.—Each 8 eligible entity applying for a grant under this 9 subsection shall develop and submit to the Sec- 10 retary a plan for a rigorous independent evalua- 11 tion of such grant program. The plan shall de- 12 scribe an independent evaluation that— 13 (i) uses sound statistical methods and 14 techniques relating to the behavioral 15 sciences, including random assignment 16 methodologies, whenever possible; 17 (ii) uses quantitative data for assess- 18 ments and impact evaluations, whenever 19 possible; and 20 (iii) is carried out by an entity inde- 21 pendent from such eligible entity. 22 (B) SELECTION OF EVALUATED PRO- 23 GRAMS; BUDGET.— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00521 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 522 •HR 5294 IH (i) SELECTION OF EVALUATED PRO- 1 GRAMS.—The Secretary shall select, at 2 random, a subset of the eligible entities 3 that the Secretary has selected to receive a 4 grant under this subsection to receive addi- 5 tional funding to carry out the evaluation 6 plan described in subparagraph (A). 7 (ii) BUDGET FOR EVALUATION ACTIVI- 8 TIES.—The Secretary, in coordination with 9 the Director of the Office of Adolescent 10 Health, shall establish a budget for each 11 eligible entity selected under clause (i) for 12 the costs of carrying out the evaluation 13 plan described in subparagraph (A). 14 (C) FUNDS FOR EVALUATION.—The Sec- 15 retary shall provide eligible entities who are se- 16 lected under subparagraph (B)(i) with addi- 17 tional funds, in accordance with the budget de- 18 scribed in subparagraph (B)(ii), to carry out 19 and report to the Secretary on the evaluation 20 plan described in subparagraph (A). 21 (D) PERFORMANCE MEASURES.—The Sec- 22 retary, in coordination with the Director of the 23 Centers for Disease Control and Prevention, 24 shall establish a common set of performance 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00522 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 523 •HR 5294 IH measures to assess the implementation and im- 1 pact of grant programs funded under this sub- 2 section. Such performance measures shall in- 3 clude— 4 (i) output measures, such as the num- 5 ber of individuals served and the number 6 of hours of service delivery; 7 (ii) outcome measures, including 8 measures relating to— 9 (I) the knowledge that youth par- 10 ticipating in the grant program have 11 gained about— 12 (aa) adolescent growth and 13 development; 14 (bb) relationship dynamics; 15 (cc) ways to prevent unin- 16 tended pregnancy and sexually 17 transmitted infections, including 18 HIV; and 19 (dd) sexual health; 20 (II) the skills that adolescents 21 participating in the grant program 22 have gained regarding— 23 (aa) negotiation and commu- 24 nication; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00523 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 524 •HR 5294 IH (bb) decisionmaking and 1 goal-setting; 2 (cc) interpersonal skills and 3 healthy relationships; and 4 (dd) condom use; and 5 (III) the behaviors of adolescents 6 participating in the grant program, 7 including data about— 8 (aa) age of first intercourse; 9 (bb) number of sexual part- 10 ners; 11 (cc) condom and contracep- 12 tive use at first intercourse; 13 (dd) recent condom and con- 14 traceptive use; and 15 (ee) dating abuse and life- 16 time history of domestic violence, 17 sexual assault, dating violence, 18 bullying, harassment, and stalk- 19 ing. 20 (E) REPORT TO THE SECRETARY.—Eligi- 21 ble entities receiving a grant under this sub- 22 section who have been selected to receive funds 23 to carry out the evaluation plan described in 24 subparagraph (A), in accordance with subpara- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00524 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 525 •HR 5294 IH graph (B)(i), shall collect and report to the Sec- 1 retary— 2 (i) the results of the independent eval- 3 uation described in subparagraph (A); and 4 (ii) information about the perform- 5 ance measures described in subparagraph 6 (B). 7 (F) EFFECTIVE PROGRAMS.—The Sec- 8 retary, in coordination with the Director of the 9 Centers for Disease Control and Prevention, 10 shall publish on the Web site of the Centers for 11 Disease Control and Prevention, a list of pro- 12 grams funded under this subsection that the 13 Secretary has determined to be effective pro- 14 grams. 15 (c) GRANTS FOR COMPREHENSIVE SEX EDUCATION 16 AT INSTITUTIONS OF HIGHER EDUCATION.— 17 (1) PROGRAM AUTHORIZED.—The Secretary, in 18 coordination with the Office of Adolescent Health 19 and the Secretary of Education, shall award grants, 20 on a competitive basis, to institutions of higher edu- 21 cation to enable such institutions to provide young 22 people with comprehensive sex education, described 23 in paragraph (5)(B), with an emphasis on reducing 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00525 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 526 •HR 5294 IH HIV, other sexually transmitted infections, and un- 1 intended pregnancy through instruction about— 2 (A) abstinence and contraception; 3 (B) reducing dating violence, sexual as- 4 sault, bullying, and harassment; 5 (C) increasing healthy relationships; and 6 (D) academic achievement. 7 (2) DURATION.—Grants awarded under this 8 subsection shall be for a period of 5 years. 9 (3) APPLICATIONS.—An institution of higher 10 education desiring a grant under this subsection 11 shall submit an application to the Secretary at such 12 time, in such manner, and containing such informa- 13 tion as the Secretary may require. 14 (4) PRIORITY.—In awarding grants under this 15 subsection, the Secretary shall give priority to an in- 16 stitution of higher education that— 17 (A) has an enrollment of needy students as 18 defined in section 318(b) of the Higher Edu- 19 cation Act of 1965 (20 U.S.C. 1059e(b)); 20 (B) is a Hispanic-serving institution, as 21 defined in section 502(a) of such Act (20 22 U.S.C. 1101a(a)); 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00526 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 527 •HR 5294 IH (C) is a Tribal College or University, as 1 defined in section 316(b) of such Act (20 2 U.S.C. 1059c(b)); 3 (D) is an Alaska Native-serving institution, 4 as defined in section 317(b) of such Act (20 5 U.S.C. 1059d(b)); 6 (E) is a Native Hawaiian-serving institu- 7 tion, as defined in section 317(b) of such Act 8 (20 U.S.C. 1059d(b)); 9 (F) is a Predominately Black Institution, 10 as defined in section 318(b) of such Act (20 11 U.S.C. 1059e(b)); 12 (G) is a Native American-serving, non- 13 tribal institution, as defined in section 319(b) 14 of such Act (20 U.S.C. 1059f(b)); 15 (H) is an Asian American and Native 16 American Pacific Islander-serving institution, as 17 defined in section 320(b) of such Act (20 18 U.S.C. 1059g(b)); or 19 (I) is a minority institution, as defined in 20 section 365 of such Act (20 U.S.C. 1067k), 21 with an enrollment of needy students, as de- 22 fined in section 312 of such Act (20 U.S.C. 23 1058). 24 (5) USES OF FUNDS.— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00527 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 528 •HR 5294 IH (A) IN GENERAL.—An institution of higher 1 education receiving a grant under this sub- 2 section may use grant funds to integrate issues 3 relating to comprehensive sex education into the 4 academic or support sectors of the institution of 5 higher education in order to reach a large num- 6 ber of students, by carrying out 1 or more of 7 the following activities: 8 (i) Developing educational content for 9 issues relating to comprehensive sex edu- 10 cation that will be incorporated into first- 11 year orientation or core courses. 12 (ii) Developing and employing 13 schoolwide educational programming out- 14 side of class that delivers elements of com- 15 prehensive sex education programs to stu- 16 dents, faculty, and staff. 17 (iii) Creating innovative technology- 18 based approaches to deliver sex education 19 to students, faculty, and staff. 20 (iv) Developing and employing peer- 21 outreach and education programs to gen- 22 erate discussion, educate, and raise aware- 23 ness among students about issues relating 24 to comprehensive sex education. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00528 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 529 •HR 5294 IH (B) CONTENTS OF SEX EDUCATION PRO- 1 GRAMS.—Each institution of higher education’s 2 program of comprehensive sex education funded 3 under this subsection shall include curricula 4 and program materials that address informa- 5 tion about— 6 (i) safe and responsible sexual behav- 7 ior with respect to the prevention of preg- 8 nancy and sexually transmitted infections, 9 including HIV, including through— 10 (I) abstinence; 11 (II) a reduced number of sexual 12 partners; and 13 (III) the use of condoms and con- 14 traception; 15 (ii) healthy relationships, including 16 the development of healthy attitudes and 17 insights necessary for understanding— 18 (I) relationships between oneself, 19 family, partners, others, and society; 20 and 21 (II) the prevention of sexual 22 abuse, dating violence, bullying, har- 23 assment, and suicide; and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00529 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 530 •HR 5294 IH (iii) referral services to local health 1 clinics where young people can obtain addi- 2 tional information and services related to 3 sexual and reproductive health, dating vio- 4 lence and sexual assault, and suicide pre- 5 vention. 6 (C) OPTIONAL COMPONENTS OF SEX EDU- 7 CATION.—Each institution of higher education’s 8 program of comprehensive sex education may 9 also include information and skills development 10 relating to— 11 (i) how to make responsible decisions 12 about sex and sexuality, including— 13 (I) how to avoid, and avoid mak- 14 ing, unwanted verbal, physical, and 15 sexual advances; and 16 (II) how alcohol and drug use 17 can affect responsible decisionmaking; 18 (ii) healthy life skills, including— 19 (I) goal-setting and decision- 20 making; 21 (II) interpersonal skills, such as 22 communication, assertiveness, and 23 peer refusal skills; 24 (III) critical thinking; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00530 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 531 •HR 5294 IH (IV) self-esteem and self-efficacy; 1 and 2 (V) stress management; 3 (iii) the development of healthy atti- 4 tudes and values about such topics as body 5 image, gender roles and gender identity, 6 racial and ethnic diversity, and sexual ori- 7 entation; and 8 (iv) the responsibilities of parenting 9 and the skills necessary to parent well. 10 (6) EVALUATION; REPORT.—The requirements 11 described in section 125B(g) shall also apply to eligi- 12 ble entities receiving a grant under this subsection 13 in the same manner as such requirements apply to 14 eligible entities receiving grants under section 125B. 15 (d) GRANTS FOR PRE-SERVICE AND IN-SERVICE 16 TEACHER TRAINING.— 17 (1) PROGRAM AUTHORIZED.—The Secretary, in 18 coordination with the Director of the Centers for 19 Disease Control and Prevention and the Secretary of 20 Education, shall award grants, on a competitive 21 basis, to eligible entities to enable such eligible enti- 22 ties to carry out the activities described in para- 23 graph (5). 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00531 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 532 •HR 5294 IH (2) DURATION.—Grants awarded under this 1 subsection shall be for a period of 5 years. 2 (3) ELIGIBLE ENTITY.—In this subsection, the 3 term ‘‘eligible entity’’ means— 4 (A) a State educational agency; 5 (B) a local educational agency; 6 (C) a tribe or tribal organization, as de- 7 fined in section 4 of the Indian Self-Determina- 8 tion and Education Assistance Act (25 U.S.C. 9 450b); 10 (D) a State or local department of health; 11 (E) a State or local department of edu- 12 cation; 13 (F) a nonprofit institution of higher edu- 14 cation; 15 (G) a national or statewide nonprofit orga- 16 nization that has as its primary purpose the im- 17 provement of provision of comprehensive sex 18 education through effective teaching of com- 19 prehensive sex education; or 20 (H) a consortium of nonprofit organiza- 21 tions that has as its primary purpose the im- 22 provement of provision of comprehensive sex 23 education through effective teaching of com- 24 prehensive sex education. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00532 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 533 •HR 5294 IH (4) APPLICATION.—An eligible entity desiring a 1 grant under this subsection shall submit an applica- 2 tion to the Secretary at such time, in such manner, 3 and containing such information as the Secretary 4 may require. 5 (5) AUTHORIZED ACTIVITIES.— 6 (A) REQUIRED ACTIVITY.—Each eligible 7 entity receiving a grant under this subsection 8 shall use grant funds to train targeted faculty 9 and staff, in order to increase effective teaching 10 of comprehensive sex education for elementary 11 school and secondary school students. 12 (B) PERMISSIBLE ACTIVITIES.—Each eligi- 13 ble entity receiving a grant under this sub- 14 section may use grant funds to— 15 (i) strengthen and expand the eligible 16 entity’s relationships with— 17 (I) institutions of higher edu- 18 cation; 19 (II) State educational agencies; 20 (III) local educational agencies; 21 or 22 (IV) other public and private or- 23 ganizations with a commitment to 24 comprehensive sex education and the 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00533 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 534 •HR 5294 IH benefits of comprehensive sex edu- 1 cation; 2 (ii) support and promote research- 3 based training of teachers of comprehen- 4 sive sex education and related disciplines 5 in elementary schools and secondary 6 schools as a means of broadening student 7 knowledge about issues related to human 8 development, relationships, personal skills, 9 sexual behavior, sexual health, and society 10 and culture; 11 (iii) support the dissemination of in- 12 formation on effective practices and re- 13 search findings concerning the teaching of 14 comprehensive sex education; 15 (iv) support research on— 16 (I) effective comprehensive sex 17 education teaching practices; and 18 (II) the development of assess- 19 ment instruments and strategies to 20 document— 21 (aa) student understanding 22 of comprehensive sex education; 23 and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00534 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 535 •HR 5294 IH (bb) the effects of com- 1 prehensive sex education; 2 (v) convene national conferences on 3 comprehensive sex education, in order to 4 effectively train teachers in the provision of 5 comprehensive sex education; and 6 (vi) develop and disseminate appro- 7 priate research-based materials to foster 8 comprehensive sex education. 9 (C) SUBGRANTS.—Each eligible entity re- 10 ceiving a grant under this subsection may 11 award subgrants to nonprofit organizations, 12 State educational agencies, or local educational 13 agencies to enable such organizations or agen- 14 cies to— 15 (i) train teachers in comprehensive 16 sex education; 17 (ii) support Internet or distance learn- 18 ing related to comprehensive sex education; 19 (iii) promote rigorous academic stand- 20 ards and assessment techniques to guide 21 and measure student performance in com- 22 prehensive sex education; 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00535 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 536 •HR 5294 IH (iv) encourage replication of best 1 practices and model programs to promote 2 comprehensive sex education; 3 (v) develop and disseminate effective, 4 research-based comprehensive sex edu- 5 cation learning materials; 6 (vi) develop academic courses on the 7 pedagogy of sex education at institutions 8 of higher education; or 9 (vii) convene State-based conferences 10 to train teachers in comprehensive sex edu- 11 cation and to identify strategies for im- 12 provement. 13 (e) REPORT TO CONGRESS.— 14 (1) IN GENERAL.—Not later than 1 year after 15 the date of the enactment of this Act, and annually 16 thereafter for a period of 5 years, the Secretary shall 17 prepare and submit to the appropriate committees of 18 Congress a report on the activities to provide adoles- 19 cents and young people with comprehensive sex edu- 20 cation funded under this section. 21 (2) REPORT ELEMENTS.—The report described 22 in paragraph (1) shall include information about— 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00536 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 537 •HR 5294 IH (A) the number of eligible entities and in- 1 stitutions of higher education that are receiving 2 grant funds under subsections (b) and (c); 3 (B) the specific activities supported by 4 grant funds awarded under subsections (b) and 5 (c); 6 (C) the number of adolescents served by 7 grant programs funded under subsection (b); 8 (D) the number of young people served by 9 grant programs funded under subsection (c); 10 and 11 (E) the status of program evaluations de- 12 scribed under subsections (b) and (c). 13 (f) LIMITATION.—No Federal funds provided under 14 this section may be used for health education programs 15 that— 16 (1) deliberately withhold life-saving information 17 about HIV; 18 (2) are medically inaccurate or have been sci- 19 entifically shown to be ineffective; 20 (3) promote gender stereotypes; 21 (4) are insensitive and unresponsive to the 22 needs of sexually active youth or lesbian, gay, bisex- 23 ual, or transgender youth; or 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00537 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 538 •HR 5294 IH (5) are inconsistent with the ethical imperatives 1 of medicine and public health. 2 (g) DEFINITIONS.—In this section: 3 (1) ESEA DEFINITIONS.—The terms ‘‘elemen- 4 tary school’’, ‘‘local educational agency’’, ‘‘secondary 5 school’’, and ‘‘State educational agency’’ have the 6 meanings given the terms in section 9101 of the Ele- 7 mentary and Secondary Education Act of 1965 (20 8 U.S.C. 7801). 9 (2) AGE AND DEVELOPMENTALLY APPRO- 10 PRIATE.—The term ‘‘age and developmentally appro- 11 priate’’ means suitable for a particular age or age 12 group of children and adolescents, based on devel- 13 oping cognitive, emotional, and behavioral capacity 14 typical for that age or age group. 15 (3) ADOLESCENTS.—The term ‘‘adolescents’’ 16 means individuals who are ages 10 through 19 at 17 the time of commencement of participation in a pro- 18 gram supported under this section. 19 (4) CHARACTERISTICS OF EFFECTIVE PRO- 20 GRAMS.—The term ‘‘characteristics of effective pro- 21 grams’’ means the aspects of evidence-based pro- 22 grams, including development, content, and imple- 23 mentation of such programs, that— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00538 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 539 •HR 5294 IH (A) have been shown to be effective in 1 terms of increasing knowledge, clarifying values 2 and attitudes, increasing skills, and impacting 3 upon behavior; and 4 (B) are widely recognized by leading med- 5 ical and public health agencies to be effective in 6 changing sexual behaviors that lead to sexually 7 transmitted infections, including HIV, unin- 8 tended pregnancy, and dating violence and sex- 9 ual assault among young people. 10 (5) COMPREHENSIVE SEX EDUCATION.—The 11 term ‘‘comprehensive sex education’’ means a pro- 12 gram that— 13 (A) includes age- and developmentally ap- 14 propriate, culturally and linguistically relevant 15 information on a broad set of topics related to 16 sexuality including human development, rela- 17 tionships, decisionmaking, communication, ab- 18 stinence, contraception, and disease and preg- 19 nancy prevention; 20 (B) provides students with opportunities 21 for developing skills as well as learning informa- 22 tion; 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00539 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 540 •HR 5294 IH (C) is inclusive of lesbian, gay, bisexual, 1 transgender, and heterosexual young people; 2 and 3 (D) aims to— 4 (i) provide scientifically accurate and 5 realistic information about human sexu- 6 ality; 7 (ii) provide opportunities for individ- 8 uals to understand their own, their fami- 9 lies’, and their communities’ values, atti- 10 tudes, and insights about sexuality; 11 (iii) help individuals develop healthy 12 relationships and interpersonal skills; and 13 (iv) help individuals exercise responsi- 14 bility regarding sexual relationships, which 15 includes addressing abstinence, pressures 16 to become prematurely involved in sexual 17 intercourse, and the use of contraception 18 and other sexual health measures. 19 (6) EVIDENCE-BASED PROGRAM.—The term 20 ‘‘evidence-based program’’ means a sex education 21 program that has been proven through rigorous eval- 22 uation to be effective in changing sexual behavior or 23 incorporates elements of other sex education pro- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00540 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 541 •HR 5294 IH grams that have been proven to be effective in 1 changing sexual behavior. 2 (7) INSTITUTION OF HIGHER EDUCATION.—The 3 term ‘‘institution of higher education’’ has the 4 meaning given the term in section 101 of the Higher 5 Education Act of 1965 (20 U.S.C. 1001). 6 (8) MEDICALLY ACCURATE AND COMPLETE.— 7 The term ‘‘medically accurate and complete’’, when 8 used with respect to a sex education program, means 9 that— 10 (A) the information provided through the 11 program is verified or supported by the weight 12 of research conducted in compliance with ac- 13 cepted scientific methods and is published in 14 peer-reviewed journals, where applicable; or 15 (B)(i) the program contains information 16 that leading professional organizations and 17 agencies with relevant expertise in the field rec- 18 ognize as accurate, objective, and complete; and 19 (ii) the program does not withhold infor- 20 mation about the effectiveness and benefits of 21 correct and consistent use of condoms and 22 other contraceptives. 23 (9) SECRETARY.—The term ‘‘Secretary’’ means 24 the Secretary of Health and Human Services. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00541 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 542 •HR 5294 IH (10) YOUNG PEOPLE.—The term ‘‘young peo- 1 ple’’ means individuals who are ages 10 through 24 2 at the time of commencement of participation in a 3 program supported under this section. 4 (h) AUTHORIZATION OF APPROPRIATIONS.—To carry 5 out this section, there are authorized to be appropriated 6 such sums as may be necessary for fiscal years 2015 7 through 2019. 8 SEC. 754. ELIMINATION OF ABSTINENCE-ONLY EDUCATION 9 PROGRAM. 10 (a) IN GENERAL.—Title V of the Social Security Act 11 (42 U.S.C. 701 et seq.) is amended by striking section 12 510. 13 (b) RESCISSION.—Amounts appropriated for fiscal 14 years 2013 and 2014 under section 510(d) of the Social 15 Security Act (42 U.S.C. 710(d)) (as in effect on the day 16 before the date of enactment of this Act) that are unobli- 17 gated as of the date of enactment of this Act are re- 18 scinded. 19 (c) REPROGRAM OF ELIMINATED ABSTINENCE-ONLY 20 FUNDS FOR THE PERSONAL RESPONSIBILITY EDUCATION 21 PROGRAM (PREP).—Section 513(f) of the Social Security 22 Act (42 U.S.C. 713(f)) is amended by striking 23 ‘‘$75,000,000 for each of fiscal years 2011 through 2015’’ 24 and inserting ‘‘$75,000,000 for each of fiscal years 2011 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00542 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 543 •HR 5294 IH through 2014, an amount for fiscal year 2015 equal to 1 $75,000,000 increased by an amount equal to the unobli- 2 gated portion of funds appropriated for fiscal year 2014 3 and 2015 under section 510(d) that are rescinded by sec- 4 tion 754(b) of the Health Equity and Accountability Act 5 of 2014, and $125,000,000 for each of fiscal years 2016 6 and 2017’’. 7 SEC. 755. REPORT ON IMPACT OF HIV/AIDS IN VULNERABLE 8 POPULATIONS. 9 (a) IN GENERAL.—The Secretary shall submit to the 10 Congress and the President an annual report on the im- 11 pact of HIV/AIDS for racial and ethnic minority commu- 12 nities, women, and youth aged 24 and younger. 13 (b) CONTENTS.—The report under subsection (a) 14 shall include information on the— 15 (1) progress that has been made in reducing 16 the impact of HIV/AIDS in such communities; 17 (2) opportunities that exist to make additional 18 progress in reducing the impact of HIV/AIDS in 19 such communities; 20 (3) challenges that may impede such additional 21 progress; and 22 (4) Federal funding necessary to achieve sub- 23 stantial reductions in HIV/AIDS in racial and ethnic 24 minority communities. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00543 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 544 •HR 5294 IH SEC. 756. NATIONAL HIV/AIDS OBSERVANCE DAYS. 1 (a) NATIONAL OBSERVANCE DAYS.—It is the sense 2 of the Congress that national observance days highlighting 3 the impact of HIV/AIDS on communities of color include 4 the following: 5 (1) National Black HIV/AIDS Awareness Day. 6 (2) National Latino AIDS Awareness Day. 7 (3) National Asian and Pacific Islander HIV/ 8 AIDS Awareness Day. 9 (4) National Native American HIV/AIDS 10 Awareness Day. 11 (5) Caribbean-American HIV/AIDS Awareness 12 Day. 13 (6) National Youth HIV/AIDS Awareness Day. 14 (7) National Black Clergy HIV/AIDS Aware- 15 ness Sunday. 16 (b) CALL TO ACTION.—It is the sense of the Con- 17 gress that the President should call on members of com- 18 munities of color— 19 (1) to become involved at the local community 20 level in HIV/AIDS testing, policy, and advocacy; 21 (2) to become aware, engaged, and empowered 22 on the HIV/AIDS epidemic within their commu- 23 nities; and 24 (3) to urge members of their communities to re- 25 duce risk factors, practice safe sex and other preven- 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00544 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 545 •HR 5294 IH tive measures, be tested for HIV/AIDS, and seek 1 care when appropriate. 2 SEC. 757. REVIEW OF ALL FEDERAL AND STATE LAWS, 3 POLICIES, AND REGULATIONS REGARDING 4 THE CRIMINAL PROSECUTION OF INDIVID- 5 UALS FOR HIV-RELATED OFFENSES. 6 (a) DEFINITIONS.— 7 (1) HIV AND HIV/AIDS.—The terms ‘‘HIV’’ and 8 ‘‘HIV/AIDS’’ have the meanings given to such terms 9 in section 2689 of the Public Health Service Act (42 10 U.S.C. 300ff–88). 11 (2) STATE.—The term ‘‘State’’ includes the 12 District of Columbia, American Samoa, the Com- 13 monwealth of the Northern Mariana Islands, Guam, 14 Puerto Rico, and the United States Virgin Islands. 15 (b) SENSE OF CONGRESS REGARDING LAWS OR REG- 16 ULATIONS DIRECTED AT PEOPLE LIVING WITH HIV/ 17 AIDS.—It is the sense of the Congress that Federal and 18 State laws, policies, and regulations regarding people liv- 19 ing with HIV/AIDS— 20 (1) should not place unique or additional bur- 21 dens on such individuals solely as a result of their 22 HIV status; and 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00545 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 546 •HR 5294 IH (2) should instead demonstrate a public health- 1 oriented, evidence-based, medically accurate, and 2 contemporary understanding of— 3 (A) the multiple factors that lead to HIV 4 transmission; 5 (B) the relative risk of HIV transmission 6 routes; 7 (C) the current health implications of liv- 8 ing with HIV; 9 (D) the associated benefits of treatment 10 and support services for people living with HIV; 11 and 12 (E) the impact of punitive HIV-specific 13 laws and policies on public health, on people liv- 14 ing with or affected by HIV, and on their fami- 15 lies and communities. 16 (c) REVIEW OF ALL FEDERAL AND STATE LAWS, 17 POLICIES, AND REGULATIONS REGARDING THE CRIMINAL 18 PROSECUTION OF INDIVIDUALS FOR HIV-RELATED OF- 19 FENSES.— 20 (1) REVIEW OF FEDERAL AND STATE LAWS.— 21 (A) IN GENERAL.—No later than 90 days 22 after the date of the enactment of this Act, the 23 Attorney General, the Secretary of Health and 24 Human Services, and the Secretary of Defense 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00546 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 547 •HR 5294 IH acting jointly (in this paragraph and paragraph 1 (2) referred to as the ‘‘designated officials’’) 2 shall initiate a national review of Federal and 3 State laws, policies, regulations, and judicial 4 precedents and decisions regarding criminal and 5 related civil commitment cases involving people 6 living with HIV/AIDS, including in regards to 7 the Uniform Code of Military Justice. 8 (B) CONSULTATION.—In carrying out the 9 review under subparagraph (A), the designated 10 officials shall ensure diverse participation and 11 consultation from each State, including with— 12 (i) State attorneys general (or their 13 representatives); 14 (ii) State public health officials (or 15 their representatives); 16 (iii) State judicial and court system 17 officers, including judges, district attor- 18 neys, prosecutors, defense attorneys, law 19 enforcement, and correctional officers; 20 (iv) members of the United States 21 Armed Forces, including members of other 22 Federal services subject to the Uniform 23 Code of Military Justice; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00547 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 548 •HR 5294 IH (v) people living with HIV/AIDS, par- 1 ticularly those who have been subject to 2 HIV-related prosecution or who are from 3 communities whose members have been 4 disproportionately subject to HIV-specific 5 arrests and prosecutions; 6 (vi) legal advocacy and HIV/AIDS 7 service organizations that work with people 8 living with HIV/AIDS; 9 (vii) nongovernmental health organi- 10 zations that work on behalf of people living 11 with HIV/AIDS; and 12 (viii) trade organizations or associa- 13 tions representing persons or entities de- 14 scribed in clauses (i) through (vii). 15 (C) RELATION TO OTHER REVIEWS.—In 16 carrying out the review under subparagraph 17 (A), the designated officials may utilize other 18 existing reviews of criminal and related civil 19 commitment cases involving people living with 20 HIV/AIDS, including any such review con- 21 ducted by any Federal or State agency or any 22 public health, legal advocacy, or trade organiza- 23 tion or association if the designated officials de- 24 termine that such reviews were conducted in ac- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00548 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 549 •HR 5294 IH cordance with the principles set forth in sub- 1 section (b). 2 (2) REPORT.—No later than 180 days after ini- 3 tiating the review required by paragraph (1), the At- 4 torney General shall transmit to the Congress and 5 make publicly available a report containing the re- 6 sults of the review, which includes the following: 7 (A) For each State and for the Uniform 8 Code of Military Justice, a summary of the rel- 9 evant laws, policies, regulations, and judicial 10 precedents and decisions regarding criminal 11 cases involving people living with HIV/AIDS, 12 including, if applicable, the following: 13 (i) A determination of whether such 14 laws, policies, regulations, and judicial 15 precedents and decisions place any unique 16 or additional burdens upon people living 17 with HIV/AIDS. 18 (ii) A determination of whether such 19 laws, policies, regulations, and judicial 20 precedents and decisions demonstrate a 21 public health-oriented, evidence-based, 22 medically accurate, and contemporary un- 23 derstanding of— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00549 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 550 •HR 5294 IH (I) the multiple factors that lead 1 to HIV transmission; 2 (II) the relative risk of HIV 3 transmission routes; 4 (III) the current health implica- 5 tions of living with HIV; 6 (IV) the associated benefits of 7 treatment and support services for 8 people living with HIV; and 9 (V) the impact of punitive HIV- 10 specific laws and policies on public 11 health, on people living with or af- 12 fected by HIV, and on their families 13 and communities. 14 (iii) An analysis of the public health 15 and legal implications of such laws, poli- 16 cies, regulations, and judicial precedents, 17 including an analysis of the consequences 18 of having a similar penal scheme applied to 19 comparable situations involving other com- 20 municable diseases. 21 (iv) An analysis of the proportionality 22 of punishments imposed under HIV-spe- 23 cific laws, policies, regulations, and judicial 24 precedents, taking into consideration pen- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00550 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 551 •HR 5294 IH alties attached to violation of State laws 1 against similar degrees of endangerment or 2 harm, such as driving while intoxicated 3 (DWI) or transmission of other commu- 4 nicable diseases, or more serious harms, 5 such as vehicular manslaughter offenses. 6 (B) An analysis of common elements 7 shared among State laws, policies, regulations, 8 and judicial precedents. 9 (C) A set of best practice recommendations 10 directed to State governments, including State 11 attorneys general, public health officials, and 12 judicial officers, in order to ensure that laws, 13 policies, regulations, and judicial precedents re- 14 garding people living with HIV/AIDS are in ac- 15 cordance with the principles set forth in sub- 16 section (b). 