Text of US HB 5942 (2018)

I 115TH CONGRESS 2D SESSION H. R. 5942 To improve the health of minority individuals, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MAY 23, 2018 Ms. LEE (for herself, Mr. AGUILAR, Ms. BARRAGA´N, Ms. BASS, Ms. BONAMICI, Ms. BORDALLO, Mr. BROWN of Maryland, Mr. CARBAJAL, Mr. CA´RDENAS, Mr. CARSON of Indiana, Mr. CASTRO of Texas, Ms. JUDY CHU of California, Ms. CLARKE of New York, Mr. CORREA, Mr. DANNY K. DAVIS of Illinois, Mr. ELLISON, Ms. ESHOO, Mr. ESPAILLAT, Ms. FUDGE, Mr. GALLEGO, Mr. GOMEZ, Mr. AL GREEN of Texas, Mr. GRIJALVA, Mr. GUTIE´RREZ, Ms. HANABUSA, Mr. HASTINGS, Ms. JAYAPAL, Ms. EDDIE BERNICE JOHNSON of Texas, Ms. KELLY of Illi- nois, Mr. KHANNA, Mr. LEWIS of Georgia, Mr. TED LIEU of California, Ms. LOFGREN, Mr. LOWENTHAL, Ms. MICHELLE LUJAN GRISHAM of New Mexico, Ms. MATSUI, Mr. MEEKS, Ms. MENG, Mrs. NAPOLITANO, Ms. NORTON, Mr. PAYNE, Mr. RASKIN, Mr. RICHMOND, Ms. ROYBAL- ALLARD, Mr. RUSH, Mr. SABLAN, Ms. SA´NCHEZ, Mr. SCHIFF, Mr. SCOTT of Virginia, Mr. SERRANO, Ms. SEWELL of Alabama, Mr. SWALWELL of California, Mr. TAKANO, Mrs. TORRES, Ms. VELA´ZQUEZ, Ms. WILSON of Florida, Mrs. WATSON COLEMAN, and Mr. KRISHNAMOORTHI) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Commit- tees on Ways and Means, Agriculture, Education and the Workforce, the Budget, the Judiciary, Veterans’ Affairs, Armed Services, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the juris- diction of the committee concerned A BILL To improve the health of minority individuals, and for other purposes. VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 2 •HR 5942 IH 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 2018’’. 5 SEC. 2. TABLE OF CONTENTS. 6 The table of contents of this Act is as follows: 7 Sec. 1. Short title. Sec. 2. Table of contents. Sec. 3. Findings. TITLE I—DATA COLLECTION AND REPORTING Sec. 101. Amendment to the Public Health Service Act. Sec. 102. Elimination of prerequisite of direct appropriations for data collection and analysis. Sec. 103. Collection of race and ethnicity data by the Social Security Adminis- tration. Sec. 104. Revision of HIPAA claims standards. Sec. 105. National Center for Health Statistics. Sec. 106. Disparities data collected by the Federal Government. Sec. 107. Data collection and analysis grants to minority-serving institutions. Sec. 108. Standards for measuring sexual orientation and gender identity in collection of health data. Sec. 109. Standards for measuring socioeconomic status in collection of health data. Sec. 110. Safety and effectiveness of drugs with respect to racial and ethnic background. Sec. 111. Improving health data regarding Native Hawaiians and other Pacific Islanders. Sec. 112. Clarification of simplified administrative reporting requirement. TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND 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. VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 3 •HR 5942 IH Sec. 209. English for speakers of other languages. Sec. 210. Implementation. Sec. 211. Language access services. TITLE III—HEALTH WORKFORCE DIVERSITY Sec. 301. Amendment to the Public Health Service Act. Sec. 302. Hispanic-serving health professions schools. Sec. 303. Loan repayment program of Centers for Disease Control and Preven- tion. Sec. 304. Cooperative agreements for online degree programs at schools of pub- lic health and schools of allied health. Sec. 305. Sense of Congress on the mission of the National Health Care Work- force Commission. Sec. 306. Scholarship and fellowship programs. Sec. 307. McNair Postbaccalaureate Achievement Program. Sec. 308. Rules for determination of full-time equivalent residents for cost-re- porting periods. Sec. 309. Developing and implementing strategies for local health equity. Sec. 310. Loan forgiveness for mental and behavioral health social workers. Sec. 311. Health Professions Workforce Fund. Sec. 312. Findings; sense of Congress relating to graduate medical education. Sec. 313. Career support for skilled, internationally educated health profes- sionals. TITLE IV—IMPROVING HEALTH CARE ACCESS AND QUALITY Subtitle A—Expansion of Coverage Sec. 401. Amendment to the Public Health Service Act. Sec. 402. Removing citizenship and immigration barriers to access to affordable health care under ACA. Sec. 403. Study on the uninsured. Sec. 404. Medicaid in the territories. Sec. 405. Extension of Medicare secondary payer. Sec. 406. Border health grants. Sec. 407. Removing Medicare barrier to health care. Sec. 408. 100 percent FMAP for medical assistance provided by urban Indian health centers. Sec. 409. 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. Subtitle B—Expansion of Access Sec. 410. Protecting sensitive locations. Sec. 411. Grants for racial and ethnic approaches to community health. Sec. 412. Critical access hospital improvements. Sec. 413. Establishment of Rural Community Hospital (RCH) Program. Sec. 414. Medicare remote monitoring pilot projects. Sec. 415. Rural health quality advisory commission and demonstration projects. Sec. 416. Rural health care services. Sec. 417. Community health center collaborative access expansion. Sec. 418. Facilitating the provision of telehealth services across State lines. Sec. 419. Scoring of preventive health savings. Sec. 420. Sense of Congress on Maintenance of Effort Provisions Regarding Children’s Health. VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6211 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 4 •HR 5942 IH Sec. 421. Repeal of requirement for documentation evidencing citizenship or nationality under the Medicaid program. Sec. 422. Protection of the HHS Offices of Minority Health. Sec. 423. Office of Minority Health in Veterans Health Administration of De- partment of Veterans Affairs. Sec. 424. Indian defined in PPACA. Sec. 425. Study of DSH payments to ensure hospital access for low-income pa- tients. Sec. 426. Assistant Secretary of the Indian Health Service. Sec. 427. Reauthorization of the Native Hawaiian Health Care Improvement Act. Sec. 428. Availability of non-English language speaking providers. Sec. 429. Access to essential community providers. Sec. 430. Provider network adequacy in communities of color. Sec. 431. Improving access to dental care. Subtitle C—Advancing Health Equity Through Payment and Delivery Reform Sec. 441. Sense of Congress. Sec. 442. Centers for Medicare & Medicaid Services quality payment program. Sec. 443. Development and testing of disparity reducing delivery and payment models. Sec. 444. Supporting safety net and community-based providers to compete in value-based payment systems. Subtitle D—Health Empowerment Zones Sec. 451. Short title. Sec. 452. Findings. Sec. 453. Designation of health empowerment zones. Sec. 454. Assistance to those seeking designation. Sec. 455. Benefits of designation. Sec. 456. Definition. Sec. 457. Authorization of appropriations. Subtitle E—At-Risk Community Coverage Sec. 461. Medicaid coverage for citizens of Freely Associated States. Sec. 462. At-risk youth Medicaid protection. TITLE V—IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES Subtitle A—In General Sec. 501. Grants to promote health for underserved communities. Sec. 502. Removing barriers to health care and nutrition assistance for chil- dren, pregnant persons, and lawfully present individuals. Sec. 503. Repeal of denial of benefits. Sec. 504. Birth defects prevention, risk reduction, and awareness. Sec. 505. Preventing maternal 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. VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6211 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 5 •HR 5942 IH Sec. 511. Comprehensive sex education programs. 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 individuals 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 & 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 maternal, reproductive, and sexual health professionals. Sec. 524. Interagency update to the quality family planning guidelines. Sec. 525. Dissemination of the quality family planning guidelines. Subtitle B—Pregnancy Screening Sec. 531. Pregnancy intention screening initiative demonstration program. TITLE VI—MENTAL HEALTH Sec. 601. Mental health findings. Sec. 602. Coverage of marriage and family therapist services, mental health counselor services, and substance abuse counselor services under part B of the Medicare 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. Sec. 606. Asian American, Native Hawaiian, and Pacific Islander behavioral and mental health outreach and education strategies. Sec. 607. Mental health in schools. Sec. 608. Geo-access study. 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. VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6211 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 6 •HR 5942 IH 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 private health insurance. 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. Sec. 752. Reducing new HIV infections among injecting drug users. Sec. 753. Report on impact of HIV/AIDS in vulnerable populations. Sec. 754. National HIV/AIDS observance days. Sec. 755. Review of all Federal and State laws, policies, and regulations regard- ing the criminal prosecution of individuals for HIV-related of- fenses. Sec. 756. Expanding support for condoms in prisons. Sec. 757. Automatic reinstatement or enrollment in Medicaid for people who test positive for HIV before reentering communities. Sec. 758. Stop AIDS in prison. Sec. 759. Support data system review and indicators for monitoring HIV care. Sec. 760. Transfer of funds for implementation of national HIV/AIDS strategy. Sec. 761. 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. VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6211 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 7 •HR 5942 IH 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—Tuberculosis Sec. 781. Elimination of all forms of tuberculosis. Sec. 782. Additional funding for States in combating and eliminating tuber- culosis. Sec. 783. Strengthening clinical research funding for tuberculosis. Subtitle I—Osteoarthritis and Musculoskeletal Diseases Sec. 785. Findings. Sec. 786. Osteoarthritis and other musculoskeletal health-related activities of the Centers for Disease Control and Prevention. Sec. 787. Grants for comprehensive osteoarthritis and musculoskeletal disease health education within health professions schools. Subtitle J—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 and racial/ethnic populations. Subtitle K—Sickle Cell Disease Research, Surveillance, Prevention, and Treatment Sec. 796. Short title. Sec. 796A. Sickle cell disease research. Sec. 796B. Sickle cell disease surveillance. Sec. 796C. Sickle cell disease prevention and treatment. Sec. 796D. Collaboration with community-based entities. 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 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6211 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 8 •HR 5942 IH Sec. 811. Extending funding to strengthen the Health IT infrastructure in ra- cial and ethnic minority communities. Sec. 812. Extending competitive grants for the development of loan programs to facilitate adoption of Certified Electronic Health Record Technology by providers serving racial and ethnic minority groups. Sec. 813. Authorization of appropriations. Subtitle C—Additional Research and Studies Sec. 821. Data collection and assessments conducted in coordination with mi- nority-serving institutions. Sec. 822. Study of health information technology in medically underserved com- munities. Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs Sec. 831. Extending Medicaid EHR incentive payments to rehabilitation facili- ties, long-term care facilities, and home health agencies. Sec. 832. 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 Subtitle A—In General Sec. 1001. Definitions. Sec. 1002. Findings. Sec. 1003. Health impact assessments. Sec. 1004. Implementation of recommendations by Environmental Protection Agency. Sec. 1005. Grant program to conduct environmental health improvement activi- ties and to improve social determinants of health. Sec. 1006. Additional research on the relationship between the built environ- ment and the health of community residents. Sec. 1007. Environment and public health restoration. Sec. 1008. GAO report on health effects of Deepwater Horizon oil rig explosion in the Gulf Coast. Subtitle B—Gun Violence Sec. 1011. Findings. VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6211 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 9 •HR 5942 IH Sec. 1012. Reaffirming research authority of the Centers for Disease Control and Prevention. Sec. 1013. National violent death reporting system. Sec. 1014. Report on effects of gun violence on public health. Sec. 1015. Report on effects of gun violence on mental health in minority com- munities. 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 this shortage disproportionately affects health pro- 22 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 10 •HR 5942 IH fessional shortage areas where many racial and eth- 1 nic minority populations reside. 2 (4) All efforts to reduce health disparities and 3 barriers to quality health services require better and 4 more consistent data. 5 (5) A full range of culturally and linguistically 6 appropriate health care and public health services 7 must be available and accessible in every community. 8 (6) Racial and ethnic minorities and under- 9 served populations must be included early and equi- 10 tably in health reform innovations. 11 (7) Efforts to improve minority health have 12 been limited by inadequate resources in funding, 13 staffing, stewardship, and accountability. Targeted 14 investments that are focused on disparities elimi- 15 nation must be made in providing care and services 16 that are community-based, including prevention and 17 policies addressing social determinants of health. 18 (8) In 2011, the Department of Health and 19 Human Services developed the HHS Action Plan to 20 Reduce Racial and Ethnic Health Disparities and 21 the National Stakeholder Strategy for Achieving 22 Health Equity, two strategic plans that represent 23 the country’s first coordinated roadmap to reducing 24 health disparities. Along with the National Preven- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 11 •HR 5942 IH tion Strategy, Healthy People 2020, and the Na- 1 tional Health Care Quality Strategy, as well as crit- 2 ical resources such as the 2012 National Healthcare 3 Quality and Disparities Reports, these comprehen- 4 sive plans will work to increase the number of Amer- 5 icans who are healthy at every stage of life. 6 (9) The Department of Health and Human 7 Services has also reviewed and advanced updated 8 clinical guidelines and developed other strategic 9 planning documents— 10 (A) to combat health disparities with a 11 high impact on minority populations including 12 the National HIV/AIDS Strategy, the Action 13 Plan for the Prevention, Care, and Treatment 14 of Viral Hepatitis; and 15 (B) to provide high-quality family planning 16 services including recommendations of the Cen- 17 ters for Disease Control and Prevention and the 18 Office of Population Affairs. 19 (10) The Patient Protection and Affordable 20 Care Act, as amended by the Health Care and Edu- 21 cation Reconciliation Act, represents the biggest ad- 22 vancement for minority health in the last 40 years. 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 12 •HR 5942 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 added by titles II and III of this 11 Act, is further amended by inserting after subtitle A the 12 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 13 •HR 5942 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, standards 8 for data collection on race, ethnicity, sex, 9 primary language, sexual orientation, dis- 10 ability status, gender identity, and socio- 11 economic 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 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 14 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 15 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 16 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 17 •HR 5942 IH cioeconomic status data at the Federal, State, territorial, 1 Tribal, and local levels, including data to be collected 2 under subsection (a), and to ensure that data collection 3 activities carried out under this section are in compliance 4 with standards developed under section 3101. The Data 5 Council of the Department of Health and Human Serv- 6 ices, in consultation with the National Committee on Vital 7 Health Statistics, the Office of Minority Health, Office on 8 Women’s Health, and other appropriate public and private 9 entities, shall make recommendations to the Secretary 10 concerning the development, implementation, and revision 11 of 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 knowledge among Federal agen- 17 cies, States, territories, Indian Tribes, counties, mu- 18 nicipalities, health providers, health plans, and the 19 general public that data collection, analysis, and re- 20 porting by race, ethnicity, primary language, sexual 21 orientation, disability status, gender identity, and so- 22 cioeconomic status is legal and necessary to assure 23 equity and nondiscrimination in the quality of health 24 care services; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 18 •HR 5942 IH ‘‘(3) ensure that future patient record systems 1 follow Federal standards promulgated under the 2 HITECH Act for the collection and meaningful use 3 of electronic health data on race, ethnicity, primary 4 language, sexual orientation, disability status, gen- 5 der identity, and socioeconomic status; 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, 11 counties, and municipalities for racial and ethnic 12 groups that comprise a significant proportion of the 13 population of the State, county, or municipality; 14 ‘‘(5) provide researchers with greater access to 15 racial, ethnic, primary language, sexual orientation, 16 disability status, gender identity, and socioeconomic 17 status data, subject to privacy and confidentiality 18 regulations; and 19 ‘‘(6) safeguard and prevent the misuse of data 20 collected under subsection (a). 21 ‘‘(d) COMPLIANCE WITH STANDARDS.—Data col- 22 lected under subsection (a) shall be obtained, maintained, 23 and presented (including for reporting purposes) in ac- 24 cordance with standards developed under section 3101. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 19 •HR 5942 IH ‘‘(e) ANALYSIS OF HEALTH DISPARITY DATA.—The 1 Secretary, acting through the Director of the Agency for 2 Healthcare Research and Quality and in coordination with 3 the Assistant Secretary for Planning and Evaluation, Ad- 4 ministrator of the Centers for Medicare & Medicaid Serv- 5 ices, the Director of the National Center for Health Statis- 6 tics, and the Director of the National Institutes of Health, 7 shall provide technical assistance to agencies of the De- 8 partment of Health and Human Services in meeting Fed- 9 eral standards for health disparity data collection and for 10 analysis of racial, ethnic, and other disparities in health 11 and health care in public programs by— 12 ‘‘(1) identifying appropriate quality assurance 13 mechanisms to monitor for health disparities; 14 ‘‘(2) specifying the clinical, diagnostic, or thera- 15 peutic measures which should be monitored; 16 ‘‘(3) developing new quality measures relating 17 to racial and ethnic disparities and their overlap 18 with other disparity factors in health and health 19 care; 20 ‘‘(4) identifying the level at which data analysis 21 should be conducted; and 22 ‘‘(5) sharing data with external organizations 23 for research and quality improvement purposes. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 20 •HR 5942 IH ‘‘(f) PRIMARY LANGUAGE.—References in this sec- 1 tion— 2 ‘‘(1) to primary language data, include spoken 3 and written primary language data; and 4 ‘‘(2) to primary language data collection activi- 5 ties, include identifying, collecting, storing, tracking, 6 and analyzing primary language data and informa- 7 tion on the methods used to meet the language ac- 8 cess needs of limited-English-proficient individuals. 9 ‘‘(g) DEFINITION.—In this section, the term ‘health- 10 related program’ mean a program— 11 ‘‘(1) under the Social Security Act (42 U.S.C. 12 301 et seq.) that pays for health care and services; 13 and 14 ‘‘(2) under this Act that provides Federal finan- 15 cial assistance for health care, biomedical research, 16 or health services research and or is designed to im- 17 prove the public’s health. 18 ‘‘(h) 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 2019 through 2024. 22 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 21 •HR 5942 IH ‘‘SEC. 3432. ESTABLISHING GRANTS FOR DATA COLLECTION 1 IMPROVEMENT ACTIVITIES. 2 ‘‘(a) IN GENERAL.—The Secretary, acting through 3 the Director of the Agency for Healthcare Research and 4 Quality and in consultation with the Deputy Assistant 5 Secretary for Minority Health, the Director of the Na- 6 tional Institutes of Health, the Assistant Secretary for 7 Planning and Evaluation, and the Director of the National 8 Center for Health Statistics, shall establish a technical as- 9 sistance program under which the Secretary provides 10 grants to eligible entities to assist such entities in com- 11 plying with section 3431. 12 ‘‘(b) TYPES OF ASSISTANCE.—Grants provided under 13 this section may include grants to— 14 ‘‘(1) enhance or upgrade computer technology 15 that will facilitate racial, ethnic, primary language, 16 sexual orientation, disability status, gender identity, 17 and socioeconomic status data collection, analysis, 18 and reporting; 19 ‘‘(2) improve methods for health data collection 20 and analysis, including additional population groups 21 if such groups can be aggregated into the race and 22 ethnicity categories outlined by standards developed 23 under section 3101; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 22 •HR 5942 IH ‘‘(3) develop mechanisms for submitting col- 1 lected data subject to existing privacy and confiden- 2 tiality regulations; and 3 ‘‘(4) develop educational programs to inform 4 health plans, health providers, health-related agen- 5 cies, and the general public that data collection and 6 reporting by race, ethnicity, primary language, sex- 7 ual orientation, disability status, gender identity, 8 and socioeconomic status are legal and essential for 9 eliminating health and health care disparities. 10 ‘‘(c) ELIGIBLE ENTITY.—To be eligible for grants 11 under this section, an entity shall be a State, territory, 12 Indian Tribe, municipality, county, health provider, health 13 care organization, or health plan making a demonstrated 14 effort to bring data collections into compliance with sec- 15 tion 3431. 16 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 17 are authorized to be appropriated to carry out this section 18 such sums as may be necessary for each of fiscal years 19 2019 through 2024. 20 ‘‘SEC. 3433. OVERSAMPLING OF UNDERREPRESENTED 21 GROUPS IN FEDERAL HEALTH SURVEYS. 22 ‘‘(a) NATIONAL STRATEGY.— 23 ‘‘(1) IN GENERAL.—The Secretary of Health 24 and Human Services, acting through the Director of 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 23 •HR 5942 IH the National Center for Health Statistics of the Cen- 1 ters for Disease Control and Prevention, and other 2 agencies within the Department of Health and 3 Human Services as the Secretary determines appro- 4 priate, shall develop and implement an ongoing and 5 sustainable national strategy for oversampling 6 underrepresented populations within the categories 7 of race, ethnicity, sex, primary language, sexual ori- 8 entation, disability status, gender identity, and socio- 9 economic status as determined appropriate by the 10 Secretary in Federal health surveys and program 11 data collections. Such national strategy shall include 12 a strategy for oversampling of Asian Americans, Na- 13 tive Hawaiians and Pacific Islanders. 14 ‘‘(2) CONSULTATION.—In developing and imple- 15 menting a national strategy, as described in para- 16 graph (1), not later than 180 days after the date of 17 the enactment of the this section, the Secretary 18 shall— 19 ‘‘(A) consult with representatives of com- 20 munity groups, nonprofit organizations, non- 21 governmental organizations, and government 22 agencies working with underrepresented popu- 23 lations; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 24 •HR 5942 IH ‘‘(B) solicit the participation of representa- 1 tives from other Federal departments and agen- 2 cies, including subagencies of the Department 3 of Health and Human Services; and 4 ‘‘(C) consult on, and use as models, the 5 2014 National Health Interview Survey over- 6 sample of Native Hawaiian and Pacific Islander 7 populations and the 2017 Behavioral Risk Fac- 8 tor Surveillance System oversample of American 9 Indian and Alaska Native communities. 10 ‘‘(b) PROGRESS REPORT.—Not later than 2 years 11 after the date of the enactment of this section, the Sec- 12 retary shall submit to the Congress a progress report, 13 which shall include the national strategy described in sub- 14 section (a)(1). 15 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—To 16 carry out this section, there are authorized to be appro- 17 priated such sums as may be necessary for fiscal years 18 2019 through 2024.’’. 19 SEC. 102. ELIMINATION OF PREREQUISITE OF DIRECT AP- 20 PROPRIATIONS FOR DATA COLLECTION AND 21 ANALYSIS. 22 Section 3101 of the Public Health Service Act (42 23 U.S.C. 300kk) is amended— 24 (1) by striking subsection (h); and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 25 •HR 5942 IH (2) by redesignating subsection (i) as subsection 1 (h). 2 SEC. 103. COLLECTION OF RACE AND ETHNICITY DATA BY 3 THE SOCIAL SECURITY ADMINISTRATION. 4 Part A of title XI of the Social Security Act (42 5 U.S.C. 1301 et seq.) is amended by adding at the end 6 the following: 7 ‘‘COLLECTION OF RACE AND ETHNICITY DATA BY THE 8 SOCIAL SECURITY ADMINISTRATION 9 ‘‘SEC. 1150C. (a) REQUIREMENT.—The Commis- 10 sioner of Social Security, in consultation with the Admin- 11 istrator of the Centers for Medicare & Medicaid Services, 12 shall— 13 ‘‘(1) require the collection of data on the race, 14 ethnicity, primary language, and disability status of 15 all applicants for Social Security account numbers or 16 benefits under title II or part A of title XVIII and 17 all individuals with respect to whom the Commis- 18 sioner maintains records of wages and self-employ- 19 ment income in accordance with reports received by 20 the Commissioner or the Secretary of the Treas- 21 ury— 22 ‘‘(A) using, at a minimum, standards for 23 data collection on race, ethnicity, primary lan- 24 guage, and disability status developed under 25 section 3101 of the Public Health Service Act; 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 26 •HR 5942 IH ‘‘(B) where practicable, collecting data for 1 additional population groups if such groups can 2 be aggregated into the race and ethnicity cat- 3 egories outlined by standards developed under 4 section 3101 of the Public Health Service Act; 5 and 6 ‘‘(C) additionally referring, where prac- 7 ticable, to the standards developed by the Insti- 8 tute of Medicine in ‘Race, Ethnicity, and Lan- 9 guage Data: Standardization for Health Care 10 Quality Improvement’ (released August 31, 11 2009); 12 ‘‘(2) with respect to the collection of the data 13 described in paragraph (1) for applicants who are 14 under 18 years of age or otherwise legally incapaci- 15 tated, require that— 16 ‘‘(A) such data be collected from the par- 17 ent or legal guardian of such an applicant; and 18 ‘‘(B) the primary language of the parent 19 or legal guardian of such an applicant or recipi- 20 ent be used in collecting the data; 21 ‘‘(3) require that such data be uniformly ana- 22 lyzed and reported at least annually to the Commis- 23 sioner of Social Security; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 27 •HR 5942 IH ‘‘(4) be responsible for storing the data re- 1 ported under paragraph (3); 2 ‘‘(5) ensure transmission to the Centers for 3 Medicare & Medicaid Services and other Federal 4 health agencies; 5 ‘‘(6) provide such data to the Secretary on at 6 least an annual basis; and 7 ‘‘(7) ensure that the provision of assistance to 8 an applicant is not denied or otherwise adversely af- 9 fected because of the failure of the applicant to pro- 10 vide race, ethnicity, primary language, and disability 11 status data. 12 ‘‘(b) PROTECTION OF DATA.—The Commissioner of 13 Social Security shall ensure (through the promulgation of 14 regulations or otherwise) that all data collected pursuant 15 to subsection (a) are protected— 16 ‘‘(1) under the same privacy protections as the 17 Secretary applies to health data under the regula- 18 tions promulgated under section 264(c) of the 19 Health Insurance Portability and Accountability Act 20 of 1996 (Public Law 104–191; 110 Stat. 2033) re- 21 lating to the privacy of individually identifiable 22 health information and other protections; and 23 ‘‘(2) from all inappropriate internal use by any 24 entity that collects, stores, or receives the data, in- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 28 •HR 5942 IH cluding use of such data in determinations of eligi- 1 bility (or continued eligibility) in health plans, and 2 from other inappropriate uses, as defined by the 3 Secretary. 4 ‘‘(c) RULE OF CONSTRUCTION.—Nothing in this sec- 5 tion shall be construed to permit the use of information 6 collected under this section in a manner that would ad- 7 versely affect any individual providing any such informa- 8 tion. 9 ‘‘(d) TECHNICAL ASSISTANCE.—The Secretary may, 10 either directly or by grant or contract, provide technical 11 assistance to enable any health entity to comply with the 12 requirements of this section. 13 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 14 are authorized to be appropriated to carry out this section 15 such sums as may be necessary for each of fiscal years 16 2019 through 2024.’’. 17 SEC. 104. REVISION OF HIPAA CLAIMS STANDARDS. 18 (a) IN GENERAL.—Not later than 1 year after the 19 date of enactment of this Act, the Secretary of Health and 20 Human Services shall revise the regulations promulgated 21 under part C of title XI of the Social Security Act (42 22 U.S.C. 1320d et seq.), relating to the collection of data 23 on race, ethnicity, and primary language in a health-re- 24 lated transaction, to require— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 29 •HR 5942 IH (1) the use, at a minimum, of standards for 1 data collection on race, ethnicity, primary language, 2 disability, sex, sexual orientation, and gender iden- 3 tity developed under section 3101 of the Public 4 Health Service Act (42 U.S.C. 300kk); and 5 (2) in consultation with the Office of the Na- 6 tional Coordinator for Health Information Tech- 7 nology, the designation of the appropriate racial, 8 ethnic, primary language, disability, sex, and other 9 code sets as required for claims and enrollment data. 10 (b) DISSEMINATION.—The Secretary of Health and 11 Human Services shall disseminate the new standards de- 12 veloped under subsection (a) to all health entities that are 13 subject to the regulations described in such subsection and 14 provide technical assistance with respect to the collection 15 of the data involved. 16 (c) COMPLIANCE.—The Secretary of Health and 17 Human Services shall require that health entities comply 18 with the new standards developed under subsection (a) not 19 later than 2 years after the final promulgation of such 20 standards. 21 SEC. 105. NATIONAL CENTER FOR HEALTH STATISTICS. 22 Section 306(n) of the Public Health Service Act (42 23 U.S.C. 242k(n)) is amended— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 30 •HR 5942 IH (1) in paragraph (1), by striking ‘‘2003’’ and 1 inserting ‘‘2022’’; 2 (2) in paragraph (2), in the first sentence, by 3 striking ‘‘2003’’ and inserting ‘‘2022’’; and 4 (3) in paragraph (3), by striking ‘‘2002’’ and 5 inserting ‘‘2022’’. 6 SEC. 106. DISPARITIES DATA COLLECTED BY THE FEDERAL 7 GOVERNMENT. 8 (a) COLLECTION; SUBMISSION.—Not later than 180 9 days after the date of the enactment of this Act, and Jan- 10 uary 31 of each year thereafter, each department, agency, 11 and office of the Federal Government that has collected 12 data on race, ethnicity, sex, primary language, sexual ori- 13 entation, disability status, gender identity, or socio- 14 economic status during the preceding calendar year shall 15 submit such data to a centralized electronic repository of 16 Government data on factors related to the health and well- 17 being of the American population. 18 (b) ANALYSIS; PUBLIC AVAILABILITY; REPORTING.— 19 Not later than April 30, 2018, and each April 30 there- 20 after, the Secretary of Health and Human Services, acting 21 through the Assistant Secretary for Planning and Evalua- 22 tion, the Assistant Secretary for Health, the Director of 23 the Agency for Healthcare Research and Quality, the Di- 24 rector of the National Center for Health Statistics, the 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 31 •HR 5942 IH Administrator of the Centers for Medicare & Medicaid 1 Services, the Director of the National Institute on Minor- 2 ity Health and Health Disparities, and the Deputy Assist- 3 ant Secretary for Minority Health, shall— 4 (1) prepare and make available datasets for 5 public use that relate to disparities in health status, 6 health care access, health care quality, health out- 7 comes, public health, and other areas of health and 8 well-being by factors that include race, ethnicity, 9 sex, primary language, sexual orientation, disability 10 status, gender identity, and socioeconomic status; 11 (2) ensure that these data sets are publicly 12 identified on a centralized electronic repository of 13 Government data as ‘‘disparities’’ data; and 14 (3) submit a report to the Congress on the 15 availability and use of such data by public stake- 16 holders. 17 SEC. 107. DATA COLLECTION AND ANALYSIS GRANTS TO MI- 18 NORITY-SERVING INSTITUTIONS. 19 (a) AUTHORITY.