Text of US HB 5475 (2016)

I 114TH CONGRESS 2D SESSION H. R. 5475 To improve the health of minority individuals, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JUNE 14, 2016 Ms. KELLY of Illinois (for herself, Ms. MICHELLE LUJAN GRISHAM of New Mexico, Ms. LINDA T. SA´NCHEZ of California, Ms. LEE, Ms. JUDY CHU of California, Mr. PAYNE, and Mr. BUTTERFIELD) introduced the fol- lowing bill; which was referred to the Committee on Energy and Com- merce, and in addition to the Committees on Ways and Means, Agri- culture, Education and the Workforce, the Budget, the Judiciary, Vet- erans’ Affairs, Armed Services, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consider- ation of such provisions as fall within the jurisdiction of the committee concerned 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 2016’’. 5 SEC. 2. TABLE OF CONTENTS. 6 The table of contents of this Act is as follows: 7 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 2 •HR 5475 IH 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. 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. VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 3 •HR 5475 IH 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. 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. 431. Grants for racial and ethnic approaches to community health. Sec. 432. Critical access hospital improvements. Sec. 433. Establishment of Rural Community Hospital (RCH) Program. Sec. 434. Medicare remote monitoring pilot projects. Sec. 435. Rural health quality advisory commission and demonstration projects. Sec. 436. Rural health care services. Sec. 437. Community health center collaborative access expansion. Sec. 438. Facilitating the provision of telehealth services across State lines. Sec. 439. Scoring of preventive health savings. Sec. 440. Sense of Congress. VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6211 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 4 •HR 5475 IH Sec. 441. Repeal of requirement for documentation evidencing citizenship or nationality under the Medicaid program. Sec. 442. Office of Minority Health in Veterans Health Administration of De- partment of Veterans Affairs. Sec. 443. Indian defined in PPACA. Sec. 444. Study of DSH payments to ensure hospital access for low-income pa- tients. Sec. 445. Assistant Secretary of the Indian Health Service. Sec. 446. Reauthorization of the Native Hawaiian Health Care Improvement Act. Sec. 447. Availability of non-English language speaking providers. Sec. 448. Access to essential community providers. Sec. 449. Provider network adequacy in communities of color. Sec. 450. Improving access to dental care. TITLE V—IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES Sec. 501. Grants to promote positive health outcomes for 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. 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 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6211 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 5 •HR 5475 IH 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 and in ACA essential health benefits . Sec. 735. Clinical research funding for oral health. Sec. 736. Participation by Medicaid beneficiaries in approved clinical trials. 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. VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6211 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 6 •HR 5475 IH Sec. 752. Reducing new HIV infections among injecting drug users. Sec. 753. Support for expansion of comprehensive sexual health and education programs. Sec. 754. Report on impact of HIV/AIDS in vulnerable populations. Sec. 755. National HIV/AIDS observance days. Sec. 756. Review of all Federal and State laws, policies, and regulations regard- ing the criminal prosecution of individuals for HIV-related of- fenses. Sec. 757. 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. 758. Expanding support for condoms in prisons. Sec. 759. Automatic reinstatement or enrollment in Medicaid for people who test positive for HIV before reentering communities. Sec. 760. Stop AIDS in prison. Sec. 761. Support data system review and indicators for monitoring HIV care. Sec. 762. Transfer of funds for implementation of national HIV/AIDS strategy. Sec. 763. HIV integrated services delivery model demonstration. Sec. 764. 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 Sec. 781. Findings. Sec. 782. Osteoarthritis and other musculoskeletal health-related activities of the Centers for Disease Control and Prevention. Sec. 783. Grants for comprehensive osteoarthritis and musculoskeletal disease health education within health professions schools. 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. Sec. 794. Grants for comprehensive sleep and circadian health education within health professions schools. Sec. 795. Report on impact of sleep and circadian health disorders in vulner- able & racial/ethnic populations. VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6211 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 7 •HR 5475 IH 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. Extending Medicaid EHR incentive payments to rehabilitation facili- ties, long-term care facilities, and home health agencies. Sec. 842. 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. 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. VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6211 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 8 •HR 5475 IH 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 gender identity, socioeconomic status, or disability 16 status—that directly and indirectly affect the health, 17 health care, and wellness of individuals and commu- 18 nities. 19 (3) By 2020, the Nation will face a shortage of 20 health care providers and allied health workers and 21 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 9 •HR 5475 IH this shortage disproportionately affects health pro- 1 fessional shortage areas where many racial and eth- 2 nic minority populations reside. 3 (4) All efforts to reduce health disparities and 4 barriers to quality health services require better and 5 more consistent data. 6 (5) A full range of culturally and linguistically 7 appropriate health care and public health services 8 must be available and accessible in every community. 9 (6) Racial and ethnic minorities and under- 10 served populations must be included early and equi- 11 tably in health reform innovations. 12 (7) Efforts to improve minority health have 13 been limited by inadequate resources in funding, 14 staffing, stewardship, and accountability. Targeted 15 investments that are focused on disparities elimi- 16 nation must be made in providing care and services 17 that are community-based, including prevention and 18 policies addressing social determinants of health. 19 (8) In 2011, the Department of Health and 20 Human Services developed the HHS Action Plan to 21 Reduce Racial and Ethnic Health Disparities and 22 the National Stakeholder Strategy for Achieving 23 Health Equity, two strategic plans that represent 24 the country’s first coordinated roadmap to reducing 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 10 •HR 5475 IH health disparities. Along with the National Preven- 1 tion Strategy, Healthy People 2020, and the Na- 2 tional Health Care Quality Strategy, as well as crit- 3 ical resources such as the 2012 National Healthcare 4 Quality and Disparities Reports, these comprehen- 5 sive plans will work to increase the number of Amer- 6 icans who are healthy at every stage of life. 7 (9) The Department of Health and Human 8 Services has also reviewed and advanced updated 9 clinical guidelines and developed other strategic 10 planning documents— 11 (A) to combat health disparities with a 12 high impact on minority populations including 13 the National HIV/AIDS Strategy, the Action 14 Plan for the Prevention, Care, and Treatment 15 of Viral Hepatitis; and 16 (B) to provide high-quality family planning 17 services including recommendations of the Cen- 18 ters for Disease Control and Prevention and the 19 Office of Population Affairs. 20 (10) The Patient Protection and Affordable 21 Care Act, as amended by the Health Care and Edu- 22 cation Reconciliation Act, represents the biggest ad- 23 vancement for minority health in the last 40 years. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 11 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 12 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 13 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 14 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 15 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 16 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 17 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 18 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 19 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 20 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 21 •HR 5475 IH such sums as may be necessary for each of fiscal years 1 2017 through 2022. 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 2016 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 22 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 23 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 24 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 25 •HR 5475 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 ‘‘COLLECTION OF RACE AND ETHNICITY DATA BY THE 16 SOCIAL SECURITY ADMINISTRATION 17 ‘‘SEC. 1150C. (a) REQUIREMENT.—The Commis- 18 sioner of Social Security, in consultation with the Admin- 19 istrator of the Centers for Medicare & Medicaid Services, 20 shall— 21 ‘‘(1) require the collection of data on the race, 22 ethnicity, primary language, and disability status of 23 all applicants for Social Security account numbers or 24 benefits under title II or part A of title XVIII and 25 all individuals with respect to whom the Commis- 26 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 26 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 27 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 28 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 29 •HR 5475 IH such sums as may be necessary for each of fiscal years 1 2017 through 2022.’’. 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 30 •HR 5475 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 ‘‘2022’’; 10 (2) in paragraph (2), in the first sentence, by 11 striking ‘‘2003’’ and inserting ‘‘2022’’; and 12 (3) in paragraph (3), by striking ‘‘2002’’ and 13 inserting ‘‘2022’’. 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 31 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 32 •HR 5475 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 2017 through 2022.’’. 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 33 •HR 5475 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, 2017, 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 34 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 35 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 36 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 37 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 38 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 39 •HR 5475 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 ‘‘(dd) 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 40 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 41 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 42 •HR 5475 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 2016, 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 43 •HR 5475 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 2016. 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 2016, 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 44 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 45 •HR 5475 IH later than 2 years after the date of the enactment 1 of the Health Equity and Accountability Act of 2 2016, 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 2017 through 2022.’’. 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 46 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 47 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 48 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 49 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 50 •HR 5475 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, 23 queer, and questioning individuals, and individ- 24 uals with physical and mental disabilities; and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 51 •HR 5475 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, speaking, or learning impairment, that enables 12 access, understanding, and benefit from health care 13 or health-care-related services, and full participation 14 in 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 52 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 53 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 54 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 55 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00055 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 56 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 57 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 58 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 59 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 60 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 61 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 62 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00062 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 63 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 64 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 65 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 66 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 67 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 68 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00068 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 69 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 70 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 71 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00071 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 72 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00072 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 73 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 74 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 75 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 76 •HR 5475 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 2017 through 2021. 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 77 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 78 •HR 5475 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; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 79 •HR 5475 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, including cultural 19 competence programs for community health workers; 20 and 21 ‘‘(13) ensure that, consistent with the privacy 22 protections provided for under the regulations pro- 23 mulgated under section 264(c) of the Health Insur- 24 ance Portability and Accountability Act of 1996 (42 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 80 •HR 5475 IH U.S.C. 1320d–2 note) and any applicable State pri- 1 vacy laws, data on the individual patient or recipi- 2 ent’s race, ethnicity, and primary language are col- 3 lected (and periodically updated) in health records 4 and integrated into the organization’s information 5 management systems or any similar system used to 6 store and retrieve data. 7 ‘‘(d) PRIORITY.—In awarding grants under this sec- 8 tion, the Secretary shall give priority to entities that pri- 9 marily engage in providing direct care and that have devel- 10 oped partnerships with community organizations or with 11 agencies with experience in improving language access. 12 ‘‘(e) EVALUATION.— 13 ‘‘(1) BY GRANTEES.—An entity that receives a 14 grant under this section shall submit to the Sec- 15 retary an evaluation that describes, in the manner 16 and to the extent required by the Secretary, the ac- 17 tivities carried out with funds received under the 18 grant, and how such activities improved access to 19 health and health-care-related services and the qual- 20 ity of health care for individuals with limited-English 21 proficiency. Such evaluation shall be collected and 22 disseminated through the Robert T. Matsui Center 23 for Cultural and Linguistic Competence in Health 24 Care established under section 3403. The Director 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 81 •HR 5475 IH of the Agency for Healthcare Research and Quality 1 shall notify grantees of the availability of technical 2 assistance for the evaluation and provide such assist- 3 ance upon request. 4 ‘‘(2) BY SECRETARY.—The Director of the 5 Agency for Healthcare Research and Quality shall 6 evaluate or arrange with other individuals or organi- 7 zations to evaluate projects funded under this sec- 8 tion. 9 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 10 is authorized to be appropriated to carry out this section, 11 $5,000,000 for each of fiscal years 2017 through 2021. 12 ‘‘SEC. 3405. RESEARCH ON CULTURAL AND LANGUAGE COM- 13 PETENCE. 14 ‘‘(a) IN GENERAL.—The Secretary, acting through 15 the Director of the Agency for Healthcare Research and 16 Quality, shall expand research concerning language access 17 in the provision of health care. 18 ‘‘(b) ELIGIBILITY.—The Director of the Agency for 19 Healthcare Research and Quality may conduct the re- 20 search described in subsection (a) or enter into contracts 21 with other individuals or organizations to do so. 22 ‘‘(c) USE OF FUNDS.—Research under this section 23 shall be designed to do one or more of the following: 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 82 •HR 5475 IH ‘‘(1) To identify the barriers to mental and be- 1 havioral services that are faced by LEP individuals. 2 ‘‘(2) To identify health care providers’ and 3 health administrators’ attitudes, knowledge, and 4 awareness of the barriers to quality health care serv- 5 ices that are faced by LEP individuals. 6 ‘‘(3) To identify optimal approaches for deliv- 7 ering language access. 8 ‘‘(4) To identify best practices for data collec- 9 tion, including— 10 ‘‘(A) the collection by providers of health 11 care and health-care-related services of data on 12 the race, ethnicity, and primary language of re- 13 cipients of such services, taking into account ex- 14 isting research conducted by the Government or 15 private sector; 16 ‘‘(B) the development and implementation 17 of data collection and reporting systems; and 18 ‘‘(C) effective privacy safeguards for col- 19 lected data. 20 ‘‘(5) To develop a minimum data collection set 21 for primary language. 22 ‘‘(6) To evaluate the most effective ways in 23 which the Department can create or coordinate, and 24 then subsidize or otherwise fund telephonic interpre- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 83 •HR 5475 IH tation providers for health care providers, taking 1 into consideration, among other factors, the flexi- 2 bility necessary for such a system to accommodate 3 variations in— 4 ‘‘(A) provider type; 5 ‘‘(B) languages needed and their frequency 6 of use; 7 ‘‘(C) type of encounter; 8 ‘‘(D) time of encounter, including regular 9 business hours and after hours; and 10 ‘‘(E) location of encounter. 11 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 12 are authorized to be appropriated to carry out this section 13 such sums as may be necessary for each of fiscal years 14 2017 through 2021.’’. 15 SEC. 203. PILOT PROGRAM FOR IMPROVEMENT AND DE- 16 VELOPMENT OF STATE MEDICAL INTER- 17 PRETING SERVICES. 18 (a) GRANTS AUTHORIZED.—The Secretary shall 19 award one grant in accordance with this section to each 20 of three States to assist each such State in designing, im- 21 plementing, and evaluating a statewide program to provide 22 onsite interpreter services under Medicaid. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00083 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 84 •HR 5475 IH (b) GRANT PERIOD.—A grant awarded under this 1 section is authorized for a period of three fiscal years be- 2 ginning on October 1, 2016. 3 (c) PREFERENCE.—In awarding a grant under this 4 section, the Secretary shall give preference to a State— 5 (1) that has a high proportion of qualified LEP 6 enrollees, as determined by the Secretary; 7 (2) that has a large number of qualified LEP 8 enrollees, as determined by the Secretary; 9 (3) that has a high growth rate of the popu- 10 lation of LEP individuals, as determined by the Sec- 11 retary; and 12 (4) that has a population of qualified LEP en- 13 rollees that is linguistically diverse, requiring inter- 14 preter services in at least 200 non-English lan- 15 guages. 16 (d) USE OF FUNDS.—A State receiving a grant under 17 this section shall use the grant funds to— 18 (1) ensure that all health care providers in the 19 State participating in the State plan under Medicaid 20 have access to onsite interpreter services, for the 21 purpose of enabling effective communication between 22 such providers and qualified LEP enrollees during 23 the furnishing of items and services and administra- 24 tive interactions; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00084 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 85 •HR 5475 IH (2) establish, expand, procure, or contract for— 1 (A) a statewide health care information 2 technology system that is designed to achieve 3 efficiencies and economies of scale with respect 4 to onsite interpreter services provided to health 5 care providers in the State participating in the 6 State plan under Medicaid; and 7 (B) an entity to administer such system, 8 the duties of which shall include— 9 (i) procuring and scheduling inter- 10 preter services for qualified LEP enrollees; 11 (ii) procuring and scheduling inter- 12 preter services for LEP individuals seeking 13 to enroll in the State plan under Medicaid; 14 (iii) ensuring that interpreters receive 15 payment for interpreter services rendered 16 under the system; and 17 (iv) consulting regularly with organi- 18 zations representing consumers, inter- 19 preters, and health care providers; and 20 (3) develop mechanisms to establish, improve, 21 and strengthen the competency of the medical inter- 22 pretation workforce that serves qualified LEP enroll- 23 ees in the State, including a national certification 24 process that is valid, credible, and vendor-neutral. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 86 •HR 5475 IH (e) APPLICATION.—To receive a grant under this sec- 1 tion, a State shall submit an application at such time and 2 containing such information as the Secretary may require, 3 which shall include the following: 4 (1) A description of the language access needs 5 of individuals in the State enrolled in the State plan 6 under Medicaid. 7 (2) A description of the extent to which the 8 program will— 9 (A) use the grant funds for the purposes 10 described in subsection (d); 11 (B) meet the health care needs of rural 12 populations of the State; and 13 (C) collect information that accurately 14 tracks the language services requested by con- 15 sumers as compared to the language services 16 provided by health care providers in the State 17 participating in the State plan under Medicaid. 18 (3) A description of how the program will be 19 evaluated, including a proposal for collaboration with 20 organizations representing interpreters, consumers, 21 and LEP individuals. 22 (f) DEFINITIONS.—In this section: 23 (1) QUALIFIED LEP ENROLLEE.—The term 24 ‘‘qualified LEP enrollee’’ means an individual— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00086 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 87 •HR 5475 IH (A) who is limited-English-proficient; and 1 (B) who is enrolled in a State plan under 2 Medicaid. 3 (2) STATE.—The term ‘‘State’’ has the mean- 4 ing given the term in section 1101(a)(1) of the So- 5 cial Security Act (42 U.S.C. 1301(a)(1)), for pur- 6 poses of title XIX of such Act. 7 (3) UNITED STATES.—The term ‘‘United 8 States’’ has the meaning given the term in section 9 1101(a)(2) of the Social Security Act (42 U.S.C. 10 1301(a)(2)), for purposes of title XIX of such Act. 11 (g) FUNDING.— 12 (1) AUTHORIZATION OF APPROPRIATIONS.— 13 There is authorized to be appropriated $5,000,000 14 to carry out this section. 15 (2) AVAILABILITY OF FUNDS.—The funds au- 16 thorized by paragraph (1) shall be available without 17 fiscal year limitation. 18 (3) INCREASED FEDERAL FINANCIAL PARTICI- 19 PATION.—Section 1903(a)(2)(E) of the Social Secu- 20 rity Act (42 U.S.C. 1396b(a)(2)(E)), as amended by 21 section 205(d)(1) of this Act, is further amended by 22 inserting ‘‘(or, in the case of a State receiving a 23 grant under section 203 of the Health Equity and 24 Accountability Act of 2016, 100 percent for each 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00087 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 88 •HR 5475 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 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 89 •HR 5475 IH (b) INDIRECT MEDICAL EDUCATION.—Section 1 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 2 1395ww(d)(5)(B)) is amended— 3 (1) by redesignating the clause (x) added by 4 section 5505(b) of the Patient Protection and Af- 5 fordable Care Act as clause (xi); and 6 (2) by adding at the end the following new 7 clause: 8 ‘‘(xii) The provisions of subparagraph (L) of 9 subsection (h)(4) shall apply under this subpara- 10 graph in the same manner as they apply under such 11 subsection.’’. 12 (c) EFFECTIVE DATE.—The amendments made by 13 subsections (a) and (b) shall apply with respect to pay- 14 ments made to hospitals on or after the date that is one 15 year after the date of the enactment of this Act. 16 SEC. 205. FEDERAL REIMBURSEMENT FOR CULTURALLY 17 AND LINGUISTICALLY APPROPRIATE SERV- 18 ICES UNDER THE MEDICARE, MEDICAID, AND 19 STATE CHILDREN’S HEALTH INSURANCE 20 PROGRAMS. 21 (a) LANGUAGE ACCESS GRANTS FOR MEDICARE 22 PROVIDERS.— 23 (1) ESTABLISHMENT.— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00089 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 90 •HR 5475 IH (A) IN GENERAL.—Not later than 6 1 months after the date of the enactment of this 2 Act, the Secretary of Health and Human Serv- 3 ices, acting through the Centers for Medicare & 4 Medicaid Services and in consultation with the 5 Center for Medicare and Medicaid Innovation, 6 shall establish a demonstration program under 7 which the Secretary shall award grants to eligi- 8 ble Medicare service providers to improve com- 9 munication between such providers and Medi- 10 care beneficiaries who are English learners, in- 11 cluding beneficiaries who live in diverse and un- 12 derserved communities. 13 (B) APPLICATION OF INNOVATION 14 RULES.—The demonstration project under sub- 15 paragraph (A) shall be conducted in a manner 16 that is consistent with the applicable provisions 17 of subsections (b), (c), and (d) of section 1115A 18 of the Social Security Act (42 U.S.C. 1315a). 19 (C) NUMBER OF GRANTS.—To the extent 20 practicable, the Secretary shall award not less 21 than 24 grants under this subsection. 22 (D) GRANT PERIOD.—Except as provided 23 under paragraph (2)(D), each grant awarded 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00090 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 91 •HR 5475 IH under this subsection shall be for a 3-year pe- 1 riod. 2 (2) ELIGIBILITY REQUIREMENTS.—To be eligi- 3 ble for a grant under this subsection, an entity must 4 meet the following requirements: 5 (A) MEDICARE PROVIDER.—The entity 6 must be— 7 (i) a provider of services under part A 8 of title XVIII of the Social Security Act; 9 (ii) a provider of services under part 10 B of such title; 11 (iii) a Medicare Advantage organiza- 12 tion offering a Medicare Advantage plan 13 under part C of such title; or 14 (iv) a PDP sponsor offering a pre- 15 scription drug plan under part D of such 16 title. 17 (B) UNDERSERVED COMMUNITIES.—The 18 entity must serve a community that, with re- 19 spect to necessary language services for improv- 20 ing access and utilization of health care among 21 English learners, is disproportionally under- 22 served. 23 (C) APPLICATION.—The entity must pre- 24 pare and submit to the Secretary an applica- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 92 •HR 5475 IH tion, at such time, in such manner, and accom- 1 panied by such additional information as the 2 Secretary may require. 3 (D) REPORTING.—In the case of a grantee 4 that received a grant under this subsection in 5 a previous year, such grantee is only eligible for 6 continued payments under a grant under this 7 subsection if the grantee met the reporting re- 8 quirements under paragraph (9) for such year. 9 If a grantee fails to meet the requirement of 10 such paragraph for the first year of a grant, the 11 Secretary may terminate the grant and solicit 12 applications from new grantees to participate in 13 the demonstration program. 14 (3) DISTRIBUTION.—To the extent feasible, the 15 Secretary shall award— 16 (A) at least 6 grants to providers of serv- 17 ices described in paragraph (2)(A)(i); 18 (B) at least 6 grants to service providers 19 described in paragraph (2)(A)(ii); 20 (C) at least 6 grants to organizations de- 21 scribed in paragraph (2)(A)(iii); and 22 (D) at least 6 grants to sponsors described 23 in paragraph (2)(A)(iv). 24 (4) CONSIDERATIONS IN AWARDING GRANTS.— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 93 •HR 5475 IH (A) VARIATION IN GRANTEES.—In award- 1 ing grants under this subsection, the Secretary 2 shall select grantees to ensure the following: 3 (i) The grantees provide many dif- 4 ferent types of language services. 5 (ii) The grantees serve Medicare bene- 6 ficiaries who speak different languages, 7 and who, as a population, have differing 8 needs for language services. 9 (iii) The grantees serve Medicare 10 beneficiaries in both urban and rural set- 11 tings. 12 (iv) The grantees serve Medicare 13 beneficiaries in at least two geographic re- 14 gions, as defined by the Secretary. 15 (v) The grantees serve Medicare bene- 16 ficiaries in at least two large metropolitan 17 statistical areas with racial, ethnic, and 18 economically diverse populations. 19 (B) PRIORITY FOR PARTNERSHIPS WITH 20 COMMUNITY ORGANIZATIONS AND AGENCIES.— 21 In awarding grants under this subsection, the 22 Secretary shall give priority to eligible entities 23 that have a partnership with— 24 (i) a community organization; or 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00093 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 94 •HR 5475 IH (ii) a consortia of community organi- 1 zations, State agencies, and local agencies, 2 that has experience in providing language serv- 3 ices. 4 (5) USE OF FUNDS FOR COMPETENT LANGUAGE 5 SERVICES.— 6 (A) IN GENERAL.—Subject to subpara- 7 graph (E), a grantee may only use grant funds 8 received under this subsection to pay for the 9 provision of competent language services to 10 Medicare beneficiaries who are English learn- 11 ers. 12 (B) COMPETENT LANGUAGE SERVICES DE- 13 FINED.—For purposes of this subsection, the 14 term ‘‘competent language services’’ means— 15 (i) interpreter and translation services 16 that— 17 (I) subject to the exceptions 18 under subparagraph (C)— 19 (aa) if the grantee operates 20 in a State that has statewide 21 health care interpreter standards, 22 meet the State standards cur- 23 rently in effect; or 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00094 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 95 •HR 5475 IH (bb) if the grantee operates 1 in a State that does not have 2 statewide health care interpreter 3 standards, utilizes competent in- 4 terpreters who follow the Na- 5 tional Council on Interpreting in 6 Health Care’s Code of Ethics and 7 Standards of Practice; and 8 (II) that, in the case of inter- 9 preter services, are provided 10 through— 11 (aa) onsite interpretation; 12 (bb) telephonic interpreta- 13 tion; or 14 (cc) video interpretation; 15 and 16 (ii) the direct provision of health care 17 or health-care-related services by a com- 18 petent bilingual health care provider. 19 (C) EXCEPTIONS.—The requirements of 20 subparagraph (B)(i)(I) do not apply, with re- 21 spect to interpreter and translation services and 22 a grantee— 23 (i) in the case of a Medicare bene- 24 ficiary who is an English learner if— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 96 •HR 5475 IH (I) such beneficiary has been in- 1 formed, in the beneficiary’s primary 2 language, of the availability of free in- 3 terpreter and translation services and 4 the beneficiary instead requests that a 5 family member, friend, or other per- 6 son provide such services; and 7 (II) the grantee documents such 8 request in the beneficiary’s medical 9 record; or 10 (ii) in the case of a medical emergency 11 where the delay directly associated with ob- 12 taining a competent interpreter or trans- 13 lation services would jeopardize the health 14 of the patient. 15 Clause (ii) shall not be construed to exempt 16 emergency rooms or similar entities that regu- 17 larly provide health care services in medical 18 emergencies to patients who are English learn- 19 ers from any applicable legal or regulatory re- 20 quirements related to providing competent in- 21 terpreter and translation services without undue 22 delay. 23 (D) MEDICARE ADVANTAGE ORGANIZA- 24 TIONS AND PDP SPONSORS.—If a grantee is a 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00096 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 97 •HR 5475 IH Medicare Advantage organization offering a 1 Medicare Advantage plan under part C of title 2 XVIII of the Social Security Act or a PDP 3 sponsor offering a prescription drug plan under 4 part D of such title, such entity must provide 5 at least 50 percent of the grant funds that the 6 entity receives under this subsection directly to 7 the entity’s network providers (including all 8 health providers and pharmacists) for the pur- 9 pose of providing support for such providers to 10 provide competent language services to Medi- 11 care beneficiaries who are English learners. 12 (E) ADMINISTRATIVE AND REPORTING 13 COSTS.—A grantee may use up to 10 percent of 14 the grant funds to pay for administrative costs 15 associated with the provision of competent lan- 16 guage services and for reporting required under 17 paragraph (9). 18 (6) DETERMINATION OF AMOUNT OF GRANT 19 PAYMENTS.— 20 (A) IN GENERAL.—Payments to grantees 21 under this subsection shall be calculated based 22 on the estimated numbers of Medicare bene- 23 ficiaries who are English learners in a grantee’s 24 service area utilizing— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00097 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 98 •HR 5475 IH (i) data on the numbers of English 1 learners who speak English less than ‘‘very 2 well’’ from the most recently available data 3 from the Bureau of the Census or other 4 State-based study the Secretary determines 5 likely to yield accurate data regarding the 6 number of such individuals in such service 7 area; or 8 (ii) data provided by the grantee, if 9 the grantee routinely collects data on the 10 primary language of the Medicare bene- 11 ficiaries that the grantee serves and the 12 Secretary determines that the data is accu- 13 rate and shows a greater number of 14 English learners than would be estimated 15 using the data under clause (i). 16 (B) DISCRETION OF SECRETARY.—Subject 17 to subparagraph (C), the amount of payment 18 made to a grantee under this subsection may be 19 modified annually at the discretion of the Sec- 20 retary, based on changes in the data under sub- 21 paragraph (A) with respect to the service area 22 of a grantee for the year. 23 (C) LIMITATION ON AMOUNT.—The 24 amount of a grant made under this subsection 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00098 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 99 •HR 5475 IH to a grantee may not exceed $500,000 for the 1 period under paragraph (1)(D). 2 (7) ASSURANCES.—Grantees under this sub- 3 section shall, as a condition of receiving a grant 4 under this subsection— 5 (A) ensure that clinical and support staff 6 receive appropriate ongoing education and 7 training in linguistically appropriate service de- 8 livery; 9 (B) ensure the linguistic competence of bi- 10 lingual providers; 11 (C) offer and provide appropriate language 12 services at no additional charge to each patient 13 who is an English learner for all points of con- 14 tact between the patient and the grantee, in a 15 timely manner during all hours of operation; 16 (D) notify Medicare beneficiaries of their 17 right to receive language services in their pri- 18 mary language; 19 (E) post signage in the primary languages 20 commonly used by the patient population in the 21 service area of the organization; and 22 (F) ensure that— 23 (i) primary language data are col- 24 lected for recipients of language services 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 100 •HR 5475 IH and such data are consistent with stand- 1 ards developed under title XXXIV of the 2 Public Health Service Act, as added by 3 section 202 of this Act, to the extent such 4 standards are available upon the initiation 5 of the demonstration program; and 6 (ii) consistent with the privacy protec- 7 tions provided under the regulations pro- 8 mulgated pursuant to section 264(c) of the 9 Health Insurance Portability and Account- 10 ability Act of 1996 (42 U.S.C. 1320d–2 11 note), if the recipient of language services 12 is a minor or is incapacitated, primary lan- 13 guage data are collected on the parent or 14 legal guardian of such recipient. 15 (8) NO COST-SHARING.—Medicare beneficiaries 16 who are English learners shall not have to pay cost- 17 sharing or co-payments for competent language serv- 18 ices provided under this demonstration program. 19 (9) REPORTING REQUIREMENTS FOR GRANT- 20 EES.—Not later than the end of each calendar year, 21 a grantee that receives funds under this subsection 22 in such year shall submit to the Secretary a report 23 that includes the following information: 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 101 •HR 5475 IH (A) The number of Medicare beneficiaries 1 to whom competent language services are pro- 2 vided. 3 (B) The primary languages of those Medi- 4 care beneficiaries. 5 (C) The types of language services pro- 6 vided to such beneficiaries. 7 (D) Whether such language services were 8 provided by employees of the grantee or 9 through a contract with external contractors or 10 agencies. 11 (E) The types of interpretation services 12 provided to such beneficiaries, and the approxi- 13 mate length of time such service is provided to 14 such beneficiaries. 15 (F) The costs of providing competent lan- 16 guage services. 17 (G) An account of the training or accredi- 18 tation of bilingual staff, interpreters, and trans- 19 lators providing services funded by the grant 20 under this subsection. 21 (10) EVALUATION AND REPORT TO CON- 22 GRESS.—Not later than 1 year after the completion 23 of a 3-year grant under this subsection, the Sec- 24 retary shall conduct an evaluation of the demonstra- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00101 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 102 •HR 5475 IH tion program under this subsection and shall submit 1 to the Congress a report that includes the following: 2 (A) An analysis of the patient outcomes 3 and the costs of furnishing care to the Medicare 4 beneficiaries who are English learners partici- 5 pating in the project as compared to such out- 6 comes and costs for such Medicare beneficiaries 7 not participating, based on the data provided 8 under paragraph (9) and any other information 9 available to the Secretary. 10 (B) The effect of delivering language serv- 11 ices on— 12 (i) Medicare beneficiary access to care 13 and utilization of services; 14 (ii) the efficiency and cost effective- 15 ness of health care delivery; 16 (iii) patient satisfaction; 17 (iv) health outcomes; and 18 (v) the provision of culturally appro- 19 priate services provided to such bene- 20 ficiaries. 21 (C) The extent to which bilingual staff, in- 22 terpreters, and translators providing services 23 under such demonstration were trained or ac- 24 credited and the nature of accreditation or 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00102 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 103 •HR 5475 IH training needed by type of provider, service, or 1 other category as determined by the Secretary 2 to ensure the provision of high-quality interpre- 3 tation, translation, or other language services to 4 Medicare beneficiaries if such services are ex- 5 panded pursuant to subsection (c) of section 6 1907 of this Act. 7 (D) Recommendations, if any, regarding 8 the extension of such project to the entire Medi- 9 care program, subject to the provisions of sec- 10 tion 1115A(c) of the Social Security Act (42 11 U.S.C. 1315a(c)). 12 (11) APPROPRIATIONS.—There is appropriated 13 to carry out this subsection, in equal parts from the 14 Federal Hospital Insurance Trust Fund under sec- 15 tion 1817 of the Social Security Act (42 U.S.C. 16 1395i) and the Federal Supplementary Medical In- 17 surance Trust Fund under section 1841 of such Act 18 (42 U.S.C. 1395t), $16,000,000 for each fiscal year 19 of the demonstration program. 20 (12) ENGLISH LEARNER DEFINED.—In this 21 subsection, the term ‘‘English learner’’ has the 22 meaning given such term in section 8101(20) of the 23 Elementary and Secondary Education Act of 1965, 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00103 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 104 •HR 5475 IH except that subparagraphs (A), (B), and (D) of such 1 section shall not apply. 2 (b) LANGUAGE SERVICES UNDER THE MEDICARE 3 PROGRAM.— 4 (1) INCLUSION AS RURAL HEALTH CLINIC 5 SERVICES.—Section 1861 of the Social Security Act 6 (42 U.S.C. 1395x) is amended— 7 (A) in subsection (aa)(1)— 8 (i) in subparagraph (B), by striking 9 the ‘‘and’’ at the end; 10 (ii) by adding ‘‘and’’ at the end of 11 subparagraph (C); and 12 (iii) by inserting after subparagraph 13 (C) the following new subparagraph: 14 ‘‘(D) language services as defined in subsection 15 (iii)(1),’’; and 16 (B) by adding at the end the following new 17 subsection: 18 ‘‘Language Services and Related Terms 19 ‘‘(iii) 20 ‘‘(1) The term ‘language services’ has the same 21 meaning given the term ‘language or language ac- 22 cess services’ in section 3400 of the Public Health 23 Service Act. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00104 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 105 •HR 5475 IH ‘‘(2) The term ‘interpreter services’ has the meaning 1 given the term ‘competent interpreter services’ in section 2 3400(3) of the Public Health Service Act. 3 ‘‘(3) The term ‘interpreter’— 4 ‘‘(A) means an individual— 5 ‘‘(i) who faithfully, accurately, and objec- 6 tively transmits a spoken message from one lan- 7 guage into another language; and 8 ‘‘(ii) who knows health and health-related 9 terminology in both languages; and 10 ‘‘(B) includes individuals who provide in-person, 11 telephonic, and video interpretation. 12 ‘‘(4) The term ‘translation’ means the transmission 13 of a written message in one language into a written mes- 14 sage in another language that retains the intended mean- 15 ing of the original message. 16 ‘‘(5) The term ‘English learner’ has the meaning 17 given such term in section 8101(20) of the Elementary 18 and Secondary Education Act of 1965, except that sub- 19 paragraphs (A), (B), and (D) of such section shall not 20 apply.’’. 21 (2) COVERAGE.—Section 1832(a)(2) of the So- 22 cial Security Act (42 U.S.C. 1395k(a)(2)) is amend- 23 ed— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 106 •HR 5475 IH (A) by striking ‘‘and’’ at the end of sub- 1 paragraph (I); 2 (B) by striking the period at the end of 3 subparagraph (J) and inserting ‘‘; and’’; and 4 (C) by adding at the end the following new 5 subparagraph: 6 ‘‘(K) language services (as defined in para- 7 graph (1) of section 1861(iii)) furnished by an 8 interpreter (as defined in paragraph (3) of such 9 section) or translator.’’. 10 (3) PAYMENT.—Section 1833(a) of the Social 11 Security Act (42 U.S.C. 1395l(a)) is amended— 12 (A) by striking ‘‘and’’ at the end of para- 13 graph (8); 14 (B) by striking the period at the end of 15 paragraph (9) and inserting ‘‘; and’’; and 16 (C) by inserting after paragraph (9) the 17 following new paragraph: 18 ‘‘(10) in the case of language services described 19 in section 1861(iii)(1), 100 percent of the reasonable 20 charges for such services, as determined in consulta- 21 tion with the Medicare Payment Advisory Commis- 22 sion; and’’. 23 (4) WAIVER OF BUDGET NEUTRALITY.—For 24 the 3-year period beginning on the date of enact- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00106 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 107 •HR 5475 IH ment of this section, the budget neutrality provision 1 of section 1848(c)(2)(B)(ii) of the Social Security 2 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 3 apply with respect to language services (as such 4 term is defined in section 1861(iii)(1) of such Act). 5 (c) MEDICARE PARTS C AND D.— 6 (1) IN GENERAL.—Medicare Advantage plans 7 under part C of the Social Security Act and pre- 8 scription drug plans under part D of such Act shall 9 comply with title VI of the Civil Rights Act of 1964 10 and section 1557 of the Patient Protection and Af- 11 fordable Care Act (42 U.S.C. 18116) to provide ef- 12 fective language services to enrollees of such plans. 13 (2) MEDICARE ADVANTAGE PLANS AND PRE- 14 SCRIPTION DRUG PLANS REPORTING REQUIRE- 15 MENT.—Section 1857(e) of the Social Security Act 16 (42 U.S.C. 1395w–27(e)) is amended by adding at 17 the end the following new paragraph: 18 ‘‘(5) REPORTING REQUIREMENTS RELATING TO 19 EFFECTIVE LANGUAGE SERVICES.—A contract under 20 this part shall require a Medicare Advantage organi- 21 zation (and, through application of section 1860D– 22 12(b)(3)(D), a contract under section 1860D–12 23 shall require a PDP sponsor) to annually submit 24 (for each year of the contract) a report that contains 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 108 •HR 5475 IH information on the plan’s internal policies and proce- 1 dures related to recruitment and retention efforts di- 2 rected to workforce diversity and linguistically and 3 culturally appropriate provision of services in each of 4 the following contexts: 5 ‘‘(A) The collection of data in a manner 6 that meets the requirements of title I of the 7 Health Equity and Accountability Act of 2016, 8 regarding the enrollee population. 9 ‘‘(B) Education of staff and contractors 10 who have routine contact with enrollees regard- 11 ing the various needs of the diverse enrollee 12 population. 13 ‘‘(C) Evaluation of the health plan’s lan- 14 guage services programs and services with re- 15 spect to the plan’s enrollee population, such as 16 through analysis of complaints or satisfaction 17 survey results. 18 ‘‘(D) Methods by which the plan provides 19 to the Secretary information regarding the eth- 20 nic diversity of the plan’s enrollee population. 21 ‘‘(E) The periodic provision of educational 22 information to plan enrollees on the plan’s lan- 23 guage services and programs.’’. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00108 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 109 •HR 5475 IH (d) IMPROVING LANGUAGE SERVICES IN MEDICAID 1 AND CHIP.— 2 (1) PAYMENTS TO STATES.—Section 3 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 4 1396b(a)(2)(E)) is amended by— 5 (A) striking ‘‘75’’ and inserting ‘‘90’’; 6 (B) striking ‘‘translation or interpretation 7 services’’ and inserting ‘‘language services’’; 8 and 9 (C) striking ‘‘children of families’’ and in- 10 serting ‘‘individuals’’. 11 (2) STATE PLAN REQUIREMENTS.—Section 12 1902(a)(10)(A) of the Social Security Act (42 13 U.S.C. 1396a(a)(10)(A)) is amended by striking 14 ‘‘and (28)’’ and inserting ‘‘(28), and (29)’’. 15 (3) DEFINITION OF MEDICAL ASSISTANCE.— 16 Section 1905(a) of the Social Security Act (42 17 U.S.C. 1396d(a)) is amended by— 18 (A) in paragraph (28), by striking ‘‘and’’ 19 at the end; 20 (B) by redesignating paragraph (29) as 21 paragraph (30); and 22 (C) by inserting after paragraph (28) the 23 following new paragraph: 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 110 •HR 5475 IH ‘‘(29) language services, as such term is defined 1 in section 1861(iii)(1), provided in a timely manner 2 to English learners (as defined in section 3 1861(iii)(5)) who need such services; and’’. 4 (4) USE OF DEDUCTIONS AND COST SHAR- 5 ING.—Section 1916(a)(2) of the Social Security Act 6 (42 U.S.C. 1396o(2)) is amended by— 7 (A) by striking ‘‘or’’ at the end of subpara- 8 graph (D); 9 (B) by striking ‘‘; and’’ at the end of sub- 10 paragraph (E) and inserting ‘‘, or’’; and 11 (C) by adding at the end the following new 12 subparagraph: 13 ‘‘(F) language services described in section 14 1905(a)(29); and’’. 15 (5) CHIP COVERAGE REQUIREMENTS.—Section 16 2103 of the Social Security Act (42 U.S.C. 1397cc) 17 is amended— 18 (A) in subsection (a), in the matter before 19 paragraph (1), by striking ‘‘and (7)’’ and in- 20 serting ‘‘(7), and (9)’’; and 21 (B) in subsection (c), by adding at the end 22 the following new paragraph: 23 ‘‘(9) LANGUAGE SERVICES.—The child health 24 assistance provided to a targeted low-income child 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00110 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 111 •HR 5475 IH shall include coverage of language services, as such 1 term is defined in section 1861(iii)(1), provided in a 2 timely manner to English learners (as defined in 3 section 1861(iii)(5)) who need such services.’’; and 4 (C) in subsection (e)(2)— 5 (i) in the heading, by striking ‘‘PRE- 6 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 7 (ii) by inserting ‘‘or subsection (c)(9)’’ 8 after ‘‘subsection (c)(1)(D)’’. 9 (6) DEFINITION OF CHILD HEALTH ASSIST- 10 ANCE.—Section 2110(a)(27) of the Social Security 11 Act (42 U.S.C. 1397jj) is amended by striking 12 ‘‘translation’’ and inserting ‘‘language services as 13 described in section 2103(c)(9)’’. 14 (7) STATE DATA COLLECTION.—Pursuant to 15 the reporting requirement described in section 16 2107(b)(1) of the Social Security Act (42 U.S.C. 17 1397gg(b)(1)), the Secretary of Health and Human 18 Services shall require that States collect data on— 19 (A) the primary language of individuals re- 20 ceiving child health assistance under title XXI 21 of the Social Security Act; and 22 (B) in the case of such individuals who are 23 minors or incapacitated, the primary language 24 of the individual’s parent or guardian. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00111 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 112 •HR 5475 IH (8) CHIP PAYMENTS TO STATES.—Section 1 2105 of the Social Security Act (42 U.S.C. 2 1397ee(c)) is amended— 3 (A) in subsection (a)(1), by striking ‘‘75’’ 4 and inserting ‘‘90’’; and 5 (B) in subsection (c)(2)(A), by inserting 6 before the period at the end the following: ‘‘, 7 except that expenditures pursuant to clause (iv) 8 of subparagraph (D) of such paragraph shall 9 not count towards this total’’. 10 (e) FUNDING LANGUAGE SERVICES FURNISHED BY 11 PROVIDERS OF HEALTH CARE AND HEALTH-CARE-RE- 12 LATED SERVICES THAT SERVE HIGH RATES OF UNIN- 13 SURED LEP INDIVIDUALS.— 14 (1) PAYMENT OF COSTS.— 15 (A) IN GENERAL.—Subject to subpara- 16 graph (B), the Secretary of Health and Human 17 Services shall make payments (on a quarterly 18 basis) directly to eligible entities to support the 19 provision of language services to English learn- 20 ers in an amount equal to an eligible entity’s el- 21 igible costs for such services for the quarter. 22 (B) FUNDING.—Out of any funds in the 23 Treasury not otherwise appropriated, there are 24 appropriated to the Secretary of Health and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00112 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 113 •HR 5475 IH Human Services such sums as may be nec- 1 essary for each of fiscal years 2017 through 2 2021. 3 (C) RELATION TO MEDICAID DSH.—Pay- 4 ments under this subsection shall not offset or 5 reduce payments under section 1923 of the So- 6 cial Security Act, nor shall payments under 7 such section be considered when determining 8 uncompensated costs associated with the provi- 9 sion of language services. 10 (2) METHODOLOGY FOR PAYMENT OF 11 CLAIMS.— 12 (A) IN GENERAL.—The Secretary shall es- 13 tablish a methodology to determine the average 14 per person cost of language services. 15 (B) DIFFERENT ENTITIES.—In estab- 16 lishing such methodology, the Secretary may es- 17 tablish different methodologies for different 18 types of eligible entities. 19 (C) NO INDIVIDUAL CLAIMS.—The Sec- 20 retary may not require eligible entities to sub- 21 mit individual claims for language services for 22 individual patients as a requirement for pay- 23 ment under this subsection. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00113 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 114 •HR 5475 IH (3) DATA COLLECTION INSTRUMENT.—For pur- 1 poses of this subsection, the Secretary shall create a 2 standard data collection instrument that is con- 3 sistent with any existing reporting requirements by 4 the Secretary or relevant accrediting organizations 5 regarding the number of individuals to whom lan- 6 guage access are provided. 7 (4) GUIDELINES.—Not later than 6 months 8 after the date of enactment of this Act, the Sec- 9 retary of Health and Human Services shall establish 10 and distribute guidelines concerning the implementa- 11 tion of this subsection. 12 (5) REPORTING REQUIREMENTS.— 13 (A) REPORT TO SECRETARY.—Entities re- 14 ceiving payment under this subsection shall pro- 15 vide the Secretary with a quarterly report on 16 how the entity used such funds. Such report 17 shall contain aggregate (and may not contain 18 individualized) data collected using the instru- 19 ment under paragraph (3) and shall otherwise 20 be in a form and manner determined by the 21 Secretary. 22 (B) REPORT TO CONGRESS.—Not later 23 than 2 years after the date of enactment of this 24 Act, and every 2 years thereafter, the Secretary 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00114 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 115 •HR 5475 IH shall submit a report to Congress concerning 1 the implementation of this subsection. 2 (6) DEFINITIONS.—In this subsection: 3 (A) ELIGIBLE COSTS.—The term ‘‘eligible 4 costs’’ means, with respect to an eligible entity 5 that provides language services to English 6 learners, the product of— 7 (i) the average per person cost of lan- 8 guage services, determined according to 9 the methodology devised under paragraph 10 (2); and 11 (ii) the number of English learners 12 who are provided language services by the 13 entity and for whom no reimbursement is 14 available for such services under the 15 amendments made by subsections (a), (b), 16 (c), or (d) or by private health insurance. 17 (B) ELIGIBLE ENTITY.—The term ‘‘eligible 18 entity’’ means an entity that— 19 (i) is a Medicaid provider that is— 20 (I) a physician; 21 (II) a hospital with a low-income 22 utilization rate (as defined in section 23 1923(b)(3) of the Social Security Act 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00115 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 116 •HR 5475 IH (42 U.S.C. 1396r–4(b)(3))) of greater 1 than 25 percent; or 2 (III) a federally qualified health 3 center (as defined in section 4 1905(l)(2)(B) of the Social Security 5 Act (42 U.S.C. 1396d(l)(2)(B))); 6 (ii) provide language services to at 7 least 8 percent of the entity’s total number 8 of patients, not later than 6 months after 9 the date of the enactment of the Act; and 10 (iii) prepare and submit an applica- 11 tion to the Secretary, at such time, in such 12 manner, and accompanied by such infor- 13 mation as the Secretary may require to as- 14 certain the entity’s eligibility for funding 15 under this subsection. 16 (C) ENGLISH LEARNER.—The term 17 ‘‘English learner’’ has the meaning given such 18 term in section 8101(20) of the Elementary 19 and Secondary Education Act of 1965, except 20 that subparagraphs (A), (B), and (D) of such 21 section shall not apply. 22 (D) LANGUAGE SERVICES.—The term 23 ‘‘language services’’ has the meaning given such 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00116 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 117 •HR 5475 IH term in section 1861(iii)(1) of the Social Secu- 1 rity Act. 2 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964 AND 3 OTHER LAWS.—Nothing in this section shall be construed 4 to limit otherwise existing obligations of recipients of Fed- 5 eral financial assistance under title VI of the Civil Rights 6 Act of 1964 (42 U.S.C. 2000(d) et seq.) or other laws 7 that protect the civil rights of individuals. 8 (g) EFFECTIVE DATE.— 9 (1) IN GENERAL.—Except as otherwise pro- 10 vided and subject to paragraph (2), the amendments 11 made by this section shall take effect on January 1, 12 2017. 13 (2) EXCEPTION IF STATE LEGISLATION RE- 14 QUIRED.—In the case of a State plan for medical as- 15 sistance under title XIX of the Social Security Act 16 which the Secretary of Health and Human Services 17 determines requires State legislation (other than leg- 18 islation appropriating funds) in order for the plan to 19 meet the additional requirement imposed by the 20 amendments made by this section, the State plan 21 shall not be regarded as failing to comply with the 22 requirements of such title solely on the basis of its 23 failure to meet this additional requirement before 24 the first day of the first calendar quarter beginning 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00117 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 118 •HR 5475 IH after the close of the first regular session of the 1 State legislature that begins after the date of the en- 2 actment of this Act. For purposes of the previous 3 sentence, in the case of a State that has a 2-year 4 legislative session, each year of such session shall be 5 deemed to be a separate regular session of the State 6 legislature. 7 SEC. 206. INCREASING UNDERSTANDING OF AND IMPROV- 8 ING HEALTH LITERACY. 9 (a) IN GENERAL.—The Secretary, acting through the 10 Director of the Agency for Healthcare Research and Qual- 11 ity and the Administrator of the Health Resources and 12 Services Administration, in consultation with the Director 13 of the National Institute on Minority Health and Health 14 Disparities and the Office of Minority Health, shall award 15 grants to eligible entities to improve health care for pa- 16 tient populations that have low functional health literacy. 17 (b) ELIGIBILITY.—To be eligible to receive a grant 18 under subsection (a), an entity shall— 19 (1) be a hospital, health center or clinic, health 20 plan, or other health entity (including a nonprofit 21 minority health organization or association); and 22 (2) prepare and submit to the Secretary an ap- 23 plication at such time, in such manner, and con- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 119 •HR 5475 IH taining such information as the Secretary may re- 1 quire. 2 (c) USE OF FUNDS.— 3 (1) AGENCY FOR HEALTHCARE RESEARCH AND 4 QUALITY.—Grants awarded under subsection (a) 5 through the Agency for Healthcare Research and 6 Quality shall be used— 7 (A) to define and increase the under- 8 standing of health literacy; 9 (B) to investigate the correlation between 10 low health literacy and health and health care; 11 (C) to clarify which aspects of health lit- 12 eracy have an effect on health outcomes; and 13 (D) for any other activity determined ap- 14 propriate by the Director of the Agency. 15 (2) HEALTH RESOURCES AND SERVICES ADMIN- 16 ISTRATION.—Grants awarded under subsection (a) 17 through the Health Resources and Services Adminis- 18 tration shall be used to conduct demonstration 19 projects for interventions for patients with low 20 health literacy that may include— 21 (A) the development of new disease man- 22 agement programs for patients with low health 23 literacy; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00119 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 120 •HR 5475 IH (B) the tailoring of existing disease man- 1 agement programs addressing mental, physical, 2 oral, and behavioral health conditions for pa- 3 tients with low health literacy; 4 (C) the translation of written health mate- 5 rials for patients with low health literacy; 6 (D) the identification, implementation, and 7 testing of low health literacy screening tools; 8 (E) the conduct of educational campaigns 9 for patients and providers about low health lit- 10 eracy; and 11 (F) other activities determined appropriate 12 by the Administrator of the Health Resources 13 and Services Administration. 14 (d) DEFINITIONS.—In this section, the term ‘‘low 15 health literacy’’ means the inability of an individual to ob- 16 tain, process, and understand basic health information 17 and services needed to make appropriate health decisions. 18 (e) AUTHORIZATION OF APPROPRIATIONS.—There 19 are authorized to be appropriated to carry out this section, 20 such sums as may be necessary for each of fiscal years 21 2017 through 2021. 22 SEC. 207. ASSURANCES FOR RECEIVING FEDERAL FUNDS. 23 (a) IN GENERAL.—Any health program or activity, 24 any part of which is receiving Federal financial assistance, 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00120 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 121 •HR 5475 IH including credits, subsidies, or contracts of insurance, and 1 any program or activity that is administered by an execu- 2 tive agency or any entity established under title I of the 3 Patient Protection and Affordable Care Act (or amend- 4 ments made thereby), as such programs, activities, agen- 5 cies, and entities are described in section 1557(a) of the 6 Patient Protection and Affordable Care Act (42 U.S.C. 7 18116), in order to ensure the right of LEP individuals 8 to receive access to quality health care, shall— 9 (1) ensure that appropriate clinical and support 10 staff receive ongoing education and training in lin- 11 guistically appropriate service delivery; 12 (2) offer and provide appropriate language serv- 13 ices at no additional charge to each patient with lim- 14 ited-English-proficiency at all points of contact, in a 15 timely manner during all hours of operation; 16 (3) notify patients of their right to receive lan- 17 guage services in their primary language; and 18 (4) utilize only competent interpreter or trans- 19 lation services, as defined in section 3400 of the 20 Public Health Service Act. 21 (b) EXEMPTIONS.—The requirements of subsection 22 (a)(4) shall not apply as follows: 23 (1) When a patient (who has been informed in 24 his or her primary language of the availability of 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00121 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 122 •HR 5475 IH free interpreter and translation services) requests 1 the use of family, friends, or other persons untrained 2 in interpretation or translation if the following con- 3 ditions are met: 4 (A) The interpreter requested by the pa- 5 tient is over the age of 18. 6 (B) The recipient informs the patient that 7 he or she has the option of having the recipient 8 provide an interpreter for him or her without 9 charge, or of using his or her own interpreter. 10 (C) The recipient informs the patient that 11 the recipient may not require an LEP person to 12 use a family member or friend as an inter- 13 preter. 14 (D) The recipient evaluates whether the 15 person the patient wishes to use as an inter- 16 preter is competent. If the recipient has reason 17 to believe that the interpreter is not competent, 18 the recipient provides the recipient’s own inter- 19 preter to protect the recipient from liability if 20 the patient’s interpreter is later found not com- 21 petent. 22 (E) If the recipient has reason to believe 23 that there is a conflict of interest between the 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 123 •HR 5475 IH interpreter and patient, the recipient may not 1 use the patient’s interpreter. 2 (F) The recipient has the patient sign a 3 waiver, witnessed by at least 1 individual not 4 related to the patient, that includes the infor- 5 mation stated in subparagraphs (A) through 6 (E) and is translated into the patient’s lan- 7 guage. 8 (2) When a medical emergency exists and the 9 delay directly associated with obtaining competent 10 interpreter or translation services would jeopardize 11 the health of the patient, but only until a competent 12 interpreter or translation service is available. 13 (c) RULE OF CONSTRUCTION.—Subsection (b)(2) 14 shall not be construed to mean that emergency rooms or 15 similar entities that regularly provide health care services 16 in medical emergencies are exempt from legal or regu- 17 latory requirements related to competent interpreter serv- 18 ices. 19 SEC. 208. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL- 20 TURALLY AND LINGUISTICALLY APPRO- 21 PRIATE HEALTH CARE SERVICES. 22 (a) REPORT.—Not later than 1 year after the date 23 of enactment of this Act and annually thereafter, the Sec- 24 retary of Health and Human Services shall enter into a 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00123 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 124 •HR 5475 IH contract with the Institute of Medicine for the preparation 1 and publication of a report that describes Federal efforts 2 to ensure that all individuals with limited-English pro- 3 ficiency have meaningful access culturally competent to 4 health care and health-care-related services. Such report 5 shall include— 6 (1) a description and evaluation of the activities 7 carried out under this Act; 8 (2) a description and analysis of best practices, 9 model programs, guidelines, and other effective 10 strategies for providing access to culturally and lin- 11 guistically appropriate health care services; 12 (3) recommendations on the development and 13 implementation of policies and practices by providers 14 of health care and health-care-related services for 15 limited-English-proficient individuals; 16 (4) a description of the effect of providing lan- 17 guage services on quality of health care and access 18 to care; and 19 (5) a description of the costs associated with or 20 savings related to the provision of language services. 21 (b) AUTHORIZATION OF APPROPRIATIONS.—There 22 are authorized to be appropriated to carry out this section 23 such sums as may be necessary for each of fiscal years 24 2017 through 2021. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00124 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 125 •HR 5475 IH SEC. 209. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES. 1 (a) GRANTS AUTHORIZED.—The Secretary of Edu- 2 cation is authorized to provide grants to eligible entities 3 for the provision of English as a second language (in this 4 section referred to ‘‘ESL’’) instruction and shall deter- 5 mine, after consultation with appropriate stakeholders, the 6 mechanism for administering and distributing such 7 grants. 8 (b) ELIGIBLE ENTITY DEFINED.—For purposes of 9 this section, the term ‘‘eligible entity’’ means a State or 10 community-based organization that employs, and serves, 11 minority populations. 12 (c) APPLICATION.—An eligible entity may apply for 13 a grant under this section by submitting such information 14 as the Secretary may require and in such form and man- 15 ner as the Secretary may require. 16 (d) USE OF GRANT.—As a condition of receiving a 17 grant under this section, an eligible entity shall— 18 (1) develop and implement a plan for assuring 19 the availability of ESL instruction that effectively 20 integrates information about the nature of the 21 United States health care system, how to access 22 care, and any special language skills that may be re- 23 quired for them to access and regularly negotiate the 24 system effectively; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00125 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 126 •HR 5475 IH (2) develop a plan, including, where appro- 1 priate, public-private partnerships, for making ESL 2 instruction progressively available to all individuals 3 seeking instruction; and 4 (3) maintain current ESL instruction efforts by 5 using the additional funds to supplement rather 6 than supplant any funds expended for ESL instruc- 7 tion in the State as of January 1, 2017. 8 (e) ADDITIONAL DUTIES OF THE SECRETARY.—The 9 Secretary of Education shall— 10 (1) collect and publicize annual data on how 11 much Federal, State, and local governments spend 12 on ESL instruction; 13 (2) collect data from State and local govern- 14 ments to identify the unmet needs of English lan- 15 guage learners for appropriate ESL instruction, in- 16 cluding— 17 (A) the preferred written and spoken lan- 18 guage of such English language learners; 19 (B) the extent of waiting lists including 20 how many programs maintain waiting lists and, 21 for programs that do not have waiting lists, the 22 reasons why not; 23 (C) the availability of programs to geo- 24 graphically isolated communities; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00126 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 127 •HR 5475 IH (D) the impact of course enrollment poli- 1 cies, including open enrollment, on the avail- 2 ability of ESL instruction; 3 (E) the number individuals in the State 4 and each participating locality; 5 (F) the effectiveness of the instruction in 6 meeting the needs of individuals receiving in- 7 struction and those needing instruction; 8 (G) as assessment of the need for pro- 9 grams that integrate job training and ESL in- 10 struction, to assist individuals to obtain better 11 jobs; and 12 (H) the availability of ESL slots by State 13 and locality; 14 (3) determine the cost and most appropriate 15 methods of making ESL instruction available to all 16 English language learners seeking instruction; and 17 (4) within 1 year of the date of enactment of 18 this Act, issue a report to Congress that assesses the 19 information collected in paragraphs (1), (2), and (3) 20 and makes recommendations on steps that should be 21 taken to progressively realize the goal of making 22 ESL instruction available to all English language 23 learners seeking instruction. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00127 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 128 •HR 5475 IH (f) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated to the Secretary of Edu- 2 cation for each of fiscal years 2017 through 2020 3 $250,000,000 to carry out this section. 4 SEC. 210. IMPLEMENTATION. 5 (a) GENERAL PROVISIONS.— 6 (1) A State shall not be immune under the 7 Eleventh Amendment of the Constitution of the 8 United States from suit in Federal court for failing 9 to provide the language access funded pursuant to 10 this title. 11 (2) In a suit against a State for a violation of 12 this title, remedies (including remedies at both at 13 law and in equity) are available for such a violation 14 to the same extent as such remedies are available for 15 such a violation in the suit against any public or pri- 16 vate entity other than a State. 17 (b) RULE OF CONSTRUCTION.—Nothing in this title 18 shall be construed to limit otherwise existing obligations 19 of recipients of Federal financial assistance under title VI 20 of the Civil Rights Act of 1964 (42 U.S.C. 2000(d) et 21 seq.) or any other statute. 22 SEC. 211. LANGUAGE ACCESS SERVICES. 23 (a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 24 the Patient Protection and Affordable Care Act (42 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00128 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 129 •HR 5475 IH U.S.C. 18022(b)(1)) is amended by adding at the end the 1 following: 2 ‘‘(K) Language access services, including 3 oral interpretation and written translations.’’. 4 (b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL 5 COVERAGE.—Section 36B(c)(2)(C) of the Internal Rev- 6 enue Code of 1986 is amended by adding at the end the 7 following: 8 ‘‘(v) COVERAGE MUST INCLUDE LAN- 9 GUAGE ACCESS AND SERVICES.—Except as 10 provided in clause (iii), an employee shall 11 not be treated as eligible for minimum es- 12 sential coverage if such coverage consists 13 of an eligible employer-sponsored plan (as 14 defined in section 5000A(f)(2)) and the 15 plan does not provide coverage for lan- 16 guage access services, including oral inter- 17 pretation and written translations.’’. 18 (c) QUALITY REPORTING.—Section 2717(a)(1) of the 19 Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 20 amended— 21 (1) by striking ‘‘and’’ at the end of subpara- 22 graph (C); 23 (2) by striking the period at the end of sub- 24 paragraph (D) and inserting ‘‘; and’’; and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00129 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 130 •HR 5475 IH (3) by adding at the end the following new sub- 1 paragraph: 2 ‘‘(E) reduce health disparities through the 3 provision of language access services, including 4 oral interpretation and written translations.’’. 5 (d) REGULATIONS REGARDING INTERNAL CLAIMS 6 AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR 7 HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 8 The Secretary of the Treasury, the Secretary of Labor, 9 and the Secretary of Health and Human Services shall 10 amend the regulations in section 54.9815–2719T(e) of 11 title 26, Code of Federal Regulations, section 2590.715– 12 2719(e) of title 29, Code of Federal Regulations, and sec- 13 tion 147.136(e) of title 45, Code of Federal Regulations, 14 respectively, to require group health plans and health in- 15 surance issuers offering group or individual health insur- 16 ance coverage to which such sections apply— 17 (1) to provide oral interpretation services with- 18 out any threshold requirements; 19 (2) to provide in the English versions of all no- 20 tices a statement prominently displayed in not less 21 than 15 non-English languages clearly indicating 22 how to access the language services provided by the 23 plan or issuer; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00130 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 131 •HR 5475 IH (3) with respect to written translations of no- 1 tices, to apply a threshold that 5 percent of the pop- 2 ulation or at least 500 individuals per service area 3 are literate only in the same non-English language 4 in lieu of 10 percent or more residing in a county. 5 (e) DATA COLLECTION AND REPORTING.—The Sec- 6 retary of Health and Human Services shall— 7 (1) amend the single streamlined application 8 form developed pursuant to section 1413 of the Pa- 9 tient Protection and Affordable Care Act (42 U.S.C. 10 18083) to collect the preferred spoken and written 11 language for each household member applying for 12 coverage under a qualified health plan through an 13 Exchange under title I of the Patient Protection and 14 Affordable Care Act; 15 (2) require navigators, certified application 16 counselors, and other enrollment assisters to collect 17 and report requests for language assistance; and 18 (3) require the Federal and State call centers 19 established pursuant to section 1311(d)(4)(b) of the 20 Patient Protection and Affordable Care Act (42 21 U.S.C. 18031(d)(4)(b)) to submit an annual report 22 documenting the number of language assistance re- 23 quests, the types of languages requested, the range 24 and average wait time for a consumer to speak with 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00131 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 132 •HR 5475 IH an interpreter, and any steps the call center and lan- 1 guage line have taken to actively address some of 2 the consumer complaints. 3 (f) EFFECTIVE DATE.—The amendments made by 4 this section shall apply to plan years beginning after the 5 date of the enactment of this Act. 6 TITLE III—HEALTH WORKFORCE 7 DIVERSITY 8 SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 9 ACT. 10 Title XXXIV of the Public Health Service Act, as 11 added by section 202, is amended by adding at the end 12 the following: 13 ‘‘Subtitle A—Diversifying the 14 Health Care Workplace 15 ‘‘SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE 16 DIVERSITY. 17 ‘‘(a) IN GENERAL.—The Secretary, acting through 18 the Bureau of Health Workforce within the Health Re- 19 sources and Services Administration, shall award a grant 20 to an entity determined appropriate by the Secretary for 21 the establishment of a national working group on work- 22 force diversity. 23 ‘‘(b) REPRESENTATION.—In establishing the national 24 working group under subsection (a): 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00132 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 133 •HR 5475 IH ‘‘(1) The grantee shall ensure that the group 1 has representatives of the following: 2 ‘‘(A) The Health Resources and Services 3 Administration. 4 ‘‘(B) The Department of Health and 5 Human Services Data Council. 6 ‘‘(C) The Office of Minority Health of the 7 Department of Health and Human Services. 8 ‘‘(D) The Substance Abuse and Mental 9 Health Services Administration. 10 ‘‘(E) The Bureau of Labor Statistics of 11 the Department of Labor. 12 ‘‘(F) The Public Health Practice Program 13 Office—Office of Workforce Policy and Plan- 14 ning. 15 ‘‘(G) The National Institute on Minority 16 Health and Health Disparities. 17 ‘‘(H) The Agency for Healthcare Research 18 and Quality. 19 ‘‘(I) The Institute of Medicine Study Com- 20 mittee for the 2004 workforce diversity report. 21 ‘‘(J) The Indian Health Service. 22 ‘‘(K) The Department of Education. 23 ‘‘(L) Minority-serving academic institu- 24 tions. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00133 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 134 •HR 5475 IH ‘‘(M) Consumer organizations. 1 ‘‘(N) Health professional associations, in- 2 cluding those that represent underrepresented 3 minority populations. 4 ‘‘(O) Researchers in the area of health 5 workforce. 6 ‘‘(P) Health workforce accreditation enti- 7 ties. 8 ‘‘(Q) Private (including nonprofit) founda- 9 tions that have sponsored workforce diversity 10 initiatives. 11 ‘‘(R) Local and State health departments. 12 ‘‘(S) Representatives of community mem- 13 bers to be included on admissions committees 14 for health profession schools pursuant to sub- 15 section (c)(8). 16 ‘‘(T) National community-based organiza- 17 tions that serve as a national intermediary to 18 their urban affiliate members and have dem- 19 onstrated capacity to train health care profes- 20 sionals. 21 ‘‘(U) Other entities determined appropriate 22 by the Secretary. 23 ‘‘(2) The grantee shall ensure that, in addition 24 to the representatives under paragraph (1), the 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00134 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 135 •HR 5475 IH group has not less than 5 health professions stu- 1 dents representing various health profession fields 2 and levels of training. 3 ‘‘(c) ACTIVITIES.—The working group established 4 under subsection (a) shall convene at least twice each year 5 to complete the following activities: 6 ‘‘(1) Review current public and private health 7 workforce diversity initiatives. 8 ‘‘(2) Identify successful health workforce diver- 9 sity programs and practices. 10 ‘‘(3) Examine challenges relating to the devel- 11 opment and implementation of health workforce di- 12 versity initiatives. 13 ‘‘(4) Draft a national strategic work plan for 14 health workforce diversity, including recommenda- 15 tions for public and private sector initiatives. 16 ‘‘(5) Develop a framework and methods for the 17 evaluation of current and future health workforce di- 18 versity initiatives. 19 ‘‘(6) Develop recommended standards for work- 20 force diversity that could be applicable to all health 21 professions programs and programs funded under 22 this Act. 23 ‘‘(7) Develop guidelines to train health profes- 24 sionals to care for a diverse population. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00135 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 136 •HR 5475 IH ‘‘(8) Develop a strategy for the inclusion of 1 community members on admissions committees for 2 health profession schools. 3 ‘‘(9) Helping with monitoring and implementa- 4 tion of standards for diversity, equity, and inclusion. 5 ‘‘(10) Other activities determined appropriate 6 by the Secretary. 7 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 8 the establishment of the working group under subsection 9 (a), and annually thereafter, the working group shall pre- 10 pare and make available to the general public for com- 11 ment, an annual report on the activities of the working 12 group. Such report shall include the recommendations of 13 the working group for improving health workforce diver- 14 sity. 15 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 16 is authorized to be appropriated to carry out this section 17 such sums as may be necessary for each of fiscal years 18 2017 through 2022. 19 ‘‘SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH 20 WORKFORCE DIVERSITY. 21 ‘‘(a) IN GENERAL.—The Secretary, acting through 22 the Deputy Assistant Secretary for Minority Health, and 23 in collaboration with the Bureau of Health Workforce 24 within the Health Resources and Services Administration, 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00136 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 137 •HR 5475 IH the National Institute on Minority Health and Health Dis- 1 parities, shall establish a technical clearinghouse on health 2 workforce diversity within the Office of Minority Health 3 and coordinate current and future clearinghouses. 4 ‘‘(b) INFORMATION AND SERVICES.—The clearing- 5 house established under subsection (a) shall offer the fol- 6 lowing information and services: 7 ‘‘(1) Information on the importance of health 8 workforce diversity. 9 ‘‘(2) Statistical information relating to under- 10 represented minority representation in health and al- 11 lied health professions and occupations. 12 ‘‘(3) Model health workforce diversity practices 13 and programs, including integrated models of care. 14 ‘‘(4) Admissions policies that promote health 15 workforce diversity and are in compliance with Fed- 16 eral and State laws. 17 ‘‘(5) Retainment policies that promote comple- 18 tion of health profession degrees for underserved 19 populations. 20 ‘‘(6) Lists of scholarship, loan repayment, and 21 loan cancellation grants as well as fellowship infor- 22 mation for underserved populations for health pro- 23 fessions schools. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00137 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 138 •HR 5475 IH ‘‘(7) Foundation and other large organizational 1 initiatives relating to health workforce diversity. 2 ‘‘(c) CONSULTATION.—In carrying out this section, 3 the Secretary shall consult with non-Federal entities which 4 may include minority health professional associations and 5 minority sections of major health professional associations 6 to ensure the adequacy and accuracy of information. 7 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 8 is authorized to be appropriated to carry out this section 9 such sums as may be necessary for each of fiscal years 10 2017 through 2022. 11 ‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO 12 WORKFORCE DIVERSITY, EQUITY, AND IN- 13 CLUSION. 14 ‘‘(a) IN GENERAL.—The Secretary, acting through 15 the Administrator of the Health Resources and Services 16 Administration and the Centers for Disease Control and 17 Prevention, shall award grants to eligible entities that 18 demonstrate a commitment to health workforce diversity. 19 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 20 under subsection (a), an entity shall— 21 ‘‘(1) be an educational institution or entity that 22 historically produces or trains meaningful numbers 23 of underrepresented minority health professionals, 24 including— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00138 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 139 •HR 5475 IH ‘‘(A) historically Black colleges and univer- 1 sities; 2 ‘‘(B) Hispanic-serving health professions 3 schools; 4 ‘‘(C) Hispanic-serving institutions; 5 ‘‘(D) tribal colleges and universities; 6 ‘‘(E) Asian-American, Native American, 7 and Pacific Islander-serving institutions; 8 ‘‘(F) institutions that have programs to re- 9 cruit and retain underrepresented minority 10 health professionals, in which a significant 11 number of the enrolled participants are under- 12 represented minorities; 13 ‘‘(G) health professional associations, 14 which may include underrepresented minority 15 health professional associations; and 16 ‘‘(H) institutions, including national and 17 regional community-based organizations with 18 demonstrated commitment to a diversified 19 workforce— 20 ‘‘(i) located in communities with pre- 21 dominantly underrepresented minority pop- 22 ulations; 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00139 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 140 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00140 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 141 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00141 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 142 •HR 5475 IH such sums as may be necessary for each of fiscal years 1 2017 through 2022. 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00142 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 143 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00143 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 144 •HR 5475 IH such sums as may be necessary for each of fiscal years 1 2017 through 2022. 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00144 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 145 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00145 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 146 •HR 5475 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 2017 through 2022. 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00146 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 147 •HR 5475 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 2017 through 2022. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00147 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 148 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00148 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 149 •HR 5475 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; 23 ‘‘(6) assess the impact of the programs estab- 24 lished under this section in raising awareness of 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00149 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 150 •HR 5475 IH health and health care disparities and providing in- 1 formation on available resources; and 2 ‘‘(7) design and implement specific educational 3 initiatives to educate the health care workforce relat- 4 ing to unconscious bias. 5 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 6 is authorized to be appropriated to carry out this section 7 such sums as may be necessary for each of fiscal years 8 2017 through 2022.’’. 9 SEC. 302. HISPANIC-SERVING HEALTH PROFESSIONS 10 SCHOOLS. 11 Part B of title VII of the Public Health Service Act 12 (42 U.S.C. 293 et seq.) is amended by adding at the end 13 the following: 14 ‘‘SEC. 742. HISPANIC-SERVING HEALTH PROFESSIONS 15 SCHOOLS. 16 ‘‘(a) IN GENERAL.—The Secretary, acting through 17 the Administrator of the Health Resources and Services 18 Administration, shall award grants to Hispanic-serving 19 health professions schools for the purpose of carrying out 20 programs to recruit Hispanic individuals to enroll in and 21 graduate from such schools, which may include providing 22 scholarships and other financial assistance as appropriate. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00150 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 151 •HR 5475 IH ‘‘(b) ELIGIBILITY.—In subsection (a), the term ‘His- 1 panic-serving health professions school’ means an entity 2 that— 3 ‘‘(1) is a school or program under section 4 799B; 5 ‘‘(2) has an enrollment of full-time equivalent 6 students that is made up of at least 9 percent His- 7 panic students; 8 ‘‘(3) has been effective in carrying out pro- 9 grams to recruit Hispanic individuals to enroll in 10 and graduate from the school; 11 ‘‘(4) has been effective in recruiting and retain- 12 ing Hispanic faculty members; 13 ‘‘(5) has a significant number of graduates who 14 are providing health services to medically under- 15 served populations or to individuals in health profes- 16 sional shortage areas; and 17 ‘‘(6) is a Regional Hispanic Center of Excel- 18 lence.’’. 19 SEC. 303. LOAN REPAYMENT PROGRAM OF CENTERS FOR 20 DISEASE CONTROL AND PREVENTION. 21 Section 317F(c) of the Public Health Service Act (42 22 U.S.C. 247b–7(c)) is amended— 23 (1) by striking ‘‘and’’ after ‘‘1994,’’; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00151 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 152 •HR 5475 IH (2) by inserting before the period at the end the 1 following: ‘‘, $750,000 for fiscal year 2017, and such 2 sums as may be necessary for each of the fiscal 3 years 2018 through 2022’’. 4 SEC. 304. COOPERATIVE AGREEMENTS FOR ONLINE DE- 5 GREE PROGRAMS AT SCHOOLS OF PUBLIC 6 HEALTH AND SCHOOLS OF ALLIED HEALTH. 7 Part B of title VII of the Public Health Service Act 8 (42 U.S.C. 293 et seq.), as amended by section 302, is 9 further amended by adding at the end the following: 10 ‘‘SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DE- 11 GREE PROGRAMS. 12 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 13 acting through the Administrator of the Health Resources 14 and Services Administration, in consultation with the Di- 15 rector of the Centers for Disease Control and Prevention, 16 the Director of the Agency for Healthcare Research and 17 Quality, and the Deputy Assistant Secretary for Minority 18 Health, shall award cooperative agreements to schools of 19 public health and schools of allied health to design and 20 implement online degree programs. 21 ‘‘(b) PRIORITY.—In awarding cooperative agreements 22 under this section, the Secretary shall give priority to any 23 school of public health or school of allied health that has 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00152 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 153 •HR 5475 IH an established track record of serving medically under- 1 served communities. 2 ‘‘(c) REQUIREMENTS.—Recipients of cooperative 3 agreements under this section shall design and implement 4 an online degree program that meets the following restric- 5 tions: 6 ‘‘(1) Enrollment of individuals who have ob- 7 tained a secondary school diploma or its recognized 8 equivalent. 9 ‘‘(2) Maintaining a significant enrollment of 10 underrepresented minority or disadvantaged stu- 11 dents. 12 ‘‘(3) Achieving a high completion rate of en- 13 rolled underrepresented minority or disadvantaged 14 students. 15 ‘‘(d) 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 2017 through 2022.’’. 19 SEC. 305. SENSE OF CONGRESS ON THE MISSION OF THE 20 NATIONAL HEALTH CARE WORKFORCE COM- 21 MISSION. 22 It is the sense of Congress that the National Health 23 Care Workforce Commission established by section 5101 24 of the Patient Protection and Affordable Care Act (42 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00153 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 154 •HR 5475 IH U.S.C. 294q) should, in carrying out its assigned duties 1 under that section, give attention to the needs of racial 2 and ethnic minorities, individuals with lower socio- 3 economic status, individuals with mental, developmental, 4 and physical disabilities, lesbian, gay, bisexual, 5 transgender, queer, and questioning populations, and indi- 6 viduals who are members of multiple minority or special 7 population groups. 8 SEC. 306. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 9 Subtitle A of title XXXIV of the Public Health Serv- 10 ice Act, as added by section 301, is further amended by 11 inserting after section 3417 the following: 12 ‘‘SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH 13 SERVICES CORPS. 14 ‘‘(a) IN GENERAL.—The Administrator of the Health 15 Resources and Services Administration and the Director 16 of the Centers for Disease Control and Prevention, in col- 17 laboration with the Deputy Assistant Secretary for Minor- 18 ity Health, shall award grants to eligible entities to in- 19 crease awareness among postprimary and postsecondary 20 students of career opportunities in the health professions. 21 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 22 under subsection (a), an entity shall— 23 ‘‘(1) be a clinical, public health, or health serv- 24 ices organization, community-based or nonprofit en- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00154 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 155 •HR 5475 IH tity, or other entity determined appropriate by the 1 Director of the Centers for Disease Control and Pre- 2 vention; 3 ‘‘(2) serve a health professional shortage area, 4 as determined by the Secretary; 5 ‘‘(3) work with students, including those from 6 racial and ethnic minority backgrounds, that have 7 expressed an interest in the health professions; and 8 ‘‘(4) submit to the Secretary an application at 9 such time, in such manner, and containing such in- 10 formation as the Secretary may require. 11 ‘‘(c) USE OF FUNDS.—Grant awards under sub- 12 section (a) shall be used to support internships that will 13 increase awareness among students of non-research-based, 14 career opportunities in the following health professions: 15 ‘‘(1) Medicine. 16 ‘‘(2) Nursing. 17 ‘‘(3) Public Health. 18 ‘‘(4) Pharmacy. 19 ‘‘(5) Health administration and management. 20 ‘‘(6) Health policy. 21 ‘‘(7) Psychology. 22 ‘‘(8) Dentistry. 23 ‘‘(9) International health. 24 ‘‘(10) Social work. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00155 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 156 •HR 5475 IH ‘‘(11) Allied health. 1 ‘‘(12) Psychiatry. 2 ‘‘(13) Hospice care. 3 ‘‘(14) Other professions deemed appropriate by 4 the Director of the Centers for Disease Control and 5 Prevention. 6 ‘‘(d) PRIORITY.—In awarding grants under sub- 7 section (a), the Director of the Centers for Disease Con- 8 trol and Prevention shall give priority to those entities 9 that— 10 ‘‘(1) serve a high proportion of individuals from 11 disadvantaged backgrounds; 12 ‘‘(2) have experience in health disparity elimi- 13 nation programs; 14 ‘‘(3) facilitate the entry of disadvantaged indi- 15 viduals into institutions of higher education; and 16 ‘‘(4) provide counseling or other services de- 17 signed to assist disadvantaged individuals in success- 18 fully completing their education at the postsecondary 19 level. 20 ‘‘(e) STIPENDS.—The Secretary may approve sti- 21 pends under this section for individuals for any period of 22 education in student-enhancement programs (other than 23 regular courses) at health professions schools, programs, 24 or entities, except that such a stipend may not be provided 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00156 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 157 •HR 5475 IH to an individual for more than 6 months, and such a sti- 1 pend may not exceed $20 per day (notwithstanding any 2 other provision of law regarding the amount of stipends). 3 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 4 is authorized to be appropriated to carry out this section 5 such sums as may be necessary for each of fiscal years 6 2017 through 2022. 7 ‘‘SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS 8 PROGRAM. 9 ‘‘(a) IN GENERAL.—The Director of the Centers for 10 Disease Control and Prevention, in collaboration with the 11 Deputy Assistant Secretary for Minority Health, shall 12 award scholarships to postsecondary students who seek a 13 career in public health. 14 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol- 15 arship under subsection (a), an individual shall— 16 ‘‘(1) have interest, knowledge, or skill in public 17 health research or public health practice, or other 18 health professions as determined appropriate by the 19 Director of the Centers for Disease Control and Pre- 20 vention; 21 ‘‘(2) reside in a health professional shortage 22 area as determined by the Secretary; 23 ‘‘(3) demonstrate promise for becoming a leader 24 in public health; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00157 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 158 •HR 5475 IH ‘‘(4) secure admission to a 4-year institution of 1 higher education; 2 ‘‘(5) comply with subsection (e); and 3 ‘‘(6) submit to the Secretary an application at 4 such time, in such manner, and containing such in- 5 formation as the Secretary may require. 6 ‘‘(c) USE OF FUNDS.—Amounts received under an 7 award under subsection (a) shall be used to support oppor- 8 tunities for students to become public health professionals. 9 ‘‘(d) PRIORITY.—In awarding grants under sub- 10 section (a), the Director shall give priority to those stu- 11 dents that— 12 ‘‘(1) are from disadvantaged backgrounds; 13 ‘‘(2) have secured admissions to a minority- 14 serving institution; and 15 ‘‘(3) have identified a health professional as a 16 mentor at their school or institution and an aca- 17 demic advisor to assist in the completion of their 18 baccalaureate degree. 19 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 20 payment of scholarships under this section for such indi- 21 viduals for any period of education in student under- 22 graduate tenure, except that such a scholarship may not 23 be provided to an individual for more than 4 years, and 24 such scholarships may not exceed $10,000 per academic 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00158 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 159 •HR 5475 IH year (notwithstanding any other provision of law regard- 1 ing the amount of scholarship). 2 ‘‘(f) 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 2017 through 2022. 6 ‘‘SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH 7 FELLOWSHIP PROGRAM. 8 ‘‘(a) IN GENERAL.—The Director of the Centers for 9 Disease Control and Prevention, in collaboration with the 10 Deputy Assistant Secretary for Minority Health, the Ad- 11 ministrator of the Substance Abuse and Mental Health 12 Services Administration, and the Director of the Indian 13 Health Services, shall award research fellowships to post- 14 baccalaureate students to conduct research that will exam- 15 ine gender and health disparities and to pursue a career 16 in the health professions. 17 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 18 ship under subsection (a) an individual shall— 19 ‘‘(1) have experience in health research or pub- 20 lic health practice; 21 ‘‘(2) reside in a health professional shortage 22 area as determined by the Secretary; 23 ‘‘(3) have expressed an interest in the health 24 professions; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00159 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 160 •HR 5475 IH ‘‘(4) demonstrate promise for becoming a leader 1 in the field of women’s health; 2 ‘‘(5) secure admission to a health professions 3 school or graduate program with an emphasis in 4 gender studies; 5 ‘‘(6) comply with subsection (f); and 6 ‘‘(7) 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 an 10 award under subsection (a) shall be used to support oppor- 11 tunities for students to become researchers and advance 12 the research base on the intersection between gender and 13 health. 14 ‘‘(d) PRIORITY.—In awarding grants under sub- 15 section (a), the Director of the Centers for Disease Con- 16 trol and Prevention shall give priority to those applicants 17 that— 18 ‘‘(1) are from disadvantaged backgrounds; and 19 ‘‘(2) have identified a mentor and academic ad- 20 visor who will assist in the completion of their grad- 21 uate or professional degree and have secured a re- 22 search assistant position with a researcher working 23 in the area of gender and health. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00160 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 161 •HR 5475 IH ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 1 Disease Control and Prevention may approve fellowships 2 for individuals under this section for any period of edu- 3 cation in the student’s graduate or health profession ten- 4 ure, except that such a fellowship may not be provided 5 to an individual for more than 3 years, and such a fellow- 6 ship may not exceed $18,000 per academic year (notwith- 7 standing any other provision of law regarding the amount 8 of fellowship). 9 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 10 is authorized to be appropriated to carry out this section 11 such sums as may be necessary for each of fiscal years 12 2017 through 2022. 13 ‘‘SEC. 3420A. PAUL DAVID WELLSTONE INTERNATIONAL 14 HEALTH FELLOWSHIP PROGRAM. 15 ‘‘(a) IN GENERAL.—The Director of the Agency for 16 Healthcare Research and Quality, in collaboration with 17 the Deputy Assistant Secretary for Minority Health, shall 18 award research fellowships to college students or recent 19 graduates to advance their understanding of international 20 health. 21 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 22 ship under subsection (a) an individual shall— 23 ‘‘(1) have educational experience in the field of 24 international health; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00161 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 162 •HR 5475 IH ‘‘(2) reside in a health professional shortage 1 area as determined by the Secretary; 2 ‘‘(3) demonstrate promise for becoming a leader 3 in the field of international health; 4 ‘‘(4) be a college senior or recent graduate of 5 a four-year higher education institution; 6 ‘‘(5) comply with subsection (e); and 7 ‘‘(6) submit to the Secretary an application at 8 such time, in such manner, and containing such in- 9 formation as the Secretary may require. 10 ‘‘(c) USE OF FUNDS.—Amounts received under an 11 award under subsection (a) shall be used to support oppor- 12 tunities for students to become health professionals and 13 to advance their knowledge about international issues re- 14 lating to health care access and quality. 15 ‘‘(d) PRIORITY.—In awarding grants under sub- 16 section (a), the Director shall give priority to those appli- 17 cants that— 18 ‘‘(1) are from a disadvantaged background; and 19 ‘‘(2) have identified a mentor at a health pro- 20 fessions school or institution, an academic advisor to 21 assist in the completion of their graduate or profes- 22 sional degree, and an advisor from an international 23 health non-governmental organization, private volun- 24 teer organization, or other international institution 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00162 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 163 •HR 5475 IH or program that focuses on increasing health care 1 access and quality for residents in developing coun- 2 tries. 3 ‘‘(e) FELLOWSHIPS.—The Secretary shall approve 4 fellowships for college seniors or recent graduates, except 5 that such a fellowship may not be provided to an indi- 6 vidual for more than 6 months, may not be awarded to 7 a graduate that has not been enrolled in school for more 8 than 1 year, and may not exceed $4,000 per academic year 9 (notwithstanding any other provision of law regarding the 10 amount of fellowship). 11 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 12 is authorized to be appropriated to carry out this section, 13 such sums as may be necessary for each of fiscal years 14 2017 through 2022. 15 ‘‘SEC. 3420B. EDWARD R. ROYBAL HEALTH SCHOLAR PRO- 16 GRAM. 17 ‘‘(a) IN GENERAL.—The Director of the Agency for 18 Healthcare Research and Quality, the Director of the Cen- 19 ters for Medicare and Medicaid Services, and the Adminis- 20 trator for Health Resources and Services Administration, 21 in collaboration with the Deputy Assistant Secretary for 22 Minority Health, shall award grants to eligible entities to 23 expose entering graduate students to the health profes- 24 sions. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00163 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 164 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00164 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 165 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00165 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 166 •HR 5475 IH such sums as may be necessary for each of fiscal years 1 2017 through 2022.’’. 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 2017 22 through 2023.’’. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00166 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 167 •HR 5475 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)), as 5 amended by section 204(a), is 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 9 (M), such rules’’; 10 (2) in subparagraph (J), by striking ‘‘Such 11 rules’’ and inserting ‘‘Subject to subparagraph (M), 12 such rules’’; 13 (3) in subparagraph (K), by striking ‘‘In deter- 14 mining’’ and inserting ‘‘Subject to subparagraph 15 (M), in determining’’; and 16 (4) by adding at the end the following new sub- 17 paragraph: 18 ‘‘(M) TREATMENT OF CERTAIN RESIDENTS 19 AND INTERNS.—For purposes of cost-reporting 20 periods beginning on or after October 1, 2016, 21 in determining the hospital’s number of full- 22 time equivalent residents for purposes of this 23 paragraph, all the time spent by an intern or 24 resident in an approved medical residency train- 25 ing program shall be counted toward the deter- 26 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00167 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 168 •HR 5475 IH mination of full-time equivalency if the hos- 1 pital— 2 ‘‘(i) is recognized as a subsection (d) 3 hospital; 4 ‘‘(ii) is recognized as a subsection (d) 5 Puerto Rico hospital; 6 ‘‘(iii) is reimbursed under a reim- 7 bursement system authorized under section 8 1814(b)(3); or 9 ‘‘(iv) is a provider-based hospital out- 10 patient department.’’. 11 (b) IME DETERMINATIONS.—Section 12 1886(d)(5)(B)(x) of the Social Security Act (42 U.S.C. 13 1395ww(d)(5)(B)(x)) is amended— 14 (1) in subclause (II), by striking ‘‘In deter- 15 mining’’ and inserting ‘‘Subject to subclause (IV), in 16 determining’’; 17 (2) in subclause (III), by striking ‘‘In deter- 18 mining’’ and inserting ‘‘Subject to subclause (IV), in 19 determining’’; and 20 (3) by inserting after subclause (III) the fol- 21 lowing new subclause: 22 ‘‘(IV) The provisions of subparagraph (L) 23 of subsection (h)(4) shall apply under this sub- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00168 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 169 •HR 5475 IH paragraph in the same manner as they apply 1 under such subsection.’’. 2 SEC. 309. DEVELOPING AND IMPLEMENTING STRATEGIES 3 FOR LOCAL HEALTH EQUITY. 4 (a) GRANTS.—The Secretaries of Health and Human 5 Services, Education, and Labor, acting jointly, shall make 6 grants to academic institutions for the purposes of— 7 (1) in accordance with subsection (b), devel- 8 oping capacity— 9 (A) to build an evidence base for successful 10 strategies for increasing local health equity; and 11 (B) to serve as national models of driving 12 local health equity; 13 (2) in accordance with subsection (c), devel- 14 oping a strategic partnership with the community in 15 which the academic institution is located; and 16 (3) collecting data on, and periodically evalu- 17 ating, the effectiveness of the institution’s programs 18 funded through this section to enable the institution 19 to adapt accordingly for maximum efficiency and 20 success. 21 (b) DEVELOPING CAPACITY FOR INCREASING LOCAL 22 HEALTH EQUITY.—As a condition on receipt of a grant 23 under subsection (a), an academic institution shall agree 24 to use the grant to build an evidence base for successful 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00169 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 170 •HR 5475 IH strategies for increasing local health equity, and to serve 1 as a national model of driving local health equity, by sup- 2 porting— 3 (1) resources to strengthen institutional metrics 4 and capacity to execute institutionwide health work- 5 force goals that can serve as models for increasing 6 health equity in communities across the country; 7 (2) collaborations among a cohort of institu- 8 tions in implementing systemic change, partnership 9 development, and programmatic efforts supportive of 10 health equity goals across disciplines and popu- 11 lations; and 12 (3) enhanced or newly developed data systems 13 and research infrastructure capable of informing 14 current and future workforce efforts and building a 15 foundation for a broader research agenda targeting 16 urban health disparities. 17 (c) STRATEGIC PARTNERSHIPS.—As a condition on 18 receipt of a grant under subsection (a), an academic insti- 19 tution shall agree to use the grant to develop a strategic 20 partnership with the community in which the institution 21 is located for the purposes of— 22 (1) strengthening connections between the insti- 23 tution and the community— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00170 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 171 •HR 5475 IH (A) to improve evaluation of and address 1 the community’s health and health workforce 2 needs; and 3 (B) to engage the community in health 4 workforce development; 5 (2) developing, enhancing, or accelerating inno- 6 vative undergraduate and graduate programs in the 7 biomedical sciences and health professions; and 8 (3) strengthening pipeline programs in the bio- 9 medical sciences and health professions, including by 10 developing partnerships between institutions of high- 11 er education and elementary and secondary schools 12 to recruit the next generation of health professionals 13 earlier in the pipeline to a health care career. 14 SEC. 310. LOAN FORGIVENESS FOR MENTAL AND BEHAV- 15 IORAL HEALTH SOCIAL WORKERS. 16 Section 455 of the Higher Education Act of 1965 (20 17 U.S.C. 1087e) is amended by adding at the end the fol- 18 lowing new subsection: 19 ‘‘(r) REPAYMENT PLAN FOR MENTAL AND BEHAV- 20 IORAL HEALTH SOCIAL WORKERS.— 21 ‘‘(1) IN GENERAL.—The Secretary shall cancel 22 the balance of interest and principal due on any eli- 23 gible Federal Direct Loan not in default for a bor- 24 rower who— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00171 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 172 •HR 5475 IH ‘‘(A) has made 120 monthly payments on 1 the eligible Federal Direct Loan after October 2 1, 2016, pursuant to any one or a combination 3 of the following— 4 ‘‘(i) payments under an income-based 5 repayment plan under section 493C; 6 ‘‘(ii) payments under a standard re- 7 payment plan under subsection (d)(1)(A), 8 based on a 10-year repayment period; 9 ‘‘(iii) monthly payments under a re- 10 payment plan under subsection (d)(1) or 11 (g) of not less than the monthly amount 12 calculated under subsection (d)(1)(A), 13 based on a 10-year repayment period; or 14 ‘‘(iv) payments under an income con- 15 tingent repayment plan under subsection 16 (d)(1)(D); and 17 ‘‘(B)(i) is employed as a mental health or 18 behavioral health social worker, as defined by 19 the Secretary by regulation, at the time of such 20 forgiveness; and 21 ‘‘(ii) has been employed as such a mental 22 health or behavioral health social worker during 23 the period in which the borrower makes each of 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00172 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 173 •HR 5475 IH the 120 payments as described in subparagraph 1 (A). 2 ‘‘(2) LOAN CANCELLATION AMOUNT.—After the 3 conclusion of the employment period described in 4 paragraph (1), the Secretary shall cancel the obliga- 5 tion to repay the balance of principal and interest 6 due as of the time of such cancellation, on the eligi- 7 ble Federal Direct Loans made to the borrower 8 under this part. 9 ‘‘(3) INELIGIBILITY FOR DOUBLE BENEFITS.— 10 No borrower may, for the same employment as a 11 mental heath or behavioral health social worker, re- 12 ceive a reduction of loan obligations under both this 13 subsection and section 455(m), 428J, 428K, 428L, 14 or 460. 15 ‘‘(4) DEFINITION OF ELIGIBLE FEDERAL DI- 16 RECT LOAN.—In this subsection, the term ‘eligible 17 Federal Direct Loan’ means a Federal Direct Staf- 18 ford Loan, Federal Direct PLUS Loan, Federal Di- 19 rect Unsubsidized Stafford Loan, or a Federal Di- 20 rect Consolidation Loan.’’. 21 SEC. 311. HEALTH PROFESSIONS WORKFORCE FUND. 22 (a) PURPOSE.—It is the purpose of this section to 23 establish a Health Professions Workforce Fund to be ad- 24 ministered through the Health Resources and Services Ad- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00173 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 174 •HR 5475 IH ministration within the Department of Health and Human 1 Services to provide for expanded and sustained national 2 investment in the health professions and nursing work- 3 force development programs under title VII and title VIII 4 of the Public Health Service Act. 5 (b) ESTABLISHING THE HEALTH PROFESSIONS 6 WORKFORCE FUND.—There is authorized to be appro- 7 priated, and there is appropriated, out of any monies in 8 the Treasury not otherwise appropriated, to the Health 9 Professions Workforce Fund— 10 (1) $355,000,000 for fiscal year 2017; 11 (2) $375,000,000 for fiscal year 2018; 12 (3) $392,000,000 for fiscal year 2019; 13 (4) $412,000,000 for fiscal year 2020; 14 (5) $432,000,000 for fiscal year 2021; 15 (6) $454,000,000 for fiscal year 2022; 16 (7) $476,000,000 for fiscal year 2023; 17 (8) $500,000,000 for fiscal year 2024; 18 (9) $525,000,000 for fiscal year 2025; and 19 (10) $552,000,000 for fiscal year 2026. 20 (c) FUNDING.— 21 (1) For the purpose of carrying out health pro- 22 fessions education programs authorized under title 23 VII of the Public Health Service Act, in addition to 24 any other amounts authorized to be appropriated for 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00174 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 175 •HR 5475 IH such purpose, there is authorized to be appropriated 1 out of any monies in the Health Professions Work- 2 force Fund, the following: 3 (A) $240,000,000 for fiscal year 2017. 4 (B) $253,000,000 for fiscal year 2018. 5 (C) $265,000,000 for fiscal year 2019. 6 (D) $278,000,000 for fiscal year 2020. 7 (E) $292,000,000 for fiscal year 2021. 8 (F) $307,000,000 for fiscal year 2022. 9 (G) $322,000,000 for fiscal year 2023. 10 (H) $338,000,000 for fiscal year 2024. 11 (I) $355,000,000 for fiscal year 2025. 12 (J) $373,000,000 for fiscal year 2026. 13 (2) For the purpose of carrying out nursing 14 workforce development programs authorized under 15 Title VIII of the Public Health Service Act, in addi- 16 tion to any other amounts authorized to be appro- 17 priated for such purpose, there is authorized to be 18 appropriated out of any monies in the Health Pro- 19 fessions Workforce Fund, the following: 20 (A) $115,000,000 for fiscal year 2017. 21 (B) $122,000,000 for fiscal year 2018. 22 (C) $127,000,000 for fiscal year 2019. 23 (D) $134,000,000 for fiscal year 2020. 24 (E) $140,000,000 for fiscal year 2021. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00175 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 176 •HR 5475 IH (F) $147,000,000 for fiscal year 2022. 1 (G) $154,000,000 for fiscal year 2023. 2 (H) $162,000,000 for fiscal year 2024. 3 (I) $170,000,000 for fiscal year 2025. 4 (J) $179,000,000 for fiscal year 2026. 5 SEC. 312. FINDINGS; SENSE OF CONGRESS RELATING TO 6 GRADUATE MEDICAL EDUCATION. 7 (a) FINDINGS.—Congress finds the following: 8 (1) Projections by the Association of American 9 Medical Colleges (AAMC) and other expert entities, 10 such as the Health Resources and Services Adminis- 11 tration (HRSA), have indicated a nationwide short- 12 age of up to 90,400 physicians, split evenly between 13 primary care and specialists, by 2025. 14 (2) Primarily due to the growing and aging 15 population, over the next decade, physician demand 16 is expected to grow up to 17 percent. 17 (3) The United States Census Bureau estimates 18 that the United States population will grow from 19 321 million in 2015 to 347 million in 2025. Further, 20 the number of Medicare beneficiaries is estimated to 21 increase from 47.8 million in 2015 to approximately 22 66 million in 2025. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00176 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 177 •HR 5475 IH (4) Approximately 36 percent of practicing phy- 1 sicians are over the age of 55 and are likely to retire 2 within the next decade. 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00177 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 178 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00178 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 179 •HR 5475 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 (500,000 by 24 2025), dentistry (15,000 by 2025), pharmacy 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00179 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 180 •HR 5475 IH (38,000 by 2030), mental and behavioral health, pri- 1 mary care (46,000 by 2025), and community and al- 2 lied health. 3 (3) A nationwide health workforce shortage will 4 result in serious health threats and more severe and 5 costly health care needs, due to, in part, a delayed 6 response to food-borne outbreaks, emerging infec- 7 tious diseases, natural disasters, fewer cancer 8 screenings, and delayed treatment. 9 (4) Vulnerable and underserved populations and 10 health professional shortage areas will be most se- 11 verely impacted by the health workforce shortage. 12 (5) According to the Migration Policy Institute, 13 over 2,000,000 college-educated immigrants in the 14 United States today are unemployed or under- 15 employed in low- or semi-skilled jobs that fail to 16 draw on their education and expertise. 17 (6) Approximately 2 out of every 5 internation- 18 ally educated immigrants are unemployed or under- 19 employed. 20 (7) According to Drexel University Center for 21 Labor Markets and Policy, underemployment for 22 internationally educated immigrant women is 28 per- 23 cent higher than for their male counterparts. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00180 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 181 •HR 5475 IH (8) According to the Drexel University Center 1 for labor markets and policy, the mean annual earn- 2 ings of underemployed immigrants were $32,000, or 3 43 percent less than United States born college 4 graduates employed in the college labor market. 5 (9) According to Upwardly Global and the Wel- 6 come Back Initiative, with proper guidance and sup- 7 port, underemployed skilled immigrants typically in- 8 crease their income by 215 percent to 900 percent. 9 (10) According to the Brookings Institution and 10 the Partnership for a New American Economy, im- 11 migrants working in the health workforce are, on av- 12 erage, better educated than United States-born 13 workers in the health workforce. 14 (b) GRANTS TO ELIGIBLE ENTITIES.— 15 (1) AUTHORITY TO PROVIDE GRANTS.—The 16 Secretary of Health and Human Services acting 17 through the Bureau of Health Workforce within the 18 Health Resources and Services Administration, the 19 National Institute on Minority Health and Health 20 Disparities, or the Office of Minority Health (in this 21 section referred to as the ‘‘Secretary’’) may award 22 grants to eligible entities to carry out activities de- 23 scribed in subsection (c). 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00181 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 182 •HR 5475 IH (2) ELIGIBILITY.—To be eligible to receive a 1 grant under this section, an entity shall— 2 (A) be a clinical, public health, or health 3 services organization, a community-based or 4 nonprofit entity, an academic institution, a 5 faith-based organization, a State, county, or 6 local government, an Area Health Education 7 Center, or another entity determined appro- 8 priate by the Secretary; and 9 (B) submit to the Secretary an application 10 at such time, in such manner, and containing 11 such information as the Secretary may require. 12 (c) AUTHORIZED ACTIVITIES.—A grant awarded 13 under this section shall be used— 14 (1) to provide services to assist unemployed and 15 underemployed skilled immigrants, residing in the 16 United States, who have legal, permanent work au- 17 thorization and who are internationally educated 18 health professionals, enter into the American health 19 workforce with employment matching their health 20 professional skills and education, and advance in em- 21 ployment to positions that better match their health 22 professional education and expertise; 23 (2) to provide training opportunities to reduce 24 barriers to entry and advancement in the health 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00182 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 183 •HR 5475 IH workforce for skilled, internationally educated immi- 1 grants; 2 (3) to educate employers regarding the abilities 3 and capacities of internationally educated health 4 professionals; 5 (4) to assist in the evaluation of foreign creden- 6 tials; and 7 (5) to facilitate access to contextualized and ac- 8 celerated courses on English as a second language. 9 (d) DEFINITION.—In this section: 10 (1) The term ‘‘health professional’’ means an 11 individual trained for employment or intended em- 12 ployment in the field of public health, health man- 13 agement, dentistry, health administration, medicine, 14 nursing, pharmacy, psychology, social work, psychi- 15 atry, other mental and behavioral health, allied 16 health, community health or wellness work, including 17 fitness and nutrition, or other fields as determined 18 appropriate by the Secretary. 19 (2) The term ‘‘underemployed’’ means being 20 employed at less skilled tasks than an employee’s 21 training or abilities would otherwise permit. 22 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 23 authorized to be appropriated to carry out this section 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00183 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 184 •HR 5475 IH such sums as may be necessary for each of fiscal years 1 2017 through 2021. 2 TITLE IV—IMPROVEMENT OF 3 HEALTH CARE SERVICES 4 Subtitle A—Health Empowerment 5 Zones 6 SEC. 401. SHORT TITLE. 7 This subtitle may be cited as the ‘‘Health Empower- 8 ment Zone Act of 2016’’. 9 SEC. 402. FINDINGS. 10 The Congress finds the following: 11 (1) Numerous studies and reports, including 12 the 2012 National Healthcare Disparities Report of 13 the Administration on Healthcare Research and 14 Quality and the 2002 Unequal Treatment Report of 15 the Institute of Medicine, document the extensive- 16 ness to which health disparities exist across the 17 country. 18 (2) These studies have found that, on average, 19 racial and ethnic minorities are disproportionately 20 afflicted with chronic and acute conditions—such as 21 cancer, diabetes, musculoskeletal disease, obesity, 22 and hypertension—and suffer worse health out- 23 comes, worse health status, and higher mortality 24 rates than their White counterparts. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00184 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 185 •HR 5475 IH (3) Several recent studies also show that health 1 disparities are a function of not only access to health 2 care, but also the social determinants of health—in- 3 cluding the environment, the physical structure of 4 communities, nutrition and food options, educational 5 attainment, employment, race, ethnicity, geography, 6 and language preference—that directly and indi- 7 rectly affect the health, health care, and wellness of 8 individuals and communities. 9 (4) Integrally involving and fully supporting the 10 communities most affected by health inequities in 11 the assessment, planning, launch, and evaluation of 12 health disparity elimination efforts are among the 13 leading recommendations made to adequately ad- 14 dress and ultimately reduce health disparities. 15 (5) Recommendations also include supporting 16 the efforts of community stakeholders from a broad 17 cross section—including, but not limited to local 18 businesses, local departments of commerce, edu- 19 cation, labor, urban planning, and transportation, 20 and community-based and other nonprofit organiza- 21 tions, including national and regional intermediaries 22 with demonstrated capacity to serve low-income 23 urban communities—to find areas of common 24 ground around health disparity elimination and col- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00185 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 186 •HR 5475 IH laborate to improve the overall health and wellness 1 of a community and its residents. 2 SEC. 403. DESIGNATION OF HEALTH EMPOWERMENT 3 ZONES. 4 (a) IN GENERAL.—At the request of an eligible com- 5 munity partnership, the Secretary may designate an eligi- 6 ble area as a health empowerment zone. 7 (b) ELIGIBILITY CRITERIA.— 8 (1) ELIGIBLE COMMUNITY PARTNERSHIP.—A 9 community partnership is eligible to submit a re- 10 quest under this section if the partnership— 11 (A) demonstrates widespread public sup- 12 port from key individuals and entities in the eli- 13 gible area, including members of the target 14 community, State and local governments, non- 15 profit organizations including national and re- 16 gional intermediaries with demonstrated capac- 17 ity to serve low-income urban communities, and 18 community and industry leaders, for designa- 19 tion of the eligible area as a health empower- 20 ment zone; and 21 (B) includes representatives of— 22 (i) a broad cross section of stake- 23 holders and residents from communities in 24 the eligible area experiencing dispropor- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00186 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 187 •HR 5475 IH tionate disparities in health status and 1 health care; and 2 (ii) organizations, facilities, and insti- 3 tutions that have a history of working 4 within and serving such communities. 5 (2) ELIGIBLE AREA.—An area is eligible to be 6 designated as a health empowerment zone under this 7 section if one or more communities in the area expe- 8 rience disproportionate disparities in health status 9 and health care. In determining whether a commu- 10 nity experiences such disparities, the Secretary shall 11 consider the data collected by the Department of 12 Health and Human Services focusing on the fol- 13 lowing areas: 14 (A) Access to affordable, high-quality 15 health services. 16 (B) The prevalence of disproportionate 17 rates of certain illnesses or diseases including 18 the following: 19 (i) Arthritis, osteoporosis, chronic 20 back conditions, and other musculoskeletal 21 diseases. 22 (ii) Cancer. 23 (iii) Chronic kidney disease. 24 (iv) Diabetes. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00187 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 188 •HR 5475 IH (v) Injury (intentional and uninten- 1 tional). 2 (vi) Violence (intimate and non- 3 intimate). 4 (vii) Maternal and paternal illnesses 5 and diseases. 6 (viii) Infant mortality. 7 (ix) Mental illness and other disabil- 8 ities. 9 (x) Substance abuse treatment and 10 prevention, including underage drinking. 11 (xi) Nutrition, obesity, and overweight 12 conditions. 13 (xii) Heart disease. 14 (xiii) Hypertension. 15 (xiv) Cerebrovascular disease or 16 stroke. 17 (xv) Tuberculosis. 18 (xvi) HIV/AIDS and other sexually 19 transmitted infections. 20 (xvii) Viral hepatitis. 21 (xviii) Asthma. 22 (xix) Tooth decay and other oral 23 health issues. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00188 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 189 •HR 5475 IH (C) Within the target community, the his- 1 torical and persistent presence of conditions 2 that have been found to contribute to health 3 disparities including any such conditions re- 4 specting the following: 5 (i) Poverty. 6 (ii) Educational status and the quality 7 of community schools. 8 (iii) Income. 9 (iv) Access to high-quality affordable 10 health care. 11 (v) Work and work environment. 12 (vi) Environmental conditions in the 13 community, including with respect to clean 14 water, clean air, and the presence or ab- 15 sence of pollutants. 16 (vii) Language and English pro- 17 ficiency. 18 (viii) Access to affordable healthy 19 food. 20 (ix) Access to ethnically and culturally 21 diverse health and human service providers 22 and practitioners. 23 (x) Access to culturally and linguis- 24 tically competent health and human serv- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00189 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 190 •HR 5475 IH ices and health and human service pro- 1 viders. 2 (xi) Health-supporting infrastructure. 3 (xii) Health insurance that is ade- 4 quate and affordable. 5 (xiii) Race, racism, and bigotry (con- 6 scious and unconscious). 7 (xiv) Sexual orientation. 8 (xv) Health literacy. 9 (xvi) Place of residence (such as 10 urban areas, rural areas, and tribal res- 11 ervations). 12 (xvii) Stress. 13 (c) PROCEDURE.— 14 (1) REQUEST.—A request under subsection (a) 15 shall— 16 (A) describe the bounds of the area to be 17 designated as a health empowerment zone and 18 the process used to select those bounds; 19 (B) demonstrate that the partnership sub- 20 mitting the request is an eligible community 21 partnership described in subsection (b)(1); 22 (C) demonstrate that the area is an eligible 23 area described in subsection (b)(2); 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00190 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 191 •HR 5475 IH (D) include a comprehensive assessment of 1 disparities in health status and health care ex- 2 perience by one or more communities in the 3 area; 4 (E) set forth— 5 (i) a vision and a set of values for the 6 area; and 7 (ii) a comprehensive and holistic set of 8 goals to be achieved in the area through 9 designation as a health empowerment zone; 10 and 11 (F) include a strategic plan and an action 12 plan for achieving the goals described in sub- 13 paragraph (E)(ii). 14 (2) APPROVAL.—Not later than 60 days after 15 the receipt of a request for designation of an area 16 as a health empowerment zone under this section, 17 the Secretary shall approve or disapprove the re- 18 quest. 19 (d) MINIMUM NUMBER.—The Secretary— 20 (1) shall designate not more than 110 health 21 empowerment zones under this section; and 22 (2) shall designate at least one health empower- 23 ment zone in each of the several States, the District 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00191 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 192 •HR 5475 IH of Columbia, and each territory or possession of the 1 United States. 2 SEC. 404. ASSISTANCE TO THOSE SEEKING DESIGNATION. 3 At the request of any organization or entity seeking 4 to submit a request under section 403(a), the Secretary 5 shall provide technical assistance, and may award a grant, 6 to assist such organization or entity— 7 (1) to form an eligible community partnership 8 described in section 403(b)(1); 9 (2) to complete a health assessment, including 10 an assessment of health disparities under section 11 403(c)(1)(D); or 12 (3) to prepare and submit a request, including 13 a strategic plan, in accordance with section 403. 14 SEC. 405. BENEFITS OF DESIGNATION. 15 (a) PRIORITY.—In awarding any competitive grant, 16 a Federal official shall give priority to any applicant 17 that— 18 (1) meets the eligibility criteria for the grant; 19 (2) proposes to use the grant for activities in a 20 health empowerment zone; and 21 (3) demonstrates that such activities will di- 22 rectly and significantly further the goals of the stra- 23 tegic plan approved for such zone under section 403. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00192 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 193 •HR 5475 IH (b) GRANTS FOR INITIAL IMPLEMENTATION OF 1 STRATEGIC PLAN.— 2 (1) IN GENERAL.—Upon designating an eligible 3 area as a health empowerment zone at the request 4 of an eligible community partnership, the Secretary 5 shall, subject to the availability of appropriations, 6 make a grant to the community partnership for im- 7 plementation of the strategic plan for such zone. 8 (2) GRANT PERIOD.—A grant under paragraph 9 (1) for a health empowerment zone shall be for a pe- 10 riod of 2 years and may be renewed, except that the 11 total period of grants under paragraph (1) for such 12 zone may not exceed 10 years. 13 (3) LIMITATION.—In awarding grants under 14 this subsection, the Secretary shall not give less pri- 15 ority to an applicant or reduce the amount of a 16 grant because the Secretary rendered technical as- 17 sistance or made a grant to the same applicant 18 under section 404. 19 (4) REPORTING.—The Secretary shall require 20 each recipient of a grant under this subsection to re- 21 port to the Secretary not less than every 6 months 22 on the progress in implementing the strategic plan 23 for the health empowerment zone. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00193 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 194 •HR 5475 IH SEC. 406. DEFINITION. 1 In this subtitle, the term ‘‘Secretary’’ means the Sec- 2 retary of Health and Human Services, acting through the 3 Administrator of the Health Resources and Services Ad- 4 ministration and the Deputy Assistant Secretary for Mi- 5 nority Health, and in cooperation with the Director of the 6 Office of Community Services and the Director of the Na- 7 tional Institute for Minority Health and Health Dispari- 8 ties. 9 SEC. 407. AUTHORIZATION OF APPROPRIATIONS. 10 To carry out this subtitle, there is authorized to be 11 appropriated $100,000,000 for fiscal year 2017. 12 Subtitle B—Other Improvements of 13 Health Care Services 14 CHAPTER 1—EXPANSION OF COVERAGE 15 SEC. 411. AMENDMENT TO THE PUBLIC HEALTH SERVICE 16 ACT. 17 Title XXXIV of the Public Health Service Act, as 18 amended by titles I, II, III, and IX of this Act, is further 19 amended by inserting after subtitle C the following: 20 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00194 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 195 •HR 5475 IH ‘‘Subtitle D—Reconstruction and 1 Improvement Grants for Public 2 Health Care Facilities Serving 3 Pacific Islanders and the Insu- 4 lar Areas 5 ‘‘SEC. 3451. GRANT SUPPORT FOR QUALITY IMPROVEMENT 6 INITIATIVES. 7 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 8 with the Administrator of the Health Resources and Serv- 9 ices Administration, the Director of the Agency for 10 Healthcare Research and Quality, and the Administrator 11 of the Centers for Medicare & Medicaid Services, shall 12 award grants to eligible entities for the conduct of dem- 13 onstration projects to improve the quality of and access 14 to health care. 15 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 16 under subsection (a), an entity shall— 17 ‘‘(1) be a health center, hospital, health plan, 18 health system, community clinic. or other health en- 19 tity determined appropriate by the Secretary— 20 ‘‘(A) that, by legal mandate or explicitly 21 adopted mission, provides patients with access 22 to services regardless of their ability to pay; 23 ‘‘(B) that provides care or treatment for a 24 substantial number of patients who are unin- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00195 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 196 •HR 5475 IH sured, are receiving assistance under a State 1 program under title XIX of the Social Security 2 Act, or are members of vulnerable populations, 3 as determined by the Secretary; and 4 ‘‘(C)(i) with respect to which, not less than 5 50 percent of the entity’s patient population is 6 made up of racial and ethnic minorities; or 7 ‘‘(ii) that— 8 ‘‘(I) serves a disproportionate percent- 9 age of local, minority racial and ethnic pa- 10 tients, or that has a patient population, at 11 least 50 percent of which is limited- 12 English-proficient; and 13 ‘‘(II) provides an assurance that 14 amounts received under the grant will be 15 used only to support quality improvement 16 activities in the racial and ethnic popu- 17 lation served; and 18 ‘‘(2) prepare and submit to the Secretary an 19 application at such time, in such manner, and con- 20 taining such information as the Secretary may re- 21 quire. 22 ‘‘(c) PRIORITY.—In awarding grants under sub- 23 section (a), the Secretary shall give priority to applicants 24 under subsection (b)(2) that— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00196 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 197 •HR 5475 IH ‘‘(1) demonstrate an intent to operate as part 1 of a health care partnership, network, collaborative, 2 coalition, or alliance where each member entity con- 3 tributes to the design, implementation, and evalua- 4 tion of the proposed intervention; or 5 ‘‘(2) intend to use funds to carry out system- 6 wide changes with respect to health care quality im- 7 provement, including— 8 ‘‘(A) improved systems for data collection 9 and reporting; 10 ‘‘(B) innovative collaborative or similar 11 processes; 12 ‘‘(C) group programs with behavioral or 13 self-management interventions; 14 ‘‘(D) case management services; 15 ‘‘(E) physician or patient reminder sys- 16 tems; 17 ‘‘(F) educational interventions; or 18 ‘‘(G) other activities determined appro- 19 priate by the Secretary. 20 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 21 received under a grant under subsection (a) to support 22 the implementation and evaluation of health care quality 23 improvement activities or minority health and health care 24 disparity reduction activities that include— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00197 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 198 •HR 5475 IH ‘‘(1) with respect to health care systems, activi- 1 ties relating to improving— 2 ‘‘(A) patient safety; 3 ‘‘(B) timeliness of care; 4 ‘‘(C) effectiveness of care; 5 ‘‘(D) efficiency of care; 6 ‘‘(E) patient centeredness; and 7 ‘‘(F) health information technology; and 8 ‘‘(2) with respect to patients, activities relating 9 to— 10 ‘‘(A) staying healthy; 11 ‘‘(B) getting well, mentally and physically; 12 ‘‘(C) living effectively with illness or dis- 13 ability; and 14 ‘‘(D) coping with end-of-life issues. 15 ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 16 provide financial and other technical assistance to grant- 17 ees under this section for the development of common data 18 systems. 19 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 20 are authorized to be appropriated to carry out this section 21 such sums as may be necessary for each of fiscal years 22 2017 through 2022. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00198 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 199 •HR 5475 IH ‘‘SEC. 3452. CENTERS OF EXCELLENCE. 1 ‘‘(a) IN GENERAL.—The Secretary, acting through 2 the Administrator of the Health Resources and Services 3 Administration, shall designate centers of excellence at 4 public hospitals, and other health systems serving large 5 numbers of minority patients, that— 6 ‘‘(1) meet the requirements of section 7 3451(b)(1); 8 ‘‘(2) demonstrate excellence in providing care to 9 minority populations; and 10 ‘‘(3) demonstrate excellence in reducing dispari- 11 ties in health and health care. 12 ‘‘(b) REQUIREMENTS.—A hospital or health system 13 that serves as a center of excellence under subsection (a) 14 shall— 15 ‘‘(1) design, implement, and evaluate programs 16 and policies relating to the delivery of care in ra- 17 cially, ethnically, and linguistically diverse popu- 18 lations; 19 ‘‘(2) provide training and technical assistance 20 to other hospitals and health systems relating to the 21 provision of quality health care to minority popu- 22 lations; and 23 ‘‘(3) develop activities for graduate or con- 24 tinuing medical education that institutionalize a 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00199 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 200 •HR 5475 IH focus on cultural competence training for health care 1 providers. 2 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 3 are authorized to be appropriated to carry out this section, 4 such sums as may be necessary for each of fiscal years 5 2017 through 2022. 6 ‘‘SEC. 3453. RECONSTRUCTION AND IMPROVEMENT GRANTS 7 FOR PUBLIC HEALTH CARE FACILITIES SERV- 8 ING PACIFIC ISLANDERS AND THE INSULAR 9 AREAS. 10 ‘‘(a) IN GENERAL.—The Secretary shall provide di- 11 rect financial assistance to designated health care pro- 12 viders and community health centers in American Samoa, 13 Guam, the Commonwealth of the Northern Mariana Is- 14 lands, the United States Virgin Islands, Puerto Rico, and 15 Hawaii for the purposes of reconstructing and improving 16 health care facilities and services in a culturally competent 17 and sustainable manner. 18 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi- 19 nancial assistance under subsection (a), an entity shall be 20 a public health facility or community health center located 21 in American Samoa, Guam, the Commonwealth of the 22 Northern Mariana Islands, the United States Virgin Is- 23 lands, Puerto Rico, or Hawaii that— 24 ‘‘(1) is owned or operated by— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00200 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 201 •HR 5475 IH ‘‘(A) the Government of American Samoa, 1 Guam, the Commonwealth of the Northern 2 Mariana Islands, the United States Virgin Is- 3 lands, Puerto Rico, or Hawaii or a unit of local 4 government; or 5 ‘‘(B) a nonprofit organization; and 6 ‘‘(2)(A) provides care or treatment for a sub- 7 stantial number of patients who are uninsured, re- 8 ceiving assistance under a State program under a 9 title XVIII of the Social Security Act, or a State 10 program under title XIX of such Act, or who are 11 members of a vulnerable population, as determined 12 by the Secretary; or 13 ‘‘(B) serves a disproportionate percentage of 14 local, minority racial and ethnic patients. 15 ‘‘(c) REPORT.—Not later than 180 days after the 16 date of enactment of this title and annually thereafter, the 17 Secretary shall submit to the Congress and the President 18 a report that includes an assessment of health resources 19 and facilities serving populations in American Samoa, 20 Guam, the Commonwealth of the Northern Mariana Is- 21 lands, the United States Virgin Islands, Puerto Rico, and 22 Hawaii. In preparing such report, the Secretary shall— 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00201 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 202 •HR 5475 IH ‘‘(1) consult with and obtain information on all 1 health care facilities needs from the entities de- 2 scribed in subsection (b); 3 ‘‘(2) include all amounts of Federal assistance 4 received by each entity in the preceding fiscal year; 5 ‘‘(3) review the total unmet needs of each juris- 6 diction for health care facilities, including needs for 7 renovation and expansion of existing facilities; 8 ‘‘(4) include a strategic plan for addressing the 9 needs of each jurisdiction identified in the report; 10 and 11 ‘‘(5) evaluate the effectiveness of the care pro- 12 vided by measuring patient outcomes and cost meas- 13 ures. 14 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 15 are authorized to be appropriated such sums as necessary 16 to carry out this section.’’. 17 SEC. 412. REMOVING CITIZENSHIP AND IMMIGRATION BAR- 18 RIERS TO ACCESS TO AFFORDABLE HEALTH 19 CARE UNDER THE ACA. 20 (a) IN GENERAL.— 21 (1) PREMIUM TAX CREDITS.—Section 36B of 22 the Internal Revenue Code of 1986 is amended— 23 (A) in subsection (c)(1)(B)— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00202 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 203 •HR 5475 IH (i) by amending the subparagraph 1 heading to read as follows: ‘‘SPECIAL RULE 2 FOR CERTAIN INDIVIDUALS INELIGIBLE 3 FOR MEDICAID DUE TO STATUS’’, and 4 (ii) in clause (ii), by striking ‘‘lawfully 5 present in the United States, but’’ and in- 6 serting ‘‘who’’, and 7 (B) by striking subsection (e). 8 (2) COST-SHARING REDUCTIONS.—Section 1402 9 of the Patient Protection and Affordable Care Act 10 (42 U.S.C. 18071) is amended by striking sub- 11 section (e). 12 (3) BASIC HEALTH PROGRAM ELIGIBILITY.— 13 Section 1331(e)(1)(B) of the Patient Protection and 14 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 15 amended by striking ‘‘lawfully present in the United 16 States’’. 17 (4) RESTRICTIONS ON FEDERAL PAYMENTS.— 18 Section 1412 of the Patient Protection and Afford- 19 able Care Act (42 U.S.C. 18082) is amended by 20 striking subsection (d). 21 (5) REQUIREMENT TO MAINTAIN MINIMUM ES- 22 SENTIAL COVERAGE.—Subsection (d) of section 23 5000A of the Internal Revenue Code of 1986 is 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00203 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 204 •HR 5475 IH amended by striking paragraph (3) and by redesig- 1 nating paragraph (4) as paragraph (3). 2 (b) CONFORMING AMENDMENT.— 3 (1) Section 1411(a) of the Patient Protection 4 and Affordable Care Act (42 U.S.C. 18081(a)) is 5 amended by striking paragraph (1) and redesig- 6 nating paragraphs (2), (3), and (4) as paragraphs 7 (1), (2), and (3), respectively. 8 (2) Section 1312(f) of the Patient Protection 9 and Affordable Care Act (42 U.S.C. 18032(f)) is 10 amended— 11 (A) in the subsection heading, by striking 12 ‘‘access limited to citizens and lawful resi- 13 dents’’; and 14 (B) by striking paragraph (3). 15 SEC. 413. STUDY ON THE UNINSURED. 16 (a) IN GENERAL.—The Secretary of Health and 17 Human Services (in this section referred to as the ‘‘Sec- 18 retary’’) shall— 19 (1) conduct a study, in accordance with the 20 standards under section 3101 of the Public Health 21 Service Act (42 U.S.C. 300kk), on the demographic 22 characteristics of the population of individuals who 23 do not have health insurance coverage; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00204 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 205 •HR 5475 IH (2) predict, based on such study, the demo- 1 graphic characteristics of the population of individ- 2 uals who would remain without health insurance cov- 3 erage after the end of open enrollment or any special 4 enrollment period. 5 (b) REPORTING REQUIREMENTS.— 6 (1) IN GENERAL.—Not later than 12 months 7 after the date of the enactment of this Act, the Sec- 8 retary shall submit to the Congress the results of 9 the study under subsection (a)(1) and the prediction 10 made under subsection (a)(2). 11 (2) REPORTING OF DEMOGRAPHIC CHARACTER- 12 ISTICS.—The Secretary shall report the demographic 13 characteristics under paragraphs (1) and (2) of sub- 14 section (a) on the basis of racial and ethnic group, 15 and shall stratify the reporting on each racial and 16 ethnic group by other demographic characteristics 17 that can impact access to health insurance coverage, 18 such as sexual orientation, gender identity, primary 19 language, disability status, sex, socioeconomic sta- 20 tus, age group, and citizenship and immigration sta- 21 tus, in a manner consistent with title I of this Act. 22 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00205 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 206 •HR 5475 IH SEC. 414. MEDICAID PAYMENT PARITY FOR THE TERRI- 1 TORIES. 2 (a) ELIMINATION OF FUNDING LIMITATIONS FOR 3 PUERTO RICO, THE UNITED STATES VIRGIN ISLANDS, 4 GUAM, THE COMMONWEALTH OF THE NORTHERN MAR- 5 IANA ISLANDS, AND AMERICAN SAMOA.— 6 (1) IN GENERAL.—Section 1108 of the Social 7 Security Act (42 U.S.C. 1308) is amended— 8 (A) in subsection (f), in the matter pre- 9 ceding paragraph (1), by striking ‘‘subsection 10 (g)’’ and inserting ‘‘subsections (g) and (h)’’; 11 (B) in subsection (g)(2), in the matter pre- 12 ceding subparagraph (A)— 13 (i) by striking ‘‘Notwithstanding sub- 14 section (f) and subject to and’’ and insert- 15 ing ‘‘Notwithstanding subsection (f) and 16 subject to’’; and 17 (ii) by striking ‘‘paragraphs (3) and 18 (5)’’ and inserting ‘‘, paragraphs (3) and 19 (5) of this subsection, and subsection (h)’’; 20 and 21 (C) by adding at the end the following new 22 subsection: 23 ‘‘(h) SUNSET OF FUNDING LIMITATIONS FOR PUER- 24 TO RICO, THE UNITED STATES VIRGIN ISLANDS, GUAM, 25 THE COMMONWEALTH OF THE NORTHERN MARIANA IS- 26 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00206 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 207 •HR 5475 IH LANDS, AND AMERICAN SAMOA.—Subsections (f) and (g) 1 shall not apply to Puerto Rico, the United States Virgin 2 Islands, Guam, the Commonwealth of the Northern Mar- 3 iana Islands, and American Samoa for any fiscal year 4 after fiscal year 2017.’’. 5 (2) CONFORMING AMENDMENT.—Section 6 1903(u) of the Social Security Act (42 U.S.C. 7 1396c(u)) is amended by striking paragraph (4). 8 (3) EFFECTIVE DATE.—The amendments made 9 by this subsection shall apply beginning with fiscal 10 year 2018. 11 (b) PARITY IN FMAP.— 12 (1) IN GENERAL.—Section 1905(b) of the So- 13 cial Security Act (42 U.S.C. 1396d(b)) is amended 14 by inserting after ‘‘and American Samoa shall be 55 15 percent,’’ the following: ‘‘(except that, beginning 16 with fiscal year 2020, the Federal medical assistance 17 percentage for Puerto Rico, the United States Virgin 18 Islands, Guam, the Commonwealth of the Northern 19 Mariana Islands, and American Samoa shall be the 20 Federal medical assistance percentage determined by 21 the Secretary in consultation (for the United States 22 Virgin Islands, Guam, the Commonwealth of the 23 Northern Mariana Islands, and American Samoa) 24 with the Secretary of the Interior)’’. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00207 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 208 •HR 5475 IH (2) 2-FISCAL-YEAR TRANSITION.—Notwith- 1 standing any other provision of law, during fiscal 2 years 2018 and 2019, the Federal medical assist- 3 ance percentage established under section 1905(b) of 4 the Social Security Act (42 U.S.C. 1396d(b)) for 5 Puerto Rico, the United States Virgin Islands, 6 Guam, the Commonwealth of the Northern Mariana 7 Islands, and American Samoa shall be the highest 8 such Federal medical assistance percentage applica- 9 ble to any of the 50 States or the District of Colum- 10 bia for the fiscal year involved. 11 (3) PER CAPITA INCOME DATA.— 12 (A) REPORT TO CONGRESS.—Not later 13 than October 1, 2018, the Secretary of Health 14 and Human Services shall submit to Congress 15 a report that describes the per capita income 16 data used to promulgate the Federal medical 17 assistance percentage in the territories and how 18 such data differ from the per capita income 19 data used to promulgate Federal medical assist- 20 ance percentages for the 50 States and the Dis- 21 trict of Columbia. The report should include 22 recommendations on how the Federal medical 23 assistance percentages can be calculated for the 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00208 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 209 •HR 5475 IH territories to ensure parity with the 50 States 1 and the District of Columbia. 2 (B) APPLICATION.—Section 1101(a)(8)(B) 3 of the Social Security Act (42 U.S.C. 4 1308(a)(8)(B)) is amended— 5 (i) by striking ‘‘(other than Puerto 6 Rico, the United States Virgin Islands, and 7 Guam)’’ and inserting ‘‘(including Puerto 8 Rico, the United States Virgin Islands, 9 Guam, the Commonwealth of the Northern 10 Mariana Islands, and American Samoa)’’; 11 and 12 (ii) by inserting ‘‘(or, if such satisfac- 13 tory data are not available in the case of 14 the United States Virgin Islands, Guam, 15 the Northern Mariana Islands, or Amer- 16 ican Samoa, satisfactory data available 17 from the Department of the Interior for 18 the same period, or if such satisfactory 19 data are not available in the case of Puerto 20 Rico, satisfactory data available from the 21 government of the Commonwealth of Puer- 22 to Rico for the same period)’’ after ‘‘De- 23 partment of Commerce’’. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00209 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 210 •HR 5475 IH SEC. 415. EXTENSION OF MEDICARE SECONDARY PAYER. 1 (a) IN GENERAL.—Section 1862(b)(1)(C) of the So- 2 cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend- 3 ed— 4 (1) in the last sentence, by inserting ‘‘, and be- 5 fore January 1, 2017’’ after ‘‘prior to such date)’’; 6 and 7 (2) by adding at the end the following new sen- 8 tence: ‘‘Effective for items and services furnished on 9 or after January 1, 2017 (with respect to periods 10 beginning on or after the date that is 42 months 11 prior to such date), clauses (i) and (ii) shall be ap- 12 plied by substituting ‘42-month’ for ‘12-month’ each 13 place it appears in the first sentence.’’. 14 (b) EFFECTIVE DATE.—The amendments made by 15 this section shall take effect on the date of enactment of 16 this Act. For purposes of determining an individual’s sta- 17 tus under section 1862(b)(1)(C) of the Social Security Act 18 (42 U.S.C. 1395y(b)(1)(C)), as amended by subsection 19 (a), an individual who is within the coordinating period 20 as of the date of enactment of this Act shall have that 21 period extended to the full 42 months described in the last 22 sentence of such section, as added by the amendment 23 made by subsection (a)(2). 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00210 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 211 •HR 5475 IH SEC. 416. BORDER HEALTH GRANTS. 1 (a) ELIGIBLE ENTITY DEFINED.—In this section, 2 the term ‘‘eligible entity’’ means a State, public institution 3 of higher education, local government, tribal government, 4 nonprofit health organization, community health center, or 5 community clinic receiving assistance under section 330 6 of the Public Health Service Act (42 U.S.C. 254b), that 7 is located in the border area. 8 (b) AUTHORIZATION.—From funds appropriated 9 under subsection (f), the Secretary of Health and Human 10 Services (in this section referred to as the ‘‘Secretary’’), 11 acting through the United States members of the United 12 States-Mexico Border Health Commission, shall award 13 grants to eligible entities to address priorities and rec- 14 ommendations to improve the health of border area resi- 15 dents that are established by— 16 (1) the United States members of the United 17 States-Mexico Border Health Commission; 18 (2) the State border health offices; and 19 (3) the Secretary. 20 (c) APPLICATION.—An eligible entity that desires a 21 grant under subsection (b) shall submit an application to 22 the Secretary at such time, in such manner, and con- 23 taining such information as the Secretary may require. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00211 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 212 •HR 5475 IH (d) USE OF FUNDS.—An eligible entity that receives 1 a grant under subsection (b) shall use the grant funds 2 for— 3 (1) programs relating to— 4 (A) maternal and child health; 5 (B) primary care and preventative health; 6 (C) public health and public health infra- 7 structure; 8 (D) musculoskeletal health and obesity; 9 (E) health education and promotion; 10 (F) oral health; 11 (G) mental and behavioral health; 12 (H) substance abuse; 13 (I) health conditions that have a high prev- 14 alence in the border area; 15 (J) medical and health services research; 16 (K) workforce training and development; 17 (L) community health workers, patient 18 navigators, and promotoras; 19 (M) health care infrastructure problems in 20 the border area (including planning and con- 21 struction grants); 22 (N) health disparities in the border area; 23 (O) environmental health; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00212 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 213 •HR 5475 IH (P) outreach and enrollment services with 1 respect to Federal programs (including pro- 2 grams authorized under titles XIX and XXI of 3 the Social Security Act (42 U.S.C. 1396 and 4 1397aa)); and 5 (2) other programs determined appropriate by 6 the Secretary. 7 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro- 8 vided to an eligible entity awarded a grant under sub- 9 section (b) shall be used to supplement and not supplant 10 other funds available to the eligible entity to carry out the 11 activities described in subsection (d). 12 (f) AUTHORIZATION OF APPROPRIATIONS.—There 13 are authorized to be appropriated to carry out this section, 14 $200,000,000 for fiscal year 2017, and such sums as may 15 be necessary for each succeeding fiscal year. 16 SEC. 417. REMOVING MEDICARE BARRIER TO HEALTH 17 CARE. 18 (a) PART A.—Section 1818(a)(3) of the Social Secu- 19 rity Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking 20 ‘‘an alien’’ and all that follows through ‘‘under this sec- 21 tion’’ and inserting ‘‘an individual who is lawfully present 22 in the United States’’. 23 (b) PART B.—Section 1836(2) of the Social Security 24 Act (42 U.S.C. 1395o(2)) is amended by striking ‘‘an 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00213 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 214 •HR 5475 IH alien’’ and all that follows through ‘‘under this part’’ and 1 inserting ‘‘an individual who is lawfully present in the 2 United States’’. 3 SEC. 418. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 4 PROVIDED BY URBAN INDIAN HEALTH CEN- 5 TERS. 6 (a) IN GENERAL.—The third sentence of section 7 1905(b) of the Social Security Act (42 U.S.C. 1396(b)) 8 is amended by inserting ‘‘or are received through a pro- 9 gram operated by an urban Indian organization through 10 a grant or contract under title V of such Act’’ after ‘‘(as 11 defined in section 4 of the Indian Health Care Improve- 12 ment Act)’’. 13 (b) EFFECTIVE DATE.—The amendment made by 14 this section shall apply to medical assistance provided on 15 or after the date of enactment of this Act. 16 SEC. 419. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 17 PROVIDED TO A NATIVE HAWAIIAN THROUGH 18 A FEDERALLY QUALIFIED HEALTH CENTER 19 OR A NATIVE HAWAIIAN HEALTH CARE SYS- 20 TEM UNDER THE MEDICAID PROGRAM. 21 (a) IN GENERAL.—The third sentence of section 22 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), 23 as amended by section 418(a), is amended by inserting 24 before the period the following: ‘‘; and, with respect to 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00214 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 215 •HR 5475 IH medical assistance provided to a Native Hawaiian (as de- 1 fined in section 12(2) of the Native Hawaiian Health Care 2 Improvement Act) through a federally qualified health 3 center or a Native Hawaiian health care system (as de- 4 fined in section 12(6) of such Act), whether directly, by 5 referral, or under contract or other arrangement between 6 such federally qualified health center or Native Hawaiian 7 health care system and another health care provider’’. 8 (b) EFFECTIVE DATE.—The amendment made by 9 this section shall apply to medical assistance provided on 10 or after the date of enactment of this Act. 11 CHAPTER 2—EXPANSION OF ACCESS 12 SEC. 431. GRANTS FOR RACIAL AND ETHNIC APPROACHES 13 TO COMMUNITY HEALTH. 14 (a) PURPOSE.—It is the purpose of this section to 15 provide for the awarding of grants to assist communities 16 in mobilizing and organizing resources in support of effec- 17 tive and sustainable programs that will reduce or eliminate 18 disparities in health and health care experienced by racial 19 and ethnic minority individuals. 20 (b) AUTHORITY TO AWARD GRANTS.—The Secretary 21 of Health and Human Services, acting through the Ad- 22 ministrator of the Health Resources and Services Admin- 23 istration, shall award grants to eligible entities to assist 24 in designing, implementing, and evaluating culturally and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00215 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 216 •HR 5475 IH linguistically appropriate, science-based, and community- 1 driven sustainable strategies to eliminate racial and ethnic 2 health and health care disparities. 3 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 4 grant under this section, an entity shall— 5 (1) represent a coalition— 6 (A) whose principal purpose is to develop 7 and implement interventions to reduce or elimi- 8 nate a health or health care disparity in a tar- 9 geted racial or ethnic minority group in the 10 community served by the coalition; and 11 (B) that includes— 12 (i) members selected from among— 13 (I) public health departments; 14 (II) community-based organiza- 15 tions; 16 (III) university and research or- 17 ganizations; 18 (IV) American Indian tribal or- 19 ganizations, national American Indian 20 organizations, Indian Health Service, 21 or organizations serving Alaska Na- 22 tives; and 23 (V) interested public or private 24 health care providers or organizations 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00216 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 217 •HR 5475 IH as deemed appropriate by the Sec- 1 retary; and 2 (ii) at least 1 member from a commu- 3 nity-based organization that represents the 4 targeted racial or ethnic minority group; 5 and 6 (2) submit to the Secretary an application at 7 such time, in such manner, and containing such in- 8 formation as the Secretary may require, which shall 9 include— 10 (A) a description of the targeted racial or 11 ethnic populations in the community to be 12 served under the grant; 13 (B) a description of at least 1 health dis- 14 parity that exists in the racial or ethnic tar- 15 geted populations, including health issues such 16 as infant mortality, breast and cervical cancer 17 screening and management, musculoskeletal 18 diseases and obesity, prostate cancer screening 19 and management, cardiovascular disease, diabe- 20 tes, child and adult immunization levels, or 21 other health priority areas as designated by the 22 Secretary; and 23 (C) a demonstration of a proven record of 24 accomplishment of the coalition members in 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00217 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 218 •HR 5475 IH serving and working with the targeted commu- 1 nity. 2 (d) SUSTAINABILITY.—The Secretary shall give pri- 3 ority to an eligible entity under this section if the entity 4 agrees that, with respect to the costs to be incurred by 5 the entity in carrying out the activities for which the grant 6 was awarded, the entity (and each of the participating 7 partners in the coalition represented by the entity) will 8 maintain its expenditures of non-Federal funds for such 9 activities at a level that is not less than the level of such 10 expenditures during the fiscal year immediately preceding 11 the first fiscal year for which the grant is awarded. 12 (e) NONDUPLICATION.—Funds provided through this 13 grant program should supplement, not supplant, existing 14 Federal funding, and the funds should not be used to du- 15 plicate the activities of the other health disparity grant 16 programs in this Act. 17 (f) TECHNICAL ASSISTANCE.—The Secretary may, 18 either directly or by grant or contract, provide any entity 19 that receives a grant under this section with technical and 20 other nonfinancial assistance necessary to meet the re- 21 quirements of this section. 22 (g) DISSEMINATION.—The Secretary shall encourage 23 and enable grantees to share best practices, evaluation re- 24 sults, and reports with communities not affiliated with 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00218 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 219 •HR 5475 IH grantees using the Internet, conferences, and other perti- 1 nent information regarding the projects funded by this 2 section, including the outreach efforts of the Office of Mi- 3 nority Health and Health Disparity Elimination and the 4 Centers for Disease Control and Prevention. 5 (h) ADMINISTRATIVE BURDENS.—The Secretary 6 shall make every effort to minimize duplicative or unneces- 7 sary administrative burdens on grantees. 8 (i) DEFINITION.—In this section, the term ‘‘Sec- 9 retary’’ means the Secretary of Health and Human Serv- 10 ices. 11 (j) AUTHORIZATION OF APPROPRIATIONS.—There 12 are authorized to be appropriated such sums as may be 13 necessary to carry out this section. 14 SEC. 432. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 15 (a) ELIMINATION OF ISOLATION TEST FOR COST- 16 BASED AMBULANCE REIMBURSEMENT.— 17 (1) IN GENERAL.—Section 1834(l)(8) of the 18 Social Security Act (42 U.S.C. 1395m(l)(8)) is 19 amended— 20 (A) in subparagraph (B)— 21 (i) by striking ‘‘owned and’’; and 22 (ii) by inserting ‘‘(including when 23 such services are provided by the entity 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00219 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 220 •HR 5475 IH under an arrangement with the hospital)’’ 1 after ‘‘hospital’’; and 2 (B) by striking the comma at the end of 3 subparagraph (B) and all that follows and in- 4 serting a period. 5 (2) EFFECTIVE DATE.—The amendments made 6 by this subsection shall apply to services furnished 7 on or after January 1, 2015. 8 (b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE 9 TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT 10 REQUIREMENT.— 11 (1) IN GENERAL.—Section 1820(c)(2) of the 12 Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 13 amended— 14 (A) in subparagraph (B)(iii), by striking 15 ‘‘provides not more than’’ and inserting ‘‘sub- 16 ject to subparagraph (F), provides not more 17 than’’; and 18 (B) by adding at the end the following new 19 subparagraph: 20 ‘‘(F) ALTERNATIVE TO 25 INPATIENT BED 21 LIMIT REQUIREMENT.— 22 ‘‘(i) IN GENERAL.—A State may elect 23 to treat a facility, with respect to the des- 24 ignation of the facility for a cost-reporting 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00220 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 221 •HR 5475 IH period, as satisfying the requirement of 1 subparagraph (B)(iii) relating to a max- 2 imum number of acute care inpatient beds 3 if the facility elects, in accordance with a 4 method specified by the Secretary and be- 5 fore the beginning of the cost reporting pe- 6 riod, to meet the requirement under clause 7 (ii). 8 ‘‘(ii) ALTERNATE REQUIREMENT.— 9 The requirement under this clause, with 10 respect to a facility and a cost-reporting 11 period, is that the total number of inpa- 12 tient bed days described in subparagraph 13 (B)(iii) during such period will not exceed 14 7,300. For purposes of this subparagraph, 15 an individual who is an inpatient in a bed 16 in the facility for a single day shall be 17 counted as one inpatient bed day. 18 ‘‘(iii) WITHDRAWAL OF ELECTION.— 19 The option described in clause (i) shall not 20 apply to a facility for a cost-reporting pe- 21 riod if the facility (for any two consecutive 22 cost-reporting periods during the previous 23 5 cost-reporting periods) was treated under 24 such option and had a total number of in- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00221 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 222 •HR 5475 IH patient bed days for each of such two cost- 1 reporting periods that exceeded the num- 2 ber specified in such clause.’’. 3 (2) EFFECTIVE DATE.—The amendments made 4 by paragraph (1) shall apply to cost-reporting peri- 5 ods beginning on or after the date of the enactment 6 of this Act. 7 SEC. 433. ESTABLISHMENT OF RURAL COMMUNITY HOS- 8 PITAL (RCH) PROGRAM. 9 (a) IN GENERAL.—Section 1861 of the Social Secu- 10 rity Act (42 U.S.C. 1395x), as amended by section 11 205(b)(1), is amended by adding at the end of the fol- 12 lowing new subsection: 13 ‘‘Rural Community Hospital; Rural Community Hospital 14 Services 15 ‘‘(jjj)(1) The term ‘rural community hospital’ means 16 a hospital (as defined in subsection (e)) that— 17 ‘‘(A) is located in a rural area (as defined in 18 section 1886(d)(2)(D)) or treated as being so lo- 19 cated pursuant to section 1886(d)(8)(E); 20 ‘‘(B) subject to paragraph (2), has less than 51 21 acute care inpatient beds, as reported in its most re- 22 cent cost report; 23 ‘‘(C) makes available 24-hour emergency care 24 services; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00222 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 223 •HR 5475 IH ‘‘(D) subject to paragraph (3), has a provider 1 agreement in effect with the Secretary and is open 2 to the public as of January 1, 2010; and 3 ‘‘(E) applies to the Secretary for such designa- 4 tion. 5 ‘‘(2) For purposes of paragraph (1)(B), beds in a 6 psychiatric or rehabilitation unit of the hospital which is 7 a distinct part of the hospital shall not be counted. 8 ‘‘(3) Paragraph (1)(D) shall not be construed to pro- 9 hibit any of the following from qualifying as a rural com- 10 munity hospital: 11 ‘‘(A) A replacement facility (as defined by the 12 Secretary in regulations in effect on January 1, 13 2012) with the same service area (as defined by the 14 Secretary in regulations in effect on such date). 15 ‘‘(B) A facility obtaining a new provider num- 16 ber pursuant to a change of ownership. 17 ‘‘(C) A facility which has a binding written 18 agreement with an outside, unrelated party for the 19 construction, reconstruction, lease, rental, or financ- 20 ing of a building as of January 1, 2012. 21 ‘‘(4) Nothing in this subsection shall be construed as 22 prohibiting a critical access hospital from qualifying as a 23 rural community hospital if the critical access hospital 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00223 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 224 •HR 5475 IH meets the conditions otherwise applicable to hospitals 1 under subsection (e) and section 1866. 2 ‘‘(5) Nothing in this subsection shall be construed as 3 prohibiting a rural community hospital participating in 4 the demonstration program under section 410A of the 5 Medicare Prescription Drug, Improvement, and Mod- 6 ernization Act of 2003 (Public Law 108–173; 117 Stat. 7 2313) from qualifying as a rural community hospital if 8 the rural community hospital meets the conditions other- 9 wise applicable to hospitals under subsection (e) and sec- 10 tion 1866.’’. 11 (b) PAYMENT.— 12 (1) INPATIENT HOSPITAL SERVICES.—Section 13 1814 of the Social Security Act (42 U.S.C. 1395f) 14 is amended by adding at the end the following new 15 subsection: 16 ‘‘Payment for Inpatient Services Furnished in Rural 17 Community Hospitals 18 ‘‘(m) The amount of payment under this part for in- 19 patient hospital services furnished in a rural community 20 hospital, other than such services furnished in a psy- 21 chiatric or rehabilitation unit of the hospital which is a 22 distinct part, is, at the election of the hospital in the appli- 23 cation referred to in section 1861(jjj)(1)(E)— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00224 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 225 •HR 5475 IH ‘‘(1) 101 percent of the reasonable costs of pro- 1 viding such services, without regard to the amount 2 of the customary or other charge, or 3 ‘‘(2) the amount of payment provided for under 4 the prospective payment system for inpatient hos- 5 pital services under section 1886(d).’’. 6 (2) OUTPATIENT SERVICES.—Section 1834 of 7 such Act (42 U.S.C. 1395m) is amended by adding 8 at the end the following new subsection: 9 ‘‘(p) PAYMENT FOR OUTPATIENT SERVICES FUR- 10 NISHED IN RURAL COMMUNITY HOSPITALS.—The 11 amount of payment under this part for outpatient services 12 furnished in a rural community hospital is, at the election 13 of the hospital in the application referred to in section 14 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 and any limitation 18 under section 1861(v)(1)(U), or 19 ‘‘(2) the amount of payment provided for under 20 the prospective payment system for covered OPD 21 services under section 1833(t).’’. 22 (3) EXEMPTION FROM 30-PERCENT REDUCTION 23 IN REIMBURSEMENT FOR BAD DEBT.—Section 24 1861(v)(1)(T) of such Act (42 U.S.C. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00225 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 226 •HR 5475 IH 1395x(v)(1)(T)) is amended by inserting ‘‘(other 1 than for a rural community hospital)’’ after ‘‘In de- 2 termining such reasonable costs for hospitals’’. 3 (c) BENEFICIARY COST-SHARING FOR OUTPATIENT 4 SERVICES.—Section 1834(p) of such Act (as added by 5 subsection (b)(2)) is amended— 6 (1) by redesignating paragraphs (1) and (2) as 7 subparagraphs (A) and (B), respectively; 8 (2) by inserting ‘‘(1)’’ after ‘‘(p)’’; and 9 (3) by adding at the end the following: 10 ‘‘(2) The amounts of beneficiary cost-sharing for out- 11 patient services furnished in a rural community hospital 12 under this part shall be as follows: 13 ‘‘(A) For items and services that would have 14 been paid under section 1833(t) if provided by a 15 hospital, the amount of cost-sharing determined 16 under paragraph (8) of such section. 17 ‘‘(B) For items and services that would have 18 been paid under section 1833(h) if furnished by a 19 provider or supplier, no cost-sharing shall apply. 20 ‘‘(C) For all other items and services, the 21 amount of cost-sharing that would apply to the item 22 or service under the methodology that would be used 23 to determine payment for such item or service if pro- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00226 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 227 •HR 5475 IH vided by a physician, provider, or supplier, as the 1 case may be.’’. 2 (d) CONFORMING AMENDMENTS.— 3 (1) PART A PAYMENT.—Section 1814(b) of 4 such Act (42 U.S.C. 1395f(b)) is amended in the 5 matter preceding paragraph (1) by inserting ‘‘other 6 than inpatient hospital services furnished by a rural 7 community hospital,’’ after ‘‘critical access hospital 8 services,’’. 9 (2) PART B PAYMENT.—Section 1833(a) of 10 such Act (42 U.S.C. 1395l(a)), as amended by sec- 11 tion 205(b)(3), is amended— 12 (A) in paragraph (2), in the matter before 13 subparagraph (A), by striking ‘‘and (I)’’ and in- 14 serting ‘‘(I), and (K)’’; 15 (B) by striking ‘‘and’’ at the end of para- 16 graph (9); 17 (C) by striking the period at the end of 18 paragraph (10) and inserting ‘‘; and’’; and 19 (D) by adding at the end the following: 20 ‘‘(11) in the case of outpatient services fur- 21 nished by a rural community hospital, the amounts 22 described in section 1834(p).’’. 23 (3) TECHNICAL AMENDMENTS.— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00227 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 228 •HR 5475 IH (A) CONSULTATION WITH STATE AGEN- 1 CIES.—Section 1863 of such Act (42 U.S.C. 2 1395z) is amended by striking ‘‘and (dd)(2)’’ 3 and inserting ‘‘(dd)(2), (mm)(1), and (jjj)(1)’’. 4 (B) PROVIDER AGREEMENTS.—Section 5 1866(a)(2)(A) of such Act (42 U.S.C. 6 1395cc(a)(2)(A)) is amended by inserting ‘‘sec- 7 tion 1834(p)(2),’’ after ‘‘section 1833(b),’’. 8 (e) EFFECTIVE DATE.—The amendments made by 9 this section shall apply to items and services furnished on 10 or after October 1, 2016. 11 SEC. 434. MEDICARE REMOTE MONITORING PILOT 12 PROJECTS. 13 (a) PILOT PROJECTS.— 14 (1) IN GENERAL.—Not later than 9 months 15 after the date of enactment of this Act, the Sec- 16 retary of Health and Human Services (in this sec- 17 tion referred to as the ‘‘Secretary’’) shall conduct 18 pilot projects under title XVIII of the Social Secu- 19 rity Act for the purpose of providing incentives to 20 home health agencies to utilize home monitoring and 21 communications technologies that— 22 (A) enhance health outcomes for Medicare 23 beneficiaries; and 24 (B) reduce expenditures under such title. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00228 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 229 •HR 5475 IH (2) SITE REQUIREMENTS.— 1 (A) URBAN AND RURAL.—The Secretary 2 shall conduct the pilot projects under this sec- 3 tion in both urban and rural areas. 4 (B) SITE IN A SMALL STATE.—The Sec- 5 retary shall conduct at least 3 of the pilot 6 projects in a State with a population of less 7 than 1,000,000. 8 (3) DEFINITION OF HOME HEALTH AGENCY.— 9 In this section, the term ‘‘home health agency’’ has 10 the meaning given that term in section 1861(o) of 11 the Social Security Act (42 U.S.C. 1395x(o)). 12 (b) MEDICARE BENEFICIARIES WITHIN THE SCOPE 13 OF PROJECTS.—The Secretary shall specify the criteria 14 for identifying those Medicare beneficiaries who shall be 15 considered within the scope of the pilot projects under this 16 section for purposes of the application of subsection (c) 17 and for the assessment of the effectiveness of the home 18 health agency in achieving the objectives of this section. 19 Such criteria may provide for the inclusion in the projects 20 of Medicare beneficiaries who begin receiving home health 21 services under title XVIII of the Social Security Act after 22 the date of the implementation of the projects. 23 (c) INCENTIVES.— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00229 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 230 •HR 5475 IH (1) PERFORMANCE TARGETS.—The Secretary 1 shall establish for each home health agency partici- 2 pating in a pilot project under this section a per- 3 formance target using one of the following meth- 4 odologies, as determined appropriate by the Sec- 5 retary: 6 (A) ADJUSTED HISTORICAL PERFORMANCE 7 TARGET.—The Secretary shall establish for the 8 agency— 9 (i) a base expenditure amount equal 10 to the average total payments made to the 11 agency under parts A and B of title XVIII 12 of the Social Security Act for Medicare 13 beneficiaries determined to be within the 14 scope of the pilot project in a base period 15 determined by the Secretary; and 16 (ii) an annual per capita expenditure 17 target for such beneficiaries, reflecting the 18 base expenditure amount adjusted for risk 19 and adjusted growth rates. 20 (B) COMPARATIVE PERFORMANCE TAR- 21 GET.—The Secretary shall establish for the 22 agency a comparative performance target equal 23 to the average total payments under such parts 24 A and B during the pilot project for comparable 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00230 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 231 •HR 5475 IH individuals in the same geographic area that 1 are not determined to be within the scope of the 2 pilot project. 3 (2) INCENTIVE.—Subject to paragraph (3), the 4 Secretary shall pay to each participating home care 5 agency an incentive payment for each year under the 6 pilot project equal to a portion of the Medicare sav- 7 ings realized for such year relative to the perform- 8 ance target under paragraph (1). 9 (3) LIMITATION ON EXPENDITURES.—The Sec- 10 retary shall limit incentive payments under this sec- 11 tion in order to ensure that the aggregate expendi- 12 tures under title XVIII of the Social Security Act 13 (including incentive payments under this subsection) 14 do not exceed the amount that the Secretary esti- 15 mates would have been expended if the pilot projects 16 under this section had not been implemented. 17 (d) WAIVER AUTHORITY.—The Secretary may waive 18 such provisions of titles XI and XVIII of the Social Secu- 19 rity Act as the Secretary determines to be appropriate for 20 the conduct of the pilot projects under this section. 21 (e) REPORT TO CONGRESS.—Not later than 5 years 22 after the date that the first pilot project under this section 23 is implemented, the Secretary shall submit to Congress a 24 report on the pilot projects. Such report shall contain a 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00231 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 232 •HR 5475 IH detailed description of issues related to the expansion of 1 the projects under subsection (f) and recommendations for 2 such legislation and administrative actions as the Sec- 3 retary considers appropriate. 4 (f) EXPANSION.—If the Secretary determines that 5 any of the pilot projects under this section enhance health 6 outcomes for Medicare beneficiaries and reduce expendi- 7 tures under title XVIII of the Social Security Act, the Sec- 8 retary may initiate comparable projects in additional 9 areas. 10 (g) INCENTIVE PAYMENTS HAVE NO EFFECT ON 11 OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen- 12 tive payment under this section— 13 (1) shall be in addition to the payments that a 14 home health agency would otherwise receive under 15 title XVIII of the Social Security Act for the provi- 16 sion of home health services; and 17 (2) shall have no effect on the amount of such 18 payments. 19 SEC. 435. RURAL HEALTH QUALITY ADVISORY COMMISSION 20 AND DEMONSTRATION PROJECTS. 21 (a) RURAL HEALTH QUALITY ADVISORY COMMIS- 22 SION.— 23 (1) ESTABLISHMENT.—Not later than 6 24 months after the date of the enactment of this sec- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00232 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 233 •HR 5475 IH tion, the Secretary of Health and Human Services 1 (in this section referred to as the ‘‘Secretary’’) shall 2 establish a commission to be known as the Rural 3 Health Quality Advisory Commission (in this section 4 referred to as the ‘‘Commission’’). 5 (2) DUTIES OF COMMISSION.— 6 (A) NATIONAL PLAN.—The Commission 7 shall develop, coordinate, and facilitate imple- 8 mentation of a national plan for rural health 9 quality improvement. The national plan shall— 10 (i) identify objectives for rural health 11 quality improvement; 12 (ii) identify strategies to eliminate 13 known gaps in rural health system capacity 14 and improve rural health quality; and 15 (iii) provide for Federal programs to 16 identify opportunities for strengthening 17 and aligning policies and programs to im- 18 prove rural health quality. 19 (B) DEMONSTRATION PROJECTS.—The 20 Commission shall design demonstration projects 21 to test alternative models for rural health qual- 22 ity improvement, including with respect to both 23 personal and population health. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00233 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 234 •HR 5475 IH (C) MONITORING.—The Commission shall 1 monitor progress toward the objectives identi- 2 fied pursuant to paragraph (1)(A). 3 (3) MEMBERSHIP.— 4 (A) NUMBER.—The Commission shall be 5 composed of 11 members appointed by the Sec- 6 retary. 7 (B) SELECTION.—The Secretary shall se- 8 lect the members of the Commission from 9 among individuals with significant rural health 10 care and health care quality expertise, including 11 expertise in clinical health care, health care 12 quality research, population or public health, or 13 purchaser organizations. 14 (4) CONTRACTING AUTHORITY.—Subject to the 15 availability of funds, the Commission may enter into 16 contracts and make other arrangements, as may be 17 necessary to carry out the duties described in para- 18 graph (2). 19 (5) STAFF.—Upon the request of the Commis- 20 sion, the Secretary may detail, on a reimbursable 21 basis, any of the personnel of the Office of Rural 22 Health Policy of the Health Resources and Services 23 Administration, the Agency for Healthcare Quality 24 and Research, or the Centers for Medicare & Med- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00234 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 235 •HR 5475 IH icaid Services to the Commission to assist in car- 1 rying out this subsection. 2 (6) REPORTS TO CONGRESS.—Not later than 1 3 year after the establishment of the Commission, and 4 annually thereafter, the Commission shall submit a 5 report to the Congress on rural health quality. Each 6 such report shall include the following: 7 (A) An inventory of relevant programs and 8 recommendations for improved coordination and 9 integration of policy and programs. 10 (B) An assessment of achievement of the 11 objectives identified in the national plan devel- 12 oped under paragraph (2) and recommenda- 13 tions for realizing such objectives. 14 (C) Recommendations on Federal legisla- 15 tion, regulations, or administrative policies to 16 enhance rural health quality and outcomes. 17 (b) RURAL HEALTH QUALITY DEMONSTRATION 18 PROJECTS.— 19 (1) IN GENERAL.—Not later than 270 days 20 after the date of the enactment of this section, the 21 Secretary, in consultation with the Rural Health 22 Quality Advisory Commission, the Office of Rural 23 Health Policy of the Health Resources and Services 24 Administration, the Agency for Healthcare Research 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00235 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 236 •HR 5475 IH and Quality, and the Centers for Medicare & Med- 1 icaid Services, shall make grants to eligible entities 2 for 5 demonstration projects to implement and 3 evaluate methods for improving the quality of health 4 care in rural communities. Each such demonstration 5 project shall include— 6 (A) alternative community models that— 7 (i) will achieve greater integration of 8 personal and population health services; 9 and 10 (ii) address safety, effectiveness, 11 patient- or community-centeredness, timeli- 12 ness, efficiency, and equity (the 6 aims 13 identified by the Institute of Medicine of 14 the National Academies in its report enti- 15 tled ‘‘Crossing the Quality Chasm: A New 16 Health System for the 21st Century’’ re- 17 leased on March 1, 2001); 18 (B) innovative approaches to the financing 19 and delivery of health services to achieve rural 20 health quality goals; and 21 (C) development of quality improvement 22 support structures to assist rural health sys- 23 tems and professionals (such as workforce sup- 24 port structures, quality monitoring and report- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00236 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 237 •HR 5475 IH ing, clinical care protocols, and information 1 technology applications). 2 (2) ELIGIBLE ENTITIES.—In this subsection, 3 the term ‘‘eligible entity’’ means a consortium 4 that— 5 (A) shall include— 6 (i) at least one health care provider or 7 health care delivery system located in a 8 rural area; and 9 (ii) at least one organization rep- 10 resenting multiple community stakeholders; 11 and 12 (B) may include other partners such as 13 rural research centers. 14 (3) CONSULTATION.—In developing the pro- 15 gram for awarding grants under this subsection, the 16 Secretary shall consult with the Administrator of the 17 Agency for Healthcare Research and Quality, rural 18 health care providers, rural health care researchers, 19 and private and nonprofit groups (including national 20 associations) which are undertaking similar efforts. 21 (4) EXPEDITED WAIVERS.—The Secretary shall 22 expedite the processing of any waiver that— 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00237 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 238 •HR 5475 IH (A) is authorized under title XVIII or XIX 1 of the Social Security Act (42 U.S.C. 1395 et 2 seq.); and 3 (B) is necessary to carry out a demonstra- 4 tion project under this subsection. 5 (5) DEMONSTRATION PROJECT SITES.—The 6 Secretary shall ensure that the 5 demonstration 7 projects funded under this subsection are conducted 8 at a variety of sites representing the diversity of 9 rural communities in the Nation. 10 (6) DURATION.—Each demonstration project 11 under this subsection shall be for a period of 4 12 years. 13 (7) INDEPENDENT EVALUATION.—The Sec- 14 retary shall enter into an arrangement with an enti- 15 ty that has experience working directly with rural 16 health systems for the conduct of an independent 17 evaluation of the program carried out under this 18 subsection. 19 (8) REPORT.—Not later than 1 year after the 20 conclusion of all of the demonstration projects fund- 21 ed under this subsection, the Secretary shall submit 22 a report to the Congress on the results of such 23 projects. The report shall include— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00238 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 239 •HR 5475 IH (A) an evaluation of patient access to care, 1 patient outcomes, and an analysis of the cost 2 effectiveness of each such project; and 3 (B) recommendations on Federal legisla- 4 tion, regulations, or administrative policies to 5 enhance rural health quality and outcomes. 6 (c) APPROPRIATION.— 7 (1) IN GENERAL.—Out of funds in the Treas- 8 ury not otherwise appropriated, there are appro- 9 priated to the Secretary to carry out this section 10 $30,000,000 for the period of fiscal years 2017 11 through 2021. 12 (2) AVAILABILITY.— 13 (A) IN GENERAL.—Funds appropriated 14 under paragraph (1) shall remain available for 15 expenditure through fiscal year 2021. 16 (B) REPORT.—For purposes of carrying 17 out subsection (b)(8), funds appropriated under 18 paragraph (1) shall remain available for ex- 19 penditure through fiscal year 2022. 20 (3) RESERVATION.—Of the amount appro- 21 priated under paragraph (1), the Secretary shall re- 22 serve— 23 (A) $5,000,000 to carry out subsection (a); 24 and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00239 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 240 •HR 5475 IH (B) $25,000,000 to carry out subsection 1 (b), of which— 2 (i) 2 percent shall be for the provision 3 of technical assistance to grant recipients; 4 and 5 (ii) 5 percent shall be for independent 6 evaluation under subsection (b)(7). 7 SEC. 436. RURAL HEALTH CARE SERVICES. 8 Section 330A of the Public Health Service Act (42 9 U.S.C. 254c) is amended to read as follows: 10 ‘‘SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, 11 RURAL HEALTH NETWORK DEVELOPMENT, 12 DELTA RURAL DISPARITIES AND HEALTH 13 SYSTEMS DEVELOPMENT, AND SMALL RURAL 14 HEALTH CARE PROVIDER QUALITY IMPROVE- 15 MENT GRANT PROGRAMS. 16 ‘‘(a) PURPOSE.—The purpose of this section is to 17 provide for grants— 18 ‘‘(1) under subsection (b), to promote rural 19 health care services outreach; 20 ‘‘(2) under subsection (c), to provide for the 21 planning and implementation of integrated health 22 care networks in rural areas; 23 ‘‘(3) under subsection (d), to assist rural com- 24 munities in the Delta Region to reduce health dis- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00240 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 241 •HR 5475 IH parities and to promote and enhance health system 1 development; and 2 ‘‘(4) under subsection (e), to provide for the 3 planning and implementation of small rural health 4 care provider quality improvement activities. 5 ‘‘(b) RURAL HEALTH CARE SERVICES OUTREACH 6 GRANTS.— 7 ‘‘(1) GRANTS.—The Director of the Office of 8 Rural Health Policy of the Health Resources and 9 Services Administration may award grants to eligible 10 entities to promote rural health care services out- 11 reach by expanding the delivery of health care serv- 12 ices to include new and enhanced services in rural 13 areas. The Director may award the grants for peri- 14 ods of not more than 3 years. 15 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 16 grant under this subsection for a project, an enti- 17 ty— 18 ‘‘(A) shall be a rural public or rural non- 19 profit private entity, a facility that qualifies as 20 a rural health clinic under title XVIII of the 21 Social Security Act, a public or nonprofit entity 22 existing exclusively to provide services to mi- 23 grant and seasonal farm workers in rural areas, 24 or a tribal government whose grant-funded ac- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00241 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 242 •HR 5475 IH tivities will be conducted within federally recog- 1 nized tribal areas; 2 ‘‘(B) shall represent a consortium com- 3 posed of members— 4 ‘‘(i) that include 3 or more independ- 5 ently owned health care entities; and 6 ‘‘(ii) that may be nonprofit or for- 7 profit entities; and 8 ‘‘(C) shall not previously have received a 9 grant under this subsection for the same or a 10 similar project, unless the entity is proposing to 11 expand the scope of the project or the area that 12 will be served through the project. 13 ‘‘(3) APPLICATIONS.—To be eligible to receive a 14 grant under this subsection, an eligible entity shall 15 prepare and submit to the Director an application at 16 such time, in such manner, and containing such in- 17 formation as the Director may require, including— 18 ‘‘(A) a description of the project that the 19 eligible entity will carry out using the funds 20 provided under the grant; 21 ‘‘(B) a description of the manner in which 22 the project funded under the grant will meet 23 the health care needs of rural populations in 24 the local community or region to be served; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00242 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 243 •HR 5475 IH ‘‘(C) a plan for quantifying how health 1 care needs will be met through identification of 2 the target population and benchmarks of service 3 delivery or health status, such as— 4 ‘‘(i) quantifiable measurements of 5 health status improvement for projects fo- 6 cusing on health promotion; or 7 ‘‘(ii) benchmarks of increased access 8 to primary care, including tracking factors 9 such as the number and type of primary 10 care visits, identification of a medical 11 home, or other general measures of such 12 access; 13 ‘‘(D) a description of how the local com- 14 munity or region to be served will be involved 15 in the development and ongoing operations of 16 the project; 17 ‘‘(E) a plan for sustaining the project after 18 Federal support for the project has ended; 19 ‘‘(F) a description of how the project will 20 be evaluated; 21 ‘‘(G) the administrative capacity to submit 22 annual performance data electronically as speci- 23 fied by the Director; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00243 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 244 •HR 5475 IH ‘‘(H) other such information as the Direc- 1 tor determines to be appropriate. 2 ‘‘(c) RURAL HEALTH NETWORK DEVELOPMENT 3 GRANTS.— 4 ‘‘(1) GRANTS.— 5 ‘‘(A) IN GENERAL.—The Director may 6 award rural health network development grants 7 to eligible entities to promote, through planning 8 and implementation, the development of inte- 9 grated health care networks that have combined 10 the functions of the entities participating in the 11 networks in order to— 12 ‘‘(i) achieve efficiencies and economies 13 of scale; 14 ‘‘(ii) expand access to, coordinate, and 15 improve the quality of the health care de- 16 livery system through development of orga- 17 nizational efficiencies; 18 ‘‘(iii) implement health information 19 technology to achieve efficiencies, reduce 20 medical errors, and improve quality; 21 ‘‘(iv) coordinate care and manage 22 chronic illness; and 23 ‘‘(v) strengthen the rural health care 24 system as a whole in such a manner as to 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00244 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 245 •HR 5475 IH show a quantifiable return on investment 1 to the participants in the network. 2 ‘‘(B) GRANT PERIODS.—The Director may 3 award such a rural health network development 4 grant— 5 ‘‘(i) for a period of 3 years for imple- 6 mentation activities; or 7 ‘‘(ii) for a period of 1 year for plan- 8 ning activities to assist in the initial devel- 9 opment of an integrated health care net- 10 work, if the proposed participants in the 11 network do not have a history of collabo- 12 rative efforts and a 3-year grant would be 13 inappropriate. 14 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 15 grant under this subsection, an entity— 16 ‘‘(A) shall be a rural public or rural non- 17 profit private entity, a facility that qualifies as 18 a rural health clinic under title XVIII of the 19 Social Security Act, a public or nonprofit entity 20 existing exclusively to provide services to mi- 21 grant and seasonal farm workers in rural areas, 22 or a tribal government whose grant-funded ac- 23 tivities will be conducted within federally recog- 24 nized tribal areas; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00245 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 246 •HR 5475 IH ‘‘(B) shall represent a network composed 1 of participants— 2 ‘‘(i) that include 3 or more independ- 3 ently owned health care entities; and 4 ‘‘(ii) that may be nonprofit or for- 5 profit entities; and 6 ‘‘(C) shall not previously have received a 7 grant under this subsection (other than a 1- 8 year grant for planning activities) for the same 9 or a similar project. 10 ‘‘(3) APPLICATIONS.—To be eligible to receive a 11 grant under this subsection, an eligible entity, in 12 consultation with the appropriate State office of 13 rural health or another appropriate State entity, 14 shall prepare and submit to the Director an applica- 15 tion at such time, in such manner, and containing 16 such information as the Director may require, in- 17 cluding— 18 ‘‘(A) a description of the project that the 19 eligible entity will carry out using the funds 20 provided under the grant; 21 ‘‘(B) an explanation of the reasons why 22 Federal assistance is required to carry out the 23 project; 24 ‘‘(C) a description of— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00246 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 247 •HR 5475 IH ‘‘(i) the history of collaborative activi- 1 ties carried out by the participants in the 2 network; 3 ‘‘(ii) the degree to which the partici- 4 pants are ready to integrate their func- 5 tions; and 6 ‘‘(iii) how the local community or re- 7 gion to be served will benefit from and be 8 involved in the activities carried out by the 9 network; 10 ‘‘(D) a description of how the local com- 11 munity or region to be served will experience in- 12 creased access to quality health care services 13 across the continuum of care as a result of the 14 integration activities carried out by the net- 15 work, including a description of— 16 ‘‘(i) return on investment for the com- 17 munity and the network members; and 18 ‘‘(ii) other quantifiable performance 19 measures that show the benefit of the net- 20 work activities; 21 ‘‘(E) a plan for sustaining the project after 22 Federal support for the project has ended; 23 ‘‘(F) a description of how the project will 24 be evaluated; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00247 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 248 •HR 5475 IH ‘‘(G) the administrative capacity to submit 1 annual performance data electronically as speci- 2 fied by the Director; and 3 ‘‘(H) other such information as the Direc- 4 tor determines to be appropriate. 5 ‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS- 6 TEMS DEVELOPMENT GRANTS.— 7 ‘‘(1) GRANTS.—The Director may award grants 8 to eligible entities to support reduction of health dis- 9 parities, improve access to health care, and enhance 10 rural health system development in the Delta Re- 11 gion. 12 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 13 grant under this subsection, an entity shall be a 14 rural public or rural nonprofit private entity, a facil- 15 ity that qualifies as a rural health clinic under title 16 XVIII of the Social Security Act, a public or non- 17 profit entity existing exclusively to provide services 18 to migrant and seasonal farm workers in rural 19 areas, or a tribal government whose grant-funded 20 activities will be conducted within federally recog- 21 nized tribal areas. 22 ‘‘(3) APPLICATIONS.—To be eligible to receive a 23 grant under this subsection, an eligible entity shall 24 prepare and submit to the Director an application at 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00248 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 249 •HR 5475 IH such time, in such manner, and containing such in- 1 formation as the Director may require, including— 2 ‘‘(A) a description of the project that the 3 eligible entity will carry out using the funds 4 provided under the grant; 5 ‘‘(B) an explanation of the reasons why 6 Federal assistance is required to carry out the 7 project; 8 ‘‘(C) a description of the manner in which 9 the project funded under the grant will meet 10 the health care needs of the Delta Region; 11 ‘‘(D) a description of how the local com- 12 munity or region to be served will experience in- 13 creased access to quality health care services as 14 a result of the activities carried out by the enti- 15 ty; 16 ‘‘(E) a description of how health dispari- 17 ties will be reduced or the health system will be 18 improved; 19 ‘‘(F) a plan for sustaining the project after 20 Federal support for the project has ended; 21 ‘‘(G) a description of how the project will 22 be evaluated including process and outcome 23 measures related to the quality of care provided 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00249 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 250 •HR 5475 IH or how the health care system improves its per- 1 formance; 2 ‘‘(H) a description of how the grantee will 3 develop an advisory group made up of rep- 4 resentatives of the communities to be served to 5 provide guidance to the grantee to best meet 6 community need; and 7 ‘‘(I) other such information as the Director 8 determines to be appropriate. 9 ‘‘(e) SMALL RURAL HEALTH CARE PROVIDER QUAL- 10 ITY IMPROVEMENT GRANTS.— 11 ‘‘(1) GRANTS.—The Director may award grants 12 to provide for the planning and implementation of 13 small rural health care provider quality improvement 14 activities. The Director may award the grants for 15 periods of 1 to 3 years. 16 ‘‘(2) ELIGIBILITY.—To be eligible for a grant 17 under this subsection, an entity— 18 ‘‘(A) shall be— 19 ‘‘(i) a rural public or rural nonprofit 20 private health care provider or provider of 21 health care services, such as a rural health 22 clinic; or 23 ‘‘(ii) another rural provider or net- 24 work of small rural providers identified by 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00250 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 251 •HR 5475 IH the Director as a key source of local care; 1 and 2 ‘‘(B) shall not previously have received a 3 grant under this subsection for the same or a 4 similar project. 5 ‘‘(3) PREFERENCE.—In awarding grants under 6 this subsection, the Director shall give preference to 7 facilities that qualify as rural health clinics under 8 title XVIII of the Social Security Act. 9 ‘‘(4) APPLICATIONS.—To be eligible to receive a 10 grant under this subsection, an eligible entity shall 11 prepare and submit to the Director an application at 12 such time, in such manner, and containing such in- 13 formation as the Director may require, including— 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 the manner in which 21 the project funded under the grant will assure 22 continuous quality improvement in the provision 23 of services by the entity; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00251 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 252 •HR 5475 IH ‘‘(D) a description of how the local com- 1 munity or region to be served will experience in- 2 creased access to quality health care services as 3 a result of the activities carried out by the enti- 4 ty; 5 ‘‘(E) a plan for sustaining the project after 6 Federal support for the project has ended; 7 ‘‘(F) a description of how the project will 8 be evaluated including process and outcome 9 measures related to the quality of care pro- 10 vided; and 11 ‘‘(G) other such information as the Direc- 12 tor determines to be appropriate. 13 ‘‘(f) GENERAL REQUIREMENTS.— 14 ‘‘(1) PROHIBITED USES OF FUNDS.—An entity 15 that receives a grant under this section may not use 16 funds provided through the grant— 17 ‘‘(A) to build or acquire real property; or 18 ‘‘(B) for construction. 19 ‘‘(2) COORDINATION WITH OTHER AGENCIES.— 20 The Director shall coordinate activities carried out 21 under grant programs described in this section, to 22 the extent practicable, with Federal and State agen- 23 cies and nonprofit organizations that are operating 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00252 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 253 •HR 5475 IH similar grant programs, to maximize the effect of 1 public dollars in funding meritorious proposals. 2 ‘‘(g) REPORT.—Not later than September 30, 2018, 3 the Secretary shall prepare and submit to the appropriate 4 committees of Congress a report on the progress and ac- 5 complishments of the grant programs described in sub- 6 sections (b), (c), (d), and (e). 7 ‘‘(h) DEFINITIONS.—In this section: 8 ‘‘(1) The term ‘Delta Region’ has the meaning 9 given to the term ‘region’ in section 382A of the 10 Consolidated Farm and Rural Development Act (7 11 U.S.C. 2009aa). 12 ‘‘(2) The term ‘Director’ means the Director of 13 the Office of Rural Health Policy of the Health Re- 14 sources and Services Administration. 15 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 16 are authorized to be appropriated to carry out this section 17 $40,000,000 for fiscal year 2017, and such sums as may 18 be necessary for each of fiscal years 2018 through 2021.’’. 19 SEC. 437. COMMUNITY HEALTH CENTER COLLABORATIVE 20 ACCESS EXPANSION. 21 Section 330 of the Public Health Service Act (42 22 U.S.C. 254b) is amended by adding at the end the fol- 23 lowing: 24 ‘‘(t) MISCELLANEOUS PROVISIONS.— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00253 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 254 •HR 5475 IH ‘‘(1) RULE OF CONSTRUCTION WITH RESPECT 1 TO RURAL HEALTH CLINICS.—Nothing in this sec- 2 tion shall be construed to prevent a community 3 health center from contracting with a federally cer- 4 tified rural health clinic (as defined by section 5 1861(aa)(2) of the Social Security Act) for the deliv- 6 ery of primary health care and other mental, dental, 7 and physical health services that are available at the 8 rural health clinic to individuals who would other- 9 wise be eligible for free or reduced cost care if that 10 individual were able to obtain that care at the com- 11 munity health center. Such services may be limited 12 in scope to those primary health care and other 13 mental, dental, and physical health services available 14 in that rural health clinic. 15 ‘‘(2) ENABLING SERVICES.—To the extent pos- 16 sible, enabling services such as transportation and 17 translation assistance shall be provided by rural 18 health clinics described in paragraph (1). 19 ‘‘(3) ASSURANCES.—In order for a rural health 20 clinic to receive funds under this section through a 21 contract with a community health center for the de- 22 livery of primary health care and other services de- 23 scribed in paragraph (1), such rural health clinic 24 shall establish policies to ensure— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00254 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 255 •HR 5475 IH ‘‘(A) nondiscrimination based upon the 1 ability of a patient to pay; 2 ‘‘(B) the establishment of a sliding fee 3 scale for low-income patients; and 4 ‘‘(C) any such services should be subject to 5 full reimbursement according to the Prospective 6 Payment System scale.’’. 7 SEC. 438. FACILITATING THE PROVISION OF TELEHEALTH 8 SERVICES ACROSS STATE LINES. 9 (a) IN GENERAL.—For purposes of expediting the 10 provision of telehealth services, for which payment is made 11 under the Medicare Program, across State lines, the Sec- 12 retary of Health and Human Services shall, in consulta- 13 tion with representatives of States, physicians, health care 14 practitioners, and patient advocates, encourage and facili- 15 tate the adoption of provisions allowing for multistate 16 practitioner practice across State lines. 17 (b) DEFINITIONS.—In subsection (a): 18 (1) TELEHEALTH SERVICE.—The term ‘‘tele- 19 health service’’ has the meaning given that term in 20 subparagraph (F) of section 1834(m)(4) of the So- 21 cial Security Act (42 U.S.C. 1395m(m)(4)). 22 (2) PHYSICIAN, PRACTITIONER.—The terms 23 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00255 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 256 •HR 5475 IH given those terms in subparagraphs (D) and (E), re- 1 spectively, of such section. 2 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 3 Program’’ means the program of health insurance 4 administered by the Secretary of Health and Human 5 Services under title XVIII of the Social Security Act 6 (42 U.S.C. 1395 et seq.). 7 SEC. 439. SCORING OF PREVENTIVE HEALTH SAVINGS. 8 Section 202 of the Congressional Budget and Im- 9 poundment Control Act of 1974 (2 U.S.C. 602) is amend- 10 ed by adding at the end the following new subsection: 11 ‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 12 ‘‘(1) DETERMINATION BY THE DIRECTOR.— 13 Upon a request by the chairman or ranking minority 14 member of the Committee on the Budget of the Sen- 15 ate, or by the chairman or ranking minority member 16 of the Committee on the Budget of the House of 17 Representatives, the Director shall determine if a 18 proposed measure would result in reductions in 19 budget outlays in budgetary outyears through the 20 use of preventive health and preventive health serv- 21 ices. 22 ‘‘(2) PROJECTIONS.—If the Director determines 23 that a measure would result in substantial reduc- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00256 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 257 •HR 5475 IH tions in budget outlays as described in paragraph 1 (1), the Director— 2 ‘‘(A) shall include, in any projection pre- 3 pared by the Director, a description and esti- 4 mate of the reductions in budget outlays in the 5 budgetary outyears and a description of the 6 basis for such conclusions; and 7 ‘‘(B) may prepare a budget projection that 8 includes some or all of the budgetary outyears, 9 notwithstanding the time periods for projections 10 described in subsection (e) and sections 308, 11 402, and 424. 12 ‘‘(3) DEFINITIONS.