17 (D) Recommendations for adjustments to 18 the Uniform Code of Military Justice, as may 19 be necessary, in order to ensure that laws, poli- 20 cies, regulations, and judicial precedents re- 21 garding people living with HIV/AIDS are in ac- 22 cordance with the principles set forth in sub- 23 section (b). 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00551 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 552 •HR 5294 IH (3) GUIDANCE.—Within 90 days of the release 1 of the report required by paragraph (2), the Attor- 2 ney General and the Secretary of Health and 3 Human Services, acting jointly, shall develop and 4 publicly release updated guidance for States based 5 on the set of best practice recommendations required 6 by paragraph (2)(C) in order to assist States dealing 7 with criminal and related civil commitment cases re- 8 garding people living with HIV/AIDS. 9 (4) MONITORING AND EVALUATION SYSTEM.— 10 Within 60 days of the release of the guidance re- 11 quired by paragraph (3), the Attorney General and 12 the Secretary of Health and Human Services, acting 13 jointly, shall establish an integrated monitoring and 14 evaluation system which includes, where appropriate, 15 objective and quantifiable performance goals and in- 16 dicators to measure progress toward statewide im- 17 plementation in each State of the best practice rec- 18 ommendations required in paragraph (2)(C), includ- 19 ing to monitor, track, and evaluate the effectiveness 20 of assistance provided pursuant to subsection (d). 21 (5) ADJUSTMENTS TO FEDERAL LAWS, POLI- 22 CIES, OR REGULATIONS.—Within 90 days of the re- 23 lease of the report required by paragraph (2), the 24 Attorney General, the Secretary of Health and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00552 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 553 •HR 5294 IH Human Services, and the Secretary of Defense, act- 1 ing jointly, shall develop and transmit to the Presi- 2 dent and the Congress, and make publicly available, 3 such proposals as may be necessary to implement 4 adjustments to Federal laws, policies, or regulations, 5 including to the Uniform Code of Military Justice, 6 based on the recommendations required by para- 7 graph (2)(D), either through Executive order or 8 through changes to statutory law. 9 (6) AUTHORIZATION OF APPROPRIATIONS.— 10 (A) IN GENERAL.—There are authorized to 11 be appropriated such sums as may be necessary 12 for the purpose of carrying out this subsection. 13 Amounts authorized to be appropriated by the 14 preceding sentence are in addition to amounts 15 otherwise authorized to be appropriated for 16 such purpose. 17 (B) AVAILABILITY OF FUNDS.—Amounts 18 appropriated pursuant to the authorization of 19 appropriations in subparagraph (A) are author- 20 ized to remain available until expended. 21 (d) AUTHORIZATION TO PROVIDE GRANTS.— 22 (1) GRANTS BY ATTORNEY GENERAL.— 23 (A) IN GENERAL.—The Attorney General 24 may provide assistance to eligible State and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00553 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 554 •HR 5294 IH local entities and eligible nongovernmental orga- 1 nizations for the purpose of incorporating the 2 best practice recommendations developed under 3 subsection (c)(2)(C) within relevant State laws, 4 policies, regulations, and judicial decisions re- 5 garding people living with HIV/AIDS. 6 (B) AUTHORIZED ACTIVITIES.—The assist- 7 ance authorized by subparagraph (A) may in- 8 clude— 9 (i) direct technical assistance to eligi- 10 ble State and local entities in order to de- 11 velop, disseminate, or implement State 12 laws, policies, regulations, or judicial deci- 13 sions that conform with the best practice 14 recommendations developed under sub- 15 section (c)(2)(C); 16 (ii) direct technical assistance to eligi- 17 ble nongovernmental organizations in order 18 to provide education and training, includ- 19 ing through classes, conferences, meetings, 20 and other educational activities, to eligible 21 State and local entities; and 22 (iii) subcontracting authority to allow 23 eligible State and local entities and eligible 24 nongovernmental organizations to seek 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00554 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 555 •HR 5294 IH technical assistance from legal and public 1 health experts with a demonstrated under- 2 standing of the principles underlying the 3 best practice recommendations developed 4 under subsection (c)(2)(C). 5 (2) GRANTS BY SECRETARY OF HEALTH AND 6 HUMAN SERVICES.— 7 (A) IN GENERAL.—The Secretary of 8 Health and Human Services, acting through the 9 Director of the Centers for Disease Control and 10 Prevention, may provide assistance to State and 11 local public health departments and eligible 12 nongovernmental organizations for the purpose 13 of supporting eligible State and local entities to 14 incorporate the best practice recommendations 15 developed under subsection (c)(2)(C) within rel- 16 evant State laws, policies, regulations, and judi- 17 cial decisions regarding people living with HIV/ 18 AIDS. 19 (B) AUTHORIZED ACTIVITIES.—The assist- 20 ance authorized by subparagraph (A) may in- 21 clude— 22 (i) direct technical assistance to State 23 and local public health departments in 24 order to support the development, dissemi- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00555 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 556 •HR 5294 IH nation, or implementation of State laws, 1 policies, regulations, or judicial decisions 2 that conform with the set of best practice 3 recommendations developed under sub- 4 section (c)(2)(C); 5 (ii) direct technical assistance to eligi- 6 ble nongovernmental organizations in order 7 to provide education and training, includ- 8 ing through classes, conferences, meetings, 9 and other educational activities, to State 10 and local public health departments; and 11 (iii) subcontracting authority to allow 12 State and local public health departments 13 and eligible nongovernmental organizations 14 to seek technical assistance from legal and 15 public health experts with a demonstrated 16 understanding of the principles underlying 17 the best practice recommendations devel- 18 oped under subsection (c)(2)(C). 19 (3) LIMITATION.—As a condition of receiving 20 assistance through this subsection, eligible State and 21 local entities, State and local public health depart- 22 ments, and eligible nongovernmental organizations 23 shall agree— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00556 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 557 •HR 5294 IH (A) not to place any unique or additional 1 burdens on people living with HIV/AIDS solely 2 as a result of their HIV status; and 3 (B) that if the entity, department, or orga- 4 nization promulgates any laws, policies, regula- 5 tions, or judicial decisions regarding people liv- 6 ing with HIV/AIDS, such actions shall dem- 7 onstrate a public health-oriented, evidence- 8 based, medically accurate, and contemporary 9 understanding of— 10 (i) the multiple factors that lead to 11 HIV transmission; 12 (ii) the relative risk of HIV trans- 13 mission routes; 14 (iii) the current health implications of 15 living with HIV; 16 (iv) the associated benefits of treat- 17 ment and support services for people living 18 with HIV; and 19 (v) the impact of punitive HIV-spe- 20 cific laws and policies on public health, on 21 people living with or affected by HIV, and 22 on their families and communities. 23 (4) REPORT.—No later than 1 year after the 24 date of the enactment of this Act, and annually 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00557 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 558 •HR 5294 IH thereafter, the Attorney General and the Secretary 1 of Health and Human Services, acting jointly, shall 2 transmit to Congress and make publicly available a 3 report describing, for each State, the impact and ef- 4 fectiveness of the assistance provided through this 5 Act. Each such report shall include— 6 (A) a detailed description of the progress 7 each State has made, if any, in implementing 8 the best practice recommendations developed 9 under subsection (c)(2)(C) as a result of the as- 10 sistance provided under this subsection, and 11 based on the performance goals and indicators 12 established as part of the monitoring and eval- 13 uation system in subsection (c)(4); 14 (B) a brief summary of any outreach ef- 15 forts undertaken during the prior year by the 16 Attorney General and the Secretary of Health 17 and Human Services to encourage States to 18 seek assistance under this subsection in order 19 to implement the best practice recommenda- 20 tions developed under subsection (c)(2)(C); 21 (C) a summary of how assistance provided 22 through this subsection is being utilized by eli- 23 gible State and local entities, State and local 24 public health departments, and eligible non- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00558 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 559 •HR 5294 IH governmental organizations and, if applicable, 1 any contractors, including with respect to non- 2 governmental organizations, the type of tech- 3 nical assistance provided, and an evaluation of 4 the impact of such assistance on eligible State 5 and local entities; and 6 (D) a summary and description of eligible 7 State and local entities, State and local public 8 health departments, and eligible nongovern- 9 mental organizations receiving assistance 10 through this subsection, including if applicable, 11 a summary and description of any contractors 12 selected to assist in implementing such assist- 13 ance. 14 (5) DEFINITIONS.—For the purposes of this 15 subsection: 16 (A) ELIGIBLE STATE AND LOCAL ENTI- 17 TIES.—The term ‘‘eligible State and local enti- 18 ties’’ means the relevant individuals, offices, or 19 organizations that directly participate in the de- 20 velopment, dissemination, or implementation of 21 State laws, policies, regulations, or judicial deci- 22 sions, including— 23 (i) State governments, including State 24 attorneys general, State departments of 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00559 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 560 •HR 5294 IH justice, and State National Guards, or 1 their equivalents; 2 (ii) State judicial and court systems, 3 including trial courts, appellate courts, 4 State supreme courts and courts of appeal, 5 and State correctional facilities, or their 6 equivalents; and 7 (iii) local governments, including city 8 and county governments, district attorneys, 9 and local law enforcement departments, or 10 their equivalents. 11 (B) STATE AND LOCAL PUBLIC HEALTH 12 DEPARTMENTS.—The term ‘‘State and local 13 public health departments’’ means the fol- 14 lowing: 15 (i) State public health departments, or 16 their equivalents, including the chief officer 17 of such departments and infectious disease 18 and communicable disease specialists with- 19 in such departments. 20 (ii) Local public health departments, 21 or their equivalents, including city and 22 county public health departments, the chief 23 officer of such departments, and infectious 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00560 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 561 •HR 5294 IH disease and communicable disease special- 1 ists within such departments. 2 (iii) Public health departments or offi- 3 cials, or their equivalents, within State or 4 local correctional facilities. 5 (iv) Public health departments or offi- 6 cials, or their equivalents, within State Na- 7 tional Guards. 8 (v) Any other recognized State or 9 local public health organization or entity 10 charged with carrying out official State or 11 local public health duties. 12 (C) ELIGIBLE NONGOVERNMENTAL ORGA- 13 NIZATIONS.—The term ‘‘eligible nongovern- 14 mental organizations’’ means the following: 15 (i) Nongovernmental organizations, 16 including trade organizations or associa- 17 tions that represent— 18 (I) State attorneys general, or 19 their equivalents; 20 (II) State public health officials, 21 or their equivalents; 22 (III) State judicial and court offi- 23 cers, including judges, district attor- 24 neys, prosecutors, defense attorneys, 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00561 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 562 •HR 5294 IH law enforcement, and correctional offi- 1 cers; 2 (IV) State National Guards; 3 (V) people living with HIV/AIDS; 4 (VI) legal advocacy and HIV/ 5 AIDS service organizations that work 6 with people living with HIV/AIDS; 7 and 8 (VII) nongovernmental health or- 9 ganizations that work on behalf of 10 people living with HIV/AIDS. 11 (ii) Nongovernmental organizations, 12 including trade organizations or associa- 13 tions that demonstrate a public-health ori- 14 ented, evidence-based, medically accurate, 15 and contemporary understanding of— 16 (I) the multiple factors that lead 17 to HIV transmission; 18 (II) the relative risk of HIV 19 transmission routes; 20 (III) the current health implica- 21 tions of living with HIV; 22 (IV) the associated benefits of 23 treatment and support services for 24 people living with HIV; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00562 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 563 •HR 5294 IH (V) the impact of punitive HIV- 1 specific laws and policies on public 2 health, on people living with or af- 3 fected by HIV, and on their families 4 and communities. 5 (6) AUTHORIZATION OF APPROPRIATIONS.— 6 (A) IN GENERAL.—In addition to amounts 7 otherwise made available, there are authorized 8 to be appropriated to the Attorney General and 9 the Secretary of Health and Human Services 10 such sums as may be necessary to carry out 11 this subsection for each of the fiscal years 2015 12 through 2019. 13 (B) AVAILABILITY OF FUNDS.—Amounts 14 appropriated pursuant to the authorizations of 15 appropriations in subparagraph (A) are author- 16 ized to remain available until expended. 17 SEC. 758. REPEAL OF LIMITATION AGAINST USE OF FUNDS 18 FOR EDUCATION OR INFORMATION DE- 19 SIGNED TO PROMOTE OR ENCOURAGE, DI- 20 RECTLY, HOMOSEXUAL OR HETEROSEXUAL 21 ACTIVITY OR INTRAVENOUS SUBSTANCE 22 ABUSE. 23 Section 2500 of the Public Health Service Act (42 24 U.S.C. 300ee) is amended— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00563 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 564 •HR 5294 IH (1) by striking subsection (c); and 1 (2) by redesignating subsection (d) as sub- 2 section (c). 3 SEC. 759. EXPANDING SUPPORT FOR CONDOMS IN PRIS- 4 ONS. 5 (a) AUTHORITY TO ALLOW COMMUNITY ORGANIZA- 6 TIONS TO PROVIDE STI COUNSELING, STI PREVENTION 7 EDUCATION, AND SEXUAL BARRIER PROTECTION DE- 8 VICES IN FEDERAL CORRECTIONAL FACILITIES.— 9 (1) DIRECTIVE TO ATTORNEY GENERAL.—Not 10 later than 30 days after the date of enactment of 11 this Act, the Attorney General shall direct the Bu- 12 reau of Prisons to allow community organizations to 13 distribute sexual barrier protection devices and to 14 engage in STI counseling and STI prevention edu- 15 cation in Federal correctional facilities. These activi- 16 ties shall be subject to all relevant Federal laws and 17 regulations which govern visitation in correctional 18 facilities. 19 (2) INFORMATION REQUIREMENT.—Any com- 20 munity organization permitted to distribute sexual 21 barrier protection devices under paragraph (1) shall 22 ensure that the persons to whom the devices are dis- 23 tributed are informed about the proper use and dis- 24 posal of sexual barrier protection devices in accord- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00564 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 565 •HR 5294 IH ance with established public health practices. Any 1 community organization conducting STI counseling 2 or STI prevention education under paragraph (1) 3 shall offer comprehensive sexuality education. 4 (3) POSSESSION OF DEVICE PROTECTED.—No 5 Federal correctional facility may, because of the pos- 6 session or use of a sexual barrier protection device— 7 (A) take adverse action against an incar- 8 cerated person; or 9 (B) consider possession or use as evidence 10 of prohibited activity for the purpose of any 11 Federal correctional facility administrative pro- 12 ceeding. 13 (4) IMPLEMENTATION.—The Attorney General 14 and Bureau of Prisons shall implement this section 15 according to established public health practices in a 16 manner that protects the health, safety, and privacy 17 of incarcerated persons and of correctional facility 18 staff. 19 (b) SENSE OF CONGRESS REGARDING DISTRIBUTION 20 OF SEXUAL BARRIER PROTECTION DEVICES IN STATE 21 PRISON SYSTEMS.—It is the sense of the Congress that 22 States should allow for the legal distribution of sexual bar- 23 rier protection devices in State correctional facilities to re- 24 duce the prevalence and spread of STIs in those facilities. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00565 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 566 •HR 5294 IH (c) SURVEY OF AND REPORT ON CORRECTIONAL FA- 1 CILITY PROGRAMS AIMED AT REDUCING THE SPREAD OF 2 STIS.— 3 (1) SURVEY.—The Attorney General, after con- 4 sulting with the Secretary of Health and Human 5 Services, State officials, and community organiza- 6 tions, shall, to the maximum extent practicable, con- 7 duct a survey of all Federal and State correctional 8 facilities, not later than 180 days after the date of 9 enactment of this Act and annually thereafter for 5 10 years, to determine the following: 11 (A) COUNSELING, TREATMENT, AND SUP- 12 PORTIVE SERVICES.—Whether the correctional 13 facility requires incarcerated persons to partici- 14 pate in counseling, treatment, and supportive 15 services related to STIs, or whether it offers 16 such programs to incarcerated persons. 17 (B) ACCESS TO SEXUAL BARRIER PROTEC- 18 TION DEVICES.—Whether incarcerated persons 19 can— 20 (i) possess sexual barrier protection 21 devices; 22 (ii) purchase sexual barrier protection 23 devices; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00566 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 567 •HR 5294 IH (iii) purchase sexual barrier protection 1 devices at a reduced cost; and 2 (iv) obtain sexual barrier protection 3 devices without cost. 4 (C) INCIDENCE OF SEXUAL VIOLENCE.— 5 The incidence of sexual violence and assault 6 committed by incarcerated persons and by cor- 7 rectional facility staff. 8 (D) PREVENTION EDUCATION OFFERED.— 9 The type of prevention education, information, 10 or training offered to incarcerated persons and 11 correctional facility staff regarding sexual vio- 12 lence and the spread of STIs, including whether 13 such education, information, or training— 14 (i) constitutes comprehensive sexuality 15 education; 16 (ii) is compulsory for new incarcerated 17 persons and for new staff; and 18 (iii) is offered on an ongoing basis. 19 (E) STI TESTING.—Whether the correc- 20 tional facility tests incarcerated persons for 21 STIs or gives them the option to undergo such 22 testing— 23 (i) at intake; 24 (ii) on a regular basis; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00567 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 568 •HR 5294 IH (iii) prior to release. 1 (F) STI TEST RESULTS.—The number of 2 incarcerated persons who are tested for STIs 3 and the outcome of such tests at each correc- 4 tional facility, disaggregated to include results 5 for— 6 (i) the type of sexually transmitted in- 7 fection tested for; 8 (ii) the race and/or ethnicity of indi- 9 viduals tested; 10 (iii) the age of individuals tested; and 11 (iv) the gender of individuals tested. 12 (G) PRERELEASE REFERRAL POLICY.— 13 Whether incarcerated persons are informed 14 prior to release about STI-related services or 15 other health services in their communities, in- 16 cluding free and low-cost counseling and treat- 17 ment options. 18 (H) PRERELEASE REFERRALS MADE.— 19 The number of referrals to community-based 20 organizations or public health facilities offering 21 STI-related or other health services provided to 22 incarcerated persons prior to release, and the 23 type of counseling or treatment for which the 24 referral was made. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00568 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 569 •HR 5294 IH (I) REINSTATEMENT OF MEDICAID BENE- 1 FITS.—Whether the correctional facility assists 2 incarcerated persons that were enrolled in the 3 State Medicaid program prior to their incarcer- 4 ation, in reinstating their enrollment upon re- 5 lease and whether such individuals receive refer- 6 rals as provided by subparagraph (G) to entities 7 that accept the State Medicaid program, includ- 8 ing if applicable— 9 (i) the number of such individuals, in- 10 cluding those diagnosed with the human 11 immunodeficiency virus, that have been re- 12 instated; 13 (ii) a list of obstacles to reinstating 14 enrollment or to making determinations of 15 eligibility for reinstatement, if any; and 16 (iii) the number of individuals denied 17 enrollment. 18 (J) OTHER ACTIONS TAKEN.—Whether the 19 correctional facility has taken any other action, 20 in conjunction with community organizations or 21 otherwise, to reduce the prevalence and spread 22 of STIs in that facility. 23 (2) PRIVACY.—In conducting the survey, the 24 Attorney General shall not request or retain the 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00569 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 570 •HR 5294 IH identity of any person who has sought or been of- 1 fered counseling, treatment, testing, or prevention 2 education information regarding an STI (including 3 information about sexual barrier protection devices), 4 or who has tested positive for an STI. 5 (3) REPORT.—The Attorney General shall 6 transmit to Congress and make publicly available 7 the results of the survey required under paragraph 8 (1), both for the Nation as a whole and 9 disaggregated as to each State and each correctional 10 facility. To the maximum extent possible, the Attor- 11 ney General shall issue the first report no later than 12 1 year after the date of enactment of this Act and 13 shall issue reports annually thereafter for 5 years. 14 (d) STRATEGY.— 15 (1) DIRECTIVE TO ATTORNEY GENERAL.—The 16 Attorney General, in consultation with the Secretary 17 of Health and Human Services, State officials, and 18 community organizations, shall develop and imple- 19 ment a 5-year strategy to reduce the prevalence and 20 spread of STIs in Federal and State correctional fa- 21 cilities. To the maximum extent possible, the strat- 22 egy shall be developed, transmitted to Congress, and 23 made publicly available no later than 180 days after 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00570 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 571 •HR 5294 IH the transmission of the first report required under 1 subsection (c)(3). 2 (2) CONTENTS OF STRATEGY.—The strategy 3 shall include the following: 4 (A) PREVENTION EDUCATION.—A plan for 5 improving prevention education, information, 6 and training offered to incarcerated persons 7 and correctional facility staff, including infor- 8 mation and training on sexual violence and the 9 spread of STIs, and comprehensive sexuality 10 education. 11 (B) SEXUAL BARRIER PROTECTION DEVICE 12 ACCESS.—A plan for expanding access to sexual 13 barrier protection devices in correctional facili- 14 ties. 15 (C) SEXUAL VIOLENCE REDUCTION.—A 16 plan for reducing the incidence of sexual vio- 17 lence among incarcerated persons and correc- 18 tional facility staff, developed in consultation 19 with the National Prison Rape Elimination 20 Commission. 21 (D) COUNSELING AND SUPPORTIVE SERV- 22 ICES.—A plan for expanding access to coun- 23 seling and supportive services related to STIs in 24 correctional facilities. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00571 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 572 •HR 5294 IH (E) TESTING.—A plan for testing incarcer- 1 ated persons for STIs during intake, during 2 regular health exams, and prior to release, and 3 that— 4 (i) is conducted in accordance with 5 guidelines established by the Centers for 6 Disease Control and Prevention; 7 (ii) includes pretest counseling; 8 (iii) requires that incarcerated persons 9 are notified of their option to decline test- 10 ing at any time; 11 (iv) requires that incarcerated persons 12 are confidentially notified of their test re- 13 sults in a timely manner; and 14 (v) ensures that incarcerated persons 15 testing positive for STIs receive post-test 16 counseling, care, treatment, and supportive 17 services. 18 (F) TREATMENT.—A plan for ensuring 19 that correctional facilities have the necessary 20 medicine and equipment to treat and monitor 21 STIs and for ensuring that incarcerated per- 22 sons living with or testing positive for STIs re- 23 ceive and have access to care and treatment 24 services. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00572 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 573 •HR 5294 IH (G) STRATEGIES FOR DEMOGRAPHIC 1 GROUPS.—A plan for developing and imple- 2 menting culturally appropriate, sensitive, and 3 specific strategies to reduce the spread of STIs 4 among demographic groups heavily impacted by 5 STIs. 6 (H) LINKAGES WITH COMMUNITIES AND 7 FACILITIES.—A plan for establishing and 8 strengthening linkages to local communities and 9 health facilities that— 10 (i) provide counseling, testing, care, 11 and treatment services; 12 (ii) may receive persons recently re- 13 leased from incarceration who are living 14 with STIs; and 15 (iii) accept payment through the State 16 Medicaid program. 17 (I) ENROLLMENT IN STATE MEDICAID 18 PROGRAMS.—Plans to ensure that incarcerated 19 persons who were— 20 (i) enrolled in their State Medicaid 21 program prior to incarceration in a correc- 22 tional facility are automatically re-enrolled 23 in such program upon their release; and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00573 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 574 •HR 5294 IH (ii) not enrolled in their State Med- 1 icaid program prior to incarceration, but 2 who are diagnosed with the human im- 3 munodeficiency virus while incarcerated in 4 a correctional facility, are automatically 5 enrolled in such program upon their re- 6 lease. 7 (J) OTHER PLANS.—Any other plans de- 8 veloped by the Attorney General for reducing 9 the spread of STIs or improving the quality of 10 health care in correctional facilities. 11 (K) MONITORING SYSTEM.—A monitoring 12 system that establishes performance goals re- 13 lated to reducing the prevalence and spread of 14 STIs in correctional facilities and which, where 15 feasible, expresses such goals in quantifiable 16 form. 17 (L) MONITORING SYSTEM PERFORMANCE 18 INDICATORS.—Performance indicators that 19 measure or assess the achievement of the per- 20 formance goals described in subparagraph (K). 21 (M) COST ESTIMATE.—A detailed estimate 22 of the funding necessary to implement the 23 strategy at the Federal and State levels for all 24 5 years, including the amount of funds required 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00574 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 575 •HR 5294 IH by community organizations to implement the 1 parts of the strategy in which they take part. 2 (3) REPORT.—The Attorney General shall 3 transmit to Congress and make publicly available an 4 annual progress report regarding the implementation 5 and effectiveness of the strategy described in para- 6 graph (1). The progress report shall include an eval- 7 uation of the implementation of the strategy using 8 the monitoring system and performance indicators 9 provided for in subparagraphs (K) and (L) of para- 10 graph (2). 11 (e) AUTHORIZATION OF APPROPRIATIONS.— 12 (1) IN GENERAL.—There are authorized to be 13 appropriated such sums as may be necessary to 14 carry out this section for each of fiscal years 2015 15 through 2020. 16 (2) AVAILABILITY OF FUNDS.—Amounts made 17 available under paragraph (1) are authorized to re- 18 main available until expended. 19 (f) DEFINITIONS.—For the purposes of this section: 20 (1) COMMUNITY ORGANIZATION.—The term 21 ‘‘community organization’’ means a public health 22 care facility or a nonprofit organization which pro- 23 vides health- or STI-related services according to es- 24 tablished public health standards. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00575 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 576 •HR 5294 IH (2) COMPREHENSIVE SEXUALITY EDUCATION.— 1 The term ‘‘comprehensive sexuality education’’ 2 means sexuality education that includes information 3 about abstinence and about the proper use and dis- 4 posal of sexual barrier protection devices and which 5 is— 6 (A) evidence-based; 7 (B) medically accurate; 8 (C) age and developmentally appropriate; 9 (D) gender and identity sensitive; 10 (E) culturally and linguistically appro- 11 priate; and 12 (F) structured to promote critical thinking, 13 self-esteem, respect for others, and the develop- 14 ment of healthy attitudes and relationships. 15 (3) CORRECTIONAL FACILITY.—The term ‘‘cor- 16 rectional facility’’ means any prison, penitentiary, 17 adult detention facility, juvenile detention facility, 18 jail, or other facility to which persons may be sent 19 after conviction of a crime or act of juvenile delin- 20 quency within the United States. 21 (4) INCARCERATED PERSON.—The term ‘‘incar- 22 cerated person’’ means any person who is serving a 23 sentence in a correctional facility after conviction of 24 a crime. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00576 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 577 •HR 5294 IH (5) SEXUALLY TRANSMITTED INFECTION.—The 1 term ‘‘sexually transmitted infection’’ or ‘‘STI’’ 2 means any disease or infection that is commonly 3 transmitted through sexual activity, including HIV/ 4 AIDS, gonorrhea, chlamydia, syphilis, genital her- 5 pes, viral hepatitis, and human papillomavirus. 6 (6) SEXUAL BARRIER PROTECTION DEVICE.— 7 The term ‘‘sexual barrier protection device’’ means 8 any FDA-approved physical device which has not 9 been tampered with and which reduces the prob- 10 ability of STI transmission or infection between sex- 11 ual partners, including female condoms, male 12 condoms, and dental dams. 13 (7) STATE.—The term ‘‘State’’ includes the 14 District of Columbia, American Samoa, the Com- 15 monwealth of the Northern Mariana Islands, Guam, 16 Puerto Rico, and the United States Virgin Islands. 17 SEC. 760. AUTOMATIC REINSTATEMENT OR ENROLLMENT 18 IN MEDICAID FOR PEOPLE WHO TEST POSI- 19 TIVE FOR HIV BEFORE REENTERING COMMU- 20 NITIES. 21 (a) IN GENERAL.—Section 1902(e) of the Social Se- 22 curity Act (42 U.S.C. 1396a(e)) is amended by adding at 23 the end the following: 24 ‘‘(15) ENROLLMENT OF EX-OFFENDERS.— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00577 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 578 •HR 5294 IH ‘‘(A) AUTOMATIC ENROLLMENT OR REIN- 1 STATEMENT.— 2 ‘‘(i) IN GENERAL.—The State plan 3 shall provide for the automatic enrollment 4 or reinstatement of enrollment of an eligi- 5 ble individual— 6 ‘‘(I) if such individual is sched- 7 uled to be released from a public insti- 8 tution due to the completion of sen- 9 tence, not less than 30 days prior to 10 the scheduled date of the release; and 11 ‘‘(II) if such individual is to be 12 released from a public institution on 13 parole or on probation, as soon as 14 possible after the date on which the 15 determination to release such indi- 16 vidual was made, and before the date 17 such individual is released. 18 ‘‘(ii) EXCEPTION.—If a State makes a 19 determination that an individual is not eli- 20 gible to be enrolled under the State plan— 21 ‘‘(I) on or before the date by 22 which the individual would be enrolled 23 under clause (i), such clause shall not 24 apply to such individual; or 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00578 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 579 •HR 5294 IH ‘‘(II) after such date, the State 1 may terminate the enrollment of such 2 individual. 3 ‘‘(B) RELATIONSHIP OF ENROLLMENT TO 4 PAYMENT FOR SERVICES.— 5 ‘‘(i) IN GENERAL.—Subject to sub- 6 paragraph (A)(ii), an eligible individual 7 who is enrolled, or whose enrollment is re- 8 instated, under subparagraph (A) shall be 9 eligible for medical assistance that is pro- 10 vided after the date that the eligible indi- 11 vidual is released from the public institu- 12 tion. 13 ‘‘(ii) RELATIONSHIP TO PAYMENT 14 PROHIBITION FOR INMATES.—No provision 15 of this paragraph may be construed to per- 16 mit payment for care or services for which 17 payment is excluded under the subdivision 18 (A) that follows paragraph (29) of section 19 1905(a). 20 ‘‘(C) TREATMENT OF CONTINUOUS ELIGI- 21 BILITY.— 22 ‘‘(i) SUSPENSION FOR INMATES.—Any 23 period of continuous eligibility under this 24 title shall be suspended on the date an in- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00579 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 580 •HR 5294 IH dividual enrolled under this title becomes 1 an inmate of a public institution (except as 2 a patient of a medical institution). 3 ‘‘(ii) DETERMINATION OF REMAINING 4 PERIOD.