—The Secretary of Health and 20 Human Services, acting through the National Institute on 21 Minority Health and Health Disparities and the Deputy 22 Assistant Secretary for Minority Health, shall award 23 grants to access and analyze racial and ethnic, and where 24 possible other health disparity data, to monitor and report 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 32 •HR 5942 IH on progress to reduce and eliminate disparities in health 1 and health care. 2 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el- 3 igible entity’’ means a historically Black college or univer- 4 sity, a Hispanic-serving institution, a Tribal college or uni- 5 versity, or an Asian American, Native American, or Pacific 6 Islander-serving institution with an accredited public 7 health, health policy, or health services research program. 8 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 9 out this section, there are authorized to be appropriated 10 such sums as may be necessary for fiscal years 2019 11 through 2024. 12 SEC. 108. STANDARDS FOR MEASURING SEXUAL ORIENTA- 13 TION AND GENDER IDENTITY IN COLLECTION 14 OF HEALTH DATA. 15 Section 3101(a) of the Public Health Service Act (42 16 U.S.C. 300kk(a)) is amended— 17 (1) in paragraph (1)(A), by inserting ‘‘sexual 18 orientation, gender identity,’’ before ‘‘and disability 19 status’’; 20 (2) in paragraph (1)(C), by inserting ‘‘sexual 21 orientation, gender identity,’’ before ‘‘and disability 22 status’’; and 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00032 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 33 •HR 5942 IH (3) in paragraph (2)(B), by inserting ‘‘sexual 1 orientation, gender identity,’’ before ‘‘and disability 2 status’’. 3 SEC. 109. 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. 110. 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 505F the following: 19 ‘‘SEC. 505G. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 34 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 35 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 36 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00036 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 37 •HR 5942 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 ‘‘(ee) 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 505G.’’. 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 505G’’. 17 SEC. 111. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 38 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 39 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 40 •HR 5942 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 2018, 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 41 •HR 5942 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 2018. 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 2018, 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 42 •HR 5942 IH ‘‘(1) IN GENERAL.—The Secretary shall enter 1 into an agreement with the Institute of Medicine 2 (IOM) to conduct a study, with input from stake- 3 holders in insular 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 43 •HR 5942 IH later than 2 years after the date of the enactment 1 of the Health Equity and Accountability Act of 2 2018, 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 2019 through 2024.’’. 12 SEC. 112. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 44 •HR 5942 IH TITLE II—CULTURALLY AND LIN- 1 GUISTICALLY APPROPRIATE 2 HEALTH AND 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 45 •HR 5942 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) Both the Americans with Disabilities Act 20 and the Rehabilitation Act of 1973 prohibit discrimi- 21 nation on the basis of disability and require the pro- 22 vision of appropriate auxiliary aids and services nec- 23 essary to ensure effective communication with indi- 24 viduals with disabilities. The type of auxiliary aid or 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 46 •HR 5942 IH service necessary to ensure effective communication 1 will vary in accordance with the method of commu- 2 nication used by the individual; the nature, length, 3 and complexity of the communication involved; and 4 the context in which the communication is taking 5 place. A public accommodation should consult with 6 individuals with disabilities whenever possible to de- 7 termine what type of auxiliary aid is needed to en- 8 sure effective communication, but the ultimate deci- 9 sion as to what measures to take rests with the pub- 10 lic accommodation, provided that the method chosen 11 results in effective communication. In order to be ef- 12 fective, auxiliary aids and services must be provided 13 in accessible formats, in a timely manner, and in 14 such a way as to protect the privacy and independ- 15 ence of the individual with a disability. 16 (7) Linguistic diversity in the health care and 17 health-care-related-services workforce is important 18 for providing all patients the environment most con- 19 ducive to positive health outcomes. 20 (8) All members of the health care and health- 21 care-related-services community should continue to 22 educate their staff and constituents about limited- 23 English-proficient and disability communication 24 issues and help them identify resources to improve 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 47 •HR 5942 IH access to quality care for limited-English-proficient 1 individuals and individuals with communication dis- 2 abilities such as hearing, vision, or print impair- 3 ments. 4 (9) Access to English as a second language, and 5 sign language instructions, readers, and other auxil- 6 iary aids and services, are essential to ensure effec- 7 tive communication and eliminate the language bar- 8 riers that impede access to health care. 9 (10) Competent language services in health care 10 settings should be available as a matter of course. 11 (b) AMENDMENT.—The Public Health Service Act 12 (42 U.S.C. 201 et seq.) is amended by adding at the end 13 the following: 14 ‘‘TITLE XXXIV—CULTURALLY 15 AND LINGUISTICALLY APPRO- 16 PRIATE HEALTH CARE 17 ‘‘SEC. 3400. DEFINITIONS. 18 ‘‘In this title: 19 ‘‘(1) BILINGUAL.—The term ‘bilingual’ with re- 20 spect to an individual means a person who has suffi- 21 cient degree of proficiency in two languages. 22 ‘‘(2) CULTURAL COMPETENCE.—The term ‘cul- 23 tural competence’ means a set of congruent behav- 24 iors, attitudes, and policies that come together in a 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 48 •HR 5942 IH system, agency, or among professionals that enables 1 effective work in cross-cultural situations. In the 2 preceding sentence— 3 ‘‘(A) the term ‘cultural’ refers to inte- 4 grated patterns of human behavior that include 5 the language, thoughts, communications, ac- 6 tions, customs, beliefs, values, and institutions 7 of racial, ethnic, religious, or social groups, in- 8 cluding lesbian, gay, bisexual, transgender, 9 queer, and questioning individuals, and individ- 10 uals with physical and mental disabilities; and 11 ‘‘(B) the term ‘competence’ implies having 12 the capacity to function effectively as an indi- 13 vidual and an organization within the context of 14 the cultural beliefs, behaviors, and needs pre- 15 sented by consumers and their communities. 16 ‘‘(3) EFFECTIVE COMMUNICATION.—The term 17 ‘effective communication’ means an exchange of in- 18 formation between the provider of health care or 19 health-care-related services and the recipient of such 20 services who is limited in English proficiency, or has 21 a communication impairment such as a hearing, vi- 22 sion, speaking, or learning impairment, that enables 23 access, understanding, and benefit from health care 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 49 •HR 5942 IH or health-care-related services, and full participation 1 in the development of their treatment plan. 2 ‘‘(4) GRIEVANCE RESOLUTION PROCESS.—The 3 term ‘grievance resolution process’ means all aspects 4 of dispute resolution including filing complaints, 5 grievance and appeal procedures, and court action. 6 ‘‘(5) HEALTH CARE GROUP.—The term ‘health 7 care group’ means a group of physicians organized, 8 at least in part, for the purposes of providing physi- 9 cians’ services under the Medicaid, SCHIP, or Medi- 10 care programs and may include a hospital and any 11 other individual or entity furnishing services covered 12 under the Medicaid, SCHIP, or Medicare programs 13 that is affiliated with the health care group. 14 ‘‘(6) HEALTH EDUCATOR.—The term ‘health 15 educator’ includes a baccalaureate prepared profes- 16 sional responsible for designing, implementing, and 17 evaluating individual and population health pro- 18 motion and chronic disease prevention programs. 19 ‘‘(7) HEALTH CARE SERVICES.—The term 20 ‘health care services’ means services that address 21 physical as well as mental health conditions in all 22 care settings. 23 ‘‘(8) HEALTH-CARE-RELATED SERVICES.—The 24 term ‘health-care-related services’ means human or 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 50 •HR 5942 IH social services programs or activities that provide ac- 1 cess, referrals or links to health care. 2 ‘‘(9) INDIAN TRIBE.—The term ‘Indian Tribe’ 3 means any Indian Tribe, band, nation, or other or- 4 ganized group or community, including any Alaska 5 Native village or group or regional or village cor- 6 poration as defined in or established pursuant to the 7 Alaska Native Claims Settlement Act (85 Stat. 688) 8 (43 U.S.C. 1601 et seq.), which is recognized as eli- 9 gible for the special programs and services provided 10 by the United States to Indians because of their sta- 11 tus as Indians. 12 ‘‘(10) INTEGRATED HEALTH CARE DELIVERY 13 SYSTEM.—The term ‘integrated health care delivery 14 system’ means an interdisciplinary system that 15 brings together providers from the primary health, 16 mental health, substance use and related disciplines 17 to improve the health outcomes of an individual. 18 Providers may include but are not limited to hos- 19 pitals, health, mental health or substance use clinics 20 and providers, home health agencies, ambulatory 21 surgery centers, skilled nursing facilities, rehabilita- 22 tion centers, and employed, independent, or con- 23 tracted physicians. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 51 •HR 5942 IH ‘‘(11) INDIVIDUAL WITH A DISABILITY.—The 1 term ‘individual with a disability’ means any indi- 2 vidual who has a disability as defined for the pur- 3 pose of section 504 of the Rehabilitation Act of 4 1973. Where this title references regulatory provi- 5 sions applicable to a ‘handicapped individual’, the 6 term ‘handicapped individual’ in such provisions 7 shall be treated to have the same meaning as the 8 term ‘individual with a disability’ as defined in this 9 section. 10 ‘‘(12) INDIVIDUAL WITH LIMITED-ENGLISH 11 PROFICIENCY.—The term ‘individual with limited- 12 English proficiency’ means an individual whose pri- 13 mary language for communication is not English 14 and who has a limited ability to read, write, speak, 15 or understand English. 16 ‘‘(13) INTERPRETING; INTERPRETATION.—The 17 terms ‘interpreting’ and ‘interpretation’ mean the 18 transmission of a spoken, written, or signed message 19 from one language or format into another, faithfully, 20 accurately, and objectively. 21 ‘‘(14) LANGUAGE ACCESS.—The term ‘language 22 access’ means the provision of language services to 23 an individual with limited-English proficiency or an 24 individual with communication disabilities designed 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 52 •HR 5942 IH to enhance that individual’s access to, understanding 1 of, or benefit from health care or health-care-related 2 services. 3 ‘‘(15) LANGUAGE ASSISTANCE SERVICES.—The 4 term ‘language assistance services’ includes— 5 ‘‘(A) oral language assistance, including in- 6 terpretation in non-English languages provided 7 in-person or remotely by a qualified interpreter 8 for an individual with limited-English pro- 9 ficiency, and the use of qualified bilingual or 10 multilingual staff to communicate directly with 11 individuals with limited-English proficiency; 12 ‘‘(B) written translation, performed by a 13 qualified translator, of written content in paper 14 or electronic form into languages other than 15 English; and 16 ‘‘(C) taglines. 17 ‘‘(16) MEDICARE, MEDICAID, AND SCHIP.—The 18 terms ‘Medicare’, ‘Medicaid’, and ‘SCHIP’ mean the 19 respective programs under titles XVIII, XIX, and 20 XXI of the Social Security Act. 21 ‘‘(17) MINORITY.— 22 ‘‘(A) IN GENERAL.—The terms ‘minority’ 23 and ‘minorities’ refer to individuals from a mi- 24 nority group. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 53 •HR 5942 IH ‘‘(B) POPULATIONS.—The term ‘minority’, 1 with respect to populations, refers to racial and 2 ethnic minority groups, members of sexual and 3 gender minority groups, and individuals with a 4 disability. 5 ‘‘(18) MINORITY GROUP.—The term ‘minority 6 group’ has the meaning given the term ‘racial and 7 ethnic minority group’. 8 ‘‘(19) QUALIFIED INTERPRETER FOR AN INDI- 9 VIDUAL WITH LIMITED-ENGLISH PROFICIENCY.— 10 The term ‘qualified interpreter for an individual with 11 limited-English proficiency’ means an interpreter 12 who via a remote interpreting service or an on-site 13 appearance— 14 ‘‘(A) adheres to generally accepted inter- 15 preter ethics principles, including client con- 16 fidentiality; 17 ‘‘(B) has demonstrated proficiency in 18 speaking and understanding both spoken 19 English and one or more other spoken lan- 20 guages; and 21 ‘‘(C) is able to interpret effectively, accu- 22 rately, and impartially, both receptively and ex- 23 pressly, to and from such languages and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 54 •HR 5942 IH English, using any necessary specialized vocab- 1 ulary, terminology, and phraseology. 2 ‘‘(20) QUALIFIED TRANSLATOR.—The term 3 ‘qualified translator’ means a translator who— 4 ‘‘(A) adheres to generally accepted trans- 5 lator ethics principles, including client confiden- 6 tiality; 7 ‘‘(B) has demonstrated proficiency in writ- 8 ing and understanding both written English 9 and one or more other written non-English lan- 10 guages; and 11 ‘‘(C) is able to translate effectively, accu- 12 rately, and impartially to and from such lan- 13 guages and English, using any necessary spe- 14 cialized vocabulary, terminology, and phrase- 15 ology. 16 ‘‘(21) 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 ‘‘(22) SEXUAL AND GENDER MINORITY 24 GROUP.—The term ‘sexual and gender minority 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 55 •HR 5942 IH group’ encompasses lesbian, gay, bisexual, and 1 transgender populations, as well as those whose sex- 2 ual orientation, gender identity and expression, or 3 reproductive development varies from traditional, so- 4 cietal, cultural, or physiological norms. 5 ‘‘(23) ONSITE INTERPRETATION.—The term 6 ‘onsite interpretation’ means a method of inter- 7 preting or interpretation for which the interpreter is 8 in the physical presence of the provider of health 9 care or health-care-related services and the recipient 10 of such services who is limited in English proficiency 11 or has a communication impairment such as hear- 12 ing, vision, or learning. 13 ‘‘(24) SECRETARY.—The term ‘Secretary’ 14 means the Secretary of Health and Human Services. 15 ‘‘(25) SIGHT TRANSLATION.—The term ‘sight 16 translation’ means the transmission of a written 17 message in one language into a spoken or signed 18 message in another language, or an alternative for- 19 mat in English or another language. 20 ‘‘(26) STATE.—The term ‘State’ means each of 21 the several States, the District of Columbia, the 22 Commonwealth of Puerto Rico, the Indian Tribes, 23 the United States Virgin Islands, Guam, American 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00055 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 56 •HR 5942 IH Samoa, and the Commonwealth of the Northern 1 Mariana Islands. 2 ‘‘(27) TELEPHONIC INTERPRETATION.—The 3 term ‘telephonic interpretation’ (also known as over 4 the phone interpretation or OPI) means a method of 5 interpretation for which the interpreter is not in the 6 physical presence of the provider of health care or 7 related services and the limited-English-proficient re- 8 cipient of such services but is connected via tele- 9 phone. 10 ‘‘(28) TRANSLATION.—The term ‘translation’ 11 means the transmission of a written message in one 12 language into a written or signed message in an- 13 other language, and includes translation into an- 14 other language or alternative format, such as large 15 print font, Braille, audio recording, or CD. 16 ‘‘(29) VIDEO REMOTE INTERPRETING SERV- 17 ICES.—The term ‘video remote interpreting services’ 18 means the provision, through a qualified interpreter 19 for an individual with limited-English proficiency, of 20 video remote interpreting services in health pro- 21 grams and activities. 22 ‘‘(A) in real-time, full-motion video, and 23 audio over a dedicated high-speed, wide-band- 24 width video connection or wireless connection 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 57 •HR 5942 IH that delivers high quality video images that do 1 not produce lags, choppy, blurry, or grainy im- 2 ages, or irregular pauses in communication; and 3 ‘‘(B) in a sharply delineated image that is 4 large enough to display. 5 ‘‘(30) VITAL DOCUMENT.—The term ‘vital doc- 6 ument’ includes but is not limited to applications for 7 government programs that provide health care serv- 8 ices, medical or financial consent forms, financial as- 9 sistance documents, letters containing important in- 10 formation regarding patient instructions (such as 11 prescriptions, referrals to other providers, and dis- 12 charge plans) and participation in a program (such 13 as a Medicaid managed care program), notices per- 14 taining to the reduction, denial, or termination of 15 services or benefits, notices of the right to appeal 16 such actions, and notices advising limited-English- 17 proficient individuals and individuals with commu- 18 nication disabilities of the availability of free lan- 19 guage services, alternative formats, and other out- 20 reach materials. 21 ‘‘SEC. 3401. IMPROVING ACCESS TO SERVICES FOR INDIVID- 22 UALS WITH LIMITED-ENGLISH PROFICIENCY. 23 ‘‘(a) PURPOSE.—As provided in Executive Order 24 13166, it is the purpose of this section— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 58 •HR 5942 IH ‘‘(1) to improve Federal agency performance re- 1 garding access to federally conducted and federally 2 assisted programs and activities for individuals who 3 are limited in their English proficiency; 4 ‘‘(2) to require each Federal agency to examine 5 the services it provides and develop and implement 6 a system by which limited-English-proficient individ- 7 uals can obtain cultural competence and meaningful 8 access to those services consistent with, and without 9 substantially burdening, the fundamental mission of 10 the agency; 11 ‘‘(3) to require each Federal agency to ensure 12 that recipients of Federal financial assistance pro- 13 vide cultural competence and meaningful access to 14 their limited-English-proficient applicants and bene- 15 ficiaries; 16 ‘‘(4) to ensure that recipients of Federal finan- 17 cial assistance take reasonable steps, consistent with 18 the guidelines set forth in the limited-English pro- 19 ficient Guidance of the Department of Justice (as 20 issued on June 12, 2002), to ensure cultural com- 21 petence and meaningful access to their programs 22 and activities by limited-English-proficient individ- 23 uals; and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 59 •HR 5942 IH ‘‘(5) to ensure compliance with title VI of the 1 Civil Rights Act of 1964 and that health care pro- 2 viders and organizations do not discriminate in the 3 provision of services. 4 ‘‘(b) FEDERALLY CONDUCTED PROGRAMS AND AC- 5 TIVITIES.— 6 ‘‘(1) IN GENERAL.—Not later than 120 days 7 after the date of enactment of this title, each Fed- 8 eral agency that carries out health-care-related ac- 9 tivities shall prepare a plan to improve access cul- 10 tural competence to the federally conducted, health- 11 care-related programs and activities of the agency by 12 limited-English-proficient individuals. Not later than 13 one year after the date of enactment of this title, 14 each such Federal agency shall ensure that such 15 plan is fully implemented. 16 ‘‘(2) PLAN REQUIREMENT.—Each plan under 17 paragraph (1) shall include— 18 ‘‘(A) the steps the agency will take to en- 19 sure that limited-English-proficient individuals 20 have access to the agency’s federally conducted 21 health care and health-care-related programs 22 and activities; 23 ‘‘(B) the policies and procedures for identi- 24 fying, assessing, and meeting the language 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00059 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 60 •HR 5942 IH needs and cultural competence needs of its lim- 1 ited-English-proficient beneficiaries served by 2 federally conducted programs and activities; 3 ‘‘(C) the steps the agency will take for its 4 federally conducted programs and activities to 5 improve cultural competence to provide a range 6 of language assistance options, notice to lim- 7 ited-English-proficient individuals of the right 8 to competent language services, periodic train- 9 ing of staff, monitoring and quality assessment 10 of the language services and, in appropriate cir- 11 cumstances, the translation of written mate- 12 rials; 13 ‘‘(D) the steps the agency will take to en- 14 sure that applications, forms, and other rel- 15 evant documents for its federally conducted pro- 16 grams and activities are competently translated 17 into the primary language of a limited-English- 18 proficient client where such materials are need- 19 ed to improve access to federally conducted and 20 federally assisted programs and activities for 21 such a limited-English-proficient individual; 22 ‘‘(E) the resources the agency will provide 23 to improve cultural competence to assist recipi- 24 ents of Federal funds to improve access to 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 61 •HR 5942 IH health care or health-care-related programs and 1 activities for limited-English-proficient individ- 2 uals; 3 ‘‘(F) the resources the agency will provide 4 to ensure that competent language assistance is 5 provided to limited-English-proficient patients 6 by interpreters or trained bilingual staff; and 7 ‘‘(G) the resources the agency will provide 8 to ensure that family, particularly minor chil- 9 dren, and friends are not used to provide inter- 10 pretation services, except— 11 ‘‘(i) in the case of a medical emer- 12 gency where delay directly associated with 13 obtaining a competent interpreter would 14 jeopardize the health of the patient; or 15 ‘‘(ii) on request of the patient, who 16 has been informed in his or her preferred 17 language of the availability of free inter- 18 pretation services, if the health care serv- 19 ices provider has determined that the fam- 20 ily or friend can provide competent inter- 21 preter services as defined in section 3400. 22 ‘‘(3) SUBMISSION OF PLAN TO DOJ.—Each 23 agency that is required to prepare a plan under 24 paragraph (1) shall send a copy of such plan to the 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 62 •HR 5942 IH Department of Justice, which shall serve as the cen- 1 tral repository of such plans. 2 ‘‘(4) RULE OF CONSTRUCTION.—Paragraph 3 (2)(G)(i) shall not be construed to mean that emer- 4 gency rooms or similar entities that regularly pro- 5 vide health care services in medical emergencies are 6 exempt from legal or regulatory requirements related 7 to competent interpreter services. 8 ‘‘(c) FEDERALLY ASSISTED PROGRAMS AND ACTIVI- 9 TIES.— 10 ‘‘(1) IN GENERAL.—Not later than 120 days 11 after the date of enactment of this title, each Fed- 12 eral agency providing health-care-related Federal fi- 13 nancial assistance shall ensure that the guidance for 14 recipients of Federal financial assistance developed 15 by the agency to ensure compliance with title VI of 16 the Civil Rights Act of 1964 (42 U.S.C. 2000d et 17 seq.) is specifically tailored to the recipients of such 18 assistance. Each agency shall send a copy of such 19 guidance to the Department of Justice which shall 20 serve as the central repository of the agency’s plans. 21 After approval by the Department of Justice, each 22 agency shall publish its guidance document in the 23 Federal Register for public comment. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00062 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 63 •HR 5942 IH ‘‘(2) REQUIREMENTS.—The agency-specific 1 guidance developed under paragraph (1) shall take 2 into account the types of health care services pro- 3 vided by the recipients, the individuals served by the 4 recipients, and other factors set out in such stand- 5 ards. 6 ‘‘(3) EXISTING GUIDANCES.—A Federal agency 7 that has developed a guidance for purposes of title 8 VI of the Civil Rights Act of 1964 shall examine 9 such existing guidance, as well as the programs and 10 activities to which such guidance applies, to deter- 11 mine if modification of such guidance is necessary to 12 comply with this subsection. 13 ‘‘(4) CONSULTATION.—Each Federal agency 14 shall consult with the Department of Justice in es- 15 tablishing the guidances under this subsection. 16 ‘‘(d) CONSULTATIONS.— 17 ‘‘(1) IN GENERAL.—In carrying out this sec- 18 tion, each Federal agency that carriers out health 19 care and health-care-related activities shall ensure 20 that stakeholders, such as limited-English-proficient 21 individuals and their representative organizations, 22 recipients of Federal assistance, and other appro- 23 priate individuals or entities, have an adequate op- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 64 •HR 5942 IH portunity to provide input with respect to the actions 1 of the agency. 2 ‘‘(2) EVALUATION.—Each Federal agency de- 3 scribed in paragraph (1) shall evaluate the— 4 ‘‘(A) particular needs of the limited- 5 English-proficient individuals served by the 6 agency; 7 ‘‘(B) particular needs of the limited- 8 English-proficient individuals served by the 9 agency’s recipients of Federal financial assist- 10 ance; and 11 ‘‘(C) burdens of compliance with the agen- 12 cy guidance and this section for the agency and 13 its recipients. 14 ‘‘SEC. 3402. NATIONAL STANDARDS FOR CULTURALLY AND 15 LINGUISTICALLY APPROPRIATE SERVICES IN 16 HEALTH CARE. 17 ‘‘(a) APPLICABILITY.—This section applies to any 18 health program or activity, any part of which is receiving 19 Federal financial assistance, including credits, subsidies, 20 or contracts of insurance, or any program or activity that 21 is administered by an executive agency or any entity estab- 22 lished under title I of the Patient Protection and Afford- 23 able Care Act (or amendments made thereby), as such 24 programs, activities, agencies, and entities are described 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 65 •HR 5942 IH in section 1557(a) of the Patient Protection and Afford- 1 able Care Act. 2 ‘‘(b) STANDARDS.—The programs, activities, agen- 3 cies, and entities described in subsection (a)— 4 ‘‘(1) shall implement strategies to recruit, re- 5 tain, and promote individuals at all levels to main- 6 tain a diverse staff and leadership that can provide 7 culturally and linguistically appropriate health care 8 to patient populations of the service area of the pro- 9 grams, activities, agencies, and entities; 10 ‘‘(2) shall educate and train governance, leader- 11 ship, and workforce at all levels and across all dis- 12 ciplines of the programs, activities, agencies, and en- 13 tities in culturally and linguistically appropriate poli- 14 cies and practices on an ongoing basis; 15 ‘‘(3) shall offer and provide language assist- 16 ance, including trained bilingual staff and inter- 17 preter services, to individuals who have limited- 18 English proficiency or other communication needs, 19 at no cost to them at all points of contact, and dur- 20 ing all hours of operation, to facilitate timely access 21 to all health care and services; 22 ‘‘(4) shall notify patients, in a culturally appro- 23 priate manner, of their right to receive language as- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 66 •HR 5942 IH sistance services in their primary language, verbally 1 and in writing; 2 ‘‘(5) shall not— 3 ‘‘(A) require an individual with limited- 4 English proficiency to provide his or her own 5 interpreter; 6 ‘‘(B) rely on an adult accompanying an in- 7 dividual with limited-English proficiency to in- 8 terpret or facilitate communication, except— 9 ‘‘(i) in an emergency involving an im- 10 minent threat to the safety or welfare of 11 an individual or the public where there is 12 no qualified interpreter for the individual 13 with limited-English proficiency imme- 14 diately available; or 15 ‘‘(ii) where the individual with limited- 16 English proficiency specifically requests 17 that the accompanying adult interpret or 18 facilitate communication, the accom- 19 panying adult agrees to provide such as- 20 sistance, and reliance on that adult for 21 such assistance is appropriate under the 22 circumstances; 23 ‘‘(C) rely on a minor child to interpret or 24 facilitate communication, except in an emer- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00066 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 67 •HR 5942 IH gency involving an imminent threat to the safe- 1 ty or welfare of an individual or the public 2 where there is no qualified interpreter for the 3 individual with limited-English proficiency im- 4 mediately available; or 5 ‘‘(D) rely on staff other than qualified bi- 6 lingual or multilingual staff to communicate di- 7 rectly with individuals; 8 ‘‘(6) shall for each eligible LEP language group 9 that constitutes 5 percent or 500 individuals, which- 10 ever is less, of the population of persons eligible to 11 be served or likely to be affected or encountered in 12 the service area of the organization, make avail- 13 able— 14 ‘‘(A) easily understood patient-related ma- 15 terials, including print and multimedia mate- 16 rials; 17 ‘‘(B) information or notices about termi- 18 nation of benefits; and 19 ‘‘(C) signage; 20 ‘‘(7) shall develop and implement clear goals, 21 policies, operational plans, and management, ac- 22 countability, and oversight mechanisms to provide 23 culturally and linguistically appropriate services and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 68 •HR 5942 IH infuse them throughout the organization’s planning 1 and operations; 2 ‘‘(8) shall conduct initial and ongoing organiza- 3 tional assessments of culturally and linguistically ap- 4 propriate services-related activities and integrate 5 valid linguistic, competence-related National Stand- 6 ards for Culturally and Linguistically Appropriate 7 Services (CLAS) measures into the internal audits, 8 performance improvement programs, patient satis- 9 faction assessments, continuous quality improvement 10 activities, and outcomes-based evaluations of the or- 11 ganization and develop ways to standardize the as- 12 sessments; 13 ‘‘(9) shall ensure that, consistent with the pri- 14 vacy protections provided for under the regulations 15 promulgated under section 264(c) of the Health In- 16 surance Portability and Accountability Act of 1996, 17 data on an individual required to be collected pursu- 18 ant to section 3101, including the individual’s alter- 19 native format preferences and policy modification 20 needs, are— 21 ‘‘(A) collected in health records; 22 ‘‘(B) integrated into the organization’s 23 management information systems; and 24 ‘‘(C) periodically updated; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00068 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 69 •HR 5942 IH ‘‘(10) shall maintain a current demographic, 1 cultural, and epidemiological profile of the commu- 2 nity, conduct regular assessments of community 3 health assets and needs, and use the results to accu- 4 rately plan for and implement services that respond 5 to the cultural and linguistic characteristics of the 6 service area of the organization; 7 ‘‘(11) shall develop participatory, collaborative 8 partnerships with communities and utilize a variety 9 of formal and informal mechanisms to facilitate 10 community and patient involvement in designing, 11 implementing, and evaluating policies and practices 12 to ensure culturally and linguistically appropriate 13 service-related activities; 14 ‘‘(12) shall ensure that conflict and grievance 15 resolution processes are culturally and linguistically 16 sensitive and capable of identifying, preventing, and 17 resolving cross-cultural conflicts or complaints by 18 patients; 19 ‘‘(13) shall regularly make available to the pub- 20 lic information about their progress and successful 21 innovations in implementing the standards under 22 this section and provide public notice in their com- 23 munities about the availability of this information; 24 and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 70 •HR 5942 IH ‘‘(14) shall, if requested, regularly make avail- 1 able to the head of each Federal entity from which 2 Federal funds are received, information about their 3 progress and successful innovations in implementing 4 the standards under this section as required by the 5 head of such entity. 6 ‘‘SEC. 3403. ROBERT T. MATSUI CENTER FOR CULTURAL 7 AND LINGUISTIC COMPETENCE IN HEALTH 8 CARE. 9 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 10 through the Director of the Agency for Healthcare Re- 11 search and Quality, shall establish and support a center 12 to be known as the ‘Robert T. Matsui Center for Cultural 13 and Linguistic Competence in Health Care’ (referred to 14 in this section as the ‘Center’) to carry out the following 15 activities: 16 ‘‘(1) INTERPRETATION SERVICES.—The Center 17 shall provide resources via the internet to identify 18 and link health care providers to competent inter- 19 preter and translation services. 20 ‘‘(2) TRANSLATION OF WRITTEN MATERIAL.— 21 ‘‘(A) The Center shall provide, directly or 22 through contract, vital documents from com- 23 petent translation services for providers of 24 health care and health-care-related services at 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 71 •HR 5942 IH no cost to such providers. Materials may be 1 submitted for translation into non-English lan- 2 guages. Translation services shall be provided 3 in a timely and reasonable manner. The quality 4 of such translation services shall be monitored 5 and reported publicly. 