—As used in this sub- 13 section— 14 ‘‘(A) the term ‘preventive health’ means an 15 action that focuses on the health of the public, 16 individuals, and defined populations in order to 17 protect, promote, and maintain health, wellness, 18 and functional ability, and prevent disease, dis- 19 ability, and premature death that is dem- 20 onstrated by credible and publicly available epi- 21 demiological projection models, incorporating 22 clinical trials or observational studies in hu- 23 mans, to avoid future health care costs; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00257 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 258 •HR 5475 IH ‘‘(B) the term ‘budgetary outyears’ means 1 the 2 consecutive 10-year periods beginning 2 with the first fiscal year that is 10 years after 3 the budget year provided for in the most re- 4 cently agreed to concurrent resolution on the 5 budget.’’. 6 SEC. 440. SENSE OF CONGRESS. 7 It is the sense of the Congress that— 8 (1) the maintenance of effort provisions added 9 to sections 1902 and 2105(d) of the Social Security 10 Act by sections 2001(b) and 2101(b) of the Patient 11 Protection and Affordable Care Act were written to 12 maintain the eligibility standards for the Medicaid 13 program under title XIX of the Social Security Act 14 and Children’s Health Insurance Program under 15 title XXI of such Act until the American Health 16 Benefit Exchanges in the States are fully oper- 17 ational; 18 (2) it is imperative that the maintenance of ef- 19 fort provisions are enforced to the strict standard in- 20 tended by the Congress; 21 (3) waiving the maintenance of effort provisions 22 should not be permitted, except in the case of a re- 23 quest for a waiver that meets the explicit non- 24 application requirements; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00258 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 259 •HR 5475 IH (4) the maintenance of effort provisions ensure 1 the continued success of the Medicaid program and 2 Children’s Health Insurance Program and were writ- 3 ten deliberately to specifically protect vulnerable and 4 disabled individuals, children, and senior citizens, 5 many of whom are also members of communities of 6 color; and 7 (5) the maintenance of effort provisions must 8 be strictly enforced and proposals to weaken the 9 maintenance of effort provisions must not be consid- 10 ered. 11 SEC. 441. REPEAL OF REQUIREMENT FOR DOCUMENTA- 12 TION EVIDENCING CITIZENSHIP OR NATION- 13 ALITY UNDER THE MEDICAID PROGRAM. 14 (a) REPEAL.—Subsections (i)(22) and (x) of section 15 1903 of the Social Security Act (42 U.S.C. 1396b) are 16 each repealed. 17 (b) CONFORMING AMENDMENTS.— 18 (1) Section 1902 of the Social Security Act (42 19 U.S.C. 1396a) is amended— 20 (A) by amending paragraph (46) of sub- 21 section (a) to read as follows: 22 ‘‘(46) provide that information is requested and 23 exchanged for purposes of income and eligibility 24 verification in accordance with a State system which 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00259 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 260 •HR 5475 IH meets the requirements of section 1137 of this 1 Act;’’; 2 (B) in subsection (e)(13)(A)(i)— 3 (i) in the matter preceding subclause 4 (I), by striking ‘‘sections 1902(a)(46)(B) 5 and 1137(d)’’ and inserting ‘‘section 6 1137(d)’’; and 7 (ii) in subclause (IV), by striking 8 ‘‘1902(a)(46)(B) or’’; and 9 (C) by striking subsection (ee). 10 (2) Section 1903 of the Social Security Act (42 11 U.S.C. 1396b) is amended— 12 (A) in subsection (i), by redesignating 13 paragraphs (23) through (26) as paragraphs 14 (22) through (25), respectively; and 15 (B) by redesignating subsections (y) and 16 (z) as subsections (x) and (y), respectively. 17 (3) Subsection (c) of section 6036 of the Deficit 18 Reduction Act of 2005 (42 U.S.C. 1396b note) is re- 19 pealed. 20 (c) EFFECTIVE DATE.—The repeals and amend- 21 ments made by this section shall take effect as if included 22 in the enactment of the Deficit Reduction Act of 2005. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00260 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 261 •HR 5475 IH SEC. 442. OFFICE OF MINORITY HEALTH IN VETERANS 1 HEALTH ADMINISTRATION OF DEPARTMENT 2 OF VETERANS AFFAIRS. 3 (a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 4 I of chapter 73 of title 38, United States Code, is amended 5 by adding at the end the following new section: 6 ‘‘§ 7310. Office of Minority Health 7 ‘‘(a) ESTABLISHMENT.—There is established in the 8 Department within the Office of the Under Secretary for 9 Health an office to be known as the ‘Office of Minority 10 Health’ (in this section referred to as the ‘Office’). 11 ‘‘(b) HEAD.—The Director of the Office of Minority 12 Health shall be the head of the Office. The Director of 13 the Office of Minority Health shall be appointed by the 14 Under Secretary of Health from among individuals quali- 15 fied to perform the duties of the position. 16 ‘‘(c) FUNCTIONS.—The functions of the Office are as 17 follows: 18 ‘‘(1) To establish short-range and long-range 19 goals and objectives and coordinate all other activi- 20 ties within the Veterans Health Administration that 21 relate to disease prevention, health promotion, health 22 care services delivery, and health care research con- 23 cerning veterans who are members of a racial or eth- 24 nic minority group. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00261 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 262 •HR 5475 IH ‘‘(2) To support research, demonstrations, and 1 evaluations to test new and innovative models for 2 the discharge of activities described in paragraph 3 (1). 4 ‘‘(3) To increase knowledge and understanding 5 of health risk factors for veterans who are members 6 of a racial or ethnic minority group. 7 ‘‘(4) To develop mechanisms that support bet- 8 ter health care information dissemination, education, 9 prevention, and services delivery to veterans from 10 disadvantaged backgrounds, including veterans who 11 are members of a racial or ethnic minority group. 12 ‘‘(5) To enter into contracts or agreements with 13 appropriate public and nonprofit private entities to 14 develop and carry out programs to provide bilingual 15 or interpretive services to assist veterans who are 16 members of a racial or ethnic minority group and 17 who lack proficiency in speaking the English lan- 18 guage in accessing and receiving health care services 19 through the Veterans Health Administration. 20 ‘‘(6) To carry out programs to improve access 21 to health care services through the Veterans Health 22 Administration for veterans with limited proficiency 23 in speaking the English language, including the de- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00262 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 263 •HR 5475 IH velopment and evaluation of demonstration and pilot 1 projects for that purpose. 2 ‘‘(7) To advise the Under Secretary of Health 3 on matters relating to the development, implementa- 4 tion, and evaluation of health professions education 5 in decreasing disparities in health care outcomes be- 6 tween veterans who are members of a racial or eth- 7 nic minority group and other veterans, including cul- 8 tural competency as a method of eliminating such 9 health disparities. 10 ‘‘(8) To perform such other functions and du- 11 ties as the Secretary or the Under Secretary for 12 Health considers appropriate. 13 ‘‘(d) DEFINITIONS.—In this section: 14 ‘‘(1) The term ‘racial or ethnic minority group’ 15 means the following: 16 ‘‘(A) American Indians (including Alaska 17 Natives, Eskimos, and Aleuts). 18 ‘‘(B) Asian-Americans. 19 ‘‘(C) Native Hawaiians and other Pacific 20 Islanders. 21 ‘‘(D) Blacks. 22 ‘‘(E) Hispanics. 23 ‘‘(2) The term ‘Hispanic’ means individuals 24 whose origin is Mexican, Puerto Rican, Cuban, Cen- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00263 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 264 •HR 5475 IH tral or South American, or any other Spanish-speak- 1 ing country.’’. 2 (b) CLERICAL AMENDMENT.—The table of sections 3 at the beginning of such chapter is amended by inserting 4 after the item relating to section 7309 the following new 5 item: 6 ‘‘7310. Office of Minority Health.’’. SEC. 443. INDIAN DEFINED IN PPACA. 7 (a) DEFINITION OF INDIAN.—Section 1304 of the 8 Patient Protection and Affordable Care Act (42 U.S.C. 9 18024) is amended by adding at the end the following: 10 ‘‘(f) INDIAN.— 11 ‘‘(1) IN GENERAL.—In this title, the term ‘In- 12 dian’ means any individual— 13 ‘‘(A) described in paragraph (13) or (28) 14 of section 4 of the Indian Health Care Improve- 15 ment Act (25 U.S.C. 1603); 16 ‘‘(B) who is eligible for health services pro- 17 vided by the Indian Health Service under sec- 18 tion 809 of the Indian Health Care Improve- 19 ment Act (25 U.S.C. 1679); 20 ‘‘(C) who is of Indian descent and belongs 21 to the Indian community served by the local fa- 22 cilities and program of the Indian Health Serv- 23 ice; or 24 ‘‘(D) who is described in paragraph (2). 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00264 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 265 •HR 5475 IH ‘‘(2) INCLUDED INDIVIDUALS.—The following 1 individuals shall be considered to be an ‘Indian’: 2 ‘‘(A) A member of a federally recognized 3 Indian tribe. 4 ‘‘(B) A resident of an urban center who 5 meets 1 or more of the following 4 criteria: 6 ‘‘(i) Membership in a tribe, band, or 7 other organized group of Indians, including 8 those tribes, bands, or groups terminated 9 since 1940 and those recognized as of the 10 date of enactment of the Health Equity 11 and Accountability Act of 2016 or later by 12 the State in which they reside, or being a 13 descendant, in the first or second degree, 14 of any such member. 15 ‘‘(ii) Is an Eskimo or Aleut or other 16 Alaska Native. 17 ‘‘(iii) Is considered by the Secretary of 18 the Interior to be an Indian for any pur- 19 pose. 20 ‘‘(iv) Is determined to be an Indian 21 under regulations promulgated by the Sec- 22 retary. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00265 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 266 •HR 5475 IH ‘‘(C) An individual who is considered by 1 the Secretary of the Interior to be an Indian for 2 any purpose. 3 ‘‘(D) An individual who is considered by 4 the Secretary to be an Indian for purposes of 5 eligibility for Indian health care services, includ- 6 ing as a California Indian, Eskimo, Aleut, or 7 other Alaska Native.’’. 8 (b) CONFORMING AMENDMENTS.— 9 (1) AFFORDABLE CHOICES HEALTH BENEFIT 10 PLANS.—Section 1311(c)(6)(D) of the Patient Pro- 11 tection and Affordable Care Act (42 U.S.C. 12 18031(c)(6)(D)) is amended by striking ‘‘section 4 13 of the Indian Health Care Improvement Act’’ and 14 inserting ‘‘section 1304(f)’’. 15 (2) REDUCED COST-SHARING FOR INDIVIDUALS 16 ENROLLING IN QUALIFIED HEALTH PLANS.—Section 17 1402(d) of the Patient Protection and Affordable 18 Care Act (42 U.S.C. 18071(d)) is amended— 19 (A) in paragraph (1), in the matter pre- 20 ceding subparagraph (A), by striking ‘‘section 21 4(d) of the Indian Self-Determination and Edu- 22 cation Assistance Act (25 U.S.C. 450b(d))’’ and 23 inserting ‘‘section 1304(f)’’; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00266 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 267 •HR 5475 IH (B) in paragraph (2), in the matter pre- 1 ceding subparagraph (A), by striking ‘‘(as so 2 defined)’’ and inserting ‘‘(as defined in section 3 1304(f))’’. 4 (3) EXEMPTION FROM PENALTY FOR NOT 5 MAINTAINING MINIMUM ESSENTIAL COVERAGE.— 6 Section 5000A(e) of the Internal Revenue Code of 7 1986 is amended by striking paragraph (3) and in- 8 serting the following: 9 ‘‘(3) INDIANS.—Any applicable individual who 10 is an Indian (as defined in section 1304(f) of the 11 Patient Protection and Affordable Care Act).’’. 12 SEC. 444. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL 13 ACCESS FOR LOW-INCOME PATIENTS. 14 (a) IN GENERAL.—Not later than January 1, 2016, 15 the Comptroller General of the United States shall con- 16 duct a study on how certain amendments made by the Pa- 17 tient Protection and Affordable Care Act (Public Law 18 111–148) to titles XVIII and XIX of the Social Security 19 Act affect the timely access to health care services for low- 20 income patients. Such study shall— 21 (1) evaluate and examine whether States elect- 22 ing to make medical assistance available under sec- 23 tion 1902(a)(10)(A)(i)(VIII) of the Social Security 24 Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) (including 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00267 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 268 •HR 5475 IH States making such an election through a waiver of 1 the State plan) to individuals described in such sec- 2 tion mitigates the need for payments to dispropor- 3 tionate share hospitals under section 1886(d)(5)(F) 4 of the Social Security Act (42 U.S.C. 5 1395ww(d)(5)(F)) and section 1923 of such Act (42 6 U.S.C. 1396r–4), including the impact of such 7 States electing to make medical assistance available 8 to such individuals on— 9 (A) the number of individuals in the 10 United States who are without health insurance 11 and the distribution of such individuals in rela- 12 tion to areas primarily served by dispropor- 13 tionate share hospitals; and 14 (B) the low-income utilization rate of such 15 hospitals and the resulting fiscal sustainability 16 of such hospitals; 17 (2) evaluate the appropriate level and distribu- 18 tion of such payments among disproportionate hos- 19 pitals for purposes of— 20 (A) sufficiently accounting for the level of 21 uncompensated care provided by such hospitals 22 to low-income patients; and 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00268 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 269 •HR 5475 IH (B) providing timely access to health serv- 1 ices for individuals in medically underserved 2 areas; and 3 (3) assess, with respect to disproportionate hos- 4 pitals— 5 (A) the role played by such hospitals in 6 providing critical access to emergency, inpa- 7 tient, and outpatient health services, as well as 8 the location of such hospitals in relation to 9 medically underserved areas; and 10 (B) the extent to which such hospitals sat- 11 isfy the requirements established for charitable 12 hospital organizations under section 501(r) of 13 the Internal Revenue Code of 1986 with respect 14 to community health needs assessments, finan- 15 cial assistance policy requirements, limitations 16 on charges, and billing and collection require- 17 ments. 18 (b) REPORTS.— 19 (1) REPORT TO CONGRESS.—Not later than 20 180 days after the date on which the study under 21 subsection (a) is completed, the Comptroller General 22 of the United States shall submit to the Committee 23 on Energy and Commerce of the House of Rep- 24 resentatives and the Committee on Health, Edu- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00269 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 270 •HR 5475 IH cation, Labor, and Pensions of the Senate a report 1 that contains— 2 (A) the results of the study; 3 (B) recommendations to Congress for any 4 legislative changes to the payments to dis- 5 proportionate share hospitals under section 6 1886(d)(5)(F) of the Social Security Act (42 7 U.S.C. 1395ww(d)(5)(F)) and section 1923 of 8 such Act (42 U.S.C. 1396r–4) that are needed 9 to ensure access to health services for low-in- 10 come patients that— 11 (i) are based on the number of indi- 12 viduals without health insurance, the 13 amount of uncompensated care provided by 14 such hospitals, and the impact of reduced 15 payments levels on low-income commu- 16 nities; and 17 (ii) takes into account any reports 18 submitted by the Secretary of the Treas- 19 ury, in consultation with the Secretary of 20 Health and Human Services, to Congres- 21 sional committees regarding the costs in- 22 curred by charitable hospital organizations 23 for charity care, bad debt, nonreimbursed 24 expenses for services provided to individ- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00270 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 271 •HR 5475 IH uals under the Medicare Program under 1 title XVIII of the Social Security Act and 2 the Medicaid Program under title XIX of 3 such Act, and any community benefit ac- 4 tivities provided by such organizations. 5 (2) REPORT TO THE SECRETARY OF HEALTH 6 AND HUMAN SERVICES.—Not later than 180 days 7 after the date on which the study under subsection 8 (a) is completed, the Comptroller General of the 9 United States shall submit to the Secretary of 10 Health and Human Services a report that con- 11 tains— 12 (A) the results of the study; and 13 (B) any recommendations for purposes of 14 assisting in the development of the methodology 15 for the adjustment of payments to dispropor- 16 tionate share hospitals, as required under sec- 17 tion 1886(r) of the Social Security Act (42 18 U.S.C. 1395ww(r)) and the reduction of such 19 payments section 1923(f)(7) of such Act (42 20 U.S.C. 1396r–4(f)(7)), taking into account the 21 reports referred to in paragraph (1)(B)(ii). 22 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00271 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 272 •HR 5475 IH SEC. 445. ASSISTANT SECRETARY OF THE INDIAN HEALTH 1 SERVICE. 2 (a) REFERENCES.—Any reference in a law, regula- 3 tion, document, paper, or other record of the United 4 States to the Director of the Indian Health Service shall 5 be deemed to be a reference to the Assistant Secretary 6 of the Indian Health Service. 7 (b) EXECUTIVE SCHEDULE.—Section 5315 of title 5, 8 United States Code, is amended in the matter relating to 9 the Assistant Secretaries of Health and Human Services 10 by striking ‘‘(6)’’ and inserting ‘‘(7), 1 of whom shall be 11 the Assistant Secretary of the Indian Health Service’’. 12 (c) CONFORMING AMENDMENT.—Section 5316 of 13 title 5, United States Code, is amended by striking ‘‘Direc- 14 tor, Indian Health Service, Department of Health and 15 Human Services.’’. 16 SEC. 446. REAUTHORIZATION OF THE NATIVE HAWAIIAN 17 HEALTH CARE IMPROVEMENT ACT. 18 (a) NATIVE HAWAIIAN HEALTH CARE SYSTEMS.— 19 Section 6(h)(1) of the Native Hawaiian Health Care Im- 20 provement Act (42 U.S.C. 11705(h)(1)) is amended by 21 striking ‘‘may be necessary for fiscal years 1993 through 22 2019’’ and inserting ‘‘are necessary’’. 23 (b) ADMINISTRATIVE GRANT FOR PAPA OLA 24 LOKAHI.—Section 7(b) of the Native Hawaiian Health 25 Care Improvement Act (42 U.S.C. 11706(b)) is amended 26 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00272 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 273 •HR 5475 IH by striking ‘‘may be necessary for fiscal years 1993 1 through 2019’’ and inserting ‘‘are necessary’’. 2 (c) NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.— 3 Section 10(c) of the Native Hawaiian Health Care Im- 4 provement Act (42 U.S.C. 11709(c)) is amended by strik- 5 ing ‘‘may be necessary for fiscal years 1993 through 6 2019’’ and inserting ‘‘are necessary’’. 7 SEC. 447. AVAILABILITY OF NON-ENGLISH LANGUAGE 8 SPEAKING PROVIDERS. 9 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa- 10 tient Protection and Affordable Care Act (42 U.S.C. 11 18031(c)(1)(B)) is amended by inserting before the semi- 12 colon the following: ‘‘and, with respect to such providers, 13 a provider’s ability to provide care in a language other 14 than English either through the provider speaking such 15 language or by the provider having a training medical in- 16 terpreter who speaks such language available during office 17 hours’’. 18 (b) EFFECTIVE DATE.—The amendment made by 19 subsection (a) shall apply for plan years beginning more 20 than 1 year after the date of the enactment of this Act. 21 SEC. 448. ACCESS TO ESSENTIAL COMMUNITY PROVIDERS. 22 (a) ESSENTIAL COMMUNITY PROVIDERS.—Section 23 1311(c)(1)(C) of the Patient Protection and Affordable 24 Care Act (42 U.S.C. 18031(c)(1)(C)) is amended— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00273 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 274 •HR 5475 IH (1) by inserting ‘‘(i)’’ after ‘‘(C)’’; and 1 (2) by adding at the end the following new 2 clauses: 3 ‘‘(ii) not later than 2018, increase the per- 4 centage of essential community providers in- 5 cluded in its network by 10 percent annually 6 (based on the level in the plan for 2016) until 7 90 percent of all federally qualified health cen- 8 ters and 75 percent of all other essential com- 9 munity providers in the contract service area 10 are in-network; and 11 ‘‘(iii) include one of each type of essential 12 community provider in network in each county 13 in their service area, where available;’’. 14 (b) REPORTING REQUIREMENTS.—Section 15 1311(e)(3) of the Patient Protection and Affordable Care 16 Act (42 U.S.C. 18031(e)(3)(A)) is amended by adding at 17 the end the following new subparagraph: 18 ‘‘(E) DATA ON ESSENTIAL COMMUNITY 19 PROVIDERS.—The Secretary shall require quali- 20 fied health plans to submit annually to the Sec- 21 retary data on the percentage of essential com- 22 munity providers, by county, that contract with 23 each qualified health plan offered in that county 24 and the percentage of essential community pro- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00274 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 275 •HR 5475 IH viders, by type, that contract with each quali- 1 fied health plan offered in that county. Data so 2 submitted shall be made available to the general 3 public’’. 4 (c) ESSENTIAL COMMUNITY PROVIDER PROVISIONS 5 APPLIED UNDER MEDICARE AND MEDICAID.— 6 (1) MEDICARE.—Section 1852(d)(1) of the So- 7 cial Security Act (42 U.S.C.1395w–22(d)(1)) is 8 amended— 9 (A) by striking ‘‘and’’ at the end of sub- 10 paragraph (D); 11 (B) by striking the period at the end of 12 subparagraph (E) and inserting ‘‘; and’’; and 13 (C) by adding at the end the following new 14 subparagraph: 15 ‘‘(F) the plan meets the requirements of 16 clauses (ii) and (iii) of section 1311(c)(1)(C) of 17 the Patient Protection and Affordable Care Act 18 (relating to inclusion in networks of essential 19 community providers).’’. 20 (2) MEDICAID.—Section 1932(b)(5) of the So- 21 cial Security Act (42 U.S.C. 1396u–2(b)(5)) is 22 amended— 23 (A) by striking ‘‘and’’ at the end of sub- 24 paragraph (A); 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00275 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 276 •HR 5475 IH (B) by striking the period at the end of 1 subparagraph (B) and inserting ‘‘; and’’; and 2 (C) by adding at the end the following new 3 subparagraph: 4 ‘‘(C) the plan meets the requirements of 5 clauses (ii) and (iii) of section 1311(c)(1)(C) of 6 the Patient Protection and Affordable Care Act 7 (relating to inclusion in networks of essential 8 community providers) with respect to services 9 offered in the service area involved.’’. 10 SEC. 449. PROVIDER NETWORK ADEQUACY IN COMMU- 11 NITIES OF COLOR. 12 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa- 13 tient Protection and Affordable Care Act (42 U.S.C. 14 18031(c)(1)(B)) is amended— 15 (1) by inserting ‘‘(i)’’ after ‘‘(B)’’; and 16 (2) by adding at the end the following the fol- 17 lowing new clauses: 18 ‘‘(ii) meet such network adequacy 19 standards as the Secretary may establish 20 with regard to— 21 ‘‘(I) appointment wait time; 22 ‘‘(II) travel time and distance to 23 health care provider facilities and pro- 24 viders by public and private transit; 25 VerDate Sep 11 2014 21:04 Jun 20, 2016 Jkt 059200 PO 00000 Frm 00276 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 277 •HR 5475 IH ‘‘(III) hours of operation to ac- 1 commodate individuals who cannot 2 come to provider appointments during 3 standard business hours; and 4 ‘‘(IV) other network adequacy 5 standards to ensure that care through 6 these plans is accessible to diverse 7 communities; and. 8 ‘‘(iii) provide coverage for services for 9 enrollees through out-of-network providers 10 at no additional cost to the enrollees in 11 cases where in-network providers are un- 12 able to comply with the standards estab- 13 lished under clause subclause (III) or (IV) 14 of clause (ii) for such services and the out- 15 of-network providers can deliver such serv- 16 ices in compliance with such standards.. 17 ‘‘(b) EFFECTIVE DATE.—The amendments made by 18 subsection (a) shall apply to plan years beginning more 19 than 1 year after the date of the enactment of this Act..’’. 20 SEC. 450. IMPROVING ACCESS TO DENTAL CARE. 21 (a) REPORTS TO CONGRESS.— 22 (1) GAO REPORT ON DENTAL THERAPIST PRO- 23 GRAMS.—Not later than 1 year after the date of the 24 enactment of this Act, the Comptroller General of 25 VerDate Sep 11 2014 21:04 Jun 20, 2016 Jkt 059200 PO 00000 Frm 00277 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 278 •HR 5475 IH the United States shall submit to Congress a report 1 on the Alaska Dental Health Aide Therapists Pro- 2 gram and the Dental Therapist and Advanced Den- 3 tal Therapist programs in Minnesota, to assess den- 4 tal therapists’ effectiveness in— 5 (A) improving access to timely dental care 6 among communities of color; 7 (B) providing high quality care; and 8 (C) providing culturally competent care. 9 (2) HRSA REPORT ON DENTAL SHORTAGE 10 AREAS.—Not later than 1 year after the date of the 11 enactment of this Act, the Secretary, acting through 12 the Administrator of the Health Resources Service 13 Administration, shall submit to Congress a report 14 which details geographic dental access shortages and 15 the preparedness of dental providers to offer cul- 16 turally and linguistically appropriate, affordable, ac- 17 cessible, and timely services. 18 (b) EXPANSION OF DENTAL HEALTH AID THERA- 19 PISTS IN TRIBAL COMMUNITIES.—Section 119(d) of the 20 Indian Health Care Improvement Act ( U.S.C. 1616l(d)) 21 is amended— 22 (1) in paragraph (2), by striking ‘‘Subject to’’ 23 and all that follows and inserting ‘‘Subject to para- 24 graph (3), in establishing a national program under 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00278 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 279 •HR 5475 IH paragraph (1), the Secretary shall not reduce the 1 amounts provided for the Community Health Aide 2 Program described in subsections (a) and (b).’’; 3 (2) by striking paragraph (3); and 4 (3) by redesignating paragraph (4) as para- 5 graph (3). 6 (c) COVERAGE OF DENTAL SERVICES UNDER THE 7 MEDICARE PROGRAM.— 8 (1) COVERAGE.—Section 1861(s)(2) of the So- 9 cial Security Act (42 U.S.C. 1395x(s)(2)) is amend- 10 ed— 11 (A) in subparagraph (EE), by striking 12 ‘‘and’’ after the semicolon at the end; 13 (B) in subparagraph (FF), by adding 14 ‘‘and’’ after the semicolon at the end; and 15 (C) by adding at the end the following new 16 subparagraph: 17 ‘‘(GG) oral health services (as defined in 18 subsection (kkk);’’. 19 (2) ORAL HEALTH SERVICES DEFINED.—Sec- 20 tion 1861 of the Social Security Act (42 U.S.C. 21 1395x), as amended by sections 205(b) and 433(a), 22 is amended by adding at the end the following new 23 subsection: 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00279 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 280 •HR 5475 IH ‘‘Oral Health Services 1 ‘‘(kkk)(1) The term ‘oral health services’ means serv- 2 ices (as defined by the Secretary) that are necessary to 3 prevent disease and promote oral health, restore oral 4 structures to health and function, and treat emergency 5 conditions. 6 ‘‘(2) For purposes of paragraph (1), such term shall 7 include mobile and portable oral health services (as de- 8 fined by the Secretary) that— 9 ‘‘(A) are provided for the purpose of over- 10 coming mobility, transportation, and access barriers 11 for individuals; and 12 ‘‘(B) satisfy the standards and certification re- 13 quirements established under section 1902(a)(82)(B) 14 for the State in which the services are provided.’’. 15 (3) PAYMENT AND COINSURANCE.—Section 16 1833(a)(1) of the Social Security Act (42 U.S.C. 17 1395l(a)(1)) is amended— 18 (A) by striking ‘‘and’’ before ‘‘(Z)’’; and 19 (B) by inserting before the semicolon at 20 the end the following: ‘‘, and (AA) with respect 21 to oral health services (as defined in section 22 1861(kkk)), the amount paid shall be (i) in the 23 case of such services that are preventive, 100 24 percent of the lesser of the actual charge for 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00280 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 281 •HR 5475 IH the services or the amount determined under 1 the payment basis determined under section 2 1848, and (ii) in the case of all other such serv- 3 ices, 80 percent of the lesser of the actual 4 charge for the services or the amount deter- 5 mined under the payment basis determined 6 under section 1848’’. 7 (4) PAYMENT UNDER PHYSICIAN FEE SCHED- 8 ULE.—Section 1848(j)(3) of the Social Security Act 9 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 10 ‘‘(2)(GG),’’ after ‘‘risk assessment),’’. 11 (5) DENTURES.—Section 1861(s)(8) of the So- 12 cial Security Act (42 U.S.C. 1395x(s)(8)) is amend- 13 ed— 14 (A) by striking ‘‘(other than dental)’’ and 15 inserting ‘‘(including dentures)’’; and 16 (B) by striking ‘‘internal body’’. 17 (6) REPEAL OF GROUND FOR EXCLUSION.— 18 Section 1862(a) of the Social Security Act (42 19 U.S.C. 1395y) is amended by striking paragraph 20 (12). 21 (7) EFFECTIVE DATE.—The amendments made 22 by this section shall apply to services furnished on 23 or after January 1, 2017. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00281 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 282 •HR 5475 IH (d) COVERAGE OF DENTAL SERVICES UNDER THE 1 MEDICAID PROGRAM.— 2 (1) IN GENERAL.—Section 1905 of the Social 3 Security Act (42 U.S.C. 1396d) is amended— 4 (A) in subsection (a)(10), by striking ‘‘den- 5 tal services’’ and inserting ‘‘oral health services 6 (as defined in subsection (ee)(1))’’; and 7 (B) by adding at the end the following new 8 subsection: 9 ‘‘(ee)(1) Subject to paragraphs (2) and (3), for pur- 10 poses of this title, the term ‘oral health services’ means 11 services (as defined by the Secretary) that are necessary 12 to prevent disease and promote oral health, restore oral 13 structures to health and function, and treat emergency 14 conditions. These services shall include, in the case of 15 pregnant or postpartum women, such services as are nec- 16 essary to address oral health conditions that exist or are 17 exacerbated by pregnancy or childbirth or which, if left 18 untreated, could adversely affect fetal or child develop- 19 ment. 20 ‘‘(2) For purposes of paragraph (1), such term shall 21 include— 22 ‘‘(A) dentures; and 23 ‘‘(B) mobile and portable oral health services 24 (as defined by the Secretary) that— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00282 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 283 •HR 5475 IH ‘‘(i) are provided for the purpose of over- 1 coming mobility, transportation, and access bar- 2 riers for individuals; and 3 ‘‘(ii) satisfy the standards and certification 4 requirements established under section 5 1902(a)(82)(C) for the State in which the serv- 6 ices are provided. 7 ‘‘(3) For purposes of paragraph (1), such term shall 8 not apply to dental care or services provided to individuals 9 under the age of 21 under subsection (r)(3).’’. 10 (2) CONFORMING AMENDMENTS.— 11 (A) STATE PLAN REQUIREMENTS.—Section 12 1902(a) of the Social Security Act (42 U.S.C. 13 1396a(a)) is amended— 14 (i) in paragraph (10)(A), in the mat- 15 ter preceding clause (i), by inserting 16 ‘‘(10),’’ after ‘‘(5),’’; 17 (ii) in paragraph (80), by striking 18 ‘‘and’’ at the end; 19 (iii) in paragraph (81), by striking the 20 period at the end and inserting ‘‘; and’’; 21 and 22 (iv) by inserting after paragraph (81) 23 the following: 24 ‘‘(82) provide for— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00283 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 284 •HR 5475 IH ‘‘(A) informing, in writing, all individuals 1 who have been determined to be eligible for 2 medical assistance of the availability of oral 3 health services (as defined in section 1905(ee)); 4 ‘‘(B) conducting targeted outreach to preg- 5 nant women who have been determined to be el- 6 igible for medical assistance about the avail- 7 ability of medical assistance for such dental 8 services and the importance of receiving dental 9 care while pregnant; and 10 ‘‘(C) establishing and maintaining stand- 11 ards for and certification of mobile and portable 12 oral health services (as described in subsections 13 (r)(3)(C) and (ee)(2)(B) of section 1905).’’. 14 (B) DEFINITION OF MEDICAL ASSIST- 15 ANCE.—Section 1905(a)(12) of the Social Secu- 16 rity Act (42 U.S.C. 1396d(a)(12)) is amended 17 by striking ‘‘, dentures,’’. 18 (3) MOBILE AND PORTABLE ORAL HEALTH 19 SERVICES UNDER EPSDT.—Section 1905(r)(3) of the 20 Social Security Act (42 U.S.C. 1396d(r)(3)) is 21 amended— 22 (A) in subparagraph (A)(ii), by striking ‘‘; 23 and’’ and inserting a semicolon; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00284 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 285 •HR 5475 IH (B) in subparagraph (B), by striking the 1 period at the end and inserting ‘‘; and’’; and 2 (C) by adding at the end the following new 3 subparagraph: 4 ‘‘(C) which shall include mobile and port- 5 able oral health services (as defined by the Sec- 6 retary) that— 7 ‘‘(i) are provided for the purpose of 8 overcoming mobility, transportation, or ac- 9 cess barriers for children; and 10 ‘‘(ii) satisfy the standards and certifi- 11 cation requirements established under sec- 12 tion 1902(a)(82)(C) for the State in which 13 the services are provided.’’. 14 (e) ORAL HEALTH SERVICES AS AN ESSENTIAL 15 HEALTH BENEFIT.—Section 1302(b) of the Patient Pro- 16 tection and Affordable Care Act (42 U.S.C. 18022(b)) is 17 amended— 18 (1) in paragraph (1)— 19 (A) in subparagraph (J), by striking ‘‘oral 20 and’’; and 21 (B) by adding at the end the following: 22 ‘‘(K) Oral health services for children and 23 adults.’’; and 24 (2) by adding at the end the following: 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00285 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 286 •HR 5475 IH ‘‘(6) ORAL HEALTH SERVICES.—For purposes 1 of paragraph (1)(K), the term ‘oral health services’ 2 means services (as defined by the Secretary), that 3 are necessary to prevent disease and promote oral 4 health, restore oral structures to health and func- 5 tion, and treat emergency conditions.’’. 6 (f) DEMONSTRATION PROGRAM ON TRAINING AND 7 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 8 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 9 VETERANS IN RURAL AND OTHER UNDERSERVED COM- 10 MUNITIES.— 11 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 12 The Secretary of Veterans Affairs may carry out a 13 demonstration program to establish programs to 14 train and employ alternative dental health care pro- 15 viders in order to increase access to dental health 16 care services for veterans who are entitled to such 17 services from the Department of Veterans Affairs 18 and reside in rural and other underserved commu- 19 nities. 20 (2) TELEHEALTH.—For purposes of alternative 21 dental health care providers and other dental care 22 providers who are licensed to provide clinical care, 23 dental services provided under the demonstration 24 program under this section may be administered by 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00286 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 287 •HR 5475 IH such providers through telehealth-enabled collabora- 1 tion and supervision when appropriate and feasible. 2 (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 3 VIDERS DEFINED.—In this section, the term ‘‘alter- 4 native dental health care providers’’ has the meaning 5 given that term in section 340G–1(a)(2) of the Pub- 6 lic Health Service Act (42 U.S.C. 256g–1(a)(2)). 7 (4) AUTHORIZATION OF APPROPRIATIONS.— 8 There are authorized to be appropriated such sums 9 as are necessary to carry out the demonstration pro- 10 gram under this subsection. 11 (g) DEMONSTRATION PROGRAM ON TRAINING AND 12 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 13 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 14 MEMBERS OF THE ARMED FORCES AND DEPENDENTS 15 LACKING READY ACCESS TO SUCH SERVICES.— 16 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 17 The Secretary of Defense may carry out a dem- 18 onstration program to establish programs to train 19 and employ alternative dental health care providers 20 in order to increase access to dental health care 21 services for members of the Armed Forces and their 22 dependents who lack ready access to such services, 23 including the following: 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00287 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 288 •HR 5475 IH (A) Members and dependents who reside in 1 rural areas or areas otherwise underserved by 2 dental health care providers. 3 (B) Members of the National Guard and 4 Reserves in active status who are potentially 5 deployable. 6 (2) TELEHEALTH.—For purposes of alternative 7 dental health care providers and other dental care 8 providers who are licensed to provide clinical care, 9 dental services provided under the demonstration 10 program under this section may be administered by 11 such providers through telehealth-enabled collabora- 12 tion and supervision when appropriate and feasible. 13 (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 14 VIDERS DEFINED.—In this section, the term ‘‘alter- 15 native dental health care providers’’ has the meaning 16 given that term in section 340G–1(a)(2) of the Pub- 17 lic Health Service Act (42 U.S.C. 256g–1(a)(2)). 18 (4) AUTHORIZATION OF APPROPRIATIONS.— 19 There are authorized to be appropriated such sums 20 as are necessary to carry out the demonstration pro- 21 gram under this subsection. 22 (h) DEMONSTRATION PROGRAM ON TRAINING AND 23 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 24 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00288 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 289 •HR 5475 IH PRISONERS WITHIN THE CUSTODY OF THE BUREAU OF 1 PRISONS.— 2 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 3 The Attorney General, acting through the Director 4 of the Bureau of Prisons, may carry out a dem- 5 onstration program to establish programs to train 6 and employ alternative dental health care providers 7 in order to increase access to dental health services 8 for prisoners within the custody of the Bureau of 9 Prisons. 10 (2) TELEHEALTH.—For purposes of alternative 11 dental health care providers and any other dental 12 care providers who are licensed to provide clinical 13 care, dental services provided under the demonstra- 14 tion program under this section may be administered 15 by such providers through telehealth-enabled collabo- 16 ration and supervision when deemed appropriate and 17 feasible. 18 (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 19 VIDERS DEFINED.—In this section, the term ‘‘alter- 20 native dental health care providers’’ has the meaning 21 given that term in section 340G–1(a)(2) of the Pub- 22 lic Health Service Act (42 U.S.C. 256g–1(a)(2)). 23 (4) AUTHORIZATION OF APPROPRIATIONS.— 24 There are authorized to be appropriated such sums 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00289 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 290 •HR 5475 IH as are necessary to carry out the demonstration pro- 1 gram under this subsection. 2 (i) DEMONSTRATION PROGRAM ON TRAINING AND 3 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 4 PROVIDERS FOR DENTAL HEALTH CARE SERVICES 5 UNDER THE INDIAN HEALTH SERVICE.— 6 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 7 The Secretary of Health and Human Services, act- 8 ing through the Indian Health Service, may carry 9 out a demonstration program to establish programs 10 to train and employ alternative dental health care 11 providers in order to help eliminate oral health dis- 12 parities and increase access to dental services 13 through health programs operated by the Indian 14 Health Service, Indian tribes, tribal organizations, 15 and urban Indian organizations (as those terms are 16 defined in section 4 of the Indian Health Care Im- 17 provement Act (25 U.S.C. 1603)). 18 (2) TELEHEALTH.—For purposes of alternative 19 dental health care providers and any other dental 20 care providers who are licensed to provide clinical 21 care, dental services provided under the demonstra- 22 tion program under this section may be administered 23 by such providers through telehealth-enabled collabo- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00290 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 291 •HR 5475 IH ration and supervision when deemed appropriate and 1 feasible. 2 (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 3 VIDERS DEFINED.—In this section, the term ‘‘alter- 4 native dental health care providers’’ has the meaning 5 given that term in section 340G–1(a)(2) of the Pub- 6 lic Health Service Act (42 U.S.C. 256g–1(a)(2)). 7 (4) AUTHORIZATION OF APPROPRIATIONS.— 8 There are authorized to be appropriated such sums 9 as are necessary to carry out the demonstration pro- 10 gram under this subsection. 11 TITLE V—IMPROVING HEALTH 12 OUTCOMES FOR WOMEN, 13 CHILDREN, AND FAMILIES 14 SEC. 501. GRANTS TO PROMOTE POSITIVE HEALTH OUT- 15 COMES FOR WOMEN AND CHILDREN. 16 Part Q of title III of the Public Health Service Act 17 (42 U.S.C. 280g et seq.) is amended by adding at the end 18 the following: 19 ‘‘SEC. 399Z–2. GRANTS TO PROMOTE POSITIVE HEALTH 20 OUTCOMES FOR WOMEN AND CHILDREN. 21 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col- 22 laboration with the Administrator of the Health Resources 23 and Services Administration and other Federal officials 24 determined appropriate by the Secretary, is authorized to 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00291 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 292 •HR 5475 IH award grants to eligible entities to promote positive health 1 outcomes for women and children in target populations, 2 especially racial and ethnic minority women and children 3 in medically underserved communities. 4 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 5 subsection (a) may be used to support the activities of 6 community health workers, including such activities— 7 ‘‘(1) to educate and provide outreach regarding 8 enrollment in health insurance including the State 9 Children’s Health Insurance Program under title 10 XXI of the Social Security Act, Medicare under title 11 XVIII of such Act, and Medicaid under title XIX of 12 such Act; 13 ‘‘(2) to educate, guide, and provide outreach in 14 a community setting regarding health problems prev- 15 alent among women and children and especially 16 among racial and ethnic minority women and chil- 17 dren; 18 ‘‘(3) to educate, guide, and provide experiential 19 learning opportunities and target risk factors and 20 healthy behaviors that impede or contribute to 21 achieving positive health outcomes, including— 22 ‘‘(A) healthy nutrition; 23 ‘‘(B) physical activity; 24 ‘‘(C) overweight or obesity; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00292 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 293 •HR 5475 IH ‘‘(D) tobacco use; 1 ‘‘(E) alcohol and substance use; 2 ‘‘(F) injury and violence; 3 ‘‘(G) sexual health; 4 ‘‘(H) mental health; 5 ‘‘(I) musculoskeletal health and arthritis; 6 ‘‘(J) dental and oral health; 7 ‘‘(K) understanding informed consent; and 8 ‘‘(L) stigma; 9 ‘‘(4) to educate and guide regarding effective 10 strategies to promote positive health outcomes for 11 women and children; 12 ‘‘(5) to promote community wellness and aware- 13 ness; and 14 ‘‘(6) to educate and refer target populations to 15 appropriate health care agencies and community- 16 based programs and organizations in order to in- 17 crease access to quality health care services, includ- 18 ing preventive health services. 19 ‘‘(c) APPLICATION.— 20 ‘‘(1) IN GENERAL.—Each eligible entity that 21 desires to receive a grant under subsection (a) shall 22 submit an application to the Secretary, at such time, 23 in such manner, and accompanied by such additional 24 information as the Secretary may require. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00293 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 294 •HR 5475 IH ‘‘(2) CONTENTS.—Each application submitted 1 pursuant to paragraph (1) shall— 2 ‘‘(A) describe the activities for which as- 3 sistance under this section is sought; 4 ‘‘(B) contain an assurance that, with re- 5 spect to each community health worker pro- 6 gram receiving funds under the grant awarded, 7 such program provides in-language training and 8 supervision to community health workers to en- 9 able such workers to provide authorized pro- 10 gram activities in (at least) the most commonly 11 used languages within a particular geographic 12 region; 13 ‘‘(C) contain an assurance that the appli- 14 cant will evaluate the effectiveness of commu- 15 nity health worker programs receiving funds 16 under the grant; 17 ‘‘(D) contain an assurance that each com- 18 munity health worker program receiving funds 19 under the grant will provide culturally com- 20 petent services in the linguistic context most 21 appropriate for the individuals served by the 22 program; 23 ‘‘(E) contain a plan to document and dis- 24 seminate project descriptions and results to 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00294 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 295 •HR 5475 IH other States and organizations as identified by 1 the Secretary; and 2 ‘‘(F) describe plans to enhance the capac- 3 ity of individuals to utilize health services and 4 health-related social services under Federal, 5 State, and local programs by— 6 ‘‘(i) assisting individuals in estab- 7 lishing eligibility under the programs and 8 in receiving the services or other benefits 9 of the programs; and 10 ‘‘(ii) providing other services, as the 11 Secretary determines to be appropriate, 12 which may include transportation and 13 translation services. 14 ‘‘(d) PRIORITY.—In awarding grants under sub- 15 section (a), the Secretary shall give priority to those appli- 16 cants— 17 ‘‘(1) who propose to target geographic areas 18 that— 19 ‘‘(A)(i) have a high percentage of residents 20 who are uninsured or underinsured (if the tar- 21 geted geographic area is located in a State that 22 has elected to make medical assistance available 23 under section 1902(a)(10)(A)(i)(VIII) of the 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00295 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 296 •HR 5475 IH Social Security Act to individuals described in 1 such section); 2 ‘‘(ii) have a high percentage of under- 3 insured residents in a particular geographic 4 area (if the targeted geographic area is located 5 in a State that has not so elected); or 6 ‘‘(iii) have a high number of households ex- 7 periencing extreme poverty; and 8 ‘‘(B) have a high percentage of families for 9 whom English is not their primary language or 10 including smaller limited-English-proficient 11 communities within the region that are not oth- 12 erwise reached by linguistically appropriate 13 health services; 14 ‘‘(2) with experience in providing health or 15 health-related social services to individuals who are 16 underserved with respect to such services; and 17 ‘‘(3) with documented community activity and 18 experience with community health workers. 19 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU- 20 TIONS.—The Secretary shall encourage community health 21 worker programs receiving funds under this section to col- 22 laborate with academic institutions, including minority- 23 serving institutions. Nothing in this section shall be con- 24 strued to require such collaboration. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00296 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 297 •HR 5475 IH ‘‘(f) QUALITY ASSURANCE AND COST EFFECTIVE- 1 NESS.—The Secretary shall establish guidelines for ensur- 2 ing the quality of the training and supervision of commu- 3 nity health workers under the programs funded under this 4 section and for ensuring the cost effectiveness of such pro- 5 grams. 6 ‘‘(g) MONITORING.—The Secretary shall monitor 7 community health worker programs identified in approved 8 applications and shall determine whether such programs 9 are in compliance with the guidelines established under 10 subsection (f). 11 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 12 provide technical assistance to community health worker 13 programs identified in approved applications with respect 14 to planning, developing, and operating programs under the 15 grant. 16 ‘‘(i) REPORT TO CONGRESS.— 17 ‘‘(1) IN GENERAL.—Not later than 4 years 18 after the date on which the Secretary first awards 19 grants under subsection (a), the Secretary shall sub- 20 mit to Congress a report regarding the grant 21 project. 22 ‘‘(2) CONTENTS.—The report required under 23 paragraph (1) shall include the following: 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00297 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 298 •HR 5475 IH ‘‘(A) A description of the programs for 1 which grant funds were used. 2 ‘‘(B) The number of individuals served. 3 ‘‘(C) An evaluation of— 4 ‘‘(i) the effectiveness of these pro- 5 grams; 6 ‘‘(ii) the cost of these programs; and 7 ‘‘(iii) the impact of the project on the 8 health outcomes of the community resi- 9 dents. 10 ‘‘(D) Recommendations for sustaining the 11 community health worker programs developed 12 or assisted under this section. 13 ‘‘(E) Recommendations regarding training 14 to enhance career opportunities for community 15 health workers. 16 ‘‘(j) DEFINITIONS.—In this section: 17 ‘‘(1) COMMUNITY HEALTH WORKER.—The term 18 ‘community health worker’ means an individual who 19 promotes health or nutrition within the community 20 in which the individual resides— 21 ‘‘(A) by serving as a liaison between com- 22 munities and health care agencies; 23 ‘‘(B) by providing guidance and social as- 24 sistance to community residents; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00298 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 299 •HR 5475 IH ‘‘(C) by enhancing community residents’ 1 ability to effectively communicate with health 2 care providers; 3 ‘‘(D) by providing culturally and linguis- 4 tically appropriate health or nutrition edu- 5 cation; 6 ‘‘(E) by advocating for individual and com- 7 munity health, including dental, oral, mental, 8 and environmental health, or nutrition needs; 9 ‘‘(F) by taking into consideration the 10 needs of the communities served, including the 11 prevalence rates of risk factors that impede 12 achieving positive healthy outcomes among 13 women and children, especially among racial 14 and ethnic minority women and children; and 15 ‘‘(G) by providing referral and followup 16 services. 17 ‘‘(2) COMMUNITY SETTING.—The term ‘commu- 18 nity setting’ means a home or a community organi- 19 zation that serves a population. 20 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en- 21 tity’ means— 22 ‘‘(A) a unit of State, territorial, local, or 23 tribal government (including a federally recog- 24 nized tribe or Alaska Native village); or 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00299 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 300 •HR 5475 IH ‘‘(B) a community-based organization. 1 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 2 The term ‘medically underserved community’ means 3 a community— 4 ‘‘(A) that has a substantial number of in- 5 dividuals who are members of a medically un- 6 derserved population, as defined by section 7 330(b)(3); 8 ‘‘(B) a significant portion of which is a 9 health professional shortage area as designated 10 under section 332; and 11 ‘‘(C) that includes populations that are lin- 12 guistically isolated, such as geographic areas 13 with a shortage of health professionals able to 14 provide linguistically appropriate services. 15 ‘‘(5) SUPPORT.—The term ‘support’ means the 16 provision of training, supervision, and materials 17 needed to effectively deliver the services described in 18 subsection (b), reimbursement for services, and 19 other benefits. 20 ‘‘(6) TARGET POPULATION.—The term ‘target 21 population’ means women of reproductive age, re- 22 gardless of their current childbearing status and 23 children under 21 years of age. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00300 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 301 •HR 5475 IH ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated to carry out this section 2 $15,000,000 for each of fiscal years 2017 through 2021.’’. 3 SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NU- 4 TRITION ASSISTANCE FOR CHILDREN, PREG- 5 NANT WOMEN, AND LAWFULLY PRESENT IN- 6 DIVIDUALS. 7 (a) MEDICAID.—Section 1903(v) of the Social Secu- 8 rity Act (42 U.S.C. 1396b(v)) is amended by striking 9 paragraph (4) and inserting the following new paragraph: 10 ‘‘(4)(A) Notwithstanding sections 401(a), 402(b), 11 403, and 421 of the Personal Responsibility and Work Op- 12 portunity Reconciliation Act of 1996 and paragraph (1), 13 payment shall be made to a State under this section for 14 medical assistance furnished to an alien under this title 15 (including an alien described in such paragraph) who 16 meets any of the following conditions: 17 ‘‘(i) The alien is otherwise eligible for such as- 18 sistance under the State plan approved under this 19 title (other than the requirement of the receipt of 20 aid or assistance under title IV, supplemental secu- 21 rity income benefits under title XVI, or a State sup- 22 plementary payment) within either or both of the 23 following eligibility categories: 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00301 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 302 •HR 5475 IH ‘‘(I) Children under 21 years of age, in- 1 cluding any optional targeted low-income child 2 (as such term is defined in section 3 1905(u)(2)(B)). 4 ‘‘(II) Pregnant women during pregnancy 5 and during the 60-day period beginning on the 6 last day of the pregnancy. 7 ‘‘(ii) The alien is lawfully present in the United 8 States. 9 ‘‘(B) No debt shall accrue under an affidavit of sup- 10 port against any sponsor of an alien who meets the condi- 11 tions specified in subparagraph (A) on the basis of the 12 provision of medical assistance to such alien under this 13 paragraph and the cost of such assistance shall not be con- 14 sidered as an unreimbursed cost.’’. 15 (b) SCHIP.—Subparagraph (J) of section 16 2107(e)(1) of the Social Security Act (42 U.S.C. 17 1397gg(e)(1)) is amended to read as follows: 18 ‘‘(J) Paragraph (4) of section 1903(v) (re- 19 lating to coverage of categories of children, 20 pregnant women, and other lawfully present in- 21 dividuals).’’. 22 (c) SUPPLEMENTAL NUTRITION ASSISTANCE.—Not- 23 withstanding sections 401(a), 402(a), and 403(a) of the 24 Personal Responsibility and Work Opportunity Reconcili- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00302 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 303 •HR 5475 IH ation Act of 1996 (8 U.S.C. 1611(a); 1612(a); 1613(a)) 1 and section 6(f) of the Food and Nutrition Act of 2008 2 (7 U.S.C. 2015(f)), persons who are lawfully present in 3 the United States shall be not be ineligible for benefits 4 under the supplemental nutrition assistance program on 5 the basis of their immigration status or date of entry into 6 the United States. 7 (d) ELIGIBILITY FOR FAMILIES WITH CHILDREN.— 8 Section 421(d)(3) of the Personal Responsibility and 9 Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 10 1631(d)(3)) is amended by striking ‘‘to the extent that 11 a qualified alien is eligible under section 402(a)(2)(J)’’ 12 and inserting, ‘‘to the extent that a child is a member of 13 a household under the supplemental nutrition assistance 14 program’’. 15 (e) ENSURING PROPER SCREENING.—Section 16 11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 17 U.S.C. 2020(e)(2)(B)) is amended— 18 (1) by redesignating clauses (vi) and (vii) as 19 clauses (vii) and (viii); and 20 (2) by inserting after clause (v) the following: 21 ‘‘(vi) shall provide a method for imple- 22 menting section 421 of the Personal Re- 23 sponsibility and Work Opportunity Rec- 24 onciliation Act of 1996 (8 U.S.C. 1631) 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00303 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 304 •HR 5475 IH that does not require any unnecessary in- 1 formation from persons who may be ex- 2 empt from that provision;’’. 3 SEC. 503. REPEAL OF DENIAL OF BENEFITS. 4 Section 115 of the Personal Responsibility and Work 5 Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) 6 is amended— 7 (1) in subsection (a), by striking paragraph (2); 8 (2) in subsection (b), by striking paragraph (2); 9 and 10 (3) in subsection (e), by striking paragraph (2). 11 SEC. 504. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 12 AND AWARENESS. 13 (a) IN GENERAL.—The Secretary shall establish and 14 implement a birth defects prevention and public awareness 15 program, consisting of the activities described in sub- 16 sections (c) and (d). 17 (b) DEFINITIONS.—In this section: 18 (1) The term ‘‘pregnancy and breastfeeding in- 19 formation services’’ includes only— 20 (A) information services to provide accu- 21 rate, evidence-based, clinical information re- 22 garding maternal exposures during pregnancy 23 that may be associated with birth defects or 24 other health risks, such as exposures to medica- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00304 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 305 •HR 5475 IH tions, chemicals, infections, foodborne patho- 1 gens, illnesses, nutrition, or lifestyle factors; 2 (B) information services to provide accu- 3 rate, evidence-based, clinical information re- 4 garding maternal exposures during breast- 5 feeding that may be associated with health risks 6 to a breast-fed infant, such as exposures to 7 medications, chemicals, infections, foodborne 8 pathogens, illnesses, nutrition, or lifestyle fac- 9 tors; 10 (C) the provision of accurate, evidence- 11 based information weighing risks of exposures 12 during breastfeeding against the benefits of 13 breastfeeding; and 14 (D) the provision of information described 15 in subparagraph (A), (B), or (C) through coun- 16 selors, Web sites, fact sheets, telephonic or elec- 17 tronic communication, community outreach ef- 18 forts, or other appropriate means. 19 (2) The term ‘‘Secretary’’ means the Secretary 20 of Health and Human Services, acting through the 21 Director of the Centers for Disease Control and Pre- 22 vention. 23 (c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 24 subsection (a), the Secretary shall conduct or support a 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00305 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 306 •HR 5475 IH nationwide media campaign to increase awareness among 1 health care providers and at-risk populations about preg- 2 nancy and breastfeeding information services. 3 (d) GRANTS FOR PREGNANCY AND BREASTFEEDING 4 INFORMATION SERVICES.— 5 (1) IN GENERAL.—In carrying out subsection 6 (a), the Secretary shall award grants to State or re- 7 gional agencies or organizations for any of the fol- 8 lowing: 9 (A) INFORMATION SERVICES.—The provi- 10 sion of, or campaigns to increase awareness 11 about, pregnancy and breastfeeding information 12 services. 13 (B) SURVEILLANCE AND RESEARCH.—The 14 conduct or support of— 15 (i) surveillance of or research on— 16 (I) maternal exposures and ma- 17 ternal health conditions that may in- 18 fluence the risk of birth defects, pre- 19 maturity, or other adverse pregnancy 20 outcomes; and 21 (II) maternal exposures that may 22 influence health risks to a breastfed 23 infant; or 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00306 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 307 •HR 5475 IH (ii) networking to facilitate surveil- 1 lance or research described in this sub- 2 paragraph. 3 (2) PREFERENCE FOR CERTAIN STATES.—The 4 Secretary, in making any grant under this sub- 5 section, shall give preference to States, otherwise 6 equally qualified, that have a pregnancy and 7 breastfeeding information service in place. 8 (3) MATCHING FUNDS.—The Secretary may 9 only award a grant under this subsection to a State 10 or regional agency or organization that agrees, with 11 respect to the costs to be incurred in carrying out 12 the grant activities, to make available (directly or 13 through donations from public or private entities) 14 non-Federal funds toward such costs in an amount 15 equal to not less than 25 percent of the amount of 16 the grant. 17 (4) COORDINATION.—The Secretary shall en- 18 sure that activities funded through a grant under 19 this subsection are coordinated, to the maximum ex- 20 tent practicable, with other birth defects prevention 21 and environmental health activities of the Federal 22 Government, including with respect to pediatric envi- 23 ronmental health specialty units and children’s envi- 24 ronmental health centers. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00307 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 308 •HR 5475 IH (e) EVALUATION.—In furtherance of the program 1 under subsection (a), the Secretary shall provide for an 2 evaluation of pregnancy and breastfeeding information 3 services to identify efficient and effective models of— 4 (1) providing information; 5 (2) raising awareness and increasing knowledge 6 about birth defects prevention measures and tar- 7 geting education to at-risk groups; 8 (3) modifying risk behaviors; or 9 (4) other outcome measures as determined ap- 10 propriate by the Secretary. 11 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 12 out this section, there are authorized to be appropriated 13 $5,000,000 for fiscal year 2017, $6,000,000 for fiscal year 14 2018, $7,000,000 for fiscal year 2019, $8,000,000 for fis- 15 cal year 2020, and $9,000,000 for fiscal year 2021. 16 SEC. 505. UNIFORM STATE MATERNAL MORTALITY REVIEW 17 COMMITTEES ON PREGNANCY-RELATED 18 DEATHS. 19 (a) IN GENERAL.—Title V of the Social Security Act 20 (42 U.S.C. 701 et seq.) is amended by adding at the end 21 the following new section: 22 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00308 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 309 •HR 5475 IH ‘‘SEC. 514. UNIFORM STATE MATERNAL MORTALITY RE- 1 VIEW COMMITTEES ON PREGNANCY-RE- 2 LATED DEATHS. 3 ‘‘(a) GRANTS.— 4 ‘‘(1) IN GENERAL.—Notwithstanding any other 5 provision of this title, for each of fiscal years 2017 6 through 2023, in addition to payments from allot- 7 ments for States under section 502 for such year, 8 the Secretary shall, subject to paragraph (3) and in 9 accordance with the criteria established under para- 10 graph (2), award grants to States to— 11 ‘‘(A) carry out the activities described in 12 subsection (b)(1); 13 ‘‘(B) establish a State maternal mortality 14 review committee, in accordance with subsection 15 (b)(2), to carry out the activities described in 16 subsection (b)(2)(A), and to establish the proc- 17 esses described in subsection (b)(1); 18 ‘‘(C) ensure the State department of 19 health carries out the applicable activities de- 20 scribed in subsection (b)(3), with respect to 21 pregnancy-related deaths occurring within the 22 State during such fiscal year; 23 ‘‘(D) implement and use the comprehensive 24 case abstraction form developed under sub- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00309 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 310 •HR 5475 IH section (c), in accordance with such subsection; 1 and 2 ‘‘(E) provide for public disclosure of infor- 3 mation, in accordance with subsection (e). 4 ‘‘(2) CRITERIA.—The Secretary shall establish 5 criteria for determining eligibility for and the 6 amount of a grant awarded to a State under para- 7 graph (1). Such criteria shall provide that in the 8 case of a State that receives such a grant for a fiscal 9 year and is determined by the Secretary to have not 10 used such grant in accordance with this section, 11 such State shall not be eligible for such a grant for 12 any subsequent fiscal year. 13 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 14 For purposes of carrying out the grant program 15 under this section, including for administrative pur- 16 poses, there is authorized to be appropriated 17 $10,000,000 for each of fiscal years 2017 through 18 2023. 19 ‘‘(b) PREGNANCY-RELATED DEATH REVIEW.— 20 ‘‘(1) REVIEW OF PREGNANCY-RELATED DEATH 21 AND PREGNANCY-ASSOCIATED DEATH CASES.—For 22 purposes of subsection (a), with respect to a State 23 that receives a grant under subsection (a), the fol- 24 lowing shall apply: 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00310 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 311 •HR 5475 IH ‘‘(A) MANDATORY REPORTING OF PREG- 1 NANCY-RELATED DEATHS.— 2 ‘‘(i) IN GENERAL.—The State shall, 3 through the State maternal mortality re- 4 view committee, develop a process, sepa- 5 rate from any reporting process established 6 by the State department of health prior to 7 the date of the enactment of this section, 8 that provides for mandatory and confiden- 9 tial case reporting by individuals and enti- 10 ties described in clause (ii) of pregnancy- 11 related deaths to the State department of 12 health. 13 ‘‘(ii) INDIVIDUALS AND ENTITIES DE- 14 SCRIBED.—Individuals and entities de- 15 scribed in this clause include each of the 16 following: 17 ‘‘(I) Health care providers. 18 ‘‘(II) Medical examiners. 19 ‘‘(III) Medical coroners. 20 ‘‘(IV) Hospitals. 21 ‘‘(V) Free-standing birth centers. 22 ‘‘(VI) Federally qualified health 23 centers. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00311 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 312 •HR 5475 IH ‘‘(VII) Other health care facili- 1 ties. 2 ‘‘(VIII) Any other individuals re- 3 sponsible for completing death certifi- 4 cates. 5 ‘‘(IX) Any other appropriate in- 6 dividuals or entities specified by the 7 Secretary. 8 ‘‘(B) VOLUNTARY REPORTING OF PREG- 9 NANCY-RELATED AND PREGNANCY-ASSOCIATED 10 DEATHS.— 11 ‘‘(i) The State shall, through the 12 State maternal mortality review committee, 13 develop a process for and encourage, sepa- 14 rate from any reporting process established 15 by the State department of health prior to 16 the date of the enactment of this section, 17 voluntary and confidential case reporting 18 by individuals described in clause (ii) of 19 pregnancy-associated deaths to the State 20 department of health. 21 ‘‘(ii) The State shall, through the 22 State maternal mortality review committee, 23 develop a process for voluntary and con- 24 fidential reporting by family members of 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00312 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 313 •HR 5475 IH the deceased and by other individuals on 1 possible pregnancy-related and pregnancy- 2 associated deaths to the State department 3 of health. Such process shall include— 4 ‘‘(I) making publicly available on 5 the Internet Web site of the State de- 6 partment of health a telephone num- 7 ber, Internet Web link, and email ad- 8 dress for such reporting; and 9 ‘‘(II) publicizing to local profes- 10 sional organizations, community orga- 11 nizations, and social services agencies 12 the availability of the telephone num- 13 ber, Internet Web link, and email ad- 14 dress made available under subclause 15 (I). 16 ‘‘(C) DEVELOPMENT OF CASE-FINDING.— 17 The State, through the vital statistics unit of 18 the State, shall annually identify pregnancy-re- 19 lated and pregnancy-associated deaths occur- 20 ring in such State during the year involved 21 by— 22 ‘‘(i) matching all death records, with 23 respect to such year, for women of child- 24 bearing age to live birth certificates and in- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00313 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 314 •HR 5475 IH fant death certificates to identify deaths of 1 women that occurred during pregnancy 2 and within one year after the end of a 3 pregnancy; 4 ‘‘(ii) identifying deaths reported dur- 5 ing such year as having an underlying or 6 contributing cause of death related to 7 pregnancy, regardless of the time that has 8 passed between the end of the pregnancy 9 and the death; 10 ‘‘(iii) collecting data from medical ex- 11 aminer and coroner reports; and 12 ‘‘(iv) any other methods the States 13 may devise to identify maternal deaths, 14 such as through review of a random sam- 15 ple of reported deaths of women of child- 16 bearing age to ascertain cases of preg- 17 nancy-related and pregnancy-associated 18 deaths that are not discernable from a re- 19 view of death certificates alone. 20 When feasible and for purposes of effectively 21 collecting and obtaining data on pregnancy-re- 22 lated and pregnancy-associated deaths, the 23 State shall adopt the most recent standardized 24 birth and death certificates, as issued by the 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00314 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 315 •HR 5475 IH National Center for Vital Health Statistics, in- 1 cluding the recommended checkbox section for 2 pregnancy on the death certificates. 3 ‘‘(D) CASE INVESTIGATION AND DEVELOP- 4 MENT OF CASE SUMMARIES.—Following receipt 5 of reports by the State department of health 6 pursuant to subparagraph (A) or (B) and col- 7 lection by the vital statistics unit of the State 8 of possible cases of pregnancy-related and preg- 9 nancy-associated deaths pursuant to subpara- 10 graph (C), the State, through the State mater- 11 nal mortality review committee established 12 under subsection (a), shall investigate each 13 case, utilizing the case abstraction form de- 14 scribed in subsection (c), and prepare de-identi- 15 fied case summaries, which shall be reviewed by 16 the committee and included in applicable re- 17 ports. For purposes of subsection (a), under the 18 processes established under subparagraphs (A), 19 (B), and (C), a State department of health or 20 vital statistics unit of a State shall provide to 21 the State maternal mortality review committee 22 access to information collected pursuant to such 23 subparagraphs as necessary to carry out this 24 subparagraph. Data and information collected 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00315 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 316 •HR 5475 IH for the case summary and review are for pur- 1 poses of public health activities, in accordance 2 with HIPAA privacy and security law (as de- 3 fined in section 3009(a)(2) of the Public Health 4 Service Act). Such case investigations shall in- 5 clude data and information obtained through— 6 ‘‘(i) medical examiner and autopsy re- 7 ports of the woman involved; 8 ‘‘(ii) medical records of the woman, 9 including such records related to health 10 care prior to pregnancy, prenatal and post- 11 natal care, labor and delivery care, emer- 12 gency room care, hospital discharge 13 records including immunization status and 14 screening status for prevalent diseases, and 15 any care delivered up until the time of 16 death of the woman for purposes of public 17 health activities, in accordance with 18 HIPAA privacy and security law (as de- 19 fined in section 3009(a)(2) of the Public 20 Health Service Act); 21 ‘‘(iii) oral and written interviews of in- 22 dividuals directly involved in the maternal 23 care of the woman during and immediately 24 following the pregnancy of the woman, in- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00316 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 317 •HR 5475 IH cluding health care, mental health, and so- 1 cial service providers in-language when 2 possible, as applicable; 3 ‘‘(iv) optional oral or written inter- 4 views of the family of the woman; 5 ‘‘(v) socioeconomic and other relevant 6 background information about the woman; 7 ‘‘(vi) information collected in subpara- 8 graph (C)(i); and 9 ‘‘(vii) other information on the cause 10 of death of the woman, such as social serv- 11 ices and child welfare reports, including ex- 12 periences with intimate partner violence. 13 ‘‘(2) STATE MATERNAL MORTALITY REVIEW 14 COMMITTEES.— 15 ‘‘(A) DUTIES.— 16 ‘‘(i) REQUIRED COMMITTEE ACTIVI- 17 TIES.—For purposes of subsection (a), a 18 maternal mortality review committee estab- 19 lished by a State pursuant to a grant 20 under such subsection shall carry out the 21 following pregnancy-related death and 22 pregnancy-associated death review activi- 23 ties and shall include all information rel- 24 evant to the death involved on the case ab- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00317 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 318 •HR 5475 IH straction form developed under subsection 1 (d): 2 ‘‘(I) With respect to a case of 3 pregnancy-related or pregnancy-asso- 4 ciated death of a woman, review the 5 case summaries prepared under sub- 6 paragraphs (A), (B), (C), and (D) of 7 paragraph (1). 8 ‘‘(II) Review aggregate statistical 9 reports developed by the vital statis- 10 tics unit of the State under paragraph 11 (1)(C) regarding pregnancy-related 12 and pregnancy-associated deaths to 13 identify trends, patterns, and dispari- 14 ties in adverse outcomes and address 15 medical, nonmedical, and system-re- 16 lated factors that may have contrib- 17 uted to such pregnancy-related and 18 pregnancy-associated deaths and dis- 19 parities. 20 ‘‘(III) Develop recommendations, 21 based on the review of the case sum- 22 maries under paragraph (1)(D) and 23 aggregate statistical reports under 24 subclause (II), to improve maternal 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00318 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 319 •HR 5475 IH care, social and health services, and 1 public health policy and institutions, 2 including with respect to improving 3 access to maternal care, improving the 4 availability of social services, and 5 eliminating disparities in maternal 6 care and outcomes. 7 ‘‘(ii) OPTIONAL COMMITTEE ACTIVI- 8 TIES.—For purposes of subsection (a), a 9 maternal mortality review committee estab- 10 lished by a State under such subsection 11 may present findings and recommendations 12 regarding a specific case or set of cir- 13 cumstances directly to a health care facil- 14 ity or its local or State professional organi- 15 zation for the purpose of instituting policy 16 changes, educational activities, or other- 17 wise improving the quality of care provided 18 by the facilities. 19 ‘‘(B) COMPOSITION OF MATERNAL MOR- 20 TALITY REVIEW COMMITTEES.— 21 ‘‘(i) IN GENERAL.—Each State mater- 22 nal mortality review committee established 23 pursuant to a grant under subsection (a) 24 shall be multidisciplinary, consisting of 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00319 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 320 •HR 5475 IH health care, behavioral health, and social 1 service providers, public health officials, 2 other persons with professional expertise 3 on maternal health and mortality, and pa- 4 tient and community advocates who rep- 5 resent those communities within such State 6 that are the most affected by maternal 7 mortality. Membership on such a com- 8 mittee of a State shall be reviewed annu- 9 ally by the State department of health to 10 ensure that membership representation re- 11 quirements are being fulfilled in accord- 12 ance with this paragraph. 13 ‘‘(ii) REQUIRED MEMBERSHIP.—Each 14 such review committee shall include— 15 ‘‘(I) representatives from medical 16 specialties providing care to pregnant 17 and postpartum patients, including 18 obstetricians (including generalists 19 and maternal fetal medicine special- 20 ists), and family practice physicians; 21 ‘‘(II) representatives from mid- 22 wifery specialties (including certified 23 professional midwives and certified 24 midwives); 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00320 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 321 •HR 5475 IH ‘‘(III) advanced practice nurses; 1 ‘‘(IV) hospital-based nurses; 2 ‘‘(V) representatives of the State 3 department of health maternal and 4 child health department; 5 ‘‘(VI) social service providers or 6 social workers; 7 ‘‘(VII) the chief medical exam- 8 iners or designees; 9 ‘‘(VIII) facility representatives, 10 such as from hospitals or free-stand- 11 ing birth centers; and 12 ‘‘(IX) community or patient ad- 13 vocates who represent those commu- 14 nities within the State that are the 15 most affected by maternal mortality. 16 ‘‘(iii) ADDITIONAL MEMBERS.—Each 17 such review committee may also include 18 representatives from other relevant aca- 19 demic, health, social service, or policy pro- 20 fessions, or community organizations, on 21 an ongoing basis, or as needed, as deter- 22 mined beneficial by the review committee, 23 including— 24 ‘‘(I) anesthesiologists; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00321 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 322 •HR 5475 IH ‘‘(II) emergency physicians; 1 ‘‘(III) pathologists; 2 ‘‘(IV) epidemiologists or biostat- 3 isticians; 4 ‘‘(V) intensivists; 5 ‘‘(VI) orthopedic surgeons and/or 6 orthopedic physicians; 7 ‘‘(VII) vital statistics officers; 8 ‘‘(VIII) nutritionists; 9 ‘‘(IX) mental health profes- 10 sionals; 11 ‘‘(X) substance abuse treatment 12 specialists; 13 ‘‘(XI) representatives of relevant 14 advocacy groups; 15 ‘‘(XII) academics; 16 ‘‘(XIII) representatives of bene- 17 ficiaries of the State plan under the 18 Medicaid Program under title XIX; 19 ‘‘(XIV) paramedics; 20 ‘‘(XV) lawyers; 21 ‘‘(XVI) risk management special- 22 ists; 23 ‘‘(XVII) representatives of the 24 departments of health or public health 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00322 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 323 •HR 5475 IH of major cities in the State involved; 1 and 2 ‘‘(XVIII) policymakers. 3 ‘‘(iv) DIVERSE COMMUNITY MEMBER- 4 SHIP.—The composition of such a com- 5 mittee, with respect to a State, shall in- 6 clude— 7 ‘‘(I) representatives from diverse 8 communities, particularly those com- 9 munities within such State most se- 10 verely affected by pregnancy-related 11 deaths or pregnancy-associated deaths 12 and by a lack of access to relevant 13 maternal care services, from commu- 14 nity maternal child health organiza- 15 tions, and from minority advocacy 16 groups; 17 ‘‘(II) members, including health 18 care providers, from different geo- 19 graphic regions in the State, including 20 any rural, urban, and tribal areas; 21 and 22 ‘‘(III) health care and social serv- 23 ice providers who work in commu- 24 nities that are diverse with regard to 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00323 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 324 •HR 5475 IH race, ethnicity, immigration status, in- 1 digenous status, and English pro- 2 ficiency. 3 ‘‘(v) MATERNAL MORTALITY REVIEW 4 STAFF.—Staff of each such review com- 5 mittee shall include— 6 ‘‘(I) vital health statisticians, ma- 7 ternal child health statisticians, or 8 epidemiologists; 9 ‘‘(II) a coordinator of the State 10 maternal mortality review committee, 11 to be designated by the State; and 12 ‘‘(III) administrative staff. 13 ‘‘(C) OPTION FOR STATES TO FORM RE- 14 GIONAL MATERNAL MORTALITY REVIEWS.— 15 States with a low rate of occurrence of preg- 16 nancy-associated or pregnancy-related deaths 17 may choose to partner with one or more neigh- 18 boring States to fulfill the activities described in 19 paragraph (1)(C). In such a case, with respect 20 to States in such a partnership, any require- 21 ment under this section relating to the report- 22 ing of information related to such activities 23 shall be deemed to be fulfilled by each such 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00324 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 325 •HR 5475 IH State if a single such report is submitted for 1 the partnership. 2 ‘‘(3) STATE DEPARTMENT OF HEALTH ACTIVI- 3 TIES.—For purposes of subsection (a), a State de- 4 partment of health of a State receiving a grant 5 under such subsection shall— 6 ‘‘(A) in consultation with the maternal 7 mortality review committee of the State and in 8 conjunction with relevant professional organiza- 9 tions, develop a plan for ongoing health care 10 provider education, based on the findings and 11 recommendations of the committee, in order to 12 improve the quality of maternal care; and 13 ‘‘(B) take steps to widely disseminate the 14 findings and recommendations of the State ma- 15 ternal mortality review committees of the State 16 and to implement the recommendations of such 17 committee. 18 ‘‘(c) CASE ABSTRACTION FORM.— 19 ‘‘(1) DEVELOPMENT.—The Director of the Cen- 20 ters for Disease Control and Prevention shall de- 21 velop a uniform, comprehensive case abstraction 22 form and make such form available to States for 23 State maternal mortality review committees for use 24 by such committees in order to— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00325 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 326 •HR 5475 IH ‘‘(A) ensure that the cases and information 1 collected and reviewed by such committees can 2 be pooled for review by the Department of 3 Health and Human Services and its agencies; 4 and 5 ‘‘(B) preserve the uniformity of the infor- 6 mation and its use for Federal public health 7 purposes. 8 ‘‘(2) PERMISSIBLE STATE MODIFICATION.— 9 Each State may modify the form developed under 10 paragraph (1) for implementation and use by such 11 State or by the State maternal mortality review com- 12 mittee of such State by including on such form addi- 13 tional information to be collected, but may not alter 14 the standard questions on such form, in order to en- 15 sure that the information can be collected and re- 16 viewed centrally at the Federal level. 17 ‘‘(d) TREATMENT AS PUBLIC HEALTH AUTHORITY 18 FOR PURPOSES OF HIPAA.—For purposes of applying 19 HIPAA privacy and security law (as defined in section 20 3009(a)(2) of the Public Health Service Act), a State ma- 21 ternal mortality review committee of a State established 22 pursuant to this section to carry out activities described 23 in subsection (b)(2)(A) shall be deemed to be a public 24 health authority described in section 164.501 (and ref- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00326 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 327 •HR 5475 IH erenced in section 164.512(b)(1)(i)) of title 45, Code of 1 Federal Regulations (or any successor regulation), car- 2 rying out public health activities and purposes described 3 in such section 164.512(b)(1)(i) (or any such successor 4 regulation). 5 ‘‘(e) PUBLIC DISCLOSURE OF INFORMATION.— 6 ‘‘(1) IN GENERAL.—For fiscal year 2017 or a 7 subsequent fiscal year, each State receiving a grant 8 under this section for such year shall, subject to 9 paragraph (3), provide for the public disclosure, and 10 submission to the information clearinghouse estab- 11 lished under paragraph (2), of the information in- 12 cluded in the report of the State under section 13 506(a)(2)(F) for such year (relating to the findings 14 for such year of the State maternal mortality review 15 committee established by the State under this sec- 16 tion). 17 ‘‘(2) INFORMATION CLEARINGHOUSE.—The 18 Secretary of Health and Human Services shall es- 19 tablish an information clearinghouse, that shall be 20 administered by the Director of the Centers for Dis- 21 ease Control and Prevention, that will maintain find- 22 ings and recommendations submitted pursuant to 23 paragraph (1) and provide such findings and rec- 24 ommendations for public review and research pur- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00327 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 328 •HR 5475 IH poses by State health departments, maternal mor- 1 tality review committees, and health providers and 2 institutions. 3 ‘‘(3) CONFIDENTIALITY OF INFORMATION.—In 4 no case shall any individually identifiable health in- 5 formation be provided to the public, or submitted to 6 the information clearinghouse, under paragraph (1). 7 ‘‘(f) CONFIDENTIALITY OF REVIEW COMMITTEE 8 PROCEEDINGS.— 9 ‘‘(1) IN GENERAL.—All proceedings and activi- 10 ties of a State maternal mortality review committee 11 under this section, opinions of members of such a 12 committee formed as a result of such proceedings 13 and activities, and records obtained, created, or 14 maintained pursuant to this section, including 15 records of interviews, written reports, and state- 16 ments procured by the Department of Health and 17 Human Services or by any other person, agency, or 18 organization acting jointly with the Department, in 19 connection with morbidity and mortality reviews 20 under this section, shall be confidential, and not sub- 21 ject to discovery, subpoena, or introduction into evi- 22 dence in any civil, criminal, legislative, or other pro- 23 ceeding. Such records shall not be open to public in- 24 spection. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00328 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 329 •HR 5475 IH ‘‘(2) TESTIMONY OF MEMBERS OF COM- 1 MITTEE.— 2 ‘‘(A) IN GENERAL.—Members of a State 3 maternal mortality review committee under this 4 section may not be questioned in any civil, 5 criminal, legislative, or other proceeding regard- 6 ing information presented in, or opinions 7 formed as a result of, a meeting or communica- 8 tion of the committee. 9 ‘‘(B) CLARIFICATION.—Nothing in this 10 subsection shall be construed to prevent a mem- 11 ber of such a committee from testifying regard- 12 ing information that was obtained independent 13 of such member’s participation on the com- 14 mittee, or that is public information. 15 ‘‘(3) AVAILABILITY OF INFORMATION FOR RE- 16 SEARCH PURPOSES.—Nothing in this subsection 17 shall prohibit the publishing by such a committee or 18 the Department of Health and Human Services of 19 statistical compilations and research reports that— 20 ‘‘(A) are based on confidential information, 21 relating to morbidity and mortality review; and 22 ‘‘(B) do not contain identifying informa- 23 tion or any other information that could be 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00329 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 330 •HR 5475 IH used to ultimately identify the individuals con- 1 cerned. 2 ‘‘(g) DEFINITIONS.—For purposes of this section: 3 ‘‘(1) The term ‘pregnancy-associated death’ 4 means the death of a woman while pregnant or dur- 5 ing the one-year period following the date of the end 6 of pregnancy, irrespective of the cause of such death. 7 ‘‘(2) The term ‘pregnancy-related death’ means 8 the death of a woman while pregnant or during the 9 one-year period following the date of the end of 10 pregnancy, irrespective of the duration or site of the 11 pregnancy, from any cause related to or aggravated 12 by the pregnancy or its management, but not from 13 any accidental or incidental cause. 14 ‘‘(3) The term ‘woman of childbearing age’ 15 means a woman who is at least 10 years of age and 16 not more than 54 years of age.’’. 17 (b) INCLUSION OF FINDINGS OF REVIEW COMMIT- 18 TEES IN REQUIRED REPORTS.— 19 (1) STATE TRIENNIAL REPORTS.—Paragraph 20 (2) of section 506(a) of the Social Security Act (42 21 U.S.C. 706(a)) is amended by inserting after sub- 22 paragraph (E) the following new subparagraph: 23 ‘‘(F) In the case of a State receiving a 24 grant under section 514, beginning for the first 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00330 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 331 •HR 5475 IH fiscal year beginning after 3 years after the 1 date of establishment of the State maternal 2 mortality review committee established by the 3 State pursuant to such grant and once every 3 4 years thereafter, information containing the 5 findings and recommendations of such com- 6 mittee and information on the implementation 7 of such recommendations during the period in- 8 volved.’’. 9 (2) ANNUAL REPORTS TO CONGRESS.—Para- 10 graph (3) of such section is amended— 11 (A) in subparagraph (D) by striking ‘‘and’’ 12 at the end; 13 (B) in subparagraph (E) by striking the 14 period at the end and inserting ‘‘; and’’; and 15 (C) by adding at the end the following new 16 subparagraph: 17 ‘‘(F) For fiscal year 2017 and each subsequent 18 fiscal year, taking into account the findings, rec- 19 ommendations, and implementation information sub- 20 mitted by States pursuant to paragraph (2)(F), on 21 the status of pregnancy-related deaths and preg- 22 nancy-associated deaths in the United States and in- 23 cluding recommendations on methods to prevent 24 such deaths in the United States.’’. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00331 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 332 •HR 5475 IH SEC. 506. ELIMINATING DISPARITIES IN MATERNITY 1 HEALTH OUTCOMES. 2 Part B of title III of the Public Health Service Act 3 is amended by inserting after section 317V, as added, the 4 following new section: 5 ‘‘SEC. 317W. ELIMINATING DISPARITIES IN MATERNITY 6 HEALTH OUTCOMES. 7 ‘‘(a) IN GENERAL.—The Secretary (in consultation 8 with the Deputy Assistant Secretary for Minority Health, 9 the Director of the National Institutes of Health, the Di- 10 rector of the Centers for Disease Control and Prevention, 11 the Administrator of the Centers for Medicare & Medicaid 12 Services, and the Administrator of the Agency for 13 Healthcare Research & Quality, and in consultation with 14 relevant national stakeholder organizations such as na- 15 tional medical specialty organizations, national maternal 16 child health organizations, national groups that represent 17 minority populations, and national health disparity organi- 18 zations) shall carry out the following activities to eliminate 19 disparities in maternal health outcomes: 20 ‘‘(1) Conduct research into the determinants 21 and the distribution of disparities in maternal care, 22 health risks, and health outcomes, and improve the 23 capacity of the performance measurement infrastruc- 24 ture to measure such disparities. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00332 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 333 •HR 5475 IH ‘‘(2) Expand access to services that have been 1 demonstrated to improve the quality and outcomes 2 of maternity care for vulnerable populations. 3 ‘‘(3) Establish a demonstration project to com- 4 pare the effectiveness of interventions to reduce dis- 5 parities in maternity services and outcomes, and im- 6 plement and assess effective interventions. 7 ‘‘(b) SCOPE AND SELECTION OF STATES FOR DEM- 8 ONSTRATION PROJECT.—The demonstration project 9 under subsection (a)(3) shall be conducted in no more 10 than 8 States, which shall be selected by the Secretary 11 based on— 12 ‘‘(1) applications submitted by States, which 13 specify which regions and populations the State in- 14 volved will serve under the demonstration project; 15 ‘‘(2) criteria designed by the Secretary to en- 16 sure that, as a whole, the demonstration project is, 17 to the greatest extent possible, representative of the 18 demographic and geographic composition of commu- 19 nities most affected by disparities; 20 ‘‘(3) criteria designed by the Secretary to en- 21 sure that a variety of types of models are tested 22 through the demonstration project and that such 23 models include interventions that have an existing 24 evidence base for effectiveness; and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00333 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 334 •HR 5475 IH ‘‘(4) criteria designed by the Secretary to as- 1 sure that the demonstration projects and models will 2 be carried out in consultation with local and regional 3 provider organizations, such as community health 4 centers, hospital systems, and medical societies rep- 5 resenting providers of maternity services. 6 ‘‘(c) DURATION OF DEMONSTRATION PROJECT.— 7 The demonstration project under subsection (a)(3) shall 8 begin on January 1, 2017, and end on December 31, 9 2021. 10 ‘‘(d) GRANTS FOR EVALUATION AND MONITORING.— 11 The Secretary may make grants to States and health care 12 providers participating in the demonstration project under 13 subsection (a)(3) for the purpose of collecting data nec- 14 essary for the evaluation and monitoring of such project. 15 ‘‘(e) REPORTS.— 16 ‘‘(1) STATE REPORTS.—Each State that par- 17 ticipates in the demonstration project under sub- 18 section (a)(3) shall report to the Secretary, in a 19 time, form, and manner specified by the Secretary, 20 the data necessary to— 21 ‘‘(A) monitor the— 22 ‘‘(i) outcomes of the project; 23 ‘‘(ii) costs of the project; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00334 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 335 •HR 5475 IH ‘‘(iii) quality of maternity care pro- 1 vided under the project; and 2 ‘‘(B) evaluate the rationale for the selec- 3 tion of the items and services included in any 4 bundled payment made by the State under the 5 project. 6 ‘‘(2) FINAL REPORT.—Not later than December 7 31, 2022, the Secretary shall submit to Congress a 8 report on the results of the demonstration project 9 under subsection (a)(3).’’. 10 SEC. 507. DECREASING THE RISK FACTORS FOR SUDDEN 11 UNEXPECTED INFANT DEATH AND SUDDEN 12 UNEXPLAINED DEATH IN CHILDHOOD. 13 (a) ESTABLISHMENT.—The Secretary of Health and 14 Human Services, acting through the Administrator of the 15 Health Resources and Services Administration and in con- 16 sultation with the Director of the Centers for Disease Con- 17 trol and Prevention and the Director of the National Insti- 18 tutes of Health (in this section referred to as the ‘‘Sec- 19 retary’’), shall establish and implement a culturally com- 20 petent public health awareness and education campaign 21 to provide information that is focused on decreasing the 22 risk factors for sudden unexpected infant death and sud- 23 den unexplained death in childhood, including educating 24 individuals about safe sleep environments, sleep positions, 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00335 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 336 •HR 5475 IH and reducing exposure to smoking during pregnancy and 1 after birth. 2 (b) TARGETED POPULATIONS.—The campaign under 3 subsection (a) shall be designed to reduce health dispari- 4 ties through the targeting of populations with high rates 5 of sudden unexpected infant death and sudden unex- 6 plained death in childhood. 7 (c) CONSULTATION.—In establishing and imple- 8 menting the campaign under subsection (a), the Secretary 9 shall consult with national organizations representing 10 health care providers, including nurses and physicians, 11 parents, child care providers, children’s advocacy and safe- 12 ty organizations, maternal and child health programs, nu- 13 trition professionals focusing on women, infants, and chil- 14 dren, and other individuals and groups determined nec- 15 essary by the Secretary for such establishment and imple- 16 mentation. 17 (d) GRANTS.— 18 (1) IN GENERAL.—In carrying out the cam- 19 paign under subsection (a), the Secretary shall 20 award grants to national organizations, State and 21 local health departments, and community-based or- 22 ganizations for the conduct of education and out- 23 reach programs for nurses, parents, child care pro- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00336 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 337 •HR 5475 IH viders, public health agencies, and community orga- 1 nizations. 2 (2) APPLICATION.—To be eligible to receive a 3 grant under paragraph (1), an entity shall submit to 4 the Secretary an application at such time, in such 5 manner, and containing such information as the Sec- 6 retary may require. 7 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 8 authorized to be appropriated to carry out this section 9 such sums as may be necessary for each of fiscal years 10 2017 through 2021. 11 SEC. 508. REDUCING UNINTENDED TEENAGE PREG- 12 NANCIES. 13 Title III of the Public Health Service Act (42 U.S.C. 14 241 et seq.) is amended by adding at the end the following 15 new part: 16 ‘‘PART W—YOUTH PREGNANCY PREVENTION 17 PROGRAMS 18 ‘‘SEC. 399OO. PURPOSE. 19 ‘‘It is the purpose of this part to develop and carry 20 out research and multimedia campaigns on new and exist- 21 ing program interventions to provide youth in communities 22 at disproportionate risk for unintended teen pregnancy 23 (particularly young people of color, immigrant commu- 24 nities, youth in the foster care system, youth in the juve- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00337 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 338 •HR 5475 IH nile justice system, rural youth, and LGBTQ youth) the 1 information and skills needed to prevent unintended teen- 2 age pregnancies, build healthy relationships, and improve 3 overall health and well-being. 4 ‘‘SEC. 399OO–1. LIMITATION. 5 ‘‘No Federal funds provided under this Act may be 6 used for media awareness campaigns that— 7 ‘‘(1) withhold health-promoting or life-saving 8 information about sexuality-related topics; 9 ‘‘(2) undermine young people’s confidence in 10 the effectiveness of contraception; 11 ‘‘(3) are medically inaccurate or have been sci- 12 entifically shown to be ineffective; 13 ‘‘(4) promote gender, racial, or ethnic stereo- 14 types; 15 ‘‘(5) are insensitive and unresponsive to the 16 needs of sexually active youth, LGBTQ youth, or 17 youth survivors of sexual violence; 18 ‘‘(6) are inconsistent with the ethical impera- 19 tives of medicine and public health; or 20 ‘‘(7) stigmatize and shame youth who are par- 21 enting or choose to parent. 22 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00338 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 339 •HR 5475 IH ‘‘SEC. 399OO–2. MULTIMEDIA CAMPAIGNS TO PROMOTE 1 TEEN SEXUAL HEALTH. 2 ‘‘(a) IN GENERAL.—The Secretary shall award com- 3 petitive grants to public and private entities, including na- 4 tional or regional intermediaries with affiliates located in 5 urban communities, to carry out multimedia campaigns to 6 provide public education and increase public awareness re- 7 garding teen sexual health, including unintended preg- 8 nancy, sexually transmitted infections including HIV, sex- 9 ual violence, and related relationship, emotional, social, 10 and cultural issues. 11 ‘‘(b) PRIORITY.—In awarding grants under this sec- 12 tion, the Secretary shall give priority to applicants pro- 13 posing to carry out campaigns developed for communities 14 with a high prevalence of unintended teen pregnancy (par- 15 ticularly young people of color, immigrant communities, 16 youth in the foster care system, youth in the juvenile jus- 17 tice system, rural youth, and LGBTQ 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 ‘‘(A) human development; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00339 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 340 •HR 5475 IH ‘‘(B) healthy relationships and personal 1 skills including communication, consent, and vi- 2 olence prevention; and 3 ‘‘(C) sexual behavior and health, including 4 abstinence, prevention of unintended teen preg- 5 nancy, and HIV and other sexually transmitted 6 infections; and 7 ‘‘(2) may provide information on the prevention 8 of dating violence and sexual assault. 9 ‘‘SEC. 399OO–3. RESEARCH ON REDUCING UNINTENDED 10 TEENAGE PREGNANCIES AND TEENAGE DAT- 11 ING VIOLENCE AND IMPROVING HEALTHY 12 RELATIONSHIPS. 13 ‘‘(a) IN GENERAL.—The Secretary, acting through 14 the Director of the Centers for Disease Control and Pre- 15 vention, shall make grants to public and private entities 16 to conduct, support, or coordinate research on teen sexual 17 health (including unintended teen pregnancy, dating vio- 18 lence, and healthy relationships among persons of color 19 and immigrant communities) that— 20 ‘‘(1) improves data collection on— 21 ‘‘(A) sexual and reproductive health, in- 22 cluding unintended teenage pregnancies and 23 births, among all minority communities and 24 subpopulations in which such data are not col- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00340 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 341 •HR 5475 IH lected, including American Indian and Alaska 1 Native youth; 2 ‘‘(B) sexual behavior, reproductive and sex- 3 ual coercion, and teenage contraceptive use pat- 4 terns at the State level, as appropriate; 5 ‘‘(C) unintended teenage pregnancies 6 among youth in and aging out of foster care or 7 juvenile justice systems and the underlying fac- 8 tors that lead to unintended teenage pregnancy 9 among youth in foster care or juvenile justice 10 systems; and 11 ‘‘(D) sexual and reproductive health, in- 12 cluding teenage pregnancies and births, sexual 13 behavior, reproductive and sexual coercion, and 14 teenage contraceptive use among— 15 ‘‘(i) LGBTQ youth; and 16 ‘‘(ii) rural youth; 17 ‘‘(2) investigates— 18 ‘‘(A) the variance in the rates of unin- 19 tended teenage pregnancy by— 20 ‘‘(i) racial and ethnic group (such as 21 Hispanic, Asian-American, African-Amer- 22 ican, Pacific Islander, American Indian, 23 and Alaska Native); and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00341 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 342 •HR 5475 IH ‘‘(ii) socioeconomic status, based on 1 the income of the family and education at- 2 tainment; 3 ‘‘(B) factors affecting the risk for youth of 4 unintended teenage pregnancy or dating vio- 5 lence, including the physical and social environ- 6 ment, level of acculturation, access to health 7 care, aspirations for the future, and history of 8 physical or sexual violence or abuse; 9 ‘‘(C) the role that violence and abuse play 10 in teenage sex, pregnancy, and childbearing; 11 ‘‘(D) strategies to address the dispropor- 12 tionate rates of unintended teenage pregnancies 13 and dating violence in racial or ethnic minority 14 or immigrant communities; 15 ‘‘(E) how effective interventions can be 16 replicated or adapted in other settings to serve 17 racial or ethnic minority or immigrant commu- 18 nities in a culturally appropriate manner; and 19 ‘‘(F) the effectiveness of media campaigns 20 in addressing healthy relationship development, 21 dating violence prevention, and unintended 22 teenage pregnancy; and 23 ‘‘(3) tests research-based strategies for address- 24 ing high rates of unintended teenage pregnancy 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00342 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 343 •HR 5475 IH through programs that emphasize healthy relation- 1 ships and violence prevention. 2 ‘‘(b) PRIORITY.—In carrying out this section, the 3 Secretary shall give priority to research that incor- 4 porates— 5 ‘‘(1) interdisciplinary approaches; 6 ‘‘(2) a strong emphasis on community-based 7 participatory research; 8 ‘‘(3) consideration and assessment of State and 9 local education and health policies that may impact 10 teen sexual health; or 11 ‘‘(4) translational research. 12 ‘‘SEC. 399OO–4. HHS ADOLESCENT HEALTH WORK GROUP. 13 ‘‘(a) PURPOSE.—Not later than 30 days after the 14 date of the enactment of this part, the Secretary shall di- 15 rect the interagency adolescent health workgroup within 16 the Office of Adolescent Health of the Department of 17 Health and Human Services to— 18 ‘‘(1) include in the work of the group strategies 19 for teenage dating violence prevention and healthy 20 teenage relationships with a particular focus among 21 racial or ethnic minority or immigrant communities; 22 and 23 ‘‘(2) with respect to including such strategies, 24 consult, to the greatest extent possible, with the 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00343 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 344 •HR 5475 IH Federal Interagency Workgroup on Teen Dating Vi- 1 olence formed under the leadership of the National 2 Institute of Justice of the Department of Justice. 3 ‘‘(b) REPORT REQUIREMENT.—The Secretary, 4 through the Office of Adolescent Health, shall periodically 5 submit to Congress a report that— 6 ‘‘(1) includes a review of the evidence-based 7 programs on preventing unintended teenage preg- 8 nancy, which are carried out and identified by the 9 Office; and 10 ‘‘(2) identifies the programs of the Department 11 of Health and Human Services that include teenage 12 dating violence prevention and the promotion of 13 healthy teenage relationships as part of a strategy to 14 prevent unintended teenage pregnancy. 15 ‘‘SEC. 399OO–5. GENERAL GRANT PROVISIONS. 16 ‘‘(a) APPLICATIONS.—To seek a grant under this 17 part, an entity shall submit an application to the Secretary 18 in such form, in such manner, and containing such agree- 19 ments, assurances, and information as the Secretary may 20 require. 21 ‘‘(b) ADDITIONAL REQUIREMENTS.