—Notwithstanding any changes to 5 State law related to continuous eligibility 6 during the time that an individual is an in- 7 mate of a public institution (except as a 8 patient of a medical institution), subject to 9 clause (iii), with respect to an eligible indi- 10 vidual who was subject to a suspension 11 under clause (i), on the date that such in- 12 dividual is released from a public institu- 13 tion the suspension of continuous eligibility 14 under such clause shall be lifted for a pe- 15 riod that is equal to the time remaining in 16 the period of continuous eligibility for such 17 individual on the date that such period was 18 suspended under such clause. 19 ‘‘(iii) EXCEPTION.—If a State makes 20 a determination that an individual is not 21 eligible to be enrolled under the State 22 plan— 23 ‘‘(I) on or before the date that 24 the suspension of continuous eligibility 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00580 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 581 •HR 5294 IH is lifted under clause (ii), such clause 1 shall not apply to such individual; or 2 ‘‘(II) after such date, the State 3 may terminate the enrollment of such 4 individual. 5 ‘‘(D) AUTOMATIC ENROLLMENT OR REIN- 6 STATEMENT OF ENROLLMENT DEFINED.—For 7 purposes of this paragraph, the term ‘automatic 8 enrollment or reinstatement of enrollment’ 9 means that the State determines eligibility for 10 medical assistance under the State plan without 11 a program application from, or on behalf of, the 12 eligible individual, but an individual can only be 13 automatically enrolled in the State Medicaid 14 plan if the individual affirmatively consents to 15 being enrolled through affirmation in writing, 16 by telephone, orally, through electronic signa- 17 ture, or through any other means specified by 18 the Secretary. 19 ‘‘(E) ELIGIBLE INDIVIDUAL DEFINED.— 20 For purposes of this paragraph, the term ‘eligi- 21 ble individual’ means an individual who is an 22 inmate of a public institution (except as a pa- 23 tient in a medical institution)— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00581 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 582 •HR 5294 IH ‘‘(i) who was enrolled under the State 1 plan for medical assistance immediately be- 2 fore becoming an inmate of such an insti- 3 tution; or 4 ‘‘(ii) is diagnosed with human im- 5 munodeficiency virus.’’. 6 (b) SUPPLEMENTAL FUNDING FOR STATE IMPLE- 7 MENTATION OF AUTOMATIC REINSTATEMENT OF MED- 8 ICAID BENEFITS.— 9 (1) IN GENERAL.—Subject to paragraph (6), 10 for each State for which the Secretary of Health and 11 Human Services has approved an application under 12 paragraph (3), the Federal matching payments (in- 13 cluding payments based on the Federal medical as- 14 sistance percentage) made to such State under sec- 15 tion 1903 of the Social Security Act (42 U.S.C. 16 1396b) shall be increased by 5.0 percentage points 17 for payments to the State for the activities per- 18 mitted under paragraph (2) or a period of one year. 19 (2) USE OF FUNDS.—A State may only use in- 20 creased matching payments authorized under para- 21 graph (1)— 22 (A) to strengthen the State’s enrollment 23 and administrative resources for the purpose of 24 improving processes for enrolling (or reinstating 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00582 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 583 •HR 5294 IH the enrollment of) eligible individuals (as such 1 term is defined in subparagraph (E) of para- 2 graph (15) of section 1902(e) of the Social Se- 3 curity Act (as amended by subsection (a))); and 4 (B) for medical assistance (as such term is 5 defined in section 1905(a) of the Social Secu- 6 rity Act) provided to such eligible individuals. 7 (3) APPLICATION AND AGREEMENT.—The Sec- 8 retary may only make payments to a State in the in- 9 creased amount if— 10 (A) the State has amended the State plan 11 under section 1902(e) of the Social Security 12 Act to incorporate the requirements of para- 13 graph (15) of such section (as added by sub- 14 section (a)); 15 (B) the State has submitted an application 16 to the Secretary that includes a plan for imple- 17 menting the requirements of section 18 1902(e)(15) of the Social Security Act under 19 the State’s amended State plan before the end 20 of the 90-day period beginning on the date that 21 the State receives increased matching payments 22 under paragraph (1); 23 (C) the State’s application meets the satis- 24 faction of the Secretary; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00583 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 584 •HR 5294 IH (D) the State enters an agreement with 1 the Secretary that states that— 2 (i) the State will only use the in- 3 creased matching funds for the uses per- 4 mitted under paragraph (2); and 5 (ii) at the end of the period under 6 paragraph (1), the State will submit to the 7 Secretary, and make publicly available, a 8 report that contains the information re- 9 quired under paragraph (4). 10 (4) REQUIRED REPORT INFORMATION.—The in- 11 formation that is required in the report under para- 12 graph (3)(D)(ii) includes— 13 (A) the results of an evaluation of the im- 14 pact of the implementation of the requirements 15 of section 1902(e)(15) of the Social Security 16 Act on improving the State’s processes for en- 17 rolling of individuals who are released from 18 public institutions into the Medicaid program; 19 (B) the number of individuals who were 20 automatically enrolled (or whose enrollment is 21 reinstated) under such section 1902(e)(15) dur- 22 ing the period under paragraph (1); and 23 (C) any other information that is required 24 by the Secretary. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00584 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 585 •HR 5294 IH (5) INCREASE IN CAP ON MEDICAID PAYMENTS 1 TO TERRITORIES.—Subject to paragraph (6), the 2 amounts otherwise determined for Puerto Rico, the 3 United States Virgin Islands, Guam, the Northern 4 Mariana Islands, and American Samoa under sub- 5 sections (f) and (g) of section 1108 of the Social Se- 6 curity Act (42 U.S.C. 1308) shall each be increased 7 by the necessary amount to allow for the increase in 8 the Federal matching payments under paragraph 9 (1), but only for the period under such paragraph 10 for such State. In the case of such an increase for 11 a territory, subsection (a)(1) of such section 1108 12 shall be applied without regard to any increase in 13 payment made to the territory under part E of title 14 IV of such Act that is attributable to the increase 15 in Federal medical assistance percentage effected 16 under paragraph (1) for the territory. 17 (6) LIMITATIONS.— 18 (A) TIMING.—With respect to a State, at 19 the end of the period under paragraph (1), no 20 increased matching payments may be made to 21 such State under this subsection. 22 (B) MAINTENANCE OF ELIGIBILITY.— 23 (i) IN GENERAL.—Subject to clause 24 (ii), a State is not eligible for an increase 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00585 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 586 •HR 5294 IH in its Federal matching payments under 1 paragraph (1), or an increase in a cap 2 amount under paragraph (5), if eligibility 3 standards, methodologies, or procedures 4 under its State plan under title XIX of the 5 Social Security Act (including any waiver 6 under such title or under section 1115 of 7 such Act (42 U.S.C. 1315)) are more re- 8 strictive than the eligibility standards, 9 methodologies, or procedures, respectively, 10 under such plan (or waiver) as in effect on 11 the date of enactment of this Act. 12 (ii) STATE REINSTATEMENT OF ELIGI- 13 BILITY PERMITTED.—A State that has re- 14 stricted eligibility standards, methodolo- 15 gies, or procedures under its State plan 16 under title XIX of the Social Security Act 17 (including any waiver under such title or 18 under section 1115 of such Act (42 U.S.C. 19 1315)) after the date of enactment of this 20 Act, is no longer ineligible under subpara- 21 graph (A) beginning with the first calendar 22 quarter in which the State has reinstated 23 eligibility standards, methodologies, or pro- 24 cedures that are no more restrictive than 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00586 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 587 •HR 5294 IH the eligibility standards, methodologies, or 1 procedures, respectively, under such plan 2 (or waiver) as in effect on such date. 3 (C) NO WAIVER AUTHORITY.—The Sec- 4 retary may not waive the application of this 5 subsection under section 1115 of the Social Se- 6 curity Act or otherwise. 7 (D) LIMITATION OF MATCHING PAYMENTS 8 TO 100 PERCENT.—In no case shall an increase 9 in Federal matching payments under this sub- 10 section result in Federal matching payments 11 that exceed 100 percent. 12 (c) EFFECTIVE DATE.— 13 (1) IN GENERAL.—Except as provided in para- 14 graph (2), the amendments made by subsection (a) 15 shall take effect 180 days after the date of the en- 16 actment of this Act and shall apply to services fur- 17 nished on or after such date. 18 (2) RULE FOR CHANGES REQUIRING STATE 19 LEGISLATION.—In the case of a State plan for med- 20 ical assistance under title XIX of the Social Security 21 Act which the Secretary of Health and Human Serv- 22 ices determines requires State legislation (other than 23 legislation appropriating funds) in order for the plan 24 to meet the additional requirement imposed by the 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00587 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 588 •HR 5294 IH amendments made by this section, the State plan 1 shall not be regarded as failing to comply with the 2 requirements of such title solely on the basis of its 3 failure to meet this additional requirement before 4 the first day of the first calendar quarter beginning 5 after the close of the first regular session of the 6 State legislature that begins after the date of the en- 7 actment of this Act. For purposes of the previous 8 sentence, in the case of a State that has a 2-year 9 legislative session, each year of such session shall be 10 deemed to be a separate regular session of the State 11 legislature. 12 SEC. 761. STOP AIDS IN PRISON. 13 (a) SHORT TITLE.—This section may be cited as the 14 ‘‘Stop AIDS in Prison Act’’. 15 (b) IN GENERAL.—The Bureau of Prisons (herein- 16 after in this section referred to as the ‘‘Bureau’’) shall 17 develop a comprehensive policy to provide HIV testing, 18 treatment, and prevention for inmates within the correc- 19 tional setting and upon reentry. 20 (c) PURPOSE.—The purposes of this policy shall be 21 as follows: 22 (1) To stop the spread of HIV/AIDS among in- 23 mates. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00588 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 589 •HR 5294 IH (2) To protect prison guards and other per- 1 sonnel from HIV/AIDS infection. 2 (3) To provide comprehensive medical treat- 3 ment to inmates who are living with HIV/AIDS. 4 (4) To promote HIV/AIDS awareness and pre- 5 vention among inmates. 6 (5) To encourage inmates to take personal re- 7 sponsibility for their health. 8 (6) To reduce the risk that inmates will trans- 9 mit HIV/AIDS to other persons in the community 10 following their release from prison. 11 (d) CONSULTATION.—The Bureau shall consult with 12 appropriate officials of the Department of Health and 13 Human Services, the Office of National Drug Control Pol- 14 icy, the Office of National AIDS Policy, and the Centers 15 for Disease Control and Prevention regarding the develop- 16 ment of this policy. 17 (e) TIME LIMIT.—The Bureau shall draft appro- 18 priate regulations to implement this policy not later than 19 1 year after the date of the enactment of this Act. 20 (f) REQUIREMENTS FOR POLICY.—The policy created 21 under subsection (b) shall provide for the following: 22 (1) TESTING AND COUNSELING UPON IN- 23 TAKE.— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00589 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 590 •HR 5294 IH (A) Health care personnel shall provide 1 routine HIV testing to all inmates as a part of 2 a comprehensive medical examination imme- 3 diately following admission to a facility. (Health 4 care personnel need not provide routine HIV 5 testing to an inmate who is transferred to a fa- 6 cility from another facility if the inmate’s med- 7 ical records are transferred with the inmate and 8 indicate that the inmate has been tested pre- 9 viously.) 10 (B) To all inmates admitted to a facility 11 prior to the effective date of this policy, health 12 care personnel shall provide routine HIV testing 13 within no more than 6 months. HIV testing for 14 these inmates may be performed in conjunction 15 with other health services provided to these in- 16 mates by health care personnel. 17 (C) All HIV tests under this paragraph 18 shall comply with the opt-out provision. 19 (2) PRE-TEST AND POST-TEST COUNSELING.— 20 Health care personnel shall provide confidential pre- 21 test and post-test counseling to all inmates who are 22 tested for HIV. Counseling may be included with 23 other general health counseling provided to inmates 24 by health care personnel. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00590 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 591 •HR 5294 IH (3) HIV/AIDS PREVENTION EDUCATION.— 1 (A) Health care personnel shall improve 2 HIV/AIDS awareness through frequent edu- 3 cational programs for all inmates. HIV/AIDS 4 educational programs may be provided by com- 5 munity-based organizations, local health depart- 6 ments, and inmate peer educators. 7 (B) HIV/AIDS educational materials shall 8 be made available to all inmates at orientation, 9 at health care clinics, at regular educational 10 programs, and prior to release. Both written 11 and audiovisual materials shall be made avail- 12 able to all inmates. 13 (C)(i) The HIV/AIDS educational pro- 14 grams and materials under this paragraph shall 15 include information on— 16 (I) modes of transmission, including 17 transmission through tattooing, sexual con- 18 tact, and intravenous drug use; 19 (II) prevention methods; 20 (III) treatment; and 21 (IV) disease progression. 22 (ii) The programs and materials shall be 23 culturally sensitive, written or designed for low- 24 literacy levels, available in a variety of lan- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00591 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 592 •HR 5294 IH guages, and present scientifically accurate in- 1 formation in a clear and understandable man- 2 ner. 3 (4) HIV TESTING UPON REQUEST.— 4 (A) Health care personnel shall allow in- 5 mates to obtain HIV tests upon request once 6 per year or whenever an inmate has a reason to 7 believe the inmate may have been exposed to 8 HIV. Health care personnel shall, both orally 9 and in writing, inform inmates, during orienta- 10 tion and periodically throughout incarceration, 11 of their right to obtain HIV tests. 12 (B) Health care personnel shall encourage 13 inmates to request HIV tests if the inmate is 14 sexually active, has been raped, uses intra- 15 venous drugs, receives a tattoo, or if the inmate 16 is concerned that the inmate may have been ex- 17 posed to HIV/AIDS. 18 (C) An inmate’s request for an HIV test 19 shall not be considered an indication that the 20 inmate has put him/herself at risk of infection 21 and/or committed a violation of prison rules. 22 (5) HIV TESTING OF PREGNANT WOMAN.— 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00592 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 593 •HR 5294 IH (A) Health care personnel shall provide 1 routine HIV testing to all inmates who become 2 pregnant. 3 (B) All HIV tests under this paragraph 4 shall comply with the opt-out provision. 5 (6) COMPREHENSIVE TREATMENT.— 6 (A) Health care personnel shall provide all 7 inmates who test positive for HIV— 8 (i) timely, comprehensive medical 9 treatment; 10 (ii) confidential counseling on man- 11 aging their medical condition and pre- 12 venting its transmission to other persons; 13 and 14 (iii) voluntary partner notification 15 services. 16 (B) Health care provided under this para- 17 graph shall be consistent with current Depart- 18 ment of Health and Human Services guidelines 19 and standard medical practice. Health care per- 20 sonnel shall discuss treatment options, the im- 21 portance of adherence to antiretroviral therapy, 22 and the side effects of medications with inmates 23 receiving treatment. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00593 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 594 •HR 5294 IH (C) Health care personnel and pharmacy 1 personnel shall ensure that the facility for- 2 mulary contains all Food and Drug Administra- 3 tion-approved medications necessary to provide 4 comprehensive treatment for inmates living with 5 HIV/AIDS, and that the facility maintains ade- 6 quate supplies of such medications to meet in- 7 mates’ medical needs. Health care personnel 8 and pharmacy personnel shall also develop and 9 implement automatic renewal systems for these 10 medications to prevent interruptions in care. 11 (D) Correctional staff, health care per- 12 sonnel, and pharmacy personnel shall develop 13 and implement distribution procedures to en- 14 sure timely and confidential access to medica- 15 tions. 16 (7) PROTECTION OF CONFIDENTIALITY.— 17 (A) Health care personnel shall develop 18 and implement procedures to ensure the con- 19 fidentiality of inmate tests, diagnoses, and 20 treatment. Health care personnel and correc- 21 tional staff shall receive regular training on the 22 implementation of these procedures. Penalties 23 for violations of inmate confidentiality by health 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00594 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 595 •HR 5294 IH care personnel or correctional staff shall be 1 specified and strictly enforced. 2 (B) HIV testing, counseling, and treat- 3 ment shall be provided in a confidential setting 4 where other routine health services are provided 5 and in a manner that allows the inmate to re- 6 quest and obtain these services as routine med- 7 ical services. 8 (8) TESTING, COUNSELING, AND REFERRAL 9 PRIOR TO REENTRY.— 10 (A) Health care personnel shall provide 11 routine HIV testing to all inmates no more 12 than 3 months prior to their release and re- 13 entry into the community. (Inmates who are al- 14 ready known to be infected need not be tested 15 again.) This requirement may be waived if an 16 inmate’s release occurs without sufficient notice 17 to the Bureau to allow health care personnel to 18 perform a routine HIV test and notify the in- 19 mate of the results. 20 (B) All HIV tests under this paragraph 21 shall comply with the opt-out provision. 22 (C) To all inmates who test positive for 23 HIV and all inmates who already are known to 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00595 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 596 •HR 5294 IH have HIV/AIDS, health care personnel shall 1 provide— 2 (i) confidential prerelease counseling 3 on managing their medical condition in the 4 community, accessing appropriate treat- 5 ment and services in the community, and 6 preventing the transmission of their condi- 7 tion to family members and other persons 8 in the community; 9 (ii) referrals to appropriate health 10 care providers and social service agencies 11 in the community that meet the inmate’s 12 individual needs, including voluntary part- 13 ner notification services and prevention 14 counseling services for people living with 15 HIV/AIDS; and 16 (iii) a 30-day supply of any medically 17 necessary medications the inmate is cur- 18 rently receiving. 19 (9) OPT-OUT PROVISION.—Inmates shall have 20 the right to refuse routine HIV testing. Inmates 21 shall be informed both orally and in writing of this 22 right. Oral and written disclosure of this right may 23 be included with other general health information 24 and counseling provided to inmates by health care 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00596 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 597 •HR 5294 IH personnel. If an inmate refuses a routine test for 1 HIV, health care personnel shall make a note of the 2 inmate’s refusal in the inmate’s confidential medical 3 records. However, the inmate’s refusal shall not be 4 considered a violation of prison rules or result in dis- 5 ciplinary action. Any reference in this section to the 6 ‘‘opt-out provision’’ shall be deemed a reference to 7 the requirement of this paragraph. 8 (10) EXCLUSION OF TESTS PERFORMED UNDER 9 SECTION 4014(b) FROM THE DEFINITION OF ROUTINE 10 HIV TESTING.—HIV testing of an inmate under sec- 11 tion 4014(b) of title 18, United States Code, is not 12 routine HIV testing for the purposes of the opt-out 13 provision. Health care personnel shall document the 14 reason for testing under section 4014(b) of title 18, 15 United States Code, in the inmate’s confidential 16 medical records. 17 (11) TIMELY NOTIFICATION OF TEST RE- 18 SULTS.—Health care personnel shall provide timely 19 notification to inmates of the results of HIV tests. 20 (g) CHANGES IN EXISTING LAW.— 21 (1) SCREENING IN GENERA.—Section 4014(a) 22 of title 18, United States Code, is amended— 23 (A) by striking ‘‘for a period of 6 months 24 or more’’; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00597 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 598 •HR 5294 IH (B) by striking ‘‘, as appropriate,’’; and 1 (C) by striking ‘‘if such individual is deter- 2 mined to be at risk for infection with such virus 3 in accordance with the guidelines issued by the 4 Bureau of Prisons relating to infectious disease 5 management’’ and inserting ‘‘unless the indi- 6 vidual declines. The Attorney General shall also 7 cause such individual to be so tested before re- 8 lease unless the individual declines.’’. 9 (2) INADMISSIBILITY OF HIV TEST RESULTS IN 10 CIVIL AND CRIMINAL PROCEEDINGS.—Section 11 4014(d) of title 18, United States Code, is amended 12 by inserting ‘‘or under the Stop AIDS in Prison 13 Act’’ after ‘‘under this section’’. 14 (3) SCREENING AS PART OF ROUTINE SCREEN- 15 ING.—Section 4014(e) of title 18, United States 16 Code, is amended by adding at the end the fol- 17 lowing: ‘‘Such rules shall also provide that the initial 18 test under this section be performed as part of the 19 routine health screening conducted at intake.’’. 20 (h) REPORTING REQUIREMENTS.— 21 (1) REPORT ON HEPATITIS AND OTHER DIS- 22 EASES.—Not later than 1 year after the date of the 23 enactment of this Act, the Bureau shall provide a re- 24 port to the Congress on Bureau policies and proce- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00598 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 599 •HR 5294 IH dures to provide testing, treatment, and prevention 1 education programs for hepatitis and other diseases 2 transmitted through sexual activity and intravenous 3 drug use. The Bureau shall consult with appropriate 4 officials of the Department of Health and Human 5 Services, the Office of National Drug Control Policy, 6 the Office of National AIDS Policy, and the Centers 7 for Disease Control and Prevention regarding the 8 development of this report. 9 (2) ANNUAL REPORTS.— 10 (A) GENERALLY.—Not later than 2 years 11 after the date of the enactment of this Act, and 12 then annually thereafter, the Bureau shall re- 13 port to Congress on the incidence among in- 14 mates of diseases transmitted through sexual 15 activity and intravenous drug use. 16 (B) MATTERS PERTAINING TO VARIOUS 17 DISEASES.—Reports under paragraph (1) shall 18 discuss— 19 (i) the incidence among inmates of 20 HIV/AIDS, hepatitis, and other diseases 21 transmitted through sexual activity and in- 22 travenous drug use; and 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00599 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 600 •HR 5294 IH (ii) updates on Bureau testing, treat- 1 ment, and prevention education programs 2 for these diseases. 3 (C) MATTERS PERTAINING TO HIV/AIDS 4 ONLY.—Reports under paragraph (1) shall also 5 include— 6 (i) the number of inmates who tested 7 positive for HIV upon intake; 8 (ii) the number of inmates who tested 9 positive prior to reentry; 10 (iii) the number of inmates who were 11 not tested prior to reentry because they 12 were released without sufficient notice; 13 (ix) the number of inmates who opted- 14 out of taking the test; 15 (x) the number of inmates who were 16 tested under section 4014(b) of title 18, 17 United States Code; and 18 (xi) the number of inmates under 19 treatment for HIV/AIDS. 20 (D) CONSULTATION.—The Bureau shall 21 consult with appropriate officials of the Depart- 22 ment of Health and Human Services, the Office 23 of National Drug Control Policy, the Office of 24 National AIDS Policy, and the Centers for Dis- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00600 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 601 •HR 5294 IH ease Control and Prevention regarding the de- 1 velopment of reports under paragraph (1). 2 SEC. 762. SUPPORT DATA SYSTEM REVIEW AND INDICA- 3 TORS FOR MONITORING HIV CARE. 4 The Secretary of Health and Human Services, in col- 5 laboration with the Assistant Secretary for Health, the Di- 6 rector of the Office of HIV/AIDS and Infectious Disease 7 Policy, the Director of the Centers for Disease Control and 8 Prevention, the Administrator of the Substance Abuse and 9 Mental Health Services Administration, the Director of 10 the Department of Housing and Urban Development, the 11 Director of the Office of AIDS Research, the Adminis- 12 trator of the Health Resources and Services Administra- 13 tion, and the Administrator of the Centers for Medicare 14 & Medicaid Services, shall expand and coordinate efforts 15 to align metrics across agencies and modify Federal data 16 systems, to— 17 (1) adopt the Institute of Medicine’s clinical 18 HIV care indicators as the core metrics for moni- 19 toring the quality of HIV care, mental health, sub- 20 stance abuse, and supportive services; 21 (2) better enable assessment of the impact of 22 the National HIV/AIDS Strategy and the Patient 23 Protection and Affordable Care Act on improving 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00601 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 602 •HR 5294 IH HIV/AIDS care and access to supportive services for 1 individuals with HIV; 2 (3) expand the demographic data elements to be 3 captured by Federal data systems relevant to HIV 4 care to permit calculation of the indicators for sub- 5 groups of the population of people with diagnosed 6 HIV infection, including— 7 (A) age; 8 (B) race; 9 (C) ethnicity; 10 (D) sex (assigned at birth); 11 (E) gender identity; 12 (F) sexual orientation; 13 (G) current geographic marker of resi- 14 dence; 15 (H) income or poverty level; and 16 (I) primary means of reimbursement for 17 medical services (including Medicaid, Medicare, 18 the Ryan White HIV/AIDS Program, private 19 insurance, health maintenance organizations, 20 and no coverage); and 21 (4) streamline data collection and systematically 22 review all existing reporting requirements for feder- 23 ally funded HIV/AIDS programs to ensure that only 24 essential data are collected. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00602 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 603 •HR 5294 IH SEC. 763. TRANSFER OF FUNDS FOR IMPLEMENTATION OF 1 NATIONAL HIV/AIDS STRATEGY. 2 Title II of the Public Health Service Act (42 U.S.C. 3 202 et seq.) is amended by inserting after section 241 the 4 following: 5 ‘‘SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION 6 OF NATIONAL HIV/AIDS STRATEGY. 7 ‘‘(a) TRANSFER AUTHORIZATION.—Of the discre- 8 tionary appropriations made available to the Department 9 of Health and Human Services for any fiscal year for pro- 10 grams and activities that, as determined by the Secretary 11 of Health and Human Services, pertain to HIV/AIDS, the 12 Secretary, in coordination with the Director of the Office 13 of National HIV/AIDS Policy, may transfer up to 1 per- 14 cent of such appropriations to the Office of the Assistant 15 Secretary for Health for implementation of the National 16 HIV/AIDS Strategy. 17 ‘‘(b) CONGRESSIONAL NOTIFICATION.—Not less than 18 30 days before making any transfer under this section, 19 the Secretary shall give notice of the transfer to the Con- 20 gress. 21 ‘‘(c) DEFINITIONS.—In this section: 22 ‘‘(1) The term ‘HIV/AIDS’ has the meaning 23 given to such term in section 2689. 24 ‘‘(2) The term ‘National HIV/AIDS Strategy’ 25 means the National HIV/AIDS Strategy for the 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00603 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 604 •HR 5294 IH United States issued by the President in July 2010 1 and includes any subsequent revisions to such Strat- 2 egy.’’. 3 SEC. 764. HIV INTEGRATED SERVICES DELIVERY MODEL 4 DEMONSTRATION. 5 (a) IN GENERAL.—Consistent with the National 6 HIV/AIDS Strategy for the United States and in accord- 7 ance with this section, the Secretary of Health and 8 Human Services acting through the Center for Medicare 9 & Medicaid Innovation and in cooperation with CDC, 10 HRSA, SAMHSA, and HUD, shall conduct a 3-year dem- 11 onstration project that is designed to integrate services 12 and funding under the Medicare and Medicaid programs, 13 under HIV-related programs conducted by the CDC, and 14 under the Ryan White HIV/AIDS Program, to reduce new 15 HIV infections, to increase the proportion of people who 16 know their status, to increase access to care, to improve 17 health outcomes, to reduce HIV-related health disparities 18 among Medicaid and Medicare beneficiaries, and to reduce 19 the cost of care provided to HIV positive Medicare and 20 Medicaid beneficiaries. 21 (b) OBJECTIVES.—The objectives of the demonstra- 22 tion are the following: 23 (1) To ensure the early identification of HIV 24 positive beneficiaries to reduce costly HIV-related 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00604 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 605 •HR 5294 IH clinical conditions through HIV screening and rapid 1 linkage to high quality HIV medical care. 2 (2) To reduce new HIV infections among Med- 3 icaid and Medicare beneficiaries through routine 4 HIV testing, prevention services for HIV negative 5 beneficiaries, and intensive ‘‘prevention for positive’’ 6 services for HIV positive beneficiaries. 7 (3) To reduce morbidity, mortality, and high 8 cost inpatient and specialty care among HIV positive 9 beneficiaries by ensuring access to high quality HIV 10 medical care, HIV medications, and support services. 11 (4) To promote HIV treatment adherence and 12 retention in care through intensive case manage- 13 ment, treatment education, and outreach services. 14 (5) To effectively treat behavioral health condi- 15 tions among HIV positive beneficiaries that impair 16 their HIV treatment adherence and lead to sec- 17 ondary HIV infections through services funded 18 under Medicare and Medicaid and programs admin- 19 istered by SAMHSA. 20 (6) To promote independence, treatment adher- 21 ence, and stable housing for HIV positive bene- 22 ficiaries through highly coordinated HIV health, 23 housing, and support services funded by HRSA and 24 HUD. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00605 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 606 •HR 5294 IH (c) DEMONSTRATION DESIGN.— 1 (1) IN GENERAL.—The Secretary shall design 2 the demonstration to test both— 3 (A) the service delivery model described in 4 paragraph (2); and 5 (B) the payment model described in para- 6 graph (3). 7 (2) SERVICE DELIVERY MODEL.— 8 (A) IN GENERAL.—Under the service deliv- 9 ery model described in this paragraph, the dem- 10 onstration shall test comprehensive HIV test- 11 ing, linkage to care, HIV medical care, and an- 12 cillary services to individuals enrolled under 13 Medicare, Medicaid, or both. The service deliv- 14 ery model will integrate services furnished 15 under Medicare and Medicaid with prevention 16 services funded by CDC for HIV positive bene- 17 ficiaries, intensive case management services 18 funded by HRSA, behavioral services funded by 19 SAMHSA, and housing assistance services 20 funded through HUD. 21 (B) CORE ELEMENTS.—The model under 22 this paragraph shall have the following 8 core 23 elements: 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00606 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 607 •HR 5294 IH (i) HIV testing services that apply the 1 CDC’s 2006 recommendations for uni- 2 versal opt-out testing among Medicare and 3 Medicaid beneficiary populations. 4 (ii) Rapid linkage from HIV testing 5 settings to treatment for HIV positive 6 beneficiaries to ensure they are engaged in 7 care in a timely basis. 8 (iii) Access to high quality HIV expe- 9 rienced medical care, laboratory moni- 10 toring, HIV medications, and other re- 11 quired services. 12 (iv) Routine screening and treatment 13 for HIV-related and other chronic condi- 14 tions, including behavioral health. 15 (v) Prevention and treatment edu- 16 cation services, including an adapted Medi- 17 cation Therapy Management (MTM) pro- 18 gram model, to optimize the benefit of 19 HIV therapeutics. 20 (vi) Risk-stratified medical case man- 21 agement. 22 (vii) Provision of preventive care, in- 23 cluding counseling to prevent secondary 24 HIV infection. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00607 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 608 •HR 5294 IH (viii) Wrap-around support and hous- 1 ing services. 2 (3) PAYMENT MODEL.—Under the payment 3 model described in this paragraph, the demonstra- 4 tion shall test the following: 5 (A) A prepaid capitated payment model 6 that adjusts payment for HIV and behavioral 7 health acuity, to be applied under contracts 8 with managed care organizations with dem- 9 onstrated HIV experience. 