6 ‘‘(B) For each form developed or revised 7 by the Secretary that will be used by LEP indi- 8 viduals in health care or health-care-related set- 9 tings, the Center shall translate the form, at a 10 minimum, into the top 15 non-English lan- 11 guages in the United States according to the 12 most recent data from the American Commu- 13 nity Survey or its replacement. The translation 14 must be completed within 45 days of the Sec- 15 retary receiving final approval of the form from 16 the Office of Management and Budget. 17 ‘‘(3) TOLL-FREE CUSTOMER SERVICE TELE- 18 PHONE NUMBER.—The Center shall provide, 19 through a toll-free number, a customer service line 20 for LEP individuals— 21 ‘‘(A) to obtain information about federally 22 conducted or funded health programs, including 23 Medicare, Medicaid, and SCHIP; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00071 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 72 •HR 5942 IH ‘‘(B) to obtain assistance with applying for 1 or accessing these programs and understanding 2 Federal notices written in English; and 3 ‘‘(C) to learn how to access language serv- 4 ices. 5 ‘‘(4) HEALTH INFORMATION CLEARING- 6 HOUSE.— 7 ‘‘(A) IN GENERAL.—The Center shall de- 8 velop and maintain an information clearing- 9 house to facilitate the provision of language 10 services by providers of health care and health- 11 care-related services to reduce medical errors, 12 improve medical outcomes, to improve cultural 13 competence, reduce health care costs caused by 14 miscommunication with individuals with lim- 15 ited-English proficiency, and reduce or elimi- 16 nate the duplication of effort to translate mate- 17 rials. The clearinghouse shall make such infor- 18 mation available on the internet and in print. 19 Such information shall include the information 20 described in the succeeding provisions of this 21 paragraph. 22 ‘‘(B) DOCUMENT TEMPLATES.—The Cen- 23 ter shall collect and evaluate for accuracy, de- 24 velop, and make available templates for stand- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00072 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 73 •HR 5942 IH ard documents that are necessary for patients 1 and consumers to access and make educated de- 2 cisions about their health care, including the 3 following: 4 ‘‘(i) Administrative and legal docu- 5 ments, including— 6 ‘‘(I) intake forms; 7 ‘‘(II) Medicare, Medicaid, and 8 SCHIP forms, including eligibility in- 9 formation; 10 ‘‘(III) forms informing patient of 11 HIPAA compliance and consent; and 12 ‘‘(IV) documents concerning in- 13 formed consent, advanced directives, 14 and waivers of rights. 15 ‘‘(ii) Clinical information, such as how 16 to take medications, how to prevent trans- 17 mission of a contagious disease, and other 18 prevention and treatment instructions. 19 ‘‘(iii) Public health, patient education, 20 and outreach materials, such as immuniza- 21 tion notices, health warnings, or screening 22 notices. 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00073 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 74 •HR 5942 IH ‘‘(iv) Additional health or health-care- 1 related materials as determined appro- 2 priate by the Director of the Center. 3 ‘‘(C) STRUCTURE OF FORMS.—In oper- 4 ating the clearinghouse, the Center shall— 5 ‘‘(i) ensure that the documents posted 6 in English and non-English languages are 7 culturally appropriate; 8 ‘‘(ii) allow public review of the docu- 9 ments before dissemination in order to en- 10 sure that the documents are understand- 11 able and culturally appropriate for the tar- 12 get populations; 13 ‘‘(iii) allow health care providers to 14 customize the documents for their use; 15 ‘‘(iv) facilitate access to these docu- 16 ments; 17 ‘‘(v) provide technical assistance with 18 respect to the access and use of such infor- 19 mation; and 20 ‘‘(vi) carry out any other activities the 21 Secretary determines to be useful to fulfill 22 the purposes of the clearinghouse. 23 ‘‘(D) LANGUAGE ASSISTANCE PRO- 24 GRAMS.—The Center shall provide for the col- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00074 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 75 •HR 5942 IH lection and dissemination of information on cur- 1 rent examples of language assistance programs 2 and strategies to improve language services for 3 LEP individuals, including case studies using 4 de-identified patient information, program sum- 5 maries, and program evaluations. 6 ‘‘(E) CULTURAL AND LINGUISTIC COM- 7 PETENCE MATERIALS.—The Center shall pro- 8 vide information relating to culturally and lin- 9 guistically competent health care for minority 10 populations residing in the United States to all 11 health care providers and health-care-related 12 services at no cost. Such information shall in- 13 clude— 14 ‘‘(i) tenets of culturally and linguis- 15 tically competent care; 16 ‘‘(ii) cultural and linguistic com- 17 petence self-assessment tools; 18 ‘‘(iii) cultural and linguistic com- 19 petence training tools; 20 ‘‘(iv) strategic plans to increase cul- 21 tural and linguistic competence in different 22 types of providers of health care and 23 health-care-related services, including re- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00075 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 76 •HR 5942 IH gional collaborations among health care or- 1 ganizations; and 2 ‘‘(v) cultural and linguistic com- 3 petence information for educators, practi- 4 tioners, and researchers. 5 ‘‘(F) INFORMATION ABOUT PROGRESS.— 6 The Center shall regularly collect and make 7 publicly available information about the 8 progress of entities receiving grants under sec- 9 tion 3404 regarding successful innovations in 10 implementing the obligations under this sub- 11 section and provide public notice in the entities’ 12 communities about the availability of this infor- 13 mation. 14 ‘‘(b) DIRECTOR.—The Center shall be headed by a 15 Director who shall be appointed by, and who shall report 16 to, the Director of the Agency for Healthcare Research 17 and Quality. 18 ‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di- 19 rector shall collaborate with the Deputy Assistant Sec- 20 retary for Minority Health, the Administrator of the Cen- 21 ters for Medicare & Medicaid Services, and the Adminis- 22 trator of the Health Resources and Services Administra- 23 tion to notify health care providers and health care organi- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00076 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 77 •HR 5942 IH zations about the availability of language access services 1 by the Center. 2 ‘‘(d) EDUCATION.—The Secretary, directly or 3 through contract, shall undertake a national education 4 campaign to inform providers, LEP individuals, health 5 professionals, graduate schools, and community health 6 centers about— 7 ‘‘(1) Federal and State laws and guidelines gov- 8 erning access to language services; 9 ‘‘(2) the value of using trained interpreters and 10 the risks associated with using family members, 11 friends, minors, and untrained bilingual staff; 12 ‘‘(3) funding sources for developing and imple- 13 menting language services; and 14 ‘‘(4) promising practices to effectively provide 15 language services. 16 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—In ad- 17 dition to the amounts authorized under subsection 18 (e)(8)(F), there are authorized to be appropriated to carry 19 out this section $5,000,000 for each of fiscal years 2019 20 through 2023. 21 ‘‘SEC. 3404. INNOVATIONS IN CULTURAL AND LINGUISTIC 22 COMPETENCE GRANTS. 23 ‘‘(a) IN GENERAL.—The Secretary, acting through 24 the Director of the Agency for Healthcare Research and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00077 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 78 •HR 5942 IH Quality, shall award grants to eligible entities to enable 1 such entities to design, implement, and evaluate innova- 2 tive, cost-effective programs to improve cultural com- 3 petence and language access in health care for individuals 4 with limited-English proficiency. The Director of the 5 Agency for Healthcare Research and Quality shall coordi- 6 nate with, and ensure the participation of, other agencies 7 including the Health Resources and Services Administra- 8 tion, the Center on Minority Health and Health Dispari- 9 ties at the National Institutes of Health, and the Office 10 of Minority Health, regarding the design and evaluation 11 of the grants program. 12 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 13 under subsection (a) an entity shall— 14 ‘‘(1) be— 15 ‘‘(A) a city, county, Indian Tribe, State, 16 territory, or subdivision thereof; 17 ‘‘(B) an organization described in section 18 501(c)(3) of the Internal Revenue Code of 1986 19 and exempt from tax under section 501(a) of 20 such Code; 21 ‘‘(C) a community health, mental health, 22 or substance use center or clinic; 23 ‘‘(D) a solo or group physician practice; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 79 •HR 5942 IH ‘‘(E) an integrated health care delivery 1 system; 2 ‘‘(F) a public hospital; 3 ‘‘(G) a health care group, university, or 4 college; or 5 ‘‘(H) other entity designated by the Sec- 6 retary; and 7 ‘‘(2) prepare and submit to the Secretary an 8 application, at such time, in such manner, and ac- 9 companied by such additional information as the 10 Secretary may require. 11 ‘‘(c) USE OF FUNDS.—An entity shall use funds re- 12 ceived under a grant under this section to— 13 ‘‘(1) develop, implement, and evaluate models of 14 providing competent interpretation services through 15 onsite interpretation, telephonic interpretation, or 16 video interpretation; 17 ‘‘(2) implement strategies to recruit, retain, and 18 promote individuals at all levels of the organization 19 to maintain a diverse staff and leadership that can 20 promote and provide language services to patient 21 populations of the service area of the organization; 22 ‘‘(3) develop and maintain a needs assessment 23 that identifies the current demographic, cultural, 24 and epidemiological profile of the community to ac- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 80 •HR 5942 IH curately plan for and implement language services 1 needed in service area of the organization; 2 ‘‘(4) develop a strategic plan to implement lan- 3 guage services; 4 ‘‘(5) develop participatory, collaborative part- 5 nerships with communities encompassing the LEP 6 patient populations being served to gain input in de- 7 signing and implementing language services; 8 ‘‘(6) develop and implement grievance resolu- 9 tion processes that are culturally and linguistically 10 sensitive and capable of identifying, preventing, and 11 resolving complaints by LEP individuals; 12 ‘‘(7) develop short-term medical mental health 13 interpretation training courses and incentives for bi- 14 lingual health care staff who are asked to interpret 15 in the workplace; 16 ‘‘(8) develop formal training programs, includ- 17 ing continued professional development and edu- 18 cation programs as well as supervision, for individ- 19 uals interested in becoming dedicated health care in- 20 terpreters and culturally competent providers; 21 ‘‘(9) provide staff language training instruction, 22 which shall include information on the practical limi- 23 tations of such instruction for nonnative speakers; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 81 •HR 5942 IH ‘‘(10) develop policies that address compensa- 1 tion in salary for staff who receive training to be- 2 come either a staff interpreter or bilingual provider; 3 ‘‘(11) develop other language assistance services 4 as determined appropriate by the Secretary; 5 ‘‘(12) develop, implement, and evaluate models 6 of improving cultural competence, including cultural 7 competence programs for community health workers; 8 and 9 ‘‘(13) ensure that, consistent with the privacy 10 protections provided for under the regulations pro- 11 mulgated under section 264(c) of the Health Insur- 12 ance Portability and Accountability Act of 1996 (42 13 U.S.C. 1320d–2 note) and any applicable State pri- 14 vacy laws, data on the individual patient or recipi- 15 ent’s race, ethnicity, and primary language are col- 16 lected (and periodically updated) in health records 17 and integrated into the organization’s information 18 management systems or any similar system used to 19 store and retrieve data. 20 ‘‘(d) PRIORITY.—In awarding grants under this sec- 21 tion, the Secretary shall give priority to entities that pri- 22 marily engage in providing direct care and that have devel- 23 oped partnerships with community organizations or with 24 agencies with experience in improving language access. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00081 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 82 •HR 5942 IH ‘‘(e) EVALUATION.— 1 ‘‘(1) BY GRANTEES.—An entity that receives a 2 grant under this section shall submit to the Sec- 3 retary an evaluation that describes, in the manner 4 and to the extent required by the Secretary, the ac- 5 tivities carried out with funds received under the 6 grant, and how such activities improved access to 7 health and health-care-related services and the qual- 8 ity of health care for individuals with limited-English 9 proficiency. Such evaluation shall be collected and 10 disseminated through the Robert T. Matsui Center 11 for Cultural and Linguistic Competence in Health 12 Care established under section 3403. The Director 13 of the Agency for Healthcare Research and Quality 14 shall notify grantees of the availability of technical 15 assistance for the evaluation and provide such assist- 16 ance upon request. 17 ‘‘(2) BY SECRETARY.—The Director of the 18 Agency for Healthcare Research and Quality shall 19 evaluate or arrange with other individuals or organi- 20 zations to evaluate projects funded under this sec- 21 tion. 22 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 23 is authorized to be appropriated to carry out this section, 24 $5,000,000 for each of fiscal years 2019 through 2023. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 83 •HR 5942 IH ‘‘SEC. 3405. RESEARCH ON CULTURAL AND LANGUAGE COM- 1 PETENCE. 2 ‘‘(a) IN GENERAL.—The Secretary, acting through 3 the Director of the Agency for Healthcare Research and 4 Quality, shall expand research concerning language access 5 in the provision of health care. 6 ‘‘(b) ELIGIBILITY.—The Director of the Agency for 7 Healthcare Research and Quality may conduct the re- 8 search described in subsection (a) or enter into contracts 9 with other individuals or organizations to do so. 10 ‘‘(c) USE OF FUNDS.—Research under this section 11 shall be designed to do one or more of the following: 12 ‘‘(1) To identify the barriers to mental and be- 13 havioral services that are faced by LEP individuals. 14 ‘‘(2) To identify health care providers’ and 15 health administrators’ attitudes, knowledge, and 16 awareness of the barriers to quality health care serv- 17 ices that are faced by LEP individuals. 18 ‘‘(3) To identify optimal approaches for deliv- 19 ering language access. 20 ‘‘(4) To identify best practices for data collec- 21 tion, including— 22 ‘‘(A) the collection by providers of health 23 care and health-care-related services of data on 24 the race, ethnicity, and primary language of re- 25 cipients of such services, taking into account ex- 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00083 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 84 •HR 5942 IH isting research conducted by the Government or 1 private sector; 2 ‘‘(B) the development and implementation 3 of data collection and reporting systems; and 4 ‘‘(C) effective privacy safeguards for col- 5 lected data. 6 ‘‘(5) To develop a minimum data collection set 7 for primary language. 8 ‘‘(6) To evaluate the most effective ways in 9 which the Department can create or coordinate, and 10 then subsidize or otherwise fund telephonic interpre- 11 tation providers for health care providers, taking 12 into consideration, among other factors, the flexi- 13 bility necessary for such a system to accommodate 14 variations in— 15 ‘‘(A) provider type; 16 ‘‘(B) languages needed and their frequency 17 of use; 18 ‘‘(C) type of encounter; 19 ‘‘(D) time of encounter, including regular 20 business hours and after hours; and 21 ‘‘(E) location of encounter. 22 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 23 are authorized to be appropriated to carry out this section 24 $5,000,000 for each of fiscal years 2019 through 2023.’’. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00084 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 85 •HR 5942 IH SEC. 203. PILOT PROGRAM FOR IMPROVEMENT AND DE- 1 VELOPMENT OF STATE MEDICAL INTER- 2 PRETING SERVICES. 3 (a) GRANTS AUTHORIZED.—The Secretary shall 4 award one grant in accordance with this section to each 5 of three States to assist each such State in designing, im- 6 plementing, and evaluating a statewide program to provide 7 onsite interpreter services under Medicaid. 8 (b) GRANT PERIOD.—A grant awarded under this 9 section is authorized for a period of three fiscal years be- 10 ginning on October 1, 2019. 11 (c) PREFERENCE.—In awarding a grant under this 12 section, the Secretary shall give preference to a State— 13 (1) that has a high proportion of qualified LEP 14 enrollees, as determined by the Secretary; 15 (2) that has a large number of qualified LEP 16 enrollees, as determined by the Secretary; 17 (3) that has a high growth rate of the popu- 18 lation of LEP individuals, as determined by the Sec- 19 retary; and 20 (4) that has a population of qualified LEP en- 21 rollees that is linguistically diverse, requiring inter- 22 preter services in at least 200 non-English lan- 23 guages. 24 (d) USE OF FUNDS.—A State receiving a grant under 25 this section shall use the grant funds to— 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 86 •HR 5942 IH (1) ensure that all health care providers in the 1 State participating in the State plan under Medicaid 2 have access to onsite interpreter services, for the 3 purpose of enabling effective communication between 4 such providers and qualified LEP enrollees during 5 the furnishing of items and services and administra- 6 tive interactions; 7 (2) establish, expand, procure, or contract for— 8 (A) a statewide health care information 9 technology system that is designed to achieve 10 efficiencies and economies of scale with respect 11 to onsite interpreter services provided to health 12 care providers in the State participating in the 13 State plan under Medicaid; and 14 (B) an entity to administer such system, 15 the duties of which shall include— 16 (i) procuring and scheduling inter- 17 preter services for qualified LEP enrollees; 18 (ii) procuring and scheduling inter- 19 preter services for LEP individuals seeking 20 to enroll in the State plan under Medicaid; 21 (iii) ensuring that interpreters receive 22 payment for interpreter services rendered 23 under the system; and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00086 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 87 •HR 5942 IH (iv) consulting regularly with organi- 1 zations representing consumers, inter- 2 preters, and health care providers; and 3 (3) develop mechanisms to establish, improve, 4 and strengthen the competency of the medical inter- 5 pretation workforce that serves qualified LEP enroll- 6 ees in the State, including a national certification 7 process that is valid, credible, and vendor-neutral. 8 (e) APPLICATION.—To receive a grant under this sec- 9 tion, a State shall submit an application at such time and 10 containing such information as the Secretary may require, 11 which shall include the following: 12 (1) A description of the language access needs 13 of individuals in the State enrolled in the State plan 14 under Medicaid. 15 (2) A description of the extent to which the 16 program will— 17 (A) use the grant funds for the purposes 18 described in subsection (d); 19 (B) meet the health care needs of rural 20 populations of the State; and 21 (C) collect information that accurately 22 tracks the language services requested by con- 23 sumers as compared to the language services 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00087 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 88 •HR 5942 IH provided by health care providers in the State 1 participating in the State plan under Medicaid. 2 (3) A description of how the program will be 3 evaluated, including a proposal for collaboration with 4 organizations representing interpreters, consumers, 5 and LEP individuals. 6 (f) DEFINITIONS.—In this section: 7 (1) QUALIFIED LEP ENROLLEE.—The term 8 ‘‘qualified LEP enrollee’’ means an individual— 9 (A) who is limited-English proficient; and 10 (B) who is enrolled in a State plan under 11 Medicaid. 12 (2) STATE.—The term ‘‘State’’ has the mean- 13 ing given the term in section 1101(a)(1) of the So- 14 cial Security Act (42 U.S.C. 1301(a)(1)), for pur- 15 poses of title XIX of such Act. 16 (3) UNITED STATES.—The term ‘‘United 17 States’’ has the meaning given the term in section 18 1101(a)(2) of the Social Security Act (42 U.S.C. 19 1301(a)(2)), for purposes of title XIX of such Act. 20 (g) FUNDING.— 21 (1) AUTHORIZATION OF APPROPRIATIONS.— 22 There is authorized to be appropriated $5,000,000 23 to carry out this section. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00088 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 89 •HR 5942 IH (2) AVAILABILITY OF FUNDS.—The funds au- 1 thorized by paragraph (1) shall be available without 2 fiscal year limitation. 3 (3) INCREASED FEDERAL FINANCIAL PARTICI- 4 PATION.—Section 1903(a)(2)(E) of the Social Secu- 5 rity Act (42 U.S.C. 1396b(a)(2)(E)), as amended by 6 section 205(d)(1) of this Act, is further amended by 7 inserting ‘‘(or, in the case of a State receiving a 8 grant under section 203 of the Health Equity and 9 Accountability Act of 2018, 100 percent for each 10 quarter occurring during the grant period)’’ after 11 ‘‘90 percent’’. 12 (h) LIMITATION.—No Federal funds under this sec- 13 tion may be used to provide interpreter services from a 14 location outside the United States. 15 SEC. 204. TRAINING TOMORROW’S DOCTORS FOR CUL- 16 TURALLY AND LINGUISTICALLY APPRO- 17 PRIATE CARE: GRADUATE MEDICAL EDU- 18 CATION. 19 (a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec- 20 tion 1886(h)(4) of the Social Security Act (42 U.S.C. 21 1395ww(h)(4)) is amended by adding at the end the fol- 22 lowing new subparagraph: 23 ‘‘(L) TREATMENT OF CULTURALLY COM- 24 PETENCY TRAINING.—In determining a hos- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00089 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 90 •HR 5942 IH pital’s number of full-time equivalent residents 1 for purposes of this subsection, all the time that 2 is spent by an intern or resident in an approved 3 medical residency training program for edu- 4 cation and training in cultural competency and 5 linguistically appropriate service delivery shall 6 be counted toward the determination of full- 7 time equivalency.’’. 8 (b) INDIRECT MEDICAL EDUCATION.—Section 9 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 10 1395ww(d)(5)(B)) is amended— 11 (1) by redesignating the clause (x) added by 12 section 5505(b) of the Patient Protection and Af- 13 fordable Care Act as clause (xi); and 14 (2) by adding at the end the following new 15 clause: 16 ‘‘(xii) The provisions of subparagraph (L) of 17 subsection (h)(4) shall apply under this subpara- 18 graph in the same manner as they apply under such 19 subsection.’’. 20 (c) EFFECTIVE DATE.—The amendments made by 21 subsections (a) and (b) shall apply with respect to pay- 22 ments made to hospitals on or after the date that is one 23 year after the date of the enactment of this Act. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00090 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 91 •HR 5942 IH SEC. 205. FEDERAL REIMBURSEMENT FOR CULTURALLY 1 AND LINGUISTICALLY APPROPRIATE SERV- 2 ICES UNDER THE MEDICARE, MEDICAID, AND 3 STATE CHILDREN’S HEALTH INSURANCE 4 PROGRAMS. 5 (a) LANGUAGE ACCESS GRANTS FOR MEDICARE 6 PROVIDERS.— 7 (1) ESTABLISHMENT.— 8 (A) IN GENERAL.—Not later than 6 9 months after the date of the enactment of this 10 Act, the Secretary of Health and Human Serv- 11 ices, acting through the Centers for Medicare & 12 Medicaid Services and in consultation with the 13 Center for Medicare and Medicaid Innovation, 14 shall establish a demonstration program under 15 which the Secretary shall award grants to eligi- 16 ble Medicare service providers to improve com- 17 munication between such providers and Medi- 18 care beneficiaries who are English learners, in- 19 cluding beneficiaries who live in diverse and un- 20 derserved communities. 21 (B) APPLICATION OF INNOVATION 22 RULES.—The demonstration project under sub- 23 paragraph (A) shall be conducted in a manner 24 that is consistent with the applicable provisions 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00091 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 92 •HR 5942 IH of subsections (b), (c), and (d) of section 1115A 1 of the Social Security Act (42 U.S.C. 1315a). 2 (C) NUMBER OF GRANTS.—To the extent 3 practicable, the Secretary shall award not less 4 than 24 grants under this subsection. 5 (D) GRANT PERIOD.—Except as provided 6 under paragraph (2)(D), each grant awarded 7 under this subsection shall be for a 3-year pe- 8 riod. 9 (2) ELIGIBILITY REQUIREMENTS.—To be eligi- 10 ble for a grant under this subsection, an entity must 11 meet the following requirements: 12 (A) MEDICARE PROVIDER.—The entity 13 must be— 14 (i) a provider of services under part A 15 of title XVIII of the Social Security Act; 16 (ii) a provider of services under part 17 B of such title; 18 (iii) a Medicare Advantage organiza- 19 tion offering a Medicare Advantage plan 20 under part C of such title; or 21 (iv) a PDP sponsor offering a pre- 22 scription drug plan under part D of such 23 title. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00092 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 93 •HR 5942 IH (B) UNDERSERVED COMMUNITIES.—The 1 entity must serve a community that, with re- 2 spect to necessary language services for improv- 3 ing access and utilization of health care among 4 English learners, is disproportionally under- 5 served. 6 (C) APPLICATION.—The entity must pre- 7 pare and submit to the Secretary an applica- 8 tion, at such time, in such manner, and accom- 9 panied by such additional information as the 10 Secretary may require. 11 (D) REPORTING.—In the case of a grantee 12 that received a grant under this subsection in 13 a previous year, such grantee is only eligible for 14 continued payments under a grant under this 15 subsection if the grantee met the reporting re- 16 quirements under paragraph (9) for such year. 17 If a grantee fails to meet the requirement of 18 such paragraph for the first year of a grant, the 19 Secretary may terminate the grant and solicit 20 applications from new grantees to participate in 21 the demonstration program. 22 (3) DISTRIBUTION.—To the extent feasible, the 23 Secretary shall award— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00093 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 94 •HR 5942 IH (A) at least 6 grants to providers of serv- 1 ices described in paragraph (2)(A)(i); 2 (B) at least 6 grants to service providers 3 described in paragraph (2)(A)(ii); 4 (C) at least 6 grants to organizations de- 5 scribed in paragraph (2)(A)(iii); and 6 (D) at least 6 grants to sponsors described 7 in paragraph (2)(A)(iv). 8 (4) CONSIDERATIONS IN AWARDING GRANTS.— 9 (A) VARIATION IN GRANTEES.—In award- 10 ing grants under this subsection, the Secretary 11 shall select grantees to ensure the following: 12 (i) The grantees provide many dif- 13 ferent types of language services. 14 (ii) The grantees serve Medicare bene- 15 ficiaries who speak different languages, 16 and who, as a population, have differing 17 needs for language services. 18 (iii) The grantees serve Medicare 19 beneficiaries in both urban and rural set- 20 tings. 21 (iv) The grantees serve Medicare 22 beneficiaries in at least two geographic re- 23 gions, as defined by the Secretary. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00094 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 95 •HR 5942 IH (v) The grantees serve Medicare bene- 1 ficiaries in at least two large metropolitan 2 statistical areas with racial, ethnic, sexual, 3 gender, disability, and economically diverse 4 populations. 5 (B) PRIORITY FOR PARTNERSHIPS WITH 6 COMMUNITY ORGANIZATIONS AND AGENCIES.— 7 In awarding grants under this subsection, the 8 Secretary shall give priority to eligible entities 9 that have a partnership with— 10 (i) a community organization; or 11 (ii) a consortia of community organi- 12 zations, State agencies, and local agencies, 13 that has experience in providing language serv- 14 ices. 15 (5) USE OF FUNDS FOR COMPETENT LANGUAGE 16 SERVICES.— 17 (A) IN GENERAL.—Subject to subpara- 18 graph (E), a grantee may only use grant funds 19 received under this subsection to pay for the 20 provision of competent language services to 21 Medicare beneficiaries who are English learn- 22 ers. 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 96 •HR 5942 IH (B) COMPETENT LANGUAGE SERVICES DE- 1 FINED.—For purposes of this subsection, the 2 term ‘‘competent language services’’ means— 3 (i) interpreter and translation services 4 that— 5 (I) subject to the exceptions 6 under subparagraph (C)— 7 (aa) if the grantee operates 8 in a State that has statewide 9 health care interpreter standards, 10 meet the State standards cur- 11 rently in effect; or 12 (bb) if the grantee operates 13 in a State that does not have 14 statewide health care interpreter 15 standards, utilizes competent in- 16 terpreters who follow the Na- 17 tional Council on Interpreting in 18 Health Care’s Code of Ethics and 19 Standards of Practice; and 20 (II) that, in the case of inter- 21 preter services, are provided 22 through— 23 (aa) onsite interpretation; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00096 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 97 •HR 5942 IH (bb) telephonic interpreta- 1 tion; or 2 (cc) video interpretation; 3 and 4 (ii) the direct provision of health care 5 or health-care-related services by a com- 6 petent bilingual health care provider. 7 (C) EXCEPTIONS.—The requirements of 8 subparagraph (B)(i)(I) do not apply, with re- 9 spect to interpreter and translation services and 10 a grantee— 11 (i) in the case of a Medicare bene- 12 ficiary who is an English learner if— 13 (I) such beneficiary has been in- 14 formed, in the beneficiary’s primary 15 language, of the availability of free in- 16 terpreter and translation services and 17 the beneficiary instead requests that a 18 family member, friend, or other per- 19 son provide such services; and 20 (II) the grantee documents such 21 request in the beneficiary’s medical 22 record; or 23 (ii) in the case of a medical emergency 24 where the delay directly associated with ob- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00097 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 98 •HR 5942 IH taining a competent interpreter or trans- 1 lation services would jeopardize the health 2 of the patient. 3 Clause (ii) shall not be construed to exempt 4 emergency rooms or similar entities that regu- 5 larly provide health care services in medical 6 emergencies to patients who are English learn- 7 ers from any applicable legal or regulatory re- 8 quirements related to providing competent in- 9 terpreter and translation services without undue 10 delay. 11 (D) MEDICARE ADVANTAGE ORGANIZA- 12 TIONS AND PDP SPONSORS.—If a grantee is a 13 Medicare Advantage organization offering a 14 Medicare Advantage plan under part C of title 15 XVIII of the Social Security Act or a PDP 16 sponsor offering a prescription drug plan under 17 part D of such title, such entity must provide 18 at least 50 percent of the grant funds that the 19 entity receives under this subsection directly to 20 the entity’s network providers (including all 21 health providers and pharmacists) for the pur- 22 pose of providing support for such providers to 23 provide competent language services to Medi- 24 care beneficiaries who are English learners. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00098 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 99 •HR 5942 IH (E) ADMINISTRATIVE AND REPORTING 1 COSTS.—A grantee may use up to 10 percent of 2 the grant funds to pay for administrative costs 3 associated with the provision of competent lan- 4 guage services and for reporting required under 5 paragraph (9). 6 (6) DETERMINATION OF AMOUNT OF GRANT 7 PAYMENTS.— 8 (A) IN GENERAL.—Payments to grantees 9 under this subsection shall be calculated based 10 on the estimated numbers of Medicare bene- 11 ficiaries who are English learners in a grantee’s 12 service area utilizing— 13 (i) data on the numbers of English 14 learners who speak English less than ‘‘very 15 well’’ from the most recently available data 16 from the Bureau of the Census or other 17 State-based study the Secretary determines 18 likely to yield accurate data regarding the 19 number of such individuals in such service 20 area; or 21 (ii) data provided by the grantee, if 22 the grantee routinely collects data on the 23 primary language of the Medicare bene- 24 ficiaries that the grantee serves and the 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 100 •HR 5942 IH Secretary determines that the data is accu- 1 rate and shows a greater number of 2 English learners than would be estimated 3 using the data under clause (i). 4 (B) DISCRETION OF SECRETARY.—Subject 5 to subparagraph (C), the amount of payment 6 made to a grantee under this subsection may be 7 modified annually at the discretion of the Sec- 8 retary, based on changes in the data under sub- 9 paragraph (A) with respect to the service area 10 of a grantee for the year. 11 (C) LIMITATION ON AMOUNT.—The 12 amount of a grant made under this subsection 13 to a grantee may not exceed $500,000 for the 14 period under paragraph (1)(D). 