—A grant may be 22 made under this part only if the applicant involved agrees 23 that information, activities, and services provided under 24 the grant— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00344 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 345 •HR 5475 IH ‘‘(1) will be evidence-based or evidence-in- 1 formed; 2 ‘‘(2) will be factually and medically accurate 3 and complete; and 4 ‘‘(3) if directed to a particular population 5 group, will be provided in an appropriate language 6 and cultural context. 7 ‘‘(c) TRAINING AND TECHNICAL ASSISTANCE.— 8 ‘‘(1) IN GENERAL.—Of the total amount made 9 available to carry out this part for a fiscal year, the 10 Secretary shall use 10 percent to provide, directly or 11 through a competitive grant process, training and 12 technical assistance to the grant recipients under 13 this part, including by disseminating research and 14 information regarding effective and promising prac- 15 tices, providing consultation and resources on a 16 broad array of teenage and unintended pregnancy 17 and violence prevention strategies, and developing 18 resources and materials. 19 ‘‘(2) COLLABORATION.—In carrying out this 20 subsection, the Secretary shall collaborate with Fed- 21 eral, State, public, and private entities that have ex- 22 pertise in sexual health education, prevention of un- 23 intended teen pregnancy, healthy relationship devel- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00345 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 346 •HR 5475 IH opment, minority health and health disparities, and 1 violence prevention. 2 ‘‘SEC. 399OO–6. DEFINITIONS. 3 ‘‘In this part: 4 ‘‘(1) EVIDENCE-BASED OR EVIDENCE-IN- 5 FORMED.—The terms ‘evidence-based or evidence-in- 6 formed’ mean having been proven through rigorous 7 evaluation to change sexual behavior or incorporate 8 characteristics of effective programs, including devel- 9 opment, content, and implementation of such pro- 10 grams, that— 11 ‘‘(A) have been shown to be effective in 12 terms of increasing knowledge, clarifying values 13 and attitudes, increasing skills, and impacting 14 upon behavior; and 15 ‘‘(B) are widely recognized by leading med- 16 ical and public health agencies to be effective in 17 changing sexual behaviors that lead to unin- 18 tended pregnancy, sexually transmitted infec- 19 tions including HIV, and dating violence and 20 sexual assault among young people. 21 ‘‘(2) LGBTQ YOUTH.—The term ‘LGBTQ 22 youth’ means lesbian, gay, bisexual, transgender, 23 queer, and questioning (LGBTQ) youth. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00346 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 347 •HR 5475 IH ‘‘(3) 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 ‘‘(4) RACIAL OR ETHNIC MINORITY OR IMMI- 13 GRANT COMMUNITIES.—The term ‘racial or ethnic 14 minority or immigrant communities’ means commu- 15 nities with a substantial number of residents who 16 are members of racial or ethnic minority groups or 17 who are immigrants. 18 ‘‘(5) REPRODUCTIVE AND SEXUAL COERCION.— 19 The term ‘reproductive and sexual coercion’— 20 ‘‘(A) means, with respect to a person, coer- 21 cive behavior that interferes with the ability of 22 such person to control the reproductive deci- 23 sionmaking of such person, such as inten- 24 tionally exposing such person to sexually trans- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00347 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 348 •HR 5475 IH mitted infections; attempting to impregnate 1 such person against their will; intentionally 2 interfering with the person’s birth control; or 3 threatening or acting violent if the person does 4 not comply with the perpetrator’s wishes re- 5 garding contraception or the decision whether 6 to terminate or continue a pregnancy; and 7 ‘‘(B) includes a range of behaviors that a 8 partner may use related to sexual decision-mak- 9 ing to pressure or coerce a person to have sex 10 without using physical force, such as repeatedly 11 pressuring a partner to have sex when they do 12 not want to; threatening to end a relationship 13 if a person does not have sex; and threatening 14 retaliation if notified of a positive sexually 15 transmitted infection test result. 16 ‘‘(6) YOUTH.—The term ‘youth’ means individ- 17 uals who are 11 to 19 years of age. 18 ‘‘SEC. 399OO–7. REPORTS. 19 ‘‘(a) REPORT ON USE OF FUNDS.—Not later than 20 1 year after the date of the enactment of this part, the 21 Secretary shall submit to Congress a report on the use 22 of funds provided pursuant to this part. 23 ‘‘(b) REPORT ON IMPACT OF PROGRAMS.—Not later 24 than March 1, 2021, the Secretary shall submit to Con- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00348 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 349 •HR 5475 IH gress a report on the impact of the programs under this 1 part on reducing unintended teenage pregnancies. 2 ‘‘SEC. 399OO–8. AUTHORIZATION OF APPROPRIATIONS. 3 ‘‘(a) IN GENERAL.—There are authorized to be ap- 4 propriated to carry out this part such sums as may be 5 necessary for each of the fiscal years 2017 through 2021. 6 ‘‘(b) AVAILABILITY.—Amounts appropriated pursu- 7 ant to subsection (a)— 8 ‘‘(1) are authorized to remain available until ex- 9 pended; and 10 ‘‘(2) are in addition to amounts otherwise made 11 available for such purposes.’’. 12 SEC. 509. GESTATIONAL DIABETES. 13 Part B of title III of the Public Health Service Act 14 (42 U.S.C. 243 et seq.) is amended by adding after section 15 317H the following: 16 ‘‘SEC. 317H–1. GESTATIONAL DIABETES. 17 ‘‘(a) UNDERSTANDING AND MONITORING GESTA- 18 TIONAL DIABETES.— 19 ‘‘(1) IN GENERAL.—The Secretary, acting 20 through the Director of the Centers for Disease 21 Control and Prevention, in consultation with the Di- 22 abetes Mellitus Interagency Coordinating Committee 23 established under section 429 and representatives of 24 appropriate national health organizations, shall de- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00349 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 350 •HR 5475 IH velop a multisite gestational diabetes research 1 project within the diabetes program of the Centers 2 for Disease Control and Prevention to expand and 3 enhance surveillance data and public health research 4 on gestational diabetes. 5 ‘‘(2) AREAS TO BE ADDRESSED.—The research 6 project developed under paragraph (1) shall ad- 7 dress— 8 ‘‘(A) procedures to establish accurate and 9 efficient systems for the collection of gestational 10 diabetes data within each State and common- 11 wealth, territory, or possession of the United 12 States; 13 ‘‘(B) the progress of collaborative activities 14 with the National Vital Statistics System, the 15 National Center for Health Statistics, and 16 State health departments with respect to the 17 standard birth certificate, in order to improve 18 surveillance of gestational diabetes; 19 ‘‘(C) postpartum methods of tracking 20 women with gestational diabetes after delivery 21 as well as targeted interventions proven to 22 lower the incidence of type 2 diabetes in that 23 population; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00350 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 351 •HR 5475 IH ‘‘(D) variations in the distribution of diag- 1 nosed and undiagnosed gestational diabetes, 2 and of impaired fasting glucose tolerance and 3 impaired fasting glucose, within and among 4 groups of women; and 5 ‘‘(E) factors and culturally sensitive inter- 6 ventions that influence risks and reduce the in- 7 cidence of gestational diabetes and related com- 8 plications during childbirth, including cultural, 9 behavioral, racial, ethnic, geographic, demo- 10 graphic, socioeconomic, and genetic factors. 11 ‘‘(3) REPORT.—Not later than 2 years after the 12 date of the enactment of this section, and annually 13 thereafter, the Secretary shall generate a report on 14 the findings and recommendations of the research 15 project including prevalence of gestational diabetes 16 in the multisite area and disseminate the report to 17 the appropriate Federal and non-Federal agencies. 18 ‘‘(b) EXPANSION OF GESTATIONAL DIABETES RE- 19 SEARCH.— 20 ‘‘(1) IN GENERAL.—The Secretary shall expand 21 and intensify public health research regarding gesta- 22 tional diabetes. Such research may include— 23 ‘‘(A) developing and testing novel ap- 24 proaches for improving postpartum diabetes 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00351 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 352 •HR 5475 IH testing or screening and for preventing type 2 1 diabetes in women with a history of gestational 2 diabetes; and 3 ‘‘(B) conducting public health research to 4 further understanding of the epidemiologic, 5 socioenvironmental, behavioral, translation, and 6 biomedical factors and health systems that in- 7 fluence the risk of gestational diabetes and the 8 development of type 2 diabetes in women with 9 a history of gestational diabetes. 10 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 11 There is authorized to be appropriated to carry out 12 this subsection $5,000,000 for each of fiscal years 13 2017 through 2021. 14 ‘‘(c) DEMONSTRATION GRANTS TO LOWER THE 15 RATE OF GESTATIONAL DIABETES.— 16 ‘‘(1) IN GENERAL.—The Secretary, acting 17 through the Director of the Centers for Disease 18 Control and Prevention, shall award grants, on a 19 competitive basis, to eligible entities for demonstra- 20 tion projects that implement evidence-based inter- 21 ventions to reduce the incidence of gestational diabe- 22 tes, the recurrence of gestational diabetes in subse- 23 quent pregnancies, and the development of type 2 di- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00352 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 353 •HR 5475 IH abetes in women with a history of gestational diabe- 1 tes. 2 ‘‘(2) PRIORITY.—In making grants under this 3 subsection, the Secretary shall give priority to 4 projects focusing on— 5 ‘‘(A) helping women who have 1 or more 6 risk factors for developing gestational diabetes; 7 ‘‘(B) working with women with a history of 8 gestational diabetes during a previous preg- 9 nancy; 10 ‘‘(C) providing postpartum care for women 11 with gestational diabetes; 12 ‘‘(D) tracking cases where women with a 13 history of gestational diabetes developed type 2 14 diabetes; 15 ‘‘(E) educating mothers with a history of 16 gestational diabetes about the increased risk of 17 their child developing diabetes; 18 ‘‘(F) working to prevent gestational diabe- 19 tes and prevent or delay the development of 20 type 2 diabetes in women with a history of ges- 21 tational diabetes; and 22 ‘‘(G) achieving outcomes designed to assess 23 the efficacy and cost-effectiveness of interven- 24 tions that can inform decisions on long-term 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00353 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 354 •HR 5475 IH sustainability, including third-party reimburse- 1 ment. 2 ‘‘(3) APPLICATION.—An eligible entity desiring 3 to receive a grant under this subsection shall submit 4 to the Secretary— 5 ‘‘(A) an application at such time, in such 6 manner, and containing such information as the 7 Secretary may require; and 8 ‘‘(B) a plan to— 9 ‘‘(i) lower the rate of gestational dia- 10 betes during pregnancy; or 11 ‘‘(ii) develop methods of tracking 12 women with a history of gestational diabe- 13 tes and develop effective interventions to 14 lower the incidence of the recurrence of 15 gestational diabetes in subsequent preg- 16 nancies and the development of type 2 dia- 17 betes. 18 ‘‘(4) USES OF FUNDS.—An eligible entity re- 19 ceiving a grant under this subsection shall use the 20 grant funds to carry out demonstration projects de- 21 scribed in paragraph (1), including— 22 ‘‘(A) expanding community-based health 23 promotion education, activities, and incentives 24 focused on the prevention of gestational diabe- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00354 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 355 •HR 5475 IH tes and development of type 2 diabetes in 1 women with a history of gestational diabetes; 2 ‘‘(B) aiding State- and tribal-based diabe- 3 tes prevention and control programs to collect, 4 analyze, disseminate, and report surveillance 5 data on women with, and at risk for, gesta- 6 tional diabetes, the recurrence of gestational di- 7 abetes in subsequent pregnancies, and, for 8 women with a history of gestational diabetes, 9 the development of type 2 diabetes; and 10 ‘‘(C) training and encouraging health care 11 providers— 12 ‘‘(i) to promote risk assessment, high- 13 quality care, and self-management for ges- 14 tational diabetes and the recurrence of ges- 15 tational diabetes in subsequent preg- 16 nancies; and 17 ‘‘(ii) to prevent the development of 18 type 2 diabetes in women with a history of 19 gestational diabetes, and its complications 20 in the practice settings of the health care 21 providers. 22 ‘‘(5) REPORT.—Not later than 4 years after the 23 date of the enactment of this section, the Secretary 24 shall prepare and submit to the Congress a report 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00355 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 356 •HR 5475 IH concerning the results of the demonstration projects 1 conducted through the grants awarded under this 2 subsection. 3 ‘‘(6) DEFINITION OF ELIGIBLE ENTITY.—In 4 this subsection, the term ‘eligible entity’ means a 5 nonprofit organization (such as a nonprofit academic 6 center or community health center) or a State, trib- 7 al, or local health agency. 8 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 9 There is authorized to be appropriated to carry out 10 this subsection $5,000,000 for each of fiscal years 11 2017 through 2021. 12 ‘‘(d) POSTPARTUM FOLLOWUP REGARDING GESTA- 13 TIONAL DIABETES.—The Secretary, acting through the 14 Director of the Centers for Disease Control and Preven- 15 tion, shall work with the State- and tribal-based diabetes 16 prevention and control programs assisted by the Centers 17 to encourage postpartum followup after gestational diabe- 18 tes, as medically appropriate, for the purpose of reducing 19 the incidence of gestational diabetes, the recurrence of 20 gestational diabetes in subsequent pregnancies, the devel- 21 opment of type 2 diabetes in women with a history of ges- 22 tational diabetes, and related complications.’’. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00356 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 357 •HR 5475 IH SEC. 510. EMERGENCY CONTRACEPTION EDUCATION AND 1 INFORMATION PROGRAMS. 2 (a) EMERGENCY CONTRACEPTION PUBLIC EDU- 3 CATION PROGRAM.— 4 (1) IN GENERAL.—The Secretary, acting 5 through the Director of the Centers for Disease 6 Control and Prevention, shall develop and dissemi- 7 nate to the public medically accurate and complete 8 information on emergency contraception. 9 (2) DISSEMINATION.—The Secretary may dis- 10 seminate medically accurate and complete informa- 11 tion under paragraph (1) directly or through ar- 12 rangements with nonprofit organizations, community 13 health workers including promotoras, consumer 14 groups, institutions of higher education, clinics, the 15 media, and Federal, State, and local agencies. 16 (3) INFORMATION.—The information dissemi- 17 nated under paragraph (1) shall— 18 (A) include, at a minimum, a description 19 of emergency contraception and an explanation 20 of the use, safety, efficacy, and availability of 21 such contraception; and 22 (B) be pilot tested for consumer com- 23 prehension, cultural and linguistic appropriate- 24 ness, and acceptance of the messages across 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00357 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 358 •HR 5475 IH geographically, racially, ethnically, and linguis- 1 tically diverse populations. 2 (b) EMERGENCY CONTRACEPTION INFORMATION 3 PROGRAM FOR HEALTH CARE PROVIDERS.— 4 (1) IN GENERAL.—The Secretary, acting 5 through the Administrator of the Health Resources 6 and Services Administration and in consultation 7 with major medical and public health organizations, 8 shall develop and disseminate to health care pro- 9 viders information on emergency contraception. 10 (2) INFORMATION.—The information dissemi- 11 nated under paragraph (1) shall include, at a min- 12 imum— 13 (A) information describing the use, safety, 14 efficacy, and availability of emergency contra- 15 ception; 16 (B) a recommendation regarding the use of 17 such contraception; and 18 (C) information explaining how to obtain 19 copies of the information developed under sub- 20 section (a) for distribution to the patients of 21 the providers. 22 (c) DEFINITIONS.—In this section: 23 (1) EMERGENCY CONTRACEPTION.—The term 24 ‘‘emergency contraception’’ means a drug or device 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00358 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 359 •HR 5475 IH (as the terms are defined in section 201 of the Fed- 1 eral Food, Drug, and Cosmetic Act (21 U.S.C. 321)) 2 or a drug regimen that— 3 (A) is used postcoitally; 4 (B) prevents pregnancy primarily by pre- 5 venting or delaying ovulation, and does not ter- 6 minate an established pregnancy; and 7 (C) is approved by the Food and Drug Ad- 8 ministration. 9 (2) HEALTH CARE PROVIDER.—The term 10 ‘‘health care provider’’ means an individual who is li- 11 censed or certified under State law to provide health 12 care services and who is operating within the scope 13 of such license. Such term shall include a phar- 14 macist. 15 (3) INSTITUTION OF HIGHER EDUCATION.—The 16 term ‘‘institution of higher education’’ has the same 17 meaning given such term in section 101(a) of the 18 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 19 (4) MEDICALLY ACCURATE AND COMPLETE.— 20 The term ‘‘medically accurate and complete’’ means, 21 with respect to information, activities, or services 22 verified or supported by the weight of research con- 23 ducted in compliance with accepted scientific meth- 24 ods and— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00359 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 360 •HR 5475 IH (A) published in peer-reviewed journals, 1 where applicable; or 2 (B) comprising information that leading 3 professional organizations and agencies with 4 relevant expertise in the field recognize as accu- 5 rate, objective, and complete. 6 (5) SECRETARY.—The term ‘‘Secretary’’ means 7 the Secretary of Health and Human Services. 8 (d) AUTHORIZATION OF APPROPRIATIONS.—There 9 are authorized to be appropriated to carry out this section 10 such sums as may be necessary for each of the fiscal years 11 2017 through 2021. 12 SEC. 511. SUPPORTING HEALTHY ADOLESCENT DEVELOP- 13 MENT. 14 (a) IN GENERAL.—The Secretary may award a grant 15 to each eligible State to conduct programs of sex education 16 described in subsection (b), including education on both 17 abstinence and contraception for the prevention of teenage 18 pregnancy and sexually transmitted infections, including 19 HIV/AIDS and viral hepatitis. 20 (b) REQUIREMENTS FOR SEX EDUCATION PRO- 21 GRAMS.—A program of sex education described in this 22 subsection is a program that— 23 (1) is age appropriate and medically accurate; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00360 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 361 •HR 5475 IH (2) stresses the value of abstinence while not ig- 1 noring those young people who have been or are sex- 2 ually active; 3 (3) includes information providing a factual un- 4 derstanding of male and female reproductive anat- 5 omy; 6 (4) provides medically accurate and complete 7 information about the health benefits side effects, 8 and availability of contraceptive and barrier methods 9 used— 10 (A) as a means to prevent pregnancy; and 11 (B) to reduce the risk of contracting a sex- 12 ually transmitted infection, including HIV/ 13 AIDS and viral hepatitis; 14 (5) encourages family communication between 15 parent and child about sexuality; 16 (6) cultivates a respectful dialogue about sexu- 17 ality, including sexual orientation and gender iden- 18 tity, and embraces the principles of nondiscrimina- 19 tion based on sexual orientation and gender identity; 20 (7) counters the perpetuation of narrow gender 21 roles, including the sexualization of female children, 22 adolescents, and adults; 23 (8) teaches young people the skills to make re- 24 sponsible decisions about sexuality, including how to 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00361 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 362 •HR 5475 IH avoid unwanted verbal, physical, and sexual ad- 1 vances and how to avoid making verbal, physical, 2 and sexual advances that are not wanted by the 3 other party; 4 (9) develops healthy relationships, including the 5 prevention of dating and sexual violence; 6 (10) teaches young people how alcohol and drug 7 use can affect responsible decisionmaking; and 8 (11) does not teach or promote religion. 9 (c) ADDITIONAL ACTIVITIES.—In carrying out a pro- 10 gram of sex education, a State may expend grant funds 11 awarded under subsection (a) to carry out educational and 12 motivational activities that help young people— 13 (1) gain knowledge about the physical, emo- 14 tional, biological, and hormonal changes of adoles- 15 cence and subsequent stages of human maturation; 16 (2) develop the knowledge and skills nec- 17 essary— 18 (A) to ensure and protect their sexual and 19 reproductive health from unintended pregnancy 20 and sexually transmitted infection, including 21 HIV/AIDS, throughout their lifespan; 22 (B) to be aware that certain racial and 23 ethnic groups are more affected by certain sex- 24 ually transmitted infections; and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00362 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 363 •HR 5475 IH (C) to receive the education to prevent fur- 1 ther transmission; 2 (3) gain knowledge about the specific involve- 3 ment and responsibility of each individual in sexual 4 decisionmaking; 5 (4) develop healthy attitudes and values about 6 adolescent growth and development, body image, 7 gender roles, racial and ethnic diversity, sexual ori- 8 entation and gender identity, and other subjects; 9 (5) develop and practice healthy life skills in- 10 cluding goal-setting, decisionmaking, negotiation, 11 communication, and stress management; and 12 (6) promote self-esteem and positive inter- 13 personal skills focusing on relationship dynamics, in- 14 cluding friendships, dating, romantic involvement, 15 marriage, and family interactions. 16 (d) MATCHING FUNDS.—The Secretary may not 17 make payments to a State under this section in an amount 18 exceeding Federal medical assistance percentage for such 19 State (as such term is defined in section 1905(b) of the 20 Social Security Act (42 U.S.C. 1396d(b))) of the costs of 21 the programs conducted by the State under this section. 22 (e) EVALUATION OF PROGRAMS.— 23 (1) IN GENERAL.—For the purpose of evalu- 24 ating the effectiveness of programs of sex education 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00363 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 364 •HR 5475 IH carried out with a grant under this section, evalua- 1 tions shall be carried out in accordance with para- 2 graphs (2) and (3). 3 (2) NATIONAL EVALUATION.— 4 (A) METHOD.—The Secretary shall pro- 5 vide for a national evaluation of a representa- 6 tive sample of programs of sex education car- 7 ried out with grants under this section to deter- 8 mine— 9 (i) the effectiveness of such programs 10 in helping to delay the initiation of sexual 11 intercourse and other high-risk behaviors; 12 (ii) the effectiveness of such programs 13 in preventing adolescent pregnancy; 14 (iii) the effectiveness of such pro- 15 grams in preventing sexually transmitted 16 infection, including HIV/AIDS and viral 17 hepatitis; 18 (iv) the effectiveness of such programs 19 in increasing contraceptive knowledge and 20 contraceptive behaviors when sexual inter- 21 course occurs; and 22 (v) a list of best practices that— 23 (I) is based upon essential pro- 24 grammatic components of evaluated 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00364 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 365 •HR 5475 IH programs that have led to success de- 1 scribed in clauses (i) through (iv); and 2 (II) documents the racial and 3 ethnic minority populations that are 4 recipients of grant funds under this 5 section or are served by programs of 6 sex education funded under this sec- 7 tion. 8 (B) GRANT CONDITION.—A condition for 9 the receipt of a grant to a State under this sec- 10 tion is that the State cooperate with the evalua- 11 tion under subparagraph (A). 12 (C) REPORT.—The Secretary shall submit 13 to the Congress— 14 (i) not later than the end of each fis- 15 cal year during the 5-year period beginning 16 with fiscal year 2017, an interim report on 17 the national evaluation under subpara- 18 graph (A); and 19 (ii) not later than March 31, 2020, a 20 final report providing the results of such 21 national evaluation. 22 (3) INDIVIDUAL STATE EVALUATIONS.—A con- 23 dition for the receipt of a grant under this section 24 is that the State evaluate the programs of sex edu- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00365 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 366 •HR 5475 IH cation funded through such grant in accordance with 1 the following requirements: 2 (A) The evaluation will be conducted by an 3 external, independent entity. 4 (B) The purposes of the evaluation will be 5 the determination of— 6 (i) the effectiveness of such programs 7 in helping to delay the initiation of sexual 8 intercourse and other high-risk behaviors; 9 (ii) the effectiveness of such programs 10 in preventing adolescent pregnancy; 11 (iii) the effectiveness of such pro- 12 grams in preventing sexually transmitted 13 infection, including HIV/AIDS; and 14 (iv) the effectiveness of such programs 15 in increasing contraceptive and barrier 16 method knowledge and contraceptive be- 17 haviors when sexual intercourse occurs. 18 (f) LIMITATIONS ON USE OF FUNDS.— 19 (1) LIMITATIONS ON SECRETARY.—Of the 20 amounts appropriated for a fiscal year for purposes 21 of this section, the Secretary may not use more 22 than— 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00366 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 367 •HR 5475 IH (A) 7 percent of such amounts for admin- 1 istrative expenses related to carrying out this 2 section for that fiscal year; and 3 (B) 10 percent of such amounts for the 4 national evaluation under subsection (e)(2). 5 (2) LIMITATIONS TO STATES.—Of amounts pro- 6 vided to an eligible State under this subsection, the 7 State may not use more than 10 percent of the 8 grant to conduct any evaluation under subsection 9 (e)(3). 10 (g) NONDISCRIMINATION REQUIRED.—Programs 11 funded under this section shall not discriminate on the 12 basis of sex, race, ethnicity, national origin, disability, reli- 13 gion, marital status, familial status, sexual orientation, or 14 gender identity. Nothing in this section shall be construed 15 to invalidate or limit rights, remedies, procedures, or legal 16 standards available to victims of discrimination under any 17 other Federal law or any law of a State or a political sub- 18 division of a State, including title VI of the Civil Rights 19 Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the 20 Education Amendments of 1972 (20 U.S.C. 1681 et seq.), 21 section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 22 794), and the Americans with Disabilities Act of 1990 (42 23 U.S.C. 12101 et seq.). 24 (h) DEFINITIONS.—For purposes of this section: 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00367 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 368 •HR 5475 IH (1) The term ‘‘age appropriate’’ means, with re- 1 spect to topics, messages, and teaching methods, 2 those suitable to particular ages or age groups of 3 children, adolescents, and adults, based on devel- 4 oping cognitive, emotional, and behavioral capacity 5 typical for the age or age group. 6 (2) The term ‘‘eligible State’’ means a State 7 that submits to the Secretary an application for a 8 grant under this section that is in such form, is 9 made in such manner, and contains such agree- 10 ments, assurances, and information as the Secretary 11 determines to be necessary to carry out this section. 12 (3) The term ‘‘HIV/AIDS’’ means the human 13 immunodeficiency virus, and includes acquired im- 14 mune deficiency syndrome. 15 (4) The term ‘‘medically accurate’’, with respect 16 to information, means information that is supported 17 by research, recognized as accurate and objective by 18 leading medical, psychological, psychiatric, and pub- 19 lic health organizations and agencies, and, published 20 in journals that are peer reviewed. 21 (5) The term ‘‘State’’ means the 50 States, the 22 District of Columbia, the Commonwealth of Puerto 23 Rico, the Commonwealth of the Northern Mariana 24 Islands, American Samoa, Guam, the United States 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00368 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 369 •HR 5475 IH Virgin Islands, and any other territory or possession 1 of the United States. 2 (i) AUTHORIZATION OF APPROPRIATIONS.—For the 3 purpose of carrying out this section, there is authorized 4 to be appropriated $50,000,000 for each of the fiscal years 5 2017 through 2021. 6 SEC. 512. COMPASSIONATE ASSISTANCE FOR RAPE EMER- 7 GENCIES. 8 (a) MEDICARE.— 9 (1) LIMITATION ON PAYMENT.—Section 10 1866(a)(1) of the Social Security Act (42 U.S.C. 11 1395cc(a)(1)) is amended— 12 (A) in the subparagraph (W) added by sec- 13 tion 3005(1)(C) of Public Law 111–148— 14 (i) by striking the period at the end 15 and inserting a comma; 16 (ii) by moving the indentation 2 ems 17 to the left; and 18 (iii) by moving such subparagraph to 19 immediately follow subparagraph (V); 20 (B) in the subparagraph (W) added by sec- 21 tion 6406(b)(3) of Public Law 111–148— 22 (i) by striking the period at the end 23 and inserting ‘‘, and’’; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00369 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 370 •HR 5475 IH (ii) by moving the indentation 2 ems 1 to the left; 2 (iii) by redesignating such subpara- 3 graph as subparagraph (X); and 4 (iv) by moving such subparagraph to 5 immediately follow subparagraph (W), as 6 moved under paragraph (2)(C); and 7 (C) by inserting after the subparagraph 8 (X), as redesignated and moved under para- 9 graph (3), the following: 10 ‘‘(Y) in the case of a hospital or critical ac- 11 cess hospital, to adopt and enforce a policy to 12 ensure compliance with the requirements of 13 subsection (l) and to meet the requirements of 14 such subsection.’’. 15 (2) ASSISTANCE TO VICTIMS.—Section 1866 of 16 the Social Security Act (42 U.S.C. 1395cc) is 17 amended by adding at the end the following new 18 subsection: 19 ‘‘(l) COMPASSIONATE ASSISTANCE FOR RAPE EMER- 20 GENCIES.— 21 ‘‘(1) IN GENERAL.—For purposes of section 22 1866(a)(1)(Y), a hospital meets the requirements of 23 this subsection if the hospital provides each of the 24 services described in paragraph (2) to each indi- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00370 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 371 •HR 5475 IH vidual, whether or not eligible for benefits under this 1 title or under any other form of health insurance. 2 who comes to the hospital on or after January 1, 3 2017, and— 4 ‘‘(A) who states to hospital personnel that 5 they are victims of sexual assault; 6 ‘‘(B) who is accompanied by an individual 7 who states to hospital personnel that the indi- 8 vidual is a victim of sexual assault; or 9 ‘‘(C) whom hospital personnel, during the 10 course of treatment and care for the individual, 11 have reason to believe is a victim of sexual as- 12 sault. 13 ‘‘(2) REQUIRED SERVICES DESCRIBED.—For 14 purposes of paragraph (1), the services described in 15 this subparagraph are the following: 16 ‘‘(A) Provision of medically and factually 17 accurate and unbiased written and oral infor- 18 mation about emergency contraception that— 19 ‘‘(i) is written in clear and concise 20 language; 21 ‘‘(ii) is readily comprehensible; 22 ‘‘(iii) includes an explanation that— 23 ‘‘(I) emergency contraception has 24 been approved by the Food and Drug 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00371 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 372 •HR 5475 IH Administration as an over-the-counter 1 medication for individuals, and is a 2 safe and effective way to prevent 3 pregnancy after unprotected inter- 4 course or contraceptive failure if 5 taken in a timely manner; 6 ‘‘(II) emergency contraception is 7 more effective the sooner it is taken; 8 and 9 ‘‘(III) emergency contraception 10 does not cause an abortion and cannot 11 interrupt an established pregnancy; 12 ‘‘(iv) meets such conditions regarding 13 the provision of such information in lan- 14 guages other than English as the Secretary 15 may establish; and 16 ‘‘(v) is provided without regard to the 17 ability of the individual or their family to 18 pay costs associated with the provision of 19 such information to the individual. 20 ‘‘(B) Immediate offer to provide emergency 21 contraception to the individual at the hospital 22 and, in the case that the individual accepts such 23 offer, immediate provision to the individual of 24 such contraception on the same day it is re- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00372 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 373 •HR 5475 IH quested without regard to the inability of the 1 individual or their family to pay costs associ- 2 ated with the offer and provision of such con- 3 traception. 4 ‘‘(C) Development and implementation of a 5 written policy to ensure that an individual is 6 present at the hospital, or on-call, who— 7 ‘‘(i) has authority to dispense or pre- 8 scribe emergency contraception, independ- 9 ently, or under a protocol prepared by a 10 physician for the administration of emer- 11 gency contraception at the hospital to a 12 victim of sexual assault; and 13 ‘‘(ii) is trained to comply with the re- 14 quirements of this section. 15 ‘‘(3) DEFINITIONS.—For purposes of this para- 16 graph: 17 ‘‘(A) The term ‘emergency contraception’ 18 means a drug or device (as such terms are de- 19 fined in section 201 of the Federal Food, Drug, 20 and Cosmetic Act (21 U.S.C. 321)) or a drug 21 regimen that— 22 ‘‘(i) is used postcoitally; 23 ‘‘(ii) prevents pregnancy primarily by 24 preventing or delaying ovulation, and does 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00373 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 374 •HR 5475 IH not terminate an established pregnancy; 1 and 2 ‘‘(iii) is approved by the Food and 3 Drug Administration. 4 ‘‘(B) The term ‘hospital’ includes a critical 5 access hospital, as defined in section 6 1861(mm)(1). 7 ‘‘(C) The term ‘sexual assault’ means co- 8 itus in which the individual involved does not 9 consent or lacks the legal capacity to consent.’’. 10 (b) LIMITATION ON PAYMENT UNDER MEDICAID.— 11 Section 1903(i) of the Social Security Act (42 U.S.C. 12 1396b(i)) is amended by inserting after paragraph (11) 13 the following new paragraph: 14 ‘‘(12) with respect to any amount expended for 15 care or services furnished under the plan by a hos- 16 pital on or after January 1, 2017, unless such hos- 17 pital meets the requirements specified in section 18 1866(l) for purposes of title XVIII.’’. 19 SEC. 513. ACCESS TO BIRTH CONTROL DUTIES OF PHAR- 20 MACIES TO ENSURE PROVISION OF FDA-AP- 21 PROVED CONTRACEPTION. 22 Part B of title II of the Public Health Service Act 23 (42 U.S.C. 238 et seq.) is amended by adding at the end 24 the following: 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00374 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 375 •HR 5475 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, in- 7 cluding emergency contraception, that is in stock, 8 the pharmacy shall ensure that the contraceptive is 9 provided to the customer— 10 ‘‘(A) without delay; 11 ‘‘(B) without regard to the customer’s age, 12 gender, gender identity, or sexual orientation; 13 ‘‘(C) without a requirement that identifica- 14 tion be presented; and 15 ‘‘(D) despite any conflicts of employees to 16 filling a prescription and dispensing a par- 17 ticular prescription drug or device due to sin- 18 cerely held moral, philosophical, or religious be- 19 liefs. 20 ‘‘(2) If a customer requests a contraceptive that 21 is not in stock and the pharmacy in the normal 22 course of business stocks contraception, the phar- 23 macy shall immediately inform the customer that the 24 contraceptive is not in stock and without delay offer 25 the customer the following options: 26 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00375 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 376 •HR 5475 IH ‘‘(A) If the customer prefers to obtain the 1 contraceptive through a referral or transfer, the 2 pharmacy shall— 3 ‘‘(i) locate a pharmacy of the cus- 4 tomer’s choice or the closest pharmacy 5 confirmed to have the contraceptive in 6 stock; and 7 ‘‘(ii) refer the customer or transfer 8 the prescription to that pharmacy. 9 ‘‘(B) If the customer prefers for the phar- 10 macy to order the contraceptive, the pharmacy 11 shall obtain the contraceptive under the phar- 12 macy’s standard procedure for expedited order- 13 ing of medication and notify the customer when 14 the contraceptive arrives. 15 ‘‘(3) The pharmacy shall ensure that its em- 16 ployees do not— 17 ‘‘(A) intimidate, threaten, or harass cus- 18 tomers in the delivery of services relating to a 19 request for contraception; 20 ‘‘(B) interfere with or obstruct the delivery 21 of services relating to a request for contracep- 22 tion; 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00376 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 377 •HR 5475 IH ‘‘(C) intentionally misrepresent or deceive 1 customers about the availability of contracep- 2 tion or its mechanism of action; 3 ‘‘(D) breach medical confidentiality with 4 respect to a request for contraception or threat- 5 en to breach such confidentiality; or 6 ‘‘(E) refuse to return a valid, lawful pre- 7 scription for contraception upon customer re- 8 quest. 9 ‘‘(b) CONTRACEPTIVES NOT ORDINARILY 10 STOCKED.—Nothing in subsection (a)(2) shall be con- 11 strued to require any pharmacy to comply with such sub- 12 section if the pharmacy does not ordinarily stock contra- 13 ceptives in the normal course of business. 14 ‘‘(c) REFUSALS PURSUANT TO STANDARD PHAR- 15 MACY PRACTICE.—This section does not prohibit a phar- 16 macy from refusing to provide a contraceptive to a cus- 17 tomer in accordance with any of the following: 18 ‘‘(1) If it is unlawful to dispense the contracep- 19 tive to the customer without a valid, lawful prescrip- 20 tion and no such prescription is presented. 21 ‘‘(2) If the customer is unable to pay for the 22 contraceptive. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00377 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 378 •HR 5475 IH ‘‘(3) If the employee of the pharmacy refuses to 1 provide the contraceptive on the basis of a profes- 2 sional clinical judgment. 3 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec- 4 tion shall be construed to invalidate or limit rights, rem- 5 edies, procedures, or legal standards under title VII of the 6 Civil Rights Act of 1964. 7 ‘‘(e) PREEMPTION.—This section does not preempt 8 any provision of State law or any professional obligation 9 made applicable by a State board or other entity respon- 10 sible for licensing or discipline of pharmacies or phar- 11 macists, to the extent that such State law or professional 12 obligation provides protections for customers that are 13 greater than the protections provided by this section. 14 ‘‘(f) ENFORCEMENT.— 15 ‘‘(1) CIVIL PENALTY.—A pharmacy that vio- 16 lates a requirement of subsection (a) is liable to the 17 United States for a civil penalty in an amount not 18 exceeding $1,000 per day of violation, not to exceed 19 $100,000 for all violations adjudicated in a single 20 proceeding. 21 ‘‘(2) PRIVATE CAUSE OF ACTION.—Any person 22 aggrieved as a result of a violation of a requirement 23 of subsection (a) may, in any court of competent ju- 24 risdiction, commence a civil action against the phar- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00378 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 379 •HR 5475 IH macy involved to obtain appropriate relief, including 1 actual and punitive damages, injunctive relief, and a 2 reasonable attorney’s fee and cost. 3 ‘‘(3) LIMITATIONS.—A civil action under para- 4 graph (1) or (2) may not be commenced against a 5 pharmacy after the expiration of the 5-year period 6 beginning on the date on which the pharmacy alleg- 7 edly engaged in the violation involved. 8 ‘‘(g) DEFINITIONS.—In this section: 9 ‘‘(1) The term ‘contraception’ or ‘contraceptive’ 10 means any drug or device approved by the Food and 11 Drug Administration to prevent pregnancy. 12 ‘‘(2) The term ‘employee’ means a person hired, 13 by contract or any other form of an agreement, by 14 a pharmacy. 15 ‘‘(3) The term ‘pharmacy’ means an entity 16 that— 17 ‘‘(A) is authorized by a State to engage in 18 the business of selling prescription drugs at re- 19 tail; and 20 ‘‘(B) employs one or more employees. 21 ‘‘(4) The term ‘product’ means a Food and 22 Drug Administration-approved drug or device. 23 ‘‘(5) The term ‘professional clinical judgment’ 24 means the use of professional knowledge and skills 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00379 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 380 •HR 5475 IH to form a clinical judgment, in accordance with pre- 1 vailing medical standards. 2 ‘‘(6) The term ‘without delay’, with respect to 3 a pharmacy providing, providing a referral for, or 4 ordering contraception, or transferring the prescrip- 5 tion for contraception, means within the usual and 6 customary timeframe at the pharmacy for providing, 7 providing a referral for, or ordering other products, 8 or transferring the prescription for other products, 9 respectively. 10 ‘‘(h) EFFECTIVE DATE.—This section shall take ef- 11 fect on the 31st day after the date of the enactment of 12 this section, without regard to whether the Secretary has 13 issued any guidance or final rule regarding this section.’’. 14 SEC. 514. ADDITIONAL FOCUS AREA FOR THE OFFICE ON 15 WOMEN’S HEALTH. 16 Section 229(b) of the Public Health Service Act (42 17 U.S.C. 237a(b)) is amended— 18 (1) in paragraph (6), at the end, by striking 19 ‘‘and’’; 20 (2) in paragraph (7), at the end, by striking the 21 period and inserting a semicolon; and 22 (3) by adding at the end the following new 23 paragraph: 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00380 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 381 •HR 5475 IH ‘‘(8) facilitate policymakers, health system lead- 1 ers and providers, consumers, and other stake- 2 holders in understanding optimal maternity care and 3 support for the provision of such care, including the 4 priorities of— 5 ‘‘(A) protecting, promoting, and supporting 6 the innate capacities of childbearing women and 7 their newborns for childbirth, breastfeeding, 8 and attachment; 9 ‘‘(B) using obstetric interventions only 10 when such interventions are supported by 11 strong, high-quality evidence, and minimizing 12 overuse of maternity practices that have been 13 shown to have benefit in limited situations and 14 that can expose women, infants, or both to risk 15 of harm if used routinely and indiscriminately, 16 including continuous electronic fetal monitoring, 17 labor induction, epidural analgesia, primary ce- 18 sarean section, and routine repeat cesarean 19 birth; 20 ‘‘(C) reliably incorporating noninvasive, 21 evidence-based practices that have documented 22 correlation with considerable improvement in 23 outcomes with no detrimental side effects, such 24 as smoking cessation programs in pregnancy 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00381 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 382 •HR 5475 IH and proven models of group prenatal care that 1 integrate health assessment, education, and 2 support into a unified program; 3 ‘‘(D) a shared understanding of the quali- 4 fications of licensed providers of maternity care 5 and the best evidence about the safety, satisfac- 6 tion, outcomes, and costs of their care, and ap- 7 propriate deployment of such caregivers within 8 the maternity care workforce to address the 9 needs of childbearing women and newborns and 10 the growing shortage of maternity caregivers; 11 ‘‘(E) a shared understanding of the results 12 of the best available research comparing hos- 13 pital, birth center, and planned home births, in- 14 cluding information about each setting’s safety, 15 satisfaction, outcomes, and costs; and 16 ‘‘(F) high-quality, evidence-based child- 17 birth education that promotes a natural, 18 healthy, and safe approach to pregnancy, child- 19 birth, and early parenting; is taught by certified 20 educators, peer counselors, and health profes- 21 sionals; and promotes informed decisionmaking 22 by childbearing women; and’’. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00382 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 383 •HR 5475 IH SEC. 515. INTERAGENCY COORDINATING COMMITTEE ON 1 THE PROMOTION OF OPTIMAL MATERNITY 2 OUTCOMES. 3 (a) IN GENERAL.—Part A of title II of the Public 4 Health Service Act (42 U.S.C. 202 et seq.) is amended 5 by adding at the end the following new section: 6 ‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 7 THE PROMOTION OF OPTIMAL MATERNITY 8 OUTCOMES. 9 ‘‘(a) IN GENERAL.—The Secretary of Health and 10 Human Services, acting through the Deputy Assistant 11 Secretary for Women’s Health under section 229 and in 12 collaboration with the Federal officials specified in sub- 13 section (b), shall establish the Interagency Coordinating 14 Committee on the Promotion of Optimal Maternity Out- 15 comes (referred to in this subsection as the ‘ICCPOM’). 16 ‘‘(b) OTHER AGENCIES.—The officials specified in 17 this subsection are the Secretary of Labor, the Secretary 18 of Defense, the Secretary of Veterans Affairs, the Surgeon 19 General, the Director of the Centers for Disease Control 20 and Prevention, the Administrator of the Health Re- 21 sources and Services Agency, the Administrator of the 22 Centers for Medicare & Medicaid Services, the Director 23 of the Indian Health Service, the Administrator of the 24 Substance Abuse and Mental Health Services Administra- 25 tion, the Director of the National Institute on Child 26 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00383 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 384 •HR 5475 IH Health and Development, the Director of the Agency for 1 Healthcare Research and Quality, the Assistant Secretary 2 for Children and Families, the Deputy Assistant Secretary 3 for Minority Health, the Director of the Office of Per- 4 sonnel Management, and such other Federal officials as 5 the Secretary of Health and Human Services determines 6 to be appropriate. 7 ‘‘(c) CHAIR.—The Deputy Assistant Secretary for 8 Women’s Health shall serve as the chair of the ICCPOM. 9 ‘‘(d) DUTIES.—The ICCPOM shall guide policy and 10 program development across the Federal Government with 11 respect to promotion of optimal maternity care, provided, 12 however, that nothing in this section shall be construed 13 as transferring regulatory or program authority from an 14 agency to the ICCPOM. 15 ‘‘(e) CONSULTATIONS.—The ICCPOM shall actively 16 seek the input of, and shall consult with, all appropriate 17 and interested stakeholders, including State health depart- 18 ments, public health research and interest groups, founda- 19 tions, childbearing women and their advocates, and mater- 20 nity care professional associations and organizations, re- 21 flecting racially, ethnically, demographically, and geo- 22 graphically diverse communities. 23 ‘‘(f) ANNUAL REPORT.— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00384 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 385 •HR 5475 IH ‘‘(1) IN GENERAL.—The Secretary, on behalf of 1 the ICCPOM, shall annually submit to Congress a 2 report that summarizes— 3 ‘‘(A) all programs and policies of Federal 4 agencies (including the Medicare Program 5 under title XVIII of the Social Security Act and 6 the Medicaid program under title XIX of such 7 Act) designed to promote optimal maternity 8 care, focusing particularly on programs and 9 policies that support the adoption of evidence 10 based maternity care, as defined by timely, sci- 11 entifically sound systematic reviews; 12 ‘‘(B) all programs and policies of Federal 13 agencies (including the Medicare Program 14 under title XVIII of the Social Security Act and 15 the Medicaid program under title XIX of such 16 Act) designed to address the problems of mater- 17 nal mortality and morbidity, infant mortality, 18 prematurity, and low birth weight, including 19 such programs and policies designed to address 20 racial and ethnic disparities with respect to 21 each of such problems; 22 ‘‘(C) the extent of progress in reducing 23 maternal mortality and infant mortality, low 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00385 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 386 •HR 5475 IH birth weight, and prematurity at State and na- 1 tional levels; and 2 ‘‘(D) such other information regarding op- 3 timal maternity care as the Secretary deter- 4 mines to be appropriate. 5 The information specified in subparagraph (C) shall 6 be included in each such report in a manner that 7 disaggregates such information by race, ethnicity, 8 and indigenous status in order to determine the ex- 9 tent of progress in reducing racial and ethnic dis- 10 parities and disparities related to indigenous status. 11 ‘‘(2) CERTAIN INFORMATION.—Each report 12 under paragraph (1) shall include information 13 (disaggregated by race, ethnicity, and indigenous 14 status, as applicable) on the following rates and 15 costs by State: 16 ‘‘(A) The rate of primary cesarean deliv- 17 eries and repeat cesarean deliveries. 18 ‘‘(B) The rate of vaginal births after cesar- 19 ean. 20 ‘‘(C) The rate of vaginal breech births. 21 ‘‘(D) The rate of induction of labor. 22 ‘‘(E) The rate of freestanding birth center 23 births. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00386 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 387 •HR 5475 IH ‘‘(F) The rate of planned and unplanned 1 home birth. 2 ‘‘(G) The rate of attended births by pro- 3 vider, including by an obstetrician-gynecologist, 4 family practice physician, obstetrician-gyne- 5 cologist physician assistant, certified nurse-mid- 6 wife, certified midwife, and certified profes- 7 sional midwife. 8 ‘‘(H) The cost of maternity care 9 disaggregated by place of birth and provider of 10 care, including— 11 ‘‘(i) uncomplicated vaginal birth; 12 ‘‘(ii) complicated vaginal birth; 13 ‘‘(iii) uncomplicated cesarean birth; 14 and 15 ‘‘(iv) complicated cesarean birth. 16 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 17 is authorized to be appropriated, in addition to amounts 18 authorized to be appropriated under section 229(e), to 19 carry out this section $1,000,000 for each of the fiscal 20 years 2017 through 2021.’’. 21 (b) CONFORMING AMENDMENTS.— 22 (1) INCLUSION AS DUTY OF HHS OFFICE ON 23 WOMEN’S HEALTH.—Section 229(b) of such Act (42 24 U.S.C. 237a(b)), as amended by section 514, is fur- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00387 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 388 •HR 5475 IH ther amended by adding at the end the following 1 new paragraph: 2 ‘‘(9) establish the Interagency Coordinating 3 Committee on the Promotion of Optimal Maternity 4 Outcomes in accordance with section 229A.’’. 5 (2) TREATMENT OF BIENNIAL REPORTS.—Sec- 6 tion 229(d) of such Act (42 U.S.C. 237a(d)) is 7 amended by inserting ‘‘(other than under subsection 8 (b)(9))’’ after ‘‘under this section’’. 9 SEC. 516. CONSUMER EDUCATION CAMPAIGN. 10 Section 229 of the Public Health Service Act (42 11 U.S.C. 237a), as amended, is further amended in sub- 12 section (b)— 13 (1) in paragraph (8), at the end, by striking 14 ‘‘and’’; 15 (2) in paragraph (9), at the end, by striking the 16 period and inserting ‘‘; and’’; and 17 (3) by adding at the end the following new 18 paragraph: 19 ‘‘(10) not later than one year after the date of 20 the enactment of the Health Equity and Account- 21 ability Act of 2016, develop and implement a 4-year 22 culturally and linguistically appropriate multimedia 23 consumer education campaign that is designed to 24 promote understanding and acceptance of evidence- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00388 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 389 •HR 5475 IH based maternity practices and models of care for op- 1 timal maternity outcomes among women of child- 2 bearing ages and families of such women and that— 3 ‘‘(A) highlights the importance of pro- 4 tecting, promoting, and supporting the innate 5 capacities of childbearing women and their 6 newborns for childbirth, breastfeeding, and at- 7 tachment; 8 ‘‘(B) promotes understanding of the impor- 9 tance of using obstetric interventions when 10 medically necessary and when supported by 11 strong, high-quality evidence; 12 ‘‘(C) highlights the widespread overuse of 13 maternity practices that have been shown to 14 have benefit when used appropriately in situa- 15 tions of medical necessity, but which can expose 16 women, infants, or both to risk of harm if used 17 routinely and indiscriminately, including contin- 18 uous fetal monitoring, labor induction, epidural 19 anesthesia, elective primary cesarean section, 20 and repeat cesarean delivery; 21 ‘‘(D) emphasizes the noninvasive maternity 22 practices that have strong proven correlation or 23 may be associated with considerable improve- 24 ment in outcomes with no detrimental side ef- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00389 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 390 •HR 5475 IH fects, and are significantly underused in the 1 United States, including smoking cessation pro- 2 grams in pregnancy, group model prenatal care, 3 continuous labor support, nonsupine positions 4 for birth, and external version to turn breech 5 babies at term; 6 ‘‘(E) educates consumers about the quali- 7 fications of licensed providers of maternity care 8 and the best evidence about their safety, satis- 9 faction, outcomes, and costs; 10 ‘‘(F) informs consumers about the best 11 available research comparing birth center 12 births, planned home births, and hospital 13 births, including information about each set- 14 ting’s safety, satisfaction, outcomes, and costs; 15 ‘‘(G) fosters participation in high-quality, 16 evidence-based childbirth education that pro- 17 motes a natural, healthy, and safe approach to 18 pregnancy, childbirth, and early parenting; is 19 taught by certified educators, peer counselors, 20 and health professionals; and promotes in- 21 formed decisionmaking by childbearing women; 22 and 23 ‘‘(H) is pilot tested for consumer com- 24 prehension, cultural sensitivity, and acceptance 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00390 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 391 •HR 5475 IH of the messages across geographically, racially, 1 ethnically, and linguistically diverse popu- 2 lations.’’. 3 SEC. 517. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE- 4 VIEWS FOR CARE OF CHILDBEARING WOMEN 5 AND NEWBORNS. 6 (a) IN GENERAL.—Not later than one year after the 7 date of the enactment of this Act, the Secretary of Health 8 and Human Services, through the Agency for Healthcare 9 Research and Quality, shall— 10 (1) make publicly available an online biblio- 11 graphic database identifying systematic reviews, in- 12 cluding an explanation of the level and quality of 13 evidence, for care of childbearing women and 14 newborns; and 15 (2) initiate regular updates that incorporate 16 newly issued and updated systematic reviews. 17 (b) SOURCES.—To aim for a comprehensive inventory 18 of systematic reviews relevant to maternal and newborn 19 care, the database shall identify reviews from diverse 20 sources, including— 21 (1) scientific peer-reviewed journals; 22 (2) databases, including Cochrane Database of 23 Systematic Reviews, Clinical Evidence, and Data- 24 base of Abstracts of Reviews of Effects; and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00391 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 392 •HR 5475 IH (3) Internet Web sites of agencies and organi- 1 zations throughout the world that produce such sys- 2 tematic reviews. 3 (c) FEATURES.—The database shall— 4 (1) provide bibliographic citations for each 5 record within the database, and for each such cita- 6 tion include an explanation of the level and quality 7 of evidence; 8 (2) include abstracts, as available; 9 (3) provide reference to companion documents 10 as may exist for each review, such as evidence tables 11 and guidelines or consumer educational materials de- 12 veloped from the review; 13 (4) provide links to the source of the full review 14 and to any companion documents; 15 (5) provide links to the source of a previous 16 version or update of the review; 17 (6) be searchable by intervention or other topic 18 of the review, reported outcomes, author, title, and 19 source; and 20 (7) offer to users periodic electronic notification 21 of database updates relating to users’ topics of inter- 22 est. 23 (d) OUTREACH.—Not later than the first date the 24 database is made publicly available and periodically there- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00392 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 393 •HR 5475 IH after, the Secretary of Health and Human Services shall 1 publicize the availability, features, and uses of the data- 2 base under this section to the stakeholders described in 3 subsection (e). 4 (e) CONSULTATION.—For purposes of developing the 5 database under this section and maintaining and updating 6 such database, the Secretary of Health and Human Serv- 7 ices shall convene and consult with an advisory committee 8 composed of relevant stakeholders, including— 9 (1) Federal Medicaid administrators and State 10 agencies administrating State plans under title XIX 11 of the Social Security Act pursuant to section 12 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)); 13 (2) providers of maternity and newborn care 14 from both academic and community-based settings, 15 including obstetrician-gynecologists, family physi- 16 cians, certified nurse midwives, certified midwives, 17 certified professional midwives, physician assistants, 18 perinatal nurses, pediatricians, and nurse practi- 19 tioners; 20 (3) maternal-fetal medicine specialists; 21 (4) neonatologists; 22 (5) childbearing women and advocates for such 23 women, including childbirth educators certified by a 24 nationally accredited program, representing commu- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00393 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 394 •HR 5475 IH nities that are diverse in terms of race, ethnicity, in- 1 digenous status, and geographic area; 2 (6) employers and purchasers; 3 (7) health facility and system leaders, including 4 both hospital and birth center facilities; 5 (8) journalists; and 6 (9) bibliographic informatics specialists. 7 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 8 authorized to be appropriated $2,500,000 for each of the 9 fiscal years 2017 through 2019 for the purpose of devel- 10 oping the database and such sums as may be necessary 11 for each subsequent fiscal year for updating the database 12 and providing outreach and notification to users, as de- 13 scribed in this section. 14 SEC. 518. MATERNITY CARE HEALTH PROFESSIONAL 15 SHORTAGE AREAS. 16 Section 332 of the Public Health Service Act (42 17 U.S.C. 254e) is amended by adding at the end the fol- 18 lowing new subsection: 19 ‘‘(k)(1) The Secretary, acting through the Adminis- 20 trator of the Health Resources and Services Administra- 21 tion, shall designate maternity care health professional 22 shortage areas in the States, publish a descriptive list of 23 the area’s population groups, medical facilities, and other 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00394 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 395 •HR 5475 IH public facilities so designated, and at least annually review 1 and, as necessary, revise such designations. 2 ‘‘(2) For purposes of paragraph (1), a complete de- 3 scriptive list shall be published in the Federal Register not 4 later than one year after the date of the enactment of the 5 Health Equity and Accountability Act of 2016 and annu- 6 ally thereafter. 7 ‘‘(3) The provisions of subsections (b), (c), (e), (f), 8 (g), (h), (i), and (j) (other than (j)(1)(B)) of this section 9 shall apply to the designation of a maternity care health 10 professional shortage area in a similar manner and extent 11 as such provisions apply to the designation of health pro- 12 fessional shortage areas, except in applying subsection 13 (b)(3), the reference in such subsection to ‘physicians’ 14 shall be deemed to be a reference to nationally certified 15 and State licensed obstetricians, family practice physicians 16 who practice full-scope maternity care, certified nurse 17 midwives, certified midwives, certified professional mid- 18 wives, and physician’s assistants who practice full scope 19 maternity care. 20 ‘‘(4) For purposes of this subsection, the term ‘ma- 21 ternity care health professional shortage area’ means— 22 ‘‘(A) an area in an urban or rural area (which 23 need not conform to the geographic boundaries of a 24 political subdivision and which is a rational area for 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00395 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 396 •HR 5475 IH the delivery of health services) which the Secretary 1 determines has a shortage of providers of maternity 2 care health services including those referenced in 3 paragraph (3) or an urban or rural area that the 4 Secretary determines has lost a significant number 5 of such providers during the 10-year period begin- 6 ning with 2004 or has no obstetrical providers li- 7 censed to provide operative obstetrical services; 8 ‘‘(B) an area in an urban or rural area (which 9 need not conform to the geographic boundaries of a 10 political subdivision and which is a rational area for 11 the delivery of health services) which the Secretary 12 determines has a shortage of hospital or labor and 13 delivery units, hospital birth center units, or free- 14 standing birth centers or an area that lost a signifi- 15 cant number of these units during the 10-year pe- 16 riod beginning with 2004; or 17 ‘‘(C) a population group which the Secretary 18 determines has such a shortage of providers or fa- 19 cilities.’’. 20 SEC. 519. EXPANSION OF CDC PREVENTION RESEARCH 21 CENTERS PROGRAM TO INCLUDE CENTERS 22 ON OPTIMAL MATERNITY OUTCOMES. 23 (a) IN GENERAL.—Not later than one year after the 24 date of the enactment of this Act, the Secretary of Health 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00396 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 397 •HR 5475 IH and Human Services, shall support the establishment of 1 additional Prevention Research Centers under the Preven- 2 tion Research Center Program administered by the Cen- 3 ters for Disease Control and Prevention. Such additional 4 centers shall each be known as a Center for Excellence 5 on Optimal Maternity Outcomes. 6 (b) RESEARCH.—Each Center for Excellence on Opti- 7 mal Maternity Outcomes shall— 8 (1) conduct at least one focused program of re- 9 search to improve maternity outcomes, including the 10 reduction of cesarean birth rates, elective inductions, 11 prematurity rates, and low birth weight rates within 12 an underserved population that has a disproportion- 13 ately large burden of suboptimal maternity out- 14 comes, including maternal mortality and morbidity, 15 infant mortality, prematurity, or low birth weight; 16 (2) work with partners on special interest 17 projects, as specified by the Centers for Disease 18 Control and Prevention and other relevant agencies 19 within the Department of Health and Human Serv- 20 ices, and on projects funded by other sources; and 21 (3) involve a minimum of two distinct birth set- 22 ting models, such as a hospital labor and delivery 23 model and freestanding birth center model; or a hos- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00397 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 398 •HR 5475 IH pital labor and delivery model and planned home 1 birth model. 2 (c) INTERDISCIPLINARY PROVIDERS.—Each Center 3 for Excellence on Optimal Maternity Outcomes shall in- 4 clude the following interdisciplinary providers of maternity 5 care: 6 (1) Obstetrician-gynecologists. 7 (2) At least two of the following providers: 8 (A) Family practice physicians. 9 (B) Nurse practitioners. 10 (C) Physician assistants. 11 (D) Certified professional midwives. 12 (d) SERVICES.—Research conducted by each Center 13 for Excellence on Optimal Maternity Outcomes shall in- 14 clude at least 2 (and preferably more) of the following sup- 15 portive provider services: 16 (1) Mental health. 17 (2) Doula labor support. 18 (3) Nutrition education. 19 (4) Childbirth education. 20 (5) Social work. 21 (6) Physical therapy or occupation therapy. 22 (7) Substance abuse services. 23 (8) Home visiting. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00398 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 399 •HR 5475 IH (e) COORDINATION.—The programs of research at 1 each of the two Centers of Excellence on Optimal Mater- 2 nity Outcomes shall compliment and not replicate the 3 work of the other. 4 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 5 authorized to be appropriated to carry out this section 6 $2,000,000 for each of the fiscal years 2017 through 7 2021. 8 SEC. 520. EXPANDING MODELS ALLOWED TO BE TESTED BY 9 CENTER FOR MEDICARE AND MEDICAID IN- 10 NOVATION TO INCLUDE MATERNITY CARE 11 MODELS. 12 Section 1115A(b)(2)(B) of the Social Security Act 13 (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the 14 end the following new clause: 15 ‘‘(xxv) Promoting evidence-based mod- 16 els of care that have been associated with 17 reductions in maternal and infant health 18 disparities, including incorporating the use 19 of doula and promotoras support for preg- 20 nant and childbearing women into evi- 21 dence-based models of prenatal care, labor 22 and delivery, and postpartum care, and 23 supporting the appropriate use of out-of- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00399 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 400 •HR 5475 IH hospital birth models, including births at 1 home and in freestanding birth centers.’’. 2 SEC. 521. DEVELOPMENT OF INTERPROFESSIONAL MATER- 3 NITY CARE EDUCATIONAL MODELS AND 4 TOOLS. 5 (a) IN GENERAL.—Not later than 6 months after the 6 date of the enactment of this Act, the Secretary of Health 7 and Human Services, acting in conjunction with the Ad- 8 ministrator of Health Resources and Services Administra- 9 tion, shall convene, for a 1-year period, an Interprofes- 10 sional Maternity Provider Education Commission to dis- 11 cuss and make recommendations for— 12 (1) a consensus standard physiologic maternity 13 care curriculum that takes into account the core 14 competencies for basic midwifery practice such as 15 those developed by the American College of Nurse 16 Midwives and the North American Registry of Mid- 17 wives, and the educational objectives for physicians 18 practicing in obstetrics and gynecology as deter- 19 mined by the Council on Resident Education in Ob- 20 stetrics and Gynecology; 21 (2) suggestions for multidisciplinary use of the 22 consensus physiologic curriculum; 23 (3) strategies to integrate and coordinate edu- 24 cation across maternity care disciplines, including 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00400 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 401 •HR 5475 IH recommendations to increase medical and midwifery 1 student exposure to out-of-hospital birth; and 2 (4) pilot demonstrations of interprofessional 3 educational models. 4 (b) PARTICIPANTS.—The Commission shall include 5 maternity care educators, curriculum developers, service 6 leaders, certification leaders, and accreditation leaders 7 from the various professions that provide maternity care 8 in this country. Such professions shall include obstetrician 9 gynecologists, certified nurse midwives or certified mid- 10 wives, family practice physicians, nurse practitioners, phy- 11 sician assistants, certified professional midwives, and 12 perinatal nurses. Additionally, the Commission shall in- 13 clude representation from maternity care consumer advo- 14 cates. 15 (c) CURRICULUM.—The consensus standard physio- 16 logic maternity care curriculum described in subsection 17 (a)(1) shall— 18 (1) have a public health focus with a foundation 19 in health promotion and disease prevention; 20 (2) foster physiologic childbearing and woman 21 and family centered care; 22 (3) integrate strategies to reduce maternal and 23 infant morbidity and mortality; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00401 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 402 •HR 5475 IH (4) incorporate recommendations to ensure re- 1 spectful, safe, and seamless consultation, referral, 2 transport, and transfer of care when necessary; and 3 (5) include cultural sensitivity and strategies to 4 decrease disparities in maternity outcomes. 5 (d) REPORT.—Not later than 6 months after the final 6 meeting of the Commission, the Secretary of Health and 7 Human Services shall— 8 (1) submit to Congress a report containing the 9 recommendations made by the Commission under 10 this section; and 11 (2) make such report publicly available. 12 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 13 authorized to be appropriated to carry out this section 14 $1,000,000 for each of the fiscal years 2017 and 2018, 15 and such sums as are necessary for each of the fiscal years 16 2019 through 2021. 17 SEC. 522. INCLUDING WITHIN INPATIENT HOSPITAL SERV- 18 ICES UNDER MEDICARE SERVICES FUR- 19 NISHED BY CERTAIN STUDENTS, INTERNS, 20 AND RESIDENTS SUPERVISED BY CERTIFIED 21 NURSE MIDWIVES. 22 (a) IN GENERAL.—Section 1861(b) of the Social Se- 23 curity Act (42 U.S.C. 1395x(b)) is amended— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00402 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 403 •HR 5475 IH (1) in paragraph (6), by striking ‘‘; or’’ and in- 1 serting ‘‘, or in the case of services in a hospital or 2 osteopathic hospital by a student midwife or an in- 3 tern or resident-in-training under a teaching pro- 4 gram previously described in this paragraph who is 5 in the field of obstetrics and gynecology, if such stu- 6 dent midwife, intern, or resident-in-training is super- 7 vised by a certified nurse-midwife to the extent per- 8 mitted under applicable State law and as may be au- 9 thorized by the hospital;’’; 10 (2) in paragraph (7), by striking the period at 11 the end and inserting ‘‘; or’’; and 12 (3) by adding at the end the following new 13 paragraph: 14 ‘‘(8) a certified nurse-midwife where the hos- 15 pital has a teaching program approved as specified 16 in paragraph (6), if— 17 ‘‘(A) the hospital elects to receive any pay- 18 ment due under this title for reasonable costs of 19 such services; and 20 ‘‘(B) all certified nurse-midwives in such 21 hospital agree not to bill charges for profes- 22 sional services rendered in such hospital to indi- 23 viduals covered under the insurance program 24 established by this title.’’. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00403 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 404 •HR 5475 IH (b) EFFECTIVE DATE.—The amendments made by 1 subsection (a) shall apply to services furnished on or after 2 the date of the enactment of this Act. 3 SEC. 523. GRANTS TO PROFESSIONAL ORGANIZATIONS TO 4 INCREASE DIVERSITY IN MATERNITY CARE 5 PROFESSIONALS. 6 (a) IN GENERAL.—The Secretary of Health and 7 Human Services, through the Administrator of the Health 8 Resources and Services Administration, shall carry out a 9 grant program under which the Secretary may make to 10 eligible health professional organizations— 11 (1) for fiscal year 2017, planning grants de- 12 scribed in subsection (b); and 13 (2) for the subsequent 4-year period, implemen- 14 tation grants described in subsection (c). 15 (b) PLANNING GRANTS.— 16 (1) IN GENERAL.—Planning grants described in 17 this subsection are grants for the following purposes: 18 (A) To collect data and identify any work- 19 force disparities, with respect to a health pro- 20 fession, at each of the following areas along the 21 health professional continuum: 22 (i) Pipeline availability with respect to 23 students at the high school and college or 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00404 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 405 •HR 5475 IH university levels considering and working 1 toward entrance in the profession. 2 (ii) Entrance into the training pro- 3 gram for the profession. 4 (iii) Graduation from such training 5 program. 6 (iv) Entrance into practice. 7 (v) Retention in practice for more 8 than a 5-year period. 9 (B) To develop one or more strategies to 10 address the workforce disparities within the 11 health profession, as identified under (and in 12 response to the findings pursuant to) subpara- 13 graph (A). 14 (2) APPLICATION.—To be eligible to receive a 15 grant under this subsection, an eligible health pro- 16 fessional organization shall submit to the Secretary 17 of Health and Human Services an application in 18 such form and manner and containing such informa- 19 tion as specified by the Secretary. 20 (3) AMOUNT.—Each grant awarded under this 21 subsection shall be for an amount not to exceed 22 $300,000. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00405 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 406 •HR 5475 IH (4) REPORT.—Each recipient of a grant under 1 this subsection shall submit to the Secretary of 2 Health and Human Services a report containing— 3 (A) information on the extent and distribu- 4 tion of workforce disparities identified through 5 the grant; and 6 (B) reasonable objectives and strategies 7 developed to address such disparities within a 8 5-, 10-, and 25-year period. 9 (c) IMPLEMENTATION GRANTS.— 10 (1) IN GENERAL.—Implementation grants de- 11 scribed in this subsection are grants to implement 12 one or more of the strategies developed pursuant to 13 a planning grant awarded under subsection (b). 14 (2) APPLICATION.—To be eligible to receive a 15 grant under this subsection, an eligible health pro- 16 fessional organization shall submit to the Secretary 17 of Health and Human Services an application in 18 such form and manner as specified by the Secretary. 19 Each such application shall contain information on 20 the capability of the organization to carry out a 21 strategy described in paragraph (1), involvement of 22 partners or coalitions, plans for developing sustain- 23 ability of the efforts after the culmination of the 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00406 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 407 •HR 5475 IH grant cycle, and any other information specified by 1 the Secretary. 2 (3) AMOUNT.—Each grant awarded under this 3 subsection shall be for an amount not to exceed 4 $500,000 each year during the 4-year period of the 5 grant. 6 (4) REPORTS.—For each of the first 3 years for 7 which an eligible health professional organization is 8 awarded a grant under this subsection, the organiza- 9 tion shall submit to the Secretary of Health and 10 Human Services a report on the activities carried 11 out by such organization through the grant during 12 such year and objectives for the subsequent year. 13 For the fourth year for which an eligible health pro- 14 fessional organization is awarded a grant under this 15 subsection, the organization shall submit to the Sec- 16 retary a report that includes an analysis of all the 17 activities carried out by the organization through the 18 grant and a detailed plan for continuation of out- 19 reach efforts. 20 (d) ELIGIBLE HEALTH PROFESSIONAL ORGANIZA- 21 TION DEFINED.—For purposes of this section, the term 22 ‘‘eligible health professional organization’’ means a profes- 23 sional organization representing obstetrician-gyne- 24 cologists, certified nurse midwives, certified midwives, 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00407 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 408 •HR 5475 IH family practice physicians, nurse practitioners whose scope 1 of practice includes maternity care, physician assistants 2 whose scope of practice includes obstetrical care, or cer- 3 tified professional midwives. 4 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 5 authorized to be appropriated to carry out this section 6 $2,000,000 for fiscal year 2017 and $3,000,000 for each 7 of the fiscal years 2018 through 2021. 8 TITLE VI—MENTAL HEALTH 9 SEC. 601. COVERAGE OF MARRIAGE AND FAMILY THERA- 10 PIST SERVICES, MENTAL HEALTH COUN- 11 SELOR SERVICES, AND SUBSTANCE ABUSE 12 COUNSELOR SERVICES UNDER PART B OF 13 THE MEDICARE PROGRAM. 14 (a) COVERAGE OF SERVICES.— 15 (1) IN GENERAL.—Section 1861(s)(2) of the 16 Social Security Act (42 U.S.C. 1395x(s)(2)), as 17 amended by section 450(c)(1), is amended— 18 (A) in subparagraph (FF), by striking 19 ‘‘and’’ at the end; 20 (B) in subparagraph (GG), by inserting 21 ‘‘and’’ at the end; and 22 (C) by adding at the end the following new 23 subparagraph: 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00408 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 409 •HR 5475 IH ‘‘(HH) marriage and family therapist services 1 (as defined in subsection (lll)(1)) and mental health 2 counselor services (as defined in subsection (lll)(3)) 3 and substance abuse counselor services (as defined 4 in subsection (lll)(5));’’. 5 (2) DEFINITIONS.—Section 1861 of such Act 6 (42 U.S.C. 1395x), as amended by sections 7 205(b)(1)(A), 423(a), and 470(a), is amended by 8 adding at the end the following new subsection: 9 ‘‘Marriage and Family Therapist Services; Marriage and 10 Family Therapist; Mental Health Counselor Serv- 11 ices; Mental Health Counselor 12 ‘‘(lll)(1) The term ‘marriage and family therapist 13 services’ means services performed by a marriage and 14 family therapist (as defined in paragraph (2)) for the diag- 15 nosis and treatment of mental illnesses, which the mar- 16 riage and family therapist is legally authorized to perform 17 under State law (or the State regulatory mechanism pro- 18 vided by State law) of the State in which such services 19 are performed, as would otherwise be covered if furnished 20 by a physician or as an incident to a physician’s profes- 21 sional service, but only if no facility or other provider 22 charges or is paid any amounts with respect to the fur- 23 nishing of such services. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00409 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 410 •HR 5475 IH ‘‘(2) The term ‘marriage and family therapist’ means 1 an individual who— 2 ‘‘(A) possesses a master’s or doctoral degree 3 which qualifies for licensure or certification as a 4 marriage and family therapist pursuant to State 5 law; 6 ‘‘(B) after obtaining such degree has performed 7 at least 2 years of clinical supervised experience in 8 marriage and family therapy; and 9 ‘‘(C) in the case of an individual performing 10 services in a State that provides for licensure or cer- 11 tification of marriage and family therapists, is li- 12 censed or certified as a marriage and family thera- 13 pist in such State. 14 ‘‘(3) The term ‘mental health counselor services’ 15 means services performed by a mental health counselor (as 16 defined in paragraph (4)) for the diagnosis and treatment 17 of mental illnesses which the mental health counselor is 18 legally authorized to perform under State law (or the 19 State regulatory mechanism provided by the State law) of 20 the State in which such services are performed, as would 21 otherwise be covered if furnished by a physician or as inci- 22 dent to a physician’s professional service, but only if no 23 facility or other provider charges or is paid any amounts 24 with respect to the furnishing of such services. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00410 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 411 •HR 5475 IH ‘‘(4) The term ‘mental health counselor’ means an 1 individual who— 2 ‘‘(A) possesses a master’s or doctor’s degree in 3 mental health counseling or a related field; 4 ‘‘(B) after obtaining such a degree has per- 5 formed at least 2 years of supervised mental health 6 counselor practice; and 7 ‘‘(C) in the case of an individual performing 8 services in a State that provides for licensure or cer- 9 tification of mental health counselors or professional 10 counselors, is licensed or certified as a mental health 11 counselor or professional counselor in such State. 12 ‘‘(5) The term ‘substance abuse counselor services’ 13 means services performed by a substance abuse counselor 14 (as defined in paragraph (6)) for the diagnosis and treat- 15 ment of substance abuse and addiction which the sub- 16 stance abuse counselor is legally authorized to perform 17 under State law (or the State regulatory mechanism pro- 18 vided by the State law) of the State in which such services 19 are performed, as would otherwise be covered if furnished 20 by a physician or as incident to a physician’s professional 21 service, but only if no facility or other provider charges 22 or is paid any amounts with respect to the furnishing of 23 such services. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00411 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 412 •HR 5475 IH ‘‘(6) The term ‘substance abuse counselor’ means an 1 individual who— 2 ‘‘(A) has performed at least 2 years of super- 3 vised substance abuse counselor practice; 4 ‘‘(B) in the case of an individual performing 5 services in a State that provides for licensure or cer- 6 tification of substance abuse counselors or profes- 7 sional counselors, is licensed or certified as a sub- 8 stance abuse counselor or professional counselor in 9 such State; or 10 ‘‘(C) the individual is a drug and alcohol coun- 11 selor as defined in section 40.281 of title 49, Code 12 of Federal Regulations.’’. 13 (3) PROVISION FOR PAYMENT UNDER PART 14 B.—Section 1832(a)(2)(B) of such Act (42 U.S.C. 15 1395k(a)(2)(B)) is amended— 16 (A) by striking ‘‘and’’ at the end of clause 17 (iv); and 18 (B) by adding at the end the following new 19 clause: 20 ‘‘(v) marriage and family therapist 21 services, mental health counselor services, 22 and substance abuse counselor services; 23 and’’. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00412 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 413 •HR 5475 IH (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 1 of such Act (42 U.S.C. 1395l(a)(1)), as amended by 2 section 450(c)(1), is amended— 3 (A) by striking ‘‘and (AA)’’ and inserting 4 ‘‘(AA)’’; and 5 (B) by inserting before the semicolon at 6 the end the following: ‘‘, and (BB) with respect 7 to marriage and family therapist services, men- 8 tal health counselor services, and substance 9 abuse counselor services under section 10 1861(s)(2)(HH), the amounts paid shall be 80 11 percent of the lesser of the actual charge for 12 the services or 75 percent of the amount deter- 13 mined for payment of a psychologist under sub- 14 paragraph (L)’’. 15 (5) EXCLUSION OF MARRIAGE AND FAMILY 16 THERAPIST SERVICES AND MENTAL HEALTH COUN- 17 SELOR SERVICES FROM SKILLED NURSING FACILITY 18 PROSPECTIVE PAYMENT SYSTEM.—Section 19 1888(e)(2)(A)(ii) of such Act (42 U.S.C. 20 1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar- 21 riage and family therapist services (as defined in 22 section 1861(lll)(1)), mental health counselor serv- 23 ices (as defined in section 1861(lll)(3)),’’ after 24 ‘‘qualified psychologist services,’’. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00413 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 414 •HR 5475 IH (6) INCLUSION OF MARRIAGE AND FAMILY 1 THERAPISTS, MENTAL HEALTH COUNSELORS, AND 2 SUBSTANCE ABUSE COUNSELORS AS PRACTITIONERS 3 FOR ASSIGNMENT OF CLAIMS.—Section 4 1842(b)(18)(C) of such Act (42 U.S.C. 5 1395u(b)(18)(C)) is amended by adding at the end 6 the following new clauses: 7 ‘‘(vii) A marriage and family therapist (as de- 8 fined in section 1861(lll)(2)). 9 ‘‘(viii) A mental health counselor (as defined in 10 section 1861(lll)(4)). 11 ‘‘(ix) A substance abuse counselor (as defined 12 in section 1861 (lll)(6)).’’. 13 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV- 14 ICES PROVIDED IN CERTAIN SETTINGS.— 15 (1) RURAL HEALTH CLINICS AND FEDERALLY 16 QUALIFIED HEALTH CENTERS.—Section 17 1861(aa)(1)(B) of the Social Security Act (42 18 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 19 by a clinical social worker (as defined in subsection 20 (hh)(1)),’’ and inserting ‘‘, by a clinical social worker 21 (as defined in subsection (hh)(1)), by a marriage 22 and family therapist (as defined in subsection 23 (lll)(2)), or by a mental health counselor (as defined 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00414 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 415 •HR 5475 IH in subsection (lll)(4)), or by a substance abuse coun- 1 selor (as defined in section 1861 (lll)(6)).’’. 2 (2) HOSPICE PROGRAMS.—Section 3 1861(dd)(2)(B)(i)(III) of such Act (42 U.S.C. 4 1395x(dd)(2)(B)(i)(III)) is amended by inserting ‘‘or 5 one marriage and family therapist (as defined in 6 subsection (lll)(2))’’ after ‘‘social worker’’. 7 (c) AUTHORIZATION OF MARRIAGE AND FAMILY 8 THERAPISTS TO DEVELOP DISCHARGE PLANS FOR POST- 9 HOSPITAL SERVICES.—Section 1861(ee)(2)(G) of the So- 10 cial Security Act (42 U.S.C. 1395x(ee)(2)(G)) is amended 11 by inserting ‘‘marriage and family therapist (as defined 12 in subsection (lll)(2)),’’ after ‘‘social worker,’’. 13 (d) EFFECTIVE DATE.—The amendments made by 14 this section shall apply with respect to services furnished 15 on or after January 1, 2017. 16 SEC. 602. MINORITY FELLOWSHIP PROGRAM. 17 Title V of the Public Health Service Act is amended 18 by inserting after section 506B (42 U.S.C. 290aa–5b) the 19 following: 20 ‘‘SEC. 506C. MINORITY FELLOWSHIP PROGRAM. 21 ‘‘(a) FELLOWSHIPS.—The Administrator shall main- 22 tain a program, to be known as the Minority Fellowship 23 Program, under which the Administrator awards grants 24 or contracts to national associations or other appropriate 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00415 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 416 •HR 5475 IH entities for the financial support of graduate students, 1 postdoctoral fellows, and residents in the professions of 2 psychology, psychiatry, social work, psychiatric advance- 3 practice nursing, marriage and family therapy, and profes- 4 sional counseling to students who demonstrate a commit- 5 ment to clinical or research careers focused on racial and 6 ethnic minority populations. 7 ‘‘(b) TERM OF FINANCIAL SUPPORT.—Financial sup- 8 port provided to an individual pursuant to subsection (a) 9 shall be for a term of not more than 12 months and may 10 be renewed thereafter. 11 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 12 carry out this section, there is authorized to be appro- 13 priated $10,000,000 for each of fiscal years 2017 through 14 2021.’’. 15 SEC. 603. INTEGRATED HEALTH CARE DEMONSTRATION 16 PROGRAM. 17 Part D of title V of the Public Health Service Act 18 (42 U.S.C. 290dd et seq.) is amended by adding at the 19 end the following: 20 ‘‘SEC. 544. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 21 PROVISION OF BEHAVIORAL HEALTH CARE 22 IN PRIMARY CARE SETTINGS. 23 ‘‘(a) GRANTS.—The Secretary, acting through the 24 Deputy Assistant Secretary for Minority Health, shall 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00416 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 417 •HR 5475 IH award grants to eligible entities for the purpose of pro- 1 viding technical assistance and training regarding the ef- 2 fective development and implementation of integrated 3 interprofessional health care teams that provide behavioral 4 health care. 5 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 6 a grant under this section, an entity shall be a federally 7 qualified health center (as defined in section 1861(aa) of 8 the Social Security Act) serving a high proportion of indi- 9 viduals from racial and ethnic minority groups (as defined 10 in section 1707(g)). 11 ‘‘(c) SCIENTIFICALLY BASED.—The technical assist- 12 ance and training funded through this section shall be sci- 13 entifically based, taking into consideration the results of 14 the most recent peer-reviewed research available. 15 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—To 16 carry out this section, there is authorized to be appro- 17 priated $20,000,000 for each of fiscal years 2017 through 18 2019.’’. 19 SEC. 604. ADDRESSING RACIAL AND ETHNIC MINORITY 20 MENTAL HEALTH DISPARITIES RESEARCH 21 GAPS. 22 Not later than 6 months after the date of the enact- 23 ment of this Act, the Director of the National Institute 24 on Minority Health and Health Disparities shall enter into 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00417 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 418 •HR 5475 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; and 13 (B) a compilation of information on the 14 impact of exposure to community violence, ad- 15 verse childhood experiences, and other psycho- 16 logical traumas on mental disorders in such ra- 17 cial and minority groups. 18 SEC. 605. HEALTH PROFESSIONS COMPETENCIES TO AD- 19 DRESS RACIAL AND ETHNIC MINORITY MEN- 20 TAL HEALTH DISPARITIES. 21 (a) IN GENERAL.—The Secretary of Health and 22 Human Services, acting through the Administrator of the 23 Substance Abuse and Mental Health Services Administra- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00418 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 419 •HR 5475 IH tion, shall award grants to qualified national organizations 1 for the purposes of— 2 (1) developing, and disseminating to health pro- 3 fessional educational programs curricula or core 4 competencies addressing mental health disparities 5 among racial and ethnic minority groups for use in 6 the training of students in the professions of social 7 work, psychology, psychiatry, marriage and family 8 therapy, peer wellness specialist, mental health coun- 9 seling, and substance abuse counseling; and 10 (2) certifying community health workers and 11 peer wellness specialists with respect to such cur- 12 ricula and core competencies and integrating and ex- 13 panding the use of such workers and specialists into 14 health care to address mental health disparities 15 among racial and ethnic minority groups. 16 (b) CURRICULA; CORE COMPETENCIES.—Organiza- 17 tions receiving funds under subsection (a) may use the 18 funds to engage in the following activities related to the 19 development and dissemination of curricula or core com- 20 petencies described in subsection (a)(1): 21 (1) Formation of committees or working groups 22 comprised of experts from accredited health profes- 23 sions schools to identify core competencies relating 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00419 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 420 •HR 5475 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 (c) 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 (d) 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 2017 through 2021. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00420 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 421 •HR 5475 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 2016’’. 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00421 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 422 •HR 5475 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) Recent research has shown that screening 21 with low-dose computed tomography (CT) scan im- 22 proved lung cancer death mortality by 20 percent for 23 those with a high risk of lung cancer through early 24 detection. The Centers for Medicare & Medicaid 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00422 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 423 •HR 5475 IH Services supports annual lung cancer screening for 1 high-risk patients with low-dose computed tomog- 2 raphy. 3 (12) Additional strategies are necessary to fur- 4 ther enhance the existing tests and therapies avail- 5 able to diagnose and treat lung cancer in the future. 6 (13) The August 2001 Report of the Lung 7 Cancer Progress Review Group of the National Can- 8 cer Institute stated that funding for lung cancer re- 9 search was ‘‘far below the levels characterized for 10 other common malignancies and far out of propor- 11 tion to its massive health impact’’. 12 (14) The Report of the Lung Cancer Progress 13 Review Group identified as its ‘‘highest priority’’ the 14 creation of integrated, multidisciplinary, multi-insti- 15 tutional research consortia organized around the 16 problem of lung cancer rather than around specific 17 research disciplines. 18 (15) The United States must enhance its re- 19 sponse to the issues raised in the Report of the 20 Lung Cancer Progress Review Group, and this can 21 be accomplished through the establishment of a co- 22 ordinated effort designed to reduce the lung cancer 23 mortality rate by 50 percent by 2020 and targeted 24 funding to support this coordinated effort. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00423 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 424 •HR 5475 IH (c) SENSE OF CONGRESS CONCERNING INVESTMENT 1 IN LUNG CANCER RESEARCH.—It is the sense of the Con- 2 gress that— 3 (1) lung cancer mortality reduction should be 4 made a national public health priority; and 5 (2) a comprehensive mortality reduction pro- 6 gram coordinated by the Secretary of Health and 7 Human Services is justified and necessary to ade- 8 quately address and reduce lung cancer mortality. 9 (d) LUNG CANCER MORTALITY REDUCTION PRO- 10 GRAM.— 11 (1) IN GENERAL.—Subpart 1 of part C of title 12 IV of the Public Health Service Act (42 U.S.C. 285 13 et seq.) is amended by adding at the end the fol- 14 lowing: 15 ‘‘SEC. 417H. LUNG CANCER MORTALITY REDUCTION PRO- 16 GRAM. 17 ‘‘(a) IN GENERAL.—Not later than 6 months after 18 the date of the enactment of this section, the Secretary, 19 in consultation with the Secretary of Defense, the Sec- 20 retary of Veterans Affairs, the Director of the National 21 Institutes of Health, the Director of the Centers for Dis- 22 ease Control and Prevention, the Commissioner of Food 23 and Drugs, the Administrator of the Centers for Medicare 24 & Medicaid Services, the Director of the National Institute 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00424 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 425 •HR 5475 IH on Minority Health and Health Disparities, and other 1 members of the Lung Cancer Advisory Board established 2 under section 701 of the Health Equity and Accountability 3 Act of 2016, shall implement a comprehensive program, 4 to be known as the Lung Cancer Mortality Reduction Pro- 5 gram, to achieve a reduction of at least 25 percent in the 6 mortality rate of lung cancer by 2020. 7 ‘‘(b) REQUIREMENTS.—The Program shall include at 8 least the following: 9 ‘‘(1) With respect to the National Institutes of 10 Health— 11 ‘‘(A) a strategic review and prioritization 12 by the National Cancer Institute of research 13 grants to achieve the goal of the Lung Cancer 14 Mortality Reduction Program in reducing lung 15 cancer mortality; 16 ‘‘(B) the provision of funds to enable the 17 Airway Biology and Disease Branch of the Na- 18 tional Heart, Lung, and Blood Institute to ex- 19 pand its research programs to include pre- 20 dispositions to lung cancer, the interrelationship 21 between lung cancer and other pulmonary and 22 cardiac disease, and the diagnosis and treat- 23 ment of these interrelationships; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00425 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 426 •HR 5475 IH ‘‘(C) the provision of funds to enable the 1 National Institute of Biomedical Imaging and 2 Bioengineering to expedite the development of 3 computer-assisted diagnostic, surgical, treat- 4 ment, and drug-testing innovations to reduce 5 lung cancer mortality, such as through expan- 6 sion of the Institute’s Quantum Grant Program 7 and Image-Guided Interventions programs; and 8 ‘‘(D) the provision of funds to enable the 9 National Institute of Environmental Health 10 Sciences to implement research programs rel- 11 ative to the lung cancer incidence. 12 ‘‘(2) With respect to the Food and Drug Ad- 13 ministration— 14 ‘‘(A) activities under section 530 of the 15 Federal Food, Drug, and Cosmetic Act; and 16 ‘‘(B) activities under section 561 of the 17 Federal Food, Drug, and Cosmetic Act to ex- 18 pand access to investigational drugs and devices 19 for the diagnosis, monitoring, or treatment of 20 lung cancer. 21 ‘‘(3) With respect to the Centers for Disease 22 Control and Prevention, the establishment of an 23 early disease research and management program 24 under section 1511. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00426 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 427 •HR 5475 IH ‘‘(4) With respect to the Agency for Healthcare 1 Research and Quality, the conduct of a biannual re- 2 view of lung cancer screening, diagnostic, and treat- 3 ment protocols, and the issuance of updated guide- 4 lines. 5 ‘‘(5) The promotion (including education) of 6 lung cancer screening within minority and rural pop- 7 ulations and the study of the effectiveness of efforts 8 to increase such screening. 9 ‘‘(6) The cooperation and coordination of all 10 minority and health disparity programs within the 11 Department of Health and Human Services to en- 12 sure that all aspects of the Lung Cancer Mortality 13 Reduction Program under this section adequately 14 address the burden of lung cancer on minority and 15 rural populations. 16 ‘‘(7) The cooperation and coordination of all to- 17 bacco control and cessation programs within agen- 18 cies of the Department of Health and Human Serv- 19 ices to achieve the goals of the Lung Cancer Mor- 20 tality Reduction Program under this section with 21 particular emphasis on the coordination of drug and 22 other cessation treatments with early detection pro- 23 tocols.’’. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00427 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 428 •HR 5475 IH (2) FEDERAL FOOD, DRUG, AND COSMETIC 1 ACT.—Subchapter B of chapter V of the Federal 2 Food, Drug, and Cosmetic Act (21 U.S.C. 360aaa et 3 seq.) is amended by adding at the end the following: 4 ‘‘DRUGS RELATING TO LUNG CANCER 5 ‘‘SEC. 530. (a) IN GENERAL.—The provisions of this 6 subchapter shall apply to a drug described in subsection 7 (b) to the same extent and in the same manner as such 8 provisions apply to a drug for a rare disease or condition. 9 ‘‘(b) QUALIFIED DRUGS.—A drug described in this 10 subsection is— 11 ‘‘(1) a chemoprevention drug for precancerous 12 conditions of the lung; 13 ‘‘(2) a drug for targeted therapeutic treat- 14 ments, including any vaccine, for lung cancer; and 15 ‘‘(3) a drug to curtail or prevent nicotine addic- 16 tion. 17 ‘‘(c) BOARD.—The Board established under the 18 Health Equity and Accountability Act of 2016 shall mon- 19 itor the program implemented under this section.’’. 20 (3) ACCESS TO UNAPPROVED THERAPIES.—Sec- 21 tion 561(e) of the Federal Food, Drug, and Cos- 22 metic Act (21 U.S.C. 360bbb(e)) is amended by in- 23 serting before the period the following: ‘‘and shall 24 include expanding access to drugs under section 25 530, with substantial consideration being given to 26 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00428 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 429 •HR 5475 IH whether the totality of information available to the 1 Secretary regarding the safety and effectiveness of 2 an investigational drug, as compared to the risk of 3 morbidity and death from the disease, indicates that 4 a patient may obtain more benefit than risk if treat- 5 ed with the drug’’. 6 (4) CDC.—Title XV of the Public Health Serv- 7 ice Act (42 U.S.C. 300k et seq.) is amended by add- 8 ing at the end the following: 9 ‘‘SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT 10 PROGRAM. 11 ‘‘The Secretary shall establish and implement an 12 early disease research and management program targeted 13 at the high incidence and mortality rates of lung cancer 14 among minority and low-income populations.’’. 15 (e) DEPARTMENT OF DEFENSE AND THE DEPART- 16 MENT OF VETERANS AFFAIRS.—The Secretary of Defense 17 and the Secretary of Veterans Affairs shall coordinate 18 with the Secretary of Health and Human Services— 19 (1) in the development of the Lung Cancer 20 Mortality Reduction Program under section 417H; 21 (2) in the implementation within the Depart- 22 ment of Defense and the Department of Veterans 23 Affairs of an early detection and disease manage- 24 ment research program for military personnel and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00429 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 430 •HR 5475 IH veterans whose smoking history and exposure to car- 1 cinogens during active duty service has increased 2 their risk for lung cancer; and 3 (3) in the implementation of coordinated care 4 programs for military personnel and veterans diag- 5 nosed with lung cancer. 6 (f) LUNG CANCER ADVISORY BOARD.— 7 (1) IN GENERAL.—The Secretary of Health and 8 Human Services shall convene a Lung Cancer Advi- 9 sory Board (referred to in this section as the 10 ‘‘Board’’)— 11 (A) to monitor the programs established 12 under this section (and the amendments made 13 by this section); and 14 (B) to provide annual reports to the Con- 15 gress concerning benchmarks, expenditures, 16 lung cancer statistics, and the public health im- 17 pact of such programs. 18 (2) COMPOSITION.—The Board shall be com- 19 posed of— 20 (A) the Secretary of Health and Human 21 Services; 22 (B) the Secretary of Defense; 23 (C) the Secretary of Veterans Affairs; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00430 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 431 •HR 5475 IH (D) two representatives each from the 1 fields of clinical medicine focused on lung can- 2 cer, lung cancer research, imaging, drug devel- 3 opment, and lung cancer advocacy, to be ap- 4 pointed by the Secretary of Health and Human 5 Services. 6 (g) AUTHORIZATION OF APPROPRIATIONS.— 7 (1) IN GENERAL.—To carry out this section 8 (and the amendments made by this section), there 9 are authorized to be appropriated such sums as may 10 be necessary for each of fiscal years 2017 through 11 2021. 12 (2) LUNG CANCER MORTALITY REDUCTION PRO- 13 GRAM.—Of the amounts authorized to be appro- 14 priated by subsection (a), there are authorized to be 15 appropriated— 16 (A) $25,000,000 for fiscal year 2017, and 17 such sums as may be necessary for each of fis- 18 cal years 2018 through 2021, for the activities 19 described in section 417H(b)(1)(B) of the Pub- 20 lic Health Service Act, as added by subsection 21 (d)(1); 22 (B) $25,000,000 for fiscal year 2017, and 23 such sums as may be necessary for each of fis- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00431 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 432 •HR 5475 IH cal years 2018 through 2021, for the activities 1 described in section 417H(b)(1)(C) of such Act; 2 (C) $10,000,000 for fiscal year 2017, and 3 such sums as may be necessary for each of fis- 4 cal years 2018 through 2021, for the activities 5 described in section 417H(b)(1)(D) of such Act; 6 and 7 (D) $15,000,000 for fiscal year 2017, and 8 such sums as may be necessary for each of fis- 9 cal years 2018 through 2021, for the activities 10 described in section 417H(b)(3) of such Act. 11 SEC. 702. EXPANDING PROSTATE CANCER RESEARCH, OUT- 12 REACH, SCREENING, TESTING, ACCESS, AND 13 TREATMENT EFFECTIVENESS. 14 (a) SHORT TITLE.—This section may be cited as the 15 ‘‘Prostate Research, Outreach, Screening, Testing, Access, 16 and Treatment Effectiveness Act of 2016’’ or the ‘‘PROS- 17 TATE Act’’. 18 (b) FINDINGS.—Congress makes the following find- 19 ings: 20 (1) Prostate cancer is the second leading cause 21 of cancer death among men. 22 (2) In 2010, more than 217,730 new patients 23 were diagnosed with prostate cancer and more than 24 32,000 men died from this disease. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00432 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 433 •HR 5475 IH (3) Roughly 2,000,000 Americans are living 1 with a diagnosis of prostate cancer and its con- 2 sequences. 