10 (B) Use of funds under the Ryan White 11 HIV/AIDS Program to purchase capitated serv- 12 ices from the contracted managed care organi- 13 zations. 14 (C) Provision of additional funds to sup- 15 port services to the extent that Medicaid and 16 Medicare coverage is limited, including for serv- 17 ices such as HIV testing (for Medicaid bene- 18 ficiaries), medical case management, prevention 19 case management, treatment education, case 20 finding, behavioral health services, and housing 21 assistance. 22 (d) BENEFICIARY CRITERIA.—Beneficiaries eligible 23 for participation in the demonstration are the following: 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00608 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 609 •HR 5294 IH (1) MEDICAID FFS BENEFICIARIES.—Fee-for- 1 service Medicaid beneficiaries 18 years of age or 2 older. 3 (2) DUAL ELIGIBLES.—Individuals who are— 4 (A) entitled to medical assistance under 5 Medicaid; and 6 (B) entitled to benefits under part A, and 7 enrolled under part B, of Medicare but are not 8 enrolled under a Medicare Advantage plan 9 under Medicare. 10 (e) ROLES AND RESPONSIBILITIES IN DEMONSTRA- 11 TION.— 12 (1) IN GENERAL.—Consistent with the National 13 HIV/AIDS Strategy for the United States, Federal 14 agencies shall coordinate their funding for the se- 15 lected States or cities covered under the demonstra- 16 tion to provide resources to fund the delivery of serv- 17 ices within the demonstration. 18 (2) HHS.—In carrying out the demonstration, 19 the Secretary shall— 20 (A) design the application process; 21 (B) solicit applications from 5 to 7 State 22 Medicaid agencies to host the demonstration; 23 (C) with respect to the service delivery 24 model described in subsection (c)(2), collaborate 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00609 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 610 •HR 5294 IH with the CDC, HRSA, and the National Insti- 1 tutes of Health to design a minimum service de- 2 livery model that reflects the current standard 3 of care as established by the Public Health 4 Service and CDC guidelines and recommenda- 5 tions; and 6 (D) fund an evaluation of the demonstra- 7 tion to ensure collection of system, provider, 8 and beneficiary-level data to address their rou- 9 tine reporting requirements. 10 The Secretary may carry out the Secretary’s author- 11 ity under this paragraph through CMMI. 12 (3) CDC.—The CDC shall collaborate with the 13 Secretary and CDC-funded HIV prevention grantees 14 in the selected States and cities to provide technical 15 assistance to design cost-effective HIV and sexually 16 transmitted infection (STI) screening and testing 17 services for Medicaid and Medicare beneficiaries, in- 18 cluding partner notification services and commu- 19 nicable disease reporting. CDC and CMS shall deter- 20 mine the extent to which testing funds shall be sup- 21 ported jointly or separately by these agencies. 22 (4) HRSA.—HRSA shall allocate funds avail- 23 able through the Special Projects of National Sig- 24 nificance (SPNS) Initiative Program (under subpart 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00610 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 611 •HR 5294 IH I of part F of the Ryan White HIV/AIDS Program) 1 to support wrap-around core and support services 2 not covered under Medicare or Medicaid and shall 3 authorize the use of Ryan White HIV/AIDS Pro- 4 gram funds to purchase services through capitated 5 managed care programs that meet or exceed the 6 services covered by the Ryan White HIV/AIDS Pro- 7 gram at rates that are no greater than current per 8 capita expenditures. HRSA is authorized to use 9 funds under SPNS, and to waive such requirements 10 of SPNS as may be necessary, to carry out the dem- 11 onstration. 12 (5) SAMHSA.—SAMHSA shall allocate funds 13 through the Minority HIV/AIDS Initiative or other 14 programs to support behavioral health services not 15 covered under Medicare or Medicaid. 16 (6) HOPWA.—HUD shall directly allocate 17 funds under the Housing Opportunities for People 18 With AIDS (HOPWA) program to the States or cit- 19 ies participating in the demonstration to provide 20 supportive housing and other housing assistance to 21 beneficiaries who otherwise meet HOPWA eligibility 22 criteria. HUD is authorized to use such HOPWA 23 funds, and to waive such requirements under 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00611 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 612 •HR 5294 IH HOPWA as may be necessary, to carry out the dem- 1 onstration. 2 (7) STATE MEDICAID AGENCIES.—Single State 3 agencies responsible for administration of the Med- 4 icaid program for individuals who are accepted to 5 participate in the demonstration shall— 6 (A) collaborate with CMS to design or re- 7 fine a prepaid capitated payment model, to allo- 8 cate and award contracts with capitated man- 9 aged care plans, to ensure such plans meet 10 State statutory or regulatory requirements, to 11 contract with a coordinating agency to organize 12 and deliver integrated HIV testing, medical 13 care, support, and housing services funded 14 under Medicare and Medicaid, other Federal, 15 State, and local government sponsors, and to 16 coordinate their activities with the State HIV/ 17 AIDS program; and 18 (B) identify and contract with a coordi- 19 nating agency to organize the demonstration in 20 the State, to establish a coordinating body rep- 21 resenting State, local, and provider agencies 22 participating in the demonstration, to establish 23 systems of care that integrate HIV prevention, 24 testing, treatment, support, and housing serv- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00612 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 613 •HR 5294 IH ices, to establish mechanisms to gather evalua- 1 tion data for reporting to CMMI and other par- 2 ticipating Federal agencies, and to establish a 3 quality management program to monitor pro- 4 vider performance in delivering the services pro- 5 vided to participating beneficiaries under the 6 demonstration. 7 (8) MANAGED CARE ORGANIZATIONS.— 8 Capitated managed care organizations participating 9 in the demonstration shall organize and deliver serv- 10 ices as specified by the minimum service delivery 11 model established by CMMI through a network of 12 providers with demonstrated HIV experience, high 13 quality, and sufficient provider capacity. 14 (f) DEFINITIONS.—In this section: 15 (1) CDC.—The term ‘‘CDC’’ means the Direc- 16 tor of the Centers for Disease Control and Preven- 17 tion. 18 (2) CMMI.—The term ‘‘CMMI’’ means the Di- 19 rector of the Center for Medicare & Medicaid Inno- 20 vation. 21 (3) CMS.—The term ‘‘CMS’’ means the Ad- 22 ministrator of the Centers for Medicare & Medicaid 23 Services. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00613 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 614 •HR 5294 IH (4) DEMONSTRATION.—The term ‘‘demonstra- 1 tion’’ means the demonstration conducted under this 2 section. 3 (5) HRSA.—The term ‘‘HRSA’’ means the Ad- 4 ministrator of the Health Resources and Services 5 Administration. 6 (6) HUD.—The term ‘‘HUD’’ means the Sec- 7 retary of Housing and Urban Development. 8 (7) MEDICARE; MEDICAID.—The terms ‘‘Medi- 9 care’’ and ‘‘Medicaid’’ mean the programs under ti- 10 tles XVIII and XIX, respectively, of the Social Secu- 11 rity Act. 12 (8) NATIONAL HIV/AIDS STRATEGY FOR THE 13 UNITED STATES.—The term ‘‘National HIV/AIDS 14 Strategy for the United States’’ has the meaning 15 given such term under section 241A(b) of the Public 16 Health Service Act. 17 (9) RYAN WHITE HIV/AIDS PROGRAM.—The 18 term ‘‘Ryan White HIV/AIDS Program’’ means the 19 program under title XXVI of the Public Health 20 Service Act. 21 (10) SAMHSA.—The term ‘‘SAMHSA’’ means 22 the Substance Abuse and Mental Health Services 23 Administration. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00614 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 615 •HR 5294 IH (11) SECRETARY.—The term ‘‘Secretary’’ 1 means the Secretary of Health and Human Services, 2 acting through CMMI. 3 SEC. 765. REPORT ON THE IMPLEMENTATION OF GOAL 4 4 (IMPROVED COORDINATION) OF THE NA- 5 TIONAL HIV/AIDS STRATEGY. 6 (a) REPORT REQUIRED.—The President, in consulta- 7 tion with the heads of all relevant Federal departments 8 and agencies including the Department of Education, the 9 Department of Health and Human Services, the Depart- 10 ment of Housing and Urban Development, the Depart- 11 ment of Justice, the Department of Labor, the Depart- 12 ment of Veteran Affairs, and the Social Security Adminis- 13 tration, shall transmit to the Congress and make publicly 14 available a report on the status of implementation of Goal 15 4 of the National HIV/AIDS Strategy. 16 (b) CONTENTS.—The report required by subsection 17 (a) shall include a description, an analysis, and an evalua- 18 tion of— 19 (1) the extent to which the National HIV/AIDS 20 Strategy has improved coordination of efforts, en- 21 hanced capacity, and strengthened infrastructure in 22 order to maximize the effective delivery of HIV/ 23 AIDS prevention, care, and treatment services at the 24 community level, including coordination— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00615 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 616 •HR 5294 IH (A) within and among Federal agencies 1 and departments; 2 (B) between the Federal Government and 3 State and local governments and health depart- 4 ments; 5 (C) between the Federal Government and 6 nonprofit foundations and civil society organiza- 7 tions, including community- and faith-based or- 8 ganizations focused on addressing the issue of 9 HIV/AIDS; and 10 (D) between the Federal Government and 11 private businesses; and 12 (2) efforts by the Federal Government to edu- 13 cate, involve, and establish and strengthen partner- 14 ships with civil society organizations, including 15 community- and faith-based organizations, in order 16 to implement the National HIV/AIDS Strategy and 17 achieve its goals. 18 (c) DEFINITION.—In this section, the term ‘‘National 19 HIV/AIDS Strategy’’ means the National HIV/AIDS 20 Strategy for the United States issued by the President in 21 July 2010 and includes any subsequent revisions to such 22 Strategy. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00616 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 617 •HR 5294 IH Subtitle F—Diabetes 1 SEC. 771. RESEARCH, TREATMENT, AND EDUCATION. 2 Subpart 3 of part C of title IV of the Public Health 3 Service Act (42 U.S.C. 285c et seq.) is amended by adding 4 at the end the following new section: 5 ‘‘SEC. 434B. DIABETES IN MINORITY POPULATIONS. 6 ‘‘(a) IN GENERAL.—The Director of NIH shall ex- 7 pand, intensify, and support ongoing research and other 8 activities with respect to prediabetes and diabetes, particu- 9 larly type 2, in minority populations. 10 ‘‘(b) RESEARCH.— 11 ‘‘(1) DESCRIPTION.—Research under subsection 12 (a) shall include investigation into— 13 ‘‘(A) the causes of diabetes, including so- 14 cioeconomic, geographic, clinical, environmental, 15 genetic, and other factors that may contribute 16 to increased rates of diabetes in minority popu- 17 lations; and 18 ‘‘(B) the causes of increased incidence of 19 diabetes complications in minority populations, 20 and possible interventions to decrease such inci- 21 dence. 22 ‘‘(2) INCLUSION OF MINORITY PARTICIPANTS.— 23 In conducting and supporting research described in 24 subsection (a), the Director of NIH shall seek to in- 25 VerDate Mar 15 2010 01:02 Aug 07, 2014 Jkt 039200 PO 00000 Frm 00617 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 618 •HR 5294 IH clude minority participants as study subjects in clin- 1 ical trials. 2 ‘‘(c) REPORT; COMPREHENSIVE PLAN.— 3 ‘‘(1) IN GENERAL.—The Diabetes Mellitus 4 Interagency Coordinating Committee shall— 5 ‘‘(A) prepare and submit to the Congress, 6 not later than 6 months after the date of enact- 7 ment of this section, a report on Federal re- 8 search and public health activities with respect 9 to prediabetes and diabetes in minority popu- 10 lations; and 11 ‘‘(B) develop and submit to the Congress, 12 not later than 1 year after the date of enact- 13 ment of this section, an effective and com- 14 prehensive Federal plan (including all appro- 15 priate Federal health programs) to address 16 prediabetes and diabetes in minority popu- 17 lations. 18 ‘‘(2) CONTENTS.—The report under paragraph 19 (1)(A) shall at minimum address each of the fol- 20 lowing: 21 ‘‘(A) Research on diabetes and prediabetes 22 in minority populations, including such research 23 on— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00618 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 619 •HR 5294 IH ‘‘(i) genetic, behavioral, and environ- 1 mental factors; and 2 ‘‘(ii) prevention and complications 3 among individuals within these populations 4 who have already developed diabetes. 5 ‘‘(B) Surveillance and data collection on 6 diabetes and prediabetes in minority popu- 7 lations, including with respect to— 8 ‘‘(i) efforts to better determine the 9 prevalence of diabetes among Asian-Amer- 10 ican and Pacific Islander subgroups; and 11 ‘‘(ii) efforts to coordinate data collec- 12 tion on the American Indian population. 13 ‘‘(C) Community-based interventions to ad- 14 dress diabetes and prediabetes targeting minor- 15 ity populations, including— 16 ‘‘(i) the evidence base for such inter- 17 ventions; 18 ‘‘(ii) the cultural appropriateness of 19 such interventions; and 20 ‘‘(iii) efforts to educate the public on 21 the causes and consequences of diabetes. 22 ‘‘(D) Education and training programs for 23 health professionals (including community 24 health workers) on the prevention and manage- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00619 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 620 •HR 5294 IH ment of diabetes and its related complications 1 that is supported by the Health Resources and 2 Services Administration, including such pro- 3 grams supported by— 4 ‘‘(i) the National Health Service 5 Corps; or 6 ‘‘(ii) the community health centers 7 program under section 330. 8 ‘‘(d) EDUCATION.—The Director of NIH shall— 9 ‘‘(1) through the National Institute on Minority 10 Health and Health Disparities and the National Di- 11 abetes Education Program— 12 ‘‘(A) make grants to programs funded 13 under section 464z–4 (relating to centers of ex- 14 cellence) for the purpose of establishing a men- 15 toring program for health care professionals to 16 be more involved in weight counseling, obesity 17 research, and nutrition; and 18 ‘‘(B) provide for the participation of mi- 19 nority health professionals in diabetes-focused 20 research programs; and 21 ‘‘(2) make grants for programs to establish a 22 pipeline from high school to professional school that 23 will increase minority representation in diabetes-fo- 24 cused health fields by expanding Minority Access to 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00620 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 621 •HR 5294 IH Research Careers (MARC) program internships and 1 mentoring opportunities for recruitment. 2 ‘‘(e) DEFINITIONS.—For purposes of this section: 3 ‘‘(1) The ‘Diabetes Mellitus Interagency Coordi- 4 nating Committee’ means the Diabetes Mellitus 5 Interagency Coordinating Committee established 6 under section 429. 7 ‘‘(2) The term ‘minority population’ means a 8 racial and ethnic minority group, as defined in sec- 9 tion 1707.’’. 10 SEC. 772. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 11 Part B of title III of the Public Health Service Act 12 (42 U.S.C. 243 et seq.) is amended by inserting after sec- 13 tion 317T the following section: 14 ‘‘SEC. 317U. DIABETES IN MINORITY POPULATIONS. 15 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 16 ‘‘(1) IN GENERAL.—The Secretary, acting 17 through the Director of the Centers for Disease 18 Control and Prevention, shall conduct and support 19 research and public health activities with respect to 20 diabetes in minority populations. 21 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 22 paragraph (1) regarding diabetes in minority popu- 23 lations shall include the following: 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00621 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 622 •HR 5294 IH ‘‘(A) Further enhancing the National 1 Health and Nutrition Examination Survey by 2 over-sampling Asian-American, Native Hawai- 3 ian, and Other Pacific Islanders in appropriate 4 geographic areas to better determine the preva- 5 lence of diabetes in such populations as well as 6 to improve the data collection of diabetes pene- 7 tration disaggregated into major ethnic groups 8 within such populations. The Secretary shall en- 9 sure that any such oversampling does not re- 10 duce the oversampling of other minority popu- 11 lations including African-American and Latino 12 populations. 13 ‘‘(B) Through the Division of Diabetes 14 Translation— 15 ‘‘(i) providing for prevention research 16 to better understand how to influence 17 health care systems changes to improve 18 quality of care being delivered to such pop- 19 ulations; 20 ‘‘(ii) carrying out model demonstra- 21 tion projects to design, implement, and 22 evaluate effective diabetes prevention and 23 control interventions for minority popu- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00622 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 623 •HR 5294 IH lations, including culturally appropriate 1 community-based interventions; 2 ‘‘(iii) developing and implementing a 3 strategic plan to reduce diabetes in minor- 4 ity populations through applied research to 5 reduce disparities and culturally and lin- 6 guistically appropriate community-based 7 interventions; 8 ‘‘(iv) supporting, through the national 9 diabetes prevention program under section 10 399V–3, diabetes prevention program sites 11 in underserved regions highly impacted by 12 diabetes; and 13 ‘‘(v) implementing, through the na- 14 tional diabetes prevention program under 15 section 399V–3, a demonstration program 16 developing new metrics measuring health 17 outcomes related to diabetes that can be 18 stratified by specific minority populations. 19 ‘‘(b) EDUCATION.—The Secretary, acting through 20 the Director of the Centers for Disease Control and Pre- 21 vention, shall direct the Division of Diabetes Translation 22 to conduct and support both programs to educate the pub- 23 lic on diabetes in minority populations and programs to 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00623 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 624 •HR 5294 IH educate minority populations about the causes and effects 1 of diabetes. 2 ‘‘(c) DIABETES; HEALTH PROMOTION, PREVENTION 3 ACTIVITIES, AND ACCESS.—The Secretary, acting through 4 the Director of the Centers for Disease Control and Pre- 5 vention and the National Diabetes Education Program, 6 shall conduct and support programs to educate specific 7 minority populations through culturally appropriate and 8 linguistically appropriate information campaigns about 9 prevention of, and managing, diabetes. 10 ‘‘(d) DEFINITION.—For purposes of this section, the 11 term ‘minority population’ means a racial and ethnic mi- 12 nority group, as defined in section 1707.’’. 13 SEC. 773. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 14 Part P of title III of the Public Health Service Act 15 (42 U.S.C. 280g et seq.), as amended, is further amended 16 by adding at the end the following new section: 17 ‘‘SEC. 399V–7. PROGRAMS TO EDUCATE HEALTH PRO- 18 VIDERS ON THE CAUSES AND EFFECTS OF DI- 19 ABETES IN MINORITY POPULATIONS. 20 ‘‘(a) IN GENERAL.—The Secretary, acting through 21 the Director of the Health Resources and Services Admin- 22 istration, shall conduct and support programs described 23 in subsection (b) to educate health professionals on the 24 causes and effects of diabetes in minority populations. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00624 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 625 •HR 5294 IH ‘‘(b) PROGRAMS.—Programs described in this sub- 1 section, with respect to education on diabetes in minority 2 populations, shall include the following: 3 ‘‘(1) Giving priority, under the primary care 4 training and enhancement program under section 5 747— 6 ‘‘(A) to awarding grants to focus on or ad- 7 dress diabetes; and 8 ‘‘(B) adding minority populations to the 9 list of vulnerable populations that should be 10 served by such grants. 11 ‘‘(2) Providing additional funds for the Health 12 Careers Opportunity Program, Centers for Excel- 13 lence, and the Minority Faculty Fellowship Program 14 to partner with the Office of Minority Health under 15 section 1707 and the National Institutes of Health 16 to strengthen programs for career opportunities fo- 17 cused on diabetes treatment and care within under- 18 served regions highly impacted by diabetes. 19 ‘‘(3) Developing a diabetes focus within, and 20 providing additional funds for, the National Health 21 Service Corps Scholarship Program— 22 ‘‘(A) to place individuals in areas that are 23 disproportionately affected by diabetes and to 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00625 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 626 •HR 5294 IH provide diabetes treatment and care in such 1 areas; and 2 ‘‘(B) to provide such individuals continuing 3 medical education specific to diabetes care.’’. 4 SEC. 774. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 5 Part P of title III of the Public Health Service Act 6 (42 U.S.C. 280g et seq.), as amended, is further amended 7 by adding at the end the following section: 8 ‘‘SEC. 399V–8. RESEARCH, EDUCATION, AND OTHER ACTIVI- 9 TIES REGARDING DIABETES IN AMERICAN IN- 10 DIAN POPULATIONS. 11 ‘‘In addition to activities under sections 317V–6 and 12 434B, the Secretary, acting through the Indian Health 13 Service and in collaboration with other appropriate Fed- 14 eral agencies, shall— 15 ‘‘(1) conduct and support research and other 16 activities with respect to diabetes; and 17 ‘‘(2) coordinate the collection of data on clini- 18 cally and culturally appropriate diabetes treatment, 19 care, prevention, and services by health care profes- 20 sionals to the American Indian population.’’. 21 SEC. 775. UPDATED REPORT ON HEALTH DISPARITIES. 22 The Secretary of Health and Human Services shall 23 seek to enter into an arrangement with the Institute of 24 Medicine under which the Institute will— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00626 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 627 •HR 5294 IH (1) not later than 1 year after the date of en- 1 actment of this Act, submit to the Congress an up- 2 dated version of the Institute’s 2002 report entitled 3 ‘‘Unequal Treatment: Confronting Racial and Ethnic 4 Disparities in Health Care’’; and 5 (2) in such updated version, address how racial 6 and ethnic health disparities have changed since the 7 publication of the original report. 8 Subtitle G—Lung Disease 9 SEC. 776. 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00627 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 628 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00628 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 629 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00629 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 630 •HR 5294 IH a new report to the Congress is necessary, and make ap- 1 propriate recommendations to the Congress. 2 SEC. 777. 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00630 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 631 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00631 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 632 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00632 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 633 •HR 5294 IH to be appropriated to such Centers such sums as may be 1 necessary for each of fiscal years 2015 through 2019 for 2 the purpose of carrying out this section.’’. 3 SEC. 778. 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00633 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 634 •HR 5294 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 2015 through 2019. 7 SEC. 779. 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00634 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 635 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00635 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 636 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00636 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 637 •HR 5294 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 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00637 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 638 •HR 5294 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 2015 through 2019. 14 Subtitle H—Osteoarthritis and 15 Musculoskeletal Diseases 16 SEC. 781. FINDINGS. 17 The Congress finds as follows: 18 (1) Eighty percent of African-American women 19 and nearly 74 percent of Hispanic men are either 20 overweight or obese, speeding the onset and progres- 21 sion of arthritis. 22 (2) Arthritis affects 46 million Americans, and 23 that number will rise to 67 million by the year 2030. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00638 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 639 •HR 5294 IH (3) Twenty-seven million Americans suffer from 1 osteoarthritis, the most common form of arthritis, 2 making it the leading cause of disability in the 3 United States. Osteoarthritis is sometimes referred 4 to as degenerative joint disease. 5 (4) Obesity accelerates the onset of arthritis: 70 6 percent of obese adults with mild osteoarthritis of 7 the knee at age 60 will develop advanced end-stage 8 disease by age 80. In contrast, just 43 percent of 9 non-obese adults will have end-stage disease over the 10 same time period. 11 (5) Arthritis affects one in five Americans, and 12 is the single greatest cause of chronic pain and dis- 13 ability in the United States. 14 (6) Women, African-Americans, and Hispanics 15 have more severe arthritis and functional limitations. 16 These same individuals are more likely to be obese, 17 diabetic, and have higher incidence of heart dis- 18 ease—medical conditions that can be improved with 19 physical activity. Instead of moving; however, these 20 groups have an inactivity rate of 40 to 50 percent, 21 which continues to increase. 22 (7) Arthritis costs $128 billion a year, including 23 $81 billion in direct costs (medical) and $47 billion 24 in indirect costs (lost earnings). Each year, $309 bil- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00639 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 640 •HR 5294 IH lion in direct and indirect costs is lost due to dis- 1 parities in osteoarthritis and musculoskeletal dis- 2 eases. 3 (8) Obesity and other chronic health conditions 4 exacerbate the debilitating impact of arthritis, lead- 5 ing to inactivity, loss of independence, and a per- 6 petual cycle of comorbid chronic conditions. 7 (9) Sixty-one percent of arthritis sufferers are 8 women, and women represent 64 percent of an esti- 9 mated 43 million annual visits to physicians’ offices 10 and outpatient clinics where arthritis was the pri- 11 mary diagnosis. Women also represented 60 percent 12 of approximately 1 million hospitalizations that oc- 13 curred in 2003 for which arthritis was the primary 14 diagnosis. 15 (10) Women ages 65 and older have up to 21⁄2 16 times more disabilities than men of the same age. 17 Higher rates of obesity and arthritis among this 18 group explained up to 48 percent of the gender gap 19 in disability, above all other common chronic health 20 conditions. 21 (11) The primary indication for total knee 22 arthroplasty (TKA), also known as knee replace- 23 ment, is relief of significant, disabling pain caused 24 by severe arthritis. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00640 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 641 •HR 5294 IH (12) Knee replacement is surgery for people 1 with severe knee damage. Knee replacement can re- 2 lieve pain and allow you to be more active. When 3 you have a total knee replacement, the surgeon re- 4 moves damaged cartilage and bone from the surface 5 of your knee joint and replaces them with a man- 6 made surface of metal and plastic. In a partial knee 7 replacement, the surgeon only replaces one part of 8 your knee joint. 9 (13) Total hip replacement, also called total hip 10 arthroplasty (THA), is used if your hip pain inter- 11 feres with daily activities and more-conservative 12 treatments have not helped. Arthritis damage is the 13 most common reason to need hip replacement. 14 (14) The odds of a family practice physician 15 recommending TKA to a male patient with moderate 16 arthritis are twice that of a female patient, while the 17 odds of an orthopaedic surgeon recommending TKA 18 to a male patient with moderate arthritis are 22 19 times that of a female patient. 20 (15) African-Americans with doctor-diagnosed 21 arthritis have a higher prevalence of severe pain at- 22 tributable to arthritis, compared with Whites (34.0 23 percent versus 22.6 percent). African-Americans, 24 compared to Whites, report a higher proportion of 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00641 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 642 •HR 5294 IH work limitations (39.5 percent versus 28.0 percent) 1 and a higher prevalence of arthritis-attributable 2 work limitation (6.6 percent versus 4.6 percent). 3 (16) Hispanics are 50 percent more likely than 4 non-Hispanic Whites to report needing assistance 5 with at least one instrumental activity of daily living 6 and to have difficulty walking. 7 (17) African-Americans and Hispanics were 1.3 8 times more likely to have activity limitation, 1.6 9 times more likely to have work limitations, and 1.9 10 times more likely to have severe joint pain than 11 Whites. 12 (18) In 2003, the Institute of Medicine reported 13 that the rates of TKA and THA among African- 14 American and Hispanic patients are significantly 15 lower than for Whites—even for those with equitable 16 health care coverage such as through Medicare or 17 the Department of Veterans Affairs. 18 (19) According to the Centers for Disease Con- 19 trol and Prevention, in 2000, African-American 20 Medicare enrollees were 37 percent less likely than 21 White Medicare enrollees to undergo total knee re- 22 placements. In 2006, the disparity increased to 39 23 percent. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00642 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 643 •HR 5294 IH (20) Even after adjusting for insurance and 1 health access, Hispanics and African-Americans are 2 almost 50 percent less likely to undergo total knee 3 replacement than Whites. 4 SEC. 782. OSTEOARTHRITIS AND OTHER MUSCULO- 5 SKELETAL HEALTH-RELATED ACTIVITIES OF 6 THE CENTERS FOR DISEASE CONTROL AND 7 PREVENTION. 8 (a) EDUCATION AND AWARENESS ACTIVITIES.—The 9 Secretary of Health and Human Services, acting through 10 the Director of the Centers for Disease Control and Pre- 11 vention, shall direct the National Center for Chronic Dis- 12 ease Prevention and Health Promotion to conduct and ex- 13 pand the Health Community Program and Arthritis Pro- 14 gram to educate the public on— 15 (1) the causes of, preventive health actions for, 16 and effects of arthritis and other musculoskeletal 17 conditions in minority patient populations; and 18 (2) the effects of such conditions on other 19 comorbidities including obesity, hypertension, and 20 cardiovascular disease. 21 (b) PROGRAMS ON ARTHRITIS AND MUSCULO- 22 SKELETAL CONDITIONS.—Education and awareness pro- 23 grams of the Centers for Disease Control and Prevention 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00643 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 644 •HR 5294 IH on arthritis and other musculoskeletal conditions in minor- 1 ity communities shall— 2 (1) be culturally and linguistically appropriate 3 to minority patients, targeting musculoskeletal 4 health promotion and prevention programs of each 5 major ethnic group, including— 6 (A) Native Americans and Alaska Natives; 7 (B) Asian-Americans; 8 (C) African-Americans/Blacks; 9 (D) Hispanic/Latino-Americans; and 10 (E) Native Hawaiians and Pacific Island- 11 ers; and 12 (2) include public awareness campaigns directed 13 toward these patient populations that emphasize the 14 importance of musculoskeletal health, physical activ- 15 ity, diet and healthy lifestyle, and weight reduction 16 for overweight and obese patients. 17 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 18 out this section, there are authorized to be appropriated 19 such sums as necessary for fiscal year 2015 and each sub- 20 sequent fiscal year. 21 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00644 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 645 •HR 5294 IH Subtitle I—Sleep and Circadian 1 Rhythm Disorders 2 SEC. 791. SHORT TITLE; FINDINGS. 3 (a) SHORT TITLE.—This subtitle may be cited as the 4 ‘‘Sleep and Circadian Rhythm Disorders Health Dispari- 5 ties Act’’. 6 (b) FINDINGS.—The Congress finds the following: 7 (1) Decrements in sleep health such as sleep 8 apnea, insufficient sleep time, and insomnia, affect 9 50–70 million United States adults. Twelve to eight- 10 een million United States adults have sleep apnea, a 11 chronic disorder characterized by one or more 12 pauses in breathing which can last from a few sec- 13 onds to minutes. They may occur 30 times or more 14 an hour, disrupting sleep and resulting in excessive 15 daytime sleepiness and loss in productivity. 