15 (7) ASSURANCES.—Grantees under this sub- 16 section shall, as a condition of receiving a grant 17 under this subsection— 18 (A) ensure that clinical and support staff 19 receive appropriate ongoing education and 20 training in linguistically appropriate service de- 21 livery; 22 (B) ensure the linguistic competence of bi- 23 lingual providers; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 101 •HR 5942 IH (C) offer and provide appropriate language 1 services at no additional charge to each patient 2 who is an English learner for all points of con- 3 tact between the patient and the grantee, in a 4 timely manner during all hours of operation; 5 (D) notify Medicare beneficiaries of their 6 right to receive language services in their pri- 7 mary language; 8 (E) post signage in the primary languages 9 commonly used by the patient population in the 10 service area of the organization; and 11 (F) ensure that— 12 (i) primary language data are col- 13 lected for recipients of language services 14 and such data are consistent with stand- 15 ards developed under title XXXIV of the 16 Public Health Service Act, as added by 17 section 202 of this Act, to the extent such 18 standards are available upon the initiation 19 of the demonstration program; and 20 (ii) consistent with the privacy protec- 21 tions provided under the regulations pro- 22 mulgated pursuant to section 264(c) of the 23 Health Insurance Portability and Account- 24 ability Act of 1996 (42 U.S.C. 1320d–2 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00101 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 102 •HR 5942 IH note), if the recipient of language services 1 is a minor or is incapacitated, primary lan- 2 guage data are collected on the parent or 3 legal guardian of such recipient. 4 (8) NO COST SHARING.—Medicare beneficiaries 5 who are English learners shall not have to pay cost 6 sharing or co-payments for competent language serv- 7 ices provided under this demonstration program. 8 (9) REPORTING REQUIREMENTS FOR GRANT- 9 EES.—Not later than the end of each calendar year, 10 a grantee that receives funds under this subsection 11 in such year shall submit to the Secretary a report 12 that includes the following information: 13 (A) The number of Medicare beneficiaries 14 to whom competent language services are pro- 15 vided. 16 (B) The primary languages of those Medi- 17 care beneficiaries. 18 (C) The types of language services pro- 19 vided to such beneficiaries. 20 (D) Whether such language services were 21 provided by employees of the grantee or 22 through a contract with external contractors or 23 agencies. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00102 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 103 •HR 5942 IH (E) The types of interpretation services 1 provided to such beneficiaries, and the approxi- 2 mate length of time such service is provided to 3 such beneficiaries. 4 (F) The costs of providing competent lan- 5 guage services. 6 (G) An account of the training or accredi- 7 tation of bilingual staff, interpreters, and trans- 8 lators providing services funded by the grant 9 under this subsection. 10 (10) EVALUATION AND REPORT TO CON- 11 GRESS.—Not later than 1 year after the completion 12 of a 3-year grant under this subsection, the Sec- 13 retary shall conduct an evaluation of the demonstra- 14 tion program under this subsection and shall submit 15 to the Congress a report that includes the following: 16 (A) An analysis of the patient outcomes 17 and the costs of furnishing care to the Medicare 18 beneficiaries who are English learners partici- 19 pating in the project as compared to such out- 20 comes and costs for such Medicare beneficiaries 21 not participating, based on the data provided 22 under paragraph (9) and any other information 23 available to the Secretary. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00103 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 104 •HR 5942 IH (B) The effect of delivering language serv- 1 ices on— 2 (i) Medicare beneficiary access to care 3 and utilization of services; 4 (ii) the efficiency and cost effective- 5 ness of health care delivery; 6 (iii) patient satisfaction; 7 (iv) health outcomes; and 8 (v) the provision of culturally appro- 9 priate services provided to such bene- 10 ficiaries. 11 (C) The extent to which bilingual staff, in- 12 terpreters, and translators providing services 13 under such demonstration were trained or ac- 14 credited and the nature of accreditation or 15 training needed by type of provider, service, or 16 other category as determined by the Secretary 17 to ensure the provision of high-quality interpre- 18 tation, translation, or other language services to 19 Medicare beneficiaries if such services are ex- 20 panded pursuant to subsection (c) of section 21 1907 of this Act. 22 (D) Recommendations, if any, regarding 23 the extension of such project to the entire Medi- 24 care Program, subject to the provisions of sec- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00104 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 105 •HR 5942 IH tion 1115A(c) of the Social Security Act (42 1 U.S.C. 1315a(c)). 2 (11) APPROPRIATIONS.—There is appropriated 3 to carry out this subsection, in equal parts from the 4 Federal Hospital Insurance Trust Fund under sec- 5 tion 1817 of the Social Security Act (42 U.S.C. 6 1395i) and the Federal Supplementary Medical In- 7 surance Trust Fund under section 1841 of such Act 8 (42 U.S.C. 1395t), $16,000,000 for each fiscal year 9 of the demonstration program. 10 (12) ENGLISH LEARNER DEFINED.—In this 11 subsection, the term ‘‘English learner’’ has the 12 meaning given such term in section 8101(20) of the 13 Elementary and Secondary Education Act of 1965, 14 except that subparagraphs (A), (B), and (D) of such 15 section shall not apply. 16 (b) LANGUAGE SERVICES UNDER THE MEDICARE 17 PROGRAM.— 18 (1) INCLUSION AS RURAL HEALTH CLINIC 19 SERVICES.—Section 1861 of the Social Security Act 20 (42 U.S.C. 1395x) is amended— 21 (A) in subsection (aa)(1)— 22 (i) in subparagraph (B), by striking 23 ‘‘and’’ at the end; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 106 •HR 5942 IH (ii) by adding ‘‘and’’ at the end of 1 subparagraph (C); and 2 (iii) by inserting after subparagraph 3 (C) the following new subparagraph: 4 ‘‘(D) language assistance services as defined in 5 subsection (iii)(1),’’; and 6 (B) by adding at the end the following new 7 subsection: 8 ‘‘Language Assistance Services and Related Terms 9 ‘‘(iii)(1) The term ‘language assistance services’ has 10 the same meaning given the term ‘language or language 11 assistance services’ in section 3400 of the Public Health 12 Service Act. 13 ‘‘(2) The term ‘interpreter services’ has the meaning 14 given the term ‘qualified interpreter for an individual with 15 limited-English proficiency’ in section 3400(3) of the Pub- 16 lic Health Service Act. 17 ‘‘(3) The term ‘qualified interpreter for an individual 18 with limited-English proficiency’ means an interpreter who 19 via a remote interpreting service or an onsite appear- 20 ance— 21 ‘‘(A) adheres to generally accepted interpreter 22 ethics principles, including client confidentiality; 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00106 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 107 •HR 5942 IH ‘‘(B) has demonstrated proficiency in speaking 1 and understanding both spoken English and at least 2 one other spoken language; and 3 ‘‘(C) is able to interpret effectively, accurately, 4 and impartially and in a culturally competent man- 5 ner, both receptively and expressly, to and from such 6 language(s) and English, using any necessary spe- 7 cialized vocabulary, terminology, and phraseology. 8 ‘‘(4) The term ‘qualified translator’ means a trans- 9 lator who— 10 ‘‘(A) adheres to generally accepted translator 11 ethics principles, including client confidentiality; 12 ‘‘(B) has demonstrated proficiency in writing 13 and understanding both written English and at least 14 one other written non-English language; and 15 ‘‘(C) is able to translate effectively, accurately, 16 and impartially to and from such language(s) and 17 English, using any necessary specialized vocabulary, 18 terminology, and phraseology. 19 ‘‘(5) The term ‘English learner’ has the meaning 20 given such term in section 8101(20) of the Elementary 21 and Secondary Education Act of 1965, except that sub- 22 paragraphs (A), (B), and (D) of such section shall not 23 apply.’’. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 108 •HR 5942 IH (2) COVERAGE.—Section 1832(a)(2) of the So- 1 cial Security Act (42 U.S.C. 1395k(a)(2)) is amend- 2 ed— 3 (A) by striking ‘‘and’’ at the end of sub- 4 paragraph (I); 5 (B) by striking the period at the end of 6 subparagraph (J) and inserting ‘‘; and’’; and 7 (C) by adding at the end the following new 8 subparagraph: 9 ‘‘(K) language services (as defined in para- 10 graph (1) of section 1861(iii)) furnished by an 11 interpreter (as defined in paragraph (3) of such 12 section) or translator.’’. 13 (3) PAYMENT.—Section 1833(a) of the Social 14 Security Act (42 U.S.C. 1395l(a)) is amended— 15 (A) by striking ‘‘and’’ at the end of para- 16 graph (8); 17 (B) by striking the period at the end of 18 paragraph (9) and inserting ‘‘; and’’; and 19 (C) by inserting after paragraph (9) the 20 following new paragraph: 21 ‘‘(10) in the case of language services described 22 in section 1861(iii)(1), 100 percent of the reasonable 23 charges for such services, as determined in consulta- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00108 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 109 •HR 5942 IH tion with the Medicare Payment Advisory Commis- 1 sion; and’’. 2 (4) WAIVER OF BUDGET NEUTRALITY.—For 3 the 3-year period beginning on the date of enact- 4 ment of this section, the budget neutrality provision 5 of section 1848(c)(2)(B)(ii) of the Social Security 6 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 7 apply with respect to language services (as such 8 term is defined in section 1861(iii)(1) of such Act). 9 (c) MEDICARE PARTS C AND D.— 10 (1) IN GENERAL.—Medicare Advantage plans 11 under part C of the Social Security Act and pre- 12 scription drug plans under part D of such Act shall 13 comply with title VI of the Civil Rights Act of 1964 14 and section 1557 of the Patient Protection and Af- 15 fordable Care Act (42 U.S.C. 18116) to provide ef- 16 fective language services to enrollees of such plans. 17 (2) MEDICARE ADVANTAGE PLANS AND PRE- 18 SCRIPTION DRUG PLANS REPORTING REQUIRE- 19 MENT.—Section 1857(e) of the Social Security Act 20 (42 U.S.C. 1395w–27(e)) is amended by adding at 21 the end the following new paragraph: 22 ‘‘(5) REPORTING REQUIREMENTS RELATING TO 23 EFFECTIVE LANGUAGE SERVICES.—A contract under 24 this part shall require a Medicare Advantage organi- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 110 •HR 5942 IH zation (and, through application of section 1860D– 1 12(b)(3)(D), a contract under section 1860D–12 2 shall require a PDP sponsor) to annually submit 3 (for each year of the contract) a report that contains 4 information on the plan’s internal policies and proce- 5 dures related to recruitment and retention efforts di- 6 rected to workforce diversity and linguistically and 7 culturally appropriate provision of services in each of 8 the following contexts: 9 ‘‘(A) The collection of data in a manner 10 that meets the requirements of title I of the 11 Health Equity and Accountability Act of 2018, 12 regarding the enrollee population. 13 ‘‘(B) Education of staff and contractors 14 who have routine contact with enrollees regard- 15 ing the various needs of the diverse enrollee 16 population. 17 ‘‘(C) Evaluation of the health plan’s lan- 18 guage services programs and services with re- 19 spect to the plan’s enrollee population, such as 20 through analysis of complaints or satisfaction 21 survey results. 22 ‘‘(D) Methods by which the plan provides 23 to the Secretary information regarding the eth- 24 nic diversity of the plan’s enrollee population. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00110 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 111 •HR 5942 IH ‘‘(E) The periodic provision of educational 1 information to plan enrollees on the plan’s lan- 2 guage services and programs.’’. 3 (d) IMPROVING LANGUAGE SERVICES IN MEDICAID 4 AND CHIP.— 5 (1) PAYMENTS TO STATES.—Section 6 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 7 1396b(a)(2)(E)) is amended by— 8 (A) striking ‘‘75’’ and inserting ‘‘90’’; 9 (B) striking ‘‘translation or interpretation 10 services’’ and inserting ‘‘language services’’; 11 and 12 (C) striking ‘‘children of families’’ and in- 13 serting ‘‘individuals’’. 14 (2) STATE PLAN REQUIREMENTS.—Section 15 1902(a)(10)(A) of the Social Security Act (42 16 U.S.C. 1396a(a)(10)(A)) is amended by striking 17 ‘‘and (28)’’ and inserting ‘‘(28), and (29)’’. 18 (3) DEFINITION OF MEDICAL ASSISTANCE.— 19 Section 1905(a) of the Social Security Act (42 20 U.S.C. 1396d(a)) is amended by— 21 (A) in paragraph (28), by striking ‘‘and’’ 22 at the end; 23 (B) by redesignating paragraph (29) as 24 paragraph (30); and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00111 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 112 •HR 5942 IH (C) by inserting after paragraph (28) the 1 following new paragraph: 2 ‘‘(29) language services, as such term is defined 3 in section 1861(iii)(1), provided in a timely manner 4 to English learners (as defined in section 5 1861(iii)(5)) who need such services; and’’. 6 (4) USE OF DEDUCTIONS AND COST SHAR- 7 ING.—Section 1916(a)(2) of the Social Security Act 8 (42 U.S.C. 1396o(2)) is amended by— 9 (A) by striking ‘‘or’’ at the end of subpara- 10 graph (D); 11 (B) by striking ‘‘; and’’ at the end of sub- 12 paragraph (E) and inserting ‘‘, or’’; and 13 (C) by adding at the end the following new 14 subparagraph: 15 ‘‘(F) language services described in section 16 1905(a)(29); and’’. 17 (5) CHIP COVERAGE REQUIREMENTS.—Section 18 2103 of the Social Security Act (42 U.S.C. 1397cc) 19 is amended— 20 (A) in subsection (a), in the matter before 21 paragraph (1), by striking ‘‘and (7)’’ and in- 22 serting ‘‘(7), and (9)’’; and 23 (B) in subsection (c), by adding at the end 24 the following new paragraph: 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00112 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 113 •HR 5942 IH ‘‘(9) LANGUAGE SERVICES.—The child health 1 assistance provided to a targeted low-income child 2 shall include coverage of language services, as such 3 term is defined in section 1861(iii)(1), provided in a 4 timely manner to English learners (as defined in 5 section 1861(iii)(5)) who need such services.’’; and 6 (C) in subsection (e)(2)— 7 (i) in the heading, by striking ‘‘PRE- 8 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 9 (ii) by inserting ‘‘or subsection (c)(9)’’ 10 after ‘‘subsection (c)(1)(D)’’. 11 (6) DEFINITION OF CHILD HEALTH ASSIST- 12 ANCE.—Section 2110(a)(27) of the Social Security 13 Act (42 U.S.C. 1397jj) is amended by striking 14 ‘‘translation’’ and inserting ‘‘language services as 15 described in section 2103(c)(9)’’. 16 (7) STATE DATA COLLECTION.—Pursuant to 17 the reporting requirement described in section 18 2107(b)(1) of the Social Security Act (42 U.S.C. 19 1397gg(b)(1)), the Secretary of Health and Human 20 Services shall require that States collect data on— 21 (A) the primary language of individuals re- 22 ceiving child health assistance under title XXI 23 of the Social Security Act; and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00113 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 114 •HR 5942 IH (B) in the case of such individuals who are 1 minors or incapacitated, the primary language 2 of the individual’s parent or guardian. 3 (8) CHIP PAYMENTS TO STATES.—Section 4 2105 of the Social Security Act (42 U.S.C. 5 1397ee(c)) is amended— 6 (A) in subsection (a)(1), by striking ‘‘75’’ 7 and inserting ‘‘90’’; and 8 (B) in subsection (c)(2)(A), by inserting 9 before the period at the end the following: ‘‘, 10 except that expenditures pursuant to clause (iv) 11 of subparagraph (D) of such paragraph shall 12 not count towards this total’’. 13 (e) FUNDING LANGUAGE SERVICES FURNISHED BY 14 PROVIDERS OF HEALTH CARE AND HEALTH-CARE-RE- 15 LATED SERVICES THAT SERVE HIGH RATES OF UNIN- 16 SURED LEP INDIVIDUALS.— 17 (1) PAYMENT OF COSTS.— 18 (A) IN GENERAL.—Subject to subpara- 19 graph (B), the Secretary of Health and Human 20 Services shall make payments (on a quarterly 21 basis) directly to eligible entities to support the 22 provision of language services to English learn- 23 ers in an amount equal to an eligible entity’s el- 24 igible costs for such services for the quarter. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00114 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 115 •HR 5942 IH (B) FUNDING.—Out of any funds in the 1 Treasury not otherwise appropriated, there are 2 appropriated to the Secretary of Health and 3 Human Services such sums as may be nec- 4 essary for each of fiscal years 2017 through 5 2021. 6 (C) RELATION TO MEDICAID DSH.—Pay- 7 ments under this subsection shall not offset or 8 reduce payments under section 1923 of the So- 9 cial Security Act, nor shall payments under 10 such section be considered when determining 11 uncompensated costs associated with the provi- 12 sion of language services. 13 (2) METHODOLOGY FOR PAYMENT OF 14 CLAIMS.— 15 (A) IN GENERAL.—The Secretary shall es- 16 tablish a methodology to determine the average 17 per person cost of language services. 18 (B) DIFFERENT ENTITIES.—In estab- 19 lishing such methodology, the Secretary may es- 20 tablish different methodologies for different 21 types of eligible entities. 22 (C) NO INDIVIDUAL CLAIMS.—The Sec- 23 retary may not require eligible entities to sub- 24 mit individual claims for language services for 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00115 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 116 •HR 5942 IH individual patients as a requirement for pay- 1 ment under this subsection. 2 (3) DATA COLLECTION INSTRUMENT.—For pur- 3 poses of this subsection, the Secretary shall create a 4 standard data collection instrument that is con- 5 sistent with any existing reporting requirements by 6 the Secretary or relevant accrediting organizations 7 regarding the number of individuals to whom lan- 8 guage access are provided. 9 (4) GUIDELINES.—Not later than 6 months 10 after the date of enactment of this Act, the Sec- 11 retary of Health and Human Services shall establish 12 and distribute guidelines concerning the implementa- 13 tion of this subsection. 14 (5) REPORTING REQUIREMENTS.— 15 (A) REPORT TO SECRETARY.—Entities re- 16 ceiving payment under this subsection shall pro- 17 vide the Secretary with a quarterly report on 18 how the entity used such funds. Such report 19 shall contain aggregate (and may not contain 20 individualized) data collected using the instru- 21 ment under paragraph (3) and shall otherwise 22 be in a form and manner determined by the 23 Secretary. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00116 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 117 •HR 5942 IH (B) REPORT TO CONGRESS.—Not later 1 than 2 years after the date of enactment of this 2 Act, and every 2 years thereafter, the Secretary 3 shall submit a report to Congress concerning 4 the implementation of this subsection. 5 (6) DEFINITIONS.—In this subsection: 6 (A) ELIGIBLE COSTS.—The term ‘‘eligible 7 costs’’ means, with respect to an eligible entity 8 that provides language services to English 9 learners, the product of— 10 (i) the average per person cost of lan- 11 guage services, determined according to 12 the methodology devised under paragraph 13 (2); and 14 (ii) the number of English learners 15 who are provided language services by the 16 entity and for whom no reimbursement is 17 available for such services under the 18 amendments made by subsections (a), (b), 19 (c), or (d) or by private health insurance. 20 (B) ELIGIBLE ENTITY.—The term ‘‘eligible 21 entity’’ means an entity that— 22 (i) is a Medicaid provider that is— 23 (I) a physician; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00117 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 118 •HR 5942 IH (II) a hospital with a low-income 1 utilization rate (as defined in section 2 1923(b)(3) of the Social Security Act 3 (42 U.S.C. 1396r–4(b)(3))) of greater 4 than 25 percent; or 5 (III) a federally qualified health 6 center (as defined in section 7 1905(l)(2)(B) of the Social Security 8 Act (42 U.S.C. 1396d(l)(2)(B))); 9 (ii) provide language services to at 10 least 8 percent of the entity’s total number 11 of patients, not later than 6 months after 12 the date of the enactment of the Act; and 13 (iii) prepare and submit an applica- 14 tion to the Secretary, at such time, in such 15 manner, and accompanied by such infor- 16 mation as the Secretary may require to as- 17 certain the entity’s eligibility for funding 18 under this subsection. 19 (C) ENGLISH LEARNER.—The term 20 ‘‘English learner’’ has the meaning given such 21 term in section 8101(20) of the Elementary 22 and Secondary Education Act of 1965, except 23 that subparagraphs (A), (B), and (D) of such 24 section shall not apply. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 119 •HR 5942 IH (D) LANGUAGE SERVICES.—The term 1 ‘‘language services’’ has the meaning given such 2 term in section 1861(iii)(1) of the Social Secu- 3 rity Act. 4 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964 AND 5 OTHER LAWS.—Nothing in this section shall be construed 6 to limit otherwise existing obligations of recipients of Fed- 7 eral financial assistance under title VI of the Civil Rights 8 Act of 1964 (42 U.S.C. 2000(d) et seq.) or other laws 9 that protect the civil rights of individuals. 10 (g) EFFECTIVE DATE.— 11 (1) IN GENERAL.—Except as otherwise pro- 12 vided and subject to paragraph (2), the amendments 13 made by this section shall take effect on January 1, 14 2017. 15 (2) EXCEPTION IF STATE LEGISLATION RE- 16 QUIRED.—In the case of a State plan for medical as- 17 sistance under title XIX of the Social Security Act 18 which the Secretary of Health and Human Services 19 determines requires State legislation (other than leg- 20 islation appropriating funds) in order for the plan to 21 meet the additional requirement imposed by the 22 amendments made by this section, the State plan 23 shall not be regarded as failing to comply with the 24 requirements of such title solely on the basis of its 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00119 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 120 •HR 5942 IH failure to meet this additional requirement before 1 the first day of the first calendar quarter beginning 2 after the close of the first regular session of the 3 State legislature that begins after the date of the en- 4 actment of this Act. For purposes of the previous 5 sentence, in the case of a State that has a 2-year 6 legislative session, each year of such session shall be 7 deemed to be a separate regular session of the State 8 legislature. 9 SEC. 206. INCREASING UNDERSTANDING OF AND IMPROV- 10 ING HEALTH LITERACY. 11 (a) IN GENERAL.—The Secretary, acting through the 12 Director of the Agency for Healthcare Research and Qual- 13 ity and the Administrator of the Health Resources and 14 Services Administration, in consultation with the Director 15 of the National Institute on Minority Health and Health 16 Disparities and the Deputy Assistant Secretary for Minor- 17 ity Health, shall award grants to eligible entities to im- 18 prove health care for patient populations that have low 19 functional health literacy. 20 (b) ELIGIBILITY.—To be eligible to receive a grant 21 under subsection (a), an entity shall— 22 (1) be a hospital, health center or clinic, health 23 plan, or other health entity (including a nonprofit 24 minority health organization or association); and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00120 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 121 •HR 5942 IH (2) prepare and submit to the Secretary an ap- 1 plication at such time, in such manner, and con- 2 taining such information as the Secretary may re- 3 quire. 4 (c) USE OF FUNDS.— 5 (1) AGENCY FOR HEALTHCARE RESEARCH AND 6 QUALITY.—Grants awarded under subsection (a) 7 through the Agency for Healthcare Research and 8 Quality shall be used— 9 (A) to define and increase the under- 10 standing of health literacy; 11 (B) to investigate the correlation between 12 low health literacy and health and health care; 13 (C) to clarify which aspects of health lit- 14 eracy have an effect on health outcomes; and 15 (D) for any other activity determined ap- 16 propriate by the Director of the Agency. 17 (2) HEALTH RESOURCES AND SERVICES ADMIN- 18 ISTRATION.—Grants awarded under subsection (a) 19 through the Health Resources and Services Adminis- 20 tration shall be used to conduct demonstration 21 projects for interventions for patients with low 22 health literacy that may include— 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00121 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 122 •HR 5942 IH (A) the development of new disease man- 1 agement programs for patients with low health 2 literacy; 3 (B) the tailoring of existing disease man- 4 agement programs addressing mental, physical, 5 oral, and behavioral health conditions for pa- 6 tients with low health literacy; 7 (C) the translation of written health mate- 8 rials for patients with low health literacy; 9 (D) the identification, implementation, and 10 testing of low health literacy screening tools; 11 (E) the conduct of educational campaigns 12 for patients and providers about low health lit- 13 eracy; and 14 (F) other activities determined appropriate 15 by the Administrator of the Health Resources 16 and Services Administration. 17 (d) DEFINITIONS.—In this section, the term ‘‘low 18 health literacy’’ means the inability of an individual to ob- 19 tain, process, and understand basic health information 20 and services needed to make appropriate health decisions. 21 (e) 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 2019 through 2023. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 123 •HR 5942 IH SEC. 207. ASSURANCES FOR RECEIVING FEDERAL FUNDS. 1 (a) IN GENERAL.—Any health program or activity, 2 any part of which is receiving Federal financial assistance, 3 including credits, subsidies, or contracts of insurance, and 4 any program or activity that is administered by an execu- 5 tive agency or any entity established under title I of the 6 Patient Protection and Affordable Care Act (or amend- 7 ments made thereby), as such programs, activities, agen- 8 cies, and entities are described in section 1557(a) of the 9 Patient Protection and Affordable Care Act (42 U.S.C. 10 18116), in order to ensure the right of LEP individuals 11 to receive access to quality health care, shall— 12 (1) ensure that appropriate clinical and support 13 staff receive ongoing education and training in lin- 14 guistically appropriate service delivery; 15 (2) offer and provide appropriate language as- 16 sistance services at no additional charge to each pa- 17 tient with limited-English-proficiency at all points of 18 contact, in a timely manner during all hours of oper- 19 ation; 20 (3) notify patients of their right to receive lan- 21 guage services in their primary language; and 22 (4) utilize only qualified interpreters for an in- 23 dividual with limited-English proficiency or qualified 24 translators, as defined in section 3400 of the Public 25 Health Service Act. 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00123 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 124 •HR 5942 IH (b) EXEMPTIONS.—The requirements of subsection 1 (a)(4) shall not apply as follows: 2 (1) When a patient (who has been informed in 3 his or her primary language of the availability of 4 free interpreter and translation services) requests 5 the use of family, friends, or other persons untrained 6 in interpretation or translation if the following con- 7 ditions are met: 8 (A) The interpreter requested by the pa- 9 tient is over the age of 18. 10 (B) The recipient informs the patient that 11 he or she has the option of having the recipient 12 provide an interpreter for him or her without 13 charge, or of using his or her own interpreter. 14 (C) The recipient informs the patient that 15 the recipient may not require an LEP person to 16 use a family member or friend as an inter- 17 preter. 18 (D) The recipient evaluates whether the 19 person the patient wishes to use as an inter- 20 preter is competent. If the recipient has reason 21 to believe that the interpreter is not competent, 22 the recipient provides the recipient’s own inter- 23 preter to protect the recipient from liability if 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00124 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 125 •HR 5942 IH the patient’s interpreter is later found not com- 1 petent. 2 (E) If the recipient has reason to believe 3 that there is a conflict of interest between the 4 interpreter and patient, the recipient may not 5 use the patient’s interpreter. 6 (F) The recipient has the patient sign a 7 waiver, witnessed by at least 1 individual not 8 related to the patient, that includes the infor- 9 mation stated in subparagraphs (A) through 10 (E) and is translated into the patient’s lan- 11 guage. 12 (2) When a medical emergency exists and the 13 delay directly associated with obtaining competent 14 interpreter or translation services would jeopardize 15 the health of the patient, but only until a competent 16 interpreter or translation service is available. 17 (c) RULE OF CONSTRUCTION.—Subsection (b)(2) 18 shall not be construed to mean that emergency rooms or 19 similar entities that regularly provide health care services 20 in medical emergencies are exempt from legal or regu- 21 latory requirements related to competent interpreter serv- 22 ices. 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00125 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 126 •HR 5942 IH SEC. 208. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL- 1 TURALLY AND LINGUISTICALLY APPRO- 2 PRIATE HEALTH CARE SERVICES. 3 (a) REPORT.—Not later than 1 year after the date 4 of enactment of this Act and annually thereafter, the Sec- 5 retary of Health and Human Services shall enter into a 6 contract with the National Academy of Medicine for the 7 preparation and publication of a report that describes 8 Federal efforts to ensure that all individuals with limited- 9 English proficiency have meaningful access culturally com- 10 petent to health care and health-care-related services. 11 Such report shall include— 12 (1) a description and evaluation of the activities 13 carried out under this Act; 14 (2) a description and analysis of best practices, 15 model programs, guidelines, and other effective 16 strategies for providing access to culturally and lin- 17 guistically appropriate health care services; 18 (3) recommendations on the development and 19 implementation of policies and practices by providers 20 of health care and health-care-related services for 21 limited-English-proficient individuals; 22 (4) recommend guidelines or standards for 23 health literacy and plain language, informed consent, 24 discharge instructions, and written communications, 25 and for improvement of health care access; 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00126 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 127 •HR 5942 IH (5) a description of the effect of providing lan- 1 guage services on quality of health care and access 2 to care; and 3 (6) a description of the costs associated with or 4 savings related to the provision of language services. 5 (b) AUTHORIZATION OF APPROPRIATIONS.—There 6 are authorized to be appropriated to carry out this section 7 such sums as may be necessary for each of fiscal years 8 2019 through 2023. 9 SEC. 209. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES. 10 (a) GRANTS AUTHORIZED.—The Secretary of Edu- 11 cation is authorized to provide grants to eligible entities 12 for the provision of English as a second language (in this 13 section referred to ‘‘ESL’’) instruction and shall deter- 14 mine, after consultation with appropriate stakeholders, the 15 mechanism for administering and distributing such 16 grants. 17 (b) ELIGIBLE ENTITY DEFINED.—For purposes of 18 this section, the term ‘‘eligible entity’’ means a State or 19 community-based organization that employs, and serves, 20 minority populations. 21 (c) APPLICATION.—An eligible entity may apply for 22 a grant under this section by submitting such information 23 as the Secretary may require and in such form and man- 24 ner as the Secretary may require. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00127 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 128 •HR 5942 IH (d) USE OF GRANT.—As a condition of receiving a 1 grant under this section, an eligible entity shall— 2 (1) develop and implement a plan for assuring 3 the availability of ESL instruction that effectively 4 integrates information about the nature of the 5 United States health care system, how to access 6 care, and any special language skills that may be re- 7 quired for them to access and regularly negotiate the 8 system effectively; 9 (2) develop a plan, including, where appro- 10 priate, public-private partnerships, for making ESL 11 instruction progressively available to all individuals 12 seeking instruction; and 13 (3) maintain current ESL instruction efforts by 14 using the additional funds to supplement rather 15 than supplant any funds expended for ESL instruc- 16 tion in the State as of January 1, 2019. 17 (e) ADDITIONAL DUTIES OF THE SECRETARY.