3 (4) While prostate cancer generally affects older 4 individuals, younger men are also at risk for the dis- 5 ease, and when prostate cancer appears in early 6 middle age it frequently takes on a more aggressive 7 form. 8 (5) There are significant racial and ethnic dis- 9 parities that demand attention, namely African- 10 Americans have prostate cancer mortality rates that 11 are more than double those in the White population. 12 (6) Underserved rural populations have higher 13 rates of mortality compared to their urban counter- 14 parts, and innovative and cost-efficient methods to 15 improve rural access to high quality care should take 16 advantage of advances in telehealth to diagnose and 17 treat prostate cancer when appropriate. 18 (7) Certain veterans populations may have 19 nearly twice the incidence of prostate cancer as the 20 general population of the United States. 21 (8) Urologists may constitute the specialists 22 who diagnose and treat the vast majority of prostate 23 cancer patients. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00433 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 434 •HR 5475 IH (9) Although much basic and translational re- 1 search has been completed and much is currently 2 known, there are still many unanswered questions. 3 For example, it is not fully understood how much of 4 known disparities are attributable to disease eti- 5 ology, access to care, or education and awareness in 6 the community. 7 (10) Causes of prostate cancer are not known. 8 There is not good information regarding how to dif- 9 ferentiate accurately, early on, between aggressive 10 and indolent forms of the disease. As a result, there 11 is significant overtreatment in prostate cancer. 12 There are no treatments that can durably arrest 13 growth or cure prostate cancer once it has metasta- 14 sized. 15 (11) A significant proportion (roughly 23 to 54 16 percent) of cases may be clinically indolent and 17 ‘‘overdiagnosed’’, resulting in significant overtreat- 18 ment. More accurate tests will allow men and their 19 families to face less physical, psychological, financial, 20 and emotional trauma and billions of dollars could 21 be saved in private and public health care systems 22 in an area that has been identified by the Medicare 23 Program as one of eight high-volume, high-cost 24 areas in the Resource Utilization Report Program 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00434 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 435 •HR 5475 IH authorized by Congress under the Medicare Im- 1 provements for Patients and Providers Act of 2008. 2 (12) Prostate cancer research and health care 3 programs across Federal agencies should be coordi- 4 nated to improve accountability and actively encour- 5 age the translation of research into practice, to iden- 6 tify and implement best practices, in order to foster 7 an integrated and consistent focus on effective pre- 8 vention, diagnosis, and treatment of this disease. 9 (c) PROSTATE CANCER COORDINATION AND EDU- 10 CATION.— 11 (1) INTERAGENCY PROSTATE CANCER COORDI- 12 NATION AND EDUCATION TASK FORCE.—Not later 13 than 180 days after the date of the enactment of 14 this section, the Secretary of Veterans Affairs, in co- 15 operation with the Secretary of Defense and the Sec- 16 retary of Health and Human Services, shall estab- 17 lish an Interagency Prostate Cancer Coordination 18 and Education Task Force (in this section referred 19 to as the ‘‘Prostate Cancer Task Force’’). 20 (2) DUTIES.—The Prostate Cancer Task Force 21 shall— 22 (A) develop a summary of advances in 23 prostate cancer research supported or con- 24 ducted by Federal agencies relevant to the diag- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00435 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 436 •HR 5475 IH nosis, prevention, and treatment of prostate 1 cancer, including psychosocial impairments re- 2 lated to prostate cancer treatment, and compile 3 a list of best practices that warrant broader 4 adoption in health care programs; 5 (B) consider establishing, and advocating 6 for, a guidance to enable physicians to allow 7 screening of men who are over age 74, on a 8 case-by-case basis, taking into account quality 9 of life and family history of prostate cancer; 10 (C) share and coordinate information on 11 Federal research and health care program ac- 12 tivities, including activities related to— 13 (i) determining how to improve re- 14 search and health care programs, including 15 psychosocial impairments related to pros- 16 tate cancer treatment; 17 (ii) identifying any gaps in the overall 18 research inventory and in health care pro- 19 grams; 20 (iii) identifying opportunities to pro- 21 mote translation of research into practice; 22 and 23 (iv) maximizing the effects of Federal 24 efforts by identifying opportunities for col- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00436 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 437 •HR 5475 IH laboration and leveraging of resources in 1 research and health care programs that 2 serve those susceptible to or diagnosed 3 with prostate cancer; 4 (D) develop a comprehensive interagency 5 strategy and advise relevant Federal agencies in 6 the solicitation of proposals for collaborative, 7 multidisciplinary research and health care pro- 8 grams, including proposals to evaluate factors 9 that may be related to the etiology of prostate 10 cancer, that would— 11 (i) result in innovative approaches to 12 study emerging scientific opportunities or 13 eliminate knowledge gaps in research to 14 improve the prostate cancer research port- 15 folio of the Federal Government; 16 (ii) outline key research questions, 17 methodologies, and knowledge gaps; and 18 (iii) ensure consistent action, as out- 19 lined by section 402(b) of the Public 20 Health Service Act; 21 (E) develop a coordinated message related 22 to screening and treatment for prostate cancer 23 to be reflected in educational and beneficiary 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00437 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 438 •HR 5475 IH materials for Federal health programs as such 1 documents are updated; and 2 (F) not later than 2 years after the date 3 of the establishment of the Prostate Cancer 4 Task Force, submit to the Expert Advisory 5 Panel to be reviewed and returned within 30 6 days, and then within 90 days submitted to 7 Congress recommendations— 8 (i) regarding any appropriate changes 9 to research and health care programs, in- 10 cluding recommendations to improve the 11 research portfolio of the Department of 12 Veterans Affairs, Department of Defense, 13 National Institutes of Health, and other 14 Federal agencies to ensure that scientif- 15 ically based strategic planning is imple- 16 mented in support of research and health 17 care program priorities; 18 (ii) designed to ensure that the re- 19 search and health care programs and ac- 20 tivities of the Department of Veterans Af- 21 fairs, the Department of Defense, the De- 22 partment of Health and Human Services, 23 and other Federal agencies are free of un- 24 necessary duplication; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00438 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 439 •HR 5475 IH (iii) regarding public participation in 1 decisions relating to prostate cancer re- 2 search and health care programs to in- 3 crease the involvement of patient advo- 4 cates, community organizations, and med- 5 ical associations representing a broad geo- 6 graphical area; 7 (iv) on how to best disseminate infor- 8 mation on prostate cancer research and 9 progress achieved by health care programs; 10 (v) about how to expand partnerships 11 between public entities, including Federal 12 agencies, and private entities to encourage 13 collaborative, cross-cutting research and 14 health care delivery; 15 (vi) assessing any cost savings and ef- 16 ficiencies realized through the efforts iden- 17 tified and supported in this section and 18 recommending expansion of those efforts 19 that have proved most promising while also 20 ensuring against any conflicts in directives 21 from other congressional or statutory man- 22 dates or enabling statutes; 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00439 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 440 •HR 5475 IH (vii) identifying key priority action 1 items from among the recommendations; 2 and 3 (viii) with respect to the level of fund- 4 ing needed by each agency to implement 5 the recommendations contained in the re- 6 port. 7 (3) MEMBERS OF THE PROSTATE CANCER TASK 8 FORCE.—The Prostate Cancer Task Force described 9 in subsection (a) shall be composed of representa- 10 tives from such Federal agencies, as each Secretary 11 determines necessary, to coordinate a uniform mes- 12 sage relating to prostate cancer screening and treat- 13 ment where appropriate, including representatives of 14 the following: 15 (A) The Department of Veterans Affairs, 16 including representatives of each relevant pro- 17 gram areas of the Department of Veterans Af- 18 fairs. 19 (B) The Prostate Cancer Research Pro- 20 gram of the Congressionally Directed Medical 21 Research Program of the Department of De- 22 fense. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00440 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 441 •HR 5475 IH (C) The Department of Health and 1 Human Services, including at a minimum rep- 2 resentatives of the following: 3 (i) The National Institutes of Health. 4 (ii) National research institutes and 5 centers, including the National Cancer In- 6 stitute, the National Institute of Allergy 7 and Infectious Diseases, and the Office of 8 Minority Health. 9 (iii) The Centers for Medicare & Med- 10 icaid Services. 11 (iv) The Food and Drug Administra- 12 tion. 13 (v) The Centers for Disease Control 14 and Prevention. 15 (vi) The Agency for Healthcare Re- 16 search and Quality. 17 (vii) The Health Resources and Serv- 18 ices Administration. 19 (4) APPOINTING EXPERT ADVISORY PANELS.— 20 The Prostate Cancer Task Force shall appoint ex- 21 pert advisory panels, as determined appropriate, to 22 provide input and concurrence from individuals and 23 organizations from the medical, prostate cancer pa- 24 tient and advocate, research, and delivery commu- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00441 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 442 •HR 5475 IH nities with expertise in prostate cancer diagnosis, 1 treatment, and research, including practicing urolo- 2 gists, primary care providers, and others and indi- 3 viduals with expertise in education and outreach to 4 underserved populations affected by prostate cancer. 5 (5) MEETINGS.—The Prostate Cancer Task 6 Force shall convene not less than twice a year, or 7 more frequently as the Secretary determines to be 8 appropriate. 9 (6) SUBMISSION OF RECOMMENDATIONS TO 10 CONGRESS.—The Secretary of Veterans Affairs shall 11 submit to Congress any recommendations submitted 12 to the Secretary under paragraph (2)(E). 13 (7) FEDERAL ADVISORY COMMITTEE ACT.— 14 (A) IN GENERAL.—Except as provided in 15 subparagraph (B), the Federal Advisory Com- 16 mittee Act (5 U.S.C. App.) shall apply to the 17 Prostate Cancer Task Force. 18 (B) EXCEPTION.—Section 14(a)(2)(B) of 19 such Act (relating to the termination of advi- 20 sory committees) shall not apply to the Prostate 21 Cancer Task Force. 22 (8) SUNSET DATE.—The Prostate Cancer Task 23 Force shall terminate at the end of fiscal year 2021. 24 (d) PROSTATE CANCER RESEARCH.— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00442 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 443 •HR 5475 IH (1) RESEARCH COORDINATION.—The Secretary 1 of Veterans Affairs, in coordination with the Secre- 2 taries of Defense and of Health and Human Serv- 3 ices, shall establish and carry out a program to co- 4 ordinate and intensify prostate cancer research as 5 needed. Specifically, such research program shall— 6 (A) develop advances in diagnostic and 7 prognostic methods and tests, including bio- 8 markers and an improved prostate cancer 9 screening blood test, including improvements or 10 alternatives to the prostate specific antigen test 11 and additional tests to distinguish indolent from 12 aggressive disease; 13 (B) better understand the etiology of the 14 disease (including an analysis of lifestyle factors 15 proven to be involved in higher rates of prostate 16 cancer, such as obesity and diet, and in dif- 17 ferent ethnic, racial, and socioeconomic groups, 18 such as the African-American, Latino or His- 19 panic, and American Indian populations and 20 men with a family history of prostate cancer) to 21 improve prevention efforts; 22 (C) expand basic research into prostate 23 cancer, including studies of fundamental molec- 24 ular and cellular mechanisms; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00443 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 444 •HR 5475 IH (D) identify and provide clinical testing of 1 novel agents for the prevention and treatment 2 of prostate cancer; 3 (E) establish clinical registries for prostate 4 cancer; 5 (F) use the National Institute of Bio- 6 medical Imaging and Bioengineering and the 7 National Cancer Institute for assessment of ap- 8 propriate imaging modalities; and 9 (G) address such other matters relating to 10 prostate cancer research as may be identified by 11 the Federal agencies participating in the pro- 12 gram under this section. 13 (2) PROSTATE CANCER ADVISORY BOARD.— 14 There is established in the Office of the Chief Sci- 15 entist of the Food and Drug Administration a Pros- 16 tate Cancer Scientific Advisory Board. Such board 17 shall be responsible for accelerating real-time shar- 18 ing of the latest research data and accelerating 19 movement of new medicines to patients. 20 (3) UNDERSERVED MINORITY GRANT PRO- 21 GRAM.—In carrying out such program, the Secretary 22 shall— 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00444 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 445 •HR 5475 IH (A) award grants to eligible entities to 1 carry out components of the research outlined 2 in paragraph (1); 3 (B) integrate and build upon existing 4 knowledge gained from comparative effective- 5 ness research; and 6 (C) recognize and address— 7 (i) the racial and ethnic disparities in 8 the incidence and mortality rates of pros- 9 tate cancer and men with a family history 10 of prostate cancer; 11 (ii) any barriers in access to care and 12 participation in clinical trials that are spe- 13 cific to racial, ethnic, and other under- 14 served minorities and men with a family 15 history of prostate cancer; 16 (iii) needed outreach and educational 17 efforts to raise awareness in these commu- 18 nities; and 19 (iv) appropriate access and utilization 20 of imaging modalities. 21 (e) TELEHEALTH AND RURAL ACCESS PILOT 22 PROJECT.— 23 (1) IN GENERAL.—The Secretary of Veterans 24 Affairs, the Secretary of Defense, and the Secretary 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00445 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 446 •HR 5475 IH of Health and Human Services (in this section re- 1 ferred to as the ‘‘Secretaries’’) shall establish 4-year 2 telehealth pilot projects for the purpose of analyzing 3 the clinical outcomes and cost effectiveness associ- 4 ated with telehealth services in a variety of geo- 5 graphic areas that contain high proportions of medi- 6 cally underserved populations, including African- 7 Americans, Latino or Hispanic, American Indians/ 8 Alaska Natives, and those in rural areas. Such 9 projects shall promote efficient use of specialist care 10 through better coordination of primary care and 11 physician extender teams in underserved areas and 12 more effectively employ tumor boards to better coun- 13 sel patients. 14 (2) ELIGIBLE ENTITIES.— 15 (A) IN GENERAL.—The Secretaries shall 16 select eligible entities to participate in the pilot 17 projects under this section. 18 (B) PRIORITY.—In selecting eligible enti- 19 ties to participate in the pilot projects under 20 this section, the Secretaries shall give priority 21 to such entities located in medically under- 22 served areas, particularly those that include Af- 23 rican-Americans, Latinos and Hispanics, and 24 facilities of the Indian Health Service, including 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00446 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 447 •HR 5475 IH Indian Health Service operated facilities, trib- 1 ally operated facilities, and Urban Indian Clin- 2 ics, and those in rural areas. 3 (3) EVALUATION.—The Secretaries shall, 4 through the pilot projects, evaluate— 5 (A) the effective and economic delivery of 6 care in diagnosing and treating prostate cancer 7 with the use of telehealth services in medically 8 underserved and tribal areas including collabo- 9 rative uses of health professionals and integra- 10 tion of the range of telehealth and other tech- 11 nologies; 12 (B) the effectiveness of improving the ca- 13 pacity of nonmedical providers and nonspecial- 14 ized medical providers to provide health services 15 for prostate cancer in medically underserved 16 and tribal areas, including the exploration of in- 17 novative medical home models with collabora- 18 tion between urologists, other relevant medical 19 specialists, including oncologists, radiologists, 20 and primary care teams and coordination of 21 care through the efficient use of primary care 22 teams and physician extenders; and 23 (C) the effectiveness of using telehealth 24 services to provide prostate cancer treatment in 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00447 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 448 •HR 5475 IH medically underserved areas, including the use 1 of tumor boards to facilitate better patient 2 counseling. 3 (4) REPORT.—Not later than 12 months after 4 the completion of the pilot projects under this sub- 5 section, the Secretaries shall submit to Congress a 6 report describing the outcomes of such pilot projects, 7 including any cost savings and efficiencies realized, 8 and providing recommendations, if any, for expand- 9 ing the use of telehealth services. 10 (f) EDUCATION AND AWARENESS.— 11 (1) IN GENERAL.—The Secretary of Veterans 12 Affairs shall develop a national education campaign 13 for prostate cancer. Such campaign shall involve the 14 use of written educational materials and public serv- 15 ice announcements consistent with the findings of 16 the Prostate Cancer Task Force under subsection 17 (c), that are intended to encourage men to seek 18 prostate cancer screening when appropriate. 19 (2) RACIAL DISPARITIES AND THE POPULATION 20 OF MEN WITH A FAMILY HISTORY OF PROSTATE 21 CANCER.—In developing the national campaign 22 under paragraph (1), the Secretary shall ensure that 23 such educational materials and public service an- 24 nouncements are more readily available in commu- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00448 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 449 •HR 5475 IH nities experiencing racial disparities in the incidence 1 and mortality rates of prostate cancer and by men 2 of any race classification with a family history of 3 prostate cancer. 4 (3) GRANTS.—In carrying out the national 5 campaign under this section, the Secretary shall 6 award grants to nonprofit private entities to enable 7 such entities to test alternative outreach and edu- 8 cation strategies. 9 (g) AUTHORIZATION OF APPROPRIATIONS.— 10 (1) IN GENERAL.—There is authorized to be 11 appropriated to carry out this section for the period 12 of fiscal years 2017 through 2021 an amount equal 13 to the savings described in paragraph (2). 14 (2) CORRESPONDING REDUCTION.—The 15 amount authorized to be appropriated by provisions 16 of law other than this section for the period of fiscal 17 years 2017 through 2021 for Federal research and 18 health care program activities related to prostate 19 cancer is reduced by the amount of Federal savings 20 projected to be achieved over such period by imple- 21 mentation of subsection (c)(2)(C) of this section. 22 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00449 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 450 •HR 5475 IH SEC. 703. IMPROVED MEDICAID COVERAGE FOR CERTAIN 1 BREAST AND CERVICAL CANCER PATIENTS 2 IN THE TERRITORIES. 3 (a) ELIMINATION OF FUNDING LIMITATIONS.— 4 (1) IN GENERAL.—Section 1108(g)(4) of the 5 Social Security Act (42 U.S.C. 1308(g)(4)) is 6 amended by adding at the end the following: ‘‘With 7 respect to fiscal years beginning with fiscal year 8 2017, payment for medical assistance for individuals 9 who are eligible for such assistance only on the basis 10 of section 1902(a)(10)(A)(ii)(XVIII) shall not be 11 taken into account in applying subsection (f) (as in- 12 creased in accordance with paragraphs (1), (2), (3), 13 and (5) of this subsection) to such commonwealth or 14 territory for such fiscal year.’’. 15 (2) TECHNICAL AMENDMENT.—Such section is 16 further amended by striking ‘‘(3), and (4)’’ and in- 17 serting ‘‘(3), and (5)’’. 18 (b) APPLICATION OF ENHANCED FMAP FOR HIGH- 19 EST STATE.—Section 1905(b) of such Act (42 U.S.C. 20 1396d(b)) is amended by adding at the end the following: 21 ‘‘Notwithstanding the first sentence of this subsection, 22 with respect to medical assistance described in clause (4) 23 of such sentence that is furnished in Puerto Rico, the 24 United States Virgin Islands, Guam, the Commonwealth 25 of the Northern Mariana Islands, or American Samoa in 26 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00450 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 451 •HR 5475 IH a fiscal year, the Federal medical assistance percentage 1 is equal to the highest such percentage applied under such 2 clause for such fiscal year for any of the 50 States or the 3 District of Columbia that provides such medical assistance 4 for any portion of such fiscal year.’’ 5 (c) EFFECTIVE DATE.—The amendments made by 6 this section shall apply to payment for medical assistance 7 for items and services furnished on or after October 1, 8 2016. 9 SEC. 704. CANCER PREVENTION AND TREATMENT DEM- 10 ONSTRATION FOR ETHNIC AND RACIAL MI- 11 NORITIES. 12 (a) DEMONSTRATION.— 13 (1) IN GENERAL.—The Secretary of Health and 14 Human Services (in this section referred to as the 15 ‘‘Secretary’’) shall conduct demonstration projects 16 (in this section referred to as ‘‘demonstration 17 projects’’) for the purpose of developing models and 18 evaluating methods that— 19 (A) improve the quality of items and serv- 20 ices provided to target individuals in order to 21 facilitate reduced disparities in early detection 22 and treatment of cancer; 23 (B) improve clinical outcomes, satisfaction, 24 quality of life, appropriate use of items and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00451 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 452 •HR 5475 IH services covered under the Medicare Program 1 under title XVIII of the Social Security Act (42 2 U.S.C. 1395 et seq.), and referral patterns with 3 respect to target individuals with cancer; 4 (C) eliminate disparities in the rate of pre- 5 ventive cancer screening measures, such as Pap 6 smears, prostate cancer screenings, colon cancer 7 screenings, breast cancer screenings, and com- 8 puted tomography (CT) scans, for lung cancer 9 among target individuals; 10 (D) promote collaboration with community- 11 based organizations to ensure cultural com- 12 petency of health care professionals and lin- 13 guistic access for target individuals who are 14 persons with limited-English proficiency; and 15 (E) encourage the incorporation of commu- 16 nity health workers to increase the efficiency 17 and appropriateness of cancer screening pro- 18 grams. 19 (2) COMMUNITY HEALTH WORKER DEFINED.— 20 In this section, the term ‘‘community health worker’’ 21 includes a community health advocate, a lay health 22 worker, a community health representative, a peer 23 health promotor, a community health outreach work- 24 er, and a promotore de salud, who promotes health 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00452 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 453 •HR 5475 IH or nutrition within the community in which the indi- 1 vidual resides. 2 (3) TARGET INDIVIDUAL DEFINED.—In this 3 section, the term ‘‘target individual’’ means an indi- 4 vidual of a racial and ethnic minority group, as de- 5 fined in section 1707(g)(1) of the Public Health 6 Service Act (42 U.S.C. 300u–6(g)(1)), who is enti- 7 tled to benefits under part A, and enrolled under 8 part B, of title XVIII of the Social Security Act. 9 (b) PROGRAM DESIGN.— 10 (1) INITIAL DESIGN.—Not later than 1 year 11 after the date of the enactment of this Act, the Sec- 12 retary shall evaluate best practices in the private 13 sector, community programs, and academic research 14 of methods that reduce disparities among individuals 15 of racial and ethnic minority groups in the preven- 16 tion and treatment of cancer and shall design the 17 demonstration projects based on such evaluation. 18 (2) NUMBER AND PROJECT AREAS.—Not later 19 than 2 years after the date of the enactment of this 20 Act, the Secretary shall implement at least nine 21 demonstration projects, including the following: 22 (A) Two projects, each of which shall tar- 23 get different ethnic subpopulations, for each of 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00453 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 454 •HR 5475 IH the four following major racial and ethnic mi- 1 nority groups: 2 (i) American Indians and Alaska Na- 3 tives, Eskimos and Aleuts. 4 (ii) Asian-Americans. 5 (iii) Blacks/African-Americans. 6 (iv) Latinos or Hispanics. 7 (v) Native Hawaiians and other Pa- 8 cific Islanders. 9 (B) One project within the Pacific Islands 10 or United States insular areas. 11 (C) At least one project each in a rural 12 area and inner-city area. 13 (3) EXPANSION OF PROJECTS; IMPLEMENTA- 14 TION OF DEMONSTRATION PROJECT RESULTS.—If 15 the initial report under subsection (c) contains an 16 evaluation that demonstration projects— 17 (A) reduce expenditures under the Medi- 18 care Program under title XVIII of the Social 19 Security Act (42 U.S.C. 1395 et seq.); or 20 (B) do not increase expenditures under the 21 Medicare Program and reduce racial and ethnic 22 health disparities in the quality of health care 23 services provided to target individuals and in- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00454 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 455 •HR 5475 IH crease satisfaction of Medicare beneficiaries and 1 health care providers; 2 the Secretary shall continue the existing demonstra- 3 tion projects and may expand the number of dem- 4 onstration projects. 5 (c) REPORT TO CONGRESS.— 6 (1) IN GENERAL.—Not later than 2 years after 7 the date the Secretary implements the initial dem- 8 onstration projects, and biannually thereafter, the 9 Secretary shall submit to Congress a report regard- 10 ing the demonstration projects. 11 (2) CONTENTS OF REPORT.—Each report under 12 paragraph (1) shall include the following: 13 (A) A description of the demonstration 14 projects. 15 (B) An evaluation of— 16 (i) the cost effectiveness of the dem- 17 onstration projects; 18 (ii) the quality of the health care serv- 19 ices provided to target individuals under 20 the demonstration projects; and 21 (iii) beneficiary and health care pro- 22 vider satisfaction under the demonstration 23 projects. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00455 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 456 •HR 5475 IH (C) Any other information regarding the 1 demonstration projects that the Secretary de- 2 termines to be appropriate. 3 (d) WAIVER AUTHORITY.—The Secretary shall waive 4 compliance with the requirements of title XVIII of the So- 5 cial Security Act (42 U.S.C. 1395 et seq.) to such extent 6 and for such period as the Secretary determines is nec- 7 essary to conduct demonstration projects. 8 SEC. 705. REDUCING CANCER DISPARITIES WITHIN MEDI- 9 CARE. 10 (a) DEVELOPMENT OF MEASURES OF DISPARITIES 11 IN QUALITY OF CANCER CARE.— 12 (1) DEVELOPMENT OF MEASURES.—The Sec- 13 retary of Health and Human Services (in this sec- 14 tion referred to as the ‘‘Secretary’’) shall enter into 15 an agreement with an entity that specializes in de- 16 veloping quality measures for cancer care under 17 which the entity shall develop a uniform set of meas- 18 ures to evaluate disparities in the quality of cancer 19 care and annually update such set of measures. 20 (2) MEASURES TO BE INCLUDED.—Such set of 21 measures shall include, with respect to the treatment 22 of cancer, measures of patient outcomes, the process 23 for delivering medical care related to such treat- 24 ment, patient counseling and engagement in deci- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00456 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 457 •HR 5475 IH sionmaking, patient experience of care, resource use, 1 and practice capabilities, such as care coordination. 2 (b) ESTABLISHMENT OF REPORTING PROCESS.— 3 (1) IN GENERAL.—The Secretary shall establish 4 a reporting process that requires and provides for a 5 method for health care providers specified under 6 paragraph (2) to submit to the Secretary and make 7 public data on the performance of such providers 8 during each reporting period through use of the 9 measures developed pursuant to subsection (a). Such 10 data shall be submitted in a form and manner and 11 at a time specified by the Secretary. 12 (2) SPECIFICATION OF PROVIDERS TO REPORT 13 ON MEASURES.—The Secretary shall specify the 14 classes of Medicare providers of services and sup- 15 pliers, including hospitals, cancer centers, physi- 16 cians, primary care providers, and specialty pro- 17 viders, that will be required under such process to 18 publicly report on the measures specified under sub- 19 section (a). 20 (3) ASSESSMENT OF CHANGES.—Under such 21 reporting process, the Secretary shall establish a for- 22 mat that assesses changes in both the absolute and 23 relative disparities in cancer care over time. These 24 measures shall be presented in an easily comprehen- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00457 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 458 •HR 5475 IH sible format, such as those presented in the final 1 publications relating to Healthy People 2010 or the 2 National Healthcare Disparities Report. 3 (4) INITIAL IMPLEMENTATION.—The Secretary 4 shall implement the reporting process under this 5 subsection for reporting periods beginning not later 6 than 6 months after the date that measures are first 7 established under subsection (a). 8 Subtitle B—Viral Hepatitis and 9 Liver Cancer Control and Pre- 10 vention 11 SEC. 711. VIRAL HEPATITIS AND LIVER CANCER CONTROL 12 AND PREVENTION. 13 (a) SHORT TITLE.—This subtitle may be cited as the 14 ‘‘Viral Hepatitis and Liver Cancer Control and Prevention 15 Act of 2016’’. 16 (b) FINDINGS.—Congress finds the following: 17 (1) Approximately 5,300,000 Americans are 18 chronically infected with the hepatitis B virus (re- 19 ferred to in this section as ‘‘HBV’’), the hepatitis C 20 virus (referred to in this section as ‘‘HCV’’), or 21 both. 22 (2) In the United States, chronic HBV and 23 HCV are the most common cause of liver cancer, 24 one of the most lethal and fastest growing cancers 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00458 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 459 •HR 5475 IH in this country. It is the most common cause of 1 chronic liver disease, liver cirrhosis, and the most 2 common indication for liver transplantation. At least 3 21,000 deaths per year in the United States can be 4 attributed to chronic HBV and HCV. Chronic HCV 5 is also a leading cause of death in Americans living 6 with HIV/AIDS, many of those living with HIV/ 7 AIDS are coinfected with chronic HBV, chronic 8 HCV, or both. 9 (3) According to the Centers for Disease Con- 10 trol and Prevention (referred to in this section as 11 the ‘‘CDC’’), approximately 2 percent of the popu- 12 lation of the United States is living with chronic 13 HBV, chronic HCV, or both. The CDC has recog- 14 nized HCV as the Nation’s most common chronic 15 bloodborne virus infection and HBV as the deadliest 16 vaccine-preventable disease. 17 (4) HBV is easily transmitted and is 100 times 18 more infectious than HIV. According to the CDC, 19 HBV is transmitted through contact with infectious 20 blood, semen, or other body fluids. HCV is trans- 21 mitted by contact with infectious blood, particularly 22 through percutaneous exposures (i.e. puncture 23 through the skin). 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00459 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 460 •HR 5475 IH (5) The CDC conservatively estimates that in 1 2013 approximately 29,700 Americans were newly 2 infected with HCV and more than 19,800 Americans 3 were newly infected with HBV. These estimates 4 could be much higher due to many reasons, includ- 5 ing lack of screening education and awareness, and 6 perceived marginalization of the populations at risk. 7 (6) In 2012, CDC released new guidelines rec- 8 ommending every person born between 1945 and 9 1965 receive a one-time test. Among the estimated 10 102 million (1.6 million chronically HCV-infected) 11 eligible for screening, birth-cohort screening leads to 12 84,000 fewer cases of decompensated cirrhosis, 13 46,000 fewer cases of hepatocellular carcinoma, 14 10,000 fewer liver transplants, and 78,000 fewer 15 HCV-related deaths gained versus risk-based screen- 16 ing. 17 (7) In 2013, the United States Preventive Serv- 18 ices Task Force (USPSTF) issued a Grade B rating 19 for screening for the hepatitis C virus (HCV) infec- 20 tion in persons at high risk for infection and adults 21 born between 1945 and 1965. In 2014, the 22 USPSTF issued a Grade B for screening for the 23 hepatitis B virus (HBV) in persons at high-risk of 24 hepatitis B infection. In 2009, the USPSTF issued 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00460 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 461 •HR 5475 IH a Grade A for screening pregnant women for the 1 hepatitis B virus (HBV) during their first prenatal 2 visit. 3 (8) There were 44 outbreaks (23 of HBV, 22 4 of HCV) reported to CDC for investigation from 5 2008 through 2014 related to health care acquired 6 infection of HBV and HCV, 42 of which occurred in 7 nonhospital settings. There were more than 101,100 8 patients potentially exposed to one of the viruses. 9 (9) Chronic HBV and chronic HCV usually do 10 not cause symptoms early in the course of the dis- 11 ease, but after many years of a clinically ‘‘silent’’ 12 phase, CDC estimates show more than 33 percent of 13 infected individuals will develop cirrhosis, end-stage 14 liver disease, or liver cancer. Since most individuals 15 with chronic HBV, HCV, or both are unaware of 16 their infection, they do not know to take precautions 17 to prevent the spread of their infection and can un- 18 knowingly exacerbate their own disease progression. 19 (10) HBV and HCV disproportionately affect 20 certain populations in the United States. Although 21 representing only 6 percent of the population, Asian- 22 Americans and Pacific Islanders account for over 23 half of the 1,400,000 domestic chronic HBV cases. 24 Baby boomers (those born between 1945 and 1965) 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00461 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 462 •HR 5475 IH account for approximately 75 percent of domestic 1 chronic hepatitis C cases. In addition, African-Amer- 2 icans, Latinos (Latinas), and American Indian/Na- 3 tive Alaskans are among the groups which have dis- 4 proportionately high rates of HBV and/or HCV in- 5 fections in the United States. 6 (11) For both chronic HBV and chronic HCV, 7 behavioral changes can slow disease progression if 8 diagnosis is made early. Early diagnosis, which is 9 determined through simple blood tests, can reduce 10 the risk of transmission and disease progression 11 through education and vaccination of household 12 members and other susceptible persons at risk. 13 (12) Advancements have led to the development 14 of improved diagnostic tests for viral hepatitis. 15 These tests, including rapid, point of care testing 16 and others in development, can facilitate testing, no- 17 tification of results and post-test counseling, and re- 18 ferral to care at the time of the testing visit. In par- 19 ticular, these tests are also advantageous because 20 they can be used simultaneously with HIV rapid 21 testing for persons at risk for both HCV and HIV 22 infections. 23 (13) For those chronically infected with HBV 24 or HCV, regular monitoring can lead to the early de- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00462 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 463 •HR 5475 IH tection of liver cancer at a stage where a cure is still 1 possible. Liver cancer is the second deadliest cancer 2 in the United States; however, liver cancer has re- 3 ceived little funding for research, prevention, or 4 treatment. 5 (14) Treatment for chronic HCV can eradicate 6 the disease in approximately 90 percent of those cur- 7 rently treated. The treatment of chronic HBV can 8 effectively suppress viral replication in the over- 9 whelming majority (over 80 percent) of those treat- 10 ed, thereby reducing the risk of transmission and 11 progression to liver scarring or liver cancer, even 12 though a complete cure is much less common than 13 for HCV. 14 (15) To combat the viral hepatitis epidemic in 15 the United States, in May 2011, the Department of 16 Health and Human Services released ‘‘Combating 17 the Silent Epidemic of Viral Hepatitis: Action Plan 18 for the Prevention, Care & Treatment of Viral Hepa- 19 titis’’ (hereafter referred to as the HHS Action 20 Plan). The Institute of Medicine (IOM) of the Na- 21 tional Academies produced a 2010 report on the 22 Federal response to HBV and HCV titled: ‘‘Hepa- 23 titis and Liver Cancer: A National Strategy for Pre- 24 vention and Control of Hepatitis B and C’’. These 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00463 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 464 •HR 5475 IH recommendations and guidelines provide a frame- 1 work for HBV and HCV prevention, education, con- 2 trol, research, and medical management programs. 3 (16) The annual health care costs attributable 4 to HBV and HCV in the United States are signifi- 5 cant. For HBV, it is estimated to be approximately 6 $2,500,000,000 ($2,000 per infected person). In 7 2000, the lifetime cost of HBV—before the avail- 8 ability of most current therapies—was approximately 9 $80,000 per chronically infected person, totaling 10 more than $100,000,000,000. For HCV, medical 11 costs for patients are expected to increase from 12 $30,000,000,000 in 2009 to over $85,000,000,000 13 in 2024. Avoiding these costs by screening and diag- 14 nosing individuals earlier—and connecting them to 15 appropriate treatment and care, will save lives and 16 critical health care dollars. Currently, without a 17 comprehensive screening, testing, and diagnosis pro- 18 gram, most patients are diagnosed too late when 19 they need a liver transplant costing at least 20 $314,000 for uncomplicated cases or when they have 21 liver cancer or end stage liver disease which costs 22 $30,980 to $110,576 per hospital admission. As 23 health care costs continue to grow, it is critical that 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00464 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 465 •HR 5475 IH the Federal Government invests in effective mecha- 1 nisms to avoid documented cost drivers. 2 (17) According to the IOM report in 2010 (de- 3 scribed in paragraph (15)), chronic HBV and HCV 4 infections cause substantial morbidity and mortality 5 despite being preventable and treatable. Deficiencies 6 in the implementation of established guidelines for 7 the prevention, diagnosis, and medical management 8 of chronic HBV and HCV infections perpetuate per- 9 sonal and economic burdens. Existing grants are not 10 sufficient for the scale of the health burden pre- 11 sented by HBV and HCV. 12 (18) Screening and testing for HBV and HCV 13 is aligned with the Healthy People 2020 goal to in- 14 crease immunization rates and reduce preventable 15 infectious diseases. Awareness of disease and access 16 to prevention and treatment remain essential compo- 17 nents for reducing infectious disease transmission. 18 (19) Federal support is necessary to increase 19 knowledge and awareness of HBV and HCV and to 20 assist State and local prevention and control efforts 21 in reducing the morbidity and mortality of these 22 epidemics. 23 (20) The Secretary of Health and Human Serv- 24 ices has the discretion to carry out this Act directly 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00465 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 466 •HR 5475 IH and through whichever of the agencies of the Public 1 Health Service the Secretary determines to be ap- 2 propriate, which may (in the Secretary’s discretion) 3 include the Centers for Disease Control and Preven- 4 tion, the Health Resources and Services Administra- 5 tion, the Substance Abuse and Mental Health Serv- 6 ices Administration, the National Institutes of 7 Health (including the National Institute on Minority 8 Health and Health Disparities), and other agencies 9 of such Service. 10 (21) The Centers for Disease Control and Pre- 11 vention reported a 151 percent increase in hepatitis 12 C cases from 2010–2013, stemming from the opioid, 13 heroin, and overdose epidemics affecting commu- 14 nities nationwide. 15 (c) BIENNIAL ASSESSMENT OF HHS HEPATITIS B 16 AND HEPATITIS C PREVENTION, EDUCATION, RESEARCH, 17 AND MEDICAL MANAGEMENT PLAN.—Title III of the 18 Public Health Service Act (42 U.S.C. 241 et seq.) is 19 amended— 20 (1) by striking section 317N (42 U.S.C. 247b– 21 15); and 22 (2) by adding at the end the following: 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00466 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 467 •HR 5475 IH ‘‘PART W—BIENNIAL ASSESSMENT OF HHS HEPA- 1 TITIS B AND HEPATITIS C PREVENTION, EDU- 2 CATION, RESEARCH, AND MEDICAL MANAGE- 3 MENT PLAN 4 ‘‘SEC. 399NN. BIENNIAL UPDATE OF THE PLAN. 5 ‘‘(a) IN GENERAL.—The Secretary shall conduct a bi- 6 ennial assessment of the Secretary’s plan for the preven- 7 tion, control, and medical management of, and education 8 and research relating to, hepatitis B and hepatitis C, for 9 the purposes of— 10 ‘‘(1) incorporating into such plan new knowl- 11 edge or observations relating to hepatitis B and hep- 12 atitis C (such as knowledge and observations that 13 may be derived from clinical, laboratory, and epide- 14 miological research and disease detection, preven- 15 tion, and surveillance outcomes); 16 ‘‘(2) addressing gaps in the coverage or effec- 17 tiveness of the plan; and 18 ‘‘(3) evaluating and, if appropriate, updating 19 recommendations, guidelines, or educational mate- 20 rials of the Centers for Disease Control and Preven- 21 tion or the National Institutes of Health for health 22 care providers or the public on viral hepatitis in 23 order to be consistent with the plan. 24 ‘‘(b) PUBLICATION OF NOTICE OF ASSESSMENTS.— 25 Not later than October 1 of the first even-numbered year 26 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00467 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 468 •HR 5475 IH beginning after the date of the enactment of this part, 1 and October 1 of each even-numbered year thereafter, the 2 Secretary shall publish in the Federal Register a notice 3 of the results of the assessments conducted under para- 4 graph (1). Such notice shall include— 5 ‘‘(1) a description of any revisions to the plan 6 referred to in subsection (a) as a result of the as- 7 sessment; 8 ‘‘(2) an explanation of the basis for any such 9 revisions, including the ways in which such revisions 10 can reasonably be expected to further promote the 11 original goals and objectives of the plan; and 12 ‘‘(3) in the case of a determination by the Sec- 13 retary that the plan does not need revision, an expla- 14 nation of the basis for such determination. 15 ‘‘SEC. 399NN–1. ELEMENTS OF PROGRAM. 16 ‘‘(a) EDUCATION AND AWARENESS PROGRAMS.—The 17 Secretary, acting through the Director of the Centers for 18 Disease Control and Prevention, the Administrator of the 19 Health Resources and Services Administration, and the 20 Administrator of the Substance Abuse and Mental Health 21 Services Administration, and in accordance with the plan 22 referred to in section 399NN(a), shall implement pro- 23 grams to increase awareness and enhance knowledge and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00468 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 469 •HR 5475 IH understanding of hepatitis B and hepatitis C. Such pro- 1 grams shall include— 2 ‘‘(1) the conduct of culturally and language ap- 3 propriate health education in primary and secondary 4 schools, college campuses, public awareness cam- 5 paigns, and community outreach activities (especially 6 to the ethnic communities with high rates of chronic 7 hepatitis B and chronic hepatitis C and other high- 8 risk groups) to promote public awareness and knowl- 9 edge about the value of hepatitis A and hepatitis B 10 immunization, risk factors, the transmission and 11 prevention of hepatitis B and hepatitis C, the value 12 of screening for the early detection of hepatitis B 13 and hepatitis C, and options available for the treat- 14 ment of chronic hepatitis B and chronic hepatitis C; 15 ‘‘(2) the promotion of immunization programs 16 that increase awareness and access to hepatitis A 17 and hepatitis B vaccines for susceptible adults and 18 children; 19 ‘‘(3) the training of health care professionals 20 regarding the importance of vaccinating individuals 21 infected with hepatitis C and individuals who are at 22 risk for hepatitis C infection against hepatitis A and 23 hepatitis B; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00469 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 470 •HR 5475 IH ‘‘(4) the training of health care professionals 1 regarding the importance of vaccinating individuals 2 chronically infected with hepatitis B and individuals 3 who are at risk for chronic hepatitis B infection 4 against the hepatitis A virus; 5 ‘‘(5) the training of health care professionals 6 and health educators to make them aware of the 7 high rates of chronic hepatitis B and chronic hepa- 8 titis C in certain adult ethnic populations, and the 9 importance of prevention, detection, and medical 10 management of hepatitis B and hepatitis C and of 11 liver cancer screening; 12 ‘‘(6) the development and distribution of health 13 education curricula (including information relating 14 to the special needs of individuals infected with hep- 15 atitis B and hepatitis C, such as the importance of 16 prevention and early intervention, regular moni- 17 toring, the recognition of psychosocial needs, appro- 18 priate treatment, and liver cancer screening) for in- 19 dividuals providing hepatitis B and hepatitis C coun- 20 seling; and 21 ‘‘(7) support for the implementation curricula 22 described in paragraph (6) by State and local public 23 health agencies. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00470 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 471 •HR 5475 IH ‘‘(b) IMMUNIZATION, PREVENTION, AND CONTROL 1 PROGRAMS.— 2 ‘‘(1) IN GENERAL.—The Secretary, acting 3 through the Director of the Centers for Disease 4 Control and Prevention, shall support the integra- 5 tion of activities described in paragraph (3) into ex- 6 isting clinical and public health programs at State, 7 local, territorial, and tribal levels (including commu- 8 nity health clinics, programs for the prevention and 9 treatment of HIV/AIDS, sexually transmitted infec- 10 tions, and substance abuse, and programs for indi- 11 viduals in correctional settings). 12 ‘‘(2) COORDINATION OF DEVELOPMENT OF 13 FEDERAL SCREENING GUIDELINES.— 14 ‘‘(A) REFERENCES.—For purposes of this 15 subsection, the term ‘CDC Director’ means the 16 Director of the Centers for Disease Control and 17 Prevention, and the term ‘AHRQ Director’ 18 means the Director of the Agency for 19 Healthcare Research and Quality. 20 ‘‘(B) AGENCY FOR HEALTHCARE RE- 21 SEARCH AND QUALITY.—Due to the rapidly 22 evolving standard of care associated with diag- 23 nosing and treating viral hepatitis infection, the 24 AHRQ Director shall convene the Preventive 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00471 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 472 •HR 5475 IH Services Task Force under section 915(a) of 1 the Public Health Service Act to review its rec- 2 ommendation for screening for HBV and HCV 3 infection every 3 years. 4 ‘‘(3) ACTIVITIES.— 5 ‘‘(A) VOLUNTARY TESTING PROGRAMS.— 6 ‘‘(i) IN GENERAL.—The Secretary 7 shall establish a mechanism by which to 8 support and promote the development of 9 State, local, territorial, and tribal vol- 10 untary hepatitis B and hepatitis C testing 11 programs to screen the high-prevalence 12 populations to aid in the early identifica- 13 tion of chronically infected individuals. 14 ‘‘(ii) CONFIDENTIALITY OF THE TEST 15 RESULTS.—The Secretary shall prohibit 16 the use of the results of a hepatitis B or 17 hepatitis C test conducted by a testing pro- 18 gram developed or supported under this 19 subparagraph for any of the following: 20 ‘‘(I) Issues relating to health in- 21 surance. 22 ‘‘(II) To screen or determine 23 suitability for employment. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00472 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 473 •HR 5475 IH ‘‘(III) To discharge a person 1 from employment. 2 ‘‘(B) COUNSELING REGARDING VIRAL HEP- 3 ATITIS.—The Secretary shall support State, 4 local, territorial, and tribal programs in a wide 5 variety of settings, including those providing 6 primary and specialty health care services in 7 nonprofit private and public sectors, to— 8 ‘‘(i) provide individuals with ongoing 9 risk factors for hepatitis B and hepatitis C 10 infection with client-centered education 11 and counseling which concentrates on— 12 ‘‘(I) promoting testing of individ- 13 uals that have been exposed to their 14 blood, family members, and their sex- 15 ual partners; and 16 ‘‘(II) changing behaviors that 17 place individuals at risk for infection; 18 ‘‘(ii) provide individuals chronically in- 19 fected with hepatitis B or hepatitis C with 20 education, health information, and coun- 21 seling to reduce their risk of— 22 ‘‘(I) dying from end-stage liver 23 disease and liver cancer; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00473 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 474 •HR 5475 IH ‘‘(II) transmitting viral hepatitis 1 to others; and 2 ‘‘(iii) provide women chronically in- 3 fected with hepatitis B or hepatitis C who 4 are pregnant or of childbearing age with 5 culturally and linguistically appropriate 6 health information, such as how to prevent 7 hepatitis B perinatal infection, and to al- 8 leviate fears associated with pregnancy or 9 raising a family. 10 ‘‘(C) IMMUNIZATION.—The Secretary shall 11 support State, local, territorial, and tribal ef- 12 forts to expand the current vaccination pro- 13 grams to protect every child in the country and 14 all susceptible adults, particularly those infected 15 with hepatitis C and high-prevalence ethnic 16 populations and other high-risk groups, from 17 the risks of acute and chronic hepatitis B infec- 18 tion by— 19 ‘‘(i) ensuring continued funding for 20 hepatitis B vaccination for all children 19 21 years of age or younger through the Vac- 22 cines for Children Program; 23 ‘‘(ii) ensuring that the recommenda- 24 tions of the Advisory Committee on Immu- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00474 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 475 •HR 5475 IH nization Practices are followed regarding 1 the birth dose of hepatitis B vaccinations 2 for newborns; 3 ‘‘(iii) requiring proof of hepatitis B 4 vaccination for entry into public or private 5 daycare, preschool, elementary school, sec- 6 ondary school, and institutions of higher 7 education; 8 ‘‘(iv) expanding the availability of 9 hepatitis B vaccination for all susceptible 10 adults to protect them from becoming 11 acutely or chronically infected, including 12 ethnic and other populations with high 13 prevalence rates of chronic hepatitis B in- 14 fection; 15 ‘‘(v) expanding the availability of hep- 16 atitis B vaccination for all susceptible 17 adults, particularly those in their reproduc- 18 tive age (women and men less than 45 19 years of age), to protect them from the 20 risk of hepatitis B infection; 21 ‘‘(vi) ensuring the vaccination of indi- 22 viduals infected, or at risk for infection, 23 with hepatitis C against hepatitis A, hepa- 24 titis B, and other infectious diseases, as 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00475 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 476 •HR 5475 IH appropriate, for which such individuals 1 may be at increased risk; and 2 ‘‘(vii) ensuring the vaccination of indi- 3 viduals infected, or at risk for infection, 4 with hepatitis B against hepatitis A virus 5 and other infectious diseases, as appro- 6 priate, for which such individuals may be 7 at increased risk. 8 ‘‘(D) MEDICAL REFERRAL.—The Secretary 9 shall support State, local, territorial, and tribal 10 programs that support— 11 ‘‘(i) referral of persons chronically in- 12 fected with hepatitis B or hepatitis C— 13 ‘‘(I) for medical evaluation to de- 14 termine the appropriateness for 15 antiviral treatment to reduce the risk 16 of progression to cirrhosis and liver 17 cancer; and 18 ‘‘(II) for ongoing medical man- 19 agement including regular monitoring 20 of liver function and screening for 21 liver cancer; and 22 ‘‘(ii) referral of persons infected with 23 acute or chronic hepatitis B infection or 24 acute or chronic hepatitis C infection for 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00476 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 477 •HR 5475 IH drug and alcohol abuse treatment where 1 appropriate. 2 ‘‘(4) INCREASED SUPPORT FOR ADULT VIRAL 3 HEPATITIS PREVENTION COORDINATORS.—The Sec- 4 retary, acting through the Director of the Centers 5 for Disease Control and Prevention, shall provide in- 6 creased support to adult viral hepatitis prevention 7 coordinators in State, local, territorial, and tribal 8 health departments in order to enhance the addi- 9 tional management, networking, and technical exper- 10 tise needed to ensure successful integration of hepa- 11 titis B and hepatitis C prevention and control activi- 12 ties into existing public health programs. 13 ‘‘(c) EPIDEMIOLOGICAL SURVEILLANCE.— 14 ‘‘(1) IN GENERAL.—The Secretary, acting 15 through the Director of the Centers for Disease 16 Control and Prevention, shall support the establish- 17 ment and maintenance of a national chronic and 18 acute hepatitis B and hepatitis C surveillance pro- 19 gram, in order to identify— 20 ‘‘(A) trends in the incidence of acute and 21 chronic hepatitis B and acute and chronic hepa- 22 titis C; 23 ‘‘(B) trends in the prevalence of acute and 24 chronic hepatitis B and acute and chronic hepa- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00477 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 478 •HR 5475 IH titis C infection among groups that may be dis- 1 proportionately affected; and 2 ‘‘(C) trends in liver cancer and end-stage 3 liver disease incidence and deaths, caused by 4 chronic hepatitis B and chronic hepatitis C in 5 the high-risk ethnic populations. 6 ‘‘(2) SEROPREVALENCE AND LIVER CANCER 7 STUDIES.—The Secretary, acting through the Direc- 8 tor of the Centers for Disease Control and Preven- 9 tion, shall prepare a report outlining the population- 10 based seroprevalence studies currently underway, fu- 11 ture planned studies, the criteria involved in deter- 12 mining which seroprevalence studies to conduct, 13 defer, or suspend, and the scope of those studies, the 14 economic and clinical impact of hepatitis B and hep- 15 atitis C, and the impact of chronic hepatitis B and 16 chronic hepatitis C infections on the quality of life. 17 Not later than one year after the date of the enact- 18 ment of this part, the Secretary shall submit the re- 19 port to the Committee on Energy and Commerce of 20 the House of Representatives and the Committee on 21 Health, Education, Labor, and Pensions of the Sen- 22 ate. 23 ‘‘(3) CONFIDENTIALITY.—The Secretary shall 24 not disclose any individually identifiable information 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00478 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 479 •HR 5475 IH identified under paragraph (1) or derived through 1 studies under paragraph (2). 2 ‘‘(d) RESEARCH.—The Secretary, acting through the 3 Director of the Centers for Disease Control and Preven- 4 tion, the Director of the National Cancer Institute, and 5 the Director of the National Institutes of Health, shall— 6 ‘‘(1) conduct epidemiologic and community- 7 based research to develop, implement, and evaluate 8 best practices for hepatitis B and hepatitis C pre- 9 vention especially in the ethnic populations with high 10 rates of chronic hepatitis B and chronic hepatitis C 11 and other high-risk groups; 12 ‘‘(2) conduct research on hepatitis B and hepa- 13 titis C natural history, pathophysiology, improved 14 treatments and prevention (such as the hepatitis C 15 vaccine), and noninvasive tests that help to predict 16 the risk of progression to liver cirrhosis and liver 17 cancer; 18 ‘‘(3) conduct research that will lead to better 19 noninvasive or blood tests to screen for liver cancer, 20 and more effective treatments of liver cancer caused 21 by chronic hepatitis B and chronic hepatitis C; and 22 ‘‘(4) conduct research comparing the effective- 23 ness of screening, diagnostic, management, and 24 treatment approaches for chronic hepatitis B, chron- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00479 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 480 •HR 5475 IH ic hepatitis C, and liver cancer in the affected com- 1 munities. 2 ‘‘(e) UNDERSERVED AND DISPROPORTIONATELY AF- 3 FECTED POPULATIONS.—In carrying out this section, the 4 Secretary shall provide expanded support for individuals 5 with limited access to health education, testing, and health 6 care services and groups that may be disproportionately 7 affected by hepatitis B and hepatitis C. 8 ‘‘(f) EVALUATION OF PROGRAM.—The Secretary 9 shall develop benchmarks for evaluating the effectiveness 10 of the programs and activities conducted under this sec- 11 tion and make determinations as to whether such bench- 12 marks have been achieved. 13 ‘‘SEC. 399NN–2. GRANTS. 14 ‘‘(a) IN GENERAL.—The Secretary may award grants 15 to, or enter into contracts or cooperative agreements with, 16 States, political subdivisions of States, territories, Indian 17 tribes, or nonprofit entities that have special expertise re- 18 lating to hepatitis B, hepatitis C, or both, to carry out 19 activities under this part. 20 ‘‘(b) APPLICATION.—To be eligible for a grant, con- 21 tract, or cooperative agreement under subsection (a), an 22 entity shall prepare and submit to the Secretary an appli- 23 cation at such time, in such manner, and containing such 24 information as the Secretary may require. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00480 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 481 •HR 5475 IH ‘‘SEC. 399NN–3. AUTHORIZATION OF APPROPRIATIONS. 1 ‘‘There are authorized to be appropriated to carry out 2 this part $90,000,000 for fiscal year 2017, $90,000,000 3 for fiscal year 2018, $110,000,000 for fiscal year 2019, 4 $130,000,000 for fiscal year 2020, and $150,000,000 for 5 fiscal year 2021.’’. 6 (d) ENHANCING SAMHSA’S ROLE IN HEPATITIS AC- 7 TIVITIES.—Paragraph (6) of section 501(d) of the Public 8 Health Service Act (42 U.S.C. 290aa(d)) is amended by 9 striking ‘‘HIV or tuberculosis’’ and inserting ‘‘HIV, tuber- 10 culosis, or hepatitis’’. 11 Subtitle C—Acquired Bone Marrow 12 Failure Diseases 13 SEC. 721. ACQUIRED BONE MARROW FAILURE DISEASES. 14 (a) SHORT TITLE.—This subtitle may be cited as the 15 ‘‘Bone Marrow Failure Disease Research and Treatment 16 Act of 2016’’. 17 (b) FINDINGS.—The Congress finds the following: 18 (1) Between 20,000 and 30,000 Americans are 19 diagnosed each year with myelodysplastic syndromes, 20 aplastic anemia, paroxysmal nocturnal hemo- 21 globinuria, and other acquired bone marrow failure 22 diseases. 23 (2) Acquired bone marrow failure diseases have 24 a debilitating and often fatal impact on those diag- 25 nosed with these diseases. 26 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00481 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 482 •HR 5475 IH (3) While some treatments for acquired bone 1 marrow failure diseases can prolong and improve the 2 quality of patients’ lives, there is no single cure for 3 these diseases. 4 (4) The prevalence of acquired bone marrow 5 failure diseases in the United States will continue to 6 grow as the general public ages. 7 (5) Evidence exists suggesting that acquired 8 bone marrow failure diseases occur more often in 9 minority populations, particularly in Asian-American 10 and Latino or Hispanic populations. 11 (6) The National Heart, Lung, and Blood Insti- 12 tute and the National Cancer Institute have con- 13 ducted important research into the causes of and 14 treatments for acquired bone marrow failure dis- 15 eases. 16 (7) The National Marrow Donor Program Reg- 17 istry has made significant contributions to the fight 18 against bone marrow failure diseases by connecting 19 millions of potential marrow donors with individuals 20 and families suffering from these conditions. 21 (8) Despite these advances, a more comprehen- 22 sive Federal strategic effort among numerous Fed- 23 eral agencies is needed to discover a cure for ac- 24 quired bone marrow failure disorders. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00482 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 483 •HR 5475 IH (9) Greater Federal surveillance of acquired 1 bone marrow failure diseases is needed to gain a bet- 2 ter understanding of the causes of acquired bone 3 marrow failure diseases. 4 (10) The Federal Government should increase 5 its research support for and engage with public and 6 private organizations in developing a comprehensive 7 approach to combat and cure acquired bone marrow 8 failure diseases. 9 (c) NATIONAL ACQUIRED BONE MARROW FAILURE 10 DISEASE REGISTRY.—Part B of the Public Health Service 11 Act (42 U.S.C. 311 et seq.) is amended by inserting after 12 section 317W, as added, the following: 13 ‘‘SEC. 317X. NATIONAL ACQUIRED BONE MARROW FAILURE 14 DISEASE REGISTRY. 15 ‘‘(a) ESTABLISHMENT OF REGISTRY.— 16 ‘‘(1) IN GENERAL.—Not later than 6 months 17 after the date of the enactment of this section, the 18 Secretary, acting through the Director of the Cen- 19 ters for Disease Control and Prevention, shall— 20 ‘‘(A) develop a system to collect data on 21 acquired bone marrow failure diseases; and 22 ‘‘(B) establish and maintain a national and 23 publicly available registry, to be known as the 24 National Acquired Bone Marrow Failure Dis- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00483 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 484 •HR 5475 IH ease Registry, in accordance with paragraph 1 (3). 2 ‘‘(2) RECOMMENDATIONS OF ADVISORY COM- 3 MITTEE.—In carrying out this subsection, the Sec- 4 retary shall take into consideration the recommenda- 5 tions of the Advisory Committee on Acquired Bone 6 Marrow Failure Diseases established under sub- 7 section (b). 8 ‘‘(3) PURPOSES OF REGISTRY.—The National 9 Acquired Bone Marrow Failure Disease Registry— 10 ‘‘(A) shall identify the incidence and preva- 11 lence of acquired bone marrow failure diseases 12 in the United States; 13 ‘‘(B) shall be used to collect and store data 14 on acquired bone marrow failure diseases, in- 15 cluding data concerning— 16 ‘‘(i) the age, race or ethnicity, general 17 geographic location, sex, and family history 18 of individuals who are diagnosed with ac- 19 quired bone marrow failure diseases, and 20 any other characteristics of such individ- 21 uals determined appropriate by the Sec- 22 retary; 23 ‘‘(ii) the genetic and environmental 24 factors that may be associated with devel- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00484 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 485 •HR 5475 IH oping acquired bone marrow failure dis- 1 eases; 2 ‘‘(iii) treatment approaches for deal- 3 ing with acquired bone marrow failure dis- 4 eases; 5 ‘‘(iv) outcomes for individuals treated 6 for acquired bone marrow failure diseases, 7 including outcomes for recipients of stem 8 cell therapeutic products as contained in 9 the database established pursuant to sec- 10 tion 379A; and 11 ‘‘(v) any other factors pertaining to 12 acquired bone marrow failure diseases de- 13 termined appropriate by the Secretary; and 14 ‘‘(C) shall be made available— 15 ‘‘(i) to the general public; and 16 ‘‘(ii) to researchers to facilitate fur- 17 ther research into the causes of, and treat- 18 ments for, acquired bone marrow failure 19 diseases in accordance with standard prac- 20 tices of the Centers for Disease Control 21 and Preventions. 22 ‘‘(b) ADVISORY COMMITTEE.— 23 ‘‘(1) ESTABLISHMENT.—Not later than 6 24 months after the date of the enactment of this sec- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00485 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 486 •HR 5475 IH tion, the Secretary, acting through the Director of 1 the Centers for Disease Control and Prevention, 2 shall establish an advisory committee, to be known 3 as the Advisory Committee on Acquired Bone Mar- 4 row Failure Diseases. 5 ‘‘(2) MEMBERS.—The members of the Advisory 6 Committee on Acquired Bone Marrow Failure Dis- 7 eases shall be appointed by the Secretary, acting 8 through the Director of the Centers for Disease 9 Control and Prevention, and shall include at least 10 one representative from each of the following: 11 ‘‘(A) A national patient advocacy organiza- 12 tion with experience advocating on behalf of pa- 13 tients suffering from acquired bone marrow 14 failure diseases. 15 ‘‘(B) The National Institutes of Health, in- 16 cluding at least one representative from each 17 of— 18 ‘‘(i) the National Cancer Institute; 19 ‘‘(ii) the National Heart, Lung, and 20 Blood Institute; and 21 ‘‘(iii) the Office of Rare Diseases. 22 ‘‘(C) The Centers for Disease Control and 23 Prevention. 24 ‘‘(D) Clinicians with experience in— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00486 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 487 •HR 5475 IH ‘‘(i) diagnosing or treating acquired 1 bone marrow failure diseases; and 2 ‘‘(ii) medical data registries. 3 ‘‘(E) Epidemiologists who have experience 4 with data registries. 5 ‘‘(F) Publicly or privately funded research- 6 ers who have experience researching acquired 7 bone marrow failure diseases. 8 ‘‘(G) The entity operating the C.W. Bill 9 Young Cell Transplantation Program estab- 10 lished pursuant to section 379 and the entity 11 operating the C.W. Bill Young Cell Transplan- 12 tation Program Outcomes Database. 13 ‘‘(3) RESPONSIBILITIES.—The Advisory Com- 14 mittee on Acquired Bone Marrow Failure Diseases 15 shall provide recommendations to the Secretary on 16 the establishment and maintenance of the National 17 Acquired Bone Marrow Failure Disease Registry, in- 18 cluding recommendations on the collection, mainte- 19 nance, and dissemination of data. 20 ‘‘(4) PUBLIC AVAILABILITY.—The Secretary 21 shall make the recommendations of the Advisory 22 Committee on Acquired Bone Marrow Failure Dis- 23 ease publicly available. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00487 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 488 •HR 5475 IH ‘‘(c) GRANTS.—The Secretary, acting through the 1 Director of the Centers for Disease Control and Preven- 2 tion, may award grants to, and enter into contracts and 3 cooperative agreements with, public or private nonprofit 4 entities for the management of, as well as the collection, 5 analysis, and reporting of data to be included in, the Na- 6 tional Acquired Bone Marrow Failure Disease Registry. 7 ‘‘(d) DEFINITION.—In this section, the term ‘ac- 8 quired bone marrow failure disease’ means— 9 ‘‘(1) myelodysplastic syndromes (MDS); 10 ‘‘(2) aplastic anemia; 11 ‘‘(3) paroxysmal nocturnal hemoglobinuria 12 (PNH); 13 ‘‘(4) pure red cell aplasia; 14 ‘‘(5) acute myeloid leukemia that has pro- 15 gressed from myelodysplastic syndromes; or 16 ‘‘(6) large granular lymphocytic leukemia. 17 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 18 is authorized to be appropriated to carry out this section 19 $3,000,000 for each of fiscal years 2017 through 2021.’’. 20 (d) PILOT STUDIES THROUGH THE AGENCY FOR 21 TOXIC SUBSTANCES AND DISEASE REGISTRY.— 22 (1) PILOT STUDIES.—The Secretary of Health 23 and Human Services, acting through the Adminis- 24 trator of the Agency for Toxic Substances and Dis- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00488 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 489 •HR 5475 IH ease Registry, shall conduct pilot studies to deter- 1 mine which environmental factors, including expo- 2 sure to toxins, may cause acquired bone marrow fail- 3 ure diseases. 4 (2) COLLABORATION WITH THE RADIATION IN- 5 JURY TREATMENT NETWORK.—In carrying out the 6 directives of this section, the Secretary may collabo- 7 rate with the Radiation Injury Treatment Network 8 of the C.W. Bill Young Cell Transplantation Pro- 9 gram established pursuant to section 379 of the 10 Public Health Service Act (42 U.S.C. 274j) to— 11 (A) augment data for the pilot studies au- 12 thorized by this section; 13 (B) access technical assistance that may be 14 provided by the Radiation Injury Treatment 15 Network; or 16 (C) perform joint research projects. 17 (3) AUTHORIZATION OF APPROPRIATIONS.— 18 There is authorized to be appropriated to carry out 19 this section $1,000,000 for each of fiscal years 2017 20 through 2021. 21 (e) MINORITY-FOCUSED PROGRAMS ON ACQUIRED 22 BONE MARROW FAILURE DISEASES.—Title XVII of the 23 Public Health Service Act (42 U.S.C. 300u et seq.) is 24 amended by inserting after section 1707A the following: 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00489 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 490 •HR 5475 IH ‘‘MINORITY-FOCUSED PROGRAMS ON ACQUIRED BONE 1 MARROW FAILURE DISEASES 2 ‘‘SEC. 1707B. (a) INFORMATION AND REFERRAL 3 SERVICES.— 4 ‘‘(1) IN GENERAL.—Not later than 6 months 5 after the date of the enactment of this section, the 6 Secretary, acting through the Deputy Assistant Sec- 7 retary for Minority Health, shall establish and co- 8 ordinate outreach and informational programs tar- 9 geted to minority populations affected by acquired 10 bone marrow failure diseases. 11 ‘‘(2) PROGRAM REQUIREMENTS.—Minority-fo- 12 cused outreach and informational programs author- 13 ized by this section— 14 ‘‘(A) shall make information about treat- 15 ment options and clinical trials for acquired 16 bone marrow failure diseases publicly available, 17 and 18 ‘‘(B) shall provide referral services for 19 treatment options and clinical trials, 20 at the National Minority Health Resource Center 21 supported under section 1707(b)(8) (including by 22 means of the Center’s Web site, through appropriate 23 locations such as the Center’s knowledge center, and 24 through appropriate programs such as the Center’s 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00490 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 491 •HR 5475 IH resource persons network) and through minority 1 health consultants located at each Department of 2 Health and Human Services regional office. 3 ‘‘(b) HISPANIC AND ASIAN-AMERICAN AND PACIFIC 4 ISLANDER OUTREACH.— 5 ‘‘(1) IN GENERAL.—The Secretary, acting 6 through the Deputy Assistant Secretary for Minority 7 Health, shall undertake a coordinated outreach ef- 8 fort to connect Hispanic, Asian-American, and Pa- 9 cific Islander communities with comprehensive serv- 10 ices focused on treatment of, and information about, 11 acquired bone marrow failure diseases. 12 ‘‘(2) COLLABORATION.—In carrying out this 13 subsection, the Secretary may collaborate with public 14 health agencies, nonprofit organizations, community 15 groups, and online entities to disseminate informa- 16 tion about treatment options and clinical trials for 17 acquired bone marrow failure diseases. 18 ‘‘(c) GRANTS AND COOPERATIVE AGREEMENTS.— 19 ‘‘(1) IN GENERAL.—Not later than 6 months 20 after the date of the enactment of this section, the 21 Secretary, acting through the Deputy Assistant Sec- 22 retary for Minority Health, shall award grants to, or 23 enter into cooperative agreements with, entities to 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00491 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 492 •HR 5475 IH perform research on acquired bone marrow failure 1 diseases. 2 ‘‘(2) REQUIREMENT.—Grants and cooperative 3 agreements authorized by this subsection shall be 4 awarded or entered into on a competitive, peer-re- 5 viewed basis. 6 ‘‘(3) SCOPE OF RESEARCH.—Research funded 7 under this section shall examine factors affecting the 8 incidence of acquired bone marrow failure diseases 9 in minority populations. 10 ‘‘(d) DEFINITION.—In this section, the term ‘ac- 11 quired bone marrow failure disease’ has the meaning given 12 to such term in section 317X(d). 13 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 14 is authorized to be appropriated to carry out this section 15 $2,000,000 for each of fiscal years 2017 through 2021.’’. 16 (f) DIAGNOSIS AND QUALITY OF CARE FOR AC- 17 QUIRED BONE MARROW FAILURE DISEASES.— 18 (1) GRANTS.—The Secretary of Health and 19 Human Services, acting through the Director of the 20 Agency for Healthcare Research and Quality, shall 21 award grants to entities to improve diagnostic prac- 22 tices and quality of care with respect to patients 23 with acquired bone marrow failure diseases. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00492 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 493 •HR 5475 IH (2) AUTHORIZATION OF APPROPRIATIONS.— 1 There is authorized to be appropriated to carry out 2 this section $2,000,000 for each of fiscal years 2017 3 through 2021. 4 (g) DEFINITION.—In this section, the term ‘‘acquired 5 bone marrow failure disease’’ means— 6 (1) myelodysplastic syndromes (MDS); 7 (2) aplastic anemia; 8 (3) paroxysmal nocturnal hemoglobinuria 9 (PNH); 10 (4) pure red cell aplasia; 11 (5) acute myeloid leukemia that progressed 12 from myelodysplastic syndromes; or 13 (6) large granular lymphocytic leukemia. 14 Subtitle D—Cardiovascular Dis- 15 ease, Chronic Disease, and 16 Other Disease Issues 17 SEC. 731. GUIDELINES FOR DISEASE SCREENING FOR MI- 18 NORITY PATIENTS. 19 (a) IN GENERAL.—The Secretary, acting through the 20 Director of the Agency for Healthcare Research and Qual- 21 ity, shall convene a series of meetings to develop guidelines 22 for disease screening for minority patient populations 23 which have a higher than average risk for many chronic 24 diseases and cancers. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00493 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 494 •HR 5475 IH (b) PARTICIPANTS.—In convening meetings under 1 subsection (a), the Secretary shall ensure that meeting 2 participants include representatives of— 3 (1) professional societies and associations; 4 (2) minority health organizations; 5 (3) health care researchers and providers, in- 6 cluding those with expertise in minority health; 7 (4) Federal health agencies, including the Of- 8 fice of Minority Health, the National Institute on 9 Minority Health and Health Disparities, and the 10 National Institutes of Health; and 11 (5) other experts determined appropriate by the 12 Secretary. 13 (c) DISEASES.—Screening guidelines for minority 14 populations shall be developed as appropriate under sub- 15 section (a) for— 16 (1) hypertension; 17 (2) hypercholesterolemia; 18 (3) diabetes; 19 (4) cardiovascular disease; 20 (5) cancers, including breast, prostate, colon, 21 cervical, and lung cancer; 22 (6) other pulmonary problems including sleep 23 apnea; 24 (7) asthma; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00494 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 495 •HR 5475 IH (8) diabetes; 1 (9) kidney diseases; 2 (10) eye diseases and disorders, including glau- 3 coma; 4 (11) HIV/AIDS and sexually transmitted infec- 5 tions; 6 (12) uterine fibroids; 7 (13) autoimmune disease; 8 (14) mental health conditions; 9 (15) dental health conditions and oral diseases, 10 including oral cancer; 11 (16) environmental and related health illnesses 12 and conditions; 13 (17) sickle cell disease and sickle cell trait; 14 (18) violence and injury prevention and control; 15 (19) genetic and related conditions; 16 (20) heart disease and stroke; 17 (21) tuberculosis; 18 (22) chronic obstructive pulmonary disease; 19 (23) musculoskeletal diseases, arthritis, and 20 obesity; and 21 (24) other diseases determined appropriate by 22 the Secretary. 23 (d) DISSEMINATION.—Not later than 24 months 24 after the date of enactment of this title, the Secretary 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00495 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 496 •HR 5475 IH shall publish and disseminate to health care provider orga- 1 nizations the guidelines developed under subsection (a). 2 (e) AUTHORIZATION OF APPROPRIATIONS.—There 3 are authorized to be appropriated to carry out this section, 4 such sums as may be necessary for each of fiscal years 5 2017 through 2021. 6 SEC. 732. CDC WISEWOMAN SCREENING PROGRAM. 7 Section 1509 of the Public Health Service Act (42 8 U.S.C. 300n–4a) is amended— 9 (1) in subsection (a)— 10 (A) by striking the heading and inserting 11 ‘‘IN GENERAL.—’’; and 12 (B) in the matter preceding paragraph (1), 13 by striking ‘‘may make grants’’ and all that fol- 14 lows through ‘‘purpose’’ and inserting the fol- 15 lowing: ‘‘may make grants to such States for 16 the purpose’’; and 17 (2) in subsection (d)(1), by striking ‘‘there are 18 authorized’’ and all that follows through the period 19 and inserting ‘‘there are authorized to be appro- 20 priated $23,000,000 for fiscal year 2017, 21 $25,300,000 for fiscal year 2018, $27,800,000 for 22 fiscal year 2019, $30,800,000 for fiscal year 2020, 23 and $34,000,000 for fiscal year 2021.’’. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00496 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 497 •HR 5475 IH SEC. 733. REPORT ON CARDIOVASCULAR CARE FOR WOMEN 1 AND MINORITIES. 2 Part P of title III of the Public Health Service Act 3 (42 U.S.C. 280g et seq.) is amended by adding at the end 4 the following: 5 ‘‘SEC. 399V–6. REPORT ON CARDIOVASCULAR CARE FOR 6 WOMEN AND MINORITIES. 7 ‘‘Not later than September 30, 2017, and annually 8 thereafter, the Secretary shall prepare and submit to the 9 Congress a report on the quality of and access to care 10 for women and minorities with heart disease, stroke, and 11 other cardiovascular diseases. The report shall contain rec- 12 ommendations for eliminating disparities in, and improv- 13 ing the treatment of, heart disease, stroke, and other car- 14 diovascular diseases in women, racial and ethnic minori- 15 ties, those for whom English is not their primary lan- 16 guage, and individuals with disabilities.’’. 17 SEC. 734. COVERAGE OF COMPREHENSIVE TOBACCO CES- 18 SATION SERVICES IN MEDICAID AND IN ACA 19 ESSENTIAL HEALTH BENEFITS . 20 (a) REQUIRING COVERAGE OF COUNSELING AND 21 PHARMACOTHERAPY FOR CESSATION OF TOBACCO 22 USE.—Section 1905 of the Social Security Act (42 U.S.C. 23 1396d) is amended— 24 (1) in subsection (a)(4)(D), is amended by 25 striking ‘‘by pregnant women’’; and 26 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00497 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 498 •HR 5475 IH (2) in subsection (bb)— 1 (A) by striking ‘‘by pregnant women’’ each 2 place it appears; 3 (B) in paragraph (1), in the matter before 4 subparagraph (A), by inserting ‘‘by individuals’’ 5 before ‘‘who use tobacco’’; and 6 (C) in paragraph (2)(A), by striking ‘‘with 7 respect to pregnant women’’. 8 (b) EXCEPTION FROM OPTIONAL RESTRICTION 9 UNDER MEDICAID PRESCRIPTION DRUG COVERAGE.— 10 Section 1927(d)(2)(F) of the Social Security Act (42 11 U.S.C. 1396r–8(d)(2)(F)) is amended by striking ‘‘in the 12 case of pregnant women’’. 13 (c) STATE MONITORING AND PROMOTING OF COM- 14 PREHENSIVE TOBACCO CESSATION SERVICES UNDER 15 MEDICAID.—Section 1902(a) of the Social Security Act 16 (42 U.S.C. 1395a(a)), as amended by section 450(c), is 17 amended— 18 (1) by striking ‘‘and’’ at the end of paragraph 19 (81); 20 (2) by striking the period at the end of para- 21 graph (82) and inserting ‘‘; and’’; and 22 (3) by inserting after paragraph (82) the fol- 23 lowing new paragraph: 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00498 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 499 •HR 5475 IH ‘‘(83) provide for the State to monitor and pro- 1 mote the use of comprehensive tobacco cessation 2 services under the State plan;’’. 3 (d) REMOVAL OF COST SHARING FOR COUNSELING 4 AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO 5 USE UNDER MEDICAID.— 6 (1) GENERAL COST SHARING LIMITATIONS.— 7 Section 1916 of the Social Security Act (42 U.S.C. 8 1396o) is amended— 9 (A) in subsections (a)(2)(B) and (b)(2)(B), 10 by striking ‘‘and counseling and pharmacother- 11 apy for cessation of tobacco use by pregnant 12 women (as defined in section 1905(bb)) and 13 covered outpatient drugs (as defined in sub- 14 section (k)(2) of section 1927 and including 15 nonprescription drugs described in subsection 16 (d)(2) of such section) that are prescribed for 17 purposes of promoting, and when used to pro- 18 mote, tobacco cessation by pregnant women in 19 accordance with the Guideline referred to in 20 section 1905(bb)(2)(A)’’ each place it appears; 21 and 22 (B) in each of subsections (a)(2)(D) and 23 (b)(2)(D) by inserting ‘‘and counseling and 24 pharmacotherapy for cessation of tobacco use 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00499 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 500 •HR 5475 IH (as defined in section 1905(bb)) and covered 1 outpatient drugs (as defined in subsection 2 (k)(2) of section 1927 and including non- 3 prescription drugs described in subsection 4 (d)(2) of such section) that are prescribed for 5 purposes of promoting, and when used to pro- 6 mote, tobacco cessation in accordance with the 7 Guideline referred to in section 8 1905(bb)(2)(A),’’ after ‘‘section 9 1905(a)(4)(C),’’. 10 (2) APPLICATION TO ALTERNATIVE COST SHAR- 11 ING.—Section 1916A(b)(3)(B) of such Act (42 12 U.S.C. 1396o–1(b)(3)(B)42 U.S.C. 1396o– 13 1(b)(3)(B)) is amended— 14 (A) in clause (iii), by striking ‘‘, and coun- 15 seling and pharmacotherapy for cessation of to- 16 bacco use by pregnant women (as defined in 17 section 1905(bb))’’; and 18 (B) by adding at the end the following: 19 ‘‘(xi) Counseling and pharmacothera- 20 py for cessation of tobacco use (as defined 21 in section 1905(bb)) and covered out- 22 patient drugs (as defined in subsection 23 (k)(2) of section 1927 and including non- 24 prescription drugs described in subsection 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00500 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 501 •HR 5475 IH (d)(2) of such section) that are prescribed 1 for purposes of promoting, and when used 2 to promote, tobacco cessation in accord- 3 ance with the Guideline referred to in sec- 4 tion 1905(bb)(2)(A).’’. 5 (e) COMPREHENSIVE COVERAGE UNDER ACA ES- 6 SENTIAL HEALTH BENEFITS.— 7 (1) COVERAGE.—Section 1302(b)(1) of the Pa- 8 tient Protection and Affordable Care Act (42 U.S.C. 9 18022(b)(1)) is amended by adding at the end the 10 following new subparagraph: 11 ‘‘(K) Comprehensive tobacco cessation 12 services and medications, including all evidence- 13 based tobacco cessation counseling and all 14 medications for tobacco cessation approved by 15 the Food and Drug Administration.’’. 16 (2) NO COST SHARING.—Section 1302(c) of the 17 Patient Protection and Affordable Care Act (42 18 U.S.C. 18022(c)) is amended by inserting after 19 paragraph (1) the following new paragraph: 20 ‘‘(2) NO COST SHARING OR PRIOR AUTHORIZA- 21 TION FOR COMPREHENSIVE TOBACCO CESSATION 22 COVERAGE.—There shall be no cost sharing or prior 23 authorization requirement imposed with respect to 24 services described in subsection (b)(1)(K).’’. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00501 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 502 •HR 5475 IH (f) EFFECTIVE DATE.—The amendments made by 1 this section shall apply to items and services furnished on 2 or after January 1, 2017. 3 SEC. 735. CLINICAL RESEARCH FUNDING FOR ORAL 4 HEALTH. 5 (a) IN GENERAL.—The Secretary of Health and 6 Human Services shall expand and intensify the conduct 7 and support of the research activities of the National In- 8 stitutes of Health and the National Institute of Dental 9 and Craniofacial Research to improve the oral health of 10 the population through the prevention and management 11 of oral diseases and conditions. 12 (b) INCLUDED RESEARCH ACTIVITIES.—Research 13 activities under subsection (a) shall include— 14 (1) comparative effectiveness research and clin- 15 ical disease management research addressing early 16 childhood caries and oral cancer; and 17 (2) awarding of grants and contracts to support 18 the training and development of health services re- 19 searchers, comparative effectiveness researchers, and 20 clinical researchers whose research improves the oral 21 health of the population. 22 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00502 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 503 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00503 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 504 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00504 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 505 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00505 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 506 •HR 5475 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 Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00506 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 507 •HR 5475 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 the Social Security Act (42 U.S.C. 1396a(a)) is amended 21 by inserting after paragraph (77) the following new para- 22 graph: 23 ‘‘(78) provide that participation in an approved 24 clinical trial and coverage of routine patient costs 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00507 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 508 •HR 5475 IH associated with such trial for an individual eligible 1 for medical assistance under this title is conducted 2 in accordance with the requirements under section 3 1944;’’. 4 (c) EFFECTIVE DATE.— 5 (1) IN GENERAL.—Except as provided in para- 6 graph (2), the amendments made by this section 7 shall apply to calendar quarters beginning on or 8 after October 1, 2016. 9 (2) DELAY PERMITTED FOR STATE PLAN 10 AMENDMENT.—In the case of a State plan for med- 11 ical assistance under title XIX of the Social Security 12 Act which the Secretary of Health and Human Serv- 13 ices determines requires State legislation (other than 14 legislation appropriating funds) in order for the plan 15 to meet the additional requirements imposed by the 16 amendments made by this section, the State plan 17 shall not be regarded as failing to comply with the 18 requirements of such title solely on the basis of its 19 failure to meet these additional requirements before 20 the first day of the first calendar quarter beginning 21 after the close of the first regular session of the 22 State legislature that begins after the date of enact- 23 ment of this Act. For purposes of the previous sen- 24 tence, in the case of a State that has a 2-year legis- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00508 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 509 •HR 5475 IH lative session, each year of such session shall be 1 deemed to be a separate regular session of the State 2 legislature. 3 Subtitle E—HIV/AIDS 4 SEC. 741. STATEMENT OF POLICY. 5 It is the policy of the United States to achieve an 6 AIDS-free generation, and to— 7 (1) expand access to lifesaving antiretroviral 8 therapy for people living with HIV/AIDS and imme- 9 diately link people to continuous and coordinated 10 high-quality care when they learn they are infected 11 with HIV; 12 (2) expand targeted efforts to prevent HIV in- 13 fection using a combination of effective, evidence- 14 based approaches, including routine HIV screening, 15 and universal access to HIV prevention tools in the 16 communities where HIV/AIDS is most heavily con- 17 centrated, particularly communities of color; 18 (3) ensure laws, policies, and regulations do not 19 impede access to prevention, treatment, and care for 20 people living with HIV/AIDS or at risk for acquiring 21 HIV; 22 (4) accelerate research for more efficacious HIV 23 prevention and treatments tools, a cure, and a vac- 24 cine; and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00509 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 510 •HR 5475 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, 16 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 2010 there were approxi- 15 mately 47,500 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). CDC data show that since 2006, HIV inci- 21 dence has increased among Black and Latino gay 22 men/MSM, notably those aged 13 to 24 years. Even 23 more concerning is that there are more new HIV in- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00510 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 511 •HR 5475 IH fections among young African American gay men/ 1 MSM than any other subgroup of gay men/MSM. 2 (4) HIV disproportionately affects certain popu- 3 lations in the United States. Though African-Ameri- 4 cans represent approximately 14 percent of the pop- 5 ulation, African-Americans account for almost half 6 (44 percent) of all people living with HIV in the 7 United States. Men who have sex with men (MSM) 8 make up approximately 4 percent of the population, 9 but account for 78 percent of all new HIV infections 10 and are the only risk group in which HIV infections 11 continue to increase. 12 (5) Disparities exist among Latinos/Hispanics; 13 they make up 16 percent of the United States popu- 14 lation and 21 percent of new infections (2010). 15 (6) Though American Indians/Alaska Natives 16 represent less than 2 percent of the total number of 17 HIV/AIDS cases, American Indians and Alaska Na- 18 tives rank fifth in rates of HIV/AIDS diagnosis, still 19 higher than their White counterparts. 20 (7) While Asian-Americans, Native Hawaiians, 21 and Pacific Islanders HIV/AIDS cases account for 22 approximately 1 percent of cases nationally, between 23 2010 and 2011, the rate of new HIV diagnoses in- 24 creased for Asian-Americans by 22 percent. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00511 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 512 •HR 5475 IH (8) The latest data from the CDC (2013) indi- 1 cate that women account for 1 in 5 (20 percent) new 2 HIV infections in the United States. Women of 3 color, particularly Black women, have been especially 4 hard hit and represent the majority of women living 5 with the disease and women newly infected. In addi- 6 tion, Black women accounted for nearly two-thirds 7 (64 percent) of all estimated new HIV infections 8 among women, while only accounting for 13 percent 9 of the female population; White women accounted 10 for 18 percent and Latinas 15 percent of new infec- 11 tions among women. 12 (9) The history of HIV shows that culturally 13 relevant and gender-responsive supportive services, 14 including psychosocial support, treatment literacy, 15 case management, and transportation are necessary 16 strategies to reach and engage women and girls in 17 medical care. 18 (10) The limited data available on transgender 19 individuals point to a disproportionate burden of 20 HIV infection. 21 (11) Stigma and discrimination contribute to 22 these disparities. 23 (12) The Centers for Disease Control and Pre- 24 vention has determined that increasing the propor- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00512 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 513 •HR 5475 IH tion of people who know their HIV status is an es- 1 sential component of comprehensive HIV/AIDS 2 treatment and prevention efforts and that early di- 3 agnosis is critical in order for people with HIV/ 4 AIDS to receive life-extending therapy. Additionally, 5 the Centers for Disease Control and Prevention rec- 6 ommend routine HIV screening in health care set- 7 tings for all patients aged 13 to 64, regardless of 8 risk. 9 (13) In 1998, Congress created the National 10 Minority AIDS Initiative to provide technical assist- 11 ance, build capacity, and strengthen outreach efforts 12 among local institutions and community-based orga- 13 nizations that serve racial and ethnic minorities liv- 14 ing with or vulnerable to HIV/AIDS. 15 (14) To combat the HIV epidemic in the United 16 States, the National HIV/AIDS Strategy (NHAS) 17 from the White House Office of National AIDS Pol- 18 icy provides a framework of increasing access to 19 care, reducing new infections, and eliminating HIV- 20 related health disparities. The vision of NHAS is 21 ‘‘The United States will become a place where new 22 HIV infections are rare and when they do occur, 23 every person, regardless of age, gender, race/eth- 24 nicity, gender identity, or socioeconomic cir- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00513 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 514 •HR 5475 IH cumstance, will have unfettered access to high qual- 1 ity, life-extending care, free from stigma and dis- 2 crimination.’’. 3 (15) In recent years, several thousand people 4 across the country were waiting to receive AIDS 5 treatment through the AIDS Drug Assistance Pro- 6 gram authorized by the provisions popularly known 7 as the Ryan White CARE Act. 8 (16) At present, 32 States and 2 United States 9 territories have criminal statutes based on ‘‘expo- 10 sure’’ to HIV. Most of these laws were adopted be- 11 fore the availability of effective antiretroviral treat- 12 ment for HIV/AIDS. 13 (17) Although the cost of education, treatment 14 and care, and research are not inconsequential, they 15 are substantially less than the annual health care 16 cost attributable to HIV in the United States. The 17 lifetime cost of HIV care and treatment was esti- 18 mated to be $326,500 to $435,000 dollars in a life- 19 time. Preventing 50,000 new infections in the 20 United States each year could save $22 billion. 21 (18) According to the Centers for Disease Con- 22 trol and Prevention (CDC), latex condoms, when 23 used consistently and correctly, are highly effective 24 in preventing the transmission of HIV. Latex 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00514 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 515 •HR 5475 IH condoms also reduce the risk of other STIs. Despite 1 the effectiveness of condoms in reducing the spread 2 of STIs, the Bureau of Prisons does not recommend 3 their use in correctional facilities. 4 (19) The distribution of condoms in correctional 5 facilities is currently legal in certain parts of the 6 United States and the world. The States of Vermont 7 and Mississippi, the District of Columbia, and the 8 cities of New York, San Francisco, Los Angeles, 9 Washington, DC, and Philadelphia allow condom 10 distribution in their correctional facilities. However, 11 these States and cities operate fewer than 1 percent 12 of all correctional facilities. 13 (20) Many correctional facilities in the United 14 States do not provide comprehensive testing and 15 treatment programs to reduce the spread of STIs. 16 Fewer than half of correctional facilities provide 17 counseling to HIV-positive incarcerated persons. 18 (21) Incarcerated individuals living with HIV/ 19 AIDS who are eligible for Medicaid would benefit 20 from prompt and automatic enrollment upon their 21 release in order to ensure their continued ability to 22 access health services, including antiretroviral treat- 23 ment. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00515 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 516 •HR 5475 IH (22) Research shows that stable housing leads 1 to better health outcomes for those living with HIV. 2 Inadequate or unstable housing is not only a barrier 3 to effective treatment, but also increases the likeli- 4 hood of engaging in risky behaviors leading to HIV 5 infection. Insecure housing puts people with HIV/ 6 AIDS at risk of premature death from exposure to 7 other diseases, poor nutrition, and lack of medical 8 care. 9 (23) Due to advances in treatment, many peo- 10 ple living with HIV/AIDS (PLWHA) today are liv- 11 ing healthy lives and have the ability and desire to 12 fully participate in all aspects of community life, in- 13 cluding employment. Research associates being em- 14 ployed with tremendous economic, social, and health 15 benefits for many people living with HIV/AIDS. 16 (24) The common benefits associated with em- 17 ployment include income, autonomy, productivity, 18 and status within society, daily structure, making a 19 contribution to one’s community, and increased skills 20 and self-esteem. Research also indicates that many 21 people with disabilities, including PLWHA, report 22 perceiving themselves as being less disabled or not 23 disabled at all, when working. Furthermore, some 24 studies link working with better physical and mental 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00516 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 517 •HR 5475 IH health outcomes for PLWHA when compared to 1 those who are not working. Preliminary data also 2 suggest that transitioning to employment is associ- 3 ated with reduced HIV-related health risk behavior 4 for many people. 5 (25) On July 16, 2012, the Food and Drug Ad- 6 ministration approved the first drug to reduce the 7 risk of HIV infection in uninfected individuals who 8 are at high risk of HIV infection and who may en- 9 gage in sexual activity with HIV-infected partners. 10 SEC. 743. ADDITIONAL FUNDING FOR AIDS DRUG ASSIST- 11 ANCE PROGRAM TREATMENTS. 12 Section 2623 of the Public Health Service Act (42 13 U.S.C. 300ff–31b) is amended by adding at the end the 14 following: 15 ‘‘(c) ADDITIONAL FUNDING FOR AIDS DRUG AS- 16 SISTANCE PROGRAM TREATMENTS.—In addition to 17 amounts otherwise authorized to be appropriated for car- 18 rying out this subpart, there are authorized to be appro- 19 priated such sums as may be necessary to carry out sec- 20 tions 2612(b)(3)(B) and 2616 for each of fiscal years 21 2017 through 2020.’’. 22 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00517 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 518 •HR 5475 IH SEC. 744. ENHANCING THE NATIONAL HIV SURVEILLANCE 1 SYSTEM. 2 (a) GRANTS.—The Secretary of Health and Human 3 Services, acting through the Director of the Centers for 4 Disease Control and Prevention, shall make grants to 5 States to support integration of public health surveillance 6 systems into all electronic health records in order to allow 7 rapid communications between the clinical setting and 8 health departments, by means that include— 9 (1) providing technical assistance and policy 10 guidance to State and local health departments, clin- 11 ical providers, and other agencies serving individuals 12 with HIV to improve the interoperability of data sys- 13 tems relevant to monitoring HIV care and sup- 14 portive services; 15 (2) capturing longitudinal data pertaining to 16 the initiation and ongoing prescription or dispensing 17 of antiretroviral therapy for individuals diagnosed 18 with HIV (such as through pharmacy-based report- 19 ing); 20 (3) obtaining information— 21 (A) on a voluntary basis, on sexual orienta- 22 tion and gender identity; and 23 (B) on sources of coverage (or the lack 24 thereof) for medical treatment (including cov- 25 erage through Medicaid, Medicare, the program 26 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00518 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 519 •HR 5475 IH under title XXVI of the Public Health Service 1 Act (42 U.S.C. 300ff–11 et seq.; commonly re- 2 ferred to as the ‘‘Ryan White HIV/AIDS Pro- 3 gram’’), other public funding, private insurance, 4 and health maintenance organizations); and 5 (4) obtaining and using current geographic 6 markers of residence (such as current address, zip 7 code, partial zip code, and census block). 8 (b) PRIVACY AND SECURITY SAFEGUARDS.—In car- 9 rying out this section, the Secretary of Health and Human 10 Services shall ensure that appropriate privacy and security 11 safeguards are met to prevent unauthorized disclosure of 12 protected health information and compliance with the 13 HIPAA privacy and security law (as defined in section 14 3009 of the Public Health Service Act (42 U.S.C. 300jj– 15 19)) and other relevant laws and regulations. 16 (c) PROHIBITION AGAINST IMPROPER USE OF 17 DATA.—No grant under this section may be used to allow 18 or facilitate the collection or use of surveillance or clinical 19 data or records— 20 (1) for punitive measures of any kind, civil or 21 criminal, against the subject of such data or records; 22 or 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00519 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 520 •HR 5475 IH (2) for imposing any requirement or restriction 1 with respect to an individual without the individual’s 2 written consent. 3 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 4 out this section, there are authorized to be appropriated 5 such sums as may be necessary for each of fiscal years 6 2017 through 2021. 7 SEC. 745. EVIDENCE-BASED STRATEGIES FOR IMPROVING 8 LINKAGE TO AND RETENTION IN APPRO- 9 PRIATE CARE. 10 (a) STRATEGIES.—The Secretary of Health and 11 Human Services, in collaboration with the Director of the 12 Centers for Disease Control and Prevention, the Adminis- 13 trator of the Substance Abuse and Mental Health Services 14 Administration, the Director of the Office of AIDS Re- 15 search, the Administrator of the Health Resources and 16 Services Administration, and the Administrator of the 17 Centers for Medicare & Medicaid Services, shall— 18 (1) identify evidence-based strategies most ef- 19 fective at addressing the multifaceted issues that im- 20 pede disease status awareness and linkage to and re- 21 tention in appropriate care, taking into consideration 22 health care systems issues, clinic and provider 23 issues, and individual psychosocial, environmental, 24 and other contextual factors; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00520 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 521 •HR 5475 IH (2) support the wide-scale implementation of 1 the evidence-based strategies identified pursuant to 2 paragraph (1), including through incorporating such 3 strategies into health care coverage supported by the 4 Medicaid program under title XIX of the Social Se- 5 curity Act (42 U.S.C. 1396 et seq.), the program 6 under title XXVI of the Public Health Service Act 7 (42 U.S.C. 300ff–11 et seq.; commonly referred to 8 as the ‘‘Ryan White HIV/AIDS Program’’), and 9 health plans purchased through an American Health 10 Benefit Exchange established pursuant to section 11 1311 of the Patient Protection and Affordable Care 12 Act (42 U.S.C. 18031); and 13 (3) not later than 12 months after the date of 14 the enactment of this Act, submit a report to the 15 Congress on the status of activities under para- 16 graphs (1) and (2). 17 (b) 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 2017 20 through 2021. 21 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00521 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 522 •HR 5475 IH SEC. 746. IMPROVING ENTRY INTO AND RETENTION IN 1 CARE AND ANTIRETROVIRAL ADHERENCE 2 FOR PERSONS WITH HIV. 3 (a) SENSE OF CONGRESS.—It is the sense of the Con- 4 gress that AIDS research has led to scientific advance- 5 ments that have— 6 (1) saved the lives of millions of people with 7 HIV/AIDS; 8 (2) prevented millions of people from being in- 9 fected; and 10 (3) had broad benefits that extend far beyond 11 helping people at risk for or living with HIV. 12 (b) IN GENERAL.