16 (2) Seventy percent of high school students are 17 not getting enough sleep on school nights, while 33 18 percent of Americans get fewer than 7 hours of sleep 19 per night and roughly 6,000 fatal motor vehicle 20 crashes are caused by drowsy drivers. 21 (3) Insufficient sleep and insomnia are more 22 prevalent in women. Women who are pregnant and 23 have sleep apnea are at an increased risk of cardio- 24 vascular complications during pregnancy. The im- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00645 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 646 •HR 5294 IH pact of disparities in sleep health is associated with 1 a growing number of health problems, including the 2 following: 3 (A) Hypertension. 4 (B) Cancer. 5 (C) Stroke. 6 (D) Cardiac arrhythmia. 7 (E) Chronic heart failure and heart dis- 8 ease. 9 (F) Diabetes. 10 (G) Cognitive functioning and behavior. 11 (H) Depression and bipolar disorder. 12 (I) Substance abuse. 13 (4) A ‘‘sleep disparity’’ exists in that poor sleep 14 quality is strongly associated with poverty and race. 15 Factors such as employment, education, and health 16 status, amongst others, significantly mediated this 17 effect only in poor subjects, suggesting a differential 18 vulnerability to these factors in poor relative to non- 19 poor individuals in the context of sleep quality. 20 (5) African-Americans sleep worse than Cauca- 21 sian Americans. African-Americans take longer to 22 fall asleep, report poorer sleep quality, have more 23 light and less deep sleep, and nap more often and 24 longer. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00646 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 647 •HR 5294 IH (6) African-Americans and individuals in lower 1 socioeconomic status groups may be at an increased 2 risk for sleep disturbances and associated health 3 consequences. 4 (7) Among young African-Americans, the likeli- 5 hood of having sleep disordered breathing and exhib- 6 iting risk factors for poor sleep is twice that in 7 young Caucasians. Frequent snoring is more com- 8 mon among African-American and Hispanic women 9 and Hispanic men compared to non-Hispanic Cauca- 10 sians, independent of other factors including obesity. 11 (8) African-Americans with sleep disordered 12 breathing develop symptoms at a younger age than 13 Caucasians but appear less likely to be diagnosed 14 and treated in a timely manner. This delay may at 15 least in part be due to reduced access to care. 16 (9) Sleep loss contributes to increased risk for 17 chronic conditions such as obesity, diabetes, and hy- 18 pertension, all of which have increased prevalence in 19 underserved, underrepresented minorities. Racial 20 and ethnic disparities related to obesity may also 21 contribute to disparities in health outcomes related 22 to sleep disordered breathing. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00647 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 648 •HR 5294 IH (10) Non-Caucasian adults report an insomnia 1 rate of 12.9 percent compared to only 6.6 percent 2 for Caucasians. 3 (11) African-American women have a higher in- 4 cidence of insomnia than African-American men, 5 perhaps related in part to higher risk for chronic 6 persisting symptoms. 7 SEC. 792. SLEEP AND CIRCADIAN RHYTHM DISORDERS RE- 8 SEARCH ACTIVITIES OF THE NATIONAL IN- 9 STITUTES OF HEALTH. 10 (a) IN GENERAL.—The Director of the National In- 11 stitutes of Health, acting through the Director of the Na- 12 tional Heart, Lung, and Blood Institute, shall— 13 (1) continue to expand research activities ad- 14 dressing sleep health disparities; and 15 (2) continue implementation of the ‘‘NIH Sleep 16 Disorders Research Plan’’ across all institutes and 17 centers of the National Institutes of Health to im- 18 prove treatment and prevention of sleep health dis- 19 parities. 20 (b) REQUIRED RESEARCH ACTIVITIES.—In con- 21 ducting or supporting research relating to sleep and circa- 22 dian rhythm, the Director of the National Heart, Lung, 23 and Blood Institute shall— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00648 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 649 •HR 5294 IH (1) advance epidemiology and clinical research 1 to achieve a more complete understanding of dispari- 2 ties in domains of sleep health and across population 3 subgroups for which cardiovascular and metabolic 4 health disparities exist, including— 5 (A) prevalence and severity of sleep apnea; 6 (B) habitual sleep duration; 7 (C) sleep timing and regularity; and 8 (D) insomnia; 9 (2) develop study designs and analytical ap- 10 proaches to explain and predict multilevel and life- 11 course determinants of sleep health and to elucidate 12 the sleep-related causes of cardiovascular and meta- 13 bolic health disparities across the age spectrum, in- 14 cluding such determinants and causes that are— 15 (A) environmental; 16 (B) biological or genetic; 17 (C) psychosocial; 18 (D) societal; 19 (E) political; or 20 (F) economic; 21 (3) determine the contribution of sleep impair- 22 ments such as sleep apnea, insufficient sleep dura- 23 tion, irregular sleep schedules, and insomnia to un- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00649 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 650 •HR 5294 IH explained disparities in cardiovascular and metabolic 1 risk and disease outcomes; 2 (4) develop study designs, data sampling and 3 collection tools, and analytical approaches to opti- 4 mize understanding of mediating and moderating 5 factors, and feedback mechanisms coupling sleep to 6 cardiovascular and metabolic health disparities; 7 (5) advance research to understand cultural 8 and linguistic barriers (on the person, provider, or 9 system level) to access to care, medical diagnosis, 10 and treatment of sleep disorders in diverse popu- 11 lation groups; 12 (6) develop and test multilevel interventions (in- 13 cluding sleep health education in diverse commu- 14 nities) to reduce disparities in sleep health that will 15 impact ability to improve disparities in cardio- 16 vascular and metabolic risk or disease; 17 (7) create opportunities to integrate sleep and 18 health disparity science by strategically utilizing re- 19 sources (existing or anticipated cohorts), exchanging 20 scientific data and ideas (cross-over into scientific 21 meetings), and develop multidisciplinary investi- 22 gator-initiated grant applications; and 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00650 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 651 •HR 5294 IH (8) enhance the diversity and foster career de- 1 velopment of young investigators involved in sleep 2 and health disparities science. 3 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 4 out this section, there are authorized to be appropriated 5 such sums as may be necessary for fiscal year 2015 and 6 each subsequent fiscal year. 7 SEC. 793. SLEEP AND CIRCADIAN RHYTHM HEALTH DIS- 8 PARITIES-RELATED ACTIVITIES OF THE CEN- 9 TERS FOR DISEASE CONTROL AND PREVEN- 10 TION. 11 (a) IN GENERAL.—The Director of the Centers for 12 Disease Control and Prevention shall conduct, support, 13 and expand public health strategies and prevention, diag- 14 nosis, surveillance, and public and professional awareness 15 activities regarding sleep and circadian rhythm disorders. 16 (b) FINDINGS.—The Congress finds as follows: 17 (1) Sleep disorders and sleep deficiency unre- 18 lated to a primary sleep disorder are underdiagnosed 19 and are increasingly detrimental to health status. 20 (2) The consequences to society include addi- 21 tional diseases, motor vehicle accidents, decreased 22 longevity, elevated direct medical costs, and indirect 23 costs related to work absenteeism and property dam- 24 age. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00651 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 652 •HR 5294 IH (c) REQUIRED SURVEILLANCE AND EDUCATION 1 AWARENESS ACTIVITIES.—In conducting or supporting 2 research relating to sleep and circadian rhythm disorders 3 surveillance and education awareness activities, the Direc- 4 tor of the Centers for Disease Control and Prevention 5 shall— 6 (1) ensure that such activities are culturally 7 and linguistically appropriate to minority patients, 8 targeting sleep and circadian rhythm health pro- 9 motion and prevention programs of each major eth- 10 nic group, including— 11 (A) Native Americans and Alaska Natives; 12 (B) Asian-Americans; 13 (C) African-Americans/Blacks; 14 (D) Hispanic/Latino-Americans; and 15 (E) Native Hawaiians and Pacific Island- 16 ers; 17 (2) collect and compile national and State sur- 18 veillance data on sleep disorders health disparities; 19 (3) continue to develop and implement new 20 sleep questions in public health surveillance systems 21 to increase public awareness of sleep health and 22 sleep disorders and their impact on health; 23 (4) publish monthly reports highlighting geo- 24 graphic, racial, and ethnic disparities in sleep health, 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00652 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 653 •HR 5294 IH as well as relationships between insufficient sleep 1 and chronic disease, health risk behaviors, and other 2 outcomes as determined necessary by the Director; 3 and 4 (5) include public awareness campaigns that in- 5 form patient populations from major ethnic groups 6 about the prevalence of sleep and circadian rhythm 7 disorders and emphasize the importance of sleep 8 health. 9 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 10 out this section, there are authorized to be appropriated 11 such sums as may be necessary for fiscal year 2015 and 12 each subsequent fiscal year. 13 TITLE VIII—HEALTH 14 INFORMATION TECHNOLOGY 15 SEC. 800. DEFINITIONS. 16 In this title: 17 (1) The term ‘‘certified EHR technology’’ has 18 the meaning given to that term in section 3000 of 19 the Public Health Service Act (42 U.S.C. 300jj). 20 (2) The term ‘‘EHR’’ means an electronic 21 health record. 22 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00653 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 654 •HR 5294 IH Subtitle A—Reducing Health 1 Disparities Through Health IT 2 SEC. 801. HRSA ASSISTANCE TO HEALTH CENTERS FOR 3 PROMOTION OF HEALTH IT. 4 The Secretary of Health and Human Services, acting 5 through the Administrator of the Health Resources and 6 Services Administration, shall expand and intensify the 7 programs and activities of the Administration (directly or 8 through grants or contracts) to provide technical assist- 9 ance and resources to health centers (as defined in section 10 330(a) of the Public Health Service Act (42 U.S.C. 11 254b(a)) to adopt and meaningfully use certified EHR 12 technology for the management of chronic diseases and 13 health conditions and reduction of health disparities. 14 SEC. 802. ASSESSMENT OF IMPACT OF HEALTH IT ON RA- 15 CIAL AND ETHNIC MINORITY COMMUNITIES; 16 OUTREACH AND ADOPTION OF HEALTH IT IN 17 SUCH COMMUNITIES. 18 (a) NATIONAL COORDINATOR FOR HEALTH INFOR- 19 MATION TECHNOLOGY.— 20 (1) IN GENERAL.—The National Coordinator 21 for Health Information Technology shall conduct an 22 evaluation of the level of use and accessibility of 23 electronic health records in racial and ethnic minor- 24 ity communities focusing on whether patients in 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00654 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 655 •HR 5294 IH those communities have providers with EHRs, 1 stratified by disparity variables. 2 (2) CONTENT.—In conducting the evaluation 3 under paragraph (1), the National Coordinator shall 4 publish the results of a study regarding the 100,000 5 providers recruited by the Regional Extension Cen- 6 ter established under section 3012 of the Public 7 Health Service Act (42 U.S.C. 300jj–32), including 8 the race and ethnicity of such providers and the pop- 9 ulations served by such providers, with the popu- 10 lations stratified by disparity variables. 11 (b) NATIONAL CENTER FOR HEALTH STATISTICS.— 12 As soon as practicable after the date of enactment of this 13 Act, the Director of the National Center for Health Statis- 14 tics shall provide to Congress a more detailed analysis of 15 the data presented in the Data Brief 79 published by such 16 Center in November 2011 (entitled ‘‘Electronic Health 17 Record Systems and Intent to Apply for Meaningful Use 18 Incentives Among Office-Based Physician Practices’’). 19 (c) INSTITUTE OF MEDICINE.—The Secretary of 20 Health and Human Services may enter into an agreement 21 with the Institute of Medicine of the National Academies 22 that provides such Institute will— 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00655 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 656 •HR 5294 IH (1) evaluate the impact of health information 1 technology in racial and ethnic minority commu- 2 nities; and 3 (2) publish a report regarding such evaluation. 4 (d) CENTERS FOR MEDICARE & MEDICAID SERV- 5 ICES.— 6 (1) IN GENERAL.—As part of the process of 7 collecting information, with respect to a provider, at 8 registration and attestation for purposes of the 9 Medicare and Medicaid Electronic Health Records 10 Incentive Programs, the Secretary of Health and 11 Human Services shall collect the race and ethnicity 12 of such provider. 13 (2) MEDICARE AND MEDICAID ELECTRONIC 14 HEALTH RECORDS INCENTIVE PROGRAMS DE- 15 FINED.—For purposes of paragraph (1), the term 16 ‘‘Medicare and Medicaid Electronic Health Records 17 Incentive Programs’’ means the incentive programs 18 under section 1814(l)(3), subsections (a)(7) and (o) 19 of section 1848, subsections (l) and (m) of section 20 1853, subsections (b)(3)(B)(ix)(I) and (n) of section 21 1886, and subsections (a)(3)(F) and (t) of section 22 1903 of the Social Security Act (42 U.S.C. 23 1395f(l)(3), 1395w–4, 1395w–23, 1395ww, and 24 1396b). 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00656 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 657 •HR 5294 IH (e) NATIONAL COORDINATOR’S ASSESSMENT OF IM- 1 PACT OF HIT.—Section 3001(c)(6)(C) of the Public 2 Health Service Act (42 U.S.C. 300jj–11(c)(6)(C)) is 3 amended— 4 (1) in the heading by inserting ‘‘, RACIAL AND 5 ETHNIC MINORITY COMMUNITIES,’’ after ‘‘HEALTH 6 DISPARITIES’’; 7 (2) by inserting ‘‘, in communities with a high 8 proportion of individuals from racial and ethnic mi- 9 nority groups (as defined in section 1707(g)), in- 10 cluding people with disabilities in these groups,’’ 11 after ‘‘communities with health disparities’’; and 12 (3) by adding at the end the following new sen- 13 tence: ‘‘In any publication under the previous sen- 14 tence, the National Coordinator shall include best 15 practices for encouraging partnerships between the 16 Federal Government, States, and private entities to 17 expand outreach for and the adoption of certified 18 EHR technology in communities with a high propor- 19 tion of individuals from racial and ethnic minority 20 groups (as so defined), while also maintaining the 21 accessibility requirements of section 508 of the Re- 22 habilitation Act to encourage patient involvement in 23 their own health care. The National Coordinator 24 shall— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00657 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 658 •HR 5294 IH ‘‘(i) not later than 6 months after the 1 submission to the Congress of the report 2 required by section 832 of the Health Eq- 3 uity and Accountability Act of 2014, estab- 4 lish criteria for evaluating the impact of 5 health information technology on commu- 6 nities with a high proportion of individuals 7 from racial and ethnic minority groups (as 8 so defined) taking into account the find- 9 ings in such report; and 10 ‘‘(ii) not later than 12 months after 11 the submission to the Congress of such re- 12 ports, conduct and publish the results of 13 an evaluation of such impact.’’. 14 Subtitle B—Modifications To 15 Achieve Parity in Existing Pro- 16 grams 17 SEC. 811. EXTENDING FUNDING TO STRENGTHEN THE 18 HEALTH IT INFRASTRUCTURE IN RACIAL 19 AND ETHNIC MINORITY COMMUNITIES. 20 Section 3011 of the Public Health Service Act (42 21 U.S.C. 300jj–31) is amended— 22 (1) in subsection (a), by adding at the end the 23 following new paragraph: 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00658 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 659 •HR 5294 IH ‘‘(8) Activities described in the previous para- 1 graphs of this subsection with respect to commu- 2 nities with a high proportion of individuals from ra- 3 cial and ethnic minority groups (as defined in sec- 4 tion 1707(g)).’’; and 5 (2) by adding at the end the following new sub- 6 section: 7 ‘‘(e) ANNUAL REPORT ON EXPENDITURES.—The 8 National Coordinator shall report annually to the Con- 9 gress on activities and expenditures under this section.’’. 10 SEC. 812. PRIORITIZING REGIONAL EXTENSION CENTER AS- 11 SISTANCE TO RACIAL AND ETHNIC MINORITY 12 GROUPS. 13 (a) IN GENERAL.—Section 3012(c)(4)(C) of the Pub- 14 lic Health Service Act (42 U.S.C. 300jj–32(c)(4)(C)) is 15 amended by inserting ‘‘or individuals from racial and eth- 16 nic minority groups (as defined in section 1707(g))’’ after 17 ‘‘medically underserved individuals’’. 18 (b) BIENNIAL EVALUATION.—Section 3012(c)(8) of 19 such Act (42 U.S.C. 300jj–32(c)(8)) is amended— 20 (1) by inserting: ‘‘Each evaluation panel shall 21 include at least one consumer advocate from a racial 22 and ethnic minority community served by the center 23 involved, at least one patient or family caregiver, 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00659 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 660 •HR 5294 IH and at least one representative of a minority-serving 1 institution.’’ after ‘‘ ‘and of Federal officials.’’; and 2 (2) by inserting ‘‘and shall determine the de- 3 gree to which such center provides outreach and as- 4 sistance to providers predominantly serving racial 5 and ethnic minority groups (as defined in section 6 1707(g))’’ after ‘‘specified in paragraph (3)’’. 7 SEC. 813. EXTENDING COMPETITIVE GRANTS FOR THE DE- 8 VELOPMENT OF LOAN PROGRAMS TO FACILI- 9 TATE ADOPTION OF CERTIFIED EHR TECH- 10 NOLOGY BY PROVIDERS SERVING RACIAL 11 AND ETHNIC MINORITY GROUPS. 12 Section 3014(e) of the Public Health Service Act (42 13 U.S.C. 300jj–34(e)) is amended— 14 (1) in paragraph (3), by striking at the end 15 ‘‘or’’; 16 (2) in paragraph (4), by striking the period at 17 the end and inserting ‘‘; or’’; and 18 (3) by adding at the end the following new 19 paragraph: 20 ‘‘(5) carry out any of the activities described in 21 a previous paragraph of this subsection with respect 22 to communities with a high proportion of individuals 23 from racial and ethnic minority groups (as defined 24 in section 1707(g)).’’. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00660 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 661 •HR 5294 IH SEC. 814. AUTHORIZATION OF APPROPRIATIONS. 1 Section 3018 of the Public Health Service Act (42 2 U.S.C. 300jj–38) is amended by striking ‘‘fiscal years 3 2009 through 2013’’ and inserting ‘‘fiscal years 2014 4 through 2021’’. 5 Subtitle C—Additional Research 6 and Studies 7 SEC. 831. DATA COLLECTION AND ASSESSMENTS CON- 8 DUCTED IN COORDINATION WITH MINORITY- 9 SERVING INSTITUTIONS. 10 Section 3001(c)(6) of the Public Health Service Act 11 (42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 12 end the following new subparagraph: 13 ‘‘(F) DATA COLLECTION AND ASSESS- 14 MENTS CONDUCTED IN COORDINATION WITH 15 MINORITY-SERVING INSTITUTIONS.— 16 ‘‘(i) IN GENERAL.—In carrying out 17 subparagraph (C) with respect to commu- 18 nities with a high proportion of individuals 19 from racial and ethnic minority groups (as 20 defined in section 1707(g)), the National 21 Coordinator shall, to the greatest extent 22 possible, coordinate with an entity de- 23 scribed in clause (ii). 24 ‘‘(ii) MINORITY-SERVING INSTITU- 25 TIONS.—For purposes of clause (i), an en- 26 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00661 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 662 •HR 5294 IH tity described in this clause is a historically 1 Black college or university, a Hispanic- 2 serving institution, a tribal college or uni- 3 versity, or an Asian-American-, Native 4 American-, and Pacific Islander-serving in- 5 stitution with an accredited public health, 6 health policy, or health services research 7 program.’’. 8 SEC. 832. STUDY OF HEALTH INFORMATION TECHNOLOGY 9 IN MEDICALLY UNDERSERVED COMMU- 10 NITIES. 11 (a) IN GENERAL.—Not later than 24 months after 12 the date of enactment of this Act, the Secretary of Health 13 and Human Services shall— 14 (1) enter into an agreement with the Institute 15 of Medicine of the National Academies (or, if the In- 16 stitute of Medicine declines, another appropriate 17 public or nonprofit private entity) to conduct a study 18 on the development, implementation, and effective- 19 ness of health information technology within medi- 20 cally underserved areas (as described in subsection 21 (c)); and 22 (2) submit a report to Congress describing the 23 results of such study, including any recommenda- 24 tions for legislative or administrative action. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00662 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 663 •HR 5294 IH (b) STUDY.—The study described in subsection 1 (a)(1) shall— 2 (1) identify barriers to successful implementa- 3 tion of health information technology in medically 4 underserved areas; 5 (2) examine the impact of health information 6 technology on providing quality care and reducing 7 the cost of care to individuals in such areas, includ- 8 ing the impact of such technology on improved 9 health outcomes for individuals, including which 10 technology worked for which population and how it 11 improved health outcomes for that population; 12 (3) examine the impact of health information 13 technology on improving health-care-related deci- 14 sions by both patients and providers in such areas; 15 (4) identify specific best practices for using 16 health information technology to foster the con- 17 sistent provision of physical accessibility and reason- 18 able policy accommodations in health care to individ- 19 uals with disabilities in such areas; 20 (5) assess the feasibility and costs associated 21 with the use of health information technology in 22 such areas; 23 (6) evaluate whether the adoption and use of 24 qualified electronic health records (as described in 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00663 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 664 •HR 5294 IH section 3000(13) of the Public Health Service Act 1 (42 U.S.C. 300jj(13)) is effective in reducing health 2 disparities, including analysis of clinical quality 3 measures reported by Medicare and Medicaid pro- 4 viders pursuant to programs to encourage the adop- 5 tion and use of certified EHR technology; 6 (7) identify providers in medically underserved 7 areas that are not electing to adopt and use elec- 8 tronic health records and determine what barriers 9 are preventing those providers from adopting and 10 using such records; and 11 (8) examine urban and rural community health 12 systems and determine the impact that health infor- 13 mation technology may have on the capacity of pri- 14 mary health providers in those systems. 15 (c) MEDICALLY UNDERSERVED AREA.—The term 16 ‘‘medically underserved area’’ means— 17 (1) a population that has been designated as a 18 medically underserved population under section 19 330(b)(3) of the Public Health Service Act (42 20 U.S.C. 254b(b)(3)); 21 (2) an area that has been designated as a 22 health professional shortage area under section 332 23 of the Public Health Service Act (42 U.S.C. 254e); 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00664 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 665 •HR 5294 IH (3) an area or population that has been des- 1 ignated as a medically underserved community under 2 section 799B(6) of the Public Health Service Act 3 (42 U.S.C. 295p(6)); or 4 (4) an area or population that— 5 (A) is not described in paragraphs (1) 6 through (3) of this subsection; 7 (B) experiences significant barriers to ac- 8 cessing quality health services; and 9 (C) has a high prevalence of diseases or 10 conditions described in title VII of this Act, 11 with such diseases or conditions having a dis- 12 proportionate impact on racial and ethnic mi- 13 nority groups (as defined in section 1707(g) of 14 the Public Health Service Act (42 U.S.C. 300u- 15 6(g))) or a subgroup of people with disabilities 16 who have specific functional impairments. 17 Subtitle D—Closing Gaps in 18 Funding To Adopt Certified EHRs 19 SEC. 841. APPLICATION OF MEDICARE HITECH PAYMENTS 20 TO HOSPITALS IN PUERTO RICO. 21 (a) IN GENERAL.—Subsection (n)(6)(B) of section 22 1886 of the Social Security Act (42 U.S.C. 1395ww) is 23 amended by striking ‘‘subsection (d) hospital’’ and insert- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00665 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 666 •HR 5294 IH ing ‘‘hospital that is a subsection (d) hospital or a sub- 1 section (d) Puerto Rico hospital’’. 2 (b) OFFSETTING REDUCTION.—Subsection (n)(2) of 3 section 1886 of the Social Security Act (42 U.S.C. 4 1395ww) is amended by adding at the end the following 5 new subparagraph: 6 ‘‘(H) BUDGET NEUTRALITY ADJUST- 7 MENT.—The Secretary shall reduce the applica- 8 ble amounts that would otherwise be deter- 9 mined under this subsection with respect to— 10 ‘‘(i) the first fiscal year to which this 11 subparagraph applies by an amount that 12 the Secretary estimates would ensure that 13 estimated aggregate payments under this 14 subsection for such fiscal year are not in- 15 creased as a result of the amendments 16 made by subsection (a) of section 841 of 17 the Health Equity and Accountability Act 18 of 2014; or 19 ‘‘(ii) a succeeding fiscal year by an 20 amount that the Secretary estimates would 21 ensure that estimated aggregate payments 22 under this subsection for such fiscal year 23 are not increased as a result of the amend- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00666 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 667 •HR 5294 IH ments made by subsections (a) and (c) of 1 such section.’’. 2 (c) CONFORMING AMENDMENTS.—(1) Subsection 3 (b)(3)(B)(ix) of such section is amended— 4 (A) in subclause (I), by striking ‘‘(n)(6)(A)’’ 5 and inserting ‘‘(n)(6)(B)’’; and 6 (B) in subclause (II), by striking ‘‘subsection 7 (d) hospital’’ and inserting ‘‘an eligible hospital’’. 8 (2) Paragraphs (2) and (4)(A) of section 1853(m) of 9 the Social Security Act (42 U.S.C. 1395w–23(m)) are 10 each amended by striking ‘‘1886(n)(6)(A)’’ and inserting 11 ‘‘1886(n)(6)(B)’’. 12 (d) IMPLEMENTATION.—Notwithstanding any other 13 provision of law, the Secretary of Health and Human 14 Services may implement the amendments made by sub- 15 sections (a), (b) and (c) by program instruction or other- 16 wise. 17 (e) EFFECTIVE DATE.—The amendments made by 18 this section shall apply to payments for payment years for 19 fiscal years beginning after the date of the enactment of 20 this Act. 21 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00667 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 668 •HR 5294 IH SEC. 842. EXTENDING MEDICAID EHR INCENTIVE PAY- 1 MENTS TO REHABILITATION FACILITIES, 2 LONG-TERM CARE FACILITIES, AND HOME 3 HEALTH AGENCIES. 4 Section 1903(t)(2)(B) of the Social Security Act (42 5 U.S.C. 1396b(t)(2)(B)) is amended— 6 (1) in clause (i), by striking ‘‘, or’’ and insert- 7 ing a semicolon; 8 (2) in clause (ii), by striking the period at the 9 end and inserting a semicolon; and 10 (3) by inserting after clause (ii) the following 11 new clauses: 12 ‘‘(iii) a rehabilitation facility (as defined in 13 section 1886(j)(1)) that furnishes acute or 14 subacute rehabilitation services; 15 ‘‘(iv) a long-term care hospital (as defined 16 in section 1886(d)(1)(B)(iv)(I)); or 17 ‘‘(v) a home health agency (as defined in 18 section 1861(o)).’’. 19 SEC. 843. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 20 FOR MEDICAID ELECTRONIC HEALTH 21 RECORD INCENTIVE PAYMENTS. 22 (a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 23 Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 24 amended to read as follows: 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00668 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 669 •HR 5294 IH ‘‘(v) physician assistant, in the case 1 that the assistant is a primary care pro- 2 vider, including an assistant who practices 3 in a rural health clinic that is led by a phy- 4 sician assistant or practices in a federally 5 qualified health center that is so led.’’. 6 (b) EFFECTIVE DATE.—The amendment made by 7 subsection (a) shall apply with respect to amounts ex- 8 pended under section 1903(a)(3)(F) of the Social Security 9 Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be- 10 ginning on or after the date of the enactment of this Act. 11 TITLE IX—ACCOUNTABILITY 12 AND EVALUATION 13 SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL 14 ASSISTED HEALTH CARE SERVICES AND RE- 15 SEARCH PROGRAMS ON THE BASIS OF SEX, 16 RACE, COLOR, NATIONAL ORIGIN, MARITAL 17 STATUS, FAMILIAL STATUS, SEXUAL ORI- 18 ENTATION, GENDER IDENTITY, OR DIS- 19 ABILITY STATUS. 20 (a) IN GENERAL.—No person in the United States 21 shall, on the basis of sex, race, color, national origin, mar- 22 ital status, familial status, sexual orientation, gender iden- 23 tity, or disability status, be excluded from participation 24 in, be denied the benefits of, or be subjected to discrimina- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00669 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 670 •HR 5294 IH tion under any health program or activity, including any 1 health research program or activity, receiving Federal fi- 2 nancial assistance. 3 (b) DEFINITION.—In this section, the term ‘‘familial 4 status’’ means, with respect to one or more individuals— 5 (1) being domiciled with any individual related 6 by blood or affinity whose close association with the 7 individual is the equivalent of a family relationship; 8 (2) being in the process of securing legal cus- 9 tody of any individual; or 10 (3) being pregnant. 11 SEC. 902. TREATMENT OF MEDICARE PAYMENTS UNDER 12 TITLE VI OF THE CIVIL RIGHTS ACT OF 1964. 13 A payment to a provider of services, physician, or 14 other supplier under part B, C, or D of title XVIII of 15 the Social Security Act shall be deemed a grant, and not 16 a contract of insurance or guaranty, for the purposes of 17 title VI of the Civil Rights Act of 1964. 18 SEC. 903. ACCOUNTABILITY AND TRANSPARENCY WITHIN 19 THE DEPARTMENT OF HEALTH AND HUMAN 20 SERVICES. 21 Title XXXIV of the Public Health Service Act, as 22 amended by titles I, II, and III of this Act, is further 23 amended by inserting after subtitle B the following: 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00670 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 671 •HR 5294 IH ‘‘Subtitle C—Strengthening 1 Accountability 2 ‘‘SEC. 3441. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 3 ‘‘(a) IN GENERAL.—The Secretary shall establish 4 within the Office for Civil Rights an Office of Health Dis- 5 parities, which shall be headed by a director to be ap- 6 pointed by the Secretary. 7 ‘‘(b) PURPOSE.—The Office of Health Disparities 8 shall ensure that the health programs, activities, and oper- 9 ations of health entities which receive Federal financial as- 10 sistance are in compliance with title VI of the Civil Rights 11 Act, which prohibits discrimination on the basis of race, 12 color, or national origin. The activities of the Office shall 13 include the following: 14 ‘‘(1) The development and implementation of 15 an action plan to address racial and ethnic health 16 care disparities, which shall address concerns relat- 17 ing to the Office for Civil Rights as released by the 18 United States Commission on Civil Rights in the re- 19 port entitled ‘Health Care Challenge: Acknowledging 20 Disparity, Confronting Discrimination, and Ensur- 21 ing Equity’ (September 1999) in conjunction with 22 the reports by the Institute of Medicine entitled ‘Un- 23 equal Treatment: Confronting Racial and Ethnic 24 Disparities in Health Care’, ‘Crossing the Quality 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00671 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 672 •HR 5294 IH Chasm: A New Health System for the 21st Cen- 1 tury’, ‘In the Nation’s Compelling Interest: Ensur- 2 ing Diversity in the Health Care Workforce’, ‘The 3 National Partnership for Action to End Health Dis- 4 parities’, and ‘The Health of Lesbian, Gay, Bisexual, 5 and Transgender People’, and other related reports 6 by the Institute of Medicine. This plan shall be pub- 7 licly disclosed for review and comment and the final 8 plan shall address any comments or concerns that 9 are received by the Office. 10 ‘‘(2) Investigative and enforcement actions 11 against intentional discrimination and policies and 12 practices that have a disparate impact on minorities. 13 ‘‘(3) The review of racial, ethnic, gender iden- 14 tity, sexual orientation, sex, disability status, socio- 15 economic status, and primary language health data 16 collected by Federal health agencies to assess health 17 care disparities related to intentional discrimination 18 and policies and practices that have a disparate im- 19 pact on minorities. 