—The 18 Secretary of Education shall— 19 (1) collect and publicize annual data on how 20 much Federal, State, and local governments spend 21 on ESL instruction; 22 (2) collect data from State and local govern- 23 ments to identify the unmet needs of English lan- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00128 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 129 •HR 5942 IH guage learners for appropriate ESL instruction, in- 1 cluding— 2 (A) the preferred written and spoken lan- 3 guage of such English language learners; 4 (B) the extent of waiting lists including 5 how many programs maintain waiting lists and, 6 for programs that do not have waiting lists, the 7 reasons why not; 8 (C) the availability of programs to geo- 9 graphically isolated communities; 10 (D) the impact of course enrollment poli- 11 cies, including open enrollment, on the avail- 12 ability of ESL instruction; 13 (E) the number individuals in the State 14 and each participating locality; 15 (F) the effectiveness of the instruction in 16 meeting the needs of individuals receiving in- 17 struction and those needing instruction; 18 (G) as assessment of the need for pro- 19 grams that integrate job training and ESL in- 20 struction, to assist individuals to obtain better 21 jobs; and 22 (H) the availability of ESL slots by State 23 and locality; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00129 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 130 •HR 5942 IH (3) determine the cost and most appropriate 1 methods of making ESL instruction available to all 2 English language learners seeking instruction; and 3 (4) not later than 1 year after the date of en- 4 actment of this Act, issue a report to Congress that 5 assesses the information collected in paragraphs (1), 6 (2), and (3) and makes recommendations on steps 7 that should be taken to progressively realize the goal 8 of making ESL instruction available to all English 9 language learners seeking instruction. 10 (f) AUTHORIZATION OF APPROPRIATIONS.—There 11 are authorized to be appropriated to the Secretary of Edu- 12 cation $250,000,000 for each of fiscal years 2019 through 13 2022 to carry out this section. 14 SEC. 210. IMPLEMENTATION. 15 (a) GENERAL PROVISIONS.— 16 (1) A State shall not be immune under the 17 Eleventh Amendment of the Constitution of the 18 United States from suit in Federal court for failing 19 to provide the language access funded pursuant to 20 this title. 21 (2) In a suit against a State for a violation of 22 this title, remedies (including remedies at both at 23 law and in equity) are available for such a violation 24 to the same extent as such remedies are available for 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00130 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 131 •HR 5942 IH such a violation in the suit against any public or pri- 1 vate entity other than a State. 2 (b) RULE OF CONSTRUCTION.—Nothing in this title 3 shall be construed to limit otherwise existing obligations 4 of recipients of Federal financial assistance under title VI 5 of the Civil Rights Act of 1964 (42 U.S.C. 2000(d) et 6 seq.) or any other statute. 7 SEC. 211. LANGUAGE ACCESS SERVICES. 8 (a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 9 the Patient Protection and Affordable Care Act (42 10 U.S.C. 18022(b)(1)) is amended by adding at the end the 11 following: 12 ‘‘(K) Language access services, including 13 oral interpretation and written translations.’’. 14 (b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL 15 COVERAGE.— 16 (1) IN GENERAL.—Section 36B(c)(2)(C) of the 17 Internal Revenue Code of 1986 is amended by redes- 18 ignating clauses (iii) and (iv) as clauses (iv) and (v), 19 respectively, and by inserting after clause (ii) the fol- 20 lowing new clause: 21 ‘‘(iii) COVERAGE MUST INCLUDE LAN- 22 GUAGE ACCESS AND SERVICES.—Except as 23 provided in clause (iv), an employee shall 24 not be treated as eligible for minimum es- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00131 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 132 •HR 5942 IH sential coverage if such coverage consists 1 of an eligible employer-sponsored plan (as 2 defined in section 5000A(f)(2)) and the 3 plan does not provide coverage for lan- 4 guage access services, including oral inter- 5 pretation and written translations.’’. 6 (2) CONFORMING AMENDMENTS.— 7 (A) Section 36B(c)(2)(C) of such Code is 8 amended by striking ‘‘clause (iii)’’ each place it 9 appears in clauses (i) and (ii) and inserting 10 ‘‘clause (iv)’’. 11 (B) Section 36B(c)(2)(C)(iv) of such Code, 12 as redesignated by this subsection, is amended 13 by striking ‘‘(i) and (ii)’’ and inserting ‘‘(i), (ii), 14 and (iii)’’. 15 (c) QUALITY REPORTING.—Section 2717(a)(1) of the 16 Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 17 amended— 18 (1) by striking ‘‘and’’ at the end of subpara- 19 graph (C); 20 (2) by striking the period at the end of sub- 21 paragraph (D) and inserting ‘‘; and’’; and 22 (3) by adding at the end the following new sub- 23 paragraph: 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00132 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 133 •HR 5942 IH ‘‘(E) reduce health disparities through the 1 provision of language access services, including 2 oral interpretation and written translations.’’. 3 (d) REGULATIONS REGARDING INTERNAL CLAIMS 4 AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR 5 HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 6 The Secretary of the Treasury, the Secretary of Labor, 7 and the Secretary of Health and Human Services shall 8 amend the regulations in section 54.9815–2719T(e) of 9 title 26, Code of Federal Regulations, section 2590.715– 10 2719(e) of title 29, Code of Federal Regulations, and sec- 11 tion 147.136(e) of title 45, Code of Federal Regulations, 12 respectively, to require group health plans and health in- 13 surance issuers offering group or individual health insur- 14 ance coverage to which such sections apply— 15 (1) to provide oral interpretation services with- 16 out any threshold requirements; 17 (2) to provide in the English versions of all no- 18 tices a statement prominently displayed in not less 19 than 15 non-English languages clearly indicating 20 how to access the language services provided by the 21 plan or issuer; and 22 (3) with respect to written translations of no- 23 tices, to apply a threshold that 5 percent of the pop- 24 ulation or at least 500 individuals per service area 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00133 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 134 •HR 5942 IH are literate only in the same non-English language 1 in lieu of 10 percent or more residing in a county. 2 (e) DATA COLLECTION AND REPORTING.—The Sec- 3 retary of Health and Human Services shall— 4 (1) amend the single streamlined application 5 form developed pursuant to section 1413 of the Pa- 6 tient Protection and Affordable Care Act (42 U.S.C. 7 18083) to collect the preferred spoken and written 8 language for each household member applying for 9 coverage under a qualified health plan through an 10 Exchange under title I of the Patient Protection and 11 Affordable Care Act; 12 (2) require navigators, certified application 13 counselors, and other enrollment assisters to collect 14 and report requests for language assistance; and 15 (3) require the Federal and State call centers 16 established pursuant to section 1311(d)(4)(b) of the 17 Patient Protection and Affordable Care Act (42 18 U.S.C. 18031(d)(4)(b)) to submit an annual report 19 documenting the number of language assistance re- 20 quests, the types of languages requested, the range 21 and average wait time for a consumer to speak with 22 an interpreter, and any steps the call center and lan- 23 guage line have taken to actively address some of 24 the consumer complaints. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00134 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 135 •HR 5942 IH (f) EFFECTIVE DATE.—The amendments made by 1 this section shall apply to plan years beginning after the 2 date of the enactment of this Act. 3 TITLE III—HEALTH WORKFORCE 4 DIVERSITY 5 SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 6 ACT. 7 Title XXXIV of the Public Health Service Act, as 8 added by section 202, is amended by adding at the end 9 the following: 10 ‘‘Subtitle A—Diversifying the 11 Health Care Workplace 12 ‘‘SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE 13 DIVERSITY. 14 ‘‘(a) IN GENERAL.—The Secretary, acting through 15 the Bureau of Health Workforce within the Health Re- 16 sources and Services Administration, shall award a grant 17 to an entity determined appropriate by the Secretary for 18 the establishment of a national working group on work- 19 force diversity. 20 ‘‘(b) REPRESENTATION.—In establishing the national 21 working group under subsection (a): 22 ‘‘(1) The grantee shall ensure that the group 23 has representatives of the following: 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00135 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 136 •HR 5942 IH ‘‘(A) The Health Resources and Services 1 Administration. 2 ‘‘(B) The Department of Health and 3 Human Services Data Council. 4 ‘‘(C) The Office of Minority Health of the 5 Department of Health and Human Services. 6 ‘‘(D) The Substance Abuse and Mental 7 Health Services Administration. 8 ‘‘(E) The Bureau of Labor Statistics of 9 the Department of Labor. 10 ‘‘(F) The Public Health Practice Program 11 Office—Office of Workforce Policy and Plan- 12 ning. 13 ‘‘(G) The National Institute on Minority 14 Health and Health Disparities. 15 ‘‘(H) The Agency for Healthcare Research 16 and Quality. 17 ‘‘(I) The Institute of Medicine Study Com- 18 mittee for the 2004 workforce diversity report. 19 ‘‘(J) The Indian Health Service. 20 ‘‘(K) The Department of Education. 21 ‘‘(L) Minority-serving academic institu- 22 tions. 23 ‘‘(M) Consumer organizations. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00136 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 137 •HR 5942 IH ‘‘(N) Health professional associations, in- 1 cluding those that represent underrepresented 2 minority populations. 3 ‘‘(O) Researchers in the area of health 4 workforce. 5 ‘‘(P) Health workforce accreditation enti- 6 ties. 7 ‘‘(Q) Private (including nonprofit) founda- 8 tions that have sponsored workforce diversity 9 initiatives. 10 ‘‘(R) Local and State health departments. 11 ‘‘(S) Representatives of community mem- 12 bers to be included on admissions committees 13 for health profession schools pursuant to sub- 14 section (c)(8). 15 ‘‘(T) National community-based organiza- 16 tions that serve as a national intermediary to 17 their urban affiliate members and have dem- 18 onstrated capacity to train health care profes- 19 sionals. 20 ‘‘(U) Other entities determined appropriate 21 by the Secretary. 22 ‘‘(V) The Veterans Health Administration. 23 ‘‘(2) The grantee shall ensure that, in addition 24 to the representatives under paragraph (1), the 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00137 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 138 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00138 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 139 •HR 5942 IH ‘‘(8) Develop a workforce data collection or 1 tracking system to identify where racial and ethnic 2 minority health professionals practice. 3 ‘‘(9) Develop a strategy for the inclusion of 4 community members on admissions committees for 5 health profession schools. 6 ‘‘(10) Helping with monitoring and implementa- 7 tion of standards for diversity, equity, and inclusion. 8 ‘‘(11) Other activities determined appropriate 9 by the Secretary. 10 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 11 the establishment of the working group under subsection 12 (a), and annually thereafter, the working group shall pre- 13 pare and make available to the general public for com- 14 ment, an annual report on the activities of the working 15 group. Such report shall include the recommendations of 16 the working group for improving health workforce diver- 17 sity. 18 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 19 is authorized to be appropriated to carry out this section 20 such sums as may be necessary for each of fiscal years 21 2019 through 2024. 22 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00139 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 140 •HR 5942 IH ‘‘SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH 1 WORKFORCE DIVERSITY. 2 ‘‘(a) IN GENERAL.—The Secretary, acting through 3 the Deputy Assistant Secretary for Minority Health, and 4 in collaboration with the Bureau of Health Workforce 5 within the Health Resources and Services Administration, 6 the National Institute on Minority Health and Health Dis- 7 parities, shall establish a technical clearinghouse on health 8 workforce diversity within the Office of Minority Health 9 and coordinate current and future clearinghouses. 10 ‘‘(b) INFORMATION AND SERVICES.—The clearing- 11 house established under subsection (a) shall offer the fol- 12 lowing information and services: 13 ‘‘(1) Information on the importance of health 14 workforce diversity. 15 ‘‘(2) Statistical information relating to under- 16 represented minority representation in health and al- 17 lied health professions and occupations. 18 ‘‘(3) Model health workforce diversity practices 19 and programs, including integrated models of care. 20 ‘‘(4) Admissions policies that promote health 21 workforce diversity and are in compliance with Fed- 22 eral and State laws. 23 ‘‘(5) Retainment policies that promote comple- 24 tion of health profession degrees for underserved 25 populations. 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00140 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 141 •HR 5942 IH ‘‘(6) Lists of scholarship, loan repayment, and 1 loan cancellation grants as well as fellowship infor- 2 mation for underserved populations for health pro- 3 fessions schools. 4 ‘‘(7) Foundation and other large organizational 5 initiatives relating to health workforce diversity. 6 ‘‘(c) CONSULTATION.—In carrying out this section, 7 the Secretary shall consult with non-Federal entities which 8 may include minority health professional associations and 9 minority sections of major health professional associations 10 to ensure the adequacy and accuracy of information. 11 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 12 is authorized to be appropriated to carry out this section 13 such sums as may be necessary for each of fiscal years 14 2019 through 2024. 15 ‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO 16 WORKFORCE DIVERSITY, EQUITY, AND IN- 17 CLUSION. 18 ‘‘(a) IN GENERAL.—The Secretary, acting through 19 the Administrator of the Health Resources and Services 20 Administration and the Centers for Disease Control and 21 Prevention, shall award grants to eligible entities that 22 demonstrate a commitment to health workforce diversity. 23 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 24 under subsection (a), an entity shall— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00141 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 142 •HR 5942 IH ‘‘(1) be an educational institution or entity that 1 historically produces or trains meaningful numbers 2 of underrepresented minority health professionals, 3 including— 4 ‘‘(A) historically Black colleges and univer- 5 sities; 6 ‘‘(B) Hispanic-serving health professions 7 schools; 8 ‘‘(C) Hispanic-serving institutions; 9 ‘‘(D) Tribal colleges and universities; 10 ‘‘(E) Asian-American, Native American, 11 and Pacific Islander-serving institutions; 12 ‘‘(F) institutions that have programs to re- 13 cruit and retain underrepresented minority 14 health professionals, in which a significant 15 number of the enrolled participants are under- 16 represented minorities; 17 ‘‘(G) health professional associations, 18 which may include underrepresented minority 19 health professional associations; and 20 ‘‘(H) institutions, including national and 21 regional community-based organizations with 22 demonstrated commitment to a diversified 23 workforce— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00142 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 143 •HR 5942 IH ‘‘(i) located in communities with pre- 1 dominantly underrepresented minority pop- 2 ulations; 3 ‘‘(ii) with whom partnerships have 4 been formed for the purpose of increasing 5 workforce diversity; and 6 ‘‘(iii) in which at least 20 percent of 7 the enrolled participants are underrep- 8 resented minorities; and 9 ‘‘(2) submit to the Secretary an application at 10 such time, in such manner, and containing such in- 11 formation as the Secretary may require. 12 ‘‘(c) USE OF FUNDS.—Amounts received under a 13 grant under subsection (a) shall be used to expand existing 14 workforce diversity programs, implement new workforce 15 diversity programs, or evaluate existing or new workforce 16 diversity programs, including with respect to mental 17 health care professions. Such programs shall enhance di- 18 versity by considering minority status as part of an indi- 19 vidualized consideration of qualifications. Possible activi- 20 ties may include— 21 ‘‘(1) educational outreach programs relating to 22 opportunities in the health professions; 23 ‘‘(2) scholarship, fellowship, grant, loan repay- 24 ment, and loan cancellation programs; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00143 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 144 •HR 5942 IH ‘‘(3) postbaccalaureate programs; 1 ‘‘(4) academic enrichment programs, particu- 2 larly targeting those who would not be competitive 3 for health professions schools; 4 ‘‘(5) kindergarten through 12th grade and 5 other health pipeline programs; 6 ‘‘(6) mentoring programs; 7 ‘‘(7) internship or rotation programs involving 8 hospitals, health systems, health plans, and other 9 health entities; 10 ‘‘(8) community partnership development for 11 purposes relating to workforce diversity; or 12 ‘‘(9) leadership training. 13 ‘‘(d) REPORTS.—Not later than 1 year after receiving 14 a grant under this section, and annually for the term of 15 the grant, a grantee shall submit to the Secretary a report 16 that summarizes and evaluates all activities conducted 17 under the grant. 18 ‘‘(e) DEFINITION.—In this section, the term ‘Asian- 19 American, Native American, and Pacific Islander-serving 20 institutions’ has the same meaning as the term ‘Asian 21 American and Native American Pacific Islander-serving 22 institution’ as defined in section 371(c) of the Higher 23 Education Act of 1965 (20 U.S.C. 1067q(c)). 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00144 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 145 •HR 5942 IH ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 1 is authorized to be appropriated to carry out this section, 2 such sums as may be necessary for each of fiscal years 3 2019 through 2024. 4 ‘‘SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND 5 RESEARCHERS. 6 ‘‘(a) IN GENERAL.—The Secretary, acting through 7 the Director of the National Institutes of Health, the Di- 8 rector of the Centers for Disease Control and Prevention, 9 the Commissioner of Food and Drugs, the Director of the 10 Agency for Healthcare Research and Quality, and the Ad- 11 ministrator of the Health Resources and Services Admin- 12 istration, shall award grants that expand existing opportu- 13 nities for scientists and researchers and promote the inclu- 14 sion of underrepresented minorities in the health profes- 15 sions. 16 ‘‘(b) RESEARCH FUNDING.—The head of each entity 17 within the Department of Health and Human Services 18 shall establish or expand existing programs to provide re- 19 search funding to scientists and researchers in training. 20 Under such programs, the head of each such entity shall 21 give priority in allocating research funding to support 22 health research in traditionally underserved communities, 23 including underrepresented minority communities, and re- 24 search classified as community or participatory. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00145 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 146 •HR 5942 IH ‘‘(c) DATA COLLECTION.—The head of each entity 1 within the Department of Health and Human Services 2 shall collect data on the number (expressed as an absolute 3 number and a percentage) of underrepresented minority 4 and nonminority applicants who receive and are denied 5 agency funding at every stage of review. Such data shall 6 be reported annually to the Secretary and the appropriate 7 committees of Congress. 8 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec- 9 retary shall establish a student loan reimbursement pro- 10 gram to provide student loan reimbursement assistance to 11 researchers who focus on racial and ethnic disparities in 12 health. The Secretary shall promulgate regulations to de- 13 fine the scope and procedures for the program under this 14 subsection. 15 ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec- 16 retary shall establish a student loan cancellation program 17 to provide student loan cancellation assistance to research- 18 ers who focus on racial and ethnic disparities in health. 19 Students participating in the program shall make a min- 20 imum 5-year commitment to work at an accredited health 21 profession school. The Secretary shall promulgate addi- 22 tional regulations to define the scope and procedures for 23 the program under this subsection. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00146 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 147 •HR 5942 IH ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 1 is authorized to be appropriated to carry out this section, 2 such sums as may be necessary for each of fiscal years 3 2019 through 2024. 4 ‘‘SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH 5 PROFESSIONALS. 6 ‘‘(a) IN GENERAL.—The Secretary, acting through 7 the Director of the Centers for Disease Control and Pre- 8 vention, the Administrator of the Substance Abuse and 9 Mental Health Services Administration, the Administrator 10 of the Health Resources and Services Administration, and 11 the Administrator of the Centers for Medicare & Medicaid 12 Services, shall establish a program to award grants to eli- 13 gible individuals for career support in nonresearch-related 14 health and wellness professions. 15 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 16 under subsection (a), an individual shall— 17 ‘‘(1) be a student in a health professions school, 18 a graduate of such a school who is working in a 19 health profession, an individual working in a health 20 or wellness profession (including mental and behav- 21 ioral health), or a faculty member of such a school; 22 and 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00147 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 148 •HR 5942 IH ‘‘(2) submit to the Secretary an application at 1 such time, in such manner, and containing such in- 2 formation as the Secretary may require. 3 ‘‘(c) USE OF FUNDS.—An individual shall use 4 amounts received under a grant under this section to— 5 ‘‘(1) support the individual’s health activities or 6 projects that involve underserved communities, in- 7 cluding racial and ethnic minority communities; 8 ‘‘(2) support health-related career advancement 9 activities; 10 ‘‘(3) to pay, or as reimbursement for payments 11 of, student loans or training or credentialing costs 12 for individuals who are health professionals and are 13 focused on health issues affecting underserved com- 14 munities, including racial and ethnic minority com- 15 munities; and 16 ‘‘(4) to establish and promote leadership train- 17 ing programs to decrease health disparities and to 18 increase cultural competence with the goal of in- 19 creasing diversity in leadership positions. 20 ‘‘(d) DEFINITION.—In this section, the term ‘career 21 in nonresearch-related health and wellness professions’ 22 means employment or intended employment in the field 23 of public health, health policy, health management, health 24 administration, medicine, nursing, pharmacy, psychology, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00148 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 149 •HR 5942 IH social work, psychiatry, other mental and behavioral 1 health, allied health, community health, social work, or 2 other fields determined appropriate by the Secretary, 3 other than in a position that involves research. 4 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 5 is authorized to be appropriated to carry out this section 6 such sums as may be necessary for each of fiscal years 7 2019 through 2024. 8 ‘‘SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DI- 9 VERSITY ON QUALITY. 10 ‘‘(a) IN GENERAL.—The Director of the Agency for 11 Healthcare Research and Quality, in collaboration with 12 the Deputy Assistant Secretary for Minority Health and 13 the Director of the National Institute on Minority Health 14 and Health Disparities, shall award grants to eligible enti- 15 ties to expand research on the link between health work- 16 force diversity and quality health care. 17 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 18 under subsection (a), an entity shall— 19 ‘‘(1) be a clinical, public health, or health serv- 20 ices research entity or other entity determined ap- 21 propriate by the Director; and 22 ‘‘(2) submit to the Secretary an application at 23 such time, in such manner, and containing such in- 24 formation as the Secretary may require. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00149 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 150 •HR 5942 IH ‘‘(c) USE OF FUNDS.—Amounts received under a 1 grant awarded under subsection (a) shall be used to sup- 2 port research that investigates the effect of health work- 3 force diversity on— 4 ‘‘(1) language access; 5 ‘‘(2) cultural competence; 6 ‘‘(3) patient satisfaction; 7 ‘‘(4) timeliness of care; 8 ‘‘(5) safety of care; 9 ‘‘(6) effectiveness of care; 10 ‘‘(7) efficiency of care; 11 ‘‘(8) patient outcomes; 12 ‘‘(9) community engagement; 13 ‘‘(10) resource allocation; 14 ‘‘(11) organizational structure; 15 ‘‘(12) compliance of care; or 16 ‘‘(13) other topics determined appropriate by 17 the Director. 18 ‘‘(d) PRIORITY.—In awarding grants under sub- 19 section (a), the Director shall give individualized consider- 20 ation to all relevant aspects of the applicant’s background. 21 Consideration of prior research experience involving the 22 health of underserved communities shall be such a factor. 23 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 24 is authorized to be appropriated to carry out this section 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00150 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 151 •HR 5942 IH such sums as may be necessary for each of fiscal years 1 2019 through 2024. 2 ‘‘SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM. 3 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 4 through the National Institute on Minority Health and 5 Health Disparities and in collaboration with the Office of 6 Minority Health, the Office for Civil Rights, the Centers 7 for Disease Control and Prevention, the Centers for Medi- 8 care & Medicaid Services, the Health Resources and Serv- 9 ices Administration, and other appropriate public and pri- 10 vate entities, shall establish and coordinate a health and 11 health care disparities education program to support, de- 12 velop, and implement educational initiatives and outreach 13 strategies that inform health care professionals and the 14 public about the existence of and methods to reduce racial 15 and ethnic disparities in health and health care. 16 ‘‘(b) ACTIVITIES.—The Secretary, through the edu- 17 cation program established under subsection (a), shall, 18 through the use of public awareness and outreach cam- 19 paigns targeting the general public and the medical com- 20 munity at large— 21 ‘‘(1) disseminate scientific evidence for the ex- 22 istence and extent of racial and ethnic disparities in 23 health care, including disparities that are not other- 24 wise attributable to known factors such as access to 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00151 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 152 •HR 5942 IH care, patient preferences, or appropriateness of 1 intervention, as described in the 2002 Institute of 2 Medicine Report entitled ‘Unequal Treatment: Con- 3 fronting Racial and Ethnic Disparities in Health 4 Care’, as well as the impact of disparities related to 5 age, disability status, socioeconomic status, sex, gen- 6 der identity, and sexual orientation on racial and 7 ethnic minorities; 8 ‘‘(2) disseminate new research findings to 9 health care providers and patients to assist them in 10 understanding, reducing, and eliminating health and 11 health care disparities; 12 ‘‘(3) disseminate information about the impact 13 of linguistic and cultural barriers on health care 14 quality and the obligation of health providers who 15 receive Federal financial assistance to ensure that 16 people with limited-English proficiency have access 17 to language access services; 18 ‘‘(4) disseminate information about the impor- 19 tance and legality of racial, ethnic, disability status, 20 socioeconomic status, sex, gender identity, and sex- 21 ual orientation, and primary language data collec- 22 tion, analysis, and reporting; 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00152 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 153 •HR 5942 IH ‘‘(5) design and implement specific educational 1 initiatives to health care providers relating to health 2 and health care disparities; 3 ‘‘(6) assess the impact of the programs estab- 4 lished under this section in raising awareness of 5 health and health care disparities and providing in- 6 formation on available resources; and 7 ‘‘(7) design and implement specific educational 8 initiatives to educate the health care workforce relat- 9 ing to unconscious bias. 10 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 11 is authorized to be appropriated to carry out this section 12 such sums as may be necessary for each of fiscal years 13 2019 through 2024.’’. 14 SEC. 302. HISPANIC-SERVING HEALTH PROFESSIONS 15 SCHOOLS. 16 Part B of title VII of the Public Health Service Act 17 (42 U.S.C. 293 et seq.) is amended by adding at the end 18 the following: 19 ‘‘SEC. 742. HISPANIC-SERVING INSTITUTIONS, HISTORI- 20 CALLY BLACK COLLEGES & UNIVERSITIES, 21 AND TRIBAL COLLEGES. 22 ‘‘(a) IN GENERAL.—The Secretary, acting through 23 the Administrator of the Health and Human Resources 24 and Services Administration, shall establish grants from 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00153 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 154 •HR 5942 IH the Department of Education to Hispanic-serving Institu- 1 tions, Historically Black Colleges & Universities, and Trib- 2 al Colleges, including Regional community based organiza- 3 tions and national minority medical associations, for schol- 4 arships and counseling services to prepare underrep- 5 resented minority individuals to enroll in and graduate 6 from health professional schools and to increase services 7 for qualified students, including— 8 ‘‘(1) mentoring with underrepresented health 9 professionals; and 10 ‘‘(2) providing financial assistance information 11 for continued education and applications to health 12 professional schools. 13 ‘‘(b) ELIGIBILITY.—In subsection (a), the term ‘His- 14 panic-serving Institutions’ means an entity that— 15 ‘‘(1) is a school or program under section 16 799B; 17 ‘‘(2) has an enrollment of full-time equivalent 18 students that is made up of at least 9 percent His- 19 panic students; 20 ‘‘(3) has been effective in carrying out pro- 21 grams to recruit Hispanic individuals to enroll in 22 and graduate from the school; 23 ‘‘(4) has been effective in recruiting and retain- 24 ing Hispanic faculty members; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00154 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 155 •HR 5942 IH ‘‘(5) has a significant number of graduates who 1 are providing health services to medically under- 2 served populations or to individuals in health profes- 3 sional shortage areas; and 4 ‘‘(6) is a Regional Hispanic Center of Excel- 5 lence. 6 ‘‘(c) CERTAIN LOAN REPAYMENT PROGRAMS.—In 7 carrying out the National Health Service Corps loan re- 8 payment program and loan repayment programs of the 9 Centers for Disease Control and Prevention, the Secretary 10 shall ensure that loan repayments of not less than $50,000 11 per year are awarded for repayment of loans incurred for 12 enrollment or participation in schools and programs de- 13 scribed in this section.’’. 14 SEC. 303. LOAN REPAYMENT PROGRAM OF CENTERS FOR 15 DISEASE CONTROL AND PREVENTION. 16 Section 317F(c) of the Public Health Service Act (42 17 U.S.C. 247b–7(c)) is amended— 18 (1) by striking ‘‘and’’ after ‘‘1994,’’; and 19 (2) by inserting before the period at the end the 20 following: ‘‘, $750,000 for fiscal year 2019, and such 21 sums as may be necessary for each of the fiscal 22 years 2020 through 2024’’. 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00155 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 156 •HR 5942 IH SEC. 304. COOPERATIVE AGREEMENTS FOR ONLINE DE- 1 GREE PROGRAMS AT SCHOOLS OF PUBLIC 2 HEALTH AND SCHOOLS OF ALLIED HEALTH. 3 Part B of title VII of the Public Health Service Act 4 (42 U.S.C. 293 et seq.), as amended by section 302, is 5 further amended by adding at the end the following: 6 ‘‘SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DE- 7 GREE PROGRAMS. 8 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 9 acting through the Administrator of the Health Resources 10 and Services Administration, in consultation with the Di- 11 rector of the Centers for Disease Control and Prevention, 12 the Director of the Agency for Healthcare Research and 13 Quality, and the Deputy Assistant Secretary for Minority 14 Health, shall award cooperative agreements to schools of 15 public health and schools of allied health to design and 16 implement online degree programs. 17 ‘‘(b) PRIORITY.—In awarding cooperative agreements 18 under this section, the Secretary shall give priority to any 19 school of public health or school of allied health that has 20 an established track record of serving medically under- 21 served communities. 22 ‘‘(c) REQUIREMENTS.—Recipients of cooperative 23 agreements under this section shall design and implement 24 an online degree program that meets the following restric- 25 tions: 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00156 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 157 •HR 5942 IH ‘‘(1) Enrollment of individuals who have ob- 1 tained a secondary school diploma or its recognized 2 equivalent. 