—The Secretary of Health and 13 Human Services, acting through the Director of the Na- 14 tional Institutes of Health, shall expand, intensify, and co- 15 ordinate operational and translational research and other 16 activities of the National Institutes of Health regarding 17 methods— 18 (1) to increase adoption of evidence-based ad- 19 herence strategies within HIV care and treatment 20 programs; 21 (2) to increase HIV testing and case detection 22 rates; 23 (3) to reduce HIV-related health disparities; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00522 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 523 •HR 5475 IH (4) to ensure that research to improve adher- 1 ence to HIV care and treatment programs address 2 the unique concerns of women; 3 (5) to integrate HIV/AIDS prevention and care 4 services with mental health and substance use pre- 5 vention and treatment delivery systems; and 6 (6) to increase knowledge on the implementa- 7 tion of preexposure prophylaxis (PrEP), including 8 with respect to— 9 (A) who can benefit most from PrEP; 10 (B) how to provide PrEP safely and effi- 11 ciently; 12 (C) how to integrate PrEP with other es- 13 sential prevention methods such as condoms; 14 and 15 (D) how to ensure high levels of adherence. 16 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 17 out this section, there are authorized to be appropriated 18 such sums as may be necessary for fiscal years 2017 19 through 2021. 20 SEC. 747. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND 21 ETHNIC MINORITY COMMUNITIES. 22 (a) IN GENERAL.—For the purpose of reducing HIV/ 23 AIDS in racial and ethnic minority communities, the Sec- 24 retary, acting through the Deputy Assistant Secretary for 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00523 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 524 •HR 5475 IH Minority Health, may make grants to public health agen- 1 cies and faith-based organizations to conduct— 2 (1) outreach activities related to HIV/AIDS 3 prevention and testing activities; 4 (2) HIV/AIDS prevention activities; and 5 (3) HIV/AIDS testing activities. 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 2017 9 through 2021. 10 SEC. 748. MINORITY AIDS INITIATIVE. 11 (a) EXPANDED FUNDING.—The Secretary, in col- 12 laboration with the Deputy Assistant Secretary for Minor- 13 ity Health, the Director of the Centers for Disease Control 14 and Prevention, the Administrator of the Health Re- 15 sources and Services Administration, and the Adminis- 16 trator of the Substance Abuse and Mental Health Services 17 Administration, shall provide funds and carry out activi- 18 ties to expand the Minority HIV/AIDS Initiative. 19 (b) USE OF FUNDS.—The additional funds made 20 available under this section may be used, through the Mi- 21 nority AIDS Initiative, to support the following activities: 22 (1) Providing technical assistance and infra- 23 structure support to reduce HIV/AIDS in minority 24 populations. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00524 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 525 •HR 5475 IH (2) Increasing minority populations’ access to 1 HIV/AIDS prevention and care services. 2 (3) Building strong community programs and 3 partnerships to address HIV prevention and the 4 health care needs of specific racial and ethnic minor- 5 ity populations. 6 (c) PRIORITY INTERVENTIONS.—Within the racial 7 and ethnic minority populations referred to in subsection 8 (b), priority in conducting intervention services shall be 9 given to— 10 (1) men who have sex with men; 11 (2) youth; 12 (3) persons who engage in intravenous drug 13 abuse; 14 (4) women; 15 (5) homeless individuals; and 16 (6) individuals incarcerated or in the penal sys- 17 tem. 18 (d) AUTHORIZATION OF APPROPRIATIONS.—For car- 19 rying out this section, there are authorized to be appro- 20 priated $610,000,0000 for fiscal year 2017 and such sums 21 as may be necessary for each of fiscal years 2018 through 22 2021. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00525 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 526 •HR 5475 IH SEC. 749. HEALTH CARE PROFESSIONALS TREATING INDI- 1 VIDUALS WITH HIV/AIDS. 2 (a) IN GENERAL.—The Secretary of Health and 3 Human Services, acting through the Administrator of the 4 Health Resources and Services Administration, shall ex- 5 pand, intensify, and coordinate workforce initiatives of the 6 Health Resources and Services Administration to increase 7 the capacity of the health workforce focusing primarily on 8 HIV/AIDS to meet the demand for culturally competent 9 care, and may award grants for any of the following: 10 (1) Development of curricula for training pri- 11 mary care providers in HIV/AIDS prevention and 12 care, including routine HIV testing. 13 (2) Support to expand access to culturally and 14 linguistically accessible benefits counselors, trained 15 peer navigators, and mental and behavioral health 16 professionals with expertise in HIV/AIDS. 17 (3) Training health care professionals to pro- 18 vide care to individuals with HIV/AIDS. 19 (4) Development by grant recipients under title 20 XXVI of the Public Health Service Act (42 U.S.C. 21 300ff–11 et seq.; commonly referred to as the Ryan 22 White HIV/AIDS Program) and other persons, of 23 policies for providing culturally relevant and sen- 24 sitive treatment to individuals with HIV/AIDS, with 25 particular emphasis on treatment to racial and eth- 26 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00526 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 527 •HR 5475 IH nic minorities, men who have sex with men, and 1 women, young people, and children with HIV/AIDS. 2 (5) Development and implementation of pro- 3 grams to increase the use of telehealth to respond to 4 HIV/AIDS-specific health care needs in rural and 5 minority communities, with particular emphasis 6 given to medically underserved communities and in- 7 sular areas. 8 (6) Evaluating interdisciplinary medical pro- 9 vider care team models that promote high quality 10 care, with particular emphasis on care to racial and 11 ethnic minorities. 12 (7) Training health care professionals to make 13 them aware of the high rates of chronic hepatitis B 14 and chronic hepatitis C in adult racial and ethnic 15 populations, and the importance of prevention, de- 16 tection, and medical management of hepatitis B and 17 hepatitis C and of liver cancer screening. 18 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 19 out this section, there are authorized to be appropriated 20 such sums as may be necessary for fiscal years 2017 21 through 2021. 22 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00527 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 528 •HR 5475 IH SEC. 750. HIV/AIDS PROVIDER LOAN REPAYMENT PRO- 1 GRAM. 2 (a) IN GENERAL.—The Secretary may enter into an 3 agreement with any physician, nurse practitioner, or phy- 4 sician assistant under which— 5 (1) the physician, nurse practitioner, or physi- 6 cian assistant agrees to serve as a medical provider 7 for a period of not less than 2 years— 8 (A) at a Ryan White-funded or title X- 9 funded facility with a critical shortage of doc- 10 tors (as determined by the Secretary); or 11 (B) in an area with a high incidence of 12 HIV/AIDS; and 13 (2) the Secretary agrees to make payments in 14 accordance with subsection (b) on the professional 15 education loans of the physician, nurse practitioner, 16 or physician assistant. 17 (b) MANNER OF PAYMENTS.—The payments de- 18 scribed in subsection (a) shall be made by the Secretary 19 as follows: 20 (1) Upon completion by the physician, nurse 21 practitioner, or physician assistant for whom the 22 payments are to be made of the first year of the 23 service specified in the agreement entered into with 24 the Secretary under subsection (a), the Secretary 25 shall pay 30 percent of the principal of and the in- 26 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00528 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 529 •HR 5475 IH terest on the individual’s professional education 1 loans. 2 (2) Upon completion by the physician, nurse 3 practitioner, or physician assistant of the second 4 year of such service, the Secretary shall pay another 5 30 percent of the principal of and the interest on 6 such loans. 7 (3) Upon completion by that individual of a 8 third year of such service, the Secretary shall pay 9 another 25 percent of the principal of and the inter- 10 est on such loans. 11 (c) APPLICABILITY OF CERTAIN PROVISIONS.—The 12 provisions of subpart III of part D of title III of the Public 13 Health Service Act (42 U.S.C. 254l et seq.) shall, except 14 as inconsistent with this section, apply to the program car- 15 ried out under this section in the same manner and to 16 the same extent as such provisions apply to the National 17 Health Service Corps Loan Repayment Program. 18 (d) REPORTS.—Not later than 18 months after the 19 date of the enactment of this Act, and annually thereafter, 20 the Secretary shall prepare and submit to the Congress 21 a report describing the program carried out under this sec- 22 tion, including statements regarding the following: 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00529 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 530 •HR 5475 IH (1) The number of physicians, nurse practi- 1 tioners, and physician assistants enrolled in the pro- 2 gram. 3 (2) The number and amount of loan repay- 4 ments. 5 (3) The placement location of loan repayment 6 recipients at facilities described in subsection (a)(1). 7 (4) The default rate and actions required. 8 (5) The amount of outstanding default funds. 9 (6) To the extent that it can be determined, the 10 reason for the default. 11 (7) The demographics of individuals partici- 12 pating in the program. 13 (8) An evaluation of the overall costs and bene- 14 fits of the program. 15 (e) DEFINITIONS.—In this section: 16 (1) The term ‘‘HIV/AIDS’’ means human im- 17 munodeficiency virus and acquired immune defi- 18 ciency syndrome. 19 (2) The term ‘‘nurse practitioner’’ means a reg- 20 istered nurse who has completed an accredited grad- 21 uate degree program in advanced nurse practice and 22 has successfully passed a national certification exam. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00530 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 531 •HR 5475 IH (3) The term ‘‘physician’’ means a graduate of 1 a school of medicine who has completed post- 2 graduate training in general or pediatric medicine. 3 (4) The term ‘‘physician assistant’’ means a 4 medical provider who completed an accredited physi- 5 cian assistant training program and successfully 6 passed the Physician Assistant National Certifying 7 Examination. 8 (5) The term ‘‘professional education loan’’— 9 (A) means a loan that is incurred for the 10 cost of attendance (including tuition, other rea- 11 sonable educational expenses, and reasonable 12 living costs) at a school of medicine, nursing, or 13 physician assistant training program; and 14 (B) includes only the portion of the loan 15 that is outstanding on the date the physician, 16 nurse practitioner, or physician assistant in- 17 volved begins the service specified in the agree- 18 ment under subsection (a). 19 (6) The term ‘‘Ryan White-funded’’ means, 20 with respect to a facility, receiving funds under title 21 XXVI of the Public Health Service Act (42 U.S.C. 22 300ff–11 et seq.). 23 (7) The term ‘‘Secretary’’ means the Secretary 24 of Health and Human Services. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00531 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 532 •HR 5475 IH (8) The term ‘‘school of medicine’’ has the 1 meaning given to that term in section 799B of the 2 Public Health Service Act (42 U.S.C. 295p). 3 (9) The term ‘‘title X-funded’’ means, with re- 4 spect to a facility, receiving funds under title X of 5 the Public Health Service Act (42 U.S.C. 300 et 6 seq.). 7 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 8 out this section, there are authorized to be appropriated 9 such sums as may be necessary for fiscal years 2017 10 through 2021. 11 SEC. 751. DENTAL EDUCATION LOAN REPAYMENT PRO- 12 GRAM. 13 (a) IN GENERAL.—The Secretary of Health and 14 Human Services may enter into an agreement with any 15 dentist under which— 16 (1) the dentist agrees to serve as a dentist for 17 a period of not less than 2 years at a facility with 18 a critical shortage of dentists (as determined by the 19 Secretary) in an area with a high incidence of HIV/ 20 AIDS; and 21 (2) the Secretary agrees to make payments in 22 accordance with subsection (b) on the dental edu- 23 cation loans of the dentist. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00532 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 533 •HR 5475 IH (b) MANNER OF PAYMENTS.—The payments de- 1 scribed in subsection (a) shall be made by the Secretary 2 as follows: 3 (1) Upon completion by the dentist for whom 4 the payments are to be made of the first year of the 5 service specified in the agreement entered into with 6 the Secretary under subsection (a), the Secretary 7 shall pay 30 percent of the principal of and the in- 8 terest on the dental education loans of the dentist. 9 (2) Upon completion by the dentist of the sec- 10 ond year of such service, the Secretary shall pay an- 11 other 30 percent of the principal of and the interest 12 on such loans. 13 (3) Upon completion by that individual of a 14 third year of such service, the Secretary shall pay 15 another 25 percent of the principal of and the inter- 16 est on such loans. 17 (c) APPLICABILITY OF CERTAIN PROVISIONS.—The 18 provisions of subpart III of part D of title III of the Public 19 Health Service Act (42 U.S.C. 254l et seq.) shall, except 20 as inconsistent with this section, apply to the program car- 21 ried out under this section in the same manner and to 22 the same extent as such provisions apply to the National 23 Health Service Corps Loan Repayment Program. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00533 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 534 •HR 5475 IH (d) REPORTS.—Not later than 18 months after the 1 date of the enactment of this Act, and annually thereafter, 2 the Secretary shall prepare and submit to the Congress 3 a report describing the program carried out under this sec- 4 tion, including statements regarding the following: 5 (1) The number of dentists enrolled in the pro- 6 gram. 7 (2) The number and amount of loan repay- 8 ments. 9 (3) The placement location of loan repayment 10 recipients at facilities described in subsection (a)(1). 11 (4) The default rate and actions required. 12 (5) The amount of outstanding default funds. 13 (6) To the extent that it can be determined, the 14 reason for the default. 15 (7) The demographics of individuals partici- 16 pating in the program. 17 (8) An evaluation of the overall costs and bene- 18 fits of the program. 19 (e) DEFINITIONS.—In this section: 20 (1) The term ‘‘dental education loan’’— 21 (A) means a loan that is incurred for the 22 cost of attendance (including tuition, other rea- 23 sonable educational expenses, and reasonable 24 living costs) at a school of dentistry; and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00534 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 535 •HR 5475 IH (B) includes only the portion of the loan 1 that is outstanding on the date the dentist in- 2 volved begins the service specified in the agree- 3 ment under subsection (a). 4 (2) The term ‘‘dentist’’ means a graduate of a 5 school of dentistry who has completed postgraduate 6 training in general or pediatric dentistry. 7 (3) The term ‘‘HIV/AIDS’’ means human im- 8 munodeficiency virus and acquired immune defi- 9 ciency syndrome. 10 (4) The term ‘‘school of dentistry’’ has the 11 meaning given to that term in section 799B of the 12 Public Health Service Act (42 U.S.C. 295p). 13 (5) The term ‘‘Secretary’’ means the Secretary 14 of Health and Human Services. 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 each of fiscal years 18 2017 through 2021. 19 SEC. 752. REDUCING NEW HIV INFECTIONS AMONG INJECT- 20 ING DRUG USERS. 21 (a) SENSE OF CONGRESS.—It is the sense of the Con- 22 gress that providing sterile syringes and sterilized equip- 23 ment to injecting drug users substantially reduces risk of 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00535 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 536 •HR 5475 IH HIV infection, increases the probability that they will ini- 1 tiate drug treatment, and does not increase drug use. 2 (b) IN GENERAL.—The Secretary of Health and 3 Human Services may provide grants and technical assist- 4 ance for the purpose of reducing the rate of HIV infections 5 among injecting drug users through a comprehensive 6 package of services for such users, including the provision 7 of sterile syringes, education and outreach, access to infec- 8 tious disease testing, overdose prevention, and treatment 9 for drug dependence. 10 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 11 out this section, there are authorized to be appropriated 12 such sums as may be necessary for fiscal years 2017 13 through 2021. 14 SEC. 753. SUPPORT FOR EXPANSION OF COMPREHENSIVE 15 SEXUAL HEALTH AND EDUCATION PRO- 16 GRAMS. 17 (a) SENSE OF CONGRESS.—It is the sense of Con- 18 gress that— 19 (1) federally funded sex education programs 20 should aim to— 21 (A) reduce unintended pregnancy and sex- 22 ually transmitted infections, including HIV; 23 (B) promote safe and healthy relation- 24 ships; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00536 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 537 •HR 5475 IH (C) use, and be informed by, the best sci- 1 entific information available; 2 (D) be built on characteristics of effective 3 programs; 4 (E) expand the existing body of evidence 5 on comprehensive sex education programs 6 through program evaluation; 7 (F) expand training programs for teachers 8 of comprehensive sex education; 9 (G) build on the personal responsibility 10 education programs funded under section 513 11 of the Social Security Act (42 U.S.C. 713) and 12 the President’s Teen Pregnancy Prevention pro- 13 gram, funded under title II of the Consolidated 14 Appropriations Act, 2010 (Public Law 111– 15 117; 123 Stat. 3253); and 16 (H) promote and uphold the rights of 17 young people to information in order to make 18 healthy and responsible decisions about their 19 sexual health; and 20 (2) no Federal funds should be used for health 21 education programs that— 22 (A) deliberately withhold life-saving infor- 23 mation about HIV; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00537 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 538 •HR 5475 IH (B) are medically inaccurate or have been 1 scientifically shown to be ineffective; 2 (C) promote gender stereotypes; 3 (D) are insensitive and unresponsive to the 4 needs of sexually active adolescents; 5 (E) are insensitive and unresponsive to the 6 needs of lesbian, gay, bisexual, transgender, 7 queer, or questioning youth; or 8 (F) are inconsistent with the ethical im- 9 peratives of medicine and public health. 10 (b) GRANTS FOR COMPREHENSIVE SEX EDUCATION 11 FOR ADOLESCENTS.— 12 (1) PROGRAM AUTHORIZED.—The Secretary, in 13 coordination with the Director of the Office of Ado- 14 lescent Health, shall award grants, on a competitive 15 basis, to eligible entities to enable such eligible enti- 16 ties to carry out programs that provide adolescents 17 with comprehensive sex education, as described in 18 paragraph (6). 19 (2) DURATION.—Grants awarded under this 20 subsection shall be for a period of 5 years. 21 (3) ELIGIBLE ENTITY.—In this subsection, the 22 term ‘‘eligible entity’’ means a public or private enti- 23 ty that focuses on adolescent health or education or 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00538 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 539 •HR 5475 IH has experience working with adolescents, which may 1 include— 2 (A) a State educational agency; 3 (B) a local educational agency; 4 (C) a tribe or tribal organization, as de- 5 fined in section 4 of the Indian Self-Determina- 6 tion and Education Assistance Act (25 U.S.C. 7 450b); 8 (D) a State or local department of health; 9 (E) a State or local department of edu- 10 cation; 11 (F) a nonprofit organization; 12 (G) a nonprofit or public institution of 13 higher education; or 14 (H) a hospital. 15 (4) APPLICATIONS.—An eligible entity desiring 16 a grant under this subsection shall submit an appli- 17 cation to the Secretary at such time, in such man- 18 ner, and containing such information as the Sec- 19 retary may require, including the evaluation plan de- 20 scribed in paragraph (7)(A). 21 (5) PRIORITY.—In awarding grants under this 22 subsection, the Secretary shall give priority to eligi- 23 ble entities that— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00539 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 540 •HR 5475 IH (A) are State or local public entities, with 1 an additional priority for State or local edu- 2 cational agencies; and 3 (B) address health disparities among 4 young people that are at highest risk for not 5 less than 1 of the following: 6 (i) Unintended pregnancies. 7 (ii) Sexually transmitted infections, 8 including HIV. 9 (iii) Dating violence and sexual as- 10 sault. 11 (6) USE OF FUNDS.— 12 (A) IN GENERAL.—Each eligible entity 13 that receives a grant under this subsection shall 14 use grant funds to carry out a program that 15 provides adolescents with comprehensive sex 16 education that— 17 (i) replicates evidence-based sex edu- 18 cation programs; 19 (ii) substantially incorporates ele- 20 ments of evidence-based sex education pro- 21 grams; or 22 (iii) creates a demonstration project 23 based on generally accepted characteristics 24 of effective sex education programs. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00540 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 541 •HR 5475 IH (B) CONTENTS OF SEX EDUCATION PRO- 1 GRAMS.—The sex education programs funded 2 under this subsection shall include curricula 3 and program materials that address— 4 (i) abstinence and delaying sexual ini- 5 tiation; 6 (ii) the health benefits and side effects 7 of all contraceptive and barrier methods as 8 a means to prevent pregnancy and sexually 9 transmitted infections, including HIV; 10 (iii) healthy relationships, including 11 the development of healthy attitudes and 12 skills necessary for understanding— 13 (I) healthy relationships between 14 oneself and family, others, and soci- 15 ety; and 16 (II) the prevention of sexual 17 abuse, teen dating violence, bullying, 18 harassment, and suicide; 19 (iv) healthy life skills including goal- 20 setting, decisionmaking, interpersonal skills 21 (such as communication, assertiveness, and 22 peer refusal skills), critical thinking, self- 23 esteem and self-efficacy, and stress man- 24 agement; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00541 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 542 •HR 5475 IH (v) how to make responsible decisions 1 about sex and sexuality, including— 2 (I) how to avoid, and how to 3 avoid making, unwanted verbal, phys- 4 ical, and sexual advances; and 5 (II) how alcohol and drug use 6 can affect responsible decisionmaking; 7 (vi) the development of healthy atti- 8 tudes and values about such topics as ado- 9 lescent growth and development, body 10 image, gender roles and gender identity, 11 racial and ethnic diversity, and sexual ori- 12 entation; and 13 (vii) referral services for local health 14 clinics and services where adolescents can 15 obtain additional information and services 16 related to sexual and reproductive health, 17 dating violence and sexual assault, and sui- 18 cide prevention. 19 (7) EVALUATION; REPORT.— 20 (A) INDEPENDENT EVALUATION.—Each 21 eligible entity applying for a grant under this 22 subsection shall develop and submit to the Sec- 23 retary a plan for a rigorous independent evalua- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00542 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 543 •HR 5475 IH tion of such grant program. The plan shall de- 1 scribe an independent evaluation that— 2 (i) uses sound statistical methods and 3 techniques relating to the behavioral 4 sciences, including random assignment 5 methodologies, whenever possible; 6 (ii) uses quantitative data for assess- 7 ments and impact evaluations, whenever 8 possible; and 9 (iii) is carried out by an entity inde- 10 pendent from such eligible entity. 11 (B) SELECTION OF EVALUATED PRO- 12 GRAMS; BUDGET.— 13 (i) SELECTION OF EVALUATED PRO- 14 GRAMS.—The Secretary shall select, at 15 random, a subset of the eligible entities 16 that the Secretary has selected to receive a 17 grant under this subsection to receive addi- 18 tional funding to carry out the evaluation 19 plan described in subparagraph (A). 20 (ii) BUDGET FOR EVALUATION ACTIVI- 21 TIES.—The Secretary, in coordination with 22 the Director of the Office of Adolescent 23 Health, shall establish a budget for each 24 eligible entity selected under clause (i) for 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00543 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 544 •HR 5475 IH the costs of carrying out the evaluation 1 plan described in subparagraph (A). 2 (C) FUNDS FOR EVALUATION.—The Sec- 3 retary shall provide eligible entities who are se- 4 lected under subparagraph (B)(i) with addi- 5 tional funds, in accordance with the budget de- 6 scribed in subparagraph (B)(ii), to carry out 7 and report to the Secretary on the evaluation 8 plan described in subparagraph (A). 9 (D) PERFORMANCE MEASURES.—The Sec- 10 retary, in coordination with the Director of the 11 Centers for Disease Control and Prevention, 12 shall establish a common set of performance 13 measures to assess the implementation and im- 14 pact of grant programs funded under this sub- 15 section. Such performance measures shall in- 16 clude— 17 (i) output measures, such as the num- 18 ber of individuals served and the number 19 of hours of service delivery; 20 (ii) outcome measures, including 21 measures relating to— 22 (I) the knowledge that youth par- 23 ticipating in the grant program have 24 gained about— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00544 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 545 •HR 5475 IH (aa) adolescent growth and 1 development; 2 (bb) relationship dynamics; 3 (cc) ways to prevent unin- 4 tended pregnancy and sexually 5 transmitted infections, including 6 HIV; and 7 (dd) sexual health; 8 (II) the skills that adolescents 9 participating in the grant program 10 have gained regarding— 11 (aa) negotiation and commu- 12 nication; 13 (bb) decisionmaking and 14 goal-setting; 15 (cc) interpersonal skills and 16 healthy relationships; and 17 (dd) condom use; and 18 (III) the behaviors of adolescents 19 participating in the grant program, 20 including data about— 21 (aa) age of first intercourse; 22 (bb) number of sexual part- 23 ners; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00545 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 546 •HR 5475 IH (cc) condom and contracep- 1 tive use at first intercourse; 2 (dd) recent condom and con- 3 traceptive use; and 4 (ee) dating abuse and life- 5 time history of domestic violence, 6 sexual assault, dating violence, 7 bullying, harassment, and stalk- 8 ing. 9 (E) REPORT TO THE SECRETARY.—Eligi- 10 ble entities receiving a grant under this sub- 11 section who have been selected to receive funds 12 to carry out the evaluation plan described in 13 subparagraph (A), in accordance with subpara- 14 graph (B)(i), shall collect and report to the Sec- 15 retary— 16 (i) the results of the independent eval- 17 uation described in subparagraph (A); and 18 (ii) information about the perform- 19 ance measures described in subparagraph 20 (B). 21 (F) EFFECTIVE PROGRAMS.—The Sec- 22 retary, in coordination with the Director of the 23 Centers for Disease Control and Prevention, 24 shall publish on the Web site of the Centers for 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00546 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 547 •HR 5475 IH Disease Control and Prevention, a list of pro- 1 grams funded under this subsection that the 2 Secretary has determined to be effective pro- 3 grams. 4 (c) GRANTS FOR COMPREHENSIVE SEX EDUCATION 5 AT INSTITUTIONS OF HIGHER EDUCATION.— 6 (1) PROGRAM AUTHORIZED.—The Secretary, in 7 coordination with the Office of Adolescent Health 8 and the Secretary of Education, shall award grants, 9 on a competitive basis, to institutions of higher edu- 10 cation to enable such institutions to provide young 11 people with comprehensive sex education, described 12 in paragraph (5)(B), with an emphasis on reducing 13 HIV, other sexually transmitted infections, and un- 14 intended pregnancy through instruction about— 15 (A) abstinence and contraception; 16 (B) reducing dating violence, sexual as- 17 sault, bullying, and harassment; 18 (C) increasing healthy relationships; and 19 (D) academic achievement. 20 (2) DURATION.—Grants awarded under this 21 subsection shall be for a period of 5 years. 22 (3) APPLICATIONS.—An institution of higher 23 education desiring a grant under this subsection 24 shall submit an application to the Secretary at such 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00547 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 548 •HR 5475 IH time, in such manner, and containing such informa- 1 tion as the Secretary may require. 2 (4) PRIORITY.—In awarding grants under this 3 subsection, the Secretary shall give priority to an in- 4 stitution of higher education that— 5 (A) has an enrollment of needy students as 6 defined in section 318(b) of the Higher Edu- 7 cation Act of 1965 (20 U.S.C. 1059e(b)); 8 (B) is a Hispanic-serving institution, as 9 defined in section 502(a) of such Act (20 10 U.S.C. 1101a(a)); 11 (C) is a Tribal College or University, as 12 defined in section 316(b) of such Act (20 13 U.S.C. 1059c(b)); 14 (D) is an Alaska Native-serving institution, 15 as defined in section 317(b) of such Act (20 16 U.S.C. 1059d(b)); 17 (E) is a Native Hawaiian-serving institu- 18 tion, as defined in section 317(b) of such Act 19 (20 U.S.C. 1059d(b)); 20 (F) is a Predominately Black Institution, 21 as defined in section 318(b) of such Act (20 22 U.S.C. 1059e(b)); 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00548 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 549 •HR 5475 IH (G) is a Native American-serving, non- 1 tribal institution, as defined in section 319(b) 2 of such Act (20 U.S.C. 1059f(b)); 3 (H) is an Asian American and Native 4 American Pacific Islander-serving institution, as 5 defined in section 320(b) of such Act (20 6 U.S.C. 1059g(b)); or 7 (I) is a minority institution, as defined in 8 section 365 of such Act (20 U.S.C. 1067k), 9 with an enrollment of needy students, as de- 10 fined in section 312 of such Act (20 U.S.C. 11 1058). 12 (5) USES OF FUNDS.— 13 (A) IN GENERAL.—An institution of higher 14 education receiving a grant under this sub- 15 section may use grant funds to integrate issues 16 relating to comprehensive sex education into the 17 academic or support sectors of the institution of 18 higher education in order to reach a large num- 19 ber of students, by carrying out 1 or more of 20 the following activities: 21 (i) Developing educational content for 22 issues relating to comprehensive sex edu- 23 cation that will be incorporated into first- 24 year orientation or core courses. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00549 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 550 •HR 5475 IH (ii) Developing and employing 1 schoolwide educational programming out- 2 side of class that delivers elements of com- 3 prehensive sex education programs to stu- 4 dents, faculty, and staff. 5 (iii) Creating innovative technology- 6 based approaches to deliver sex education 7 to students, faculty, and staff. 8 (iv) Developing and employing peer- 9 outreach and education programs to gen- 10 erate discussion, educate, and raise aware- 11 ness among students about issues relating 12 to comprehensive sex education. 13 (B) CONTENTS OF SEX EDUCATION PRO- 14 GRAMS.—Each institution of higher education’s 15 program of comprehensive sex education funded 16 under this subsection shall include curricula 17 and program materials that address informa- 18 tion about— 19 (i) safe and responsible sexual behav- 20 ior with respect to the prevention of preg- 21 nancy and sexually transmitted infections, 22 including HIV, including through— 23 (I) abstinence; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00550 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 551 •HR 5475 IH (II) a reduced number of sexual 1 partners; and 2 (III) the use of condoms and con- 3 traception; 4 (ii) healthy relationships, including 5 the development of healthy attitudes and 6 insights necessary for understanding— 7 (I) relationships between oneself, 8 family, partners, others, and society; 9 and 10 (II) the prevention of sexual 11 abuse, dating violence, bullying, har- 12 assment, and suicide; and 13 (iii) referral services to local health 14 clinics where young people can obtain addi- 15 tional information and services related to 16 sexual and reproductive health, dating vio- 17 lence and sexual assault, and suicide pre- 18 vention. 19 (C) OPTIONAL COMPONENTS OF SEX EDU- 20 CATION.—Each institution of higher education’s 21 program of comprehensive sex education may 22 also include information and skills development 23 relating to— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00551 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 552 •HR 5475 IH (i) how to make responsible decisions 1 about sex and sexuality, including— 2 (I) how to avoid, and avoid mak- 3 ing, unwanted verbal, physical, and 4 sexual advances; and 5 (II) how alcohol and drug use 6 can affect responsible decisionmaking; 7 (ii) healthy life skills, including— 8 (I) goal-setting and decision- 9 making; 10 (II) interpersonal skills, such as 11 communication, assertiveness, and 12 peer refusal skills; 13 (III) critical thinking; 14 (IV) self-esteem and self-efficacy; 15 and 16 (V) stress management; 17 (iii) the development of healthy atti- 18 tudes and values about such topics as body 19 image, gender roles and gender identity, 20 racial and ethnic diversity, and sexual ori- 21 entation; and 22 (iv) the responsibilities of parenting 23 and the skills necessary to parent well. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00552 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 553 •HR 5475 IH (6) EVALUATION; REPORT.—The requirements 1 described in section 125B(g) shall also apply to eligi- 2 ble entities receiving a grant under this subsection 3 in the same manner as such requirements apply to 4 eligible entities receiving grants under section 125B. 5 (d) GRANTS FOR PRE-SERVICE AND IN-SERVICE 6 TEACHER TRAINING.— 7 (1) PROGRAM AUTHORIZED.—The Secretary, in 8 coordination with the Director of the Centers for 9 Disease Control and Prevention and the Secretary of 10 Education, shall award grants, on a competitive 11 basis, to eligible entities to enable such eligible enti- 12 ties to carry out the activities described in para- 13 graph (5). 14 (2) DURATION.—Grants awarded under this 15 subsection shall be for a period of 5 years. 16 (3) ELIGIBLE ENTITY.—In this subsection, the 17 term ‘‘eligible entity’’ means— 18 (A) a State educational agency; 19 (B) a local educational agency; 20 (C) a tribe or tribal organization, as de- 21 fined in section 4 of the Indian Self-Determina- 22 tion and Education Assistance Act (25 U.S.C. 23 450b); 24 (D) a State or local department of health; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00553 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 554 •HR 5475 IH (E) a State or local department of edu- 1 cation; 2 (F) a nonprofit institution of higher edu- 3 cation; 4 (G) a national or statewide nonprofit orga- 5 nization that has as its primary purpose the im- 6 provement of provision of comprehensive sex 7 education through effective teaching of com- 8 prehensive sex education; or 9 (H) a consortium of nonprofit organiza- 10 tions that has as its primary purpose the im- 11 provement of provision of comprehensive sex 12 education through effective teaching of com- 13 prehensive sex education. 14 (4) APPLICATION.—An eligible entity desiring a 15 grant under this subsection shall submit an applica- 16 tion to the Secretary at such time, in such manner, 17 and containing such information as the Secretary 18 may require. 19 (5) AUTHORIZED ACTIVITIES.— 20 (A) REQUIRED ACTIVITY.—Each eligible 21 entity receiving a grant under this subsection 22 shall use grant funds to train targeted faculty 23 and staff, in order to increase effective teaching 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00554 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 555 •HR 5475 IH of comprehensive sex education for elementary 1 school and secondary school students. 2 (B) PERMISSIBLE ACTIVITIES.—Each eligi- 3 ble entity receiving a grant under this sub- 4 section may use grant funds to— 5 (i) strengthen and expand the eligible 6 entity’s relationships with— 7 (I) institutions of higher edu- 8 cation; 9 (II) State educational agencies; 10 (III) local educational agencies; 11 or 12 (IV) other public and private or- 13 ganizations with a commitment to 14 comprehensive sex education and the 15 benefits of comprehensive sex edu- 16 cation; 17 (ii) support and promote research- 18 based training of teachers of comprehen- 19 sive sex education and related disciplines 20 in elementary schools and secondary 21 schools as a means of broadening student 22 knowledge about issues related to human 23 development, relationships, personal skills, 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00555 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 556 •HR 5475 IH sexual behavior, sexual health, and society 1 and culture; 2 (iii) support the dissemination of in- 3 formation on effective practices and re- 4 search findings concerning the teaching of 5 comprehensive sex education; 6 (iv) support research on— 7 (I) effective comprehensive sex 8 education teaching practices; and 9 (II) the development of assess- 10 ment instruments and strategies to 11 document— 12 (aa) student understanding 13 of comprehensive sex education; 14 and 15 (bb) the effects of com- 16 prehensive sex education; 17 (v) convene national conferences on 18 comprehensive sex education, in order to 19 effectively train teachers in the provision of 20 comprehensive sex education; and 21 (vi) develop and disseminate appro- 22 priate research-based materials to foster 23 comprehensive sex education. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00556 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 557 •HR 5475 IH (C) SUBGRANTS.—Each eligible entity re- 1 ceiving a grant under this subsection may 2 award subgrants to nonprofit organizations, 3 State educational agencies, or local educational 4 agencies to enable such organizations or agen- 5 cies to— 6 (i) train teachers in comprehensive 7 sex education; 8 (ii) support Internet or distance learn- 9 ing related to comprehensive sex education; 10 (iii) promote rigorous academic stand- 11 ards and assessment techniques to guide 12 and measure student performance in com- 13 prehensive sex education; 14 (iv) encourage replication of best 15 practices and model programs to promote 16 comprehensive sex education; 17 (v) develop and disseminate effective, 18 research-based comprehensive sex edu- 19 cation learning materials; 20 (vi) develop academic courses on the 21 pedagogy of sex education at institutions 22 of higher education; or 23 (vii) convene State-based conferences 24 to train teachers in comprehensive sex edu- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00557 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 558 •HR 5475 IH cation and to identify strategies for im- 1 provement. 2 (e) REPORT TO CONGRESS.— 3 (1) IN GENERAL.—Not later than 1 year after 4 the date of the enactment of this Act, and annually 5 thereafter for a period of 5 years, the Secretary shall 6 prepare and submit to the appropriate committees of 7 Congress a report on the activities to provide adoles- 8 cents and young people with comprehensive sex edu- 9 cation funded under this section. 10 (2) REPORT ELEMENTS.—The report described 11 in paragraph (1) shall include information about— 12 (A) the number of eligible entities and in- 13 stitutions of higher education that are receiving 14 grant funds under subsections (b) and (c); 15 (B) the specific activities supported by 16 grant funds awarded under subsections (b) and 17 (c); 18 (C) the number of adolescents served by 19 grant programs funded under subsection (b); 20 (D) the number of young people served by 21 grant programs funded under subsection (c); 22 and 23 (E) the status of program evaluations de- 24 scribed under subsections (b) and (c). 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00558 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 559 •HR 5475 IH (f) LIMITATION.—No Federal funds provided under 1 this section may be used for health education programs 2 that— 3 (1) deliberately withhold life-saving information 4 about HIV; 5 (2) are medically inaccurate or have been sci- 6 entifically shown to be ineffective; 7 (3) promote gender stereotypes; 8 (4) are insensitive and unresponsive to the 9 needs of sexually active youth or lesbian, gay, bisex- 10 ual, transgender, queer, or questioning youth; or 11 (5) are inconsistent with the ethical imperatives 12 of medicine and public health. 13 (g) DEFINITIONS.—In this section: 14 (1) ESEA DEFINITIONS.—The terms ‘‘elemen- 15 tary school’’, ‘‘local educational agency’’, ‘‘secondary 16 school’’, and ‘‘State educational agency’’ have the 17 meanings given the terms in section 8101 of the Ele- 18 mentary and Secondary Education Act of 1965 (20 19 U.S.C. 7801). 20 (2) AGE AND DEVELOPMENTALLY APPRO- 21 PRIATE.—The term ‘‘age and developmentally appro- 22 priate’’ means suitable for a particular age or age 23 group of children and adolescents, based on devel- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00559 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 560 •HR 5475 IH oping cognitive, emotional, and behavioral capacity 1 typical for that age or age group. 2 (3) ADOLESCENTS.—The term ‘‘adolescents’’ 3 means individuals who are ages 10 through 19 at 4 the time of commencement of participation in a pro- 5 gram supported under this section. 6 (4) CHARACTERISTICS OF EFFECTIVE PRO- 7 GRAMS.—The term ‘‘characteristics of effective pro- 8 grams’’ means the aspects of evidence-based pro- 9 grams, including development, content, and imple- 10 mentation of such programs, that— 11 (A) have been shown to be effective in 12 terms of increasing knowledge, clarifying values 13 and attitudes, increasing skills, and impacting 14 upon behavior; and 15 (B) are widely recognized by leading med- 16 ical and public health agencies to be effective in 17 changing sexual behaviors that lead to sexually 18 transmitted infections, including HIV, unin- 19 tended pregnancy, and dating violence and sex- 20 ual assault among young people. 21 (5) COMPREHENSIVE SEX EDUCATION.—The 22 term ‘‘comprehensive sex education’’ means a pro- 23 gram that— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00560 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 561 •HR 5475 IH (A) includes age- and developmentally ap- 1 propriate, culturally and linguistically relevant 2 information on a broad set of topics related to 3 sexuality including human development, rela- 4 tionships, decisionmaking, communication, ab- 5 stinence, contraception, and disease and preg- 6 nancy prevention; 7 (B) provides students with opportunities 8 for developing skills as well as learning informa- 9 tion; 10 (C) is inclusive of lesbian, gay, bisexual, 11 transgender, queer, questioning, and hetero- 12 sexual young people; and 13 (D) aims to— 14 (i) provide scientifically accurate and 15 realistic information about human sexu- 16 ality; 17 (ii) provide opportunities for individ- 18 uals to understand their own, their fami- 19 lies’, and their communities’ values, atti- 20 tudes, and insights about sexuality; 21 (iii) help individuals develop healthy 22 relationships and interpersonal skills; and 23 (iv) help individuals exercise responsi- 24 bility regarding sexual relationships, which 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00561 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 562 •HR 5475 IH includes addressing abstinence, pressures 1 to become prematurely involved in sexual 2 intercourse, and the use of contraception 3 and other sexual health measures. 4 (6) EVIDENCE-BASED PROGRAM.—The term 5 ‘‘evidence-based program’’ means a sex education 6 program that has been proven through rigorous eval- 7 uation to be effective in changing sexual behavior or 8 incorporates elements of other sex education pro- 9 grams that have been proven to be effective in 10 changing sexual behavior. 11 (7) INSTITUTION OF HIGHER EDUCATION.—The 12 term ‘‘institution of higher education’’ has the 13 meaning given the term in section 101 of the Higher 14 Education Act of 1965 (20 U.S.C. 1001). 15 (8) MEDICALLY ACCURATE AND COMPLETE.— 16 The term ‘‘medically accurate and complete’’, when 17 used with respect to a sex education program, means 18 that— 19 (A) the information provided through the 20 program is verified or supported by the weight 21 of research conducted in compliance with ac- 22 cepted scientific methods and is published in 23 peer-reviewed journals, where applicable; or 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00562 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 563 •HR 5475 IH (B)(i) the program contains information 1 that leading professional organizations and 2 agencies with relevant expertise in the field rec- 3 ognize as accurate, objective, and complete; and 4 (ii) the program does not withhold infor- 5 mation about the effectiveness and benefits of 6 correct and consistent use of condoms and 7 other contraceptives. 8 (9) SECRETARY.—The term ‘‘Secretary’’ means 9 the Secretary of Health and Human Services. 10 (10) YOUNG PEOPLE.—The term ‘‘young peo- 11 ple’’ means individuals who are ages 10 through 24 12 at the time of commencement of participation in a 13 program supported under this section. 14 (h) FUNDING.— 15 (1) ELIMINATION OF ABSTINENCE-ONLY-UNTIL- 16 MARRIAGE PROGRAM.—Title V of the Social Security 17 Act (42 U.S.C. 701 et seq.) is amended by striking 18 section 510. 19 (2) RESCISSION.—Amounts appropriated for 20 fiscal years 2016 and 2017 under section 510(d) of 21 the Social Security Act (42 U.S.C. 710(d)) (as in ef- 22 fect on the day before the date of enactment of this 23 Act) that are unobligated as of the date of enact- 24 ment of this Act are rescinded. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00563 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 564 •HR 5475 IH (3) AUTHORIZATION OF APPROPRIATIONS.— 1 There are authorized to be appropriated to carry out 2 this section for fiscal years 2017 through 2021 an 3 amount equal to the funds appropriated for fiscal 4 years 2016 and 2017 under section 510(d) of the 5 Social Security Act (42 U.S.C. 710(d)) (as in effect 6 on the day before the date of enactment of this Act) 7 that are rescinded by paragraph (2). 8 SEC. 754. REPORT ON IMPACT OF HIV/AIDS IN VULNERABLE 9 POPULATIONS. 10 (a) IN GENERAL.—The Secretary shall submit to the 11 Congress and the President an annual report on the im- 12 pact of HIV/AIDS for racial and ethnic minority commu- 13 nities, women, and youth aged 24 and younger. 14 (b) CONTENTS.—The report under subsection (a) 15 shall include information on the— 16 (1) progress that has been made in reducing 17 the impact of HIV/AIDS in such communities; 18 (2) opportunities that exist to make additional 19 progress in reducing the impact of HIV/AIDS in 20 such communities; 21 (3) challenges that may impede such additional 22 progress; and 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00564 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 565 •HR 5475 IH (4) Federal funding necessary to achieve sub- 1 stantial reductions in HIV/AIDS in racial and ethnic 2 minority communities. 3 SEC. 755. NATIONAL HIV/AIDS OBSERVANCE DAYS. 4 (a) NATIONAL OBSERVANCE DAYS.—It is the sense 5 of the Congress that national observance days highlighting 6 the impact of HIV/AIDS on communities of color include 7 the following: 8 (1) National Black HIV/AIDS Awareness Day. 9 (2) National Latino AIDS Awareness Day. 10 (3) National Asian and Pacific Islander HIV/ 11 AIDS Awareness Day. 12 (4) National Native American HIV/AIDS 13 Awareness Day. 14 (5) Caribbean-American HIV/AIDS Awareness 15 Day. 16 (6) National Youth HIV/AIDS Awareness Day. 17 (7) National Black Clergy HIV/AIDS Aware- 18 ness Sunday. 19 (b) CALL TO ACTION.—It is the sense of the Con- 20 gress that the President should call on members of com- 21 munities of color— 22 (1) to become involved at the local community 23 level in HIV/AIDS testing, policy, and advocacy; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00565 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 566 •HR 5475 IH (2) to become aware, engaged, and empowered 1 on the HIV/AIDS epidemic within their commu- 2 nities; and 3 (3) to urge members of their communities to re- 4 duce risk factors, practice safe sex and other preven- 5 tive measures, be tested for HIV/AIDS, and seek 6 care when appropriate. 7 SEC. 756. REVIEW OF ALL FEDERAL AND STATE LAWS, 8 POLICIES, AND REGULATIONS REGARDING 9 THE CRIMINAL PROSECUTION OF INDIVID- 10 UALS FOR HIV-RELATED OFFENSES. 11 (a) DEFINITIONS.— 12 (1) HIV AND HIV/AIDS.—The terms ‘‘HIV’’ and 13 ‘‘HIV/AIDS’’ have the meanings given to such terms 14 in section 2689 of the Public Health Service Act (42 15 U.S.C. 300ff–88). 16 (2) STATE.—The term ‘‘State’’ includes the 17 District of Columbia, American Samoa, the Com- 18 monwealth of the Northern Mariana Islands, Guam, 19 Puerto Rico, and the United States Virgin Islands. 20 (b) SENSE OF CONGRESS REGARDING LAWS OR REG- 21 ULATIONS DIRECTED AT PEOPLE LIVING WITH HIV/ 22 AIDS.—It is the sense of the Congress that Federal and 23 State laws, policies, and regulations regarding people liv- 24 ing with HIV/AIDS— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00566 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 567 •HR 5475 IH (1) should not place unique or additional bur- 1 dens on such individuals solely as a result of their 2 HIV status; and 3 (2) should instead demonstrate a public health- 4 oriented, evidence-based, medically accurate, and 5 contemporary understanding of— 6 (A) the multiple factors that lead to HIV 7 transmission; 8 (B) the relative risk of HIV transmission 9 routes; 10 (C) the current health implications of liv- 11 ing with HIV; 12 (D) the associated benefits of treatment 13 and support services for people living with HIV; 14 and 15 (E) the impact of punitive HIV-specific 16 laws and policies on public health, on people liv- 17 ing with or affected by HIV, and on their fami- 18 lies and communities. 19 (c) REVIEW OF ALL FEDERAL AND STATE LAWS, 20 POLICIES, AND REGULATIONS REGARDING THE CRIMINAL 21 PROSECUTION OF INDIVIDUALS FOR HIV-RELATED OF- 22 FENSES.— 23 (1) REVIEW OF FEDERAL AND STATE LAWS.— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00567 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 568 •HR 5475 IH (A) IN GENERAL.—No later than 90 days 1 after the date of the enactment of this Act, the 2 Attorney General, the Secretary of Health and 3 Human Services, and the Secretary of Defense 4 acting jointly (in this paragraph and paragraph 5 (2) referred to as the ‘‘designated officials’’) 6 shall initiate a national review of Federal and 7 State laws, policies, regulations, and judicial 8 precedents and decisions regarding criminal and 9 related civil commitment cases involving people 10 living with HIV/AIDS, including in regards to 11 the Uniform Code of Military Justice. 12 (B) CONSULTATION.—In carrying out the 13 review under subparagraph (A), the designated 14 officials shall ensure diverse participation and 15 consultation from each State, including with— 16 (i) State attorneys general (or their 17 representatives); 18 (ii) State public health officials (or 19 their representatives); 20 (iii) State judicial and court system 21 officers, including judges, district attor- 22 neys, prosecutors, defense attorneys, law 23 enforcement, and correctional officers; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00568 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 569 •HR 5475 IH (iv) members of the United States 1 Armed Forces, including members of other 2 Federal services subject to the Uniform 3 Code of Military Justice; 4 (v) people living with HIV/AIDS, par- 5 ticularly those who have been subject to 6 HIV-related prosecution or who are from 7 communities whose members have been 8 disproportionately subject to HIV-specific 9 arrests and prosecutions; 10 (vi) legal advocacy and HIV/AIDS 11 service organizations that work with people 12 living with HIV/AIDS; 13 (vii) nongovernmental health organi- 14 zations that work on behalf of people living 15 with HIV/AIDS; and 16 (viii) trade organizations or associa- 17 tions representing persons or entities de- 18 scribed in clauses (i) through (vii). 19 (C) RELATION TO OTHER REVIEWS.—In 20 carrying out the review under subparagraph 21 (A), the designated officials may utilize other 22 existing reviews of criminal and related civil 23 commitment cases involving people living with 24 HIV/AIDS, including any such review con- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00569 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 570 •HR 5475 IH ducted by any Federal or State agency or any 1 public health, legal advocacy, or trade organiza- 2 tion or association if the designated officials de- 3 termine that such reviews were conducted in ac- 4 cordance with the principles set forth in sub- 5 section (b). 6 (2) REPORT.—No later than 180 days after ini- 7 tiating the review required by paragraph (1), the At- 8 torney General shall transmit to the Congress and 9 make publicly available a report containing the re- 10 sults of the review, which includes the following: 11 (A) For each State and for the Uniform 12 Code of Military Justice, a summary of the rel- 13 evant laws, policies, regulations, and judicial 14 precedents and decisions regarding criminal 15 cases involving people living with HIV/AIDS, 16 including, if applicable, the following: 17 (i) A determination of whether such 18 laws, policies, regulations, and judicial 19 precedents and decisions place any unique 20 or additional burdens upon people living 21 with HIV/AIDS. 22 (ii) A determination of whether such 23 laws, policies, regulations, and judicial 24 precedents and decisions demonstrate a 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00570 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 571 •HR 5475 IH public health-oriented, evidence-based, 1 medically accurate, and contemporary un- 2 derstanding of— 3 (I) the multiple factors that lead 4 to HIV transmission; 5 (II) the relative risk of HIV 6 transmission routes; 7 (III) the current health implica- 8 tions of living with HIV; 9 (IV) the associated benefits of 10 treatment and support services for 11 people living with HIV; and 12 (V) the impact of punitive HIV- 13 specific laws and policies on public 14 health, on people living with or af- 15 fected by HIV, and on their families 16 and communities. 17 (iii) An analysis of the public health 18 and legal implications of such laws, poli- 19 cies, regulations, and judicial precedents, 20 including an analysis of the consequences 21 of having a similar penal scheme applied to 22 comparable situations involving other com- 23 municable diseases. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00571 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 572 •HR 5475 IH (iv) An analysis of the proportionality 1 of punishments imposed under HIV-spe- 2 cific laws, policies, regulations, and judicial 3 precedents, taking into consideration pen- 4 alties attached to violation of State laws 5 against similar degrees of endangerment or 6 harm, such as driving while intoxicated 7 (DWI) or transmission of other commu- 8 nicable diseases, or more serious harms, 9 such as vehicular manslaughter offenses. 10 (B) An analysis of common elements 11 shared among State laws, policies, regulations, 12 and judicial precedents. 13 (C) A set of best practice recommendations 14 directed to State governments, including State 15 attorneys general, public health officials, and 16 judicial officers, in order to ensure that laws, 17 policies, regulations, and judicial precedents re- 18 garding people living with HIV/AIDS are in ac- 19 cordance with the principles set forth in sub- 20 section (b). 21 (D) Recommendations for adjustments to 22 the Uniform Code of Military Justice, as may 23 be necessary, in order to ensure that laws, poli- 24 cies, regulations, and judicial precedents re- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00572 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 573 •HR 5475 IH garding people living with HIV/AIDS are in ac- 1 cordance with the principles set forth in sub- 2 section (b). 3 (3) GUIDANCE.—Within 90 days of the release 4 of the report required by paragraph (2), the Attor- 5 ney General and the Secretary of Health and 6 Human Services, acting jointly, shall develop and 7 publicly release updated guidance for States based 8 on the set of best practice recommendations required 9 by paragraph (2)(C) in order to assist States dealing 10 with criminal and related civil commitment cases re- 11 garding people living with HIV/AIDS. 12 (4) MONITORING AND EVALUATION SYSTEM.— 13 Within 60 days of the release of the guidance re- 14 quired by paragraph (3), the Attorney General and 15 the Secretary of Health and Human Services, acting 16 jointly, shall establish an integrated monitoring and 17 evaluation system which includes, where appropriate, 18 objective and quantifiable performance goals and in- 19 dicators to measure progress toward statewide im- 20 plementation in each State of the best practice rec- 21 ommendations required in paragraph (2)(C), includ- 22 ing to monitor, track, and evaluate the effectiveness 23 of assistance provided pursuant to subsection (d). 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00573 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 574 •HR 5475 IH (5) ADJUSTMENTS TO FEDERAL LAWS, POLI- 1 CIES, OR REGULATIONS.—Within 90 days of the re- 2 lease of the report required by paragraph (2), the 3 Attorney General, the Secretary of Health and 4 Human Services, and the Secretary of Defense, act- 5 ing jointly, shall develop and transmit to the Presi- 6 dent and the Congress, and make publicly available, 7 such proposals as may be necessary to implement 8 adjustments to Federal laws, policies, or regulations, 9 including to the Uniform Code of Military Justice, 10 based on the recommendations required by para- 11 graph (2)(D), either through Executive order or 12 through changes to statutory law. 13 (6) AUTHORIZATION OF APPROPRIATIONS.— 14 (A) IN GENERAL.—There are authorized to 15 be appropriated such sums as may be necessary 16 for the purpose of carrying out this subsection. 17 Amounts authorized to be appropriated by the 18 preceding sentence are in addition to amounts 19 otherwise authorized to be appropriated for 20 such purpose. 21 (B) AVAILABILITY OF FUNDS.—Amounts 22 appropriated pursuant to the authorization of 23 appropriations in subparagraph (A) are author- 24 ized to remain available until expended. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00574 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 575 •HR 5475 IH (d) AUTHORIZATION TO PROVIDE GRANTS.— 1 (1) GRANTS BY ATTORNEY GENERAL.— 2 (A) IN GENERAL.—The Attorney General 3 may provide assistance to eligible State and 4 local entities and eligible nongovernmental orga- 5 nizations for the purpose of incorporating the 6 best practice recommendations developed under 7 subsection (c)(2)(C) within relevant State laws, 8 policies, regulations, and judicial decisions re- 9 garding people living with HIV/AIDS. 10 (B) AUTHORIZED ACTIVITIES.—The assist- 11 ance authorized by subparagraph (A) may in- 12 clude— 13 (i) direct technical assistance to eligi- 14 ble State and local entities in order to de- 15 velop, disseminate, or implement State 16 laws, policies, regulations, or judicial deci- 17 sions that conform with the best practice 18 recommendations developed under sub- 19 section (c)(2)(C); 20 (ii) direct technical assistance to eligi- 21 ble nongovernmental organizations in order 22 to provide education and training, includ- 23 ing through classes, conferences, meetings, 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00575 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 576 •HR 5475 IH and other educational activities, to eligible 1 State and local entities; and 2 (iii) subcontracting authority to allow 3 eligible State and local entities and eligible 4 nongovernmental organizations to seek 5 technical assistance from legal and public 6 health experts with a demonstrated under- 7 standing of the principles underlying the 8 best practice recommendations developed 9 under subsection (c)(2)(C). 10 (2) GRANTS BY SECRETARY OF HEALTH AND 11 HUMAN SERVICES.— 12 (A) IN GENERAL.—The Secretary of 13 Health and Human Services, acting through the 14 Director of the Centers for Disease Control and 15 Prevention, may provide assistance to State and 16 local public health departments and eligible 17 nongovernmental organizations for the purpose 18 of supporting eligible State and local entities to 19 incorporate the best practice recommendations 20 developed under subsection (c)(2)(C) within rel- 21 evant State laws, policies, regulations, and judi- 22 cial decisions regarding people living with HIV/ 23 AIDS. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00576 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 577 •HR 5475 IH (B) AUTHORIZED ACTIVITIES.—The assist- 1 ance authorized by subparagraph (A) may in- 2 clude— 3 (i) direct technical assistance to State 4 and local public health departments in 5 order to support the development, dissemi- 6 nation, or implementation of State laws, 7 policies, regulations, or judicial decisions 8 that conform with the set of best practice 9 recommendations developed under sub- 10 section (c)(2)(C); 11 (ii) direct technical assistance to eligi- 12 ble nongovernmental organizations in order 13 to provide education and training, includ- 14 ing through classes, conferences, meetings, 15 and other educational activities, to State 16 and local public health departments; and 17 (iii) subcontracting authority to allow 18 State and local public health departments 19 and eligible nongovernmental organizations 20 to seek technical assistance from legal and 21 public health experts with a demonstrated 22 understanding of the principles underlying 23 the best practice recommendations devel- 24 oped under subsection (c)(2)(C). 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00577 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 578 •HR 5475 IH (3) LIMITATION.—As a condition of receiving 1 assistance through this subsection, eligible State and 2 local entities, State and local public health depart- 3 ments, and eligible nongovernmental organizations 4 shall agree— 5 (A) not to place any unique or additional 6 burdens on people living with HIV/AIDS solely 7 as a result of their HIV status; and 8 (B) that if the entity, department, or orga- 9 nization promulgates any laws, policies, regula- 10 tions, or judicial decisions regarding people liv- 11 ing with HIV/AIDS, such actions shall dem- 12 onstrate a public health-oriented, evidence- 13 based, medically accurate, and contemporary 14 understanding of— 15 (i) the multiple factors that lead to 16 HIV transmission; 17 (ii) the relative risk of HIV trans- 18 mission routes; 19 (iii) the current health implications of 20 living with HIV; 21 (iv) the associated benefits of treat- 22 ment and support services for people living 23 with HIV; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00578 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 579 •HR 5475 IH (v) the impact of punitive HIV-spe- 1 cific laws and policies on public health, on 2 people living with or affected by HIV, and 3 on their families and communities. 4 (4) REPORT.—No later than 1 year after the 5 date of the enactment of this Act, and annually 6 thereafter, the Attorney General and the Secretary 7 of Health and Human Services, acting jointly, shall 8 transmit to Congress and make publicly available a 9 report describing, for each State, the impact and ef- 10 fectiveness of the assistance provided through this 11 Act. Each such report shall include— 12 (A) a detailed description of the progress 13 each State has made, if any, in implementing 14 the best practice recommendations developed 15 under subsection (c)(2)(C) as a result of the as- 16 sistance provided under this subsection, and 17 based on the performance goals and indicators 18 established as part of the monitoring and eval- 19 uation system in subsection (c)(4); 20 (B) a brief summary of any outreach ef- 21 forts undertaken during the prior year by the 22 Attorney General and the Secretary of Health 23 and Human Services to encourage States to 24 seek assistance under this subsection in order 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00579 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 580 •HR 5475 IH to implement the best practice recommenda- 1 tions developed under subsection (c)(2)(C); 2 (C) a summary of how assistance provided 3 through this subsection is being utilized by eli- 4 gible State and local entities, State and local 5 public health departments, and eligible non- 6 governmental organizations and, if applicable, 7 any contractors, including with respect to non- 8 governmental organizations, the type of tech- 9 nical assistance provided, and an evaluation of 10 the impact of such assistance on eligible State 11 and local entities; and 12 (D) a summary and description of eligible 13 State and local entities, State and local public 14 health departments, and eligible nongovern- 15 mental organizations receiving assistance 16 through this subsection, including if applicable, 17 a summary and description of any contractors 18 selected to assist in implementing such assist- 19 ance. 20 (5) DEFINITIONS.—For the purposes of this 21 subsection: 22 (A) ELIGIBLE STATE AND LOCAL ENTI- 23 TIES.—The term ‘‘eligible State and local enti- 24 ties’’ means the relevant individuals, offices, or 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00580 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 581 •HR 5475 IH organizations that directly participate in the de- 1 velopment, dissemination, or implementation of 2 State laws, policies, regulations, or judicial deci- 3 sions, including— 4 (i) State governments, including State 5 attorneys general, State departments of 6 justice, and State National Guards, or 7 their equivalents; 8 (ii) State judicial and court systems, 9 including trial courts, appellate courts, 10 State supreme courts and courts of appeal, 11 and State correctional facilities, or their 12 equivalents; and 13 (iii) local governments, including city 14 and county governments, district attorneys, 15 and local law enforcement departments, or 16 their equivalents. 17 (B) STATE AND LOCAL PUBLIC HEALTH 18 DEPARTMENTS.—The term ‘‘State and local 19 public health departments’’ means the fol- 20 lowing: 21 (i) State public health departments, or 22 their equivalents, including the chief officer 23 of such departments and infectious disease 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00581 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 582 •HR 5475 IH and communicable disease specialists with- 1 in such departments. 2 (ii) Local public health departments, 3 or their equivalents, including city and 4 county public health departments, the chief 5 officer of such departments, and infectious 6 disease and communicable disease special- 7 ists within such departments. 8 (iii) Public health departments or offi- 9 cials, or their equivalents, within State or 10 local correctional facilities. 11 (iv) Public health departments or offi- 12 cials, or their equivalents, within State Na- 13 tional Guards. 14 (v) Any other recognized State or 15 local public health organization or entity 16 charged with carrying out official State or 17 local public health duties. 18 (C) ELIGIBLE NONGOVERNMENTAL ORGA- 19 NIZATIONS.—The term ‘‘eligible nongovern- 20 mental organizations’’ means the following: 21 (i) Nongovernmental organizations, 22 including trade organizations or associa- 23 tions that represent— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00582 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 583 •HR 5475 IH (I) State attorneys general, or 1 their equivalents; 2 (II) State public health officials, 3 or their equivalents; 4 (III) State judicial and court offi- 5 cers, including judges, district attor- 6 neys, prosecutors, defense attorneys, 7 law enforcement, and correctional offi- 8 cers; 9 (IV) State National Guards; 10 (V) people living with HIV/AIDS; 11 (VI) legal advocacy and HIV/ 12 AIDS service organizations that work 13 with people living with HIV/AIDS; 14 and 15 (VII) nongovernmental health or- 16 ganizations that work on behalf of 17 people living with HIV/AIDS. 18 (ii) Nongovernmental organizations, 19 including trade organizations or associa- 20 tions that demonstrate a public-health ori- 21 ented, evidence-based, medically accurate, 22 and contemporary understanding of— 23 (I) the multiple factors that lead 24 to HIV transmission; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00583 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 584 •HR 5475 IH (II) the relative risk of HIV 1 transmission routes; 2 (III) the current health implica- 3 tions of living with HIV; 4 (IV) the associated benefits of 5 treatment and support services for 6 people living with HIV; and 7 (V) the impact of punitive HIV- 8 specific laws and policies on public 9 health, on people living with or af- 10 fected by HIV, and on their families 11 and communities. 12 (6) AUTHORIZATION OF APPROPRIATIONS.— 13 (A) IN GENERAL.—In addition to amounts 14 otherwise made available, there are authorized 15 to be appropriated to the Attorney General and 16 the Secretary of Health and Human Services 17 such sums as may be necessary to carry out 18 this subsection for each of the fiscal years 2017 19 through 2021. 20 (B) AVAILABILITY OF FUNDS.—Amounts 21 appropriated pursuant to the authorizations of 22 appropriations in subparagraph (A) are author- 23 ized to remain available until expended. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00584 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 585 •HR 5475 IH SEC. 757. REPEAL OF LIMITATION AGAINST USE OF FUNDS 1 FOR EDUCATION OR INFORMATION DE- 2 SIGNED TO PROMOTE OR ENCOURAGE, DI- 3 RECTLY, HOMOSEXUAL OR HETEROSEXUAL 4 ACTIVITY OR INTRAVENOUS SUBSTANCE 5 ABUSE. 6 Section 2500 of the Public Health Service Act (42 7 U.S.C. 300ee) is amended— 8 (1) by striking subsection (c); and 9 (2) by redesignating subsection (d) as sub- 10 section (c). 11 SEC. 758. EXPANDING SUPPORT FOR CONDOMS IN PRIS- 12 ONS. 13 (a) AUTHORITY TO ALLOW COMMUNITY ORGANIZA- 14 TIONS TO PROVIDE STI COUNSELING, STI PREVENTION 15 EDUCATION, AND SEXUAL BARRIER PROTECTION DE- 16 VICES IN FEDERAL CORRECTIONAL FACILITIES.— 17 (1) DIRECTIVE TO ATTORNEY GENERAL.—Not 18 later than 30 days after the date of enactment of 19 this Act, the Attorney General shall direct the Bu- 20 reau of Prisons to allow community organizations to 21 distribute sexual barrier protection devices and to 22 engage in STI counseling and STI prevention edu- 23 cation in Federal correctional facilities. These activi- 24 ties shall be subject to all relevant Federal laws and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00585 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 586 •HR 5475 IH regulations which govern visitation in correctional 1 facilities. 2 (2) INFORMATION REQUIREMENT.—Any com- 3 munity organization permitted to distribute sexual 4 barrier protection devices under paragraph (1) shall 5 ensure that the persons to whom the devices are dis- 6 tributed are informed about the proper use and dis- 7 posal of sexual barrier protection devices in accord- 8 ance with established public health practices. Any 9 community organization conducting STI counseling 10 or STI prevention education under paragraph (1) 11 shall offer comprehensive sexuality education. 12 (3) POSSESSION OF DEVICE PROTECTED.—No 13 Federal correctional facility may, because of the pos- 14 session or use of a sexual barrier protection device— 15 (A) take adverse action against an incar- 16 cerated person; or 17 (B) consider possession or use as evidence 18 of prohibited activity for the purpose of any 19 Federal correctional facility administrative pro- 20 ceeding. 21 (4) IMPLEMENTATION.—The Attorney General 22 and Bureau of Prisons shall implement this section 23 according to established public health practices in a 24 manner that protects the health, safety, and privacy 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00586 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 587 •HR 5475 IH of incarcerated persons and of correctional facility 1 staff. 2 (b) SENSE OF CONGRESS REGARDING DISTRIBUTION 3 OF SEXUAL BARRIER PROTECTION DEVICES IN STATE 4 PRISON SYSTEMS.—It is the sense of the Congress that 5 States should allow for the legal distribution of sexual bar- 6 rier protection devices in State correctional facilities to re- 7 duce the prevalence and spread of STIs in those facilities. 8 (c) SURVEY OF AND REPORT ON CORRECTIONAL FA- 9 CILITY PROGRAMS AIMED AT REDUCING THE SPREAD OF 10 STIS.— 11 (1) SURVEY.—The Attorney General, after con- 12 sulting with the Secretary of Health and Human 13 Services, State officials, and community organiza- 14 tions, shall, to the maximum extent practicable, con- 15 duct a survey of all Federal and State correctional 16 facilities, not later than 180 days after the date of 17 enactment of this Act and annually thereafter for 5 18 years, to determine the following: 19 (A) COUNSELING, TREATMENT, AND SUP- 20 PORTIVE SERVICES.—Whether the correctional 21 facility requires incarcerated persons to partici- 22 pate in counseling, treatment, and supportive 23 services related to STIs, or whether it offers 24 such programs to incarcerated persons. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00587 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 588 •HR 5475 IH (B) ACCESS TO SEXUAL BARRIER PROTEC- 1 TION DEVICES.—Whether incarcerated persons 2 can— 3 (i) possess sexual barrier protection 4 devices; 5 (ii) purchase sexual barrier protection 6 devices; 7 (iii) purchase sexual barrier protection 8 devices at a reduced cost; and 9 (iv) obtain sexual barrier protection 10 devices without cost. 11 (C) INCIDENCE OF SEXUAL VIOLENCE.— 12 The incidence of sexual violence and assault 13 committed by incarcerated persons and by cor- 14 rectional facility staff. 15 (D) PREVENTION EDUCATION OFFERED.— 16 The type of prevention education, information, 17 or training offered to incarcerated persons and 18 correctional facility staff regarding sexual vio- 19 lence and the spread of STIs, including whether 20 such education, information, or training— 21 (i) constitutes comprehensive sexuality 22 education; 23 (ii) is compulsory for new incarcerated 24 persons and for new staff; and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00588 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 589 •HR 5475 IH (iii) is offered on an ongoing basis. 1 (E) STI TESTING.—Whether the correc- 2 tional facility tests incarcerated persons for 3 STIs or gives them the option to undergo such 4 testing— 5 (i) at intake; 6 (ii) on a regular basis; and 7 (iii) prior to release. 8 (F) STI TEST RESULTS.—The number of 9 incarcerated persons who are tested for STIs 10 and the outcome of such tests at each correc- 11 tional facility, disaggregated to include results 12 for— 13 (i) the type of sexually transmitted in- 14 fection tested for; 15 (ii) the race and/or ethnicity of indi- 16 viduals tested; 17 (iii) the age of individuals tested; and 18 (iv) the gender of individuals tested. 19 (G) PRERELEASE REFERRAL POLICY.— 20 Whether incarcerated persons are informed 21 prior to release about STI-related services or 22 other health services in their communities, in- 23 cluding free and low-cost counseling and treat- 24 ment options. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00589 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 590 •HR 5475 IH (H) PRERELEASE REFERRALS MADE.— 1 The number of referrals to community-based 2 organizations or public health facilities offering 3 STI-related or other health services provided to 4 incarcerated persons prior to release, and the 5 type of counseling or treatment for which the 6 referral was made. 7 (I) REINSTATEMENT OF MEDICAID BENE- 8 FITS.—Whether the correctional facility assists 9 incarcerated persons that were enrolled in the 10 State Medicaid program prior to their incarcer- 11 ation, in reinstating their enrollment upon re- 12 lease and whether such individuals receive refer- 13 rals as provided by subparagraph (G) to entities 14 that accept the State Medicaid program, includ- 15 ing if applicable— 16 (i) the number of such individuals, in- 17 cluding those diagnosed with the human 18 immunodeficiency virus, that have been re- 19 instated; 20 (ii) a list of obstacles to reinstating 21 enrollment or to making determinations of 22 eligibility for reinstatement, if any; and 23 (iii) the number of individuals denied 24 enrollment. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00590 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 591 •HR 5475 IH (J) OTHER ACTIONS TAKEN.—Whether the 1 correctional facility has taken any other action, 2 in conjunction with community organizations or 3 otherwise, to reduce the prevalence and spread 4 of STIs in that facility. 5 (2) PRIVACY.—In conducting the survey, the 6 Attorney General shall not request or retain the 7 identity of any person who has sought or been of- 8 fered counseling, treatment, testing, or prevention 9 education information regarding an STI (including 10 information about sexual barrier protection devices), 11 or who has tested positive for an STI. 12 (3) REPORT.—The Attorney General shall 13 transmit to Congress and make publicly available 14 the results of the survey required under paragraph 15 (1), both for the Nation as a whole and 16 disaggregated as to each State and each correctional 17 facility. To the maximum extent possible, the Attor- 18 ney General shall issue the first report no later than 19 1 year after the date of enactment of this Act and 20 shall issue reports annually thereafter for 5 years. 21 (d) STRATEGY.— 22 (1) DIRECTIVE TO ATTORNEY GENERAL.—The 23 Attorney General, in consultation with the Secretary 24 of Health and Human Services, State officials, and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00591 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 592 •HR 5475 IH community organizations, shall develop and imple- 1 ment a 5-year strategy to reduce the prevalence and 2 spread of STIs in Federal and State correctional fa- 3 cilities. To the maximum extent possible, the strat- 4 egy shall be developed, transmitted to Congress, and 5 made publicly available no later than 180 days after 6 the transmission of the first report required under 7 subsection (c)(3). 8 (2) CONTENTS OF STRATEGY.—The strategy 9 shall include the following: 10 (A) PREVENTION EDUCATION.—A plan for 11 improving prevention education, information, 12 and training offered to incarcerated persons 13 and correctional facility staff, including infor- 14 mation and training on sexual violence and the 15 spread of STIs, and comprehensive sexuality 16 education. 17 (B) SEXUAL BARRIER PROTECTION DEVICE 18 ACCESS.—A plan for expanding access to sexual 19 barrier protection devices in correctional facili- 20 ties. 21 (C) SEXUAL VIOLENCE REDUCTION.—A 22 plan for reducing the incidence of sexual vio- 23 lence among incarcerated persons and correc- 24 tional facility staff, developed in consultation 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00592 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 593 •HR 5475 IH with the National Prison Rape Elimination 1 Commission. 2 (D) COUNSELING AND SUPPORTIVE SERV- 3 ICES.—A plan for expanding access to coun- 4 seling and supportive services related to STIs in 5 correctional facilities. 6 (E) TESTING.—A plan for testing incarcer- 7 ated persons for STIs during intake, during 8 regular health exams, and prior to release, and 9 that— 10 (i) is conducted in accordance with 11 guidelines established by the Centers for 12 Disease Control and Prevention; 13 (ii) includes pretest counseling; 14 (iii) requires that incarcerated persons 15 are notified of their option to decline test- 16 ing at any time; 17 (iv) requires that incarcerated persons 18 are confidentially notified of their test re- 19 sults in a timely manner; and 20 (v) ensures that incarcerated persons 21 testing positive for STIs receive post-test 22 counseling, care, treatment, and supportive 23 services. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00593 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 594 •HR 5475 IH (F) TREATMENT.—A plan for ensuring 1 that correctional facilities have the necessary 2 medicine and equipment to treat and monitor 3 STIs and for ensuring that incarcerated per- 4 sons living with or testing positive for STIs re- 5 ceive and have access to care and treatment 6 services. 7 (G) STRATEGIES FOR DEMOGRAPHIC 8 GROUPS.—A plan for developing and imple- 9 menting culturally appropriate, sensitive, and 10 specific strategies to reduce the spread of STIs 11 among demographic groups heavily impacted by 12 STIs. 13 (H) LINKAGES WITH COMMUNITIES AND 14 FACILITIES.—A plan for establishing and 15 strengthening linkages to local communities and 16 health facilities that— 17 (i) provide counseling, testing, care, 18 and treatment services; 19 (ii) may receive persons recently re- 20 leased from incarceration who are living 21 with STIs; and 22 (iii) accept payment through the State 23 Medicaid program. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00594 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 595 •HR 5475 IH (I) ENROLLMENT IN STATE MEDICAID 1 PROGRAMS.—Plans to ensure that incarcerated 2 persons who were— 3 (i) enrolled in their State Medicaid 4 program prior to incarceration in a correc- 5 tional facility are automatically re-enrolled 6 in such program upon their release; and 7 (ii) not enrolled in their State Med- 8 icaid program prior to incarceration, but 9 who are diagnosed with the human im- 10 munodeficiency virus while incarcerated in 11 a correctional facility, are automatically 12 enrolled in such program upon their re- 13 lease. 14 (J) OTHER PLANS.—Any other plans de- 15 veloped by the Attorney General for reducing 16 the spread of STIs or improving the quality of 17 health care in correctional facilities. 18 (K) MONITORING SYSTEM.—A monitoring 19 system that establishes performance goals re- 20 lated to reducing the prevalence and spread of 21 STIs in correctional facilities and which, where 22 feasible, expresses such goals in quantifiable 23 form. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00595 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 596 •HR 5475 IH (L) MONITORING SYSTEM PERFORMANCE 1 INDICATORS.—Performance indicators that 2 measure or assess the achievement of the per- 3 formance goals described in subparagraph (K). 4 (M) COST ESTIMATE.—A detailed estimate 5 of the funding necessary to implement the 6 strategy at the Federal and State levels for all 7 5 years, including the amount of funds required 8 by community organizations to implement the 9 parts of the strategy in which they take part. 10 (3) REPORT.—The Attorney General shall 11 transmit to Congress and make publicly available an 12 annual progress report regarding the implementation 13 and effectiveness of the strategy described in para- 14 graph (1). The progress report shall include an eval- 15 uation of the implementation of the strategy using 16 the monitoring system and performance indicators 17 provided for in subparagraphs (K) and (L) of para- 18 graph (2). 19 (e) AUTHORIZATION OF APPROPRIATIONS.— 20 (1) IN GENERAL.—There are authorized to be 21 appropriated such sums as may be necessary to 22 carry out this section for each of fiscal years 2017 23 through 2021. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00596 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 597 •HR 5475 IH (2) AVAILABILITY OF FUNDS.—Amounts made 1 available under paragraph (1) are authorized to re- 2 main available until expended. 3 (f) DEFINITIONS.—For the purposes of this section: 4 (1) COMMUNITY ORGANIZATION.—The term 5 ‘‘community organization’’ means a public health 6 care facility or a nonprofit organization which pro- 7 vides health- or STI-related services according to es- 8 tablished public health standards. 9 (2) COMPREHENSIVE SEXUALITY EDUCATION.— 10 The term ‘‘comprehensive sexuality education’’ 11 means sexuality education that includes information 12 about abstinence and about the proper use and dis- 13 posal of sexual barrier protection devices and which 14 is— 15 (A) evidence-based; 16 (B) medically accurate; 17 (C) age and developmentally appropriate; 18 (D) gender and identity sensitive; 19 (E) culturally and linguistically appro- 20 priate; and 21 (F) structured to promote critical thinking, 22 self-esteem, respect for others, and the develop- 23 ment of healthy attitudes and relationships. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00597 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 598 •HR 5475 IH (3) CORRECTIONAL FACILITY.—The term ‘‘cor- 1 rectional facility’’ means any prison, penitentiary, 2 adult detention facility, juvenile detention facility, 3 jail, or other facility to which persons may be sent 4 after conviction of a crime or act of juvenile delin- 5 quency within the United States. 6 (4) INCARCERATED PERSON.—The term ‘‘incar- 7 cerated person’’ means any person who is serving a 8 sentence in a correctional facility after conviction of 9 a crime. 10 (5) SEXUALLY TRANSMITTED INFECTION.—The 11 term ‘‘sexually transmitted infection’’ or ‘‘STI’’ 12 means any disease or infection that is commonly 13 transmitted through sexual activity, including HIV/ 14 AIDS, gonorrhea, chlamydia, syphilis, genital her- 15 pes, viral hepatitis, and human papillomavirus. 16 (6) SEXUAL BARRIER PROTECTION DEVICE.— 17 The term ‘‘sexual barrier protection device’’ means 18 any FDA-approved physical device which has not 19 been tampered with and which reduces the prob- 20 ability of STI transmission or infection between sex- 21 ual partners, including female condoms, male 22 condoms, and dental dams. 23 (7) STATE.—The term ‘‘State’’ includes the 24 District of Columbia, American Samoa, the Com- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00598 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 599 •HR 5475 IH monwealth of the Northern Mariana Islands, Guam, 1 Puerto Rico, and the United States Virgin Islands. 2 SEC. 759. AUTOMATIC REINSTATEMENT OR ENROLLMENT 3 IN MEDICAID FOR PEOPLE WHO TEST POSI- 4 TIVE FOR HIV BEFORE REENTERING COMMU- 5 NITIES. 6 (a) IN GENERAL.—Section 1902(e) of the Social Se- 7 curity Act (42 U.S.C. 1396a(e)) is amended by adding at 8 the end the following: 9 ‘‘(15) ENROLLMENT OF EX-OFFENDERS.— 10 ‘‘(A) AUTOMATIC ENROLLMENT OR REIN- 11 STATEMENT.— 12 ‘‘(i) IN GENERAL.—The State plan 13 shall provide for the automatic enrollment 14 or reinstatement of enrollment of an eligi- 15 ble individual— 16 ‘‘(I) if such individual is sched- 17 uled to be released from a public insti- 18 tution due to the completion of sen- 19 tence, not less than 30 days prior to 20 the scheduled date of the release; and 21 ‘‘(II) if such individual is to be 22 released from a public institution on 23 parole or on probation, as soon as 24 possible after the date on which the 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00599 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 600 •HR 5475 IH determination to release such indi- 1 vidual was made, and before the date 2 such individual is released. 3 ‘‘(ii) EXCEPTION.—If a State makes a 4 determination that an individual is not eli- 5 gible to be enrolled under the State plan— 6 ‘‘(I) on or before the date by 7 which the individual would be enrolled 8 under clause (i), such clause shall not 9 apply to such individual; or 10 ‘‘(II) after such date, the State 11 may terminate the enrollment of such 12 individual. 13 ‘‘(B) RELATIONSHIP OF ENROLLMENT TO 14 PAYMENT FOR SERVICES.— 15 ‘‘(i) IN GENERAL.—Subject to sub- 16 paragraph (A)(ii), an eligible individual 17 who is enrolled, or whose enrollment is re- 18 instated, under subparagraph (A) shall be 19 eligible for medical assistance that is pro- 20 vided after the date that the eligible indi- 21 vidual is released from the public institu- 22 tion. 23 ‘‘(ii) RELATIONSHIP TO PAYMENT 24 PROHIBITION FOR INMATES.—No provision 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00600 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 601 •HR 5475 IH of this paragraph may be construed to per- 1 mit payment for care or services for which 2 payment is excluded under the subdivision 3 (A) that follows paragraph (30) of section 4 1905(a). 5 ‘‘(C) TREATMENT OF CONTINUOUS ELIGI- 6 BILITY.— 7 ‘‘(i) SUSPENSION FOR INMATES.—Any 8 period of continuous eligibility under this 9 title shall be suspended on the date an in- 10 dividual enrolled under this title becomes 11 an inmate of a public institution (except as 12 a patient of a medical institution). 13 ‘‘(ii) DETERMINATION OF REMAINING 14 PERIOD.—Notwithstanding any changes to 15 State law related to continuous eligibility 16 during the time that an individual is an in- 17 mate of a public institution (except as a 18 patient of a medical institution), subject to 19 clause (iii), with respect to an eligible indi- 20 vidual who was subject to a suspension 21 under clause (i), on the date that such in- 22 dividual is released from a public institu- 23 tion the suspension of continuous eligibility 24 under such clause shall be lifted for a pe- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00601 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 602 •HR 5475 IH riod that is equal to the time remaining in 1 the period of continuous eligibility for such 2 individual on the date that such period was 3 suspended under such clause. 4 ‘‘(iii) EXCEPTION.—If a State makes 5 a determination that an individual is not 6 eligible to be enrolled under the State 7 plan— 8 ‘‘(I) on or before the date that 9 the suspension of continuous eligibility 10 is lifted under clause (ii), such clause 11 shall not apply to such individual; or 12 ‘‘(II) after such date, the State 13 may terminate the enrollment of such 14 individual. 15 ‘‘(D) AUTOMATIC ENROLLMENT OR REIN- 16 STATEMENT OF ENROLLMENT DEFINED.—For 17 purposes of this paragraph, the term ‘automatic 18 enrollment or reinstatement of enrollment’ 19 means that the State determines eligibility for 20 medical assistance under the State plan without 21 a program application from, or on behalf of, the 22 eligible individual, but an individual can only be 23 automatically enrolled in the State Medicaid 24 plan if the individual affirmatively consents to 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00602 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 603 •HR 5475 IH being enrolled through affirmation in writing, 1 by telephone, orally, through electronic signa- 2 ture, or through any other means specified by 3 the Secretary. 4 ‘‘(E) ELIGIBLE INDIVIDUAL DEFINED.— 5 For purposes of this paragraph, the term ‘eligi- 6 ble individual’ means an individual who is an 7 inmate of a public institution (except as a pa- 8 tient in a medical institution)— 9 ‘‘(i) who was enrolled under the State 10 plan for medical assistance immediately be- 11 fore becoming an inmate of such an insti- 12 tution; or 13 ‘‘(ii) is diagnosed with human im- 14 munodeficiency virus.’’. 15 (b) SUPPLEMENTAL FUNDING FOR STATE IMPLE- 16 MENTATION OF AUTOMATIC REINSTATEMENT OF MED- 17 ICAID BENEFITS.— 18 (1) IN GENERAL.—Subject to paragraph (6), 19 for each State for which the Secretary of Health and 20 Human Services has approved an application under 21 paragraph (3), the Federal matching payments (in- 22 cluding payments based on the Federal medical as- 23 sistance percentage) made to such State under sec- 24 tion 1903 of the Social Security Act (42 U.S.C. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00603 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 604 •HR 5475 IH 1396b) shall be increased by 5.0 percentage points 1 for payments to the State for the activities per- 2 mitted under paragraph (2) or a period of one year. 3 (2) USE OF FUNDS.—A State may only use in- 4 creased matching payments authorized under para- 5 graph (1)— 6 (A) to strengthen the State’s enrollment 7 and administrative resources for the purpose of 8 improving processes for enrolling (or reinstating 9 the enrollment of) eligible individuals (as such 10 term is defined in subparagraph (E) of para- 11 graph (15) of section 1902(e) of the Social Se- 12 curity Act (as amended by subsection (a))); and 13 (B) for medical assistance (as such term is 14 defined in section 1905(a) of the Social Secu- 15 rity Act) provided to such eligible individuals. 16 (3) APPLICATION AND AGREEMENT.—The Sec- 17 retary may only make payments to a State in the in- 18 creased amount if— 19 (A) the State has amended the State plan 20 under section 1902(e) of the Social Security 21 Act to incorporate the requirements of para- 22 graph (15) of such section (as added by sub- 23 section (a)); 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00604 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 605 •HR 5475 IH (B) the State has submitted an application 1 to the Secretary that includes a plan for imple- 2 menting the requirements of section 3 1902(e)(15) of the Social Security Act under 4 the State’s amended State plan before the end 5 of the 90-day period beginning on the date that 6 the State receives increased matching payments 7 under paragraph (1); 8 (C) the State’s application meets the satis- 9 faction of the Secretary; and 10 (D) the State enters an agreement with 11 the Secretary that states that— 12 (i) the State will only use the in- 13 creased matching funds for the uses per- 14 mitted under paragraph (2); and 15 (ii) at the end of the period under 16 paragraph (1), the State will submit to the 17 Secretary, and make publicly available, a 18 report that contains the information re- 19 quired under paragraph (4). 20 (4) REQUIRED REPORT INFORMATION.—The in- 21 formation that is required in the report under para- 22 graph (3)(D)(ii) includes— 23 (A) the results of an evaluation of the im- 24 pact of the implementation of the requirements 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00605 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 606 •HR 5475 IH of section 1902(e)(15) of the Social Security 1 Act on improving the State’s processes for en- 2 rolling of individuals who are released from 3 public institutions into the Medicaid program; 4 (B) the number of individuals who were 5 automatically enrolled (or whose enrollment is 6 reinstated) under such section 1902(e)(15) dur- 7 ing the period under paragraph (1); and 8 (C) any other information that is required 9 by the Secretary. 10 (5) INCREASE IN CAP ON MEDICAID PAYMENTS 11 TO TERRITORIES.—Subject to paragraph (6), the 12 amounts otherwise determined for Puerto Rico, the 13 United States Virgin Islands, Guam, the Northern 14 Mariana Islands, and American Samoa under sub- 15 sections (f) and (g) of section 1108 of the Social Se- 16 curity Act (42 U.S.C. 1308) shall each be increased 17 by the necessary amount to allow for the increase in 18 the Federal matching payments under paragraph 19 (1), but only for the period under such paragraph 20 for such State. In the case of such an increase for 21 a territory, subsection (a)(1) of such section 1108 22 shall be applied without regard to any increase in 23 payment made to the territory under part E of title 24 IV of such Act that is attributable to the increase 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00606 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 607 •HR 5475 IH in Federal medical assistance percentage effected 1 under paragraph (1) for the territory. 2 (6) LIMITATIONS.— 3 (A) TIMING.—With respect to a State, at 4 the end of the period under paragraph (1), no 5 increased matching payments may be made to 6 such State under this subsection. 7 (B) MAINTENANCE OF ELIGIBILITY.— 8 (i) IN GENERAL.—Subject to clause 9 (ii), a State is not eligible for an increase 10 in its Federal matching payments under 11 paragraph (1), or an increase in a cap 12 amount under paragraph (5), if eligibility 13 standards, methodologies, or procedures 14 under its State plan under title XIX of the 15 Social Security Act (including any waiver 16 under such title or under section 1115 of 17 such Act (42 U.S.C. 1315)) are more re- 18 strictive than the eligibility standards, 19 methodologies, or procedures, respectively, 20 under such plan (or waiver) as in effect on 21 the date of enactment of this Act. 22 (ii) STATE REINSTATEMENT OF ELIGI- 23 BILITY PERMITTED.—A State that has re- 24 stricted eligibility standards, methodolo- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00607 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 608 •HR 5475 IH gies, or procedures under its State plan 1 under title XIX of the Social Security Act 2 (including any waiver under such title or 3 under section 1115 of such Act (42 U.S.C. 4 1315)) after the date of enactment of this 5 Act, is no longer ineligible under subpara- 6 graph (A) beginning with the first calendar 7 quarter in which the State has reinstated 8 eligibility standards, methodologies, or pro- 9 cedures that are no more restrictive than 10 the eligibility standards, methodologies, or 11 procedures, respectively, under such plan 12 (or waiver) as in effect on such date. 13 (C) NO WAIVER AUTHORITY.—The Sec- 14 retary may not waive the application of this 15 subsection under section 1115 of the Social Se- 16 curity Act or otherwise. 17 (D) LIMITATION OF MATCHING PAYMENTS 18 TO 100 PERCENT.—In no case shall an increase 19 in Federal matching payments under this sub- 20 section result in Federal matching payments 21 that exceed 100 percent. 22 (c) EFFECTIVE DATE.— 23 (1) IN GENERAL.—Except as provided in para- 24 graph (2), the amendments made by subsection (a) 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00608 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 609 •HR 5475 IH shall take effect 180 days after the date of the en- 1 actment of this Act and shall apply to services fur- 2 nished on or after such date. 3 (2) RULE FOR CHANGES REQUIRING STATE 4 LEGISLATION.—In the case of a State plan for med- 5 ical assistance under title XIX of the Social Security 6 Act which the Secretary of Health and Human Serv- 7 ices determines requires State legislation (other than 8 legislation appropriating funds) in order for the plan 9 to meet the additional requirement imposed by the 10 amendments made by this section, the State plan 11 shall not be regarded as failing to comply with the 12 requirements of such title solely on the basis of its 13 failure to meet this additional requirement before 14 the first day of the first calendar quarter beginning 15 after the close of the first regular session of the 16 State legislature that begins after the date of the en- 17 actment of this Act. For purposes of the previous 18 sentence, in the case of a State that has a 2-year 19 legislative session, each year of such session shall be 20 deemed to be a separate regular session of the State 21 legislature. 22 SEC. 760. STOP AIDS IN PRISON. 23 (a) SHORT TITLE.—This section may be cited as the 24 ‘‘Stop AIDS in Prison Act’’. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00609 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 610 •HR 5475 IH (b) IN GENERAL.—The Bureau of Prisons (herein- 1 after in this section referred to as the ‘‘Bureau’’) shall 2 develop a comprehensive policy to provide HIV testing, 3 treatment, and prevention for inmates within the correc- 4 tional setting and upon reentry. 5 (c) PURPOSE.—The purposes of this policy shall be 6 as follows: 7 (1) To stop the spread of HIV/AIDS among in- 8 mates. 9 (2) To protect prison guards and other per- 10 sonnel from HIV/AIDS infection. 11 (3) To provide comprehensive medical treat- 12 ment to inmates who are living with HIV/AIDS. 13 (4) To promote HIV/AIDS awareness and pre- 14 vention among inmates. 15 (5) To encourage inmates to take personal re- 16 sponsibility for their health. 17 (6) To reduce the risk that inmates will trans- 18 mit HIV/AIDS to other persons in the community 19 following their release from prison. 20 (d) CONSULTATION.—The Bureau shall consult with 21 appropriate officials of the Department of Health and 22 Human Services, the Office of National Drug Control Pol- 23 icy, the Office of National AIDS Policy, and the Centers 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00610 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 611 •HR 5475 IH for Disease Control and Prevention regarding the develop- 1 ment of this policy. 2 (e) TIME LIMIT.—The Bureau shall draft appro- 3 priate regulations to implement this policy not later than 4 1 year after the date of the enactment of this Act. 5 (f) REQUIREMENTS FOR POLICY.—The policy created 6 under subsection (b) shall provide for the following: 7 (1) TESTING AND COUNSELING UPON IN- 8 TAKE.— 9 (A) Health care personnel shall provide 10 routine HIV testing to all inmates as a part of 11 a comprehensive medical examination imme- 12 diately following admission to a facility. (Health 13 care personnel need not provide routine HIV 14 testing to an inmate who is transferred to a fa- 15 cility from another facility if the inmate’s med- 16 ical records are transferred with the inmate and 17 indicate that the inmate has been tested pre- 18 viously.) 19 (B) To all inmates admitted to a facility 20 prior to the effective date of this policy, health 21 care personnel shall provide routine HIV testing 22 within no more than 6 months. HIV testing for 23 these inmates may be performed in conjunction 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00611 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 612 •HR 5475 IH with other health services provided to these in- 1 mates by health care personnel. 2 (C) All HIV tests under this paragraph 3 shall comply with the opt-out provision. 4 (2) PRE-TEST AND POST-TEST COUNSELING.— 5 Health care personnel shall provide confidential pre- 6 test and post-test counseling to all inmates who are 7 tested for HIV. Counseling may be included with 8 other general health counseling provided to inmates 9 by health care personnel. 10 (3) HIV/AIDS PREVENTION EDUCATION.— 11 (A) Health care personnel shall improve 12 HIV/AIDS awareness through frequent edu- 13 cational programs for all inmates. HIV/AIDS 14 educational programs may be provided by com- 15 munity-based organizations, local health depart- 16 ments, and inmate peer educators. 17 (B) HIV/AIDS educational materials shall 18 be made available to all inmates at orientation, 19 at health care clinics, at regular educational 20 programs, and prior to release. Both written 21 and audiovisual materials shall be made avail- 22 able to all inmates. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00612 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 613 •HR 5475 IH (C)(i) The HIV/AIDS educational pro- 1 grams and materials under this paragraph shall 2 include information on— 3 (I) modes of transmission, including 4 transmission through tattooing, sexual con- 5 tact, and intravenous drug use; 6 (II) prevention methods; 7 (III) treatment; and 8 (IV) disease progression. 9 (ii) The programs and materials shall be 10 culturally sensitive, written or designed for low- 11 literacy levels, available in a variety of lan- 12 guages, and present scientifically accurate in- 13 formation in a clear and understandable man- 14 ner. 15 (4) HIV TESTING UPON REQUEST.— 16 (A) Health care personnel shall allow in- 17 mates to obtain HIV tests upon request once 18 per year or whenever an inmate has a reason to 19 believe the inmate may have been exposed to 20 HIV. Health care personnel shall, both orally 21 and in writing, inform inmates, during orienta- 22 tion and periodically throughout incarceration, 23 of their right to obtain HIV tests. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00613 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 614 •HR 5475 IH (B) Health care personnel shall encourage 1 inmates to request HIV tests if the inmate is 2 sexually active, has been raped, uses intra- 3 venous drugs, receives a tattoo, or if the inmate 4 is concerned that the inmate may have been ex- 5 posed to HIV/AIDS. 6 (C) An inmate’s request for an HIV test 7 shall not be considered an indication that the 8 inmate has put him/herself at risk of infection 9 and/or committed a violation of prison rules. 10 (5) HIV TESTING OF PREGNANT WOMAN.— 11 (A) Health care personnel shall provide 12 routine HIV testing to all inmates who become 13 pregnant. 14 (B) All HIV tests under this paragraph 15 shall comply with the opt-out provision. 16 (6) COMPREHENSIVE TREATMENT.— 17 (A) Health care personnel shall provide all 18 inmates who test positive for HIV— 19 (i) timely, comprehensive medical 20 treatment; 21 (ii) confidential counseling on man- 22 aging their medical condition and pre- 23 venting its transmission to other persons; 24 and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00614 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 615 •HR 5475 IH (iii) voluntary partner notification 1 services. 2 (B) Health care provided under this para- 3 graph shall be consistent with current Depart- 4 ment of Health and Human Services guidelines 5 and standard medical practice. Health care per- 6 sonnel shall discuss treatment options, the im- 7 portance of adherence to antiretroviral therapy, 8 and the side effects of medications with inmates 9 receiving treatment. 10 (C) Health care personnel and pharmacy 11 personnel shall ensure that the facility for- 12 mulary contains all Food and Drug Administra- 13 tion-approved medications necessary to provide 14 comprehensive treatment for inmates living with 15 HIV/AIDS, and that the facility maintains ade- 16 quate supplies of such medications to meet in- 17 mates’ medical needs. Health care personnel 18 and pharmacy personnel shall also develop and 19 implement automatic renewal systems for these 20 medications to prevent interruptions in care. 21 (D) Correctional staff, health care per- 22 sonnel, and pharmacy personnel shall develop 23 and implement distribution procedures to en- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00615 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 616 •HR 5475 IH sure timely and confidential access to medica- 1 tions. 2 (7) PROTECTION OF CONFIDENTIALITY.— 3 (A) Health care personnel shall develop 4 and implement procedures to ensure the con- 5 fidentiality of inmate tests, diagnoses, and 6 treatment. Health care personnel and correc- 7 tional staff shall receive regular training on the 8 implementation of these procedures. Penalties 9 for violations of inmate confidentiality by health 10 care personnel or correctional staff shall be 11 specified and strictly enforced. 12 (B) HIV testing, counseling, and treat- 13 ment shall be provided in a confidential setting 14 where other routine health services are provided 15 and in a manner that allows the inmate to re- 16 quest and obtain these services as routine med- 17 ical services. 18 (8) TESTING, COUNSELING, AND REFERRAL 19 PRIOR TO REENTRY.— 20 (A) Health care personnel shall provide 21 routine HIV testing to all inmates no more 22 than 3 months prior to their release and re- 23 entry into the community. (Inmates who are al- 24 ready known to be infected need not be tested 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00616 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 617 •HR 5475 IH again.) This requirement may be waived if an 1 inmate’s release occurs without sufficient notice 2 to the Bureau to allow health care personnel to 3 perform a routine HIV test and notify the in- 4 mate of the results. 5 (B) All HIV tests under this paragraph 6 shall comply with the opt-out provision. 7 (C) To all inmates who test positive for 8 HIV and all inmates who already are known to 9 have HIV/AIDS, health care personnel shall 10 provide— 11 (i) confidential prerelease counseling 12 on managing their medical condition in the 13 community, accessing appropriate treat- 14 ment and services in the community, and 15 preventing the transmission of their condi- 16 tion to family members and other persons 17 in the community; 18 (ii) referrals to appropriate health 19 care providers and social service agencies 20 in the community that meet the inmate’s 21 individual needs, including voluntary part- 22 ner notification services and prevention 23 counseling services for people living with 24 HIV/AIDS; and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00617 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 618 •HR 5475 IH (iii) a 30-day supply of any medically 1 necessary medications the inmate is cur- 2 rently receiving. 3 (9) OPT-OUT PROVISION.—Inmates shall have 4 the right to refuse routine HIV testing. Inmates 5 shall be informed both orally and in writing of this 6 right. Oral and written disclosure of this right may 7 be included with other general health information 8 and counseling provided to inmates by health care 9 personnel. If an inmate refuses a routine test for 10 HIV, health care personnel shall make a note of the 11 inmate’s refusal in the inmate’s confidential medical 12 records. However, the inmate’s refusal shall not be 13 considered a violation of prison rules or result in dis- 14 ciplinary action. Any reference in this section to the 15 ‘‘opt-out provision’’ shall be deemed a reference to 16 the requirement of this paragraph. 17 (10) EXCLUSION OF TESTS PERFORMED UNDER 18 SECTION 4014(b) FROM THE DEFINITION OF ROU- 19 TINE HIV TESTING.—HIV testing of an inmate 20 under section 4014(b) of title 18, United States 21 Code, is not routine HIV testing for the purposes of 22 the opt-out provision. Health care personnel shall 23 document the reason for testing under section 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00618 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 619 •HR 5475 IH 4014(b) of title 18, United States Code, in the in- 1 mate’s confidential medical records. 2 (11) TIMELY NOTIFICATION OF TEST RE- 3 SULTS.—Health care personnel shall provide timely 4 notification to inmates of the results of HIV tests. 5 (g) CHANGES IN EXISTING LAW.— 6 (1) SCREENING IN GENERA.—Section 4014(a) 7 of title 18, United States Code, is amended— 8 (A) by striking ‘‘for a period of 6 months 9 or more’’; 10 (B) by striking ‘‘, as appropriate,’’; and 11 (C) by striking ‘‘if such individual is deter- 12 mined to be at risk for infection with such virus 13 in accordance with the guidelines issued by the 14 Bureau of Prisons relating to infectious disease 15 management’’ and inserting ‘‘unless the indi- 16 vidual declines. The Attorney General shall also 17 cause such individual to be so tested before re- 18 lease unless the individual declines.’’. 19 (2) INADMISSIBILITY OF HIV TEST RESULTS IN 20 CIVIL AND CRIMINAL PROCEEDINGS.—Section 21 4014(d) of title 18, United States Code, is amended 22 by inserting ‘‘or under the Stop AIDS in Prison 23 Act’’ after ‘‘under this section’’. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00619 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 620 •HR 5475 IH (3) SCREENING AS PART OF ROUTINE SCREEN- 1 ING.—Section 4014(e) of title 18, United States 2 Code, is amended by adding at the end the fol- 3 lowing: ‘‘Such rules shall also provide that the initial 4 test under this section be performed as part of the 5 routine health screening conducted at intake.’’. 6 (h) REPORTING REQUIREMENTS.— 7 (1) REPORT ON HEPATITIS, LIVER, AND OTHER 8 DISEASES.—Not later than 1 year after the date of 9 the enactment of this Act, the Bureau shall provide 10 a report to the Congress on Bureau policies and pro- 11 cedures to provide testing, treatment, and prevention 12 education programs for hepatitis, liver failure, and 13 other liver-related diseases transmitted through sex- 14 ual activity, intravenous drug use, or other means. 15 The Bureau shall consult with appropriate officials 16 of the Department of Health and Human Services, 17 the Office of National Drug Control Policy, the Of- 18 fice of National AIDS Policy, and the Centers for 19 Disease Control and Prevention regarding the devel- 20 opment of this report. 21 (2) ANNUAL REPORTS.— 22 (A) GENERALLY.—Not later than 2 years 23 after the date of the enactment of this Act, and 24 then annually thereafter, the Bureau shall re- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00620 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 621 •HR 5475 IH port to Congress on the incidence among in- 1 mates of diseases transmitted through sexual 2 activity and intravenous drug use. 3 (B) MATTERS PERTAINING TO VARIOUS 4 DISEASES.—Reports under paragraph (1) shall 5 discuss— 6 (i) the incidence among inmates of 7 HIV/AIDS, hepatitis, and other diseases 8 transmitted through sexual activity and in- 9 travenous drug use; and 10 (ii) updates on Bureau testing, treat- 11 ment, and prevention education programs 12 for these diseases. 13 (C) MATTERS PERTAINING TO HIV/AIDS 14 ONLY.—Reports under paragraph (1) shall also 15 include— 16 (i) the number of inmates who tested 17 positive for HIV upon intake; 18 (ii) the number of inmates who tested 19 positive prior to reentry; 20 (iii) the number of inmates who were 21 not tested prior to reentry because they 22 were released without sufficient notice; 23 (iv) the number of inmates who opted- 24 out of taking the test; 25 VerDate Sep 11 2014 21:04 Jun 20, 2016 Jkt 059200 PO 00000 Frm 00621 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 622 •HR 5475 IH (v) the number of inmates who were 1 tested under section 4014(b) of title 18, 2 United States Code; and 3 (vi) the number of inmates under 4 treatment for HIV/AIDS. 5 (D) CONSULTATION.—The Bureau shall 6 consult with appropriate officials of the Depart- 7 ment of Health and Human Services, the Office 8 of National Drug Control Policy, the Office of 9 National AIDS Policy, and the Centers for Dis- 10 ease Control and Prevention regarding the de- 11 velopment of reports under paragraph (1). 12 SEC. 761. SUPPORT DATA SYSTEM REVIEW AND INDICA- 13 TORS FOR MONITORING HIV CARE. 14 The Secretary of Health and Human Services, in col- 15 laboration with the Assistant Secretary for Health, the Di- 16 rector of the Office of HIV/AIDS and Infectious Disease 17 Policy, the Director of the Centers for Disease Control and 18 Prevention, the Administrator of the Substance Abuse and 19 Mental Health Services Administration, the Director of 20 the Department of Housing and Urban Development, the 21 Director of the Office of AIDS Research, the Adminis- 22 trator of the Health Resources and Services Administra- 23 tion, and the Administrator of the Centers for Medicare 24 & Medicaid Services, shall expand and coordinate efforts 25 VerDate Sep 11 2014 21:04 Jun 20, 2016 Jkt 059200 PO 00000 Frm 00622 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 623 •HR 5475 IH to align metrics across agencies and modify Federal data 1 systems, to— 2 (1) adopt the Institute of Medicine’s clinical 3 HIV care indicators as the core metrics for moni- 4 toring the quality of HIV care, mental health, sub- 5 stance abuse, and supportive services; 6 (2) better enable assessment of the impact of 7 the National HIV/AIDS Strategy and the Patient 8 Protection and Affordable Care Act on improving 9 HIV/AIDS care and access to supportive services for 10 individuals with HIV; 11 (3) expand the demographic data elements to be 12 captured by Federal data systems relevant to HIV 13 care to permit calculation of the indicators for sub- 14 groups of the population of people with diagnosed 15 HIV infection, including— 16 (A) age; 17 (B) race; 18 (C) ethnicity; 19 (D) sex (assigned at birth); 20 (E) gender identity; 21 (F) sexual orientation; 22 (G) current geographic marker of resi- 23 dence; 24 (H) income or poverty level; and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00623 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 624 •HR 5475 IH (I) primary means of reimbursement for 1 medical services (including Medicaid, Medicare, 2 the Ryan White HIV/AIDS Program, private 3 insurance, health maintenance organizations, 4 and no coverage); and 5 (4) streamline data collection and systematically 6 review all existing reporting requirements for feder- 7 ally funded HIV/AIDS programs to ensure that only 8 essential data are collected. 9 SEC. 762. TRANSFER OF FUNDS FOR IMPLEMENTATION OF 10 NATIONAL HIV/AIDS STRATEGY. 11 Title II of the Public Health Service Act (42 U.S.C. 12 202 et seq.) is amended by inserting after section 241 the 13 following: 14 ‘‘SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION 15 OF NATIONAL HIV/AIDS STRATEGY. 16 ‘‘(a) TRANSFER AUTHORIZATION.—Of the discre- 17 tionary appropriations made available to the Department 18 of Health and Human Services for any fiscal year for pro- 19 grams and activities that, as determined by the Secretary 20 of Health and Human Services, pertain to HIV/AIDS, the 21 Secretary, in coordination with the Director of the Office 22 of National HIV/AIDS Policy, may transfer up to 1 per- 23 cent of such appropriations to the Office of the Assistant 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00624 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 625 •HR 5475 IH Secretary for Health for implementation of the National 1 HIV/AIDS Strategy. 2 ‘‘(b) CONGRESSIONAL NOTIFICATION.—Not less than 3 30 days before making any transfer under this section, 4 the Secretary shall give notice of the transfer to the Con- 5 gress. 6 ‘‘(c) DEFINITIONS.—In this section: 7 ‘‘(1) The term ‘HIV/AIDS’ has the meaning 8 given to such term in section 2689. 9 ‘‘(2) The term ‘National HIV/AIDS Strategy’ 10 means the National HIV/AIDS Strategy for the 11 United States issued by the President in July 2010 12 and includes any subsequent revisions to such Strat- 13 egy.’’. 14 SEC. 763. HIV INTEGRATED SERVICES DELIVERY MODEL 15 DEMONSTRATION. 16 (a) IN GENERAL.—Consistent with the National 17 HIV/AIDS Strategy for the United States and in accord- 18 ance with this section, the Secretary of Health and 19 Human Services acting through the Center for Medicare 20 & Medicaid Innovation and in cooperation with CDC, 21 HRSA, SAMHSA, and HUD, shall conduct a 3-year dem- 22 onstration project that is designed to integrate services 23 and funding under the Medicare and Medicaid programs, 24 under HIV-related programs conducted by the CDC, and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00625 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 626 •HR 5475 IH under the Ryan White HIV/AIDS Program, to reduce new 1 HIV infections, to increase the proportion of people who 2 know their status, to increase access to care, to improve 3 health outcomes, to reduce HIV-related health disparities 4 among Medicaid and Medicare beneficiaries, and to reduce 5 the cost of care provided to HIV positive Medicare and 6 Medicaid beneficiaries. 7 (b) OBJECTIVES.—The objectives of the demonstra- 8 tion are the following: 9 (1) To ensure the early identification of HIV 10 positive beneficiaries to reduce costly HIV-related 11 clinical conditions through HIV screening and rapid 12 linkage to high quality HIV medical care. 13 (2) To reduce new HIV infections among Med- 14 icaid and Medicare beneficiaries through routine 15 HIV testing, prevention services for HIV negative 16 beneficiaries, and intensive ‘‘prevention for positive’’ 17 services for HIV positive beneficiaries. 18 (3) To reduce morbidity, mortality, and high 19 cost inpatient and specialty care among HIV positive 20 beneficiaries by ensuring access to high quality HIV 21 medical care, HIV medications, and support services. 22 (4) To promote HIV treatment adherence and 23 retention in care through intensive case manage- 24 ment, treatment education, and outreach services. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00626 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 627 •HR 5475 IH (5) To effectively treat behavioral health condi- 1 tions among HIV positive beneficiaries that impair 2 their HIV treatment adherence and lead to sec- 3 ondary HIV infections through services funded 4 under Medicare and Medicaid and programs admin- 5 istered by SAMHSA. 6 (6) To promote independence, treatment adher- 7 ence, and stable housing for HIV positive bene- 8 ficiaries through highly coordinated HIV health, 9 housing, and support services funded by HRSA and 10 HUD. 11 (c) DEMONSTRATION DESIGN.— 12 (1) IN GENERAL.—The Secretary shall design 13 the demonstration to test both— 14 (A) the service delivery model described in 15 paragraph (2); and 16 (B) the payment model described in para- 17 graph (3). 18 (2) SERVICE DELIVERY MODEL.— 19 (A) IN GENERAL.—Under the service deliv- 20 ery model described in this paragraph, the dem- 21 onstration shall test comprehensive HIV test- 22 ing, linkage to care, HIV medical care, and an- 23 cillary services to individuals enrolled under 24 Medicare, Medicaid, or both. The service deliv- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00627 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 628 •HR 5475 IH ery model will integrate services furnished 1 under Medicare and Medicaid with prevention 2 services funded by CDC for HIV positive bene- 3 ficiaries, intensive case management services 4 funded by HRSA, behavioral services funded by 5 SAMHSA, and housing assistance services 6 funded through HUD. 7 (B) CORE ELEMENTS.—The model under 8 this paragraph shall have the following 8 core 9 elements: 10 (i) HIV testing services that apply the 11 CDC’s 2006 recommendations for uni- 12 versal opt-out testing among Medicare and 13 Medicaid beneficiary populations. 14 (ii) Rapid linkage from HIV testing 15 settings to treatment for HIV positive 16 beneficiaries to ensure they are engaged in 17 care in a timely basis. 18 (iii) Access to high quality HIV expe- 19 rienced medical care, laboratory moni- 20 toring, HIV medications, and other re- 21 quired services. 22 (iv) Routine screening and treatment 23 for HIV-related and other chronic condi- 24 tions, including behavioral health. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00628 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 629 •HR 5475 IH (v) Prevention and treatment edu- 1 cation services, including an adapted Medi- 2 cation Therapy Management (MTM) pro- 3 gram model, to optimize the benefit of 4 HIV therapeutics. 5 (vi) Risk-stratified medical case man- 6 agement. 7 (vii) Provision of preventive care, in- 8 cluding counseling to prevent secondary 9 HIV infection. 10 (viii) Wrap-around support and hous- 11 ing services. 12 (3) PAYMENT MODEL.—Under the payment 13 model described in this paragraph, the demonstra- 14 tion shall test the following: 15 (A) A prepaid capitated payment model 16 that adjusts payment for HIV and behavioral 17 health acuity, to be applied under contracts 18 with managed care organizations with dem- 19 onstrated HIV experience. 20 (B) Use of funds under the Ryan White 21 HIV/AIDS Program to purchase capitated serv- 22 ices from the contracted managed care organi- 23 zations. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00629 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 630 •HR 5475 IH (C) Provision of additional funds to sup- 1 port services to the extent that Medicaid and 2 Medicare coverage is limited, including for serv- 3 ices such as HIV testing (for Medicaid bene- 4 ficiaries), medical case management, prevention 5 case management, treatment education, case 6 finding, behavioral health services, and housing 7 assistance. 8 (d) BENEFICIARY CRITERIA.—Beneficiaries eligible 9 for participation in the demonstration are the following: 10 (1) MEDICAID FFS BENEFICIARIES.—Fee-for- 11 service Medicaid beneficiaries 18 years of age or 12 older. 13 (2) DUAL ELIGIBLES.—Individuals who are— 14 (A) entitled to medical assistance under 15 Medicaid; and 16 (B) entitled to benefits under part A, and 17 enrolled under part B, of Medicare but are not 18 enrolled under a Medicare Advantage plan 19 under Medicare. 20 (e) ROLES AND RESPONSIBILITIES IN DEMONSTRA- 21 TION.— 22 (1) IN GENERAL.—Consistent with the National 23 HIV/AIDS Strategy for the United States, Federal 24 agencies shall coordinate their funding for the se- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00630 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 631 •HR 5475 IH lected States or cities covered under the demonstra- 1 tion to provide resources to fund the delivery of serv- 2 ices within the demonstration. 3 (2) HHS.—In carrying out the demonstration, 4 the Secretary shall— 5 (A) design the application process; 6 (B) solicit applications from 5 to 7 State 7 Medicaid agencies to host the demonstration; 8 (C) with respect to the service delivery 9 model described in subsection (c)(2), collaborate 10 with the CDC, HRSA, and the National Insti- 11 tutes of Health to design a minimum service de- 12 livery model that reflects the current standard 13 of care as established by the Public Health 14 Service and CDC guidelines and recommenda- 15 tions; and 16 (D) fund an evaluation of the demonstra- 17 tion to ensure collection of system, provider, 18 and beneficiary-level data to address their rou- 19 tine reporting requirements. 20 The Secretary may carry out the Secretary’s author- 21 ity under this paragraph through CMMI. 22 (3) CDC.—The CDC shall collaborate with the 23 Secretary and CDC-funded HIV prevention grantees 24 in the selected States and cities to provide technical 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00631 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 632 •HR 5475 IH assistance to design cost-effective HIV and sexually 1 transmitted infection (STI) screening and testing 2 services for Medicaid and Medicare beneficiaries, in- 3 cluding partner notification services and commu- 4 nicable disease reporting. CDC and CMS shall deter- 5 mine the extent to which testing funds shall be sup- 6 ported jointly or separately by these agencies. 7 (4) HRSA.—HRSA shall allocate funds avail- 8 able through the Special Projects of National Sig- 9 nificance (SPNS) Initiative Program (under subpart 10 I of part F of the Ryan White HIV/AIDS Program) 11 to support wrap-around core and support services 12 not covered under Medicare or Medicaid and shall 13 authorize the use of Ryan White HIV/AIDS Pro- 14 gram funds to purchase services through capitated 15 managed care programs that meet or exceed the 16 services covered by the Ryan White HIV/AIDS Pro- 17 gram at rates that are no greater than current per 18 capita expenditures. HRSA is authorized to use 19 funds under SPNS, and to waive such requirements 20 of SPNS as may be necessary, to carry out the dem- 21 onstration. 22 (5) SAMHSA.—SAMHSA shall allocate funds 23 through the Minority HIV/AIDS Initiative or other 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00632 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 633 •HR 5475 IH programs to support behavioral health services not 1 covered under Medicare or Medicaid. 2 (6) HOPWA.—HUD shall directly allocate 3 funds under the Housing Opportunities for People 4 With AIDS (HOPWA) program to the States or cit- 5 ies participating in the demonstration to provide 6 supportive housing and other housing assistance to 7 beneficiaries who otherwise meet HOPWA eligibility 8 criteria. HUD is authorized to use such HOPWA 9 funds, and to waive such requirements under 10 HOPWA as may be necessary, to carry out the dem- 11 onstration. 12 (7) STATE MEDICAID AGENCIES.—Single State 13 agencies responsible for administration of the Med- 14 icaid program for individuals who are accepted to 15 participate in the demonstration shall— 16 (A) collaborate with CMS to design or re- 17 fine a prepaid capitated payment model, to allo- 18 cate and award contracts with capitated man- 19 aged care plans, to ensure such plans meet 20 State statutory or regulatory requirements, to 21 contract with a coordinating agency to organize 22 and deliver integrated HIV testing, medical 23 care, support, and housing services funded 24 under Medicare and Medicaid, other Federal, 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00633 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 634 •HR 5475 IH State, and local government sponsors, and to 1 coordinate their activities with the State HIV/ 2 AIDS program; and 3 (B) identify and contract with a coordi- 4 nating agency to organize the demonstration in 5 the State, to establish a coordinating body rep- 6 resenting State, local, and provider agencies 7 participating in the demonstration, to establish 8 systems of care that integrate HIV prevention, 9 testing, treatment, support, and housing serv- 10 ices, to establish mechanisms to gather evalua- 11 tion data for reporting to CMMI and other par- 12 ticipating Federal agencies, and to establish a 13 quality management program to monitor pro- 14 vider performance in delivering the services pro- 15 vided to participating beneficiaries under the 16 demonstration. 17 (8) MANAGED CARE ORGANIZATIONS.— 18 Capitated managed care organizations participating 19 in the demonstration shall organize and deliver serv- 20 ices as specified by the minimum service delivery 21 model established by CMMI through a network of 22 providers with demonstrated HIV experience, high 23 quality, and sufficient provider capacity. 24 (f) DEFINITIONS.—In this section: 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00634 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 635 •HR 5475 IH (1) CDC.—The term ‘‘CDC’’ means the Direc- 1 tor of the Centers for Disease Control and Preven- 2 tion. 3 (2) CMMI.—The term ‘‘CMMI’’ means the Di- 4 rector of the Center for Medicare & Medicaid Inno- 5 vation. 6 (3) CMS.—The term ‘‘CMS’’ means the Ad- 7 ministrator of the Centers for Medicare & Medicaid 8 Services. 9 (4) DEMONSTRATION.—The term ‘‘demonstra- 10 tion’’ means the demonstration conducted under this 11 section. 12 (5) HRSA.—The term ‘‘HRSA’’ means the Ad- 13 ministrator of the Health Resources and Services 14 Administration. 15 (6) HUD.—The term ‘‘HUD’’ means the Sec- 16 retary of Housing and Urban Development. 17 (7) MEDICARE; MEDICAID.—The terms ‘‘Medi- 18 care’’ and ‘‘Medicaid’’ mean the programs under ti- 19 tles XVIII and XIX, respectively, of the Social Secu- 20 rity Act. 21 (8) NATIONAL HIV/AIDS STRATEGY FOR THE 22 UNITED STATES.—The term ‘‘National HIV/AIDS 23 Strategy for the United States’’ has the meaning 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00635 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 636 •HR 5475 IH given such term under section 241A(b) of the Public 1 Health Service Act. 2 (9) RYAN WHITE HIV/AIDS PROGRAM.—The 3 term ‘‘Ryan White HIV/AIDS Program’’ means the 4 program under title XXVI of the Public Health 5 Service Act. 6 (10) SAMHSA.—The term ‘‘SAMHSA’’ means 7 the Substance Abuse and Mental Health Services 8 Administration. 9 (11) SECRETARY.—The term ‘‘Secretary’’ 10 means the Secretary of Health and Human Services, 11 acting through CMMI. 12 SEC. 764. REPORT ON THE IMPLEMENTATION OF GOAL 4 13 (IMPROVED COORDINATION) OF THE NA- 14 TIONAL HIV/AIDS STRATEGY. 15 (a) REPORT REQUIRED.—The President, in consulta- 16 tion with the heads of all relevant Federal departments 17 and agencies including the Department of Education, the 18 Department of Health and Human Services, the Depart- 19 ment of Housing and Urban Development, the Depart- 20 ment of Justice, the Department of Labor, the Depart- 21 ment of Veteran Affairs, and the Social Security Adminis- 22 tration, shall transmit to the Congress and make publicly 23 available a report on the status of implementation of Goal 24 4 of the National HIV/AIDS Strategy. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00636 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 637 •HR 5475 IH (b) CONTENTS.—The report required by subsection 1 (a) shall include a description, an analysis, and an evalua- 2 tion of— 3 (1) the extent to which the National HIV/AIDS 4 Strategy has improved coordination of efforts, en- 5 hanced capacity, and strengthened infrastructure in 6 order to maximize the effective delivery of HIV/ 7 AIDS prevention, care, and treatment services at the 8 community level, including coordination— 9 (A) within and among Federal agencies 10 and departments; 11 (B) between the Federal Government and 12 State and local governments and health depart- 13 ments; 14 (C) between the Federal Government and 15 nonprofit foundations and civil society organiza- 16 tions, including community- and faith-based or- 17 ganizations focused on addressing the issue of 18 HIV/AIDS; and 19 (D) between the Federal Government and 20 private businesses; and 21 (2) efforts by the Federal Government to edu- 22 cate, involve, and establish and strengthen partner- 23 ships with civil society organizations, including 24 community- and faith-based organizations, in order 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00637 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 638 •HR 5475 IH to implement the National HIV/AIDS Strategy and 1 achieve its goals. 2 (c) DEFINITION.—In this section, the term ‘‘National 3 HIV/AIDS Strategy’’ means the National HIV/AIDS 4 Strategy for the United States issued by the President in 5 July 2010, the revision to such Strategy issued in July 6 2015, and any subsequent revisions to such Strategy. 7 Subtitle F—Diabetes 8 SEC. 771. RESEARCH, TREATMENT, AND EDUCATION. 9 Subpart 3 of part C of title IV of the Public Health 10 Service Act (42 U.S.C. 285c et seq.) is amended by adding 11 at the end the following new section: 12 ‘‘SEC. 434B. DIABETES IN MINORITY POPULATIONS. 13 ‘‘(a) IN GENERAL.—The Director of NIH shall ex- 14 pand, intensify, and support ongoing research and other 15 activities with respect to prediabetes and diabetes, particu- 16 larly type 2, in minority populations. 17 ‘‘(b) RESEARCH.— 18 ‘‘(1) DESCRIPTION.—Research under subsection 19 (a) shall include investigation into— 20 ‘‘(A) the causes of diabetes, including so- 21 cioeconomic, geographic, clinical, environmental, 22 genetic, and other factors that may contribute 23 to increased rates of diabetes in minority popu- 24 lations; and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00638 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 639 •HR 5475 IH ‘‘(B) the causes of increased incidence of 1 diabetes complications in minority populations, 2 and possible interventions to decrease such inci- 3 dence. 4 ‘‘(2) INCLUSION OF MINORITY PARTICIPANTS.— 5 In conducting and supporting research described in 6 subsection (a), the Director of NIH shall seek to in- 7 clude minority participants as study subjects in clin- 8 ical trials. 9 ‘‘(c) REPORT; COMPREHENSIVE PLAN.— 10 ‘‘(1) IN GENERAL.—The Diabetes Mellitus 11 Interagency Coordinating Committee shall— 12 ‘‘(A) prepare and submit to the Congress, 13 not later than 6 months after the date of enact- 14 ment of this section, a report on Federal re- 15 search and public health activities with respect 16 to prediabetes and diabetes in minority popu- 17 lations; and 18 ‘‘(B) develop and submit to the Congress, 19 not later than 1 year after the date of enact- 20 ment of this section, an effective and com- 21 prehensive Federal plan (including all appro- 22 priate Federal health programs) to address 23 prediabetes and diabetes in minority popu- 24 lations. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00639 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 640 •HR 5475 IH ‘‘(2) CONTENTS.—The report under paragraph 1 (1)(A) shall at minimum address each of the fol- 2 lowing: 3 ‘‘(A) Research on diabetes and prediabetes 4 in minority populations, including such research 5 on— 6 ‘‘(i) genetic, behavioral, and environ- 7 mental factors; and 8 ‘‘(ii) prevention and complications 9 among individuals within these populations 10 who have already developed diabetes. 11 ‘‘(B) Surveillance and data collection on 12 diabetes and prediabetes in minority popu- 13 lations, including with respect to— 14 ‘‘(i) efforts to better determine the 15 prevalence of diabetes among Asian-Amer- 16 ican and Pacific Islander subgroups; and 17 ‘‘(ii) efforts to coordinate data collec- 18 tion on the American Indian population. 19 ‘‘(C) Community-based interventions to ad- 20 dress diabetes and prediabetes targeting minor- 21 ity populations, including— 22 ‘‘(i) the evidence base for such inter- 23 ventions; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00640 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 641 •HR 5475 IH ‘‘(ii) the cultural appropriateness of 1 such interventions; and 2 ‘‘(iii) efforts to educate the public on 3 the causes and consequences of diabetes. 4 ‘‘(D) Education and training programs for 5 health professionals (including community 6 health workers) on the prevention and manage- 7 ment of diabetes and its related complications 8 that is supported by the Health Resources and 9 Services Administration, including such pro- 10 grams supported by— 11 ‘‘(i) the National Health Service 12 Corps; or 13 ‘‘(ii) the community health centers 14 program under section 330. 15 ‘‘(d) EDUCATION.—The Director of NIH shall— 16 ‘‘(1) through the National Institute on Minority 17 Health and Health Disparities and the National Di- 18 abetes Education Program— 19 ‘‘(A) make grants to programs funded 20 under section 464z–4 (relating to centers of ex- 21 cellence) for the purpose of establishing a men- 22 toring program for health care professionals to 23 be more involved in weight counseling, obesity 24 research, and nutrition; and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00641 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 642 •HR 5475 IH ‘‘(B) provide for the participation of mi- 1 nority health professionals in diabetes-focused 2 research programs; and 3 ‘‘(2) make grants for programs to establish a 4 pipeline from high school to professional school that 5 will increase minority representation in diabetes-fo- 6 cused health fields by expanding Minority Access to 7 Research Careers (MARC) program internships and 8 mentoring opportunities for recruitment. 9 ‘‘(e) DEFINITIONS.—For purposes of this section: 10 ‘‘(1) The ‘Diabetes Mellitus Interagency Coordi- 11 nating Committee’ means the Diabetes Mellitus 12 Interagency Coordinating Committee established 13 under section 429. 14 ‘‘(2) The term ‘minority population’ means a 15 racial and ethnic minority group, as defined in sec- 16 tion 1707.’’. 17 SEC. 772. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 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 section: 21 ‘‘SEC. 317U. DIABETES IN MINORITY POPULATIONS. 22 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 23 ‘‘(1) IN GENERAL.—The Secretary, acting 24 through the Director of the Centers for Disease 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00642 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 643 •HR 5475 IH Control and Prevention, shall conduct and support 1 research and public health activities with respect to 2 diabetes in minority populations. 3 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 4 paragraph (1) regarding diabetes in minority popu- 5 lations shall include the following: 6 ‘‘(A) Further enhancing the National 7 Health and Nutrition Examination Survey by 8 over-sampling Asian-American, Native Hawai- 9 ian, and Other Pacific Islanders in appropriate 10 geographic areas to better determine the preva- 11 lence of diabetes in such populations as well as 12 to improve the data collection of diabetes pene- 13 tration disaggregated into major ethnic groups 14 within such populations. The Secretary shall en- 15 sure that any such oversampling does not re- 16 duce the oversampling of other minority popu- 17 lations including African-American and Latino 18 populations. 19 ‘‘(B) Through the Division of Diabetes 20 Translation— 21 ‘‘(i) providing for prevention research 22 to better understand how to influence 23 health care systems changes to improve 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00643 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 644 •HR 5475 IH quality of care being delivered to such pop- 1 ulations; 2 ‘‘(ii) carrying out model demonstra- 3 tion projects to design, implement, and 4 evaluate effective diabetes prevention and 5 control interventions for minority popu- 6 lations, including culturally appropriate 7 community-based interventions; 8 ‘‘(iii) developing and implementing a 9 strategic plan to reduce diabetes in minor- 10 ity populations through applied research to 11 reduce disparities and culturally and lin- 12 guistically appropriate community-based 13 interventions; 14 ‘‘(iv) supporting, through the national 15 diabetes prevention program under section 16 399V–3, diabetes prevention program sites 17 in underserved regions highly impacted by 18 diabetes; and 19 ‘‘(v) implementing, through the na- 20 tional diabetes prevention program under 21 section 399V–3, a demonstration program 22 developing new metrics measuring health 23 outcomes related to diabetes that can be 24 stratified by specific minority populations. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00644 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 645 •HR 5475 IH ‘‘(b) EDUCATION.—The Secretary, acting through 1 the Director of the Centers for Disease Control and Pre- 2 vention, shall direct the Division of Diabetes Translation 3 to conduct and support both programs to educate the pub- 4 lic on diabetes in minority populations and programs to 5 educate minority populations about the causes and effects 6 of diabetes. 7 ‘‘(c) DIABETES; HEALTH PROMOTION, PREVENTION 8 ACTIVITIES, AND ACCESS.—The Secretary, acting through 9 the Director of the Centers for Disease Control and Pre- 10 vention and the National Diabetes Education Program, 11 shall conduct and support programs to educate specific 12 minority populations through culturally appropriate and 13 linguistically appropriate information campaigns about 14 prevention of, and managing, diabetes. 15 ‘‘(d) DEFINITION.—For purposes of this section, the 16 term ‘minority population’ means a racial and ethnic mi- 17 nority group, as defined in section 1707.’’. 18 SEC. 773. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 19 Part P of title III of the Public Health Service Act 20 (42 U.S.C. 280g et seq.), as amended, is further amended 21 by adding at the end the following new section: 22 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00645 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 646 •HR 5475 IH ‘‘SEC. 399V–7. PROGRAMS TO EDUCATE HEALTH PRO- 1 VIDERS ON THE CAUSES AND EFFECTS OF DI- 2 ABETES IN MINORITY POPULATIONS. 3 ‘‘(a) IN GENERAL.—The Secretary, acting through 4 the Director of the Health Resources and Services Admin- 5 istration, shall conduct and support programs described 6 in subsection (b) to educate health professionals on the 7 causes and effects of diabetes in minority populations. 8 ‘‘(b) PROGRAMS.—Programs described in this sub- 9 section, with respect to education on diabetes in minority 10 populations, shall include the following: 11 ‘‘(1) Giving priority, under the primary care 12 training and enhancement program under section 13 747— 14 ‘‘(A) to awarding grants to focus on or ad- 15 dress diabetes; and 16 ‘‘(B) adding minority populations to the 17 list of vulnerable populations that should be 18 served by such grants. 19 ‘‘(2) Providing additional funds for the Health 20 Careers Opportunity Program, Centers for Excel- 21 lence, and the Minority Faculty Fellowship Program 22 to partner with the Office of Minority Health under 23 section 1707 and the National Institutes of Health 24 to strengthen programs for career opportunities fo- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00646 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 647 •HR 5475 IH cused on diabetes treatment and care within under- 1 served regions highly impacted by diabetes. 2 ‘‘(3) Developing a diabetes focus within, and 3 providing additional funds for, the National Health 4 Service Corps Scholarship Program— 5 ‘‘(A) to place individuals in areas that are 6 disproportionately affected by diabetes and to 7 provide diabetes treatment and care in such 8 areas; and 9 ‘‘(B) to provide such individuals continuing 10 medical education specific to diabetes care.’’. 11 SEC. 774. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 12 Part P of title III of the Public Health Service Act 13 (42 U.S.C. 280g et seq.), as amended, is further amended 14 by adding at the end the following section: 15 ‘‘SEC. 399V–8. RESEARCH, EDUCATION, AND OTHER ACTIVI- 16 TIES REGARDING DIABETES IN AMERICAN IN- 17 DIAN POPULATIONS. 18 ‘‘In addition to activities under sections 317V–6 and 19 434B, the Secretary, acting through the Indian Health 20 Service and in collaboration with other appropriate Fed- 21 eral agencies, shall— 22 ‘‘(1) conduct and support research and other 23 activities with respect to diabetes; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00647 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 648 •HR 5475 IH ‘‘(2) coordinate the collection of data on clini- 1 cally and culturally appropriate diabetes treatment, 2 care, prevention, and services by health care profes- 3 sionals to the American Indian population.’’. 4 SEC. 775. UPDATED REPORT ON HEALTH DISPARITIES. 5 The Secretary of Health and Human Services shall 6 seek to enter into an arrangement with the Institute of 7 Medicine under which the Institute will— 8 (1) not later than 1 year after the date of en- 9 actment of this Act, submit to the Congress an up- 10 dated version of the Institute’s 2002 report entitled 11 ‘‘Unequal Treatment: Confronting Racial and Ethnic 12 Disparities in Health Care’’; and 13 (2) in such updated version, address how racial 14 and ethnic health disparities have changed since the 15 publication of the original report. 16 Subtitle G—Lung Disease 17 SEC. 776. EXPANSION OF THE NATIONAL ASTHMA EDU- 18 CATION AND PREVENTION PROGRAM. 19 (a) FINDINGS.—The Congress finds as follows: 20 (1) The prevalence of asthma has increased 21 since 1980 and affects 25 million Americans. 22 (2) Significant disparities in asthma morbidity 23 and mortality exist for both adults and children par- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00648 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 649 •HR 5475 IH ticularly for low-income and minority populations, 1 particularly African-Americans and Puerto Ricans. 2 (3) African-American children are twice as like- 3 ly to have asthma as White children. 4 (4) In 2010, almost 4.5 million non-Hispanic 5 African-Americans reported having asthma. African- 6 Americans with asthma are three times as likely to 7 visit the emergency department and twice as likely 8 to get hospitalized as White patients with asthma. 9 (5) Puerto Ricans are 3.4 times as likely to die 10 from asthma compared with all other Hispanic or 11 Latino groups. Overall Hispanic Americans are 30 12 percent more likely to be hospitalized for asthma 13 than non-Hispanic Whites. 14 (6) More than 65 percent of adults with asthma 15 are women. 16 (b) IN GENERAL.—Not later than 2 years after the 17 date of the enactment of this Act, the Secretary of Health 18 and Human Services shall convene a working group com- 19 prised of patient groups, nonprofit organizations, medical 20 societies, and other relevant governmental and nongovern- 21 mental entities, including those that participate in the Na- 22 tional Asthma Education and Prevention Program, to de- 23 velop a report to Congress that— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00649 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 650 •HR 5475 IH (1) catalogs, with respect to asthma prevention, 1 management, and surveillance— 2 (A) the activities of the Federal Govern- 3 ment, including identifying all Federal pro- 4 grams that carry out asthma-related activities, 5 as well as assessment of the progress of the 6 Federal Government and States, with respect to 7 achieving the goals of the Healthy People 2020 8 initiative; and 9 (B) the activities of other entities that par- 10 ticipate in the program, including nonprofit or- 11 ganizations, patient advocacy groups, and med- 12 ical societies; and 13 (2) makes recommendations for the future di- 14 rection of asthma activities, in consultation with re- 15 searchers from the National Institutes of Health and 16 other member bodies of the National Asthma Edu- 17 cation and Prevention Program who are qualified to 18 review and analyze data and evaluate interventions, 19 including— 20 (A) description of how the Federal Govern- 21 ment may better coordinate and improve its re- 22 sponse to asthma including identifying any bar- 23 riers that may exist; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00650 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 651 •HR 5475 IH (B) description of how the Federal Govern- 1 ment may continue, expand, and improve its 2 private-public partnerships with respect to asth- 3 ma including identifying any barriers that may 4 exist; 5 (C) identification of steps that may be 6 taken to reduce the— 7 (i) morbidity, mortality, and overall 8 prevalence of asthma; 9 (ii) financial burden of asthma on so- 10 ciety; 11 (iii) burden of asthma on dispropor- 12 tionately affected areas, particularly those 13 in medically underserved populations (as 14 defined in section 330(b)(3) of the Public 15 Health Service Act (42 U.S.C. 16 254b(b)(3))); and 17 (iv) burden of asthma as a chronic 18 disease; 19 (D) identification of programs and policies 20 that have achieved the steps described in sub- 21 paragraph (C), and steps that may be taken to 22 expand such programs and policies to benefit 23 larger populations; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00651 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 652 •HR 5475 IH (E) recommendations for future research 1 and interventions. 2 (c) REPORT TO CONGRESS.—At the end of the 5-year 3 period following the submission of the report under sub- 4 section (a), the National Asthma Education and Preven- 5 tion Program shall evaluate the analyses and rec- 6 ommendations under such report and determine whether 7 a new report to the Congress is necessary, and make ap- 8 propriate recommendations to the Congress. 9 SEC. 777. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 10 FOR DISEASE CONTROL AND PREVENTION. 11 Section 317I of the Public Health Service Act (42 12 U.S.C. 247b–10) is amended to read as follows: 13 ‘‘SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 14 FOR DISEASE CONTROL AND PREVENTION. 15 ‘‘(a) PROGRAM FOR PROVIDING INFORMATION AND 16 EDUCATION TO THE PUBLIC.—The Secretary, acting 17 through the Director of the Centers for Disease Control 18 and Prevention, shall collaborate with State and local 19 health departments to conduct activities, including the 20 provision of information and education to the public re- 21 garding asthma including— 22 ‘‘(1) deterring the harmful consequences of un- 23 controlled asthma; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00652 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 653 •HR 5475 IH ‘‘(2) disseminating health education and infor- 1 mation regarding prevention of asthma episodes and 2 strategies for managing asthma. 3 ‘‘(b) DEVELOPMENT OF STATE ASTHMA PLANS.— 4 The Secretary, acting through the Director of the Centers 5 for Disease Control and Prevention, shall collaborate with 6 State and local health departments to develop State plans 7 incorporating public health responses to reduce the burden 8 of asthma, particularly regarding disproportionately af- 9 fected populations. 10 ‘‘(c) COMPILATION OF DATA.—The Secretary, acting 11 through the Director of the Centers for Disease Control 12 and Prevention, shall, in cooperation with State and local 13 public health officials— 14 ‘‘(1) conduct asthma surveillance activities to 15 collect data on the prevalence and severity of asth- 16 ma, the effectiveness of public health asthma inter- 17 ventions, and the quality of asthma management, in- 18 cluding— 19 ‘‘(A) collection of household data on the 20 local burden of asthma; 21 ‘‘(B) surveillance of health care facilities; 22 and 23 ‘‘(C) collection of data not containing indi- 24 vidually identifiable information from electronic 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00653 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 654 •HR 5475 IH health records or other electronic communica- 1 tions; 2 ‘‘(2) compile and annually publish data regard- 3 ing the prevalence and incidence of childhood asth- 4 ma, the child mortality rate, and the number of hos- 5 pital admissions and emergency department visits by 6 children associated with asthma nationally and in 7 each State and at the county level by age, sex, race, 8 and ethnicity, as well as lifetime and current preva- 9 lence; and 10 ‘‘(3) compile and annually publish data regard- 11 ing the prevalence and incidence of adult asthma, 12 the adult mortality rate, and the number of hospital 13 admissions and emergency department visits by 14 adults associated with asthma nationally and in each 15 State and at the county level by age, sex, race, eth- 16 nicity, industry, and occupation, as well as lifetime 17 and current prevalence. 18 ‘‘(d) COORDINATION OF DATA COLLECTION.—The 19 Director of the Centers for Disease Control and Preven- 20 tion, in conjunction with State and local health depart- 21 ments, shall coordinate data collection activities under 22 subsection (c)(2) so as to maximize comparability of re- 23 sults. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00654 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 655 •HR 5475 IH ‘‘(e) COLLABORATION.—The Centers for Disease 1 Control and Prevention are encouraged to collaborate with 2 national, State, and local nonprofit organizations to pro- 3 vide information and education about asthma, and to 4 strengthen such collaborations when possible. 5 ‘‘(f) ADDITIONAL FUNDING.—In addition to any 6 other authorization of appropriations that is available to 7 the Centers for Disease Control and Prevention for the 8 purpose of carrying out this section, there are authorized 9 to be appropriated to such Centers such sums as may be 10 necessary for each of fiscal years 2017 through 2021 for 11 the purpose of carrying out this section.’’. 12 SEC. 778. INFLUENZA AND PNEUMONIA VACCINATION CAM- 13 PAIGN. 14 (a) IN GENERAL.—The Secretary of Health and 15 Human Services shall— 16 (1) enhance the annual campaign by the De- 17 partment of Health and Human Services to increase 18 the number of people vaccinated each year for influ- 19 enza and pneumonia; and 20 (2) include in such campaign the use of written 21 educational materials, public service announcements, 22 physician education, and any other means which the 23 Secretary deems effective. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00655 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 656 •HR 5475 IH (b) MATERIALS AND ANNOUNCEMENTS.—In carrying 1 out the annual campaign described in subsection (a), the 2 Secretary of Health and Human Services shall ensure 3 that— 4 (1) educational materials and public service an- 5 nouncements are readily and widely available in 6 communities experiencing disparities in the incidence 7 and mortality rates of influenza and pneumonia; and 8 (2) the campaign uses targeted, culturally ap- 9 propriate messages and messengers to reach under- 10 served communities. 11 (c) AUTHORIZATION OF APPROPRIATIONS.—There 12 are authorized to be appropriated to carry out this section 13 such sums as may be necessary for each of fiscal years 14 2017 through 2021. 15 SEC. 779. CHRONIC OBSTRUCTIVE PULMONARY DISEASE 16 ACTION PLAN. 17 (a) FINDINGS.—The Congress finds as follows: 18 (1) Chronic obstructive pulmonary disease 19 (‘‘COPD’’) refers to chronic bronchitis and emphy- 20 sema, incurable diseases that make it difficult to ex- 21 hale all the air from one’s lungs, and that can cause 22 persistent coughing, shortness of breath, and spu- 23 tum. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00656 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 657 •HR 5475 IH (2) COPD exacerbations—episodes of acute dif- 1 ficulty breathing and moderate to severe fatigue— 2 are dangerous, and their treatment often requires 3 hospitalization. 4 (3) While smoking is the primary risk factor for 5 COPD, other risk factors include air pollution, occu- 6 pational exposures, heredity, a history of childhood 7 respiratory infections, and socioeconomic status. 8 (4) Over 13.5 million United States adults are 9 estimated to have COPD. 10 (5) COPD is the third leading cause of death 11 in America, claiming over 134,000 lives in 2010. 12 (6) Since 2000, deaths for women with COPD 13 have exceed deaths in men. 14 (7) Although African-Americans have a lower 15 prevalence of COPD in the United States, research- 16 ers have shown that African-Americans may be 17 underdiagnosed. Furthermore, research has shown 18 that African-Americans develop COPD with less cu- 19 mulative smoke exposure and at a younger age. 20 (b) IN GENERAL.—The Director of the Centers for 21 Disease Control and Prevention shall conduct, support, 22 and expand public health strategies, prevention, diagnosis, 23 surveillance, and public and professional awareness activi- 24 ties regarding chronic obstructive pulmonary disease. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00657 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 658 •HR 5475 IH (c) NATIONAL ACTION PLAN.— 1 (1) DEVELOPMENT.—Not later than 2 years 2 after the date of the enactment of this Act, the Di- 3 rector of the National Heart, Lung, and Blood Insti- 4 tute, in consultation with the Director of the Centers 5 for Disease Control and Prevention, shall develop a 6 national action plan to address chronic obstructive 7 pulmonary disease in the United States with partici- 8 pation from patients, caregivers, health profes- 9 sionals, patient advocacy organizations, researchers, 10 providers, public health professionals, and other 11 stakeholders. 12 (2) CONTENTS.—At a minimum, such plan 13 shall include recommendations for— 14 (A) public health interventions for the pur- 15 pose of implementation of the national plan; 16 (B) biomedical, health services, and public 17 health research on chronic obstructive pul- 18 monary disease; and 19 (C) inclusion of chronic obstructive pul- 20 monary disease in the health data collections of 21 all Federal agencies. 22 (3) CONSIDERATION.—In developing such plan, 23 the Director of the National Heart, Lung, and Blood 24 Institute shall consider the recommendations and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00658 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 659 •HR 5475 IH findings of the Institute of Medicine in the report 1 entitled ‘‘A Nationwide Framework for Surveillance 2 of Cardiovascular and Chronic Lung Diseases’’ (July 3 22, 2011). 4 (d) CHRONIC DISEASE PREVENTION PROGRAMS.— 5 The Director of the National Heart, Lung, and Blood In- 6 stitute shall carry out the following: 7 (1) Conduct public education and awareness ac- 8 tivities with patient and professional organizations 9 to stimulate earlier diagnosis and improve patient 10 outcomes from treatment of chronic obstructive pul- 11 monary disease. To the extent known and relevant, 12 such public education and awareness activities shall 13 reflect differences in chronic obstructive pulmonary 14 disease by cause (tobacco, environmental, occupa- 15 tional, biological, and genetic) and include a focus 16 on outreach to undiagnosed and, as appropriate, mi- 17 nority populations. 18 (2) Supplement and expand upon the activities 19 of the National Heart, Lung, and Blood Institute by 20 making grants to nonprofit organizations, State and 21 local jurisdictions, and Indian tribes for the purpose 22 of reducing the burden of chronic obstructive pul- 23 monary disease, especially in disproportionately im- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00659 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 660 •HR 5475 IH pacted communities, through public health interven- 1 tions and related activities. 2 (3) Coordinate with the Centers for Disease 3 Control and Prevention, the Indian Health Service, 4 the Health Resources and Services Administration, 5 and the Department of Veterans Affairs to develop 6 pilot programs to demonstrate best practices for the 7 diagnosis and management of chronic obstructive 8 pulmonary disease. 9 (4) Develop improved techniques and identify 10 best practices, in coordination with the Secretary of 11 Veterans Affairs, for assisting chronic obstructive 12 pulmonary disease patients to successfully stop 13 smoking, including identification of subpopulations 14 with different needs. Initiatives under this para- 15 graph may include research to determine whether 16 successful smoking cessation strategies are different 17 for chronic obstructive pulmonary disease patients 18 compared to such strategies for patients with other 19 chronic diseases. 20 (e) ENVIRONMENTAL AND OCCUPATIONAL HEALTH 21 PROGRAMS.—The Director of the Centers for Disease 22 Control and Prevention shall— 23 (1) support research into the environmental and 24 occupational causes and biological mechanisms that 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00660 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 661 •HR 5475 IH contribute to chronic obstructive pulmonary disease; 1 and 2 (2) develop and disseminate public health inter- 3 ventions that will lessen the impact of environmental 4 and occupational causes of chronic obstructive pul- 5 monary disease. 6 (f) DATA COLLECTION.—Not later than 180 days 7 after the enactment of this Act, the Director of the Na- 8 tional Heart, Lung, and Blood Institute and the Director 9 of the Centers for Disease Control and Prevention, acting 10 jointly, shall assess the depth and quality of information 11 on chronic obstructive pulmonary disease that is collected 12 in surveys and population studies conducted by the Cen- 13 ters for Disease Control and Prevention, including wheth- 14 er there are additional opportunities for information to be 15 collected in the National Health and Nutrition Examina- 16 tion Survey, the National Health Interview Survey, and 17 the Behavioral Risk Factors Surveillance System surveys. 18 The Director of the National Heart, Lung, and Blood In- 19 stitute shall include the results of such assessment in the 20 national action plan under subsection (b). 21 (g) AUTHORIZATION OF APPROPRIATIONS.—There 22 are authorized to be appropriated to carry out this section 23 such sums as may be necessary for each of fiscal years 24 2017 through 2021. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00661 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 662 •HR 5475 IH Subtitle H—Osteoarthritis and 1 Musculoskeletal Diseases 2 SEC. 781. FINDINGS. 3 The Congress finds as follows: 4 (1) Eighty percent of African-American women 5 and nearly 74 percent of Hispanic men are either 6 overweight or obese, speeding the onset and progres- 7 sion of arthritis. 8 (2) Arthritis affects 46 million Americans, and 9 that number will rise to 67 million by the year 2030. 10 (3) Twenty-seven million Americans suffer from 11 osteoarthritis, the most common form of arthritis, 12 making it the leading cause of disability in the 13 United States. Osteoarthritis is sometimes referred 14 to as degenerative joint disease. 15 (4) Obesity accelerates the onset of arthritis: 70 16 percent of obese adults with mild osteoarthritis of 17 the knee at age 60 will develop advanced end-stage 18 disease by age 80. In contrast, just 43 percent of 19 non-obese adults will have end-stage disease over the 20 same time period. 21 (5) Arthritis affects one in five Americans, and 22 is the single greatest cause of chronic pain and dis- 23 ability in the United States. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00662 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 663 •HR 5475 IH (6) Women, African-Americans, and Hispanics 1 have more severe arthritis and functional limitations. 2 These same individuals are more likely to be obese, 3 diabetic, and have higher incidence of heart dis- 4 ease—medical conditions that can be improved with 5 physical activity. Instead of moving; however, these 6 groups have an inactivity rate of 40 to 50 percent, 7 which continues to increase. 8 (7) Arthritis costs $128 billion a year, including 9 $81 billion in direct costs (medical) and $47 billion 10 in indirect costs (lost earnings). Each year, $309 bil- 11 lion in direct and indirect costs is lost due to dis- 12 parities in osteoarthritis and musculoskeletal dis- 13 eases. 14 (8) Obesity and other chronic health conditions 15 exacerbate the debilitating impact of arthritis, lead- 16 ing to inactivity, loss of independence, and a per- 17 petual cycle of comorbid chronic conditions. 18 (9) Sixty-one percent of arthritis sufferers are 19 women, and women represent 64 percent of an esti- 20 mated 43 million annual visits to physicians’ offices 21 and outpatient clinics where arthritis was the pri- 22 mary diagnosis. Women also represented 60 percent 23 of approximately 1 million hospitalizations that oc- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00663 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 664 •HR 5475 IH curred in 2003 for which arthritis was the primary 1 diagnosis. 2 (10) Women ages 65 and older have up to 21⁄2 3 times more disabilities than men of the same age. 4 Higher rates of obesity and arthritis among this 5 group explained up to 48 percent of the gender gap 6 in disability, above all other common chronic health 7 conditions. 8 (11) The primary indication for total knee 9 arthroplasty (TKA), also known as knee replace- 10 ment, is relief of significant, disabling pain caused 11 by severe arthritis. 12 (12) Knee replacement is surgery for people 13 with severe knee damage. Knee replacement can re- 14 lieve pain and allow you to be more active. When 15 you have a total knee replacement, the surgeon re- 16 moves damaged cartilage and bone from the surface 17 of your knee joint and replaces them with a man- 18 made surface of metal and plastic. In a partial knee 19 replacement, the surgeon only replaces one part of 20 your knee joint. 21 (13) Total hip replacement, also called total hip 22 arthroplasty (THA), is used if your hip pain inter- 23 feres with daily activities and more-conservative 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00664 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 665 •HR 5475 IH treatments have not helped. Arthritis damage is the 1 most common reason to need hip replacement. 2 (14) The odds of a family practice physician 3 recommending TKA to a male patient with moderate 4 arthritis are twice that of a female patient, while the 5 odds of an orthopaedic surgeon recommending TKA 6 to a male patient with moderate arthritis are 22 7 times that of a female patient. 8 (15) African-Americans with doctor-diagnosed 9 arthritis have a higher prevalence of severe pain at- 10 tributable to arthritis, compared with Whites (34.0 11 percent versus 22.6 percent). African-Americans, 12 compared to Whites, report a higher proportion of 13 work limitations (39.5 percent versus 28.0 percent) 14 and a higher prevalence of arthritis-attributable 15 work limitation (6.6 percent versus 4.6 percent). 16 (16) Hispanics are 50 percent more likely than 17 non-Hispanic Whites to report needing assistance 18 with at least one instrumental activity of daily living 19 and to have difficulty walking. 20 (17) African-Americans and Hispanics were 1.3 21 times more likely to have activity limitation, 1.6 22 times more likely to have work limitations, and 1.9 23 times more likely to have severe joint pain than 24 Whites. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00665 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 666 •HR 5475 IH (18) In 2003, the Institute of Medicine reported 1 that the rates of TKA and THA among African- 2 American and Hispanic patients are significantly 3 lower than for Whites—even for those with equitable 4 health care coverage such as through Medicare or 5 the Department of Veterans Affairs. 6 (19) According to the Centers for Disease Con- 7 trol and Prevention, in 2000, African-American 8 Medicare enrollees were 37 percent less likely than 9 White Medicare enrollees to undergo total knee re- 10 placements. In 2006, the disparity increased to 39 11 percent. 12 (20) Even after adjusting for insurance and 13 health access, Hispanics and African-Americans are 14 almost 50 percent less likely to undergo total knee 15 replacement than Whites. 16 SEC. 782. OSTEOARTHRITIS AND OTHER MUSCULO- 17 SKELETAL HEALTH-RELATED ACTIVITIES OF 18 THE CENTERS FOR DISEASE CONTROL AND 19 PREVENTION. 20 (a) EDUCATION AND AWARENESS ACTIVITIES.—The 21 Secretary of Health and Human Services, acting through 22 the Director of the Centers for Disease Control and Pre- 23 vention, shall direct the National Center for Chronic Dis- 24 ease Prevention and Health Promotion to conduct and ex- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00666 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 667 •HR 5475 IH pand the Health Community Program and Arthritis Pro- 1 gram to educate the public on— 2 (1) the causes of, preventive health actions for, 3 and effects of arthritis and other musculoskeletal 4 conditions in minority patient populations; and 5 (2) the effects of such conditions on other 6 comorbidities including obesity, hypertension, and 7 cardiovascular disease. 8 (b) PROGRAMS ON ARTHRITIS AND MUSCULO- 9 SKELETAL CONDITIONS.—Education and awareness pro- 10 grams of the Centers for Disease Control and Prevention 11 on arthritis and other musculoskeletal conditions in minor- 12 ity communities shall— 13 (1) be culturally and linguistically appropriate 14 to minority patients, targeting musculoskeletal 15 health promotion and prevention programs of each 16 major ethnic group, including— 17 (A) Native Americans and Alaska Natives; 18 (B) Asian-Americans; 19 (C) African-Americans/Blacks; 20 (D) Hispanic/Latino-Americans; and 21 (E) Native Hawaiians and Pacific Island- 22 ers; and 23 (2) include public awareness campaigns directed 24 toward these patient populations that emphasize the 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00667 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 668 •HR 5475 IH importance of musculoskeletal health, physical activ- 1 ity, diet and healthy lifestyle, and weight reduction 2 for overweight and obese patients. 3 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 4 out this section, there are authorized to be appropriated 5 such sums as necessary for fiscal year 2017 and each sub- 6 sequent fiscal year. 7 SEC. 783. GRANTS FOR COMPREHENSIVE OSTEOARTHRITIS 8 AND MUSCULOSKELETAL DISEASE HEALTH 9 EDUCATION WITHIN HEALTH PROFESSIONS 10 SCHOOLS. 11 (a) PROGRAM AUTHORIZED.—The Secretary of 12 Health and Human Services (in this section referred to 13 as the ‘‘Secretary’’), in coordination with the Secretary of 14 Education, shall award grants, on a competitive basis, to 15 academic health science centers, health professions 16 schools, and other institutions of higher education to en- 17 able such institutions to provide people with comprehen- 18 sive education on arthritis and musculoskeletal health, 19 particularly— 20 (1) obesity related musculoskeletal diseases; 21 (2) arthritis and osteoarthritis; 22 (3) arthritis and musculoskeletal health dispari- 23 ties; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00668 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 669 •HR 5475 IH (4) the relationship between arthritis and mus- 1 culoskeletal diseases and metabolic activity, psycho- 2 logical health, and co-morbidities such as diabetes, 3 cardiovascular disease, and hypertension. 4 (b) DURATION.—Grants awarded under this section 5 shall be for a period of 5 years. 6 (c) APPLICATIONS.—An academic health science cen- 7 ter, health professions school, or other institution of high- 8 er education seeking a grant under this section shall sub- 9 mit an application to the Secretary at such time, in such 10 manner, and containing such information as the Secretary 11 may require. 12 (d) PRIORITY.—In awarding grants under this sec- 13 tion, the Secretary shall give priority to an institution of 14 higher education that— 15 (1) has an enrollment of needy students, as de- 16 fined in section 318(b) of the Higher Education Act 17 of 1965 (20 U.S.C. 1059e(b)); 18 (2) is a Hispanic-serving institution, as defined 19 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 20 (3) is a Tribal College or University, as defined 21 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 22 (4) is an Alaska Native-serving institution, as 23 defined in section 317(b) of such Act (20 U.S.C. 24 1059d(b)); 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00669 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 670 •HR 5475 IH (5) is a Native Hawaiian-serving institution, as 1 defined in section 317(b) of such Act (20 U.S.C. 2 1059d(b)); 3 (6) is a Predominately Black Institution, as de- 4 fined in section 318(b) of such Act (20 U.S.C. 5 1059e(b)); 6 (7) is a Native American-serving, nontribal in- 7 stitution, as defined in section 319(b) of such Act 8 (20 U.S.C. 1059f(b)); 9 (8) is an Asian American and Native American 10 Pacific Islander-serving institution, as defined in 11 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 12 (9) is a minority institution, as defined in sec- 13 tion 365 of such Act (20 U.S.C. 1067k), with an en- 14 rollment of needy students, as defined in section 312 15 of such Act (20 U.S.C. 1058). 16 (e) USES OF FUNDS.—An institution of higher edu- 17 cation receiving a grant under this section may use grant 18 funds to integrate issues relating to comprehensive arthri- 19 tis and musculoskeletal health into the academic or sup- 20 port sectors of the institution in order to reach a large 21 number of students, by carrying out 1 or more of the fol- 22 lowing activities: 23 (1) Developing educational content for issues 24 relating to comprehensive arthritis and musculo- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00670 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 671 •HR 5475 IH skeletal health education that will be incorporated 1 into first-year orientation or core courses. 2 (2) Creating innovative technology-based ap- 3 proaches to deliver arthritis and musculoskeletal 4 health education to students, faculty, and staff. 5 (3) Developing and employing peer-outreach 6 and education programs to generate discussion, edu- 7 cate, and raise awareness among students about 8 issues relating to arthritis and musculoskeletal 9 health disorders, and their relationship to diabetes, 10 hypertension, cardiovascular disease, psychological 11 health, and other co-morbid conditions. 12 (f) REPORT TO CONGRESS.— 13 (1) IN GENERAL.—Not later than 1 year after 14 the date of the enactment of this Act, and annually 15 thereafter for a period of 5 years, the Secretary shall 16 prepare and submit to the appropriate committees of 17 Congress a report on the activities to provide health 18 professions students with comprehensive arthritis 19 and musculoskeletal health education funded under 20 this section. 21 (2) REPORT ELEMENTS.—The report described 22 in paragraph (1) shall include information about— 23 (A) the number of entities that are receiv- 24 ing grant funds; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00671 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 672 •HR 5475 IH (B) the specific activities supported by 1 grant funds; 2 (C) the number of students served by 3 grant programs; and 4 (D) the status of program evaluations. 5 Subtitle I—Sleep and Circadian 6 Rhythm Disorders 7 SEC. 791. SHORT TITLE; FINDINGS. 8 (a) SHORT TITLE.—This subtitle may be cited as the 9 ‘‘Sleep and Circadian Rhythm Disorders Health Dispari- 10 ties Act’’. 11 (b) FINDINGS.—The Congress finds the following: 12 (1) Decrements in sleep health such as sleep 13 apnea, insufficient sleep time, and insomnia, affect 14 50–70 million United States adults. Twelve to eight- 15 een million United States adults have sleep apnea, a 16 chronic disorder characterized by one or more 17 pauses in breathing which can last from a few sec- 18 onds to minutes. They may occur 30 times or more 19 an hour, disrupting sleep and resulting in excessive 20 daytime sleepiness and loss in productivity. 21 (2) Seventy percent of high school students are 22 not getting enough sleep on school nights, while 33 23 percent of Americans get fewer than 7 hours of sleep 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00672 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 673 •HR 5475 IH per night and roughly 6,000 fatal motor vehicle 1 crashes are caused by drowsy drivers. 2 (3) Insufficient sleep and insomnia are more 3 prevalent in women. Women who are pregnant and 4 have sleep apnea are at an increased risk of cardio- 5 vascular complications during pregnancy. The im- 6 pact of disparities in sleep health is associated with 7 a growing number of health problems, including the 8 following: 9 (A) Hypertension. 10 (B) Cancer. 11 (C) Stroke. 12 (D) Cardiac arrhythmia. 13 (E) Chronic heart failure and heart dis- 14 ease. 15 (F) Diabetes. 16 (G) Cognitive functioning and behavior. 17 (H) Depression and bipolar disorder. 18 (I) Substance abuse. 19 (4) A ‘‘sleep disparity’’ exists in that poor sleep 20 quality is strongly associated with poverty and race. 21 Factors such as employment, education, and health 22 status, amongst others, significantly mediated this 23 effect only in poor subjects, suggesting a differential 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00673 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 674 •HR 5475 IH vulnerability to these factors in poor relative to non- 1 poor individuals in the context of sleep quality. 2 (5) African-Americans sleep worse than Cauca- 3 sian Americans. African-Americans take longer to 4 fall asleep, report poorer sleep quality, have more 5 light and less deep sleep, and nap more often and 6 longer. 7 (6) African-Americans and individuals in lower 8 socioeconomic status groups may be at an increased 9 risk for sleep disturbances and associated health 10 consequences. 11 (7) Among young African-Americans, the likeli- 12 hood of having sleep disordered breathing and exhib- 13 iting risk factors for poor sleep is twice that in 14 young Caucasians. Frequent snoring is more com- 15 mon among African-American and Hispanic women 16 and Hispanic men compared to non-Hispanic Cauca- 17 sians, independent of other factors including obesity. 18 (8) African-Americans with sleep disordered 19 breathing develop symptoms at a younger age than 20 Caucasians but appear less likely to be diagnosed 21 and treated in a timely manner. This delay may at 22 least in part be due to reduced access to care. 23 (9) Sleep loss contributes to increased risk for 24 chronic conditions such as obesity, diabetes, and hy- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00674 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 675 •HR 5475 IH pertension, all of which have increased prevalence in 1 underserved, underrepresented minorities. Racial 2 and ethnic disparities related to obesity may also 3 contribute to disparities in health outcomes related 4 to sleep disordered breathing. 5 (10) Non-Caucasian adults report an insomnia 6 rate of 12.9 percent compared to only 6.6 percent 7 for Caucasians. 8 (11) African-American women have a higher in- 9 cidence of insomnia than African-American men, 10 perhaps related in part to higher risk for chronic 11 persisting symptoms. 12 SEC. 792. SLEEP AND CIRCADIAN RHYTHM DISORDERS RE- 13 SEARCH ACTIVITIES OF THE NATIONAL IN- 14 STITUTES OF HEALTH. 15 (a) IN GENERAL.—The Director of the National In- 16 stitutes of Health, acting through the Director of the Na- 17 tional Heart, Lung, and Blood Institute, shall— 18 (1) continue to expand research activities ad- 19 dressing sleep health disparities; and 20 (2) continue implementation of the ‘‘NIH Sleep 21 Disorders Research Plan’’ across all institutes and 22 centers of the National Institutes of Health to im- 23 prove treatment and prevention of sleep health dis- 24 parities. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00675 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 676 •HR 5475 IH (b) REQUIRED RESEARCH ACTIVITIES.—In con- 1 ducting or supporting research relating to sleep and circa- 2 dian rhythm, the Director of the National Heart, Lung, 3 and Blood Institute shall— 4 (1) advance epidemiology and clinical research 5 to achieve a more complete understanding of dispari- 6 ties in domains of sleep health and across population 7 subgroups for which cardiovascular and metabolic 8 health disparities exist, including— 9 (A) prevalence and severity of sleep apnea; 10 (B) habitual sleep duration; 11 (C) sleep timing and regularity; and 12 (D) insomnia; 13 (2) develop study designs and analytical ap- 14 proaches to explain and predict multilevel and life- 15 course determinants of sleep health and to elucidate 16 the sleep-related causes of cardiovascular and meta- 17 bolic health disparities across the age spectrum, in- 18 cluding such determinants and causes that are— 19 (A) environmental; 20 (B) biological or genetic; 21 (C) psychosocial; 22 (D) societal; 23 (E) political; or 24 (F) economic; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00676 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 677 •HR 5475 IH (3) determine the contribution of sleep impair- 1 ments such as sleep apnea, insufficient sleep dura- 2 tion, irregular sleep schedules, and insomnia to un- 3 explained disparities in cardiovascular and metabolic 4 risk and disease outcomes; 5 (4) develop study designs, data sampling and 6 collection tools, and analytical approaches to opti- 7 mize understanding of mediating and moderating 8 factors, and feedback mechanisms coupling sleep to 9 cardiovascular and metabolic health disparities; 10 (5) advance research to understand cultural 11 and linguistic barriers (on the person, provider, or 12 system level) to access to care, medical diagnosis, 13 and treatment of sleep disorders in diverse popu- 14 lation groups; 15 (6) develop and test multilevel interventions (in- 16 cluding sleep health education in diverse commu- 17 nities) to reduce disparities in sleep health that will 18 impact ability to improve disparities in cardio- 19 vascular and metabolic risk or disease; 20 (7) create opportunities to integrate sleep and 21 health disparity science by strategically utilizing re- 22 sources (existing or anticipated cohorts), exchanging 23 scientific data and ideas (cross-over into scientific 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00677 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 678 •HR 5475 IH meetings), and develop multidisciplinary investi- 1 gator-initiated grant applications; and 2 (8) enhance the diversity and foster career de- 3 velopment of young investigators involved in sleep 4 and health disparities science. 5 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 6 out this section, there are authorized to be appropriated 7 such sums as may be necessary for fiscal year 2017 and 8 each subsequent fiscal year. 9 SEC. 793. SLEEP AND CIRCADIAN RHYTHM HEALTH DIS- 10 PARITIES-RELATED ACTIVITIES OF THE CEN- 11 TERS FOR DISEASE CONTROL AND PREVEN- 12 TION. 13 (a) IN GENERAL.—The Director of the Centers for 14 Disease Control and Prevention shall conduct, support, 15 and expand public health strategies and prevention, diag- 16 nosis, surveillance, and public and professional awareness 17 activities regarding sleep and circadian rhythm disorders. 18 (b) FINDINGS.—The Congress finds as follows: 19 (1) Sleep disorders and sleep deficiency unre- 20 lated to a primary sleep disorder are underdiagnosed 21 and are increasingly detrimental to health status. 22 (2) The consequences to society include addi- 23 tional diseases, motor vehicle accidents, decreased 24 longevity, elevated direct medical costs, and indirect 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00678 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 679 •HR 5475 IH costs related to work absenteeism and property dam- 1 age. 2 (c) REQUIRED SURVEILLANCE AND EDUCATION 3 AWARENESS ACTIVITIES.—In conducting or supporting 4 research relating to sleep and circadian rhythm disorders 5 surveillance and education awareness activities, the Direc- 6 tor of the Centers for Disease Control and Prevention 7 shall— 8 (1) ensure that such activities are culturally 9 and linguistically appropriate to minority patients, 10 targeting sleep and circadian rhythm health pro- 11 motion and prevention programs of each major eth- 12 nic group, including— 13 (A) Native Americans and Alaska Natives; 14 (B) Asian-Americans; 15 (C) African-Americans/Blacks; 16 (D) Hispanic/Latino-Americans; and 17 (E) Native Hawaiians and Pacific Island- 18 ers; 19 (2) collect and compile national and State sur- 20 veillance data on sleep disorders health disparities; 21 (3) continue to develop and implement new 22 sleep questions in public health surveillance systems 23 to increase public awareness of sleep health and 24 sleep disorders and their impact on health; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00679 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 680 •HR 5475 IH (4) publish monthly reports highlighting geo- 1 graphic, racial, and ethnic disparities in sleep health, 2 as well as relationships between insufficient sleep 3 and chronic disease, health risk behaviors, and other 4 outcomes as determined necessary by the Director; 5 and 6 (5) include public awareness campaigns that in- 7 form patient populations from major ethnic groups 8 about the prevalence of sleep and circadian rhythm 9 disorders and emphasize the importance of sleep 10 health. 11 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 12 out this section, there are authorized to be appropriated 13 such sums as may be necessary for fiscal year 2017 and 14 each subsequent fiscal year. 15 SEC. 794. GRANTS FOR COMPREHENSIVE SLEEP AND CIR- 16 CADIAN HEALTH EDUCATION WITHIN 17 HEALTH PROFESSIONS SCHOOLS. 18 (a) PROGRAM AUTHORIZED.—The Secretary of 19 Health and Human Services (in this section referred to 20 as the ‘‘Secretary’’), in coordination with the Secretary of 21 Education, shall award grants, on a competitive basis, to 22 academic health science centers, health professions 23 schools, and other institutions of higher education to en- 24 able such institutions to provide people with comprehen- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00680 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 681 •HR 5475 IH sive education on sleep and circadian health, particu- 1 larly— 2 (1) poor sleep health; 3 (2) sleep disorders; 4 (3) sleep health disparities; and 5 (4) the relationship between sleep and circadian 6 health on metabolic activity, neurological activity, co- 7 morbidities, and other diseases. 8 (b) DURATION.—Grants awarded under this section 9 shall be for a period of 5 years. 10 (c) APPLICATIONS.—Any academic health science 11 center, health professions school, or other institutions of 12 higher education seeking a grant under this section shall 13 submit an application to the Secretary at such time, in 14 such manner, and containing such information as the Sec- 15 retary may require. 16 (d) PRIORITY.—In awarding grants under this sec- 17 tion, the Secretary shall give priority to an institution 18 that— 19 (1) has an enrollment of needy students, as de- 20 fined in section 318(b) of the Higher Education Act 21 of 1965 (20 U.S.C. 1059e(b)); 22 (2) is a Hispanic-serving institution, as defined 23 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00681 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 682 •HR 5475 IH (3) is a Tribal College or University, as defined 1 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 2 (4) is an Alaska Native-serving institution, as 3 defined in section 317(b) of such Act (20 U.S.C. 4 1059d(b)); 5 (5) is a Native Hawaiian-serving institution, as 6 defined in section 317(b) of such Act (20 U.S.C. 7 1059d(b)); 8 (6) is a Predominately Black Institution, as de- 9 fined in section 318(b) of such Act (20 U.S.C. 10 1059e(b)); 11 (7) is a Native American-serving, nontribal in- 12 stitution, as defined in section 319(b) of such Act 13 (20 U.S.C. 1059f(b)); 14 (8) is an Asian American and Native American 15 Pacific Islander-serving institution, as defined in 16 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 17 (9) is a minority institution, as defined in sec- 18 tion 365 of such Act (20 U.S.C. 1067k), with an en- 19 rollment of needy students, as defined in section 312 20 of such Act (20 U.S.C. 1058). 21 (e) USES OF FUNDS.—An institution of higher edu- 22 cation receiving a grant under this section may use grant 23 funds to integrate issues relating to comprehensive sleep 24 and circadian health into the academic or support sectors 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00682 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 683 •HR 5475 IH of the institution in order to reach a large number of stu- 1 dents, by carrying out 1 or more of the following activities: 2 (1) Developing educational content for issues 3 relating to comprehensive sleep and circadian health 4 education that will be incorporated into first-year 5 orientation or core courses. 6 (2) Creating innovative technology-based ap- 7 proaches to deliver sleep health education to stu- 8 dents, faculty, and staff. 9 (3) Developing and employing peer-outreach 10 and education programs to generate discussion, edu- 11 cate, and raise awareness among students about 12 issues relating to poor quality sleep, sleep and circa- 13 dian disorders, and the role sleep health plays in 14 other diseases and co-morbidities. 15 (f) REPORT TO CONGRESS.— 16 (1) IN GENERAL.—Not later than 1 year after 17 the date of the enactment of this Act, and annually 18 thereafter for a period of 5 years, the Secretary shall 19 prepare and submit to the appropriate committees of 20 Congress a report on the activities to provide health 21 professions students with comprehensive sleep and 22 circadian health education funded under this section. 23 (2) REPORT ELEMENTS.—The report described 24 in paragraph (1) shall include information about— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00683 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 684 •HR 5475 IH (A) the number of eligible entities and in- 1 stitutions of higher education that are receiving 2 grant funds; 3 (B) the specific activities supported by 4 grant funds; 5 (C) the number of students served by 6 grant programs; and 7 (D) the status of program evaluations. 8 SEC. 795. REPORT ON IMPACT OF SLEEP AND CIRCADIAN 9 HEALTH DISORDERS IN VULNERABLE & RA- 10 CIAL/ETHNIC POPULATIONS. 11 (a) IN GENERAL.—Not later than 1 year after the 12 date of enactment of this Act, the Secretary of Health and 13 Human Services shall submit to the Congress and the 14 President a report on the impact of sleep and circadian 15 health disorders for racial and ethnic minority commu- 16 nities and other vulnerable populations. 17 (b) CONTENTS.—The report under subsection (a) 18 shall include information on the— 19 (1) progress that has been made in reducing 20 the impact of sleep and circadian health disorders in 21 such communities and populations; 22 (2) opportunities that exist to make additional 23 progress in reducing the impact of sleep and circa- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00684 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 685 •HR 5475 IH dian health disorders in such communities and popu- 1 lations; 2 (3) challenges that may impede such additional 3 progress; and 4 (4) Federal funding necessary to achieve sub- 5 stantial reductions in sleep and circadian health dis- 6 orders in racial and ethnic minority communities. 7 TITLE VIII—HEALTH 8 INFORMATION TECHNOLOGY 9 SEC. 800. DEFINITIONS. 10 In this title: 11 (1) The term ‘‘certified EHR technology’’ has 12 the meaning given to that term in section 3000 of 13 the Public Health Service Act (42 U.S.C. 300jj). 14 (2) The term ‘‘EHR’’ means an electronic 15 health record. 16 Subtitle A—Reducing Health 17 Disparities Through Health IT 18 SEC. 801. HRSA ASSISTANCE TO HEALTH CENTERS FOR 19 PROMOTION OF HEALTH IT. 20 The Secretary of Health and Human Services, acting 21 through the Administrator of the Health Resources and 22 Services Administration, shall expand and intensify the 23 programs and activities of the Administration (directly or 24 through grants or contracts) to provide technical assist- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00685 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 686 •HR 5475 IH ance and resources to health centers (as defined in section 1 330(a) of the Public Health Service Act (42 U.S.C. 2 254b(a)) to adopt and meaningfully use certified EHR 3 technology for the management of chronic diseases and 4 health conditions and reduction of health disparities. 5 SEC. 802. ASSESSMENT OF IMPACT OF HEALTH IT ON RA- 6 CIAL AND ETHNIC MINORITY COMMUNITIES; 7 OUTREACH AND ADOPTION OF HEALTH IT IN 8 SUCH COMMUNITIES. 9 (a) NATIONAL COORDINATOR FOR HEALTH INFOR- 10 MATION TECHNOLOGY.— 11 (1) IN GENERAL.—The National Coordinator 12 for Health Information Technology shall conduct an 13 evaluation of the level of use and accessibility of 14 electronic health records in racial and ethnic minor- 15 ity communities focusing on whether patients in 16 those communities have providers with electronic 17 health records, stratified by disparity variables. 18 (2) CONTENT.—In conducting the evaluation 19 under paragraph (1), the National Coordinator shall 20 publish the results of a study regarding the 100,000 21 providers recruited by the Regional Extension Cen- 22 ter established under section 3012 of the Public 23 Health Service Act (42 U.S.C. 300jj–32), including 24 the race and ethnicity of such providers and the pop- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00686 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 687 •HR 5475 IH ulations served by such providers, with the popu- 1 lations stratified by disparity variables. 2 (b) NATIONAL CENTER FOR HEALTH STATISTICS.— 3 As soon as practicable after the date of enactment of this 4 Act, the Director of the National Center for Health Statis- 5 tics shall provide to Congress a more detailed analysis of 6 the data presented in the Data Brief 79 published by such 7 Center in November 2011 (entitled ‘‘Electronic Health 8 Record Systems and Intent to Apply for Meaningful Use 9 Incentives Among Office-Based Physician Practices’’). 10 (c) INSTITUTE OF MEDICINE.—The Secretary of 11 Health and Human Services may enter into an agreement 12 with the Institute of Medicine of the National Academies 13 that provides such Institute will— 14 (1) evaluate the impact of health information 15 technology in racial and ethnic minority commu- 16 nities; and 17 (2) publish a report regarding such evaluation. 18 (d) CENTERS FOR MEDICARE & MEDICAID SERV- 19 ICES.— 20 (1) IN GENERAL.—As part of the process of 21 collecting information, with respect to a provider, at 22 registration and attestation for purposes of the 23 Medicare and Medicaid Electronic Health Records 24 Incentive Programs, the Secretary of Health and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00687 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 688 •HR 5475 IH Human Services shall collect the race and ethnicity 1 of such provider. 2 (2) MEDICARE AND MEDICAID ELECTRONIC 3 HEALTH RECORDS INCENTIVE PROGRAMS DE- 4 FINED.—For purposes of paragraph (1), the term 5 ‘‘Medicare and Medicaid Electronic Health Records 6 Incentive Programs’’ means the incentive programs 7 under section 1814(l)(3), subsections (a)(7) and (o) 8 of section 1848, subsections (l) and (m) of section 9 1853, subsections (b)(3)(B)(ix)(I) and (n) of section 10 1886, and subsections (a)(3)(F) and (t) of section 11 1903 of the Social Security Act (42 U.S.C. 12 1395f(l)(3), 1395w–4, 1395w–23, 1395ww, and 13 1396b). 14 (e) NATIONAL COORDINATOR’S ASSESSMENT OF IM- 15 PACT OF HIT.—Section 3001(c)(6)(C) of the Public 16 Health Service Act (42 U.S.C. 300jj–11(c)(6)(C)) is 17 amended— 18 (1) in the heading by inserting ‘‘, RACIAL AND 19 ETHNIC MINORITY COMMUNITIES,’’ after ‘‘HEALTH 20 DISPARITIES’’; 21 (2) by inserting ‘‘, in communities with a high 22 proportion of individuals from racial and ethnic mi- 23 nority groups (as defined in section 1707(g)), in- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00688 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 689 •HR 5475 IH cluding people with disabilities in these groups,’’ 1 after ‘‘communities with health disparities’’; and 2 (3) by adding at the end the following new sen- 3 tence: ‘‘In any publication under the previous sen- 4 tence, the National Coordinator shall include best 5 practices for encouraging partnerships between the 6 Federal Government, States, and private entities to 7 expand outreach for and the adoption of certified 8 EHR technology in communities with a high propor- 9 tion of individuals from racial and ethnic minority 10 groups (as so defined), while also maintaining the 11 accessibility requirements of section 508 of the Re- 12 habilitation Act to encourage patient involvement in 13 their own health care. The National Coordinator 14 shall— 15 ‘‘(i) not later than 6 months after the 16 submission to the Congress of the report 17 required by section 832 of the Health Eq- 18 uity and Accountability Act of 2016, estab- 19 lish criteria for evaluating the impact of 20 health information technology on commu- 21 nities with a high proportion of individuals 22 from racial and ethnic minority groups (as 23 so defined) taking into account the find- 24 ings in such report; and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00689 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 690 •HR 5475 IH ‘‘(ii) not later than 12 months after 1 the submission to the Congress of such re- 2 ports, conduct and publish the results of 3 an evaluation of such impact.’’. 4 Subtitle B—Modifications To 5 Achieve Parity in Existing Pro- 6 grams 7 SEC. 811. EXTENDING FUNDING TO STRENGTHEN THE 8 HEALTH IT INFRASTRUCTURE IN RACIAL 9 AND ETHNIC MINORITY COMMUNITIES. 10 Section 3011 of the Public Health Service Act (42 11 U.S.C. 300jj–31) is amended— 12 (1) in subsection (a), by adding at the end the 13 following new paragraph: 14 ‘‘(8) Activities described in the previous para- 15 graphs of this subsection with respect to commu- 16 nities with a high proportion of individuals from ra- 17 cial and ethnic minority groups (as defined in sec- 18 tion 1707(g)).’’; and 19 (2) by adding at the end the following new sub- 20 section: 21 ‘‘(e) ANNUAL REPORT ON EXPENDITURES.—The 22 National Coordinator shall report annually to the Con- 23 gress on activities and expenditures under this section.’’. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00690 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 691 •HR 5475 IH SEC. 812. PRIORITIZING REGIONAL EXTENSION CENTER AS- 1 SISTANCE TO RACIAL AND ETHNIC MINORITY 2 GROUPS. 3 (a) IN GENERAL.—Section 3012(c)(4)(C) of the Pub- 4 lic Health Service Act (42 U.S.C. 300jj–32(c)(4)(C)) is 5 amended by inserting ‘‘or individuals from racial and eth- 6 nic minority groups (as defined in section 1707(g))’’ after 7 ‘‘medically underserved individuals’’. 8 (b) BIENNIAL EVALUATION.—Section 3012(c)(8) of 9 the Public Health Service Act (42 U.S.C. 300jj–32(c)(8)) 10 is amended— 11 (1) by inserting: ‘‘Each evaluation panel shall 12 include at least one consumer advocate from a racial 13 and ethnic minority community served by the center 14 involved, at least one patient or family caregiver, 15 and at least one representative of a minority-serving 16 institution.’’ after ‘‘ ‘and of Federal officials.’’; and 17 (2) by inserting ‘‘and shall determine the de- 18 gree to which such center provides outreach and as- 19 sistance to providers predominantly serving racial 20 and ethnic minority groups (as defined in section 21 1707(g))’’ after ‘‘specified in paragraph (3)’’. 22 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00691 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 692 •HR 5475 IH SEC. 813. EXTENDING COMPETITIVE GRANTS FOR THE DE- 1 VELOPMENT OF LOAN PROGRAMS TO FACILI- 2 TATE ADOPTION OF CERTIFIED EHR TECH- 3 NOLOGY BY PROVIDERS SERVING RACIAL 4 AND ETHNIC MINORITY GROUPS. 5 Section 3014(e) of the Public Health Service Act (42 6 U.S.C. 300jj–34(e)) is amended— 7 (1) in paragraph (3), by striking at the end 8 ‘‘or’’; 9 (2) in paragraph (4), by striking the period at 10 the end and inserting ‘‘; or’’; and 11 (3) by adding at the end the following new 12 paragraph: 13 ‘‘(5) carry out any of the activities described in 14 a previous paragraph of this subsection with respect 15 to communities with a high proportion of individuals 16 from racial and ethnic minority groups (as defined 17 in section 1707(g)).’’. 18 SEC. 814. AUTHORIZATION OF APPROPRIATIONS. 19 Section 3018 of the Public Health Service Act (42 20 U.S.C. 300jj–38) is amended by striking ‘‘fiscal years 21 2009 through 2013’’ and inserting ‘‘fiscal years 2017 22 through 2021’’. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00692 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 693 •HR 5475 IH Subtitle C—Additional Research 1 and Studies 2 SEC. 831. DATA COLLECTION AND ASSESSMENTS CON- 3 DUCTED IN COORDINATION WITH MINORITY- 4 SERVING INSTITUTIONS. 5 Section 3001(c)(6) of the Public Health Service Act 6 (42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 7 end the following new subparagraph: 8 ‘‘(F) DATA COLLECTION AND ASSESS- 9 MENTS CONDUCTED IN COORDINATION WITH 10 MINORITY-SERVING INSTITUTIONS.— 11 ‘‘(i) IN GENERAL.—In carrying out 12 subparagraph (C) with respect to commu- 13 nities with a high proportion of individuals 14 from racial and ethnic minority groups (as 15 defined in section 1707(g)), the National 16 Coordinator shall, to the greatest extent 17 possible, coordinate with an entity de- 18 scribed in clause (ii). 19 ‘‘(ii) MINORITY-SERVING INSTITU- 20 TIONS.—For purposes of clause (i), an en- 21 tity described in this clause is a historically 22 Black college or university, a Hispanic- 23 serving institution, a tribal college or uni- 24 versity, or an Asian-American-, Native 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00693 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 694 •HR 5475 IH American-, and Pacific Islander-serving in- 1 stitution with an accredited public health, 2 health policy, or health services research 3 program.’’. 4 SEC. 832. STUDY OF HEALTH INFORMATION TECHNOLOGY 5 IN MEDICALLY UNDERSERVED COMMU- 6 NITIES. 7 (a) IN GENERAL.—Not later than 24 months after 8 the date of enactment of this Act, the Secretary of Health 9 and Human Services shall— 10 (1) enter into an agreement with the Institute 11 of Medicine of the National Academies (or, if the In- 12 stitute of Medicine declines, another appropriate 13 public or nonprofit private entity) to conduct a study 14 on the development, implementation, and effective- 15 ness of health information technology within medi- 16 cally underserved areas (as described in subsection 17 (c)); and 18 (2) submit a report to Congress describing the 19 results of such study, including any recommenda- 20 tions for legislative or administrative action. 21 (b) STUDY.—The study described in subsection 22 (a)(1) shall— 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00694 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 695 •HR 5475 IH (1) identify barriers to successful implementa- 1 tion of health information technology in medically 2 underserved areas; 3 (2) examine the impact of health information 4 technology on providing quality care and reducing 5 the cost of care to individuals in such areas, includ- 6 ing the impact of such technology on improved 7 health outcomes for individuals, including which 8 technology worked for which population and how it 9 improved health outcomes for that population; 10 (3) examine the impact of health information 11 technology on improving health-care-related deci- 12 sions by both patients and providers in such areas; 13 (4) identify specific best practices for using 14 health information technology to foster the con- 15 sistent provision of physical accessibility and reason- 16 able policy accommodations in health care to individ- 17 uals with disabilities in such areas; 18 (5) assess the feasibility and costs associated 19 with the use of health information technology in 20 such areas; 21 (6) evaluate whether the adoption and use of 22 qualified electronic health records (as described in 23 section 3000(13) of the Public Health Service Act 24 (42 U.S.C. 300jj(13)) is effective in reducing health 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00695 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 696 •HR 5475 IH disparities, including analysis of clinical quality 1 measures reported by Medicare and Medicaid pro- 2 viders pursuant to programs to encourage the adop- 3 tion and use of certified EHR technology; 4 (7) identify providers in medically underserved 5 areas that are not electing to adopt and use elec- 6 tronic health records and determine what barriers 7 are preventing those providers from adopting and 8 using such records; and 9 (8) examine urban and rural community health 10 systems and determine the impact that health infor- 11 mation technology may have on the capacity of pri- 12 mary health providers in those systems. 13 (c) MEDICALLY UNDERSERVED AREA.—The term 14 ‘‘medically underserved area’’ means— 15 (1) a population that has been designated as a 16 medically underserved population under section 17 330(b)(3) of the Public Health Service Act (42 18 U.S.C. 254b(b)(3)); 19 (2) an area that has been designated as a 20 health professional shortage area under section 332 21 of the Public Health Service Act (42 U.S.C. 254e); 22 (3) an area or population that has been des- 23 ignated as a medically underserved community under 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00696 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 697 •HR 5475 IH section 799B(6) of the Public Health Service Act 1 (42 U.S.C. 295p(6)); or 2 (4) an area or population that— 3 (A) is not described in paragraphs (1) 4 through (3) of this subsection; 5 (B) experiences significant barriers to ac- 6 cessing quality health services; and 7 (C) has a high prevalence of diseases or 8 conditions described in title VII of this Act, 9 with such diseases or conditions having a dis- 10 proportionate impact on racial and ethnic mi- 11 nority groups (as defined in section 1707(g) of 12 the Public Health Service Act (42 U.S.C. 300u- 13 6(g))) or a subgroup of people with disabilities 14 who have specific functional impairments. 15 Subtitle D—Closing Gaps in 16 Funding To Adopt Certified EHRs 17 SEC. 841. EXTENDING MEDICAID EHR INCENTIVE PAY- 18 MENTS TO REHABILITATION FACILITIES, 19 LONG-TERM CARE FACILITIES, AND HOME 20 HEALTH AGENCIES. 21 Section 1903(t)(2)(B) of the Social Security Act (42 22 U.S.C. 1396b(t)(2)(B)) is amended— 23 (1) in clause (i), by striking ‘‘, or’’ and insert- 24 ing a semicolon; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00697 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 698 •HR 5475 IH (2) in clause (ii), by striking the period at the 1 end and inserting a semicolon; and 2 (3) by inserting after clause (ii) the following 3 new clauses: 4 ‘‘(iii) a rehabilitation facility (as defined in sec- 5 tion 1886(j)(1)) that furnishes acute or subacute re- 6 habilitation services; 7 ‘‘(iv) a long-term care hospital (as defined in 8 section 1886(d)(1)(B)(iv)(I)); or 9 ‘‘(v) a home health agency (as defined in sec- 10 tion 1861(o)).’’. 11 SEC. 842. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 12 FOR MEDICAID ELECTRONIC HEALTH 13 RECORD INCENTIVE PAYMENTS. 14 (a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 15 Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 16 amended to read as follows: 17 ‘‘(v) physician assistant, in the case that 18 the assistant is a primary care provider, includ- 19 ing an assistant who practices in a rural health 20 clinic that is led by a physician assistant or 21 practices in a federally qualified health center 22 that is so led.’’. 23 (b) EFFECTIVE DATE.—The amendment made by 24 subsection (a) shall apply with respect to amounts ex- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00698 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 699 •HR 5475 IH pended under section 1903(a)(3)(F) of the Social Security 1 Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be- 2 ginning on or after the date of the enactment of this Act. 3 TITLE IX—ACCOUNTABILITY 4 AND EVALUATION 5 SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL 6 ASSISTED HEALTH CARE SERVICES AND RE- 7 SEARCH PROGRAMS ON THE BASIS OF SEX, 8 RACE, COLOR, NATIONAL ORIGIN, MARITAL 9 STATUS, FAMILIAL STATUS, SEXUAL ORI- 10 ENTATION, GENDER IDENTITY, OR DIS- 11 ABILITY STATUS. 