20 ‘‘(4) Outreach and education activities relating 21 to compliance with title VI of the Civil Rights Act. 22 ‘‘(5) The provision of technical assistance for 23 health entities to facilitate compliance with title VI 24 of the Civil Rights Act. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00672 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 673 •HR 5294 IH ‘‘(6) Coordination and oversight of activities of 1 the civil rights compliance offices established under 2 section 3442. 3 ‘‘(7) Ensuring— 4 ‘‘(A) at a minimum, compliance with the 5 1997 Office of Management and Budget Stand- 6 ards for Maintaining, Collecting, and Pre- 7 senting Federal Data on Race and Ethnicity; 8 and 9 ‘‘(B) consideration of available data and 10 language standards such as— 11 ‘‘(i) the standards for collecting and 12 reporting data under section 3101; and 13 ‘‘(ii) the National Standards on Cul- 14 turally and Linguistically Appropriate 15 Services of the Office of Minority Health 16 within the Department of Health and 17 Human Services. 18 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en- 19 sure the effectiveness of the Office of Health Disparities 20 by ensuring that the Office is provided with— 21 ‘‘(1) adequate funding to enable the Office to 22 carry out its duties under this section; and 23 ‘‘(2) staff with expertise in— 24 ‘‘(A) epidemiology; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00673 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 674 •HR 5294 IH ‘‘(B) statistics; 1 ‘‘(C) health quality assurance; 2 ‘‘(D) minority health and health dispari- 3 ties; 4 ‘‘(E) cultural and linguistic competency; 5 ‘‘(F) civil rights; and 6 ‘‘(G) social, behavioral, and economic de- 7 terminants of health. 8 ‘‘(d) REPORT.—Not later than December 31, 2015, 9 and annually thereafter, the Secretary, in collaboration 10 with the Director of the Office for Civil Rights and the 11 Deputy Assistant Secretary for Minority Health, shall 12 submit a report to the Committee on Health, Education, 13 Labor, and Pensions of the Senate and the Committee on 14 Energy and Commerce of the House of Representatives 15 that includes— 16 ‘‘(1) the number of cases filed, broken down by 17 category; 18 ‘‘(2) the number of cases investigated and 19 closed by the office; 20 ‘‘(3) the outcomes of cases investigated; 21 ‘‘(4) the staffing levels of the office including 22 staff credentials; 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00674 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 675 •HR 5294 IH ‘‘(5) the number of other lingering and emerg- 1 ing cases in which civil rights inequities can be dem- 2 onstrated; and 3 ‘‘(6) the number of cases remaining open and 4 an explanation for their open status. 5 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 6 are authorized to be appropriated to carry out this section 7 such sums as may be necessary for each of fiscal years 8 2015 through 2020. 9 ‘‘SEC. 3442. ESTABLISHMENT OF HEALTH PROGRAM OF- 10 FICES FOR CIVIL RIGHTS WITHIN FEDERAL 11 HEALTH AND HUMAN SERVICES AGENCIES. 12 ‘‘(a) IN GENERAL.—The Secretary shall establish 13 civil rights compliance offices in each agency within the 14 Department of Health and Human Services that admin- 15 isters health programs. 16 ‘‘(b) PURPOSE OF OFFICES.—Each office established 17 under subsection (a) shall ensure that recipients of Fed- 18 eral financial assistance under Federal health programs 19 administer their programs, services, and activities in a 20 manner that— 21 ‘‘(1) does not discriminate, either intentionally 22 or in effect, on the basis of race, national origin, lan- 23 guage, ethnicity, sex, age, disability, sexual orienta- 24 tion, and gender identity; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00675 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 676 •HR 5294 IH ‘‘(2) promotes the reduction and elimination of 1 disparities in health and health care based on race, 2 national origin, language, ethnicity, sex, age, dis- 3 ability, sexual orientation, and gender identity. 4 ‘‘(c) POWERS AND DUTIES.—The offices established 5 in subsection (a) shall have the following powers and du- 6 ties: 7 ‘‘(1) The establishment of compliance and pro- 8 gram participation standards for recipients of Fed- 9 eral financial assistance under each program admin- 10 istered by an agency within the Department of 11 Health and Human Services including the establish- 12 ment of disparity reduction standards to encompass 13 disparities in health and health care related to race, 14 national origin, language, ethnicity, sex, age, dis- 15 ability, sexual orientation, and gender identity. 16 ‘‘(2) The development and implementation of 17 program-specific guidelines that interpret and apply 18 Department of Health and Human Services guid- 19 ance under title VI of the Civil Rights Act of 1964 20 and section 1557 of the Patient Protection and Af- 21 fordable Care Act to each Federal health program 22 administered by the agency. 23 ‘‘(3) The development of a disparity-reduction 24 impact analysis methodology that shall be applied to 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00676 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 677 •HR 5294 IH every rule issued by the agency and published as 1 part of the formal rulemaking process under sections 2 555, 556, and 557 of title 5, United States Code. 3 ‘‘(4) Oversight of data collection, analysis, and 4 publication requirements for all recipients of Federal 5 financial assistance under each Federal health pro- 6 gram administered by the agency; compliance with, 7 at a minimum, the 1997 Office of Management and 8 Budget Standards for Maintaining, Collecting, and 9 Presenting Federal Data on Race and Ethnicity; and 10 consideration of available data and language stand- 11 ards such as— 12 ‘‘(A) the standards for collecting and re- 13 porting data under section 3101; and 14 ‘‘(B) the National Standards on Culturally 15 and Linguistically Appropriate Services of the 16 Office of Minority Health within the Depart- 17 ment of Health and Human Services. 18 ‘‘(5) The conduct of publicly available studies 19 regarding discrimination within Federal health pro- 20 grams administered by the agency as well as dis- 21 parity reduction initiatives by recipients of Federal 22 financial assistance under Federal health programs. 23 ‘‘(6) Annual reports to the Committee on 24 Health, Education, Labor, and Pensions and the 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00677 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 678 •HR 5294 IH Committee on Finance of the Senate and the Com- 1 mittee on Energy and Commerce and the Committee 2 on Ways and Means of the House of Representatives 3 on the progress in reducing disparities in health and 4 health care through the Federal programs adminis- 5 tered by the agency. 6 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS 7 IN THE DEPARTMENT OF JUSTICE.— 8 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN 9 SERVICES.—The Office for Civil Rights in the De- 10 partment of Health and Human Services shall pro- 11 vide standard-setting and compliance review inves- 12 tigation support services to the Civil Rights Compli- 13 ance Office for each agency. 14 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 15 for Civil Rights in the Department of Justice shall 16 continue to maintain the power to institute formal 17 proceedings when an agency Office for Civil Rights 18 determines that a recipient of Federal financial as- 19 sistance is not in compliance with the disparity re- 20 duction standards of the agency. 21 ‘‘(e) DEFINITION.—In this section, the term ‘Federal 22 health programs’ mean programs— 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00678 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 679 •HR 5294 IH ‘‘(1) under the Social Security Act (42 U.S.C. 1 301 et seq.) that pay for health care and services; 2 and 3 ‘‘(2) under this Act that provide Federal finan- 4 cial assistance for health care, biomedical research, 5 health services research, and programs designed to 6 improve the public’s health, including health service 7 programs.’’. 8 SEC. 904. UNITED STATES COMMISSION ON CIVIL RIGHTS. 9 (a) COORDINATION WITHIN DEPARTMENT OF JUS- 10 TICE OF ACTIVITIES REGARDING HEALTH DISPARI- 11 TIES.—Section 3(a) of the Civil Rights Commission Act 12 of 1983 (42 U.S.C. 1975a(a)) is amended— 13 (1) in paragraph (1), by striking ‘‘and’’ at the 14 end; 15 (2) in paragraph (2), by striking the period at 16 the end and inserting ‘‘; and’’; and 17 (3) by adding at the end the following: 18 ‘‘(3) shall, with respect to activities carried out 19 in health care and correctional facilities toward the 20 goal of eliminating health disparities between the 21 general population and members of racial or ethnic 22 minority groups, coordinate such activities of— 23 ‘‘(A) the Office for Civil Rights within the 24 Department of Justice; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00679 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 680 •HR 5294 IH ‘‘(B) the Office of Justice Programs within 1 the Department of Justice; 2 ‘‘(C) the Office for Civil Rights within the 3 Department of Health and Human Services; 4 and 5 ‘‘(D) the Office of Minority Health within 6 the Department of Health and Human Services 7 (headed by the Deputy Assistant Secretary for 8 Minority Health).’’. 9 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 10 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 11 1975c) is amended by striking the first sentence and in- 12 serting the following: ‘‘For the purpose of carrying out 13 this Act, there are authorized to be appropriated 14 $30,000,000 for fiscal year 2015, and such sums as may 15 be necessary for each of the fiscal years 2016 through 16 2020.’’. 17 SEC. 905. SENSE OF CONGRESS CONCERNING FULL FUND- 18 ING OF ACTIVITIES TO ELIMINATE RACIAL 19 AND ETHNIC HEALTH DISPARITIES. 20 (a) FINDINGS.—Congress makes the following find- 21 ings: 22 (1) The health status of the American populace 23 is declining and the United States currently ranks 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00680 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 681 •HR 5294 IH below most industrialized nations in health status 1 measured by longevity, sickness, and mortality. 2 (2) Racial and ethnic minority populations tend 3 have the poorest health status and face substantial 4 cultural, social, and economic barriers to obtaining 5 quality health care. 6 (3) Lesbian, gay, bisexual and transgender 7 (LGBT) populations experience significant personal 8 and structural barriers to obtaining high-quality 9 health care. 10 (4) Efforts to improve minority health have 11 been limited by inadequate resources (funding, staff- 12 ing, and stewardship) and lack of accountability. 13 (b) SENSE OF CONGRESS.—It is the sense of Con- 14 gress that— 15 (1) funding should be doubled by fiscal year 16 2016 for the National Institute for Minority Health 17 Disparities, the Office of Civil Rights in the Depart- 18 ment of Health and Human Services, the National 19 Institute of Nursing Research, and the Office of Mi- 20 nority Health; 21 (2) adequate funding by fiscal year 2016, and 22 subsequent funding increases, should be provided for 23 health and human service professions training pro- 24 grams, the Racial and Ethnic Approaches to Com- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00681 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 682 •HR 5294 IH munity Health (REACH) Initiative at the Centers 1 for Disease Control and Prevention, the Minority 2 HIV/AIDS Initiative, and the Excellence Centers to 3 Eliminate Ethnic/Racial Disparities (EXCEED) 4 Program at the Agency for Healthcare Research and 5 Quality; 6 (3) funding should be fully restored to the Ra- 7 cial and Ethnic Approaches to Community Health 8 (REACH) Initiative at the Centers for Disease Con- 9 trol and Prevention, which has been a successful 10 program at the community health level, and efforts 11 should continue to place a strong emphasis on build- 12 ing community capacity to secure financial resources 13 and technical assistance to eliminate health dispari- 14 ties; 15 (4) adequate funding for fiscal year 2016 and 16 increased funding for future years should be pro- 17 vided for the REACH Initiative’s United States Risk 18 Factor Survey to ensure adequate data collection to 19 track health disparities, and there should be appro- 20 priate avenues provided to disseminate findings to 21 the general public; 22 (5) current and newly created health disparity 23 elimination incentives, programs, agencies, and de- 24 partments under this Act (and the amendments 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00682 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 683 •HR 5294 IH made by this Act) should receive adequate staffing 1 and funding by fiscal year 2016; and 2 (6) stewardship and accountability should be 3 provided to the Congress and the President for 4 measurable and sustainable progress toward health 5 disparity elimination. 6 SEC. 906. GAO AND NIH REPORTS. 7 (a) GAO REPORT ON NIH GRANT RACIAL AND ETH- 8 NIC DIVERSITY.— 9 (1) IN GENERAL.—The Comptroller General of 10 the United States shall conduct a study on the racial 11 and ethnic diversity among the following groups: 12 (A) All applicants for grants, contracts, 13 and cooperative agreements awarded by the Na- 14 tional Institutes of Health during the period be- 15 ginning on January 1, 1990, and ending De- 16 cember 31, 2013. 17 (B) All recipients of such grants, con- 18 tracts, and cooperative agreements. 19 (C) All members of the peer review panels 20 of such applicants and recipients, respectively. 21 (2) REPORT.—Not later than six months after 22 the date of the enactment of this Act, the Comp- 23 troller General shall complete the study under para- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00683 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 684 •HR 5294 IH graph (1) and submit to Congress a report con- 1 taining the results of such study. 2 (b) NIH REPORT ON CERTAIN AUTHORITY OF NA- 3 TIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH 4 DISPARITIES.—Not later than six months after the date 5 of the enactment of this Act, and biennially thereafter, the 6 Director of the National Institutes of Health, in collabora- 7 tion with the Director of the National Institute on Minor- 8 ity Health and Health Disparities, shall submit to Con- 9 gress a report that details and evaluates— 10 (1) the steps taken during the applicable report 11 period by the Director of the National Institutes of 12 Health to enforce the expanded planning, coordina- 13 tion, review, and evaluation authority provided the 14 National Institute on Minority Health and Health 15 Disparities under section 464z–3(h) of the Public 16 Health Service Act (42 U.S.C. 285(h)), as added by 17 section 10334(c) of the Patient Protection and Af- 18 fordable Care Act, over all minority health and 19 health disparity research that is conducted or sup- 20 ported by the Institutes and Centers at the National 21 Institutes of Health; and 22 (2) the outcomes of such steps. 23 (c) GAO REPORT RELATED TO RECIPIENTS OF 24 PPACA FUNDING.—Not later than one year after the 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00684 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 685 •HR 5294 IH date of the enactment of this Act and biennially thereafter 1 until 2024, the Comptroller General of the United States 2 shall submit to Congress a report that identifies, with re- 3 spect to minority community-based organizations that ap- 4 plied during the applicable report period for Federal fund- 5 ing provided pursuant to the provisions of (and amend- 6 ments made by) the Patient Protection and Affordable 7 Care Act for purposes of achieving health equity and elimi- 8 nating health disparities, the percentage of such organiza- 9 tions that were awarded such funding. 10 (d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL 11 INSTITUTE ON MINORITY HEALTH AND HEALTH DIS- 12 PARITIES.—The Director of the National Institute on Mi- 13 nority Health and Health Disparities shall prepare an an- 14 nual report on the activities carried out or to be carried 15 out by the Institute, and shall submit each such report 16 to the Committee on Health, Education, Labor, and Pen- 17 sions of the Senate, the Committee on Energy and Com- 18 merce of the House of Representatives, the Secretary of 19 Health and Human Services, and the Director of the Na- 20 tional Institutes of Health. With respect to the fiscal year 21 involved, the report shall— 22 (1) describe and evaluate the progress made in 23 health disparities research conducted or supported 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00685 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 686 •HR 5294 IH by institutes and centers of the National Institutes 1 of Health; 2 (2) summarize and analyze expenditures made 3 for activities with respect to health disparities re- 4 search conducted or supported by the National Insti- 5 tutes of Health; 6 (3) include a separate statement applying the 7 requirements of paragraphs (1) and (2) specifically 8 to minority health disparities research; and 9 (4) contain such recommendations as the Direc- 10 tor of the Institute considers appropriate. 11 TITLE X—ADDRESSING SOCIAL 12 DETERMINANTS AND IM- 13 PROVING ENVIRONMENTAL 14 JUSTICE 15 SEC. 1001. DEFINITIONS. 16 (a) DETERMINANTS OF HEALTH.—The term ‘‘deter- 17 minants of health’’— 18 (1) refers to the range of personal, social, eco- 19 nomic, and environmental factors that influence 20 health status; and 21 (2) includes social determinants of health 22 (which are sometimes referred to as ‘‘social and eco- 23 nomic determinants of health’’ or ‘‘socioeconomic de- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00686 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 687 •HR 5294 IH terminants of health’’), environmental determinants 1 of health, and personal determinants of health. 2 (b) ENVIRONMENTAL DETERMINANTS OF 3 HEALTH.—The term ‘‘environmental determinants of 4 health’’ refers to the broad physical, psychological, social, 5 and aesthetic environment. 6 (c) PERSONAL DETERMINANTS OF HEALTH.—The 7 term ‘‘personal determinants of health’’ refers to an indi- 8 vidual’s behavior, biology, and genetics. 9 (d) SOCIAL DETERMINANTS OF HEALTH .—The term 10 ‘‘social determinants of health’’ refers to a subset of deter- 11 minants of the health of individuals and environments 12 (such as communities, neighborhoods, and societies) that 13 describe people’s social identity, describe the social and 14 economic resources to which people have access, and de- 15 scribe the conditions in which people work, live, and play. 16 SEC. 1002. FINDINGS. 17 The Congress finds as follows: 18 (1) There are more opportunities to improve 19 health for everyone when we understand that health 20 starts, first, not in a medical setting, but in our 21 families, in our schools and workplaces, in our 22 neighborhoods, and in the air we breathe and water 23 we drink. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00687 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 688 •HR 5294 IH (2) The social determinants of health are the 1 largest predictors of health outcomes. 2 (3) Healthy People 2020 identifies health and 3 health care quality as a function of not only access 4 to health care, but also the social determinants of 5 health, categorized into the following: neighborhoods 6 and the built environment; social and community 7 context; education; and economic stability. The fol- 8 lowing examples illustrate the nexus between the un- 9 equal distribution of the social determinants of 10 health and health disparities: 11 (A) The built environment influences resi- 12 dents’ level of physical activity. Neighborhoods 13 with high levels of poverty are significantly less 14 likely to have places where children can be 15 physically active, such as parks, green spaces, 16 and bike paths and lanes. Neighborhoods and 17 communities can provide opportunities for phys- 18 ical activity and support active lifestyles 19 through accessible and safe parks and open 20 spaces and through land use policy, zoning, and 21 healthy community design. 22 (B) Emotional and physical health and 23 well-being are directly impacted by perceived 24 levels of safety, such as unlit streets at night. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00688 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 689 •HR 5294 IH Community members have expressed that safety 1 is not only a barrier to accessing programs and 2 services that increase quality of life but they 3 are also not able to access physical activity in 4 their community through the built environment. 5 (C) In many workplace environments, toxic 6 chemicals have lasting detrimental effects on 7 employees’ health. The hazardous compounds 8 found in most nail salon products affect the 9 respiratory system, reproductive system, and 10 central nervous system, and also cause kidney 11 and liver damage. Recognizing the importance 12 of addressing occupational hazards as a matter 13 of public health, especially for Asian-American 14 women who constitute 40 percent of nail salon 15 technicians—with Vietnamese-American women 16 accounting for 37 percent of this—the White 17 House Initiative on Asian American Pacific Is- 18 landers has created an interagency working 19 group to coordinate efforts by the Environ- 20 mental Protection Agency, Occupational and 21 Safety Health Administration, Food and Drug 22 Administration, and other Federal agencies to 23 create programming, draft regulations, and con- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00689 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 690 •HR 5294 IH duct more outreach on educating workers on 1 health and safety issues. 2 (D) Historical and institutional discrimina- 3 tion against certain racial groups in the United 4 States has shaped the way in which social and 5 economic resources and exposure to health pro- 6 moting environments are distributed. Income, 7 education, occupation, neighborhood conditions, 8 schools, workplaces, the use of and health and 9 social services, and experiences with the crimi- 10 nal justice system are all highly patterned by 11 race, with racial minorities (compared to 12 Whites) experiencing more that is health harm- 13 ing. Finding ways to uncouple the link between 14 race and access to resources and healthy envi- 15 ronments is a principal means of reducing 16 health disparities. Additionally, the anticipation 17 of racism itself causes higher psychological and 18 cardiovascular stress levels that are linked to 19 poor health outcomes. Remedying discrimina- 20 tory practices at the individual and systemic 21 levels will likely reduce health disparities caused 22 by this unequal distribution of stress. 23 (E) Poor health among Native Americans 24 has largely been driven by post-colonial oppres- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00690 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 691 •HR 5294 IH sion and historical trauma. The expropriation of 1 native lands and territories to the American 2 state had severe consequences on Native Amer- 3 ican health. This resulted in the deprivation of 4 traditional food sources—and nutrients—for 5 Native Americans and also the destruction of 6 traditional economies and community organiza- 7 tion. Today, Native Americans have twice the 8 rate of diabetes than non-Hispanic Whites. Rec- 9 ognition of the origins of the diabetes as having 10 a social and community context, rather than 11 just individual responsibility and genetic pre- 12 disposition, will shape better policy to provide 13 food security. 14 (F) In the context of prisons, overcrowding 15 has led to the deterioration of the physical and 16 mental health of individuals after they leave 17 prison. In particular, the mass incarceration of 18 African-American males as a result of unequal 19 contact with and treatment in the criminal jus- 20 tice system has contributed to an overburdening 21 of certain infectious diseases within the African- 22 American community. As a social institution, 23 incarceration amplifies existing adverse health 24 conditions by concentrating diseases and harm 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00691 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 692 •HR 5294 IH health behaviors such as tobacco use, drug use, 1 and violence. 2 (G) Educational attainment is the strong- 3 est predictor of adult mortality. It is a basic 4 component of socioeconomic status by shaping 5 earning potential to access resources that pro- 6 mote health. People with more education are 7 less likely to report that they are in poor health, 8 and are also less likely to have diabetes and 9 other chronic diseases. 10 (H) Similarly, reading ability is a strong 11 predictor of adult health status and is often 12 correlated with other child health issues, such 13 as developmental problems, vision and hearing 14 impairments, and frequent school absence due 15 to illness. 16 (I) Individuals with lower levels of edu- 17 cational attainment are much more likely to re- 18 port to be current smokers. In 2011, smoking 19 prevalence was 45.3 percent among adults with 20 a GED diploma, 34.6 percent with nine to 11 21 years of education, and 23.8 percent with a 22 high school diploma, while dropping signifi- 23 cantly to 9.3 percent among adults with an un- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00692 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 693 •HR 5294 IH dergraduate college degree and 5.0 percent with 1 a postgraduate college degree. 2 (J) Social class differences account for a 3 large part of health disparities. For example, 4 children living in poverty experience poorer 5 housing conditions, increased exposure to in- 6 door allergens and toxins (such as pesticides, 7 lead, mercury, radon, air pollution, and carcino- 8 gens), and more psychological stress. These ex- 9 periences culminate in worse adult health as 10 compared with children with higher socio- 11 economic status. Specifically, children living in 12 socioeconomic neighborhoods have higher rates 13 of asthma due to higher rates of psychological 14 stress resulting from higher rates of violence. 15 (K) Lesbian, gay, bisexual, and 16 transgender (LGBT) individuals face health 17 disparities linked to societal stigma, discrimina- 18 tion, and denial of their civil and human rights. 19 Discrimination against LGBT individuals has 20 been associated with high rates of psychiatric 21 disorders, substance abuse, and suicide. Experi- 22 ences of violence and victimization are frequent 23 for LGBT individuals, and have long-lasting ef- 24 fects on the individual and the community. Per- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00693 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 694 •HR 5294 IH sonal, family, and social acceptance of sexual 1 orientation and gender identity affects the men- 2 tal health and personal safety of LGBT individ- 3 uals. 4 (4) Laws and regulations that improve opportu- 5 nities to live in safe neighborhoods, with more social 6 cohesion, attain higher education, sustain stable em- 7 ployment, and bridge class differences help foster 8 the health and safety of individuals. 9 (5) The global public health community has 10 reached consensus through the Rio Political Declara- 11 tion of Social Determinants of Health that 12 ‘‘[c]ollaboration in coordinated and intersectoral pol- 13 icy actions has proven to be effective. Health in All 14 Policies, together with intersectoral cooperation and 15 action, is one promising approach to enhance ac- 16 countability in other sectors of health, as well as the 17 promotion of health equity and more inclusive and 18 productive societies.’’ 19 SEC. 1003. HEALTH IMPACT ASSESSMENTS. 20 (a) FINDINGS.—Congress makes the following find- 21 ings: 22 (1) Health Impact Assessment is a tool to help 23 planners, health officials, decisionmakers, and the 24 public make more informed decisions about the po- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00694 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 695 •HR 5294 IH tential health effects of proposed plans, policies, pro- 1 grams, and projects in order to maximize health 2 benefits and minimize harms. 3 (2) Health Impact Assessments can be done at 4 a fraction of the cost and time typically required for 5 other planning and permitting reviews. 6 (3) Health Impact Assessments can build com- 7 munity support and reduce opposition to a project or 8 policy, thereby facilitating economic growth by aid- 9 ing the development of consensus regarding new de- 10 velopment proposals. 11 (4) Health Impact Assessments facilitate col- 12 laboration across sectors. 13 (b) PURPOSES.—It is the purpose of this section to— 14 (1) provide more information about the poten- 15 tial human health effects of policy decisions and the 16 distribution of those effects; 17 (2) improve how health is considered in plan- 18 ning and decisionmaking processes; and 19 (3) build stronger, healthier communities 20 through the use of Health Impact Assessment. 21 (c) HEALTH IMPACT ASSESSMENTS.—Part P of title 22 III of the Public Health Service Act (42 U.S.C. 280g et 23 seq.), as amended, is further amended by adding at the 24 end the following: 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00695 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 696 •HR 5294 IH ‘‘SEC. 399V–9. HEALTH IMPACT ASSESSMENTS. 1 ‘‘(a) DEFINITIONS.—In this section and section 2 399V–10: 3 ‘‘(1) ADMINISTRATOR.—The term ‘Adminis- 4 trator’ means the Administrator of the Environ- 5 mental Protection Agency. 6 ‘‘(2) BUILT ENVIRONMENT.—The term ‘built 7 environment’ means the components of the environ- 8 ment, and the location of these components in a geo- 9 graphically defined space, that are created or modi- 10 fied by individuals to form the physical and social 11 characteristics of a community or enhance quality of 12 human life, including— 13 ‘‘(A) homes, schools, and places of work 14 and worship; 15 ‘‘(B) parks, recreation areas, and green- 16 ways; 17 ‘‘(C) transportation systems; 18 ‘‘(D) business, industry, and agriculture; 19 and 20 ‘‘(E) land-use plans, projects, and policies 21 that impact the physical or social characteris- 22 tics of a community, including access to services 23 and amenities. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00696 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 697 •HR 5294 IH ‘‘(3) DIRECTOR.—The term ‘Director’ means 1 the Director of the Centers for Disease Control and 2 Prevention. 3 ‘‘(4) ELIGIBLE ENTITY.—The term ‘eligible en- 4 tity’ means a unit of State or tribal government the 5 jurisdiction of which includes individuals or popu- 6 lations the health of which are, or will be, affected 7 by an activity or a proposed activity. 8 ‘‘(5) ELIGIBLE INSTITUTION.—The term ‘eligi- 9 ble institution’ means a public agency or private 10 nonprofit institution that submits to the Secretary, 11 in consultation with the Administrator, an applica- 12 tion for a grant authorized under such section at 13 such time, in such manner, and containing such 14 agreements, assurances, and information as the Sec- 15 retary and Administrator may require. 16 ‘‘(6) HEALTH IMPACT ASSESSMENT.—The term 17 ‘Health Impact Assessment’ means a systematic 18 process that uses an array of data sources and ana- 19 lytic methods and considers input from stakeholders 20 to determine the potential effects of a proposed pol- 21 icy, plan, program, or project on the health of a pop- 22 ulation and the distribution of those effects within 23 the population. Such term includes identifying and 24 recommending appropriate actions on monitoring 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00697 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 698 •HR 5294 IH and maximizing potential benefits and minimizing 1 the potential harms. 2 ‘‘(7) HEALTH DISPARITIES.—The term ‘health 3 disparities’ are a particular type of health dif- 4 ferences that are closely linked with social, economic, 5 and/or environmental disadvantage. Health dispari- 6 ties adversely affect groups of people who have sys- 7 tematically experienced greater obstacles to health 8 based on their racial or ethnic group; religion; socio- 9 economic status; gender; age; mental health; cog- 10 nitive, sensory, or physical disability; sexual orienta- 11 tion or gender identity; geographic location; or other 12 characterisitics historically linked to discrimination 13 or exclusion. 14 ‘‘(8) PROPOSED ACTIVITY.—The term ‘proposed 15 activity’ means a proposed policy, program, plan, or 16 project currently under consideration by a local, 17 State, tribal, or Federal agency or government. 18 ‘‘(b) ESTABLISHMENT.