3 ‘‘(2) Maintaining a significant enrollment of 4 underrepresented minority or disadvantaged stu- 5 dents. 6 ‘‘(3) Achieving a high completion rate of en- 7 rolled underrepresented minority or disadvantaged 8 students. 9 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 10 are authorized to be appropriated to carry out this section 11 such sums as may be necessary for each of fiscal years 12 2019 through 2024.’’. 13 SEC. 305. SENSE OF CONGRESS ON THE MISSION OF THE 14 NATIONAL HEALTH CARE WORKFORCE COM- 15 MISSION. 16 It is the sense of Congress that the National Health 17 Care Workforce Commission established by section 5101 18 of the Patient Protection and Affordable Care Act (42 19 U.S.C. 294q) should, in carrying out its assigned duties 20 under that section, give attention to the needs of racial 21 and ethnic minorities, individuals with lower socio- 22 economic status, individuals with mental, developmental, 23 and physical disabilities, lesbian, gay, bisexual, 24 transgender, queer, and questioning populations, and indi- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00157 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 158 •HR 5942 IH viduals who are members of multiple minority or special 1 population groups. 2 SEC. 306. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 3 Subtitle A of title XXXIV of the Public Health Serv- 4 ice Act, as added by section 301, is further amended by 5 inserting after section 3417 the following: 6 ‘‘SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH 7 SERVICES CORPS. 8 ‘‘(a) IN GENERAL.—The Administrator of the Health 9 Resources and Services Administration and the Director 10 of the Centers for Disease Control and Prevention, in col- 11 laboration with the Deputy Assistant Secretary for Minor- 12 ity Health, shall award grants to eligible entities to in- 13 crease awareness among postprimary and postsecondary 14 students of career opportunities in the health professions. 15 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 16 under subsection (a), an entity shall— 17 ‘‘(1) be a clinical, public health, or health serv- 18 ices organization, community-based or nonprofit en- 19 tity, or other entity determined appropriate by the 20 Director of the Centers for Disease Control and Pre- 21 vention; 22 ‘‘(2) serve a health professional shortage area, 23 as determined by the Secretary; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00158 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 159 •HR 5942 IH ‘‘(3) work with students, including those from 1 racial and ethnic minority backgrounds, that have 2 expressed an interest in the health professions; and 3 ‘‘(4) submit to the Secretary an application at 4 such time, in such manner, and containing such in- 5 formation as the Secretary may require. 6 ‘‘(c) USE OF FUNDS.—Grant awards under sub- 7 section (a) shall be used to support internships that will 8 increase awareness among students of non-research-based, 9 career opportunities in the following health professions: 10 ‘‘(1) Medicine. 11 ‘‘(2) Nursing. 12 ‘‘(3) Public Health. 13 ‘‘(4) Pharmacy. 14 ‘‘(5) Health administration and management. 15 ‘‘(6) Health policy. 16 ‘‘(7) Psychology. 17 ‘‘(8) Dentistry. 18 ‘‘(9) International health. 19 ‘‘(10) Social work. 20 ‘‘(11) Allied health. 21 ‘‘(12) Psychiatry. 22 ‘‘(13) Hospice care. 23 ‘‘(14) Community health, patient navigation, 24 and peer support. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00159 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 160 •HR 5942 IH ‘‘(15) Other professions deemed appropriate by 1 the Director of the Centers for Disease Control and 2 Prevention. 3 ‘‘(d) PRIORITY.—In awarding grants under sub- 4 section (a), the Director of the Centers for Disease Con- 5 trol and Prevention shall give priority to those entities 6 that— 7 ‘‘(1) serve a high proportion of individuals from 8 disadvantaged backgrounds; 9 ‘‘(2) have experience in health disparity elimi- 10 nation programs; 11 ‘‘(3) facilitate the entry of disadvantaged indi- 12 viduals into institutions of higher education; and 13 ‘‘(4) provide counseling or other services de- 14 signed to assist disadvantaged individuals in success- 15 fully completing their education at the postsecondary 16 level. 17 ‘‘(e) STIPENDS.—The Secretary may approve sti- 18 pends under this section for individuals for any period of 19 education in student-enhancement programs (other than 20 regular courses) at health professions schools, programs, 21 or entities, except that such a stipend may not be provided 22 to an individual for more than 6 months, and such a sti- 23 pend may not exceed $20 per day (notwithstanding any 24 other provision of law regarding the amount of stipends). 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00160 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 161 •HR 5942 IH ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 1 is authorized to be appropriated to carry out this section 2 such sums as may be necessary for each of fiscal years 3 2019 through 2024. 4 ‘‘SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS 5 PROGRAM. 6 ‘‘(a) IN GENERAL.—The Director of the Centers for 7 Disease Control and Prevention, in collaboration with the 8 Deputy Assistant Secretary for Minority Health, shall 9 award scholarships to postsecondary students who seek a 10 career in public health. 11 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol- 12 arship under subsection (a), an individual shall— 13 ‘‘(1) have interest, knowledge, or skill in public 14 health research or public health practice, or other 15 health professions as determined appropriate by the 16 Director of the Centers for Disease Control and Pre- 17 vention; 18 ‘‘(2) reside in a health professional shortage 19 area as determined by the Secretary; 20 ‘‘(3) demonstrate promise for becoming a leader 21 in public health; 22 ‘‘(4) secure admission to a 4-year institution of 23 higher education; 24 ‘‘(5) comply with subsection (e); and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00161 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 162 •HR 5942 IH ‘‘(6) submit to the Secretary an application at 1 such time, in such manner, and containing such in- 2 formation as the Secretary may require. 3 ‘‘(c) USE OF FUNDS.—Amounts received under an 4 award under subsection (a) shall be used to support oppor- 5 tunities for students to become public health professionals. 6 ‘‘(d) PRIORITY.—In awarding grants under sub- 7 section (a), the Director shall give priority to those stu- 8 dents that— 9 ‘‘(1) are from disadvantaged backgrounds; 10 ‘‘(2) have secured admissions to a minority- 11 serving institution; and 12 ‘‘(3) have identified a health professional as a 13 mentor at their school or institution and an aca- 14 demic advisor to assist in the completion of their 15 baccalaureate degree. 16 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 17 payment of scholarships under this section for such indi- 18 viduals for any period of education in student under- 19 graduate tenure, except that such a scholarship may not 20 be provided to an individual for more than 4 years, and 21 such scholarships may not exceed $10,000 per academic 22 year (notwithstanding any other provision of law regard- 23 ing the amount of scholarship). 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00162 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 163 •HR 5942 IH ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 1 is authorized to be appropriated to carry out this section 2 such sums as may be necessary for each of fiscal years 3 2019 through 2024. 4 ‘‘SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH 5 FELLOWSHIP PROGRAM. 6 ‘‘(a) IN GENERAL.—The Director of the Centers for 7 Disease Control and Prevention, in collaboration with the 8 Deputy Assistant Secretary for Minority Health, the Ad- 9 ministrator of the Substance Abuse and Mental Health 10 Services Administration, and the Director of the Indian 11 Health Services, shall award research fellowships to post- 12 baccalaureate students to conduct research that will exam- 13 ine gender and health disparities and to pursue a career 14 in the health professions. 15 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 16 ship under subsection (a) an individual shall— 17 ‘‘(1) have experience in health research or pub- 18 lic health practice; 19 ‘‘(2) reside in a health professional shortage 20 area as determined by the Secretary; 21 ‘‘(3) have expressed an interest in the health 22 professions; 23 ‘‘(4) demonstrate promise for becoming a leader 24 in the field of women’s health; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00163 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 164 •HR 5942 IH ‘‘(5) secure admission to a health professions 1 school or graduate program with an emphasis in 2 gender studies; 3 ‘‘(6) comply with subsection (f); and 4 ‘‘(7) submit to the Secretary an application at 5 such time, in such manner, and containing such in- 6 formation as the Secretary may require. 7 ‘‘(c) USE OF FUNDS.—Amounts received under an 8 award under subsection (a) shall be used to support oppor- 9 tunities for students to become researchers and advance 10 the research base on the intersection between gender and 11 health. 12 ‘‘(d) PRIORITY.—In awarding grants under sub- 13 section (a), the Director of the Centers for Disease Con- 14 trol and Prevention shall give priority to those applicants 15 that— 16 ‘‘(1) are from disadvantaged backgrounds; and 17 ‘‘(2) have identified a mentor and academic ad- 18 visor who will assist in the completion of their grad- 19 uate or professional degree and have secured a re- 20 search assistant position with a researcher working 21 in the area of gender and health. 22 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 23 Disease Control and Prevention may approve fellowships 24 for individuals under this section for any period of edu- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00164 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 165 •HR 5942 IH cation in the student’s graduate or health profession ten- 1 ure, except that such a fellowship may not be provided 2 to an individual for more than 3 years, and such a fellow- 3 ship may not exceed $18,000 per academic year (notwith- 4 standing any other provision of law regarding the amount 5 of fellowship). 6 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 7 is authorized to be appropriated to carry out this section 8 such sums as may be necessary for each of fiscal years 9 2019 through 2024. 10 ‘‘SEC. 3420A. PAUL DAVID WELLSTONE INTERNATIONAL 11 HEALTH FELLOWSHIP PROGRAM. 12 ‘‘(a) IN GENERAL.—The Director of the Agency for 13 Healthcare Research and Quality, in collaboration with 14 the Deputy Assistant Secretary for Minority Health, shall 15 award research fellowships to college students or recent 16 graduates to advance their understanding of international 17 health. 18 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow- 19 ship under subsection (a) an individual shall— 20 ‘‘(1) have educational experience in the field of 21 international health; 22 ‘‘(2) reside in a health professional shortage 23 area as determined by the Secretary; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00165 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 166 •HR 5942 IH ‘‘(3) demonstrate promise for becoming a leader 1 in the field of international health; 2 ‘‘(4) be a college senior or recent graduate of 3 a four-year higher education institution; 4 ‘‘(5) comply with subsection (e); and 5 ‘‘(6) submit to the Secretary an application at 6 such time, in such manner, and containing such in- 7 formation as the Secretary may require. 8 ‘‘(c) USE OF FUNDS.—Amounts received under an 9 award under subsection (a) shall be used to support oppor- 10 tunities for students to become health professionals and 11 to advance their knowledge about international issues re- 12 lating to health care access and quality. 13 ‘‘(d) PRIORITY.—In awarding grants under sub- 14 section (a), the Director shall give priority to those appli- 15 cants that— 16 ‘‘(1) are from a disadvantaged background; and 17 ‘‘(2) have identified a mentor at a health pro- 18 fessions school or institution, an academic advisor to 19 assist in the completion of their graduate or profes- 20 sional degree, and an advisor from an international 21 health non-governmental organization, private volun- 22 teer organization, or other international institution 23 or program that focuses on increasing health care 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00166 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 167 •HR 5942 IH access and quality for residents in developing coun- 1 tries. 2 ‘‘(e) FELLOWSHIPS.—The Secretary shall approve 3 fellowships for college seniors or recent graduates, except 4 that such a fellowship may not be provided to an indi- 5 vidual for more than 6 months, may not be awarded to 6 a graduate that has not been enrolled in school for more 7 than 1 year, and may not exceed $4,000 per academic year 8 (notwithstanding any other provision of law regarding the 9 amount of fellowship). 10 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 11 is authorized to be appropriated to carry out this section, 12 such sums as may be necessary for each of fiscal years 13 2019 through 2024. 14 ‘‘SEC. 3420B. EDWARD R. ROYBAL HEALTH SCHOLAR PRO- 15 GRAM. 16 ‘‘(a) IN GENERAL.—The Director of the Agency for 17 Healthcare Research and Quality, the Director of the Cen- 18 ters for Medicare and Medicaid Services, and the Adminis- 19 trator for Health Resources and Services Administration, 20 in collaboration with the Deputy Assistant Secretary for 21 Minority Health, shall award grants to eligible entities to 22 expose entering graduate students to the health profes- 23 sions. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00167 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 168 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00168 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 169 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00169 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 170 •HR 5942 IH such sums as may be necessary for each of fiscal years 1 2019 through 2024. 2 ‘‘SEC. 3420C. LEADERSHIP FELLOWSHIP PROGRAMS. 3 ‘‘The Secretary of Health and Human Services shall 4 award grants to entities to develop leadership fellowship 5 programs for underrepresented health professionals to be- 6 come future leaders in public health and health care deliv- 7 ery institutions.’’. 8 SEC. 307. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 9 PROGRAM. 10 Section 402E of the Higher Education Act of 1965 11 (20 U.S.C. 1070a–15) is amended by striking subsection 12 (g) and inserting the following: 13 ‘‘(g) COLLABORATION IN HEALTH PROFESSION DI- 14 VERSITY TRAINING PROGRAMS.—The Secretary shall co- 15 ordinate with the Secretary of Health and Human Serv- 16 ices to ensure that there is collaboration between the goals 17 of the program under this section and programs of the 18 Health Resources and Services Administration that pro- 19 mote health workforce diversity. The Secretary of Edu- 20 cation shall take such measures as may be necessary to 21 encourage students participating in projects assisted 22 under this section to consider health profession careers. 23 ‘‘(h) FUNDING.—From amounts appropriated pursu- 24 ant to the authority of section 402A(g), the Secretary 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00170 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 171 •HR 5942 IH shall, to the extent practicable, allocate funds for projects 1 authorized by this section in an amount which is not less 2 than $31,000,000 for each of the fiscal years 2019 3 through 2025.’’. 4 SEC. 308. RULES FOR DETERMINATION OF FULL-TIME 5 EQUIVALENT RESIDENTS FOR COST-REPORT- 6 ING PERIODS. 7 (a) DGME DETERMINATIONS.—Section 1886(h)(4) 8 of the Social Security Act (42 U.S.C. 1395ww(h)(4)), as 9 amended by section 204(a), is amended— 10 (1) in subparagraph (E), by striking ‘‘Subject 11 to subparagraphs (J) and (K), such rules’’ and in- 12 serting ‘‘Subject to subparagraphs (J), (K), and 13 (M), such rules’’; 14 (2) in subparagraph (J), by striking ‘‘Such 15 rules’’ and inserting ‘‘Subject to subparagraph (M), 16 such rules’’; 17 (3) in subparagraph (K), by striking ‘‘In deter- 18 mining’’ and inserting ‘‘Subject to subparagraph 19 (M), in determining’’; and 20 (4) by adding at the end the following new sub- 21 paragraph: 22 ‘‘(M) TREATMENT OF CERTAIN RESIDENTS 23 AND INTERNS.—For purposes of cost-reporting 24 periods beginning on or after October 1, 2016, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00171 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 172 •HR 5942 IH in determining the hospital’s number of full- 1 time equivalent residents for purposes of this 2 paragraph, all the time spent by an intern or 3 resident in an approved medical residency train- 4 ing program shall be counted toward the deter- 5 mination of full-time equivalency if the hos- 6 pital— 7 ‘‘(i) is recognized as a subsection (d) 8 hospital; 9 ‘‘(ii) is recognized as a subsection (d) 10 Puerto Rico hospital; 11 ‘‘(iii) is reimbursed under a reim- 12 bursement system authorized under section 13 1814(b)(3); or 14 ‘‘(iv) is a provider-based hospital out- 15 patient department.’’. 16 (b) IME DETERMINATIONS.—Section 17 1886(d)(5)(B)(x) of the Social Security Act (42 U.S.C. 18 1395ww(d)(5)(B)(x)) is amended— 19 (1) in subclause (II), by striking ‘‘In deter- 20 mining’’ and inserting ‘‘Subject to subclause (IV), in 21 determining’’; 22 (2) in subclause (III), by striking ‘‘In deter- 23 mining’’ and inserting ‘‘Subject to subclause (IV), in 24 determining’’; and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00172 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 173 •HR 5942 IH (3) by inserting after subclause (III) the fol- 1 lowing new subclause: 2 ‘‘(IV) The provisions of subparagraph (L) 3 of subsection (h)(4) shall apply under this sub- 4 paragraph in the same manner as they apply 5 under such subsection.’’. 6 SEC. 309. DEVELOPING AND IMPLEMENTING STRATEGIES 7 FOR LOCAL HEALTH EQUITY. 8 (a) GRANTS.—The Secretaries of Health and Human 9 Services, Education, and Labor, acting jointly, shall make 10 grants to academic institutions for the purposes of— 11 (1) in accordance with subsection (b), devel- 12 oping capacity— 13 (A) to build an evidence base for successful 14 strategies for increasing local health equity; and 15 (B) to serve as national models of driving 16 local health equity; 17 (2) in accordance with subsection (c), devel- 18 oping a strategic partnership with the community in 19 which the academic institution is located; and 20 (3) collecting data on, and periodically evalu- 21 ating, the effectiveness of the institution’s programs 22 funded through this section to enable the institution 23 to adapt accordingly for maximum efficiency and 24 success. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00173 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 174 •HR 5942 IH (b) DEVELOPING CAPACITY FOR INCREASING LOCAL 1 HEALTH EQUITY.—As a condition on receipt of a grant 2 under subsection (a), an academic institution shall agree 3 to use the grant to build an evidence base for successful 4 strategies for increasing local health equity, and to serve 5 as a national model of driving local health equity, by sup- 6 porting— 7 (1) resources to strengthen institutional metrics 8 and capacity to execute institutionwide health work- 9 force goals that can serve as models for increasing 10 health equity in communities across the country; 11 (2) collaborations among a cohort of institu- 12 tions in implementing systemic change, partnership 13 development, and programmatic efforts supportive of 14 health equity goals across disciplines and popu- 15 lations; and 16 (3) enhanced or newly developed data systems 17 and research infrastructure capable of informing 18 current and future workforce efforts and building a 19 foundation for a broader research agenda targeting 20 urban health disparities. 21 (c) STRATEGIC PARTNERSHIPS.—As a condition on 22 receipt of a grant under subsection (a), an academic insti- 23 tution shall agree to use the grant to develop a strategic 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00174 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 175 •HR 5942 IH partnership with the community in which the institution 1 is located for the purposes of— 2 (1) strengthening connections between the insti- 3 tution and the community— 4 (A) to improve evaluation of and address 5 the community’s health and health workforce 6 needs; and 7 (B) to engage the community in health 8 workforce development; 9 (2) developing, enhancing, or accelerating inno- 10 vative undergraduate and graduate programs in the 11 biomedical sciences and health professions; and 12 (3) strengthening pipeline programs in the bio- 13 medical sciences and health professions, including by 14 developing partnerships between institutions of high- 15 er education and elementary and secondary schools 16 to recruit the next generation of health professionals 17 earlier in the pipeline to a health care career. 18 SEC. 310. LOAN FORGIVENESS FOR MENTAL AND BEHAV- 19 IORAL HEALTH SOCIAL WORKERS. 20 Section 455 of the Higher Education Act of 1965 (20 21 U.S.C. 1087e) is amended by adding at the end the fol- 22 lowing new subsection: 23 ‘‘(r) REPAYMENT PLAN FOR MENTAL AND BEHAV- 24 IORAL HEALTH SOCIAL WORKERS.— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00175 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 176 •HR 5942 IH ‘‘(1) IN GENERAL.—The Secretary shall cancel 1 the balance of interest and principal due on any eli- 2 gible Federal Direct Loan not in default for a bor- 3 rower who— 4 ‘‘(A) has made 120 monthly payments on 5 the eligible Federal Direct Loan after October 6 1, 2016, pursuant to any one or a combination 7 of the following— 8 ‘‘(i) payments under an income-based 9 repayment plan under section 493C; 10 ‘‘(ii) payments under a standard re- 11 payment plan under subsection (d)(1)(A), 12 based on a 10-year repayment period; 13 ‘‘(iii) monthly payments under a re- 14 payment plan under subsection (d)(1) or 15 (g) of not less than the monthly amount 16 calculated under subsection (d)(1)(A), 17 based on a 10-year repayment period; or 18 ‘‘(iv) payments under an income con- 19 tingent repayment plan under subsection 20 (d)(1)(D); and 21 ‘‘(B)(i) is employed as a mental health or 22 behavioral health social worker, as defined by 23 the Secretary by regulation, at the time of such 24 forgiveness; and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00176 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 177 •HR 5942 IH ‘‘(ii) has been employed as such a mental 1 health or behavioral health social worker during 2 the period in which the borrower makes each of 3 the 120 payments as described in subparagraph 4 (A). 5 ‘‘(2) LOAN CANCELLATION AMOUNT.—After the 6 conclusion of the employment period described in 7 paragraph (1), the Secretary shall cancel the obliga- 8 tion to repay the balance of principal and interest 9 due as of the time of such cancellation, on the eligi- 10 ble Federal Direct Loans made to the borrower 11 under this part. 12 ‘‘(3) INELIGIBILITY FOR DOUBLE BENEFITS.— 13 No borrower may, for the same employment as a 14 mental health or behavioral health social worker, re- 15 ceive a reduction of loan obligations under both this 16 subsection and subsection (m), 428J, 428K, 428L, 17 or 460. 18 ‘‘(4) DEFINITION OF ELIGIBLE FEDERAL DI- 19 RECT LOAN.—In this subsection, the term ‘eligible 20 Federal Direct Loan’ means a Federal Direct Staf- 21 ford Loan, Federal Direct PLUS Loan, Federal Di- 22 rect Unsubsidized Stafford Loan, or a Federal Di- 23 rect Consolidation Loan.’’. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00177 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 178 •HR 5942 IH SEC. 311. HEALTH PROFESSIONS WORKFORCE FUND. 1 (a) PURPOSE.—It is the purpose of this section to 2 establish a Health Professions Workforce Fund to be ad- 3 ministered through the Health Resources and Services Ad- 4 ministration within the Department of Health and Human 5 Services to provide for expanded and sustained national 6 investment in the health professions and nursing work- 7 force development programs under title VII and title VIII 8 of the Public Health Service Act. 9 (b) ESTABLISHING THE HEALTH PROFESSIONS 10 WORKFORCE FUND.—There is authorized to be appro- 11 priated, and there is appropriated, out of any monies in 12 the Treasury not otherwise appropriated, to the Health 13 Professions Workforce Fund— 14 (1) $355,000,000 for fiscal year 2019; 15 (2) $375,000,000 for fiscal year 2020; 16 (3) $392,000,000 for fiscal year 2021; 17 (4) $412,000,000 for fiscal year 2022; 18 (5) $432,000,000 for fiscal year 2023; 19 (6) $454,000,000 for fiscal year 2024; 20 (7) $476,000,000 for fiscal year 2025; 21 (8) $500,000,000 for fiscal year 2026; 22 (9) $525,000,000 for fiscal year 2027; and 23 (10) $552,000,000 for fiscal year 2028. 24 (c) FUNDING.— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00178 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 179 •HR 5942 IH (1) For the purpose of carrying out health pro- 1 fessions education programs authorized under title 2 VII of the Public Health Service Act, in addition to 3 any other amounts authorized to be appropriated for 4 such purpose, there is authorized to be appropriated 5 out of any monies in the Health Professions Work- 6 force Fund, the following: 7 (A) $240,000,000 for fiscal year 2019. 8 (B) $253,000,000 for fiscal year 2020. 9 (C) $265,000,000 for fiscal year 2021. 10 (D) $278,000,000 for fiscal year 2022. 11 (E) $292,000,000 for fiscal year 2023. 12 (F) $307,000,000 for fiscal year 2024. 13 (G) $322,000,000 for fiscal year 2025. 14 (H) $338,000,000 for fiscal year 2026. 15 (I) $355,000,000 for fiscal year 2027. 16 (J) $373,000,000 for fiscal year 2028. 17 (2) For the purpose of carrying out nursing 18 workforce development programs authorized under 19 Title VIII of the Public Health Service Act, in addi- 20 tion to any other amounts authorized to be appro- 21 priated for such purpose, there is authorized to be 22 appropriated out of any monies in the Health Pro- 23 fessions Workforce Fund, the following: 24 (A) $115,000,000 for fiscal year 2019. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00179 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 180 •HR 5942 IH (B) $122,000,000 for fiscal year 2020. 1 (C) $127,000,000 for fiscal year 2021. 2 (D) $134,000,000 for fiscal year 2022. 3 (E) $140,000,000 for fiscal year 2023. 4 (F) $147,000,000 for fiscal year 2024. 5 (G) $154,000,000 for fiscal year 2025. 6 (H) $162,000,000 for fiscal year 2026. 7 (I) $170,000,000 for fiscal year 2027. 8 (J) $179,000,000 for fiscal year 2028. 9 SEC. 312. FINDINGS; SENSE OF CONGRESS RELATING TO 10 GRADUATE MEDICAL EDUCATION. 11 (a) FINDINGS.—Congress finds the following: 12 (1) Projections by the Association of American 13 Medical Colleges (AAMC) and other expert entities, 14 such as the Health Resources and Services Adminis- 15 tration (HRSA), have indicated a nationwide short- 16 age of up to 104,900 physicians, split evenly be- 17 tween primary care and specialists, by 2030. 18 (2) Primarily due to the growing and aging 19 population, over the next decade, physician demand 20 is expected to grow up to 17 percent. 21 (3) The United States Census Bureau estimates 22 that the United States population will grow from 23 321 million in 2015 to 347 million in 2025. Further, 24 the number of Medicare beneficiaries is estimated to 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00180 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 181 •HR 5942 IH increase from 47.8 million in 2015 to approximately 1 66 million in 2025. 2 (4) Approximately 36 percent of practicing phy- 3 sicians are over the age of 55 and are likely to retire 4 within the next decade. 5 (5) A nationwide physician shortage will result 6 in many Americans waiting longer and traveling far- 7 ther for health care; seeking nonemergent care in 8 emergency departments; and delaying treatment 9 until their health care needs become more serious, 10 complex, and costly. 11 (6) Changing demographics (such as an aging 12 population), new health care delivery models (such 13 as medical homes), and other factors (such as dis- 14 aster preparedness) are contributing to a shortage of 15 both generalist and specialist physicians. 16 (7) These shortages will have the most severe 17 impact on vulnerable and underserved populations, 18 including racial/ethnic minorities and the approxi- 19 mately 20 percent of Americans who live in rural or 20 inner-city locations designated as health professional 21 shortage areas. 22 (8) The AAMC’s Health Care Utilization Eq- 23 uity model estimates that if racial and ethnic minori- 24 ties and individuals from rural areas utilized health 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00181 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 182 •HR 5942 IH care in a similar way to their Caucasian counter- 1 parts living in metropolitan areas, the physician 2 shortage would require an additional 96,000 physi- 3 cians. 4 (9) To address the physician shortage, medical 5 education and training need to be accessible for stu- 6 dents and physicians from all backgrounds. Inter- 7 national graduates play an important role in U.S. 8 health care, representing roughly 25 percent of the 9 health care workforce. Immigration pathways like 10 student, exchange-visitor, and employment visas, and 11 programs like the National Interest Waiver and 12 Conrad 30 J–1 Visa Waiver, help improve health ac- 13 cess across the country. 14 (10) United States medical schools have com- 15 mitted to and have initiated a 30 percent increase 16 in enrollment by 2017 to help reduce the Nation’s 17 shortage of quality physicians. 18 (11) An increase in United States medical 19 school graduates must be accompanied by an in- 20 crease of 4,000 graduate medical education (GME) 21 training positions each year. 22 (12) Graduate medical education programs and 23 teaching hospitals provide venues in which the next 24 generation of physicians learns to work collabo- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00182 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 183 •HR 5942 IH ratively with other physicians and health profes- 1 sionals, adopt more efficient care delivery models 2 (such as care coordination and medical homes), in- 3 corporate health information technology and elec- 4 tronic health records in every aspect of their work, 5 apply new methods of assuring quality and safety, 6 and participate in groundbreaking clinical and public 7 health research. 8 (13) The Medicare Program under title XVIII 9 of the Social Security Act (having more beneficiaries 10 than any other health care program), supports its 11 ‘‘fair share’’ of the costs associated with graduate 12 medical education (GME). 13 (14) In general, the level of support of graduate 14 medical education by the Medicare Program has 15 been capped since 1997 and has not been increased 16 to support the expansion of graduate medical edu- 17 cation programs needed to avert the projected physi- 18 cian shortage or to accommodate the increase in 19 United States medical school graduates. 20 (b) SENSE OF CONGRESS.—It is the sense of Con- 21 gress that eliminating the limit of the number of residency 22 positions that receive some level of Medicare support 23 under section 1886(h) of the Social Security Act (42 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00183 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 184 •HR 5942 IH U.S.C. 1395ww(h)), also referred to as the Medical grad- 1 uate medical education cap, is critical to— 2 (1) ensuring an appropriate supply of physi- 3 cians to meet the Nation’s health care needs; 4 (2) facilitating equitable access for all who seek 5 health care; and 6 (3) mitigating disparities in health and health 7 care. 8 SEC. 313. CAREER SUPPORT FOR SKILLED, INTERNATION- 9 ALLY EDUCATED HEALTH PROFESSIONALS. 10 (a) FINDINGS.—Congress finds the following: 11 (1) According to the Association of Schools of 12 Public Health, projections indicate a nationwide 13 shortage of up to 250,000 public health workers 14 needed by 2020. 15 (2) Similar trends are projected for other health 16 professions indicating shortages across disciplines, 17 including within the fields of nursing (500,000 by 18 2025), dentistry (15,000 by 2025), pharmacy 19 (38,000 by 2030), mental and behavioral health, pri- 20 mary care (46,000 by 2025), and community and al- 21 lied health. 22 (3) A nationwide health workforce shortage will 23 result in serious health threats and more severe and 24 costly health care needs, due to, in part, a delayed 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00184 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 185 •HR 5942 IH response to food-borne outbreaks, emerging infec- 1 tious diseases, natural disasters, fewer cancer 2 screenings, and delayed treatment. 3 (4) Vulnerable and underserved populations and 4 health professional shortage areas will be most se- 5 verely impacted by the health workforce shortage. 6 (5) According to the Migration Policy Institute, 7 over 2,000,000 college-educated immigrants in the 8 United States today are unemployed or under- 9 employed in low- or semi-skilled jobs that fail to 10 draw on their education and expertise. 11 (6) Approximately 2 out of every 5 internation- 12 ally educated immigrants are unemployed or under- 13 employed. 14 (7) According to Drexel University Center for 15 Labor Markets and Policy, underemployment for 16 internationally educated immigrant women is 28 per- 17 cent higher than for their male counterparts. 18 (8) According to the Drexel University Center 19 for labor markets and policy, the mean annual earn- 20 ings of underemployed immigrants were $32,000, or 21 43 percent less than United States born college 22 graduates employed in the college labor market. 23 (9) According to Upwardly Global and the Wel- 24 come Back Initiative, with proper guidance and sup- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00185 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 186 •HR 5942 IH port, underemployed skilled immigrants typically in- 1 crease their income by 215 percent to 900 percent. 