12 (a) IN GENERAL.—No person in the United States 13 shall, on the basis of sex, race, color, national origin, mar- 14 ital status, familial status, sexual orientation, gender iden- 15 tity, or disability status, be excluded from participation 16 in, be denied the benefits of, or be subjected to discrimina- 17 tion under any health program or activity, including any 18 health research program or activity, receiving Federal fi- 19 nancial assistance. 20 (b) DEFINITION.—In this section, the term ‘‘familial 21 status’’ means, with respect to one or more individuals— 22 (1) being domiciled with any individual related 23 by blood or affinity whose close association with the 24 individual is the equivalent of a family relationship; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00699 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 700 •HR 5475 IH (2) being in the process of securing legal cus- 1 tody of any individual; or 2 (3) being pregnant. 3 SEC. 902. TREATMENT OF MEDICARE PAYMENTS UNDER 4 TITLE VI OF THE CIVIL RIGHTS ACT OF 1964. 5 A payment to a provider of services, physician, or 6 other supplier under part B, C, or D of title XVIII of 7 the Social Security Act shall be deemed a grant, and not 8 a contract of insurance or guaranty, for the purposes of 9 title VI of the Civil Rights Act of 1964. 10 SEC. 903. ACCOUNTABILITY AND TRANSPARENCY WITHIN 11 THE DEPARTMENT OF HEALTH AND HUMAN 12 SERVICES. 13 Title XXXIV of the Public Health Service Act, as 14 amended by titles I, II, and III of this Act, is further 15 amended by inserting after subtitle B the following: 16 ‘‘Subtitle C—Strengthening 17 Accountability 18 ‘‘SEC. 3441. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 19 ‘‘(a) IN GENERAL.—The Secretary shall establish 20 within the Office for Civil Rights an Office of Health Dis- 21 parities, which shall be headed by a director to be ap- 22 pointed by the Secretary. 23 ‘‘(b) PURPOSE.—The Office of Health Disparities 24 shall ensure that the health programs, activities, and oper- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00700 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 701 •HR 5475 IH ations of health entities which receive Federal financial as- 1 sistance are in compliance with title VI of the Civil Rights 2 Act, which prohibits discrimination on the basis of race, 3 color, or national origin. The activities of the Office shall 4 include the following: 5 ‘‘(1) The development and implementation of 6 an action plan to address racial and ethnic health 7 care disparities, which shall address concerns relat- 8 ing to the Office for Civil Rights as released by the 9 United States Commission on Civil Rights in the re- 10 port entitled ‘Health Care Challenge: Acknowledging 11 Disparity, Confronting Discrimination, and Ensur- 12 ing Equity’ (September 1999) in conjunction with 13 the reports by the Institute of Medicine entitled ‘Un- 14 equal Treatment: Confronting Racial and Ethnic 15 Disparities in Health Care’, ‘Crossing the Quality 16 Chasm: A New Health System for the 21st Cen- 17 tury’, ‘In the Nation’s Compelling Interest: Ensur- 18 ing Diversity in the Health Care Workforce’, ‘The 19 National Partnership for Action to End Health Dis- 20 parities’, and ‘The Health of Lesbian, Gay, Bisexual, 21 and Transgender People’, and other related reports 22 by the Institute of Medicine. This plan shall be pub- 23 licly disclosed for review and comment and the final 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00701 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 702 •HR 5475 IH plan shall address any comments or concerns that 1 are received by the Office. 2 ‘‘(2) Investigative and enforcement actions 3 against intentional discrimination and policies and 4 practices that have a disparate impact on minorities. 5 ‘‘(3) The review of racial, ethnic, gender iden- 6 tity, sexual orientation, sex, disability status, socio- 7 economic status, and primary language health data 8 collected by Federal health agencies to assess health 9 care disparities related to intentional discrimination 10 and policies and practices that have a disparate im- 11 pact on minorities. 12 ‘‘(4) Outreach and education activities relating 13 to compliance with title VI of the Civil Rights Act. 14 ‘‘(5) The provision of technical assistance for 15 health entities to facilitate compliance with title VI 16 of the Civil Rights Act. 17 ‘‘(6) Coordination and oversight of activities of 18 the civil rights compliance offices established under 19 section 3442. 20 ‘‘(7) Ensuring— 21 ‘‘(A) at a minimum, compliance with the 22 1997 Office of Management and Budget Stand- 23 ards for Maintaining, Collecting, and Pre- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00702 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 703 •HR 5475 IH senting Federal Data on Race and Ethnicity; 1 and 2 ‘‘(B) consideration of available data and 3 language standards such as— 4 ‘‘(i) the standards for collecting and 5 reporting data under section 3101; and 6 ‘‘(ii) the National Standards on Cul- 7 turally and Linguistically Appropriate 8 Services of the Office of Minority Health 9 within the Department of Health and 10 Human Services. 11 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en- 12 sure the effectiveness of the Office of Health Disparities 13 by ensuring that the Office is provided with— 14 ‘‘(1) adequate funding to enable the Office to 15 carry out its duties under this section; and 16 ‘‘(2) staff with expertise in— 17 ‘‘(A) epidemiology; 18 ‘‘(B) statistics; 19 ‘‘(C) health quality assurance; 20 ‘‘(D) minority health and health dispari- 21 ties; 22 ‘‘(E) cultural and linguistic competency; 23 ‘‘(F) civil rights; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00703 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 704 •HR 5475 IH ‘‘(G) social, behavioral, and economic de- 1 terminants of health. 2 ‘‘(d) REPORT.—Not later than December 31, 2017, 3 and annually thereafter, the Secretary, in collaboration 4 with the Director of the Office for Civil Rights and the 5 Deputy Assistant Secretary for Minority Health, shall 6 submit a report to the Committee on Health, Education, 7 Labor, and Pensions of the Senate and the Committee on 8 Energy and Commerce of the House of Representatives 9 that includes— 10 ‘‘(1) the number of cases filed, broken down by 11 category; 12 ‘‘(2) the number of cases investigated and 13 closed by the office; 14 ‘‘(3) the outcomes of cases investigated; 15 ‘‘(4) the staffing levels of the office including 16 staff credentials; 17 ‘‘(5) the number of other lingering and emerg- 18 ing cases in which civil rights inequities can be dem- 19 onstrated; and 20 ‘‘(6) the number of cases remaining open and 21 an explanation for their open status. 22 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 23 are authorized to be appropriated to carry out this section 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00704 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 705 •HR 5475 IH such sums as may be necessary for each of fiscal years 1 2017 through 2022. 2 ‘‘SEC. 3442. ESTABLISHMENT OF HEALTH PROGRAM OF- 3 FICES FOR CIVIL RIGHTS WITHIN FEDERAL 4 HEALTH AND HUMAN SERVICES AGENCIES. 5 ‘‘(a) IN GENERAL.—The Secretary shall establish 6 civil rights compliance offices in each agency within the 7 Department of Health and Human Services that admin- 8 isters health programs. 9 ‘‘(b) PURPOSE OF OFFICES.—Each office established 10 under subsection (a) shall ensure that recipients of Fed- 11 eral financial assistance under Federal health programs 12 administer their programs, services, and activities in a 13 manner that— 14 ‘‘(1) does not discriminate, either intentionally 15 or in effect, on the basis of race, national origin, lan- 16 guage, ethnicity, sex, age, disability, sexual orienta- 17 tion, and gender identity; and 18 ‘‘(2) promotes the reduction and elimination of 19 disparities in health and health care based on race, 20 national origin, language, ethnicity, sex, age, dis- 21 ability, sexual orientation, and gender identity. 22 ‘‘(c) POWERS AND DUTIES.—The offices established 23 in subsection (a) shall have the following powers and du- 24 ties: 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00705 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 706 •HR 5475 IH ‘‘(1) The establishment of compliance and pro- 1 gram participation standards for recipients of Fed- 2 eral financial assistance under each program admin- 3 istered by an agency within the Department of 4 Health and Human Services including the establish- 5 ment of disparity reduction standards to encompass 6 disparities in health and health care related to race, 7 national origin, language, ethnicity, sex, age, dis- 8 ability, sexual orientation, and gender identity. 9 ‘‘(2) The development and implementation of 10 program-specific guidelines that interpret and apply 11 Department of Health and Human Services guid- 12 ance under title VI of the Civil Rights Act of 1964 13 and section 1557 of the Patient Protection and Af- 14 fordable Care Act to each Federal health program 15 administered by the agency. 16 ‘‘(3) The development of a disparity-reduction 17 impact analysis methodology that shall be applied to 18 every rule issued by the agency and published as 19 part of the formal rulemaking process under sections 20 555, 556, and 557 of title 5, United States Code. 21 ‘‘(4) Oversight of data collection, analysis, and 22 publication requirements for all recipients of Federal 23 financial assistance under each Federal health pro- 24 gram administered by the agency; compliance with, 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00706 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 707 •HR 5475 IH at a minimum, the 1997 Office of Management and 1 Budget Standards for Maintaining, Collecting, and 2 Presenting Federal Data on Race and Ethnicity; and 3 consideration of available data and language stand- 4 ards such as— 5 ‘‘(A) the standards for collecting and re- 6 porting data under section 3101; and 7 ‘‘(B) the National Standards on Culturally 8 and Linguistically Appropriate Services of the 9 Office of Minority Health within the Depart- 10 ment of Health and Human Services. 11 ‘‘(5) The conduct of publicly available studies 12 regarding discrimination within Federal health pro- 13 grams administered by the agency as well as dis- 14 parity reduction initiatives by recipients of Federal 15 financial assistance under Federal health programs. 16 ‘‘(6) Annual reports to the Committee on 17 Health, Education, Labor, and Pensions and the 18 Committee on Finance of the Senate and the Com- 19 mittee on Energy and Commerce and the Committee 20 on Ways and Means of the House of Representatives 21 on the progress in reducing disparities in health and 22 health care through the Federal programs adminis- 23 tered by the agency. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00707 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 708 •HR 5475 IH ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS 1 IN THE DEPARTMENT OF JUSTICE.— 2 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN 3 SERVICES.—The Office for Civil Rights in the De- 4 partment of Health and Human Services shall pro- 5 vide standard-setting and compliance review inves- 6 tigation support services to the Civil Rights Compli- 7 ance Office for each agency. 8 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 9 for Civil Rights in the Department of Justice shall 10 continue to maintain the power to institute formal 11 proceedings when an agency Office for Civil Rights 12 determines that a recipient of Federal financial as- 13 sistance is not in compliance with the disparity re- 14 duction standards of the agency. 15 ‘‘(e) DEFINITION.—In this section, the term ‘Federal 16 health programs’ mean programs— 17 ‘‘(1) under the Social Security Act (42 U.S.C. 18 301 et seq.) that pay for health care and services; 19 and 20 ‘‘(2) under this Act that provide Federal finan- 21 cial assistance for health care, biomedical research, 22 health services research, and programs designed to 23 improve the public’s health, including health service 24 programs.’’. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00708 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 709 •HR 5475 IH SEC. 904. UNITED STATES COMMISSION ON CIVIL RIGHTS. 1 (a) COORDINATION WITHIN DEPARTMENT OF JUS- 2 TICE OF ACTIVITIES REGARDING HEALTH DISPARI- 3 TIES.—Section 3(a) of the Civil Rights Commission Act 4 of 1983 (42 U.S.C. 1975a(a)) is amended— 5 (1) in paragraph (1), by striking ‘‘and’’ at the 6 end; 7 (2) in paragraph (2), by striking the period at 8 the end and inserting ‘‘; and’’; and 9 (3) by adding at the end the following: 10 ‘‘(3) shall, with respect to activities carried out 11 in health care and correctional facilities toward the 12 goal of eliminating health disparities between the 13 general population and members of racial or ethnic 14 minority groups, coordinate such activities of— 15 ‘‘(A) the Office for Civil Rights within the 16 Department of Justice; 17 ‘‘(B) the Office of Justice Programs within 18 the Department of Justice; 19 ‘‘(C) the Office for Civil Rights within the 20 Department of Health and Human Services; 21 and 22 ‘‘(D) the Office of Minority Health within 23 the Department of Health and Human Services 24 (headed by the Deputy Assistant Secretary for 25 Minority Health).’’. 26 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00709 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 710 •HR 5475 IH (b) AUTHORIZATION OF APPROPRIATIONS.—Section 1 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 2 1975c) is amended by striking the first sentence and in- 3 serting the following: ‘‘For the purpose of carrying out 4 this Act, there are authorized to be appropriated 5 $30,000,000 for fiscal year 2017, and such sums as may 6 be necessary for each of the fiscal years 2018 through 7 2022.’’. 8 SEC. 905. SENSE OF CONGRESS CONCERNING FULL FUND- 9 ING OF ACTIVITIES TO ELIMINATE RACIAL 10 AND ETHNIC HEALTH DISPARITIES. 11 (a) FINDINGS.—Congress makes the following find- 12 ings: 13 (1) The health status of the American populace 14 is declining and the United States currently ranks 15 below most industrialized nations in health status 16 measured by longevity, sickness, and mortality. 17 (2) Racial and ethnic minority populations tend 18 have the poorest health status and face substantial 19 cultural, social, and economic barriers to obtaining 20 quality health care. 21 (3) Lesbian, gay, bisexual, transgender, queer, 22 and questioning (LGBTQ) populations experience 23 significant personal and structural barriers to ob- 24 taining high-quality health care. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00710 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 711 •HR 5475 IH (4) Efforts to improve minority health have 1 been limited by inadequate resources (funding, staff- 2 ing, and stewardship) and lack of accountability. 3 (b) SENSE OF CONGRESS.—It is the sense of Con- 4 gress that— 5 (1) funding should be doubled by fiscal year 6 2018 for the National Institute for Minority Health 7 Disparities, the Office of Civil Rights in the Depart- 8 ment of Health and Human Services, the National 9 Institute of Nursing Research, and the Office of Mi- 10 nority Health; 11 (2) adequate funding by fiscal year 2018, and 12 subsequent funding increases, should be provided for 13 health and human service professions training pro- 14 grams, the Racial and Ethnic Approaches to Com- 15 munity Health (REACH) Initiative at the Centers 16 for Disease Control and Prevention, the Minority 17 HIV/AIDS Initiative, and the Excellence Centers to 18 Eliminate Ethnic/Racial Disparities (EXCEED) 19 Program at the Agency for Healthcare Research and 20 Quality; 21 (3) funding should be fully restored to the Ra- 22 cial and Ethnic Approaches to Community Health 23 (REACH) Initiative at the Centers for Disease Con- 24 trol and Prevention, which has been a successful 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00711 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 712 •HR 5475 IH program at the community health level, and efforts 1 should continue to place a strong emphasis on build- 2 ing community capacity to secure financial resources 3 and technical assistance to eliminate health dispari- 4 ties; 5 (4) adequate funding for fiscal year 2018 and 6 increased funding for future years should be pro- 7 vided for the REACH Initiative’s United States Risk 8 Factor Survey to ensure adequate data collection to 9 track health disparities, and there should be appro- 10 priate avenues provided to disseminate findings to 11 the general public; 12 (5) current and newly created health disparity 13 elimination incentives, programs, agencies, and de- 14 partments under this Act (and the amendments 15 made by this Act) should receive adequate staffing 16 and funding by fiscal year 2018; and 17 (6) stewardship and accountability should be 18 provided to the Congress and the President for 19 measurable and sustainable progress toward health 20 disparity elimination. 21 SEC. 906. GAO AND NIH REPORTS. 22 (a) GAO REPORT ON NIH GRANT RACIAL AND ETH- 23 NIC DIVERSITY.— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00712 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 713 •HR 5475 IH (1) IN GENERAL.—The Comptroller General of 1 the United States shall conduct a study on the racial 2 and ethnic diversity among the following groups: 3 (A) All applicants for grants, contracts, 4 and cooperative agreements awarded by the Na- 5 tional Institutes of Health during the period be- 6 ginning on January 1, 2006, and ending De- 7 cember 31, 2015. 8 (B) All recipients of such grants, con- 9 tracts, and cooperative agreements. 10 (C) All members of the peer review panels 11 of such applicants and recipients, respectively. 12 (2) REPORT.—Not later than six months after 13 the date of the enactment of this Act, the Comp- 14 troller General shall complete the study under para- 15 graph (1) and submit to Congress a report con- 16 taining the results of such study. 17 (b) NIH REPORT ON CERTAIN AUTHORITY OF NA- 18 TIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH 19 DISPARITIES.—Not later than six months after the date 20 of the enactment of this Act, and biennially thereafter, the 21 Director of the National Institutes of Health, in collabora- 22 tion with the Director of the National Institute on Minor- 23 ity Health and Health Disparities, shall submit to Con- 24 gress a report that details and evaluates— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00713 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 714 •HR 5475 IH (1) the steps taken during the applicable report 1 period by the Director of the National Institutes of 2 Health to enforce the expanded planning, coordina- 3 tion, review, and evaluation authority provided the 4 National Institute on Minority Health and Health 5 Disparities under section 464z–3(h) of the Public 6 Health Service Act (42 U.S.C. 285(h)), as added by 7 section 10334(c) of the Patient Protection and Af- 8 fordable Care Act, over all minority health and 9 health disparity research that is conducted or sup- 10 ported by the Institutes and Centers at the National 11 Institutes of Health; and 12 (2) the outcomes of such steps. 13 (c) GAO REPORT RELATED TO RECIPIENTS OF 14 PPACA FUNDING.—Not later than one year after the 15 date of the enactment of this Act and biennially thereafter 16 until 2022, the Comptroller General of the United States 17 shall submit to Congress a report that identifies— 18 (1) the racial and ethnic diversity of commu- 19 nity-based organizations that applied for Federal en- 20 rollment funding provided pursuant to the provisions 21 of (and amendments made by) the Patient Protec- 22 tion and Affordable Care Act; 23 (2) the percentage of such organizations that 24 were awarded such funding; and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00714 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 715 •HR 5475 IH (3) the impact of such community-based organi- 1 zations’ enrollment efforts on the insurance status of 2 their communities. 3 (d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL 4 INSTITUTE ON MINORITY HEALTH AND HEALTH DIS- 5 PARITIES.—The Director of the National Institute on Mi- 6 nority Health and Health Disparities shall prepare an an- 7 nual report on the activities carried out or to be carried 8 out by the Institute, and shall submit each such report 9 to the Committee on Health, Education, Labor, and Pen- 10 sions of the Senate, the Committee on Energy and Com- 11 merce of the House of Representatives, the Secretary of 12 Health and Human Services, and the Director of the Na- 13 tional Institutes of Health. With respect to the fiscal year 14 involved, the report shall— 15 (1) describe and evaluate the progress made in 16 health disparities research conducted or supported 17 by institutes and centers of the National Institutes 18 of Health; 19 (2) summarize and analyze expenditures made 20 for activities with respect to health disparities re- 21 search conducted or supported by the National Insti- 22 tutes of Health; 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00715 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 716 •HR 5475 IH (3) include a separate statement applying the 1 requirements of paragraphs (1) and (2) specifically 2 to minority health disparities research; and 3 (4) contain such recommendations as the Direc- 4 tor of the Institute considers appropriate. 5 TITLE X—ADDRESSING SOCIAL 6 DETERMINANTS AND IM- 7 PROVING ENVIRONMENTAL 8 JUSTICE 9 SEC. 1001. DEFINITIONS. 10 (a) DETERMINANTS OF HEALTH.—The term ‘‘deter- 11 minants of health’’— 12 (1) refers to the range of personal, social, eco- 13 nomic, and environmental factors that influence 14 health status; and 15 (2) includes social determinants of health 16 (which are sometimes referred to as ‘‘social and eco- 17 nomic determinants of health’’ or ‘‘socioeconomic de- 18 terminants of health’’), environmental determinants 19 of health, and personal determinants of health. 20 (b) ENVIRONMENTAL DETERMINANTS OF 21 HEALTH.—The term ‘‘environmental determinants of 22 health’’ refers to the broad physical, psychological, social, 23 and aesthetic environment. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00716 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 717 •HR 5475 IH (c) PERSONAL DETERMINANTS OF HEALTH.—The 1 term ‘‘personal determinants of health’’ refers to an indi- 2 vidual’s behavior, biology, and genetics. 3 (d) SOCIAL DETERMINANTS OF HEALTH.—The term 4 ‘‘social determinants of health’’ refers to a subset of deter- 5 minants of the health of individuals and environments 6 (such as communities, neighborhoods, and societies) that 7 describe people’s social identity, describe the social and 8 economic resources to which people have access, and de- 9 scribe the conditions in which people work, live, and play. 10 SEC. 1002. FINDINGS. 11 The Congress finds as follows: 12 (1) There are more opportunities to improve 13 health for everyone when we understand that health 14 starts, first, not in a medical setting, but in our 15 families, in our schools and workplaces, in our 16 neighborhoods, and in the air we breathe and water 17 we drink. 18 (2) The social determinants of health are the 19 largest predictors of health outcomes. 20 (3) Healthy People 2020 identifies health and 21 health care quality as a function of not only access 22 to health care, but also the social determinants of 23 health, categorized into the following: neighborhoods 24 and the built environment; social and community 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00717 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 718 •HR 5475 IH context; education; and economic stability. The fol- 1 lowing examples illustrate the nexus between the un- 2 equal distribution of the social determinants of 3 health and health disparities: 4 (A) The built environment influences resi- 5 dents’ level of physical activity. Neighborhoods 6 with high levels of poverty are significantly less 7 likely to have places where children can be 8 physically active, such as parks, green spaces, 9 and bike paths and lanes. Neighborhoods and 10 communities can provide opportunities for phys- 11 ical activity and support active lifestyles 12 through accessible and safe parks and open 13 spaces and through land use policy, zoning, and 14 healthy community design. 15 (B) Emotional and physical health and 16 well-being are directly impacted by perceived 17 levels of safety, such as unlit streets at night. 18 Community members have expressed that safety 19 is not only a barrier to accessing programs and 20 services that increase quality of life but they 21 are also not able to access physical activity in 22 their community through the built environment. 23 (C) In many workplace environments, toxic 24 chemicals have lasting detrimental effects on 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00718 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 719 •HR 5475 IH employees’ health. The hazardous compounds 1 found in most nail salon products affect the 2 respiratory system, reproductive system, and 3 central nervous system, and also cause kidney 4 and liver damage. Recognizing the importance 5 of addressing occupational hazards as a matter 6 of public health, especially for Asian-American 7 women who constitute 40 percent of nail salon 8 technicians—with Vietnamese-American women 9 accounting for 37 percent of this—the White 10 House Initiative on Asian American Pacific Is- 11 landers has created an interagency working 12 group to coordinate efforts by the Environ- 13 mental Protection Agency, Occupational and 14 Safety Health Administration, Food and Drug 15 Administration, and other Federal agencies to 16 create programming, draft regulations, and con- 17 duct more outreach on educating workers on 18 health and safety issues. 19 (D) Historical and institutional discrimina- 20 tion against certain racial groups in the United 21 States has shaped the way in which social and 22 economic resources and exposure to health pro- 23 moting environments are distributed. Income, 24 education, occupation, neighborhood conditions, 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00719 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 720 •HR 5475 IH schools, workplaces, the use of and health and 1 social services, and experiences with the crimi- 2 nal justice system are all highly patterned by 3 race, with racial minorities (compared to 4 Whites) experiencing more that is health harm- 5 ing. Finding ways to uncouple the link between 6 race and access to resources and healthy envi- 7 ronments is a principal means of reducing 8 health disparities. Additionally, the anticipation 9 of racism itself causes higher psychological and 10 cardiovascular stress levels that are linked to 11 poor health outcomes. Remedying discrimina- 12 tory practices at the individual and systemic 13 levels will likely reduce health disparities caused 14 by this unequal distribution of stress. 15 (E) Poor health among Native Americans 16 has largely been driven by post-colonial oppres- 17 sion and historical trauma. The expropriation of 18 native lands and territories to the American 19 state had severe consequences on Native Amer- 20 ican health. This resulted in the deprivation of 21 traditional food sources—and nutrients—for 22 Native Americans and also the destruction of 23 traditional economies and community organiza- 24 tion. Today, Native Americans have twice the 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00720 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 721 •HR 5475 IH rate of diabetes than non-Hispanic Whites. Rec- 1 ognition of the origins of the diabetes as having 2 a social and community context, rather than 3 just individual responsibility and genetic pre- 4 disposition, will shape better policy to provide 5 food security. 6 (F) In the context of prisons, overcrowding 7 has led to the deterioration of the physical and 8 mental health of individuals after they leave 9 prison. In particular, the mass incarceration of 10 African-American males as a result of unequal 11 contact with and treatment in the criminal jus- 12 tice system has contributed to an overburdening 13 of certain infectious diseases within the African- 14 American community. As a social institution, 15 incarceration amplifies existing adverse health 16 conditions by concentrating diseases and harm 17 health behaviors such as tobacco use, drug use, 18 and violence. 19 (G) Educational attainment is the strong- 20 est predictor of adult mortality. It is a basic 21 component of socioeconomic status by shaping 22 earning potential to access resources that pro- 23 mote health. People with more education are 24 less likely to report that they are in poor health, 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00721 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 722 •HR 5475 IH and are also less likely to have diabetes and 1 other chronic diseases. 2 (H) Similarly, reading ability is a strong 3 predictor of adult health status and is often 4 correlated with other child health issues, such 5 as developmental problems, vision and hearing 6 impairments, and frequent school absence due 7 to illness. 8 (I) Individuals with lower levels of edu- 9 cational attainment are much more likely to re- 10 port to be current smokers. In 2011, smoking 11 prevalence was 45.3 percent among adults with 12 a GED diploma, 34.6 percent with nine to 11 13 years of education, and 23.8 percent with a 14 high school diploma, while dropping signifi- 15 cantly to 9.3 percent among adults with an un- 16 dergraduate college degree and 5.0 percent with 17 a postgraduate college degree. 18 (J) Social class differences account for a 19 large part of health disparities. For example, 20 children living in poverty experience poorer 21 housing conditions, increased exposure to in- 22 door allergens and toxins (such as pesticides, 23 lead, mercury, radon, air pollution, and carcino- 24 gens), and more psychological stress. These ex- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00722 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 723 •HR 5475 IH periences culminate in worse adult health as 1 compared with children with higher socio- 2 economic status. Specifically, children living in 3 socioeconomic neighborhoods have higher rates 4 of asthma due to higher rates of psychological 5 stress resulting from higher rates of violence. 6 (K) Lesbian, gay, bisexual, transgender, 7 queer, and questioning (LGBTQ) individuals 8 face health disparities linked to societal stigma, 9 discrimination, and denial of their civil and 10 human rights. Discrimination against LGBTQ 11 individuals has been associated with high rates 12 of psychiatric disorders, substance abuse, and 13 suicide. Experiences of violence and victimiza- 14 tion are frequent for LGBTQ individuals, and 15 have long-lasting effects on the individual and 16 the community. Personal, family, and social ac- 17 ceptance of sexual orientation and gender iden- 18 tity affects the mental health and personal safe- 19 ty of LGBTQ individuals. 20 (4) Laws and regulations that improve opportu- 21 nities to live in safe neighborhoods, with more social 22 cohesion, attain higher education, sustain stable em- 23 ployment, and bridge class differences help foster 24 the health and safety of individuals. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00723 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 724 •HR 5475 IH (5) The global public health community has 1 reached consensus through the Rio Political Declara- 2 tion of Social Determinants of Health that 3 ‘‘[c]ollaboration in coordinated and intersectoral pol- 4 icy actions has proven to be effective. Health in All 5 Policies, together with intersectoral cooperation and 6 action, is one promising approach to enhance ac- 7 countability in other sectors of health, as well as the 8 promotion of health equity and more inclusive and 9 productive societies.’’ 10 SEC. 1003. HEALTH IMPACT ASSESSMENTS. 11 (a) FINDINGS.—Congress makes the following find- 12 ings: 13 (1) Health Impact Assessment is a tool to help 14 planners, health officials, decisionmakers, and the 15 public make more informed decisions about the po- 16 tential health effects of proposed plans, policies, pro- 17 grams, and projects in order to maximize health 18 benefits and minimize harms. 19 (2) Health Impact Assessments can be done at 20 a fraction of the cost and time typically required for 21 other planning and permitting reviews. 22 (3) Health Impact Assessments can build com- 23 munity support and reduce opposition to a project or 24 policy, thereby facilitating economic growth by aid- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00724 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 725 •HR 5475 IH ing the development of consensus regarding new de- 1 velopment proposals. 2 (4) Health Impact Assessments facilitate col- 3 laboration across sectors. 4 (b) PURPOSES.—It is the purpose of this section to— 5 (1) provide more information about the poten- 6 tial human health effects of policy decisions and the 7 distribution of those effects; 8 (2) improve how health is considered in plan- 9 ning and decisionmaking processes; and 10 (3) build stronger, healthier communities 11 through the use of Health Impact Assessment. 12 (c) HEALTH IMPACT ASSESSMENTS.—Part P of title 13 III of the Public Health Service Act (42 U.S.C. 280g et 14 seq.), as amended, is further amended by adding at the 15 end the following: 16 ‘‘SEC. 399V–9. HEALTH IMPACT ASSESSMENTS. 17 ‘‘(a) DEFINITIONS.—In this section and section 18 399V–10: 19 ‘‘(1) ADMINISTRATOR.—The term ‘Adminis- 20 trator’ means the Administrator of the Environ- 21 mental Protection Agency. 22 ‘‘(2) BUILT ENVIRONMENT.—The term ‘built 23 environment’ means the components of the environ- 24 ment, and the location of these components in a geo- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00725 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 726 •HR 5475 IH graphically defined space, that are created or modi- 1 fied by individuals to form the physical and social 2 characteristics of a community or enhance quality of 3 human life, including— 4 ‘‘(A) homes, schools, and places of work 5 and worship; 6 ‘‘(B) parks, recreation areas, and green- 7 ways; 8 ‘‘(C) transportation systems; 9 ‘‘(D) business, industry, and agriculture; 10 and 11 ‘‘(E) land-use plans, projects, and policies 12 that impact the physical or social characteris- 13 tics of a community, including access to services 14 and amenities. 15 ‘‘(3) DIRECTOR.—The term ‘Director’ means 16 the Director of the Centers for Disease Control and 17 Prevention. 18 ‘‘(4) ELIGIBLE ENTITY.—The term ‘eligible en- 19 tity’ means a unit of State or tribal government the 20 jurisdiction of which includes individuals or popu- 21 lations the health of which are, or will be, affected 22 by an activity or a proposed activity. 23 ‘‘(5) ELIGIBLE INSTITUTION.—The term ‘eligi- 24 ble institution’ means a public agency or private 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00726 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 727 •HR 5475 IH nonprofit institution that submits to the Secretary, 1 in consultation with the Administrator, an applica- 2 tion for a grant authorized under such section at 3 such time, in such manner, and containing such 4 agreements, assurances, and information as the Sec- 5 retary and Administrator may require. 6 ‘‘(6) HEALTH IMPACT ASSESSMENT.—The term 7 ‘Health Impact Assessment’ means a systematic 8 process that uses an array of data sources and ana- 9 lytic methods and considers input from stakeholders 10 to determine the potential effects of a proposed pol- 11 icy, plan, program, or project on the health of a pop- 12 ulation and the distribution of those effects within 13 the population. Such term includes identifying and 14 recommending appropriate actions on monitoring 15 and maximizing potential benefits and minimizing 16 the potential harms. 17 ‘‘(7) HEALTH DISPARITIES.—The term ‘health 18 disparities’ are a particular type of health dif- 19 ferences that are closely linked with social, economic, 20 and/or environmental disadvantage. Health dispari- 21 ties adversely affect groups of people who have sys- 22 tematically experienced greater obstacles to health 23 based on their racial or ethnic group; religion; socio- 24 economic status; gender; age; mental health; cog- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00727 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 728 •HR 5475 IH nitive, sensory, or physical disability; sexual orienta- 1 tion or gender identity; geographic location; or other 2 characterisitics historically linked to discrimination 3 or exclusion. 4 ‘‘(8) PROPOSED ACTIVITY.—The term ‘proposed 5 activity’ means a proposed policy, program, plan, or 6 project currently under consideration by a local, 7 State, tribal, or Federal agency or government. 8 ‘‘(b) ESTABLISHMENT.—The Secretary, acting 9 through the Director and in collaboration with the Admin- 10 istrator, shall carry out the following: 11 ‘‘(1) Establish a program at the National Cen- 12 ter for Environmental Health at the Centers for Dis- 13 ease Control and Prevention focused on advancing 14 the field of Health Impact Assessment. In devel- 15 oping and implementing the program, the Director 16 of the National Center for Environmental Health 17 shall consult with the Director of the National Cen- 18 ter for Chronic Disease Prevention and Health Pro- 19 motion as well as relevant offices within the Depart- 20 ment of Housing and Urban Development, the De- 21 partment of Transportation, and the Department of 22 Agriculture. The program shall include— 23 ‘‘(A) collecting and disseminating best 24 practices; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00728 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 729 •HR 5475 IH ‘‘(B) administering capacity building 1 grants to States to support grantees in initi- 2 ating Health Impact Assessments, in accord- 3 ance with subsection (d); 4 ‘‘(C) providing technical assistance; 5 ‘‘(D) developing training tools and pro- 6 viding training on conducting Health Impact 7 Assessment and the implementation of built en- 8 vironment and health indicators; 9 ‘‘(E) making information available, as ap- 10 propriate, regarding the existence of other com- 11 munity healthy living tools, checklists, and indi- 12 ces that help connect public health to other sec- 13 tors, and tools to help examine the effect of the 14 indoor built environment and building codes on 15 population health; 16 ‘‘(F) conducting research and evaluations 17 of Health Impact Assessments; and 18 ‘‘(G) awarding competitive extramural re- 19 search grants. 20 ‘‘(2) In accordance with subsection (c), develop 21 guidance and guidelines to conduct Health Impact 22 Assessments. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00729 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 730 •HR 5475 IH ‘‘(3) In accordance with subsection (d), estab- 1 lish a grant program to allow States to fund eligible 2 entities to conduct Health Impact Assessments. 3 ‘‘(c) GUIDANCE.—The Director, in consultation with 4 the Director of the National Center for Environmental 5 Health and, the Director of the National Center for 6 Chronic Disease Prevention and Health Promotion, and 7 relevant offices within the Department of Housing and 8 Urban Development, the Department of Transportation, 9 and the Department of Agriculture, shall— 10 ‘‘(1) develop guidance for conducting Health 11 Impact Assessment, including— 12 ‘‘(A) background on national and inter- 13 national efforts to bridge urban planning and 14 public health institutions and disciplines, in- 15 cluding a review of Health Impact Assessment 16 best practices internationally; 17 ‘‘(B) evidence-based direct and indirect 18 pathways that link land-use planning, transpor- 19 tation, and housing policy and objectives to 20 human health outcomes; 21 ‘‘(C) data resources and quantitative and 22 qualitative forecasting methods to evaluate both 23 the status of health determinants and health ef- 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00730 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 731 •HR 5475 IH fects, including identification of existing pro- 1 grams that can disseminate these resources; 2 ‘‘(D) best practices for inclusive public in- 3 volvement in conducting Health Impact Assess- 4 ments; and 5 ‘‘(E) technical assistance for other agen- 6 cies seeking to develop their own guidelines and 7 procedures for Health Impact Assessment; 8 ‘‘(2) in developing the guidance, consider avail- 9 able international Health Impact Assessment guid- 10 ance, North American Health Impact Assessment 11 Practice Standards, and recommendations from the 12 National Academy of Science; and 13 ‘‘(3) not later than 1 year after the date of en- 14 actment of this section, publish the guidance. 15 ‘‘(d) GRANT PROGRAM.—The Secretary, acting 16 through the Director and in collaboration with the Admin- 17 istrator, shall establish a program under which the Sec- 18 retary shall award grants to States to fund eligible entities 19 for capacity building or to prepare Health Impact Assess- 20 ments, and shall ensure that States receiving a grant 21 under this subsection further support training and tech- 22 nical assistance for grantees under the program by fund- 23 ing and overseeing appropriate local, State, tribal, Fed- 24 eral, university, or nonprofit Health Impact Assessment 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00731 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 732 •HR 5475 IH experts to provide technical assistance. Such assessments 1 shall— 2 ‘‘(1) ensure that appropriate health factors are 3 taken into consideration as early as practicable dur- 4 ing the planning, review, or decisionmaking proc- 5 esses; 6 ‘‘(2) assess the effect on the health of individ- 7 uals and populations of proposed policies, projects, 8 or plans that result in modifications to the built en- 9 vironment; and 10 ‘‘(3) assess the distribution of health effects 11 across various factors, such as race, income, eth- 12 nicity, age, disability status, gender, and geography. 13 ‘‘(e) APPLICATIONS.— 14 ‘‘(1) IN GENERAL.—To be eligible to receive a 15 grant under this section, an eligible entity shall sub- 16 mit to the Secretary an application in accordance 17 with this subsection, at such time, in such manner, 18 and containing such additional information as the 19 Secretary may require. 20 ‘‘(2) INCLUSION.—An application under this 21 subsection shall include a list of proposed activities 22 that require or would benefit from conducting a 23 Health Impact Assessment within six months of 24 awarding funds. The list should be accompanied by 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00732 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 733 •HR 5475 IH supporting documentation, including letters of sup- 1 port, from potential conductors of Health Impact 2 Assessments for the listed proposed activities. Each 3 application should also include an assessment by the 4 eligible entity of the health of the population of its 5 jurisdiction and describe potential adverse or positive 6 effects on health that the proposed activities may 7 create. 8 ‘‘(3) PREFERENCE.—Preference in awarding 9 funds under this section may be given to eligible en- 10 tities that demonstrate the potential to significantly 11 improve population health or lower health care costs 12 as a result of potential Health Impact Assessment 13 work. 14 ‘‘(f) USE OF FUNDS.— 15 ‘‘(1) IN GENERAL.—An eligible entity shall use 16 amounts provided under a grant under this section 17 to conduct Health Impact Assessment capacity 18 building or to conduct or fund subgrantees to con- 19 duct a Health Impact Assessment for a proposed ac- 20 tivity in accordance with this subsection. 21 ‘‘(2) PURPOSES.—The purposes of a Health 22 Impact Assessment under this subsection are— 23 ‘‘(A) to facilitate the involvement of tribal, 24 State, and local public health officials in com- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00733 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 734 •HR 5475 IH munity planning, transportation, housing, and 1 land use decisions and other decisions affecting 2 the built environment to identify any potential 3 health concern or health benefit relating to an 4 activity or proposed activity; 5 ‘‘(B) to provide for an investigation of any 6 health-related issue of concern raised in a plan- 7 ning process, an environmental impact assess- 8 ment process, or policy appraisal relating to a 9 proposed activity; 10 ‘‘(C) to describe and compare alternatives 11 (including no-action alternatives) to a proposed 12 activity to provide clarification with respect to 13 the potential health outcomes associated with 14 the proposed activity and, where appropriate, to 15 the related benefit-cost or cost-effectiveness of 16 the proposed activity and alternatives; 17 ‘‘(D) to contribute, when applicable, to the 18 findings of a planning process, policy appraisal, 19 or an environmental impact statement with re- 20 spect to the terms and conditions of imple- 21 menting a proposed activity or related mitiga- 22 tion recommendations, as necessary; 23 ‘‘(E) to ensure that the disproportionate 24 distribution of negative impacts among vulner- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00734 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 735 •HR 5475 IH able populations is minimized as much as pos- 1 sible; 2 ‘‘(F) to engage affected community mem- 3 bers and ensure adequate opportunity for public 4 comment on all stages of the Health Impact As- 5 sessment; and 6 ‘‘(G) where appropriate, to consult with 7 local and county health departments and appro- 8 priate organizations, including planning, trans- 9 portation, and housing organizations and pro- 10 viding them with information and tools regard- 11 ing how to conduct and integrate Health Im- 12 pact Assessment into their work. 13 ‘‘(3) ELIGIBLE ACTIVITIES.— 14 ‘‘(A) IN GENERAL.—Eligible entities fund- 15 ed under this subsection shall conduct an eval- 16 uation of any proposed activity to determine 17 whether it will have a significant adverse or 18 positive effect on the health of the affected pop- 19 ulation in the jurisdiction of the eligible entity, 20 based on the criteria described in subparagraph 21 (B). 22 ‘‘(B) CRITERIA.—The criteria described in 23 this subparagraph include, as applicable to the 24 proposed activity, the following: 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00735 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 736 •HR 5475 IH ‘‘(i) Any substantial adverse effect or 1 significant health benefit on health out- 2 comes or factors known to influence health, 3 including the following: 4 ‘‘(I) Physical activity. 5 ‘‘(II) Injury. 6 ‘‘(III) Mental health. 7 ‘‘(IV) Accessibility to health-pro- 8 moting goods and services. 9 ‘‘(V) Respiratory health. 10 ‘‘(VI) Chronic disease. 11 ‘‘(VII) Nutrition. 12 ‘‘(VIII) Land use changes that 13 promote local, sustainable food 14 sources. 15 ‘‘(IX) Infectious disease. 16 ‘‘(X) Health disparities. 17 ‘‘(XI) Existing air quality, 18 ground or surface water quality or 19 quantity, or noise levels; and 20 ‘‘(ii) Other factors that may be con- 21 sidered, including— 22 ‘‘(I) the potential for a proposed 23 activity to result in systems failure 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00736 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 737 •HR 5475 IH that leads to a public health emer- 1 gency; 2 ‘‘(II) the probability that the pro- 3 posed activity will result in a signifi- 4 cant increase in tourism, economic de- 5 velopment, or employment in the ju- 6 risdiction of the eligible entity; 7 ‘‘(III) any other significant po- 8 tential hazard or enhancement to 9 human health, as determined by the 10 eligible entity; or 11 ‘‘(IV) whether the evaluation of a 12 proposed activity would duplicate an- 13 other analysis or study being under- 14 taken in conjunction with the pro- 15 posed activity. 16 ‘‘(C) FACTORS FOR CONSIDERATION.—In 17 evaluating a proposed activity under subpara- 18 graph (A), an eligible entity may take into con- 19 sideration any reasonable, direct, indirect, or 20 cumulative effect that can be clearly related to 21 potential health effects and that is related to 22 the proposed activity, including the effect of 23 any action that is— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00737 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 738 •HR 5475 IH ‘‘(i) included in the long-range plan 1 relating to the proposed activity; 2 ‘‘(ii) likely to be carried out in coordi- 3 nation with the proposed activity; 4 ‘‘(iii) dependent on the occurrence of 5 the proposed activity; or 6 ‘‘(iv) likely to have a disproportionate 7 impact on high-risk or vulnerable popu- 8 lations. 9 ‘‘(4) REQUIREMENTS.—A Health Impact As- 10 sessment prepared with funds awarded under this 11 subsection shall incorporate the following, after con- 12 ducting the screening phase (identifying projects or 13 policies for which a Health Impact Assessment 14 would be valuable and feasible) through the applica- 15 tion process: 16 ‘‘(A) SCOPING.—Identifying which health 17 effects to consider and the research methods to 18 be utilized. 19 ‘‘(B) ASSESSING RISKS AND BENEFITS.— 20 Assessing the baseline health status and factors 21 known to influence the health status in the af- 22 fected community, which may include aggre- 23 gating and synthesizing existing health assess- 24 ment evidence and data from the community. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00738 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 739 •HR 5475 IH ‘‘(C) DEVELOPING RECOMMENDATIONS.— 1 Suggesting changes to proposals to promote 2 positive or mitigate adverse health effects. 3 ‘‘(D) REPORTING.—Synthesizing the as- 4 sessment and recommendations and commu- 5 nicating the results to decisionmakers. 6 ‘‘(E) MONITORING AND EVALUATING.— 7 Tracking the decision and implementation effect 8 on health determinants and health status. 9 ‘‘(5) PLAN.—An eligible entity that is awarded 10 a grant under this section shall develop and imple- 11 ment a plan, to be approved by the Director, for 12 meaningful and inclusive stakeholder involvement in 13 all phases of the Health Impact Assessment. Stake- 14 holders may include community-based organizations, 15 youth-serving organizations, planners, public health 16 experts, State and local public health departments 17 and officials, health care experts or officials, housing 18 experts or officials, and transportation experts or of- 19 ficials. 20 ‘‘(6) SUBMISSION OF FINDINGS.—An eligible 21 entity that is awarded a grant under this section 22 shall submit the findings of any funded Health Im- 23 pact Assessment activities to the Secretary and 24 make these findings publicly available. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00739 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 740 •HR 5475 IH ‘‘(7) ASSESSMENT OF IMPACTS.—An eligible en- 1 tity that is awarded a grant under this section shall 2 ensure the assessment of the distribution of health 3 impacts (related to the proposed activity) across 4 race, ethnicity, income, age, gender, disability status, 5 and geography. 6 ‘‘(8) CONDUCT OF ASSESSMENT.—To the great- 7 est extent feasible, a Health Impact Assessment 8 shall be conducted under this section in a manner 9 that respects the needs and timing of the decision- 10 making process it evaluates. 11 ‘‘(9) METHODOLOGY.—In preparing a Health 12 Impact Assessment under this subsection, an eligible 13 entity or partner shall follow the guidance published 14 under subsection (c). 15 ‘‘(g) HEALTH IMPACT ASSESSMENT DATABASE.— 16 The Secretary, acting through the Director and in collabo- 17 ration with the Administrator, shall establish, maintain, 18 and make publicly available a Health Impact Assessment 19 database, including— 20 ‘‘(1) a catalog of Health Impact Assessments 21 received under this section; 22 ‘‘(2) an inventory of tools used by eligible enti- 23 ties to conduct Health Impact Assessments; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00740 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 741 •HR 5475 IH ‘‘(3) guidance for eligible entities with respect 1 to the selection of appropriate tools described in 2 paragraph (2). 3 ‘‘(h) EVALUATION OF GRANTEE ACTIVITIES.—The 4 Secretary shall award competitive grants to Prevention 5 Research Centers, or nonprofit organizations or academic 6 institutions with expertise in Health Impact Assessments 7 to— 8 ‘‘(1) assist grantees with the provision of train- 9 ing and technical assistance in the conducting of 10 Health Impact Assessments; 11 ‘‘(2) evaluate the activities carried out with 12 grants under subsection (d); and 13 ‘‘(3) assist the Secretary in disseminating evi- 14 dence, best practices, and lessons learned from 15 grantees. 16 ‘‘(i) REPORT TO CONGRESS.—Not later than 1 year 17 after the date of enactment of this section, the Secretary 18 shall submit to Congress a report concerning the evalua- 19 tion of the programs under this section, including rec- 20 ommendations as to how lessons learned from such pro- 21 grams can be incorporated into future guidance docu- 22 ments developed and provided by the Secretary and other 23 Federal agencies, as appropriate. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00741 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 742 •HR 5475 IH ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated to carry out this section 2 such sums as may be necessary. 3 ‘‘SEC. 399V–10. ADDITIONAL RESEARCH ON THE RELATION- 4 SHIP BETWEEN THE BUILT ENVIRONMENT 5 AND HEALTH OUTCOMES. 6 ‘‘(a) RESEARCH GRANT PROGRAM.— 7 ‘‘(1) GRANTS.—The Secretary, in collaboration 8 with the Administrator, shall award grants to eligi- 9 ble institutions to conduct and coordinate research 10 on the built environment and its influence on human 11 health. Factors that influence health that may be 12 considered include— 13 ‘‘(A) levels of physical activity; 14 ‘‘(B) consumption of nutritional foods; 15 ‘‘(C) rates of crime; 16 ‘‘(D) air, water, and soil quality; 17 ‘‘(E) risk or rate of injury; 18 ‘‘(F) accessibility to health-promoting 19 goods and services; 20 ‘‘(G) chronic disease rates; 21 ‘‘(H) community design; 22 ‘‘(I) housing; and 23 ‘‘(J) other indicators as determined appro- 24 priate by the Secretary. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00742 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 743 •HR 5475 IH ‘‘(2) RESEARCH.—The Secretary, in consulta- 1 tion with the Administrator, shall support research 2 under this section that— 3 ‘‘(A) investigates and defines links between 4 the built environment and human health and 5 identifies causal relationships; 6 ‘‘(B) examines— 7 ‘‘(i) the scope and intensity of the im- 8 pact that the built environment (including 9 the various characteristics of the built en- 10 vironment) has on the human health; or 11 ‘‘(ii) the distribution of such impacts 12 by— 13 ‘‘(I) location; and 14 ‘‘(II) population subgroup; 15 ‘‘(C) is used to develop— 16 ‘‘(i) measures and indicators to ad- 17 dress health impacts and the connection of 18 health to the built environment; 19 ‘‘(ii) efforts to link the measures to 20 transportation, land use, and health data- 21 bases; and 22 ‘‘(iii) efforts to enhance the collection 23 of built environment surveillance data; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00743 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 744 •HR 5475 IH ‘‘(D) distinguishes carefully between per- 1 sonal attitudes and choices and external influ- 2 ences on behavior to determine how much the 3 association between the built environment and 4 the health of residents, versus the lifestyle pref- 5 erences of the people that choose to live in the 6 neighborhood, reflects the physical characteris- 7 tics of the neighborhood; and 8 ‘‘(E)(i) identifies or develops effective 9 intervention strategies focusing on enhance- 10 ments to the built environment that promote in- 11 creased use physical activity, access to nutri- 12 tious foods, or other health-promoting activities 13 by residents; and 14 ‘‘(ii) in developing the intervention strate- 15 gies under clause (i), ensures that the interven- 16 tion strategies will reach out to high-risk or vul- 17 nerable populations, including low-income urban 18 and rural communities and aging populations, 19 in addition to the general population. 20 ‘‘(3) SURVEYS.—The Secretary may use funds 21 appropriated under this section to support the ex- 22 pansion of national surveys and data tracking sys- 23 tems to provide more detailed information about the 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00744 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 745 •HR 5475 IH connection between the built environment and 1 health. 2 ‘‘(4) PRIORITY.—In providing assistance under 3 the grant program under this section, the Secretary 4 and the Administrator shall give priority to research 5 that incorporates— 6 ‘‘(A) interdisciplinary approaches; or 7 ‘‘(B) the expertise of the public health, 8 physical activity, urban planning, land use, and 9 transportation research communities in the 10 United States and abroad. 11 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 12 are authorized to be appropriated such sums as may be 13 necessary to carry out this section. Not to exceed 20 per- 14 cent of amounts appropriated for each fiscal year under 15 this subsection may be used for the research component 16 of the program under this section.’’. 17 SEC. 1004. IMPLEMENTATION OF RECOMMENDATIONS BY 18 ENVIRONMENTAL PROTECTION AGENCY. 19 (a) INSPECTOR GENERAL RECOMMENDATIONS.—The 20 Administrator of the Environmental Protection Agency 21 shall, as promptly as practicable, carry out each of the 22 following recommendations of the Inspector General of the 23 Agency as set forth in Report No. 2006–P–00034 entitled 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00745 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 746 •HR 5475 IH ‘‘EPA needs to conduct environmental justice reviews of 1 its programs, policies and activities’’: 2 (1) The recommendation that the Agency’s pro- 3 gram and regional offices identify which programs, 4 policies, and activities need environmental justice re- 5 views and require these offices to establish a plan to 6 complete the necessary reviews. 7 (2) The recommendation that the Administrator 8 of the Agency ensure that these reviews determine 9 whether the programs, policies, and activities may 10 have a disproportionately high and adverse health or 11 environmental impact on minority and low-income 12 populations. 13 (3) The recommendation that each program 14 and regional office develop specific environmental 15 justice review guidance for conducting environmental 16 justice reviews. 17 (4) The recommendation that the Administrator 18 designate a responsible office to compile results of 19 environmental justice reviews and recommend appro- 20 priate actions. 21 (b) GAO RECOMMENDATIONS.—In developing rules 22 under laws administered by the Environmental Protection 23 Agency, the Administrator of the Agency shall, as prompt- 24 ly as practicable, carry out each of the following rec- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00746 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 747 •HR 5475 IH ommendations of the Comptroller General of the United 1 States as set forth in GAO Report numbered GAO–05– 2 289 entitled ‘‘EPA Should Devote More Attention to En- 3 vironmental Justice when Developing Clean Air Rules’’: 4 (1) The recommendation that the Administrator 5 ensure that workgroups involved in developing a rule 6 devote attention to environmental justice while draft- 7 ing and finalizing the rule. 8 (2) The recommendation that the Administrator 9 enhance the ability of such workgroups to identify 10 potential environmental justice issues through such 11 steps as providing workgroup members with guid- 12 ance and training to help them identify potential en- 13 vironmental justice problems and involving environ- 14 mental justice coordinators in the workgroups when 15 appropriate. 16 (3) The recommendation that the Administrator 17 improve assessments of potential environmental jus- 18 tice impacts in economic reviews by identifying the 19 data and developing the modeling techniques needed 20 to assess such impacts. 21 (4) The recommendation that the Administrator 22 direct appropriate Agency officers and employees to 23 respond fully when feasible to public comments on 24 environmental justice, including improving the Agen- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00747 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 748 •HR 5475 IH cy’s explanation of the basis for its conclusions, to- 1 gether with supporting data. 2 (c) 2004 INSPECTOR GENERAL REPORT.—The Ad- 3 ministrator of the Environmental Protection Agency shall, 4 as promptly as practicable, carry out each of the following 5 recommendations of the Inspector General of the Agency 6 as set forth in the report entitled ‘‘EPA Needs to Consist- 7 ently Implement the Intent of the Executive Order on En- 8 vironmental Justice’’ (Report No. 2004–P–00007): 9 (1) The recommendation that the Agency clear- 10 ly define the mission of the Office of Environmental 11 Justice (OEJ) and provide Agency staff with an un- 12 derstanding of the roles and responsibilities of the 13 Office. 14 (2) The recommendation that the Agency estab- 15 lish (through issuing guidance or a policy statement 16 from the Administrator) specific timeframes for the 17 development of definitions, goals, and measurements 18 regarding environmental justice and provide the re- 19 gions and program offices a standard and consistent 20 definition for a minority and low-income community, 21 with instructions on how the Agency will implement 22 and put into operation environmental justice in the 23 Agency’s daily activities. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00748 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 749 •HR 5475 IH (3) The recommendation that the Agency en- 1 sure the comprehensive training program currently 2 under development includes standard and consistent 3 definitions of the key environmental justice concepts 4 (such as ‘‘low-income’’, ‘‘minority’’, and ‘‘dispropor- 5 tionately impacted’’) and instructions for implemen- 6 tation of those concepts. 7 The Administrator shall submit an initial report to Con- 8 gress within 6 months after the enactment of this Act re- 9 garding the Administrator’s strategy for implementing the 10 recommendations referred to in paragraphs (1), (2), and 11 (3). Thereafter, the Administrator shall provide semi- 12 annual reports to Congress regarding the Administrator’s 13 progress in implementing such recommendations and 14 modifying the Administrator’s emergency management 15 procedures to incorporate environmental justice in the 16 Agency’s Incident Command Structure (in accordance 17 with the December 18, 2006, letter from the Deputy Ad- 18 ministrator to the Acting Inspector General of the Agen- 19 cy). 20 (d) FEDERAL ACTION PLAN FOR SAVING LIVES, 21 PROTECTING PEOPLE AND THEIR FAMILIES FROM 22 RADON.— 23 (1) IN GENERAL.—Because radon is a naturally 24 occurring radioactive gas that is recognized as the 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00749 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 750 •HR 5475 IH leading cause of lung cancer among nonsmokers and 1 is a particular environmental threat for low-income 2 and minority individuals because of the lack of infor- 3 mation about radon levels in their own homes, the 4 Administrator of the Environmental Protection 5 Agency shall within 6 months after the date of the 6 enactment of this Act, implement the action plan en- 7 titled ‘‘Protecting People and Families from Radon: 8 A Federal Action Plan for Saving Lives’’ (June 20, 9 2011), working with the Secretary of Health and 10 Human Services acting through the Director of the 11 Centers for Disease Control and Prevention, and 12 with the other Federal agencies mentioned in and as 13 set forth in the action plan. 14 (2) SPECIFIC STEPS.—In carrying out para- 15 graph (1), the Administrator shall take steps to 16 achieve each of the following: 17 (A) The recommendation that the 18 workgroup comprised of the Federal agencies 19 participating in the development of the action 20 plan referred to in paragraph (1) implement 21 specific steps within the current authority and 22 activities of each Federal agency to reduce ex- 23 posure to radon. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00750 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 751 •HR 5475 IH (B) The recommendation that such 1 workgroup meet on the 1-year anniversary of 2 the plan to assess and recognize achievements 3 of the plan. 4 (3) REPORT.—The Administrator shall report 5 to the Congress on the 1-year assessment of the 6 plan’s implementation, including the challenges re- 7 maining and the progress in reducing radon expo- 8 sure particularly to low-income and minority fami- 9 lies. 10 SEC. 1005. GRANT PROGRAM TO CONDUCT ENVIRON- 11 MENTAL HEALTH IMPROVEMENT ACTIVITIES 12 AND TO IMPROVE SOCIAL DETERMINANTS OF 13 HEALTH. 14 (a) DEFINITIONS.—In this section: 15 (1) DIRECTOR.—The term ‘‘Director’’ means 16 the Director of the Centers for Disease Control and 17 Prevention, acting in collaboration with the Adminis- 18 trator of the Environmental Protection Agency and 19 the Director of the National Institute of Environ- 20 mental Health Sciences. 21 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti- 22 ty’’ means a State or local community that— 23 (A) bears a disproportionate burden of ex- 24 posure to environmental health hazards; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00751 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 752 •HR 5475 IH (B) bears a disproportionate burden of ex- 1 posure to unhealthy living conditions, low 2 standard housing conditions, low socioeconomic 3 status, poor nutrition, less opportunity for edu- 4 cational attainment, disproportionate unemploy- 5 ment rates, or lower literacy levels; 6 (C) has established a coalition— 7 (i) with not less than 1 community- 8 based organization or demonstration pro- 9 gram; and 10 (ii) with not less than 1— 11 (I) public health entity; 12 (II) health care provider organi- 13 zation; 14 (III) academic institution, includ- 15 ing any minority-serving institution 16 (including a Hispanic-serving institu- 17 tion, a historically Black college or 18 university, and a tribal college or uni- 19 versity); or 20 (IV) child-serving institution; 21 (D) ensures planned activities and funding 22 streams are coordinated to improve community 23 health; and 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00752 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 753 •HR 5475 IH (E) submits an application in accordance 1 with subsection (c). 2 (b) ESTABLISHMENT.—The Director shall establish a 3 grant program under which eligible entities shall receive 4 grants to conduct environmental health improvement ac- 5 tivities and to improve social determinants of health. 6 (c) APPLICATION.—To receive a grant under this sec- 7 tion, an eligible entity shall submit an application to the 8 Director at such time, in such manner, and accompanied 9 by such information as the Director may require. 10 (d) COOPERATIVE AGREEMENTS.—An eligible entity 11 may use a grant under this section— 12 (1) to promote environmental health; 13 (2) to address environmental health disparities 14 among all populations, including children; and 15 (3) to address racial and ethnic disparities in 16 social determinants of health. 17 (e) AMOUNT OF COOPERATIVE AGREEMENT.— 18 (1) IN GENERAL.—The Director shall award 19 grants to eligible entities at the 3 different funding 20 levels described in this subsection. 21 (2) LEVEL 1 COOPERATIVE AGREEMENTS.— 22 (A) IN GENERAL.—An eligible entity 23 awarded a grant under this paragraph shall use 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00753 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 754 •HR 5475 IH the funds to identify environmental health prob- 1 lems and solutions by— 2 (i) establishing a planning and 3 prioritizing council in accordance with sub- 4 paragraph (B); and 5 (ii) conducting an environmental 6 health assessment in accordance with sub- 7 paragraph (C). 8 (B) PLANNING AND PRIORITIZING COUN- 9 CIL.— 10 (i) IN GENERAL.—A prioritizing and 11 planning council established under sub- 12 paragraph (A)(i) (referred to in this para- 13 graph as a ‘‘PPC’’) shall assist the envi- 14 ronmental health assessment process and 15 environmental health promotion activities 16 of the eligible entity. 17 (ii) MEMBERSHIP.—Membership of a 18 PPC shall consist of representatives from 19 various organizations within public health, 20 planning, development, and environmental 21 services and shall include stakeholders 22 from vulnerable groups such as children, 23 the elderly, disabled, and minority ethnic 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00754 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 755 •HR 5475 IH groups that are often not actively involved 1 in democratic or decisionmaking processes. 2 (iii) DUTIES.—A PPC shall— 3 (I) identify key stakeholders and 4 engage and coordinate potential part- 5 ners in the planning process; 6 (II) establish a formal advisory 7 group to plan for the establishment of 8 services; 9 (III) conduct an in-depth review 10 of the nature and extent of the need 11 for an environmental health assess- 12 ment, including a local epidemiological 13 profile, an evaluation of the service 14 provider capacity of the community, 15 and a profile of any target popu- 16 lations; and 17 (IV) define the components of 18 care and form essential programmatic 19 linkages with related providers in the 20 community. 21 (C) ENVIRONMENTAL HEALTH ASSESS- 22 MENT.— 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00755 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 756 •HR 5475 IH (i) IN GENERAL.—A PPC shall carry 1 out an environmental health assessment to 2 identify environmental health concerns. 3 (ii) ASSESSMENT PROCESS.—The 4 PPC shall— 5 (I) define the goals of the assess- 6 ment; 7 (II) generate the environmental 8 health issue list; 9 (III) analyze issues with a sys- 10 tems framework; 11 (IV) develop appropriate commu- 12 nity environmental health indicators; 13 (V) rank the environmental 14 health issues; 15 (VI) set priorities for action; 16 (VII) develop an action plan; 17 (VIII) implement the plan; and 18 (IX) evaluate progress and plan- 19 ning for the future. 20 (D) EVALUATION.—Each eligible entity 21 that receives a grant under this paragraph shall 22 evaluate, report, and disseminate program find- 23 ings and outcomes. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00756 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 757 •HR 5475 IH (E) TECHNICAL ASSISTANCE.—The Direc- 1 tor may provide such technical and other non- 2 financial assistance to eligible entities as the 3 Director determines to be necessary. 4 (3) LEVEL 2 COOPERATIVE AGREEMENTS.— 5 (A) ELIGIBILITY.— 6 (i) IN GENERAL.—The Director shall 7 award grants under this paragraph to eli- 8 gible entities that have already— 9 (I) established broad-based col- 10 laborative partnerships; and 11 (II) completed environmental as- 12 sessments. 13 (ii) NO LEVEL 1 REQUIREMENT.—To 14 be eligible to receive a grant under this 15 paragraph, an eligible entity is not re- 16 quired to have successfully completed a 17 Level 1 Cooperative Agreement (as de- 18 scribed in paragraph (2)). 19 (B) USE OF GRANT FUNDS.—An eligible 20 entity awarded a grant under this paragraph 21 shall use the funds to further activities to carry 22 out environmental health improvement activi- 23 ties, including— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00757 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 758 •HR 5475 IH (i) addressing community environ- 1 mental health priorities in accordance with 2 paragraph (2)(C)(ii), including— 3 (I) geography; 4 (II) the built environment; 5 (III) air quality; 6 (IV) water quality; 7 (V) land use; 8 (VI) solid waste; 9 (VII) housing; 10 (VIII) crime; 11 (IX) socioeconomic status; 12 (X) ethnicity, social construct 13 and language preference; 14 (XI) educational attainment; 15 (XII) employment; 16 (XIII) food safety; 17 (XIV) nutrition; 18 (XV) health care services; and 19 (XVI) injuries; 20 (ii) building partnerships between 21 planning, public health, and other sectors, 22 including child-serving institutions, to ad- 23 dress how the built environment impacts 24 food availability and access and physical 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00758 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 759 •HR 5475 IH activity to promote healthy behaviors and 1 lifestyles and reduce overweight and obe- 2 sity, musculoskeletal diseases, respiratory 3 conditions, dental, oral and mental health 4 conditions, poverty, and related co- 5 morbidities; 6 (iii) establishing programs to ad- 7 dress— 8 (I) how environmental and social 9 conditions of work and living choices 10 influence physical activity and dietary 11 intake; or 12 (II) how those conditions influ- 13 ence the concerns and needs of people 14 who have impaired mobility and use 15 assistance devices, including wheel- 16 chairs, lower limb prostheses, and hip, 17 knee, and other joint replacements; 18 and 19 (iv) convening intervention and dem- 20 onstration programs that examine the role 21 of the social environment in connection 22 with the physical and chemical environ- 23 ment in— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00759 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 760 •HR 5475 IH (I) determining access to nutri- 1 tional food; and 2 (II) improving physical activity to 3 reduce overweight, obesity, and co- 4 morbidities and increase quality of 5 life. 6 (4) LEVEL 3 COOPERATIVE AGREEMENTS.— 7 (A) IN GENERAL.—An eligible entity 8 awarded a grant under this paragraph shall use 9 the funds to identify and address racial and 10 ethnic disparities in social determinants of 11 health by creating demonstration programs that 12 assess the feasibility of establishing a federally 13 funded comprehensive program and describe 14 key outcomes that address racial and ethnic dis- 15 parities in social determinants of health. 16 (B) PROGRAM DESIGN.— 17 (i) EVALUATION.—No later than 1 18 year after enactment of this Act, the Di- 19 rector shall evaluate the best practices of 20 existing programs from the private, public, 21 community based, and academically sup- 22 ported initiatives focused on reducing dis- 23 parities in the social determinants of 24 health for racial and ethnic populations. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00760 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 761 •HR 5475 IH (ii) DEMONSTRATION PROJECTS.— 1 Not later than two years after the date of 2 enactment of this Act, the Director shall 3 implement at least ten demonstration 4 projects including at least one project for 5 each major racial and ethnic minority 6 group, each of which is unique to the cul- 7 tural and linguistic needs of each of the 8 following groups: 9 (I) Native Americans and Alaska 10 Natives. 11 (II) Asian-Americans. 12 (III) African-Americans/Blacks. 13 (IV) Hispanic/Latino-Americans. 14 (V) Native Hawaiians and Pacific 15 Islanders. 16 (iii) REPORT TO CONGRESS.—No later 17 than 2 years after the implementation of 18 the initial demonstration projects, the Di- 19 rector shall submit to Congress a report 20 which includes— 21 (I) a description of each dem- 22 onstration project and design; 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00761 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 762 •HR 5475 IH (II) an evaluation of the cost ef- 1 fectiveness of each project’s preven- 2 tion and treatment efforts; 3 (III) an evaluation of the cultural 4 and linguistic appropriateness of each 5 project by racial and ethnic group; 6 and 7 (IV) an evaluation of the bene- 8 ficiary’s health status improvement 9 under the demonstration project. 10 (iv) ANY OTHER INFORMATION 11 DEEMED APPROPRIATE BY THE DIREC- 12 TOR.—The Director shall require any other 13 information deemed appropriate to be 14 shared by or developed by eligible entities 15 awarded a grant under this paragraph, in- 16 cluding the following: 17 (I) Developing models and evalu- 18 ating methods that improve the cul- 19 tural and linguistically appropriate 20 services provided through the Centers 21 for Disease Control and Prevention to 22 target individuals impacted by health 23 disparities based on their race, eth- 24 nicity, and gender. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00762 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 763 •HR 5475 IH (II) Promoting the collaboration 1 between primary and specialty care 2 health care providers and patients, to 3 ensure patients impacted by health 4 disparities based on race, ethnicity, 5 and gender are receiving comprehen- 6 sive and organized treatment and 7 care. 8 (III) Educating health care pro- 9 fessionals on the causes and effects of 10 disparities in the social determinants 11 of health as it relates to minority and 12 racial and ethnic communities and the 13 need for culturally and linguistically 14 appropriate care in the prevention and 15 treatment of high-impact diseases. 16 (IV) Encouraging collaboration 17 among community and patient-based 18 organizations which work to address 19 disparities in the social determinants 20 of health as it relates to high-impact 21 diseases in minority and racial and 22 ethnic populations. 23 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00763 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 764 •HR 5475 IH (f) AUTHORIZATION OF APPROPRIATIONS.—There 1 are authorized to be appropriated to carry out this sec- 2 tion— 3 (1) $25,000,000 for fiscal year 2017; and 4 (2) such sums as may be necessary for fiscal 5 years 2018 through 2020. 6 SEC. 1006. ADDITIONAL RESEARCH ON THE RELATIONSHIP 7 BETWEEN THE BUILT ENVIRONMENT AND 8 THE HEALTH OF COMMUNITY RESIDENTS. 9 (a) DEFINITION OF ELIGIBLE INSTITUTION.—In this 10 section, the term ‘‘eligible institution’’ means a public or 11 private nonprofit institution that submits to the Secretary 12 of Health and Human Services (in this section referred 13 to as the ‘‘Secretary’’) and the Administrator of the Envi- 14 ronmental Protection Agency (in this section referred to 15 as the ‘‘Administrator’’) an application for a grant under 16 the grant program authorized under subsection (b)(2) at 17 such time, in such manner, and containing such agree- 18 ments, assurances, and information as the Secretary and 19 Administrator may require. 20 (b) RESEARCH GRANT PROGRAM.— 21 (1) DEFINITION OF HEALTH.—In this section, 22 the term ‘‘health’’ includes— 23 (A) levels of physical activity; 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00764 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 765 •HR 5475 IH (B) degree of mobility due to factors such 1 as musculoskeletal diseases, arthritis, and obe- 2 sity; 3 (C) consumption of nutritional foods; 4 (D) rates of crime; 5 (E) air, water, and soil quality; 6 (F) risk of injury; 7 (G) accessibility to health care services; 8 (H) levels of educational attainment; and 9 (I) other indicators as determined appro- 10 priate by the Secretary. 11 (2) GRANTS.—The Secretary, in collaboration 12 with the Administrator, shall provide grants to eligi- 13 ble institutions to conduct and coordinate research 14 on the built environment and its influence on indi- 15 vidual and population-based health. 16 (3) RESEARCH.—The Secretary shall support 17 research that— 18 (A) investigates and defines the causal 19 links between all aspects of the built environ- 20 ment and the health of residents; 21 (B) examines— 22 (i) the extent of the impact of the 23 built environment (including the various 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00765 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 766 •HR 5475 IH characteristics of the built environment) on 1 the health of residents; 2 (ii) the variance in the health of resi- 3 dents by— 4 (I) location (such as inner cities, 5 inner suburbs, and outer suburbs); 6 and 7 (II) population subgroup (includ- 8 ing children, the elderly, the disadvan- 9 taged); or 10 (iii) the importance of the built envi- 11 ronment to the total health of residents, 12 which is the primary variable of interest 13 from a public health perspective; 14 (C) is used to develop— 15 (i) measures to address health and the 16 connection of health to the built environ- 17 ment; and 18 (ii) efforts to link the measures to 19 travel and health databases; and 20 (D) distinguishes carefully between per- 21 sonal attitudes and choices and external influ- 22 ences on observed behavior to determine how 23 much an observed association between the built 24 environment and the health of residents, versus 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00766 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 767 •HR 5475 IH the lifestyle preferences of the people that 1 choose to live in the neighborhood, reflects the 2 physical characteristics of the neighborhood; 3 and 4 (E)(i) identifies or develops effective inter- 5 vention strategies to promote better health 6 among residents with a focus on behavioral 7 interventions and enhancements of the built en- 8 vironment that promote increased use by resi- 9 dents; and 10 (ii) in developing the intervention strate- 11 gies under clause (i), ensures that the interven- 12 tion strategies will reach out to high-risk popu- 13 lations, including racial and ethnic minorities, 14 low-income urban and rural communities, and 15 children. 16 (4) PRIORITY.—In providing assistance under 17 the grant program authorized under paragraph (2), 18 the Secretary and the Administrator shall give pri- 19 ority to research that incorporates— 20 (A) minority-serving institutions as grant- 21 ees; 22 (B) interdisciplinary approaches; or 23 (C) the expertise of the public health, 24 physical activity, nutrition and health care (in- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00767 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 768 •HR 5475 IH cluding child health), urban planning, and 1 transportation research communities in the 2 United States and abroad. 3 SEC. 1007. ENVIRONMENT AND PUBLIC HEALTH RESTORA- 4 TION. 5 (a) FINDINGS.— 6 (1) GENERAL FINDINGS.—The Congress finds 7 as follows: 8 (A) As human beings, we share our envi- 9 ronment with a wide variety of habitats and 10 ecosystems that nurture and sustain a diversity 11 of species. 12 (B) The abundance of natural resources in 13 our environment forms the basis for our econ- 14 omy and has greatly contributed to human de- 15 velopment throughout history. 16 (C) The accelerated pace of human devel- 17 opment over the last several hundred years has 18 significantly impacted our natural environment 19 and its resources, the health and diversity of 20 plant and animal wildlife, the availability of 21 critical habitats, the quality of our air and our 22 water, and our global climate. 23 (D) The intervention of the Federal Gov- 24 ernment is necessary to minimize and mitigate 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00768 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 769 •HR 5475 IH human impact on the environment for the ben- 1 efit of public health, to maintain air quality and 2 water quality, to sustain the diversity of plants 3 and animals, to combat global climate change, 4 and to protect the environment. 5 (E) Laws and regulations in the United 6 States have been created and promulgated to 7 minimize and mitigate human impact on the en- 8 vironment for the benefit of public health, to 9 maintain air quality and water quality, to sus- 10 tain wildlife, and to protect the environment. 11 (F) Such laws include the Antiquities Act 12 of 1906 (16 U.S.C. 431 et seq.) initiated by 13 President Theodore Roosevelt to create the na- 14 tional park system, the National Environmental 15 Policy Act of 1969 (42 U.S.C. 4321 et seq.), 16 the Clean Air Act (42 U.S.C. 7401 et seq.), the 17 Federal Water Pollution Control Act (33 U.S.C. 18 1251 et seq.), the Comprehensive Environ- 19 mental Response, Compensation, and Liability 20 Act of 1980 (Public Law 96–510), the Endan- 21 gered Species Act of 1973 (Public Law 93– 22 205), and the National Forest Management Act 23 of 1976 (Public Law 94–588). 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00769 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 770 •HR 5475 IH (G) Attempts to repeal or weaken key envi- 1 ronmental safeguards pose dangers to the pub- 2 lic health, air quality, water quality, wildlife, 3 and the environment. 4 (2) FINDINGS ON CHANGES AND PROPOSED 5 CHANGES IN LAW.—The Congress finds that, since 6 2001, the following changes and proposed changes 7 to existing law or regulations have negatively im- 8 pacted or will negatively impact the environment and 9 public health: 10 (A) CLEAN WATER.— 11 (i) On May 9, 2002, the Environ- 12 mental Protection Agency (EPA) and the 13 Army Corps of Engineers put forth a final 14 rule that reconciled regulations imple- 15 menting section 404 of the Federal Water 16 Pollution Control Act by redefining the 17 term ‘‘fill material’’ and amending the def- 18 inition of the term ‘‘discharge of fill mate- 19 rial’’, reversing a 25-year-old regulation. 20 The new rule fails to restrict the dumping 21 of hardrock mining waste, construction de- 22 bris, and other industrial wastes into riv- 23 ers, streams, lakes, and wetlands. The rule 24 further allows destructive mountaintop re- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00770 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 771 •HR 5475 IH moval coal mining companies to dump 1 waste into streams and lakes, polluting the 2 surrounding natural habitat and poisoning 3 plants and animals that depend on those 4 water sources. 5 (ii) On February 12, 2003, the Envi- 6 ronmental Protection Agency published the 7 rule ‘‘National Pollutant Discharge Elimi- 8 nation System Permit Regulation and Ef- 9 fluent Limitation Guidelines and Stand- 10 ards for Concentrated Animal Feeding Op- 11 erations’’, new livestock waste regulations 12 that aimed to control factory farm pollu- 13 tion but which would severely undermine 14 existing protections under the Federal 15 Water Pollution Control Act. This regula- 16 tion allows large-scale animal factories to 17 foul the Nation’s waters with animal 18 waste, allows livestock owners to draft 19 their own pollution-management plans and 20 avoid ground water monitoring, legalizes 21 the discharge of contaminated runoff water 22 rich in nitrogen, phosphorus, bacteria, and 23 metals, and ensures that large factory 24 farms are not held liable for the environ- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00771 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 772 •HR 5475 IH mental damage they cause. In a 2005 Fed- 1 eral court decision (‘‘Waterkeeper Alliance, 2 et al. v. Environmental Protection Agen- 3 cy’’, 399 F.3d 486 (2nd Cir. 2005)), major 4 parts of the rule were upheld, others va- 5 cated, and still others remanded back to 6 the EPA. On November 20, 2008, the En- 7 vironmental Protection Agency published a 8 revised final rule which undermines envi- 9 ronmental protection provisions by remov- 10 ing mandatory permitting requirements 11 and allowing large animal farms to self- 12 certify the absence of pollutant discharge 13 activity. 14 (iii) On March 19, 2003, the Environ- 15 mental Protection Agency published a new 16 rule regarding the Total Maximum Daily 17 Load program of the Federal Water Pollu- 18 tion Control Act that regulates the max- 19 imum amount of a particular pollutant 20 that can be present in a body of water and 21 still meet water quality standards. The new 22 rule withdrew the existing regulation put 23 forth on July 13, 2000, and halted mo- 24 mentum in cleaning up polluted waterways 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00772 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 773 •HR 5475 IH throughout the Nation. By abandoning the 1 existing rule, the Environmental Protection 2 Agency is undermining the effectiveness of 3 cleanup plans and is allowing States to 4 avoid cleaning polluted waters entirely by 5 dropping them from their cleanup lists. 6 Waterways play a crucial role in the lives 7 of the people of the United States and are 8 critical to the livelihood of fish and wildlife. 9 The result of dropping the July 2000 rule 10 is that the restoration of polluted rivers, 11 shorelines, and lakes will be delayed, harm- 12 ing more fish and wildlife and worsening 13 the quality of drinking water. 14 (iv) On December 2, 2008, the Envi- 15 ronmental Protection Agency and the 16 Army Corps of Engineers jointly issued a 17 guidance document in the form of a legal 18 memorandum, titled ‘‘Clean Water Act Ju- 19 risdiction Following the U.S. Supreme 20 Court’s Decision in Rapanos v. United 21 States & Carabell v. United States’’. This 22 new guidance dictates enforcement actions 23 under the Federal Water Pollution Control 24 Act and calls for a complicated ‘‘case-by- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00773 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 774 •HR 5475 IH case’’ analysis to determine jurisdiction for 1 waterways that do not flow all year. Such 2 actions endanger small streams and wet- 3 lands that serve as important habitats for 4 aquatic life, which play a fundamental role 5 in safeguarding sources of clean drinking 6 water and mitigate the risks and effects of 7 floods and droughts. Further, the defini- 8 tion provided therein for ‘‘waters of the 9 United States’’ is applicable to the Federal 10 Water Pollution Control Act as a whole, 11 potentially affecting programs that control 12 industrial pollution and sewage levels, pre- 13 vent oil spills, and set water quality stand- 14 ards for all waters in the United States 15 protected under the Federal Water Pollu- 16 tion Control Act. 17 (B) FORESTS AND LAND MANAGEMENT.— 18 (i) On December 3, 2003, the Presi- 19 dent signed into law the Healthy Forests 20 Restoration Act of 2003 (Public Law 108– 21 148; 16 U.S.C. 6501 et seq.). Although the 22 law attempts to reduce the risk of cata- 23 strophic forest fires, it provides a boon to 24 timber companies by accelerating the ag- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00774 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 775 •HR 5475 IH gressive thinning of backcountry forests 1 that are far from at-risk communities. The 2 law allows for increased logging of large, 3 fire-resistant trees that are not in close 4 proximity of homes and communities; it 5 undermines critical protections for endan- 6 gered species by exempting Federal land 7 management agencies from consulting with 8 the United States Fish and Wildlife Serv- 9 ice before approving any action that could 10 harm endangered plants or wildlife; and it 11 limits public participation by reducing the 12 number of environmental project reviews. 13 (ii) On April 21, 2008, the Depart- 14 ment of Agriculture issued a Final Plan- 15 ning Rule and Record of Decision for Na- 16 tional Forest System Land Management 17 Planning. Similar to rules enacted by the 18 Administration on January 5, 2005, later 19 remanded back to the agency in Federal 20 district court for violating the National 21 Environmental Policy Act of 1969, the En- 22 dangered Species Act of 1973, and the Ad- 23 ministrative Procedure Act (‘‘Citizens for 24 Better Forestry v. United States Depart- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00775 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 776 •HR 5475 IH ment of Agriculture’’, 481 F. Supp. 2d 1 1059 (N.D. Cal. 2007)), this revised rule 2 eliminates strict forest planning standards 3 established in 1982, and opens millions of 4 acres of public lands to damaging and 5 invasive logging, mining, and drilling oper- 6 ations. These regulations would reverse 7 more than 20 years of protection for wild- 8 life and national forests by removing the 9 overall goal of ensuring ecological sustain- 10 ability in managing the national forest sys- 11 tem, weakening the National Forest Man- 12 agement Act of 1976, and effectively end- 13 ing the review of forest management plans 14 under the National Environmental Policy 15 Act of 1969. 16 (iii) On September 20, 2006, the Dis- 17 trict Court for the Northern District of 18 California vacated the Protection of Inven- 19 toried Roadless Areas rule, enacted on May 20 13, 2005, which gave State Governors 18 21 months to petition the Federal Government 22 to either restore the previous rule for their 23 States, or submit a new management and 24 development plan for national forest areas 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00776 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 777 •HR 5475 IH inventoried under the rule. Despite the 1 enjoinment of the Administration’s 2005 2 rule, and the subsequent restoration of the 3 original Roadless Area Conservation Rule, 4 the United States Forest Service has con- 5 tinued to allow States to petition for a spe- 6 cial rule under the authority of the Admin- 7 istrative Procedure Act, publishing a final 8 special rule for Idaho on October 16, 2008. 9 As a result, 58.5 million acres of wild na- 10 tional forests are still vulnerable to log- 11 ging, road building, and other develop- 12 ments that may fragment natural habitats 13 and negatively impact fish and wildlife. 14 (iv) On November 17, 2008, the De- 15 partment of the Interior’s Bureau of Land 16 Management (BLM) signed the Record of 17 Decision (ROD) amending 12 resource 18 management plans in Colorado, Utah, and 19 Wyoming, opening 2,000,000 acres of pub- 20 lic lands to commercial tar sands and oil 21 shale exploration and development. On No- 22 vember 18, 2008, the BLM published a 23 final rule for Oil Shale Management set- 24 ting the policies and procedures for a com- 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00777 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 778 •HR 5475 IH mercial leasing program for the manage- 1 ment of federally owned oil shale in those 2 three States. Previously barred by a con- 3 gressional moratorium on the commercial 4 leasing regulations for oil shale until Sep- 5 tember 30, 2008, the development of oil 6 shale on public lands poses a serious threat 7 to land conservation, endangered and 8 threatened species, and critical habitat. 9 Domestic shale oil production allowed by 10 these regulations is highly water and en- 11 ergy intensive, the impacts of which will in- 12 tensify existing water scarcity in the arid 13 Western Region and potentially degrade 14 air and water quality for surrounding pop- 15 ulations. 16 (C) SCIENTIFIC REVIEW.—On December 17 16, 2008, the United States Fish and Wildlife 18 Service of the Department of the Interior and 19 the National Oceanic and Atmospheric Admin- 20 istration of the Department of Commerce joint- 21 ly issued a new rule amending regulations gov- 22 erning interagency cooperation under section 7 23 of the Endangered Species Act of 1973 (ESA). 24 This rule undermines the intention of the ESA 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00778 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 779 •HR 5475 IH to protect species and the ecosystems upon 1 which they depend by allowing Federal agencies 2 to carry out, permit, or fund an action without 3 proper environmental review and expert third- 4 party consultation from Federal wildlife ex- 5 perts. Under this new rule, Federal agencies 6 can unilaterally circumvent the formal review 7 process, eliminating longstanding and scientif- 8 ically grounded safeguards that serve to protect 9 the biodiversity of our Nation’s ecosystems and 10 avert harm to thousands of endangered and 11 threatened species. 12 (b) STATEMENT OF POLICY.—It is the policy of the 13 United States Government to work in conjunction with 14 States, territories, tribal governments, international orga- 15 nizations, and foreign governments in order to act as a 16 steward of the environment for the benefit of public 17 health, to maintain air quality and water quality, to sus- 18 tain the diversity of plant and animal species, to combat 19 global climate change, and to protect the environment for 20 future generations to enjoy. 21 (c) STUDY AND REPORT ON PUBLIC HEALTH OR EN- 22 VIRONMENTAL IMPACT OF REVISED RULES, REGULA- 23 TIONS, LAWS, OR PROPOSED LAWS.— 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00779 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 780 •HR 5475 IH (1) STUDY.—Not later than 30 days after the 1 date of enactment of this Act, the President shall 2 enter into an arrangement under which the National 3 Academy of Sciences will conduct a study to deter- 4 mine the impact on public health, air quality, water 5 quality, wildlife, and the environment of the fol- 6 lowing regulations, laws, and proposed laws: 7 (A) CLEAN WATER.— 8 (i) Final revisions to the Federal 9 Water Pollution Control Act regulatory 10 definitions of ‘‘fill material’’ and ‘‘dis- 11 charge of fill material’’, finalized and pub- 12 lished in the Federal Register on May 9, 13 2002 (67 Fed. Reg. 31129), amending 14 part 232 of title 40, Code of Federal Regu- 15 lations. 16 (ii) Revised National Pollutant Dis- 17 charge Elimination System Permit Regula- 18 tion and Effluent Limitation Guidelines 19 and Standards for Concentrated Animal 20 Feeding Operations in response to the 21 ‘‘Waterkeeper Alliance, et al. v. Environ- 22 mental Protection Agency’’ decision, final- 23 ized and published in the Federal Register 24 on November 20, 2008 (73 Fed. Reg. 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00780 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 781 •HR 5475 IH 225), amending parts 9, 122, and 412 of 1 title 40, Code of Federal Regulations. 2 (iii) A March 19, 2003, rule published 3 in the Federal Register (68 Fed. Reg. 4 13608) withdrawing a July 13, 2000, rule 5 revising the Total Maximum Daily Load 6 program of the Federal Water Pollution 7 Control Act (65 Fed. Reg. 43586), amend- 8 ing parts 9, 122, 123, 124, and 130 of 9 title 40, Code of Federal Regulations. 10 (iv) Official Guidance Document, 11 ‘‘Clean Water Act Jurisdiction Following 12 the United States Supreme Court’s Deci- 13 sion in Rapanos v. United States & 14 Carabell v. United States’’, issued on De- 15 cember 2, 2008, relating to jurisdiction 16 under section 404 of the Federal Water 17 Pollution Control Act. 18 (B) FORESTS AND LAND MANAGEMENT.— 19 (i) Healthy Forests Restoration Act of 20 2003, signed into law on December 3, 21 2003 (Public Law 108–148; 16 U.S.C. 22 6501 et seq.). 23 (ii) National Forest System Land 24 Management Planning Rule, finalized and 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00781 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 782 •HR 5475 IH published in the Federal Register on April 1 21, 2008 (73 Fed. Reg. 21468), replacing 2 the 2005 final rule (70 Fed. Reg. 1022, 3 Jan. 5, 2005), as amended March 3, 2006 4 (71 Fed. Reg. 10837), and the 2000 final 5 rule adopted on November 9, 2000 (65 6 Fed. Reg. 67514), as amended on Sep- 7 tember 29, 2004 (69 Fed. Reg. 58055), 8 amending title 36, Code of Federal Regula- 9 tions, part 219. 10 (iii) The application of the Adminis- 11 trative Procedure Act (5 U.S.C. 551 to 12 559, 701 to 706, et seq.), such that States 13 may petition for a special rule for the 14 roadless areas in all or part of said State. 15 (iv) Record of Decision, ‘‘Oil Shale 16 and Tar Sands Resources Resource Man- 17 agement Plan Amendments’’, issued on 18 November 17, 2008, along with the Final 19 Rule, Oil Shale Management-General, pub- 20 lished in the Federal Register on Novem- 21 ber 18, 2008 (73 Fed. Reg. 223), amend- 22 ing title 43, Code of Federal Regulations, 23 parts 3900, 3910, 3920, and 3930. 24 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00782 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 783 •HR 5475 IH (C) SCIENTIFIC REVIEW.—Final Rule, 1 Interagency Cooperation Under the Endangered 2 Species Act, published in the Federal Register 3 on December 16, 2008, amending title 50, Code 4 of Federal Regulations, part 402. 5 (2) METHOD.—In conducting the study under 6 paragraph (1), the National Academy of Sciences 7 may utilize and compare existing scientific studies 8 regarding the regulations, laws, and proposed laws 9 listed in paragraph (1). 10 (3) REPORT.—Under the arrangement entered 11 into under paragraph (1), not later than 270 days 12 after the date on which such arrangement is entered 13 into, the National Academy of Sciences shall make 14 publicly available and shall submit to the Congress 15 and to the head of each department and agency of 16 the Federal Government that issued, implements, or 17 would implement a regulation, law, or proposed law 18 listed in paragraph (1), a report containing— 19 (A) a description of the impact of all such 20 regulations, laws, and proposed laws on public 21 health, air quality, water quality, wildlife, and 22 the environment, compared to the impact of 23 preexisting regulations, or laws in effect, includ- 24 ing— 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00783 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 784 •HR 5475 IH (i) any negative impacts to air quality 1 or water quality; 2 (ii) any negative impacts to wildlife; 3 (iii) any delays in hazardous waste 4 cleanup that are projected to be hazardous 5 to public health; and 6 (iv) any other negative impact on pub- 7 lic health or the environment; and 8 (B) any recommendations that the Na- 9 tional Academy of Sciences considers appro- 10 priate to maintain, restore, or improve in whole 11 or in part protections for public health, air 12 quality, water quality, wildlife, and the environ- 13 ment for each of the regulations, laws, and pro- 14 posed laws listed in paragraph (1), which may 15 include recommendations for the adoption of 16 any regulation or law in place or proposed prior 17 to January 1, 2001. 18 (d) DEPARTMENT AND AGENCY REVISION OF EXIST- 19 ING RULES, REGULATIONS, OR LAWS.—Not later than 20 180 days after the date on which the report is submitted 21 pursuant to subsection (c)(3), the head of each depart- 22 ment and agency that has issued or implemented a regula- 23 tion or law listed in subsection (c)(1) shall submit to the 24 Congress a plan describing the steps such department or 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00784 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 785 •HR 5475 IH such agency will take, or has taken, to restore or improve 1 protections for public health and the environment in whole 2 or in part that were in existence prior to the issuance of 3 such regulation or law. 4 SEC. 1008. GAO REPORT ON HEALTH EFFECTS OF DEEP- 5 WATER HORIZON OIL RIG EXPLOSION IN THE 6 GULF COAST. 7 (a) STUDY.—The Comptroller General of the United 8 States shall conduct a study on the type and scope of 9 health care services administered through the Department 10 of Health and Human Services addressing the provision 11 of health care to racial and ethnic minorities (whether 12 residents, cleanup workers, or volunteers) affected by the 13 explosion of the mobile offshore drilling unit Deepwater 14 Horizon that occurred on April 20, 2010. 15 (b) SPECIFIC COMPONENTS; REPORTING.—In car- 16 rying out subsection (a), the Comptroller General shall— 17 (1) assess the type, size, and scope of programs 18 administered by the Department of Health and 19 Human Services that focus on provision of health 20 care to communities in the Gulf Coast; 21 (2) identify the merits and disadvantages asso- 22 ciated with each the programs; 23 (3) perform an analysis of the costs and bene- 24 fits of the programs; 25 VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00785 Fmt 6652 Sfmt 6201 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS 786 •HR 5475 IH (4) determine whether there is any duplication 1 of programs; and 2 (5) not later than 180 days after the date of 3 the enactment of this Act, report findings and rec- 4 ommendations for improving access to health care 5 for racial and ethnic minorities to the Congress. 6 Æ VerDate Sep 11 2014 08:12 Jun 15, 2016 Jkt 059200 PO 00000 Frm 00786 Fmt 6652 Sfmt 6301 E:\BILLS\H5475.IH H5475 rmajette on DSK2TPTVN1PROD with BILLS