—The Secretary, acting 19 through the Director and in collaboration with the Admin- 20 istrator, shall carry out the following: 21 ‘‘(1) Establish a program at the National Cen- 22 ter for Environmental Health at the Centers for Dis- 23 ease Control and Prevention focused on advancing 24 the field of Health Impact Assessment. In devel- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00698 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 699 •HR 5294 IH oping and implementing the program, the Director 1 of the National Center for Environmental Health 2 shall consult with the Director of the National Cen- 3 ter for Chronic Disease Prevention and Health Pro- 4 motion as well as relevant offices within the Depart- 5 ment of Housing and Urban Development, the De- 6 partment of Transportation, and the Department of 7 Agriculture. The program shall include— 8 ‘‘(A) collecting and disseminating best 9 practices; 10 ‘‘(B) administering capacity building 11 grants to States to support grantees in initi- 12 ating Health Impact Assessments, in accord- 13 ance with subsection (d); 14 ‘‘(C) providing technical assistance; 15 ‘‘(D) developing training tools and pro- 16 viding training on conducting Health Impact 17 Assessment and the implementation of built en- 18 vironment and health indicators; 19 ‘‘(E) making information available, as ap- 20 propriate, regarding the existence of other com- 21 munity healthy living tools, checklists, and indi- 22 ces that help connect public health to other sec- 23 tors, and tools to help examine the effect of the 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00699 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 700 •HR 5294 IH indoor built environment and building codes on 1 population health; 2 ‘‘(F) conducting research and evaluations 3 of Health Impact Assessments; and 4 ‘‘(G) awarding competitive extramural re- 5 search grants. 6 ‘‘(2) In accordance with subsection (c), develop 7 guidance and guidelines to conduct Health Impact 8 Assessments. 9 ‘‘(3) In accordance with subsection (d), estab- 10 lish a grant program to allow States to fund eligible 11 entities to conduct Health Impact Assessments. 12 ‘‘(c) GUIDANCE.—The Director, in consultation with 13 the Director of the National Center for Environmental 14 Health and, the Director of the National Center for 15 Chronic Disease Prevention and Health Promotion, and 16 relevant offices within the Department of Housing and 17 Urban Development, the Department of Transportation, 18 and the Department of Agriculture, shall— 19 ‘‘(1) develop guidance for conducting Health 20 Impact Assessment, including— 21 ‘‘(A) background on national and inter- 22 national efforts to bridge urban planning and 23 public health institutions and disciplines, in- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00700 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 701 •HR 5294 IH cluding a review of Health Impact Assessment 1 best practices internationally; 2 ‘‘(B) evidence-based direct and indirect 3 pathways that link land-use planning, transpor- 4 tation, and housing policy and objectives to 5 human health outcomes; 6 ‘‘(C) data resources and quantitative and 7 qualitative forecasting methods to evaluate both 8 the status of health determinants and health ef- 9 fects, including identification of existing pro- 10 grams that can disseminate these resources; 11 ‘‘(D) best practices for inclusive public in- 12 volvement in conducting Health Impact Assess- 13 ments; and 14 ‘‘(E) technical assistance for other agen- 15 cies seeking to develop their own guidelines and 16 procedures for Health Impact Assessment; 17 ‘‘(2) in developing the guidance, consider avail- 18 able international Health Impact Assessment guid- 19 ance, North American Health Impact Assessment 20 Practice Standards, and recommendations from the 21 National Academy of Science; and 22 ‘‘(3) not later than 1 year after the date of en- 23 actment of this section, publish the guidance. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00701 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 702 •HR 5294 IH ‘‘(d) GRANT PROGRAM.—The Secretary, acting 1 through the Director and in collaboration with the Admin- 2 istrator, shall establish a program under which the Sec- 3 retary shall award grants to States to fund eligible entities 4 for capacity building or to prepare Health Impact Assess- 5 ments, and shall ensure that States receiving a grant 6 under this subsection further support training and tech- 7 nical assistance for grantees under the program by fund- 8 ing and overseeing appropriate local, State, tribal, Fed- 9 eral, university, or nonprofit Health Impact Assessment 10 experts to provide technical assistance. Such assessments 11 shall— 12 ‘‘(1) ensure that appropriate health factors are 13 taken into consideration as early as practicable dur- 14 ing the planning, review, or decisionmaking proc- 15 esses; 16 ‘‘(2) assess the effect on the health of individ- 17 uals and populations of proposed policies, projects, 18 or plans that result in modifications to the built en- 19 vironment; and 20 ‘‘(3) assess the distribution of health effects 21 across various factors, such as race, income, eth- 22 nicity, age, disability status, gender, and geography. 23 ‘‘(e) APPLICATIONS.— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00702 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 703 •HR 5294 IH ‘‘(1) IN GENERAL.—To be eligible to receive a 1 grant under this section, an eligible entity shall sub- 2 mit to the Secretary an application in accordance 3 with this subsection, at such time, in such manner, 4 and containing such additional information as the 5 Secretary may require. 6 ‘‘(2) INCLUSION.—An application under this 7 subsection shall include a list of proposed activities 8 that require or would benefit from conducting a 9 Health Impact Assessment within six months of 10 awarding funds. The list should be accompanied by 11 supporting documentation, including letters of sup- 12 port, from potential conductors of Health Impact 13 Assessments for the listed proposed activities. Each 14 application should also include an assessment by the 15 eligible entity of the health of the population of its 16 jurisdiction and describe potential adverse or positive 17 effects on health that the proposed activities may 18 create. 19 ‘‘(3) PREFERENCE.—Preference in awarding 20 funds under this section may be given to eligible en- 21 tities that demonstrate the potential to significantly 22 improve population health or lower health care costs 23 as a result of potential Health Impact Assessment 24 work. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00703 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 704 •HR 5294 IH ‘‘(f) USE OF FUNDS.— 1 ‘‘(1) IN GENERAL.—An eligible entity shall use 2 amounts provided under a grant under this section 3 to conduct Health Impact Assessment capacity 4 building or to conduct or fund subgrantees to con- 5 duct a Health Impact Assessment for a proposed ac- 6 tivity in accordance with this subsection. 7 ‘‘(2) PURPOSES.—The purposes of a Health 8 Impact Assessment under this subsection are— 9 ‘‘(A) to facilitate the involvement of tribal, 10 State, and local public health officials in com- 11 munity planning, transportation, housing, and 12 land use decisions and other decisions affecting 13 the built environment to identify any potential 14 health concern or health benefit relating to an 15 activity or proposed activity; 16 ‘‘(B) to provide for an investigation of any 17 health-related issue of concern raised in a plan- 18 ning process, an environmental impact assess- 19 ment process, or policy appraisal relating to a 20 proposed activity; 21 ‘‘(C) to describe and compare alternatives 22 (including no-action alternatives) to a proposed 23 activity to provide clarification with respect to 24 the potential health outcomes associated with 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00704 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 705 •HR 5294 IH the proposed activity and, where appropriate, to 1 the related benefit-cost or cost-effectiveness of 2 the proposed activity and alternatives; 3 ‘‘(D) to contribute, when applicable, to the 4 findings of a planning process, policy appraisal, 5 or an environmental impact statement with re- 6 spect to the terms and conditions of imple- 7 menting a proposed activity or related mitiga- 8 tion recommendations, as necessary; 9 ‘‘(E) to ensure that the disproportionate 10 distribution of negative impacts among vulner- 11 able populations is minimized as much as pos- 12 sible; 13 ‘‘(F) to engage affected community mem- 14 bers and ensure adequate opportunity for public 15 comment on all stages of the Health Impact As- 16 sessment; and 17 ‘‘(G) where appropriate, to consult with 18 local and county health departments and appro- 19 priate organizations, including planning, trans- 20 portation, and housing organizations and pro- 21 viding them with information and tools regard- 22 ing how to conduct and integrate Health Im- 23 pact Assessment into their work. 24 ‘‘(3) ELIGIBLE ACTIVITIES.— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00705 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 706 •HR 5294 IH ‘‘(A) IN GENERAL.—Eligible entities fund- 1 ed under this subsection shall conduct an eval- 2 uation of any proposed activity to determine 3 whether it will have a significant adverse or 4 positive effect on the health of the affected pop- 5 ulation in the jurisdiction of the eligible entity, 6 based on the criteria described in subparagraph 7 (B). 8 ‘‘(B) CRITERIA.—The criteria described in 9 this subparagraph include, as applicable to the 10 proposed activity, the following: 11 ‘‘(i) Any substantial adverse effect or 12 significant health benefit on health out- 13 comes or factors known to influence health, 14 including the following: 15 ‘‘(I) Physical activity. 16 ‘‘(II) Injury. 17 ‘‘(III) Mental health. 18 ‘‘(IV) Accessibility to health-pro- 19 moting goods and services. 20 ‘‘(V) Respiratory health. 21 ‘‘(VI) Chronic disease. 22 ‘‘(VII) Nutrition. 23 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00706 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 707 •HR 5294 IH ‘‘(VIII) Land use changes that 1 promote local, sustainable food 2 sources. 3 ‘‘(IX) Infectious disease. 4 ‘‘(X) Health disparities. 5 ‘‘(XI) Existing air quality, 6 ground or surface water quality or 7 quantity, or noise levels; and 8 ‘‘(ii) Other factors that may be con- 9 sidered, including— 10 ‘‘(I) the potential for a proposed 11 activity to result in systems failure 12 that leads to a public health emer- 13 gency; 14 ‘‘(II) the probability that the pro- 15 posed activity will result in a signifi- 16 cant increase in tourism, economic de- 17 velopment, or employment in the ju- 18 risdiction of the eligible entity; 19 ‘‘(III) any other significant po- 20 tential hazard or enhancement to 21 human health, as determined by the 22 eligible entity; or 23 ‘‘(IV) whether the evaluation of a 24 proposed activity would duplicate an- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00707 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 708 •HR 5294 IH other analysis or study being under- 1 taken in conjunction with the pro- 2 posed activity. 3 ‘‘(C) FACTORS FOR CONSIDERATION.—In 4 evaluating a proposed activity under subpara- 5 graph (A), an eligible entity may take into con- 6 sideration any reasonable, direct, indirect, or 7 cumulative effect that can be clearly related to 8 potential health effects and that is related to 9 the proposed activity, including the effect of 10 any action that is— 11 ‘‘(i) included in the long-range plan 12 relating to the proposed activity; 13 ‘‘(ii) likely to be carried out in coordi- 14 nation with the proposed activity; 15 ‘‘(iii) dependent on the occurrence of 16 the proposed activity; or 17 ‘‘(iv) likely to have a disproportionate 18 impact on high-risk or vulnerable popu- 19 lations. 20 ‘‘(4) REQUIREMENTS.—A Health Impact As- 21 sessment prepared with funds awarded under this 22 subsection shall incorporate the following, after con- 23 ducting the screening phase (identifying projects or 24 policies for which a Health Impact Assessment 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00708 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 709 •HR 5294 IH would be valuable and feasible) through the applica- 1 tion process: 2 ‘‘(A) SCOPING.—Identifying which health 3 effects to consider and the research methods to 4 be utilized. 5 ‘‘(B) ASSESSING RISKS AND BENEFITS.— 6 Assessing the baseline health status and factors 7 known to influence the health status in the af- 8 fected community, which may include aggre- 9 gating and synthesizing existing health assess- 10 ment evidence and data from the community. 11 ‘‘(C) DEVELOPING RECOMMENDATIONS.— 12 Suggesting changes to proposals to promote 13 positive or mitigate adverse health effects. 14 ‘‘(D) REPORTING.—Synthesizing the as- 15 sessment and recommendations and commu- 16 nicating the results to decisionmakers. 17 ‘‘(E) MONITORING AND EVALUATING.— 18 Tracking the decision and implementation effect 19 on health determinants and health status. 20 ‘‘(5) PLAN.—An eligible entity that is awarded 21 a grant under this section shall develop and imple- 22 ment a plan, to be approved by the Director, for 23 meaningful and inclusive stakeholder involvement in 24 all phases of the Health Impact Assessment. Stake- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00709 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 710 •HR 5294 IH holders may include community-based organizations, 1 youth-serving organizations, planners, public health 2 experts, State and local public health departments 3 and officials, health care experts or officials, housing 4 experts or officials, and transportation experts or of- 5 ficials. 6 ‘‘(6) SUBMISSION OF FINDINGS.—An eligible 7 entity that is awarded a grant under this section 8 shall submit the findings of any funded Health Im- 9 pact Assessment activities to the Secretary and 10 make these findings publicly available. 11 ‘‘(7) ASSESSMENT OF IMPACTS.—An eligible en- 12 tity that is awarded a grant under this section shall 13 ensure the assessment of the distribution of health 14 impacts (related to the proposed activity) across 15 race, ethnicity, income, age, gender, disability status, 16 and geography. 17 ‘‘(8) CONDUCT OF ASSESSMENT.—To the great- 18 est extent feasible, a Health Impact Assessment 19 shall be conducted under this section in a manner 20 that respects the needs and timing of the decision- 21 making process it evaluates. 22 ‘‘(9) METHODOLOGY.—In preparing a Health 23 Impact Assessment under this subsection, an eligible 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00710 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 711 •HR 5294 IH entity or partner shall follow the guidance published 1 under subsection (c). 2 ‘‘(g) HEALTH IMPACT ASSESSMENT DATABASE.— 3 The Secretary, acting through the Director and in collabo- 4 ration with the Administrator, shall establish, maintain, 5 and make publicly available a Health Impact Assessment 6 database, including— 7 ‘‘(1) a catalog of Health Impact Assessments 8 received under this section; 9 ‘‘(2) an inventory of tools used by eligible enti- 10 ties to conduct Health Impact Assessments; and 11 ‘‘(3) guidance for eligible entities with respect 12 to the selection of appropriate tools described in 13 paragraph (2). 14 ‘‘(h) EVALUATION OF GRANTEE ACTIVITIES.—The 15 Secretary shall award competitive grants to Prevention 16 Research Centers, or nonprofit organizations or academic 17 institutions with expertise in Health Impact Assessments 18 to— 19 ‘‘(1) assist grantees with the provision of train- 20 ing and technical assistance in the conducting of 21 Health Impact Assessments; 22 ‘‘(2) evaluate the activities carried out with 23 grants under subsection (d); and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00711 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 712 •HR 5294 IH ‘‘(3) assist the Secretary in disseminating evi- 1 dence, best practices, and lessons learned from 2 grantees. 3 ‘‘(i) REPORT TO CONGRESS.—Not later than 1 year 4 after the date of enactment of this section, the Secretary 5 shall submit to Congress a report concerning the evalua- 6 tion of the programs under this section, including rec- 7 ommendations as to how lessons learned from such pro- 8 grams can be incorporated into future guidance docu- 9 ments developed and provided by the Secretary and other 10 Federal agencies, as appropriate. 11 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 12 are authorized to be appropriated to carry out this section 13 such sums as may be necessary. 14 ‘‘SEC. 399V–10. ADDITIONAL RESEARCH ON THE RELATION- 15 SHIP BETWEEN THE BUILT ENVIRONMENT 16 AND HEALTH OUTCOMES. 17 ‘‘(a) RESEARCH GRANT PROGRAM.— 18 ‘‘(1) GRANTS.—The Secretary, in collaboration 19 with the Administrator, shall award grants to eligi- 20 ble institutions to conduct and coordinate research 21 on the built environment and its influence on human 22 health. Factors that influence health that may be 23 considered include— 24 ‘‘(A) levels of physical activity; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00712 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 713 •HR 5294 IH ‘‘(B) consumption of nutritional foods; 1 ‘‘(C) rates of crime; 2 ‘‘(D) air, water, and soil quality; 3 ‘‘(E) risk or rate of injury; 4 ‘‘(F) accessibility to health-promoting 5 goods and services; 6 ‘‘(G) chronic disease rates; 7 ‘‘(H) community design; 8 ‘‘(I) housing; and 9 ‘‘(J) other indicators as determined appro- 10 priate by the Secretary. 11 ‘‘(2) RESEARCH.—The Secretary, in consulta- 12 tion with the Administrator, shall support research 13 under this section that— 14 ‘‘(A) investigates and defines links between 15 the built environment and human health and 16 identifies causal relationships; 17 ‘‘(B) examines— 18 ‘‘(i) the scope and intensity of the im- 19 pact that the built environment (including 20 the various characteristics of the built en- 21 vironment) has on the human health; or 22 ‘‘(ii) the distribution of such impacts 23 by— 24 ‘‘(I) location; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00713 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 714 •HR 5294 IH ‘‘(II) population subgroup; 1 ‘‘(C) is used to develop— 2 ‘‘(i) measures and indicators to ad- 3 dress health impacts and the connection of 4 health to the built environment; 5 ‘‘(ii) efforts to link the measures to 6 transportation, land use, and health data- 7 bases; and 8 ‘‘(iii) efforts to enhance the collection 9 of built environment surveillance data; 10 ‘‘(D) distinguishes carefully between per- 11 sonal attitudes and choices and external influ- 12 ences on behavior to determine how much the 13 association between the built environment and 14 the health of residents, versus the lifestyle pref- 15 erences of the people that choose to live in the 16 neighborhood, reflects the physical characteris- 17 tics of the neighborhood; and 18 ‘‘(E)(i) identifies or develops effective 19 intervention strategies focusing on enhance- 20 ments to the built environment that promote in- 21 creased use physical activity, access to nutri- 22 tious foods, or other health-promoting activities 23 by residents; and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00714 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 715 •HR 5294 IH ‘‘(ii) in developing the intervention strate- 1 gies under clause (i), ensures that the interven- 2 tion strategies will reach out to high-risk or vul- 3 nerable populations, including low-income urban 4 and rural communities and aging populations, 5 in addition to the general population. 6 ‘‘(3) SURVEYS.—The Secretary may use funds 7 appropriated under this section to support the ex- 8 pansion of national surveys and data tracking sys- 9 tems to provide more detailed information about the 10 connection between the built environment and 11 health. 12 ‘‘(4) PRIORITY.—In providing assistance under 13 the grant program under this section, the Secretary 14 and the Administrator shall give priority to research 15 that incorporates— 16 ‘‘(A) interdisciplinary approaches; or 17 ‘‘(B) the expertise of the public health, 18 physical activity, urban planning, land use, and 19 transportation research communities in the 20 United States and abroad. 21 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 22 are authorized to be appropriated such sums as may be 23 necessary to carry out this section. Not to exceed 20 per- 24 cent of amounts appropriated for each fiscal year under 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00715 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 716 •HR 5294 IH this subsection may be used for the research component 1 of the program under this section.’’. 2 SEC. 1004. IMPLEMENTATION OF RECOMMENDATIONS BY 3 ENVIRONMENTAL PROTECTION AGENCY. 4 (a) INSPECTOR GENERAL RECOMMENDATIONS.—The 5 Administrator of the Environmental Protection Agency 6 shall, as promptly as practicable, carry out each of the 7 following recommendations of the Inspector General of the 8 Agency as set forth in Report No. 2006–P–00034 entitled 9 ‘‘EPA needs to conduct environmental justice reviews of 10 its programs, policies and activities’’: 11 (1) The recommendation that the Agency’s pro- 12 gram and regional offices identify which programs, 13 policies, and activities need environmental justice re- 14 views and require these offices to establish a plan to 15 complete the necessary reviews. 16 (2) The recommendation that the Administrator 17 of the Agency ensure that these reviews determine 18 whether the programs, policies, and activities may 19 have a disproportionately high and adverse health or 20 environmental impact on minority and low-income 21 populations. 22 (3) The recommendation that each program 23 and regional office develop specific environmental 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00716 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 717 •HR 5294 IH justice review guidance for conducting environmental 1 justice reviews. 2 (4) The recommendation that the Administrator 3 designate a responsible office to compile results of 4 environmental justice reviews and recommend appro- 5 priate actions. 6 (b) GAO RECOMMENDATIONS.—In developing rules 7 under laws administered by the Environmental Protection 8 Agency, the Administrator of the Agency shall, as prompt- 9 ly as practicable, carry out each of the following rec- 10 ommendations of the Comptroller General of the United 11 States as set forth in GAO Report numbered GAO–05– 12 289 entitled ‘‘EPA Should Devote More Attention to En- 13 vironmental Justice when Developing Clean Air Rules’’: 14 (1) The recommendation that the Administrator 15 ensure that workgroups involved in developing a rule 16 devote attention to environmental justice while draft- 17 ing and finalizing the rule. 18 (2) The recommendation that the Administrator 19 enhance the ability of such workgroups to identify 20 potential environmental justice issues through such 21 steps as providing workgroup members with guid- 22 ance and training to help them identify potential en- 23 vironmental justice problems and involving environ- 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00717 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 718 •HR 5294 IH mental justice coordinators in the workgroups when 1 appropriate. 2 (3) The recommendation that the Administrator 3 improve assessments of potential environmental jus- 4 tice impacts in economic reviews by identifying the 5 data and developing the modeling techniques needed 6 to assess such impacts. 7 (4) The recommendation that the Administrator 8 direct appropriate Agency officers and employees to 9 respond fully when feasible to public comments on 10 environmental justice, including improving the Agen- 11 cy’s explanation of the basis for its conclusions, to- 12 gether with supporting data. 13 (c) 2004 INSPECTOR GENERAL REPORT.—The Ad- 14 ministrator of the Environmental Protection Agency shall, 15 as promptly as practicable, carry out each of the following 16 recommendations of the Inspector General of the Agency 17 as set forth in the report entitled ‘‘EPA Needs to Consist- 18 ently Implement the Intent of the Executive Order on En- 19 vironmental Justice’’ (Report No. 2004–P–00007): 20 (1) The recommendation that the Agency clear- 21 ly define the mission of the Office of Environmental 22 Justice (OEJ) and provide Agency staff with an un- 23 derstanding of the roles and responsibilities of the 24 Office. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00718 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 719 •HR 5294 IH (2) The recommendation that the Agency estab- 1 lish (through issuing guidance or a policy statement 2 from the Administrator) specific timeframes for the 3 development of definitions, goals, and measurements 4 regarding environmental justice and provide the re- 5 gions and program offices a standard and consistent 6 definition for a minority and low-income community, 7 with instructions on how the Agency will implement 8 and put into operation environmental justice in the 9 Agency’s daily activities. 10 (3) The recommendation that the Agency en- 11 sure the comprehensive training program currently 12 under development includes standard and consistent 13 definitions of the key environmental justice concepts 14 (such as ‘‘low-income’’, ‘‘minority’’, and ‘‘dispropor- 15 tionately impacted’’) and instructions for implemen- 16 tation of those concepts. 17 The Administrator shall submit an initial report to Con- 18 gress within 6 months after the enactment of this Act re- 19 garding the Administrator’s strategy for implementing the 20 recommendations referred to in paragraphs (1), (2), and 21 (3). Thereafter, the Administrator shall provide semi- 22 annual reports to Congress regarding the Administrator’s 23 progress in implementing such recommendations and 24 modifying the Administrator’s emergency management 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00719 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 720 •HR 5294 IH procedures to incorporate environmental justice in the 1 Agency’s Incident Command Structure (in accordance 2 with the December 18, 2006, letter from the Deputy Ad- 3 ministrator to the Acting Inspector General of the Agen- 4 cy). 5 (d) FEDERAL ACTION PLAN FOR SAVING LIVES, 6 PROTECTING PEOPLE AND THEIR FAMILIES FROM 7 RADON.— 8 (1) IN GENERAL.—Because radon is a naturally 9 occurring radioactive gas that is recognized as the 10 leading cause of lung cancer among nonsmokers and 11 is a particular environmental threat for low-income 12 and minority individuals because of the lack of infor- 13 mation about radon levels in their own homes, the 14 Administrator of the Environmental Protection 15 Agency shall within 6 months after the date of the 16 enactment of this Act, implement the action plan en- 17 titled ‘‘Protecting People and Families from Radon: 18 A Federal Action Plan for Saving Lives’’ (June 20, 19 2011), working with the Secretary of Health and 20 Human Services acting through the Director of the 21 Centers for Disease Control and Prevention, and 22 with the other Federal agencies mentioned in and as 23 set forth in the action plan. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00720 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 721 •HR 5294 IH (2) SPECIFIC STEPS.—In carrying out para- 1 graph (1), the Administrator shall take steps to 2 achieve each of the following: 3 (A) The recommendation that the 4 workgroup comprised of the Federal agencies 5 participating in the development of the action 6 plan referred to in paragraph (1) implement 7 specific steps within the current authority and 8 activities of each Federal agency to reduce ex- 9 posure to radon. 10 (B) The recommendation that such 11 workgroup meet on the 1-year anniversary of 12 the plan to assess and recognize achievements 13 of the plan. 14 (3) REPORT.—The Administrator shall report 15 to the Congress on the 1-year assessment of the 16 plan’s implementation, including the challenges re- 17 maining and the progress in reducing radon expo- 18 sure particularly to low-income and minority fami- 19 lies. 20 SEC. 1005. GRANT PROGRAM TO CONDUCT ENVIRON- 21 MENTAL HEALTH IMPROVEMENT ACTIVITIES 22 AND TO IMPROVE SOCIAL DETERMINANTS OF 23 HEALTH. 24 (a) DEFINITIONS.—In this section: 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00721 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 722 •HR 5294 IH (1) DIRECTOR.—The term ‘‘Director’’ means 1 the Director of the Centers for Disease Control and 2 Prevention, acting in collaboration with the Adminis- 3 trator of the Environmental Protection Agency and 4 the Director of the National Institute of Environ- 5 mental Health Sciences. 6 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti- 7 ty’’ means a State or local community that— 8 (A) bears a disproportionate burden of ex- 9 posure to environmental health hazards; 10 (B) bears a disproportionate burden of ex- 11 posure to unhealthy living conditions, low 12 standard housing conditions, low socioeconomic 13 status, poor nutrition, less opportunity for edu- 14 cational attainment, disproportionate unemploy- 15 ment rates, or lower literacy levels; 16 (C) has established a coalition— 17 (i) with not less than 1 community- 18 based organization or demonstration pro- 19 gram; and 20 (ii) with not less than 1— 21 (I) public health entity; 22 (II) health care provider organi- 23 zation; 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00722 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 723 •HR 5294 IH (III) academic institution, includ- 1 ing any minority-serving institution 2 (including a Hispanic-serving institu- 3 tion, a historically Black college or 4 university, and a tribal college or uni- 5 versity); or 6 (IV) child-serving institution; 7 (D) ensures planned activities and funding 8 streams are coordinated to improve community 9 health; and 10 (E) submits an application in accordance 11 with subsection (c). 12 (b) ESTABLISHMENT.—The Director shall establish a 13 grant program under which eligible entities shall receive 14 grants to conduct environmental health improvement ac- 15 tivities and to improve social determinants of health. 16 (c) APPLICATION.—To receive a grant under this sec- 17 tion, an eligible entity shall submit an application to the 18 Director at such time, in such manner, and accompanied 19 by such information as the Director may require. 20 (d) COOPERATIVE AGREEMENTS.—An eligible entity 21 may use a grant under this section— 22 (1) to promote environmental health; 23 (2) to address environmental health disparities 24 among all populations, including children; and 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00723 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 724 •HR 5294 IH (3) to address racial and ethnic disparities in 1 social determinants of health. 2 (e) AMOUNT OF COOPERATIVE AGREEMENT.— 3 (1) IN GENERAL.—The Director shall award 4 grants to eligible entities at the 3 different funding 5 levels described in this subsection. 6 (2) LEVEL 1 COOPERATIVE AGREEMENTS.— 7 (A) IN GENERAL.—An eligible entity 8 awarded a grant under this paragraph shall use 9 the funds to identify environmental health prob- 10 lems and solutions by— 11 (i) establishing a planning and 12 prioritizing council in accordance with sub- 13 paragraph (B); and 14 (ii) conducting an environmental 15 health assessment in accordance with sub- 16 paragraph (C). 17 (B) PLANNING AND PRIORITIZING COUN- 18 CIL.— 19 (i) IN GENERAL.—A prioritizing and 20 planning council established under sub- 21 paragraph (A)(i) (referred to in this para- 22 graph as a ‘‘PPC’’) shall assist the envi- 23 ronmental health assessment process and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00724 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 725 •HR 5294 IH environmental health promotion activities 1 of the eligible entity. 2 (ii) MEMBERSHIP.—Membership of a 3 PPC shall consist of representatives from 4 various organizations within public health, 5 planning, development, and environmental 6 services and shall include stakeholders 7 from vulnerable groups such as children, 8 the elderly, disabled, and minority ethnic 9 groups that are often not actively involved 10 in democratic or decisionmaking processes. 11 (iii) DUTIES.—A PPC shall— 12 (I) identify key stakeholders and 13 engage and coordinate potential part- 14 ners in the planning process; 15 (II) establish a formal advisory 16 group to plan for the establishment of 17 services; 18 (III) conduct an in-depth review 19 of the nature and extent of the need 20 for an environmental health assess- 21 ment, including a local epidemiological 22 profile, an evaluation of the service 23 provider capacity of the community, 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00725 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 726 •HR 5294 IH and a profile of any target popu- 1 lations; and 2 (IV) define the components of 3 care and form essential programmatic 4 linkages with related providers in the 5 community. 6 (C) ENVIRONMENTAL HEALTH ASSESS- 7 MENT.— 8 (i) IN GENERAL.—A PPC shall carry 9 out an environmental health assessment to 10 identify environmental health concerns. 11 (ii) ASSESSMENT PROCESS.—The 12 PPC shall— 13 (I) define the goals of the assess- 14 ment; 15 (II) generate the environmental 16 health issue list; 17 (III) analyze issues with a sys- 18 tems framework; 19 (IV) develop appropriate commu- 20 nity environmental health indicators; 21 (V) rank the environmental 22 health issues; 23 (VI) set priorities for action; 24 (VII) develop an action plan; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00726 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 727 •HR 5294 IH (VIII) implement the plan; and 1 (IX) evaluate progress and plan- 2 ning for the future. 3 (D) EVALUATION.—Each eligible entity 4 that receives a grant under this paragraph shall 5 evaluate, report, and disseminate program find- 6 ings and outcomes. 7 (E) TECHNICAL ASSISTANCE.