2 (10) According to the Brookings Institution and 3 the Partnership for a New American Economy, im- 4 migrants working in the health workforce are, on av- 5 erage, better educated than United States-born 6 workers in the health workforce. 7 (b) GRANTS TO ELIGIBLE ENTITIES.— 8 (1) AUTHORITY TO PROVIDE GRANTS.—The 9 Secretary of Health and Human Services acting 10 through the Bureau of Health Workforce within the 11 Health Resources and Services Administration, the 12 National Institute on Minority Health and Health 13 Disparities, or the Office of Minority Health (in this 14 section referred to as the ‘‘Secretary’’) may award 15 grants to eligible entities to carry out activities de- 16 scribed in subsection (c). 17 (2) ELIGIBILITY.—To be eligible to receive a 18 grant under this section, an entity shall— 19 (A) be a clinical, public health, or health 20 services organization, a community-based or 21 nonprofit entity, an academic institution, a 22 faith-based organization, a State, county, or 23 local government, an Area Health Education 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00186 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 187 •HR 5942 IH Center, or another entity determined appro- 1 priate by the Secretary; and 2 (B) submit to the Secretary an application 3 at such time, in such manner, and containing 4 such information as the Secretary may require. 5 (c) AUTHORIZED ACTIVITIES.—A grant awarded 6 under this section shall be used— 7 (1) to provide services to assist unemployed and 8 underemployed skilled immigrants, residing in the 9 United States, who have legal, permanent work au- 10 thorization and who are internationally educated 11 health professionals, enter into the American health 12 workforce with employment matching their health 13 professional skills and education, and advance in em- 14 ployment to positions that better match their health 15 professional education and expertise; 16 (2) to provide training opportunities to reduce 17 barriers to entry and advancement in the health 18 workforce for skilled, internationally educated immi- 19 grants; 20 (3) to educate employers regarding the abilities 21 and capacities of internationally educated health 22 professionals; 23 (4) to assist in the evaluation of foreign creden- 24 tials; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00187 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 188 •HR 5942 IH (5) to support preceptorships for international 1 medical graduates in hospital primary care training; 2 and 3 (6) to facilitate access to contextualized and ac- 4 celerated courses on English as a second language. 5 TITLE IV—IMPROVING HEALTH 6 CARE ACCESS AND QUALITY 7 Subtitle A—Expansion of Coverage 8 SEC. 401. AMENDMENT TO THE PUBLIC HEALTH SERVICE 9 ACT. 10 Title XXXIV of the Public Health Service Act, as 11 amended by titles I, II, III, and IX of this Act, is further 12 amended by inserting after subtitle C the following: 13 ‘‘Subtitle D—Reconstruction and 14 Improvement Grants for Public 15 Health Care Facilities Serving 16 Pacific Islanders and the Insu- 17 lar Areas 18 ‘‘SEC. 3451. GRANT SUPPORT FOR QUALITY IMPROVEMENT 19 INITIATIVES. 20 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 21 with the Administrator of the Health Resources and Serv- 22 ices Administration, the Director of the Agency for 23 Healthcare Research and Quality, and the Administrator 24 of the Centers for Medicare & Medicaid Services, shall 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00188 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 189 •HR 5942 IH award grants to eligible entities for the conduct of dem- 1 onstration projects to improve the quality of and access 2 to health care. 3 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 4 under subsection (a), an entity shall— 5 ‘‘(1) be a health center, hospital, health plan, 6 health system, community clinic. or other health en- 7 tity determined appropriate by the Secretary— 8 ‘‘(A) that, by legal mandate or explicitly 9 adopted mission, provides patients with access 10 to services regardless of their ability to pay; 11 ‘‘(B) that provides care or treatment for a 12 substantial number of patients who are unin- 13 sured, are receiving assistance under a State 14 program under title XIX of the Social Security 15 Act, or are members of vulnerable populations, 16 as determined by the Secretary; and 17 ‘‘(C)(i) with respect to which, not less than 18 50 percent of the entity’s patient population is 19 made up of racial and ethnic minorities; or 20 ‘‘(ii) that— 21 ‘‘(I) serves a disproportionate percent- 22 age of local, minority racial and ethnic pa- 23 tients, or that has a patient population, at 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00189 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 190 •HR 5942 IH least 50 percent of which is limited- 1 English-proficient; and 2 ‘‘(II) provides an assurance that 3 amounts received under the grant will be 4 used only to support quality improvement 5 activities in the racial and ethnic popu- 6 lation served; and 7 ‘‘(2) prepare and submit to the Secretary an 8 application at such time, in such manner, and con- 9 taining such information as the Secretary may re- 10 quire. 11 ‘‘(c) PRIORITY.—In awarding grants under sub- 12 section (a), the Secretary shall give priority to applicants 13 under subsection (b)(2) that— 14 ‘‘(1) demonstrate an intent to operate as part 15 of a health care partnership, network, collaborative, 16 coalition, or alliance where each member entity con- 17 tributes to the design, implementation, and evalua- 18 tion of the proposed intervention; or 19 ‘‘(2) intend to use funds to carry out system- 20 wide changes with respect to health care quality im- 21 provement, including— 22 ‘‘(A) improved systems for data collection 23 and reporting; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00190 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 191 •HR 5942 IH ‘‘(B) innovative collaborative or similar 1 processes; 2 ‘‘(C) group programs with behavioral or 3 self-management interventions; 4 ‘‘(D) case management services; 5 ‘‘(E) physician or patient reminder sys- 6 tems; 7 ‘‘(F) educational interventions; or 8 ‘‘(G) other activities determined appro- 9 priate by the Secretary. 10 ‘‘(d) USE OF FUNDS.—An entity shall use amounts 11 received under a grant under subsection (a) to support 12 the implementation and evaluation of health care quality 13 improvement activities or minority health and health care 14 disparity reduction activities that include— 15 ‘‘(1) with respect to health care systems, activi- 16 ties relating to improving— 17 ‘‘(A) patient safety; 18 ‘‘(B) timeliness of care; 19 ‘‘(C) effectiveness of care; 20 ‘‘(D) efficiency of care; 21 ‘‘(E) patient centeredness; and 22 ‘‘(F) health information technology; and 23 ‘‘(2) with respect to patients, activities relating 24 to— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00191 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 192 •HR 5942 IH ‘‘(A) staying healthy; 1 ‘‘(B) getting well, mentally and physically; 2 ‘‘(C) living effectively with illness or dis- 3 ability; 4 ‘‘(D) coping with end-of-life issues; and 5 ‘‘(E) shared decisionmaking. 6 ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 7 provide financial and other technical assistance to grant- 8 ees under this section for the development of common data 9 systems. 10 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 11 are authorized to be appropriated to carry out this section 12 such sums as may be necessary for each of fiscal years 13 2019 through 2024. 14 ‘‘SEC. 3452. CENTERS OF EXCELLENCE. 15 ‘‘(a) IN GENERAL.—The Secretary, acting through 16 the Administrator of the Health Resources and Services 17 Administration, shall designate centers of excellence at 18 public hospitals, and other health systems serving large 19 numbers of minority patients, that— 20 ‘‘(1) meet the requirements of section 21 3451(b)(1); 22 ‘‘(2) demonstrate excellence in providing care to 23 minority populations; and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00192 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 193 •HR 5942 IH ‘‘(3) demonstrate excellence in reducing dispari- 1 ties in health and health care. 2 ‘‘(b) REQUIREMENTS.—A hospital or health system 3 that serves as a center of excellence under subsection (a) 4 shall— 5 ‘‘(1) design, implement, and evaluate programs 6 and policies relating to the delivery of care in ra- 7 cially, ethnically, and linguistically diverse popu- 8 lations; 9 ‘‘(2) provide training and technical assistance 10 to other hospitals and health systems relating to the 11 provision of quality health care to minority popu- 12 lations; and 13 ‘‘(3) develop activities for graduate or con- 14 tinuing medical education that institutionalize a 15 focus on cultural competence training for health care 16 providers. 17 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 18 are authorized to be appropriated to carry out this section, 19 such sums as may be necessary for each of fiscal years 20 2019 through 2024. 21 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00193 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 194 •HR 5942 IH ‘‘SEC. 3453. RECONSTRUCTION AND IMPROVEMENT GRANTS 1 FOR PUBLIC HEALTH CARE FACILITIES SERV- 2 ING PACIFIC ISLANDERS AND THE INSULAR 3 AREAS. 4 ‘‘(a) IN GENERAL.—The Secretary shall provide di- 5 rect financial assistance to designated health care pro- 6 viders and community health centers in American Samoa, 7 Guam, the Commonwealth of the Northern Mariana Is- 8 lands, the United States Virgin Islands, Puerto Rico, and 9 Hawaii for the purposes of reconstructing and improving 10 health care facilities and services in a culturally competent 11 and sustainable manner. 12 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi- 13 nancial assistance under subsection (a), an entity shall be 14 a public health facility or community health center located 15 in American Samoa, Guam, the Commonwealth of the 16 Northern Mariana Islands, the United States Virgin Is- 17 lands, Puerto Rico, or Hawaii that— 18 ‘‘(1) is owned or operated by— 19 ‘‘(A) the Government of American Samoa, 20 Guam, the Commonwealth of the Northern 21 Mariana Islands, the United States Virgin Is- 22 lands, Puerto Rico, or Hawaii or a unit of local 23 government; or 24 ‘‘(B) a nonprofit organization; and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00194 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 195 •HR 5942 IH ‘‘(2)(A) provides care or treatment for a sub- 1 stantial number of patients who are uninsured, re- 2 ceiving assistance under a State program under a 3 title XVIII of the Social Security Act, or a State 4 program under title XIX of such Act, or who are 5 members of a vulnerable population, as determined 6 by the Secretary; or 7 ‘‘(B) serves a disproportionate percentage of 8 local, minority racial and ethnic patients. 9 ‘‘(c) REPORT.—Not later than 180 days after the 10 date of enactment of this title and annually thereafter, the 11 Secretary shall submit to the Congress and the President 12 a report that includes an assessment of health resources 13 and facilities serving populations in American Samoa, 14 Guam, the Commonwealth of the Northern Mariana Is- 15 lands, the United States Virgin Islands, Puerto Rico, and 16 Hawaii. In preparing such report, the Secretary shall— 17 ‘‘(1) consult with and obtain information on all 18 health care facilities needs from the entities de- 19 scribed in subsection (b); 20 ‘‘(2) include all amounts of Federal assistance 21 received by each entity in the preceding fiscal year; 22 ‘‘(3) review the total unmet needs of each juris- 23 diction for health care facilities, including needs for 24 renovation and expansion of existing facilities; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00195 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 196 •HR 5942 IH ‘‘(4) include a strategic plan for addressing the 1 needs of each jurisdiction identified in the report; 2 and 3 ‘‘(5) evaluate the effectiveness of the care pro- 4 vided by measuring patient outcomes and cost meas- 5 ures. 6 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 7 are authorized to be appropriated such sums as necessary 8 to carry out this section.’’. 9 SEC. 402. REMOVING CITIZENSHIP AND IMMIGRATION BAR- 10 RIERS TO ACCESS TO AFFORDABLE HEALTH 11 CARE UNDER ACA. 12 (a) IN GENERAL.— 13 (1) PREMIUM TAX CREDITS.—Section 36B of 14 the Internal Revenue Code of 1986 is amended— 15 (A) in subsection (c)(1)(B)— 16 (i) by amending the heading to read 17 as follows: ‘‘SPECIAL RULE FOR CERTAIN 18 INDIVIDUALS INELIGIBLE FOR MEDICAID 19 DUE TO STATUS’’, and 20 (ii) in clause (ii), by striking ‘‘lawfully 21 present in the United States, but’’ and in- 22 serting ‘‘who’’, and 23 (B) by striking subsection (e). 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00196 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 197 •HR 5942 IH (2) COST-SHARING REDUCTIONS.—Section 1402 1 of the Patient Protection and Affordable Care Act 2 (42 U.S.C. 18071) is amended by striking sub- 3 section (e). 4 (3) BASIC HEALTH PROGRAM ELIGIBILITY.— 5 Section 1331(e)(1)(B) of the Patient Protection and 6 Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 7 amended by striking ‘‘lawfully present in the United 8 States’’. 9 (4) RESTRICTIONS ON FEDERAL PAYMENTS.— 10 Section 1412 of the Patient Protection and Afford- 11 able Care Act (42 U.S.C. 18082) is amended by 12 striking subsection (d). 13 (5) REQUIREMENT TO MAINTAIN MINIMUM ES- 14 SENTIAL COVERAGE.—Section 5000A(d) of the In- 15 ternal Revenue Code of 1986 is amended by striking 16 paragraph (3) and by redesignating paragraph (4) 17 as paragraph (3). 18 (b) CONFORMING AMENDMENTS.— 19 (1) Section 1411(a) of the Patient Protection 20 and Affordable Care Act (42 U.S.C. 18081(a)) is 21 amended by striking paragraph (1) and redesig- 22 nating paragraphs (2), (3), and (4) as paragraphs 23 (1), (2), and (3), respectively. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00197 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 198 •HR 5942 IH (2) Section 1312(f) of the Patient Protection 1 and Affordable Care Act (42 U.S.C. 18032(f)) is 2 amended— 3 (A) in the heading, by striking ‘‘; ACCESS 4 LIMITED TO CITIZENS AND LAWFUL RESI- 5 DENTS’’; and 6 (B) by striking paragraph (3). 7 SEC. 403. STUDY ON THE UNINSURED. 8 (a) IN GENERAL.—The Secretary of Health and 9 Human Services (in this section referred to as the ‘‘Sec- 10 retary’’) shall— 11 (1) conduct a study, in accordance with the 12 standards under section 3101 of the Public Health 13 Service Act (42 U.S.C. 300kk), on the demographic 14 characteristics of the population of individuals who 15 do not have health insurance coverage or oral health 16 coverage; and 17 (2) predict, based on such study, the demo- 18 graphic characteristics of the population of individ- 19 uals who would remain without health insurance cov- 20 erage after the end of any annual open enrollment 21 or any special enrollment period or upon enactment 22 and implementation of any legislative changes to the 23 Patient Protection and Affordable Care Act that af- 24 fect the number of persons eligible for coverage. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00198 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 199 •HR 5942 IH (b) REPORTING REQUIREMENTS.— 1 (1) IN GENERAL.—Not later than 12 months 2 after the date of the enactment of this Act, the Sec- 3 retary shall submit to the Congress the results of 4 the study under subsection (a)(1) and the prediction 5 made under subsection (a)(2). 6 (2) REPORTING OF DEMOGRAPHIC CHARACTER- 7 ISTICS.—The Secretary shall— 8 (A) report the demographic characteristics 9 under paragraphs (1) and (2) of subsection (a) 10 on the basis of racial and ethnic group, and 11 shall stratify the reporting on each racial and 12 ethnic group by other demographic characteris- 13 tics that can impact access to health insurance 14 coverage, such as sexual orientation, gender 15 identity, primary language, disability status, 16 sex, socioeconomic status, age group, and citi- 17 zenship and immigration status, in a manner 18 consistent with title I of this Act; and 19 (B) not use such report to engage in or an- 20 ticipate any deportation or immigration related 21 enforcement action by any entity, including the 22 Department of Homeland Security. 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00199 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 200 •HR 5942 IH SEC. 404. MEDICAID IN THE TERRITORIES. 1 (a) ELIMINATION OF GENERAL MEDICAID FUNDING 2 LIMITATIONS (‘‘CAP’’) FOR TERRITORIES.— 3 (1) IN GENERAL.—Section 1108 of the Social 4 Security Act (42 U.S.C. 1308) is amended— 5 (A) in subsection (f), in the matter before 6 paragraph (1), by striking ‘‘subsection (g)’’ and 7 inserting ‘‘subsections (g) and (h)’’; 8 (B) in subsection (g)(2), in the matter be- 9 fore subparagraph (A), by inserting ‘‘and sub- 10 section (h)’’ after ‘‘paragraphs (3) and (5)’’; 11 and 12 (C) by adding at the end the following new 13 subsection: 14 ‘‘(h) SUNSET OF MEDICAID FUNDING LIMITATIONS 15 FOR PUERTO RICO, THE VIRGIN ISLANDS OF THE 16 UNITED STATES, GUAM, THE NORTHERN MARIANA IS- 17 LANDS, AND AMERICAN SAMOA.—Subsections (f) and (g) 18 shall not apply to Puerto Rico, the Virgin Islands of the 19 United States, Guam, the Northern Mariana Islands, and 20 American Samoa beginning with fiscal year 2019.’’. 21 (2) CONFORMING AMENDMENTS.— 22 (A) Section 1902(j) of the Social Security 23 Act (42 U.S.C. 1396a(j)) is amended by strik- 24 ing ‘‘, the limitation in section 1108(f),’’. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00200 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 201 •HR 5942 IH (B) Section 1903(u) of the Social Security 1 Act (42 U.S.C. 1396b(u)) is amended by strik- 2 ing paragraph (4). 3 (C) Section 1323(c)(1) of the Patient Pro- 4 tection and Affordable Care Act (42 U.S.C. 5 18043(c)(1)) is amended by striking ‘‘2019’’ 6 and inserting ‘‘2018’’. 7 (3) EFFECTIVE DATE.—The amendments made 8 by this section shall apply beginning with fiscal year 9 2019. 10 (b) ELIMINATION OF SPECIFIC FEDERAL MEDICAL 11 ASSISTANCE PERCENTAGE (FMAP) LIMITATION FOR 12 TERRITORIES.—Section 1905(b) of the Social Security 13 Act (42 U.S.C. 1396d(b)) is amended, in clause (2), by 14 inserting ‘‘for fiscal years before fiscal year 2019’’ after 15 ‘‘American Samoa’’. 16 (c) APPLICATION OF MEDICAID WAIVER AUTHORITY 17 TO ALL OF THE TERRITORIES.— 18 (1) IN GENERAL.—Section 1902(j) of the Social 19 Security Act (42 U.S.C. 1396a(j)) is amended— 20 (A) by striking ‘‘American Samoa and the 21 Northern Mariana Islands’’ and inserting 22 ‘‘Puerto Rico, the Virgin Islands of the United 23 States, Guam, the Northern Mariana Islands, 24 and American Samoa’’; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00201 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 202 •HR 5942 IH (B) by striking ‘‘American Samoa or the 1 Northern Mariana Islands’’ and inserting 2 ‘‘Puerto Rico, the Virgin Islands of the United 3 States, Guam, the Northern Mariana Islands, 4 or American Samoa’’; 5 (C) by inserting ‘‘(1)’’ after ‘‘(j)’’; 6 (D) by inserting ‘‘except as otherwise pro- 7 vided in this subsection,’’ after ‘‘Notwith- 8 standing any other requirement of this title’’; 9 and 10 (E) by adding at the end the following: 11 ‘‘(2) The Secretary may not waive under this sub- 12 section the requirement of subsection (a)(10)(A)(i)(IX) 13 (relating to coverage of adults formerly under foster care) 14 with respect to any territory.’’. 15 (2) EFFECTIVE DATE.—The amendments made 16 by this section shall apply beginning October 1, 17 2018. 18 (d) PERMITTING MEDICAID DSH ALLOTMENTS FOR 19 TERRITORIES.—Section 1923(f) of the Social Security Act 20 (42 U.S.C. 1396) is amended— 21 (1) in paragraph (6), by adding at the end the 22 following new subparagraph: 23 ‘‘(C) TERRITORIES.— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00202 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 203 •HR 5942 IH ‘‘(i) FISCAL YEAR 2019.—For fiscal 1 year 2019, the DSH allotment for Puerto 2 Rico, the Virgin Islands of the United 3 States, Guam, the Northern Mariana Is- 4 lands, and American Samoa shall bear the 5 same ratio to $150,000,000 as the ratio of 6 the number of individuals who are low-in- 7 come or uninsured and residing in such re- 8 spective territory (as estimated from time 9 to time by the Secretary) bears to the 10 sums of the number of such individuals re- 11 siding in all of the territories. 12 ‘‘(ii) SUBSEQUENT FISCAL YEAR.— 13 For each subsequent fiscal year, the DSH 14 allotment for each such territory is subject 15 to an increase in accordance with para- 16 graph (2).’’; and 17 (2) in paragraph (9), by inserting before the pe- 18 riod at the end the following: ‘‘, and includes, begin- 19 ning with fiscal year 2019, Puerto Rico, the Virgin 20 Islands of the United States, Guam, the Northern 21 Mariana Islands, and American Samoa’’. 22 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00203 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 204 •HR 5942 IH SEC. 405. 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, 2019’’ 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, 2019 (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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00204 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 205 •HR 5942 IH SEC. 406. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00205 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 206 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00206 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 207 •HR 5942 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 2019, and such sums as may 15 be necessary for each succeeding fiscal year. 16 SEC. 407. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00207 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 208 •HR 5942 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. 408. 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. 409. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00208 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 209 •HR 5942 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 Subtitle B—Expansion of Access 12 SEC. 410. PROTECTING SENSITIVE LOCATIONS. 13 Section 287 of the Immigration and Nationality Act 14 (8 U.S.C. 1357) is amended by adding at the end the fol- 15 lowing: 16 ‘‘(i)(1) In this subsection: 17 ‘‘(A) The term ‘appropriate committees of Con- 18 gress’ means— 19 ‘‘(i) the Committee on Homeland Security 20 and Governmental Affairs of the Senate; 21 ‘‘(ii) the Committee on the Judiciary of the 22 Senate; 23 ‘‘(iii) the Committee on Homeland Security 24 of the House of Representatives; and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00209 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 210 •HR 5942 IH ‘‘(iv) the Committee on the Judiciary of 1 the House of Representatives. 2 ‘‘(B) The term ‘enforcement action’— 3 ‘‘(i) means an apprehension, arrest, inter- 4 view, request for identification, search, or sur- 5 veillance for the purposes of immigration en- 6 forcement; and 7 ‘‘(ii) includes an enforcement action at, or 8 focused on, a sensitive location that is part of 9 a joint case led by another law enforcement 10 agency. 11 ‘‘(C) The term ‘exigent circumstances’ means a 12 situation involving— 13 ‘‘(i) the imminent risk of death, violence, 14 or physical harm to any person or property, in- 15 cluding a situation implicating terrorism or the 16 national security of the United States; 17 ‘‘(ii) the immediate arrest or pursuit of a 18 dangerous felon, terrorist suspect, or other indi- 19 vidual presenting an imminent danger; or 20 ‘‘(iii) the imminent risk of destruction of 21 evidence that is material to an ongoing criminal 22 case. 23 ‘‘(D) The term ‘prior approval’ means— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00210 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 211 •HR 5942 IH ‘‘(i) in the case of officers and agents of 1 U.S. Immigration and Customs Enforcement, 2 prior written approval to carry out an enforce- 3 ment action involving a specific individual or in- 4 dividuals authorized by— 5 ‘‘(I) the Assistant Director of Oper- 6 ations, Homeland Security Investigations; 7 ‘‘(II) the Executive Associate Director 8 of Homeland Security Investigations; 9 ‘‘(III) the Assistant Director for Field 10 Operations, Enforcement and Removal Op- 11 erations; or 12 ‘‘(IV) the Executive Associate Direc- 13 tor for Field Operations, Enforcement and 14 Removal Operations; 15 ‘‘(ii) in the case of officers and agents of 16 U.S. Customs and Border Protection, prior 17 written approval to carry out an enforcement 18 action involving a specific individual or individ- 19 uals authorized by— 20 ‘‘(I) a Chief Patrol Agent; 21 ‘‘(II) the Director of Field Operations; 22 ‘‘(III) the Director of Air and Marine 23 Operations; or 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00211 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 212 •HR 5942 IH ‘‘(IV) the Internal Affairs Special 1 Agent in Charge; and 2 ‘‘(iii) in the case of other Federal, State, 3 or local law enforcement officers, to carry out 4 an enforcement action involving a specific indi- 5 vidual or individuals authorized by— 6 ‘‘(I) the head of the Federal agency 7 carrying out the enforcement action; or 8 ‘‘(II) the head of the State or local 9 law enforcement agency carrying out the 10 enforcement action. 11 ‘‘(E) The term ‘sensitive location’ includes all of 12 the physical space located within 1,000 feet of— 13 ‘‘(i) any medical treatment or health care 14 facility, including any hospital, doctor’s office, 15 accredited health clinic, alcohol or drug treat- 16 ment center, or emergent or urgent care facil- 17 ity; 18 ‘‘(ii) any public or private school, including 19 any known and licensed day care facility, pre- 20 school, other early learning program facility, 21 primary school, secondary school, postsecondary 22 school (including colleges and universities), or 23 other institution of learning (including voca- 24 tional or trade schools); 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00212 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 213 •HR 5942 IH ‘‘(iii) any scholastic or education-related 1 activity or event, including field trips and inter- 2 scholastic events; 3 ‘‘(iv) any school bus or school bus stop 4 during periods when school children are present 5 on the bus or at the stop; 6 ‘‘(v) any organization that— 7 ‘‘(I) assists children, pregnant women, 8 victims of crime or abuse, or individuals 9 with significant mental or physical disabil- 10 ities; or 11 ‘‘(II) provides disaster or emergency 12 social services and assistance; 13 ‘‘(vi) any church, synagogue, mosque, or 14 other place of worship, including buildings 15 rented for the purpose of religious services, re- 16 treats, counseling, workshops, instruction, and 17 education; 18 ‘‘(vii) any Federal, State, or local court- 19 house, including the office of an individual’s 20 legal counsel or representative, and a probation, 21 parole, or supervised release office; 22 ‘‘(viii) the site of a funeral, wedding, or 23 other religious ceremony or observance; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00213 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 214 •HR 5942 IH ‘‘(ix) any public demonstration, such as a 1 march, rally, or parade; 2 ‘‘(x) any domestic violence shelter, rape 3 crisis center, supervised visitation center, family 4 justice center, or victim services provider; or 5 ‘‘(xi) any other location specified by the 6 Secretary of Homeland Security for purposes of 7 this subsection. 8 ‘‘(2)(A) An enforcement action may not take place 9 at, or be focused on, a sensitive location unless— 10 ‘‘(i) the action involves exigent circumstances; 11 and 12 ‘‘(ii) prior approval for the enforcement action 13 was obtained from the appropriate official. 14 ‘‘(B) If an enforcement action is initiated pursuant 15 to subparagraph (A) and the exigent circumstances per- 16 mitting the enforcement action cease, the enforcement ac- 17 tion shall be discontinued until such exigent circumstances 18 reemerge. 19 ‘‘(C) If an enforcement action is carried out in viola- 20 tion of this subsection— 21 ‘‘(i) no information resulting from the enforce- 22 ment action may be entered into the record or re- 23 ceived into evidence in a removal proceeding result- 24 ing from the enforcement action; and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00214 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 215 •HR 5942 IH ‘‘(ii) the alien who is the subject of such re- 1 moval proceeding may file a motion for the imme- 2 diate termination of the removal proceeding. 3 ‘‘(3)(A) This subsection shall apply to any enforce- 4 ment action by officers or agents of the Department of 5 Homeland Security, including— 6 ‘‘(i) officers or agents of U.S. Immigration and 7 Customs Enforcement; 8 ‘‘(ii) officers or agents of U.S. Customs and 9 Border Protection; and 10 ‘‘(iii) any individual designated to perform im- 11 migration enforcement functions pursuant to sub- 12 section (g). 13 ‘‘(B) While carrying out an enforcement action at a 14 sensitive location, officers and agents referred to in sub- 15 paragraph (A) shall make every effort— 16 ‘‘(i) to limit the time spent at the sensitive loca- 17 tion; 18 ‘‘(ii) to limit the enforcement action at the sen- 19 sitive location to the person or persons for whom 20 prior approval was obtained; and 21 ‘‘(iii) to conduct themselves discreetly. 22 ‘‘(C) If, while carrying out an enforcement action 23 that is not initiated at or focused on a sensitive location, 24 officers or agents are led to a sensitive location, and no 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00215 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 216 •HR 5942 IH exigent circumstance and prior approval with respect to 1 the sensitive location exists, such officers or agents shall— 2 ‘‘(i) cease before taking any further enforce- 3 ment action; 4 ‘‘(ii) conduct themselves in a discreet manner; 5 ‘‘(iii) maintain surveillance; and 6 ‘‘(iv) immediately consult their supervisor in 7 order to determine whether such enforcement action 8 should be discontinued. 9 ‘‘(D) The limitations under this paragraph shall not 10 apply to the transportation of an individual apprehended 11 at or near a land or sea border to a hospital or health 12 care provider for the purpose of providing medical care 13 to such individual. 14 ‘‘(4)(A) Each official specified in subparagraph (B) 15 shall ensure that the employees under his or her super- 16 vision receive annual training on compliance with— 17 ‘‘(i) the requirements under this subsection in 18 enforcement actions at or focused on sensitive loca- 19 tions and enforcement actions that lead officers or 20 agents to a sensitive location; and 21 ‘‘(ii) the requirements under section 239 of this 22 Act and section 384 of the Illegal Immigration Re- 23 form and Immigrant Responsibility Act of 1996 (8 24 U.S.C. 1367). 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00216 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 217 •HR 5942 IH ‘‘(B) The officials specified in this subparagraph 1 are— 2 ‘‘(i) the Chief Counsel of U.S. Immigration and 3 Customs Enforcement; 4 ‘‘(ii) the Field Office Directors of U.S. Immi- 5 gration and Customs Enforcement; 6 ‘‘(iii) each Special Agent in Charge of U.S. Im- 7 migration and Customs Enforcement; 8 ‘‘(iv) each Chief Patrol Agent of U.S. Customs 9 and Border Protection; 10 ‘‘(v) the Director of Field Operations of U.S. 11 Customs and Border Protection; 12 ‘‘(vi) the Director of Air and Marine Operations 13 of U.S. Customs and Border Protection; 14 ‘‘(vii) the Internal Affairs Special Agent in 15 Charge of U.S. Customs and Border Protection; and 16 ‘‘(viii) the chief law enforcement officer of each 17 State or local law enforcement agency that enters 18 into a written agreement with the Department of 19 Homeland Security pursuant to subsection (g). 20 ‘‘(5) The Secretary of Homeland Security shall mod- 21 ify the Notice to Appear form (I–862)— 22 ‘‘(A) to provide the subjects of an enforcement 23 action with information, written in plain language, 24 summarizing the restrictions against enforcement 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00217 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 218 •HR 5942 IH actions at sensitive locations set forth in this sub- 1 section and the remedies available to the alien if 2 such action violates such restrictions; 3 ‘‘(B) so that the information described in sub- 4 paragraph (A) is accessible to individuals with lim- 5 ited-English proficiency; and 6 ‘‘(C) so that subjects of an enforcement action 7 are not permitted to verify that the officers or 8 agents that carried out such action complied with 9 the restrictions set forth in this subsection. 10 ‘‘(6)(A) The Director of U.S. Immigration and Cus- 11 toms Enforcement and the Commissioner of U.S. Customs 12 and Border Protection shall each submit an annual report 13 to the appropriate committees of Congress that includes 14 the information set forth in subparagraph (B) with respect 15 to the respective agency. 16 ‘‘(B) Each report submitted under subparagraph (A) 17 shall include, with respect to the submitting agency during 18 the reporting period— 19 ‘‘(i) the number of enforcement actions that 20 were carried out at, or focused on, a sensitive loca- 21 tion; 22 ‘‘(ii) the number of enforcement actions in 23 which officers or agents were subsequently led to a 24 sensitive location; and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00218 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 219 •HR 5942 IH ‘‘(iii) for each enforcement action described in 1 clause (i) or (ii)— 2 ‘‘(I) the date on which it occurred; 3 ‘‘(II) the specific site, city, county, and 4 State in which it occurred; 5 ‘‘(III) the components of the agency in- 6 volved in the enforcement action; 7 ‘‘(IV) a description of the enforcement ac- 8 tion, including the nature of the criminal activ- 9 ity of its intended target; 10 ‘‘(V) the number of individuals, if any, ar- 11 rested or taken into custody; 12 ‘‘(VI) the number of collateral arrests, if 13 any, and the reasons for each such arrest; 14 ‘‘(VII) a certification whether the location 15 administrator was contacted before, during, or 16 after the enforcement action; and 17 ‘‘(VIII) the percentage of all of the staff 18 members and supervisors reporting to the offi- 19 cials listed in paragraph (4)(B) who completed 20 the training required under paragraph (4)(A). 