—The Direc- 8 tor may provide such technical and other non- 9 financial assistance to eligible entities as the 10 Director determines to be necessary. 11 (3) LEVEL 2 COOPERATIVE AGREEMENTS.— 12 (A) ELIGIBILITY.— 13 (i) IN GENERAL.—The Director shall 14 award grants under this paragraph to eli- 15 gible entities that have already— 16 (I) established broad-based col- 17 laborative partnerships; and 18 (II) completed environmental as- 19 sessments. 20 (ii) NO LEVEL 1 REQUIREMENT.—To 21 be eligible to receive a grant under this 22 paragraph, an eligible entity is not re- 23 quired to have successfully completed a 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00727 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 728 •HR 5294 IH Level 1 Cooperative Agreement (as de- 1 scribed in paragraph (2)). 2 (B) USE OF GRANT FUNDS.—An eligible 3 entity awarded a grant under this paragraph 4 shall use the funds to further activities to carry 5 out environmental health improvement activi- 6 ties, including— 7 (i) addressing community environ- 8 mental health priorities in accordance with 9 paragraph (2)(C)(ii), including— 10 (I) geography; 11 (II) the built environment; 12 (III) air quality; 13 (IV) water quality; 14 (V) land use; 15 (VI) solid waste; 16 (VII) housing; 17 (VIII) crime; 18 (IX) socioeconomic status; 19 (X) ethnicity, social construct 20 and language preference; 21 (XI) educational attainment; 22 (XII) employment; 23 (XIII) food safety; 24 (XIV) nutrition; 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00728 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 729 •HR 5294 IH (XV) health care services; and 1 (XVI) injuries; 2 (ii) building partnerships between 3 planning, public health, and other sectors, 4 including child-serving institutions, to ad- 5 dress how the built environment impacts 6 food availability and access and physical 7 activity to promote healthy behaviors and 8 lifestyles and reduce overweight and obe- 9 sity, musculoskeletal diseases, respiratory 10 conditions, dental, oral and mental health 11 conditions, poverty, and related co- 12 morbidities; 13 (iii) establishing programs to ad- 14 dress— 15 (I) how environmental and social 16 conditions of work and living choices 17 influence physical activity and dietary 18 intake; or 19 (II) how those conditions influ- 20 ence the concerns and needs of people 21 who have impaired mobility and use 22 assistance devices, including wheel- 23 chairs, lower limb prostheses, and hip, 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00729 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 730 •HR 5294 IH knee, and other joint replacements; 1 and 2 (iv) convening intervention and dem- 3 onstration programs that examine the role 4 of the social environment in connection 5 with the physical and chemical environ- 6 ment in— 7 (I) determining access to nutri- 8 tional food; and 9 (II) improving physical activity to 10 reduce overweight, obesity, and co- 11 morbidities and increase quality of 12 life. 13 (4) LEVEL 3 COOPERATIVE AGREEMENTS.— 14 (A) IN GENERAL.—An eligible entity 15 awarded a grant under this paragraph shall use 16 the funds to identify and address racial and 17 ethnic disparities in social determinants of 18 health by creating demonstration programs that 19 assess the feasibility of establishing a federally 20 funded comprehensive program and describe 21 key outcomes that address racial and ethnic dis- 22 parities in social determinants of health. 23 (B) PROGRAM DESIGN.— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00730 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 731 •HR 5294 IH (i) EVALUATION.—No later than 1 1 year after enactment of this Act, the Di- 2 rector shall evaluate the best practices of 3 existing programs from the private, public, 4 community based, and academically sup- 5 ported initiatives focused on reducing dis- 6 parities in the social determinants of 7 health for racial and ethnic populations. 8 (ii) DEMONSTRATION PROJECTS.— 9 Not later than two years after the date of 10 enactment of this Act, the Director shall 11 implement at least ten demonstration 12 projects including at least one project for 13 each major racial and ethnic minority 14 group, each of which is unique to the cul- 15 tural and linguistic needs of each of the 16 following groups: 17 (I) Native Americans and Alaska 18 Natives. 19 (II) Asian-Americans. 20 (III) African-Americans/Blacks. 21 (IV) Hispanic/Latino-Americans. 22 (V) Native Hawaiians and Pacific 23 Islanders. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00731 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 732 •HR 5294 IH (iii) REPORT TO CONGRESS.—No later 1 than 2 years after the implementation of 2 the initial demonstration projects, the Di- 3 rector shall submit to Congress a report 4 which includes— 5 (I) a description of each dem- 6 onstration project and design; 7 (II) an evaluation of the cost ef- 8 fectiveness of each project’s preven- 9 tion and treatment efforts; 10 (III) an evaluation of the cultural 11 and linguistic appropriateness of each 12 project by racial and ethnic group; 13 and 14 (IV) an evaluation of the bene- 15 ficiary’s health status improvement 16 under the demonstration project. 17 (iv) ANY OTHER INFORMATION 18 DEEMED APPROPRIATE BY THE DIREC- 19 TOR.—The Director shall require any other 20 information deemed appropriate to be 21 shared by or developed by eligible entities 22 awarded a grant under this paragraph, in- 23 cluding the following: 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00732 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 733 •HR 5294 IH (I) Developing models and evalu- 1 ating methods that improve the cul- 2 tural and linguistically appropriate 3 services provided through the Centers 4 for Disease Control and Prevention to 5 target individuals impacted by health 6 disparities based on their race, eth- 7 nicity, and gender. 8 (II) Promoting the collaboration 9 between primary and specialty care 10 health care providers and patients, to 11 ensure patients impacted by health 12 disparities based on race, ethnicity, 13 and gender are receiving comprehen- 14 sive and organized treatment and 15 care. 16 (III) Educating health care pro- 17 fessionals on the causes and effects of 18 disparities in the social determinants 19 of health as it relates to minority and 20 racial and ethnic communities and the 21 need for culturally and linguistically 22 appropriate care in the prevention and 23 treatment of high-impact diseases. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00733 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 734 •HR 5294 IH (IV) Encouraging collaboration 1 among community and patient-based 2 organizations which work to address 3 disparities in the social determinants 4 of health as it relates to high-impact 5 diseases in minority and racial and 6 ethnic populations. 7 (f) AUTHORIZATION OF APPROPRIATIONS.—There 8 are authorized to be appropriated to carry out this sec- 9 tion— 10 (1) $25,000,000 for fiscal year 2015; and 11 (2) such sums as may be necessary for fiscal 12 years 2016 through 2018. 13 SEC. 1006. ADDITIONAL RESEARCH ON THE RELATIONSHIP 14 BETWEEN THE BUILT ENVIRONMENT AND 15 THE HEALTH OF COMMUNITY RESIDENTS. 16 (a) DEFINITION OF ELIGIBLE INSTITUTION.—In this 17 section, the term ‘‘eligible institution’’ means a public or 18 private nonprofit institution that submits to the Secretary 19 of Health and Human Services (in this section referred 20 to as the ‘‘Secretary’’) and the Administrator of the Envi- 21 ronmental Protection Agency (in this section referred to 22 as the ‘‘Administrator’’) an application for a grant under 23 the grant program authorized under subsection (b)(2) at 24 such time, in such manner, and containing such agree- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00734 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 735 •HR 5294 IH ments, assurances, and information as the Secretary and 1 Administrator may require. 2 (b) RESEARCH GRANT PROGRAM.— 3 (1) DEFINITION OF HEALTH.—In this section, 4 the term ‘‘health’’ includes— 5 (A) levels of physical activity; 6 (B) degree of mobility due to factors such 7 as musculoskeletal diseases, arthritis, and obe- 8 sity; 9 (C) consumption of nutritional foods; 10 (D) rates of crime; 11 (E) air, water, and soil quality; 12 (F) risk of injury; 13 (G) accessibility to health care services; 14 (H) levels of educational attainment; and 15 (I) other indicators as determined appro- 16 priate by the Secretary. 17 (2) GRANTS.—The Secretary, in collaboration 18 with the Administrator, shall provide grants to eligi- 19 ble institutions to conduct and coordinate research 20 on the built environment and its influence on indi- 21 vidual and population-based health. 22 (3) RESEARCH.—The Secretary shall support 23 research that— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00735 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 736 •HR 5294 IH (A) investigates and defines the causal 1 links between all aspects of the built environ- 2 ment and the health of residents; 3 (B) examines— 4 (i) the extent of the impact of the 5 built environment (including the various 6 characteristics of the built environment) on 7 the health of residents; 8 (ii) the variance in the health of resi- 9 dents by— 10 (I) location (such as inner cities, 11 inner suburbs, and outer suburbs); 12 and 13 (II) population subgroup (includ- 14 ing children, the elderly, the disadvan- 15 taged); or 16 (iii) the importance of the built envi- 17 ronment to the total health of residents, 18 which is the primary variable of interest 19 from a public health perspective; 20 (C) is used to develop— 21 (i) measures to address health and the 22 connection of health to the built environ- 23 ment; and 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00736 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 737 •HR 5294 IH (ii) efforts to link the measures to 1 travel and health databases; and 2 (D) distinguishes carefully between per- 3 sonal attitudes and choices and external influ- 4 ences on observed behavior to determine how 5 much an observed association between the built 6 environment and the health of residents, versus 7 the lifestyle preferences of the people that 8 choose to live in the neighborhood, reflects the 9 physical characteristics of the neighborhood; 10 and 11 (E)(i) identifies or develops effective inter- 12 vention strategies to promote better health 13 among residents with a focus on behavioral 14 interventions and enhancements of the built en- 15 vironment that promote increased use by resi- 16 dents; and 17 (ii) in developing the intervention strate- 18 gies under clause (i), ensures that the interven- 19 tion strategies will reach out to high-risk popu- 20 lations, including racial and ethnic minorities, 21 low-income urban and rural communities, and 22 children. 23 (4) PRIORITY.—In providing assistance under 24 the grant program authorized under paragraph (2), 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00737 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 738 •HR 5294 IH the Secretary and the Administrator shall give pri- 1 ority to research that incorporates— 2 (A) minority-serving institutions as grant- 3 ees; 4 (B) interdisciplinary approaches; or 5 (C) the expertise of the public health, 6 physical activity, nutrition and health care (in- 7 cluding child health), urban planning, and 8 transportation research communities in the 9 United States and abroad. 10 SEC. 1007. ENVIRONMENT AND PUBLIC HEALTH RESTORA- 11 TION. 12 (a) FINDINGS.— 13 (1) GENERAL FINDINGS.—The Congress finds 14 as follows: 15 (A) As human beings, we share our envi- 16 ronment with a wide variety of habitats and 17 ecosystems that nurture and sustain a diversity 18 of species. 19 (B) The abundance of natural resources in 20 our environment forms the basis for our econ- 21 omy and has greatly contributed to human de- 22 velopment throughout history. 23 (C) The accelerated pace of human devel- 24 opment over the last several hundred years has 25 VerDate Mar 15 2010 01:02 Aug 07, 2014 Jkt 039200 PO 00000 Frm 00738 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 739 •HR 5294 IH significantly impacted our natural environment 1 and its resources, the health and diversity of 2 plant and animal wildlife, the availability of 3 critical habitats, the quality of our air and our 4 water, and our global climate. 5 (D) The intervention of the Federal Gov- 6 ernment is necessary to minimize and mitigate 7 human impact on the environment for the ben- 8 efit of public health, to maintain air quality and 9 water quality, to sustain the diversity of plants 10 and animals, to combat global climate change, 11 and to protect the environment. 12 (E) Laws and regulations in the United 13 States have been created and promulgated to 14 minimize and mitigate human impact on the en- 15 vironment for the benefit of public health, to 16 maintain air quality and water quality, to sus- 17 tain wildlife, and to protect the environment. 18 (F) Such laws include the Antiquities Act 19 of 1906 (16 U.S.C. 431 et seq.) initiated by 20 President Theodore Roosevelt to create the na- 21 tional park system, the National Environmental 22 Policy Act of 1969 (42 U.S.C. 4321 et seq.), 23 the Clean Air Act (42 U.S.C. 7401 et seq.), the 24 Federal Water Pollution Control Act (33 U.S.C. 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00739 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 740 •HR 5294 IH 1251 et seq.), the Comprehensive Environ- 1 mental Response, Compensation, and Liability 2 Act of 1980 (Public Law 96–510), the Endan- 3 gered Species Act of 1973 (Public Law 93– 4 205), and the National Forest Management Act 5 of 1976 (Public Law 94–588). 6 (G) Attempts to repeal or weaken key envi- 7 ronmental safeguards pose dangers to the pub- 8 lic health, air quality, water quality, wildlife, 9 and the environment. 10 (2) FINDINGS ON CHANGES AND PROPOSED 11 CHANGES IN LAW.—The Congress finds that, since 12 2001, the following changes and proposed changes 13 to existing law or regulations have negatively im- 14 pacted or will negatively impact the environment and 15 public health: 16 (A) CLEAN WATER.— 17 (i) On May 9, 2002, the Environ- 18 mental Protection Agency (EPA) and the 19 Army Corps of Engineers put forth a final 20 rule that reconciled regulations imple- 21 menting section 404 of the Federal Water 22 Pollution Control Act by redefining the 23 term ‘‘fill material’’ and amending the def- 24 inition of the term ‘‘discharge of fill mate- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00740 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 741 •HR 5294 IH rial’’, reversing a 25-year-old regulation. 1 The new rule fails to restrict the dumping 2 of hardrock mining waste, construction de- 3 bris, and other industrial wastes into riv- 4 ers, streams, lakes, and wetlands. The rule 5 further allows destructive mountaintop re- 6 moval coal mining companies to dump 7 waste into streams and lakes, polluting the 8 surrounding natural habitat and poisoning 9 plants and animals that depend on those 10 water sources. 11 (ii) On February 12, 2003, the Envi- 12 ronmental Protection Agency published the 13 rule ‘‘National Pollutant Discharge Elimi- 14 nation System Permit Regulation and Ef- 15 fluent Limitation Guidelines and Stand- 16 ards for Concentrated Animal Feeding Op- 17 erations’’, new livestock waste regulations 18 that aimed to control factory farm pollu- 19 tion but which would severely undermine 20 existing protections under the Federal 21 Water Pollution Control Act. This regula- 22 tion allows large-scale animal factories to 23 foul the Nation’s waters with animal 24 waste, allows livestock owners to draft 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00741 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 742 •HR 5294 IH their own pollution-management plans and 1 avoid ground water monitoring, legalizes 2 the discharge of contaminated runoff water 3 rich in nitrogen, phosphorus, bacteria, and 4 metals, and ensures that large factory 5 farms are not held liable for the environ- 6 mental damage they cause. In a 2005 Fed- 7 eral court decision (‘‘Waterkeeper Alliance, 8 et al. v. Enviromental Protection Agency’’, 9 399 F.3d 486 (2nd Cir. 2005)), major 10 parts of the rule were upheld, others va- 11 cated, and still others remanded back to 12 the EPA. On November 20, 2008, the En- 13 vironmental Protection Agency published a 14 revised final rule which undermines envi- 15 ronmental protection provisions by remov- 16 ing mandatory permitting requirements 17 and allowing large animal farms to self- 18 certify the absence of pollutant discharge 19 activity. 20 (iii) On March 19, 2003, the Environ- 21 mental Protection Agency published a new 22 rule regarding the Total Maximum Daily 23 Load program of the Federal Water Pollu- 24 tion Control Act that regulates the max- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00742 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 743 •HR 5294 IH imum amount of a particular pollutant 1 that can be present in a body of water and 2 still meet water quality standards. The new 3 rule withdrew the existing regulation put 4 forth on July 13, 2000, and halted mo- 5 mentum in cleaning up polluted waterways 6 throughout the Nation. By abandoning the 7 existing rule, the Environmental Protection 8 Agency is undermining the effectiveness of 9 cleanup plans and is allowing States to 10 avoid cleaning polluted waters entirely by 11 dropping them from their cleanup lists. 12 Waterways play a crucial role in the lives 13 of the people of the United States and are 14 critical to the livelihood of fish and wildlife. 15 The result of dropping the July 2000 rule 16 is that the restoration of polluted rivers, 17 shorelines, and lakes will be delayed, harm- 18 ing more fish and wildlife and worsening 19 the quality of drinking water. 20 (iv) On December 2, 2008, the Envi- 21 ronmental Protection Agency and the 22 Army Corps of Engineers jointly issued a 23 guidance document in the form of a legal 24 memorandum, titled ‘‘Clean Water Act Ju- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00743 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 744 •HR 5294 IH risdiction Following the U.S. Supreme 1 Court’s Decision in Rapanos v. United 2 States & Carabell v. United States’’. This 3 new guidance dictates enforcement actions 4 under the Federal Water Pollution Control 5 Act and calls for a complicated ‘‘case-by- 6 case’’ analysis to determine jurisdiction for 7 waterways that do not flow all year. Such 8 actions endanger small streams and wet- 9 lands that serve as important habitats for 10 aquatic life, which play a fundamental role 11 in safeguarding sources of clean drinking 12 water and mitigate the risks and effects of 13 floods and droughts. Further, the defini- 14 tion provided therein for ‘‘waters of the 15 United States’’ is applicable to the Federal 16 Water Pollution Control Act as a whole, 17 potentially affecting programs that control 18 industrial pollution and sewage levels, pre- 19 vent oil spills, and set water quality stand- 20 ards for all waters in the United States 21 protected under the Federal Water Pollu- 22 tion Control Act. 23 (B) FORESTS AND LAND MANAGEMENT.— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00744 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 745 •HR 5294 IH (i) On December 3, 2003, the Presi- 1 dent signed into law the Healthy Forests 2 Restoration Act of 2003 (Public Law 108– 3 148; 16 U.S.C. 6501 et seq.). Although the 4 law attempts to reduce the risk of cata- 5 strophic forest fires, it provides a boon to 6 timber companies by accelerating the ag- 7 gressive thinning of backcountry forests 8 that are far from at-risk communities. The 9 law allows for increased logging of large, 10 fire-resistant trees that are not in close 11 proximity of homes and communities; it 12 undermines critical protections for endan- 13 gered species by exempting Federal land 14 management agencies from consulting with 15 the United States Fish and Wildlife Serv- 16 ice before approving any action that could 17 harm endangered plants or wildlife; and it 18 limits public participation by reducing the 19 number of environmental project reviews. 20 (ii) On April 21, 2008, the Depart- 21 ment of Agriculture issued a Final Plan- 22 ning Rule and Record of Decision for Na- 23 tional Forest System Land Management 24 Planning. Similar to rules enacted by the 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00745 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 746 •HR 5294 IH Administration on January 5, 2005, later 1 remanded back to the agency in Federal 2 district court for violating the National 3 Environmental Policy Act of 1969, the En- 4 dangered Species Act of 1973, and the Ad- 5 ministrative Procedure Act (‘‘Citizens for 6 Better Forestry v. United States Depart- 7 ment of Agriculture’’, 481 F. Supp. 2d 8 1059 (N.D. Cal. 2007)), this revised rule 9 eliminates strict forest planning standards 10 established in 1982, and opens millions of 11 acres of public lands to damaging and 12 invasive logging, mining, and drilling oper- 13 ations. These regulations would reverse 14 more than 20 years of protection for wild- 15 life and national forests by removing the 16 overall goal of ensuring ecological sustain- 17 ability in managing the national forest sys- 18 tem, weakening the National Forest Man- 19 agement Act of 1976, and effectively end- 20 ing the review of forest management plans 21 under the National Environmental Policy 22 Act of 1969. 23 (iii) On September 20, 2006, the Dis- 24 trict Court for the Northern District of 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00746 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 747 •HR 5294 IH California vacated the Protection of Inven- 1 toried Roadless Areas rule, enacted on May 2 13, 2005, which gave State Governors 18 3 months to petition the Federal Government 4 to either restore the previous rule for their 5 States, or submit a new management and 6 development plan for national forest areas 7 inventoried under the rule. Despite the 8 enjoinment of the Administration’s 2005 9 rule, and the subsequent restoration of the 10 original Roadless Area Conservation Rule, 11 the United States Forest Service has con- 12 tinued to allow States to petition for a spe- 13 cial rule under the authority of the Admin- 14 istrative Procedure Act, publishing a final 15 special rule for Idaho on October 16, 2008. 16 As a result, 58.5 million acres of wild na- 17 tional forests are still vulnerable to log- 18 ging, road building, and other develop- 19 ments that may fragment natural habitats 20 and negatively impact fish and wildlife. 21 (iv) On November 17, 2008, the De- 22 partment of the Interior’s Bureau of Land 23 Management (BLM) signed the Record of 24 Decision (ROD) amending 12 resource 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00747 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 748 •HR 5294 IH management plans in Colorado, Utah, and 1 Wyoming, opening 2,000,000 acres of pub- 2 lic lands to commercial tar sands and oil 3 shale exploration and development. On No- 4 vember 18, 2008, the BLM published a 5 final rule for Oil Shale Management set- 6 ting the policies and procedures for a com- 7 mercial leasing program for the manage- 8 ment of federally owned oil shale in those 9 three States. Previously barred by a con- 10 gressional moratorium on the commercial 11 leasing regulations for oil shale until Sep- 12 tember 30, 2008, the development of oil 13 shale on public lands poses a serious threat 14 to land conservation, endangered and 15 threatened species, and critical habitat. 16 Domestic shale oil production allowed by 17 these regulations is highly water and en- 18 ergy intensive, the impacts of which will in- 19 tensify existing water scarcity in the arid 20 Western Region and potentially degrade 21 air and water quality for surrounding pop- 22 ulations. 23 (C) SCIENTIFIC REVIEW.—On December 24 16, 2008, the United States Fish and Wildlife 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00748 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 749 •HR 5294 IH Service of the Department of the Interior and 1 the National Oceanic and Atmospheric Admin- 2 istration of the Department of Commerce joint- 3 ly issued a new rule amending regulations gov- 4 erning interagency cooperation under section 7 5 of the Endangered Species Act of 1973 (ESA). 6 This rule undermines the intention of the ESA 7 to protect species and the ecosystems upon 8 which they depend by allowing Federal agencies 9 to carry out, permit, or fund an action without 10 proper environmental review and expert third- 11 party consultation from Federal wildlife ex- 12 perts. Under this new rule, Federal agencies 13 can unilaterally circumvent the formal review 14 process, eliminating longstanding and scientif- 15 ically grounded safeguards that serve to protect 16 the biodiversity of our Nation’s ecosystems and 17 avert harm to thousands of endangered and 18 threatened species. 19 (b) STATEMENT OF POLICY.—It is the policy of the 20 United States Government to work in conjunction with 21 States, territories, tribal governments, international orga- 22 nizations, and foreign governments in order to act as a 23 steward of the environment for the benefit of public 24 health, to maintain air quality and water quality, to sus- 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00749 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 750 •HR 5294 IH tain the diversity of plant and animal species, to combat 1 global climate change, and to protect the environment for 2 future generations to enjoy. 3 (c) STUDY AND REPORT ON PUBLIC HEALTH OR EN- 4 VIRONMENTAL IMPACT OF REVISED RULES, REGULA- 5 TIONS, LAWS, OR PROPOSED LAWS.— 6 (1) STUDY.—Not later than 30 days after the 7 date of enactment of this Act, the President shall 8 enter into an arrangement under which the National 9 Academy of Sciences will conduct a study to deter- 10 mine the impact on public health, air quality, water 11 quality, wildlife, and the environment of the fol- 12 lowing regulations, laws, and proposed laws: 13 (A) CLEAN WATER.— 14 (i) Final revisions to the Federal 15 Water Pollution Control Act regulatory 16 definitions of ‘‘fill material’’ and ‘‘dis- 17 charge of fill material’’, finalized and pub- 18 lished in the Federal Register on May 9, 19 2002 (67 Fed. Reg. 31129), amending 20 part 232 of title 40, Code of Federal Regu- 21 lations. 22 (ii) Revised National Pollutant Dis- 23 charge Elimination System Permit Regula- 24 tion and Effluent Limitation Guidelines 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00750 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 751 •HR 5294 IH and Standards for Concentrated Animal 1 Feeding Operations in response to the 2 ‘‘Waterkeeper Alliance, et al. v. 3 Enviromental Protection Agency’’ decision, 4 finalized and published in the Federal Reg- 5 ister on November 20, 2008 (73 Fed. Reg. 6 225), amending parts 9, 122, and 412 of 7 title 40, Code of Federal Regulations. 8 (iii) A March 19, 2003, rule published 9 in the Federal Register (68 Fed. Reg. 10 13608) withdrawing a July 13, 2000, rule 11 revising the Total Maximum Daily Load 12 program of the Federal Water Pollution 13 Control Act (65 Fed. Reg. 43586), amend- 14 ing parts 9, 122, 123, 124, and 130 of 15 title 40, Code of Federal Regulations. 16 (iv) Official Guidance Document, 17 ‘‘Clean Water Act Jurisdiction Following 18 the United States Supreme Court’s Deci- 19 sion in Rapanos v. United States & 20 Carabell v. United States’’, issued on De- 21 cember 2, 2008, relating to jurisdiction 22 under section 404 of the Federal Water 23 Pollution Control Act. 24 (B) FORESTS AND LAND MANAGEMENT.— 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00751 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 752 •HR 5294 IH (i) Healthy Forests Restoration Act of 1 2003, signed into law on December 3, 2 2003 (Public Law 108–148; 16 U.S.C. 3 6501 et seq.). 4 (ii) National Forest System Land 5 Management Planning Rule, finalized and 6 published in the Federal Register on April 7 21, 2008 (73 Fed. Reg. 21468), replacing 8 the 2005 final rule (70 Fed. Reg. 1022, 9 Jan. 5, 2005), as amended March 3, 2006 10 (71 Fed. Reg. 10837) and the 2000 final 11 rule adopted on November 9, 2000 (65 12 Fed. Reg. 67514) as amended on Sep- 13 tember 29, 2004 (69 Fed. Reg. 58055), 14 amending title 36, Code of Federal Regula- 15 tions, part 219. 16 (iii) The application of the Adminis- 17 trative Procedure Act (5 U.S.C. 551 to 18 559, 701 to 706, et seq.), such that States 19 may petition for a special rule for the 20 roadless areas in all or part of said State. 21 (iv) Record of Decision, ‘‘Oil Shale 22 and Tar Sands Resources Resource Man- 23 agement Plan Amendments’’, issued on 24 November 17, 2008, along with the Final 25 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00752 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 753 •HR 5294 IH Rule, Oil Shale Management-General, pub- 1 lished in the Federal Register on Novem- 2 ber 18, 2008 (73 Fed. Reg. 223), amend- 3 ing title 43, Code of Federal Regulations, 4 parts 3900, 3910, 3920, and 3930. 5 (C) SCIENTIFIC REVIEW.—Final Rule, 6 Interagency Cooperation Under the Endangered 7 Species Act, published in the Federal Register 8 on December 16, 2008, amending title 50, Code 9 of Federal Regulations, part 402. 10 (2) METHOD.—In conducting the study under 11 paragraph (1), the National Academy of Sciences 12 may utilize and compare existing scientific studies 13 regarding the regulations, laws, and proposed laws 14 listed in paragraph (1). 15 (3) REPORT.—Under the arrangement entered 16 into under paragraph (1), not later than 270 days 17 after the date on which such arrangement is entered 18 into, the National Academy of Sciences shall make 19 publicly available and shall submit to the Congress 20 and to the head of each department and agency of 21 the Federal Government that issued, implements, or 22 would implement a regulation, law, or proposed law 23 listed in paragraph (1), a report containing— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00753 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 754 •HR 5294 IH (A) a description of the impact of all such 1 regulations, laws, and proposed laws on public 2 health, air quality, water quality, wildlife, and 3 the environment, compared to the impact of 4 preexisting regulations, or laws in effect, includ- 5 ing— 6 (i) any negative impacts to air quality 7 or water quality; 8 (ii) any negative impacts to wildlife; 9 (iii) any delays in hazardous waste 10 cleanup that are projected to be hazardous 11 to public health; and 12 (iv) any other negative impact on pub- 13 lic health or the environment; and 14 (B) any recommendations that the Na- 15 tional Academy of Sciences considers appro- 16 priate to maintain, restore, or improve in whole 17 or in part protections for public health, air 18 quality, water quality, wildlife, and the environ- 19 ment for each of the regulations, laws, and pro- 20 posed laws listed in paragraph (1), which may 21 include recommendations for the adoption of 22 any regulation or law in place or proposed prior 23 to January 1, 2001. 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00754 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 755 •HR 5294 IH (d) DEPARTMENT AND AGENCY REVISION OF EXIST- 1 ING RULES, REGULATIONS, OR LAWS.—Not later than 2 180 days after the date on which the report is submitted 3 pursuant to subsection (c)(3), the head of each depart- 4 ment and agency that has issued or implemented a regula- 5 tion or law listed in subsection (c)(1) shall submit to the 6 Congress a plan describing the steps such department or 7 such agency will take, or has taken, to restore or improve 8 protections for public health and the environment in whole 9 or in part that were in existence prior to the issuance of 10 such regulation or law. 11 SEC. 1008. GAO REPORT ON HEALTH EFFECTS OF DEEP- 12 WATER HORIZON OIL RIG EXPLOSION IN THE 13 GULF COAST. 14 (a) STUDY.—The Comptroller General of the United 15 States shall conduct a study on the type and scope of 16 health care services administered through the Department 17 of Health and Human Services addressing the provision 18 of health care to racial and ethnic minorities (whether 19 residents, cleanup workers, or volunteers) affected by the 20 explosion of the mobile offshore drilling unit Deepwater 21 Horizon that occurred on April 20, 2010. 22 (b) SPECIFIC COMPONENTS; REPORTING.—In car- 23 rying out subsection (a), the Comptroller General shall— 24 VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00755 Fmt 6652 Sfmt 6201 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS 756 •HR 5294 IH (1) assess the type, size, and scope of programs 1 administered by the Department of Health and 2 Human Services that focus on provision of health 3 care to communities in the Gulf Coast; 4 (2) identify the merits and disadvantages asso- 5 ciated with each the programs; 6 (3) perform an analysis of the costs and bene- 7 fits of the programs; 8 (4) determine whether there is any duplication 9 of programs; and 10 (5) not later than 180 days after the date of 11 the enactment of this Act, report findings and rec- 12 ommendations for improving access to health care 13 for racial and ethnic minorities to the Congress. 14 Æ VerDate Mar 15 2010 23:38 Aug 05, 2014 Jkt 039200 PO 00000 Frm 00756 Fmt 6652 Sfmt 6301 E:\BILLS\H5294.IH H5294 smartinez on DSK4TPTVN1PROD with BILLS