21 ‘‘(7) Nothing in the subsection may be construed— 22 ‘‘(A) to affect the authority of Federal, State, 23 or local law enforcement agencies— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00219 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 220 •HR 5942 IH ‘‘(i) to enforce generally applicable Federal 1 or State criminal laws unrelated to immigra- 2 tion; or 3 ‘‘(ii) to protect residents from imminent 4 threats to public safety; or 5 ‘‘(B) to limit or override the protections pro- 6 vided in— 7 ‘‘(i) section 239; or 8 ‘‘(ii) section 384 of the Illegal Immigration 9 Reform and Immigrant Responsibility Act of 10 1996 (8 U.S.C. 1367).’’. 11 SEC. 411. GRANTS FOR RACIAL AND ETHNIC APPROACHES 12 TO COMMUNITY HEALTH. 13 (a) PURPOSE.—It is the purpose of this section to 14 provide for the awarding of grants to assist communities 15 in mobilizing and organizing resources in support of effec- 16 tive and sustainable programs that will reduce or eliminate 17 disparities in health and health care experienced by racial 18 and ethnic minority individuals. 19 (b) AUTHORITY TO AWARD GRANTS.—The Secretary 20 of Health and Human Services, acting through the Ad- 21 ministrator of the Health Resources and Services Admin- 22 istration, shall award grants to eligible entities to assist 23 in designing, implementing, and evaluating culturally and 24 linguistically appropriate, science-based, and community- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00220 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 221 •HR 5942 IH driven sustainable strategies to eliminate racial and ethnic 1 health and health care disparities. 2 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 3 grant under this section, an entity shall— 4 (1) represent a coalition— 5 (A) whose principal purpose is to develop 6 and implement interventions to reduce or elimi- 7 nate a health or health care disparity in a tar- 8 geted racial or ethnic minority group in the 9 community served by the coalition; and 10 (B) that includes— 11 (i) members selected from among— 12 (I) public health departments; 13 (II) community-based organiza- 14 tions; 15 (III) university and research or- 16 ganizations; 17 (IV) American Indian Tribal or- 18 ganizations, national American Indian 19 organizations, Indian Health Service, 20 or organizations serving Alaska Na- 21 tives; and 22 (V) interested public or private 23 health care providers or organizations 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00221 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 222 •HR 5942 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, oral 21 disease, or other health priority areas as des- 22 ignated by the Secretary; and 23 (C) a demonstration of a proven record of 24 accomplishment of the coalition members in 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00222 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 223 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00223 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 224 •HR 5942 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. 412. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00224 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 225 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00225 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 226 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00226 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 227 •HR 5942 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. 413. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00227 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 228 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00228 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 229 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00229 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 230 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00230 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 231 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00231 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 232 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00232 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 233 •HR 5942 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. 414. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00233 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 234 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00234 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 235 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00235 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 236 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00236 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 237 •HR 5942 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. 415. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00237 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 238 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00238 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 239 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00239 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 240 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00240 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 241 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00241 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 242 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00242 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 243 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00243 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 244 •HR 5942 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 2019 11 through 2023. 12 (2) AVAILABILITY.— 13 (A) IN GENERAL.—Funds appropriated 14 under paragraph (1) shall remain available for 15 expenditure through fiscal year 2023. 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 2024. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00244 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 245 •HR 5942 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. 416. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00245 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 246 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00246 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 247 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00247 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 248 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00248 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 249 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00249 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 250 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00250 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 251 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00251 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 252 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00252 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 253 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00253 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 254 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00254 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 255 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00255 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 256 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00256 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 257 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00257 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 258 •HR 5942 IH similar grant programs, to maximize the effect of 1 public dollars in funding meritorious proposals. 2 ‘‘(g) REPORT.—Not later than September 30, 2020, 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 2019, and such sums as may 18 be necessary for each of fiscal years 2020 through 2023.’’. 19 SEC. 417. 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 ‘‘(s) MISCELLANEOUS PROVISIONS.— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00258 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 259 •HR 5942 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 language assistance (including translation and inter- 18 pretation) shall be provided by rural health clinics 19 described in paragraph (1). 20 ‘‘(3) ASSURANCES.—In order for a rural health 21 clinic to receive funds under this section through a 22 contract with a community health center for the de- 23 livery of primary health care and other services de- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00259 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 260 •HR 5942 IH scribed in paragraph (1), such rural health clinic 1 shall establish policies to ensure— 2 ‘‘(A) nondiscrimination based upon the 3 ability of a patient to pay; 4 ‘‘(B) the establishment of a sliding fee 5 scale for low-income patients; and 6 ‘‘(C) any such services should be subject to 7 full reimbursement according to the Prospective 8 Payment System scale.’’. 9 SEC. 418. FACILITATING THE PROVISION OF TELEHEALTH 10 SERVICES ACROSS STATE LINES. 11 (a) IN GENERAL.—For purposes of expediting the 12 provision of telehealth services, for which payment is made 13 under the Medicare Program, across State lines, the Sec- 14 retary of Health and Human Services shall, in consulta- 15 tion with representatives of States, physicians, health care 16 practitioners, and patient advocates, encourage and facili- 17 tate the adoption of provisions allowing for multistate 18 practitioner practice across State lines. 19 (b) DEFINITIONS.—In subsection (a): 20 (1) TELEHEALTH SERVICE.—The term ‘‘tele- 21 health service’’ has the meaning given that term in 22 subparagraph (F) of section 1834(m)(4) of the So- 23 cial Security Act (42 U.S.C. 1395m(m)(4)). 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00260 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 261 •HR 5942 IH (2) PHYSICIAN, PRACTITIONER.—The terms 1 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 2 given those terms in subparagraphs (D) and (E), re- 3 spectively, of such section. 4 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 5 Program’’ means the program of health insurance 6 administered by the Secretary of Health and Human 7 Services under title XVIII of the Social Security Act 8 (42 U.S.C. 1395 et seq.). 9 SEC. 419. SCORING OF PREVENTIVE HEALTH SAVINGS. 10 Section 202 of the Congressional Budget and Im- 11 poundment Control Act of 1974 (2 U.S.C. 602) is amend- 12 ed by adding at the end the following new subsection: 13 ‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 14 ‘‘(1) DETERMINATION BY THE DIRECTOR.— 15 Upon a request by the chairman or ranking minority 16 member of the Committee on the Budget of the Sen- 17 ate, or by the chairman or ranking minority member 18 of the Committee on the Budget of the House of 19 Representatives, the Director shall determine if a 20 proposed measure would result in reductions in 21 budget outlays in budgetary outyears through the 22 use of preventive health and preventive health serv- 23 ices. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00261 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 262 •HR 5942 IH ‘‘(2) PROJECTIONS.—If the Director determines 1 that a measure would result in substantial reduc- 2 tions in budget outlays as described in paragraph 3 (1), the Director— 4 ‘‘(A) shall include, in any projection pre- 5 pared by the Director, a description and esti- 6 mate of the reductions in budget outlays in the 7 budgetary outyears and a description of the 8 basis for such conclusions; and 9 ‘‘(B) may prepare a budget projection that 10 includes some or all of the budgetary outyears, 11 notwithstanding the time periods for projections 12 described in subsection (e) and sections 308, 13 402, and 424. 14 ‘‘(3) DEFINITIONS.—As used in this sub- 15 section— 16 ‘‘(A) the term ‘preventive health’ means an 17 action that focuses on the health of the public, 18 individuals, and defined populations in order to 19 protect, promote, and maintain health, wellness, 20 and functional ability, and prevent disease, dis- 21 ability, and premature death that is dem- 22 onstrated by credible and publicly available epi- 23 demiological projection models, incorporating 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00262 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 263 •HR 5942 IH clinical trials or observational studies in hu- 1 mans, to avoid future health care costs; and 2 ‘‘(B) the term ‘budgetary outyears’ means 3 the 2 consecutive 10-year periods beginning 4 with the first fiscal year that is 10 years after 5 the budget year provided for in the most re- 6 cently agreed to concurrent resolution on the 7 budget.’’. 8 SEC. 420. SENSE OF CONGRESS ON MAINTENANCE OF EF- 9 FORT PROVISIONS REGARDING CHILDREN’S 10 HEALTH. 11 It is the sense of the Congress that— 12 (1) the maintenance of effort provisions added 13 to sections 1902 and 2105(d) of the Social Security 14 Act by sections 2001(b) and 2101(b) of the Patient 15 Protection and Affordable Care Act were written to 16 maintain the eligibility standards for the Medicaid 17 program under title XIX of the Social Security Act 18 and Children’s Health Insurance Program under 19 title XXI of such Act until the American Health 20 Benefit Exchanges in the States are fully oper- 21 ational; 22 (2) it is imperative that the maintenance of ef- 23 fort provisions are enforced to the strict standard in- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00263 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 264 •HR 5942 IH tended by the Congress through September 30, 1 2022; 2 (3) waiving the maintenance of effort provisions 3 should not be permitted, except in the case of a re- 4 quest for a waiver that meets the explicit non- 5 application requirements; 6 (4) the maintenance of effort provisions ensure 7 the continued success of the Medicaid program and 8 Children’s Health Insurance Program and were writ- 9 ten deliberately to specifically protect vulnerable and 10 disabled individuals, children, and senior citizens, 11 many of whom are also members of communities of 12 color; and 13 (5) the maintenance of effort provisions must 14 be strictly enforced and proposals to weaken the 15 maintenance of effort provisions must not be consid- 16 ered. 17 SEC. 421. REPEAL OF REQUIREMENT FOR DOCUMENTA- 18 TION EVIDENCING CITIZENSHIP OR NATION- 19 ALITY UNDER THE MEDICAID PROGRAM. 20 (a) REPEAL.—Subsections (i)(22) and (x) of section 21 1903 of the Social Security Act (42 U.S.C. 1396b) are 22 each repealed. 23 (b) CONFORMING AMENDMENTS.— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00264 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 265 •HR 5942 IH (1) Section 1902 of the Social Security Act (42 1 U.S.C. 1396a) is amended— 2 (A) by amending paragraph (46) of sub- 3 section (a) to read as follows: 4 ‘‘(46) provide that information is requested and 5 exchanged for purposes of income and eligibility 6 verification in accordance with a State system which 7 meets the requirements of section 1137 of this 8 Act;’’; 9 (B) in subsection (e)(13)(A)(i)— 10 (i) in the matter preceding subclause 11 (I), by striking ‘‘sections 1902(a)(46)(B) 12 and 1137(d)’’ and inserting ‘‘section 13 1137(d)’’; and 14 (ii) in subclause (IV), by striking 15 ‘‘1902(a)(46)(B) or’’; and 16 (C) by striking subsection (ee). 17 (2) Section 1903 of the Social Security Act (42 18 U.S.C. 1396b) is amended— 19 (A) in subsection (i), by redesignating 20 paragraphs (23) through (26) as paragraphs 21 (22) through (25), respectively; and 22 (B) by redesignating subsections (y) and 23 (z) as subsections (x) and (y), respectively. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00265 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 266 •HR 5942 IH (3) Subsection (c) of section 6036 of the Deficit 1 Reduction Act of 2005 (42 U.S.C. 1396b note) is re- 2 pealed. 3 (c) EFFECTIVE DATE.—The repeals and amend- 4 ments made by this section shall take effect as if included 5 in the enactment of the Deficit Reduction Act of 2005. 6 SEC. 422. PROTECTION OF THE HHS OFFICES OF MINORITY 7 HEALTH. 8 (a) IN GENERAL.—Pursuant to the Patient Protec- 9 tion and Affordable Care Act (Public Law 111–148), the 10 Offices of Minority Health established within the Centers 11 for Disease Control and Prevention, the Health Resources 12 and Services Administration, the Substance Abuse and 13 Mental Health Services Administration, the Agency for 14 Healthcare Research and Quality, the Food and Drug Ad- 15 ministration, and the Centers for Medicare & Medicaid 16 Services, are offices that, regardless of change in the 17 structure of the Department of Health and Human Serv- 18 ices, shall report to the Secretary of Health and Human 19 Services. 20 (b) SENSE OF CONGRESS.—It is the sense of the 21 Congress that any effort to eliminate or consolidate such 22 Offices of Minority Health undermines the progress 23 achieved so far. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00266 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 267 •HR 5942 IH SEC. 423. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00267 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 268 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00268 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 269 •HR 5942 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 any of 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00269 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 270 •HR 5942 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 7309A the following new 5 item: 6 ‘‘7310. Office of Minority Health.’’. SEC. 424. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00270 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 271 •HR 5942 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 2018 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00271 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 272 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00272 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 273 •HR 5942 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. 425. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL 13 ACCESS FOR LOW-INCOME PATIENTS. 14 (a) IN GENERAL.—Not later than January 1, 2019, 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00273 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 274 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00274 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 275 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00275 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 276 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00276 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 277 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00277 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 278 •HR 5942 IH SEC. 426. 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. 427. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00278 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 279 •HR 5942 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. 428. 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 trained medical in- 16 terpreter, as defined in subsection (b) of this section, who 17 speaks such language available during office hours’’. 18 (b) QUALIFIED INTERPRETER FOR AN INDIVIDUAL 19 WITH LIMITED-ENGLISH PROFICIENCY, DEFINED.—The 20 term ‘‘Qualified interpreter for an individual with limited- 21 English proficiency’’ means an interpreter who via a re- 22 mote interpreting service or an on-site appearance— 23 (1) adheres to generally accepted interpreter 24 ethics principles, including client confidentiality; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00279 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 280 •HR 5942 IH (2) has demonstrated proficiency in speaking 1 and understanding both spoken English and at least 2 one other spoken language; and 3 (3) is able to interpret effectively, accurately, 4 and impartially, both receptively and expressly, to 5 and from such language(s) and English, using any 6 necessary specialized vocabulary, terminology and 7 phraseology. 8 (c) EFFECTIVE DATE.—The amendment made by 9 subsection (a) shall apply for plan years beginning more 10 than 1 year after the date of the enactment of this Act. 11 SEC. 429. ACCESS TO ESSENTIAL COMMUNITY PROVIDERS. 12 (a) ESSENTIAL COMMUNITY PROVIDERS.—Section 13 1311(c)(1)(C) of the Patient Protection and Affordable 14 Care Act (42 U.S.C. 18031(c)(1)(C)) is amended— 15 (1) by inserting ‘‘(i)’’ after ‘‘(C)’’; and 16 (2) by adding at the end the following new 17 clauses: 18 ‘‘(ii) not later than 2018, increase the per- 19 centage of essential community providers in- 20 cluded in its network by 10 percent annually 21 (based on the level in the plan for 2016) until 22 90 percent of all federally qualified health cen- 23 ters and 75 percent of all other essential com- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00280 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 281 •HR 5942 IH munity providers in the contract service area 1 are in-network; and 2 ‘‘(iii) include one of each type of essential 3 community provider in network in each county 4 in their service area, where available;’’. 5 (b) REPORTING REQUIREMENTS.—Section 6 1311(e)(3) of the Patient Protection and Affordable Care 7 Act (42 U.S.C. 18031(e)(3)(A)) is amended by adding at 8 the end the following new subparagraph: 9 ‘‘(E) DATA ON ESSENTIAL COMMUNITY 10 PROVIDERS.—The Secretary shall require quali- 11 fied health plans to submit annually to the Sec- 12 retary data on the percentage of essential com- 13 munity providers, by county, that contract with 14 each qualified health plan offered in that county 15 and the percentage of essential community pro- 16 viders, by type, that contract with each quali- 17 fied health plan offered in that county. Data so 18 submitted shall be made available to the general 19 public’’. 20 (c) ESSENTIAL COMMUNITY PROVIDER PROVISIONS 21 APPLIED UNDER MEDICARE AND MEDICAID.— 22 (1) MEDICARE.—Section 1852(d)(1) of the So- 23 cial Security Act (42 U.S.C.1395w–22(d)(1)) is 24 amended— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00281 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 282 •HR 5942 IH (A) by striking ‘‘and’’ at the end of sub- 1 paragraph (D); 2 (B) by striking the period at the end of 3 subparagraph (E) and inserting ‘‘; and’’; and 4 (C) by adding at the end the following new 5 subparagraph: 6 ‘‘(F) the plan meets the requirements of 7 clauses (ii) and (iii) of section 1311(c)(1)(C) of 8 the Patient Protection and Affordable Care Act 9 (relating to inclusion in networks of essential 10 community providers).’’. 11 (2) MEDICAID.—Section 1932(b)(5) of the So- 12 cial Security Act (42 U.S.C. 1396u–2(b)(5)) is 13 amended— 14 (A) by striking ‘‘and’’ at the end of sub- 15 paragraph (A); 16 (B) by striking the period at the end of 17 subparagraph (B) and inserting ‘‘; and’’; and 18 (C) by adding at the end the following new 19 subparagraph: 20 ‘‘(C) the plan meets the requirements of 21 clauses (ii) and (iii) of section 1311(c)(1)(C) of 22 the Patient Protection and Affordable Care Act 23 (relating to inclusion in networks of essential 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00282 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 283 •HR 5942 IH community providers) with respect to services 1 offered in the service area involved.’’. 2 SEC. 430. PROVIDER NETWORK ADEQUACY IN COMMU- 3 NITIES OF COLOR. 4 (a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa- 5 tient Protection and Affordable Care Act (42 U.S.C. 6 18031(c)(1)(B)) is amended— 7 (1) by inserting ‘‘(i)’’ after ‘‘(B)’’; and 8 (2) by adding at the end the following the fol- 9 lowing new clauses: 10 ‘‘(ii) meet such network adequacy 11 standards as the Secretary may establish 12 with regard to— 13 ‘‘(I) appointment wait time; 14 ‘‘(II) travel time and distance to 15 health care provider facilities and pro- 16 viders by public and private transit; 17 ‘‘(III) hours of operation to ac- 18 commodate individuals who cannot 19 come to provider appointments during 20 standard business hours; and 21 ‘‘(IV) other network adequacy 22 standards to ensure that care through 23 these plans is accessible to diverse 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00283 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 284 •HR 5942 IH communities, including those who are 1 limited-English proficient; and 2 ‘‘(iii) provide coverage for services for 3 enrollees through out-of-network providers 4 at no additional cost to the enrollees in 5 cases where in-network providers are un- 6 able to comply with the standards estab- 7 lished under clause subclause (III) or (IV) 8 of clause (ii) for such services and the out- 9 of-network providers can deliver such serv- 10 ices in compliance with such standards. 11 ‘‘(b) EFFECTIVE DATE.—The amendments made by 12 subsection (a) shall apply to plan years beginning more 13 than 1 year after the date of the enactment of this Act.’’. 14 SEC. 431. IMPROVING ACCESS TO DENTAL CARE. 15 (a) REPORTS TO CONGRESS.— 16 (1) GAO REPORT ON DENTAL THERAPIST PRO- 17 GRAMS.—Not later than 1 year after the date of the 18 enactment of this Act, the Comptroller General of 19 the United States shall submit to Congress a report 20 on the Alaska Dental Health Aide Therapists Pro- 21 gram and the Dental Therapist and Advanced Den- 22 tal Therapist programs in Minnesota, to assess den- 23 tal therapists’ effectiveness in— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00284 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 285 •HR 5942 IH (A) improving access to timely dental care 1 among communities of color; 2 (B) providing high quality care; and 3 (C) providing culturally competent care. 4 (2) GAO REPORT OF EXPANDING SCOPE OF 5 CERTAIN PRACTICES.—The GAO shall also report on 6 state variations in use of dental hygienists and as- 7 sess the effectiveness of expanding the scope of prac- 8 tice for hygienists in— 9 (A) improving access to timely dental care 10 among communities of color; 11 (B) providing high quality care; and 12 (C) providing culturally competent care. 13 (3) HRSA REPORT ON DENTAL SHORTAGE 14 AREAS.—Not later than 1 year after the date of the 15 enactment of this Act, the Secretary, acting through 16 the Administrator of the Health Resources Service 17 Administration, shall submit to Congress a report 18 which details geographic dental access shortages and 19 the preparedness of dental providers to offer cul- 20 turally and linguistically appropriate, affordable, ac- 21 cessible, and timely services. 22 (b) EXPANSION OF DENTAL HEALTH AID THERA- 23 PISTS IN TRIBAL COMMUNITIES.—Section 119(d) of the 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00285 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 286 •HR 5942 IH Indian Health Care Improvement Act ( U.S.C. 1616l(d)) 1 is amended— 2 (1) in paragraph (2), by striking ‘‘Subject to’’ 3 and all that follows and inserting ‘‘Subject to para- 4 graph (3), in establishing a national program under 5 paragraph (1), the Secretary shall not reduce the 6 amounts provided for the Community Health Aide 7 Program described in subsections (a) and (b).’’; 8 (2) by striking paragraph (3); and 9 (3) by redesignating paragraph (4) as para- 10 graph (3). 11 (c) COVERAGE OF DENTAL SERVICES UNDER THE 12 MEDICARE PROGRAM.— 13 (1) COVERAGE.—Section 1861(s)(2) of the So- 14 cial Security Act (42 U.S.C. 1395x(s)(2)) is amend- 15 ed— 16 (A) in subparagraph (EE), by striking 17 ‘‘and’’ after the semicolon at the end; 18 (B) in subparagraph (FF), by adding 19 ‘‘and’’ after the semicolon at the end; and 20 (C) by adding at the end the following new 21 subparagraph: 22 ‘‘(GG) oral health services (as defined in 23 subsection (kkk);’’. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00286 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 287 •HR 5942 IH (2) ORAL HEALTH SERVICES DEFINED.—Sec- 1 tion 1861 of the Social Security Act (42 U.S.C. 2 1395x), as amended by sections 205(b) and 433(a), 3 is amended by adding at the end the following new 4 subsection: 5 ‘‘Oral Health Services 6 ‘‘(kkk)(1) The term ‘oral health services’ means serv- 7 ices (as defined by the Secretary) that are necessary to 8 prevent disease and promote oral health, restore oral 9 structures to health and function, and treat emergency 10 conditions. 11 ‘‘(2) For purposes of paragraph (1), such term shall 12 include mobile and portable oral health services (as de- 13 fined by the Secretary) that— 14 ‘‘(A) are provided for the purpose of over- 15 coming mobility, transportation, and access barriers 16 for individuals; and 17 ‘‘(B) satisfy the standards and certification re- 18 quirements established under section 1902(a)(82)(B) 19 for the State in which the services are provided.’’. 20 (3) PAYMENT AND COINSURANCE.—Section 21 1833(a)(1) of the Social Security Act (42 U.S.C. 22 1395l(a)(1)) is amended— 23 (A) by striking ‘‘and’’ before ‘‘(Z)’’; and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00287 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 288 •HR 5942 IH (B) by inserting before the semicolon at 1 the end the following: ‘‘, and (AA) with respect 2 to oral health services (as defined in section 3 1861(kkk)), the amount paid shall be (i) in the 4 case of such services that are preventive, 100 5 percent of the lesser of the actual charge for 6 the services or the amount determined under 7 the payment basis determined under section 8 1848, and (ii) in the case of all other such serv- 9 ices, 80 percent of the lesser of the actual 10 charge for the services or the amount deter- 11 mined under the payment basis determined 12 under section 1848’’. 13 (4) PAYMENT UNDER PHYSICIAN FEE SCHED- 14 ULE.—Section 1848(j)(3) of the Social Security Act 15 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 16 ‘‘(2)(GG),’’ after ‘‘risk assessment),’’. 17 (5) DENTURES.—Section 1861(s)(8) of the So- 18 cial Security Act (42 U.S.C. 1395x(s)(8)) is amend- 19 ed— 20 (A) by striking ‘‘(other than dental)’’ and 21 inserting ‘‘(including dentures)’’; and 22 (B) by striking ‘‘internal body’’. 23 (6) REPEAL OF GROUND FOR EXCLUSION.— 24 Section 1862(a) of the Social Security Act (42 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00288 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 289 •HR 5942 IH U.S.C. 1395y) is amended by striking paragraph 1 (12). 2 (7) EFFECTIVE DATE.—The amendments made 3 by this section shall apply to services furnished on 4 or after January 1, 2019. 5 (d) COVERAGE OF DENTAL SERVICES UNDER THE 6 MEDICAID PROGRAM.— 7 (1) IN GENERAL.—Section 1905 of the Social 8 Security Act (42 U.S.C. 1396d) is amended— 9 (A) in subsection (a)(10), by striking ‘‘den- 10 tal services’’ and inserting ‘‘oral health services 11 (as defined in subsection (ee)(1))’’; and 12 (B) by adding at the end the following new 13 subsection: 14 ‘‘(ee)(1) Subject to paragraphs (2) and (3), for pur- 15 poses of this title, the term ‘oral health services’ means 16 services (as defined by the Secretary) that are necessary 17 to prevent disease and promote oral health, restore oral 18 structures to health and function, and treat emergency 19 conditions. These services shall include, in the case of 20 pregnant or postpartum women, such services as are nec- 21 essary to address oral health conditions that exist or are 22 exacerbated by pregnancy or childbirth or which, if left 23 untreated, could adversely affect fetal or child develop- 24 ment. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00289 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 290 •HR 5942 IH ‘‘(2) For purposes of paragraph (1), such term shall 1 include— 2 ‘‘(A) dentures; and 3 ‘‘(B) mobile and portable oral health services 4 (as defined by the Secretary) that— 5 ‘‘(i) are provided for the purpose of over- 6 coming mobility, transportation, and access bar- 7 riers for individuals; and 8 ‘‘(ii) satisfy the standards and certification 9 requirements established under section 10 1902(a)(82)(C) for the State in which the serv- 11 ices are provided. 12 ‘‘(3) For purposes of paragraph (1), such term shall 13 not apply to dental care or services provided to individuals 14 under the age of 21 under subsection (r)(3).’’. 15 (2) CONFORMING AMENDMENTS.— 16 (A) STATE PLAN REQUIREMENTS.—Section 17 1902(a) of the Social Security Act (42 U.S.C. 18 1396a(a)) is amended— 19 (i) in paragraph (10)(A), in the mat- 20 ter preceding clause (i), by inserting 21 ‘‘(10),’’ after ‘‘(5),’’; 22 (ii) in paragraph (80), by striking 23 ‘‘and’’ at the end; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00290 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 291 •HR 5942 IH (iii) in paragraph (81), by striking the 1 period at the end and inserting ‘‘; and’’; 2 and 3 (iv) by inserting after paragraph (81) 4 the following: 5 ‘‘(82) provide for— 6 ‘‘(A) informing, in writing, all individuals 7 who have been determined to be eligible for 8 medical assistance of the availability of oral 9 health services (as defined in section 1905(ee)); 10 ‘‘(B) conducting targeted outreach to preg- 11 nant women who have been determined to be el- 12 igible for medical assistance about the avail- 13 ability of medical assistance for such dental 14 services and the importance of receiving dental 15 care while pregnant; and 16 ‘‘(C) establishing and maintaining stand- 17 ards for and certification of mobile and portable 18 oral health services (as described in subsections 19 (r)(3)(C) and (ee)(2)(B) of section 1905).’’. 20 (B) DEFINITION OF MEDICAL ASSIST- 21 ANCE.—Section 1905(a)(12) of the Social Secu- 22 rity Act (42 U.S.C. 1396d(a)(12)) is amended 23 by striking ‘‘, dentures,’’. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00291 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 292 •HR 5942 IH (3) MOBILE AND PORTABLE ORAL HEALTH 1 SERVICES UNDER EPSDT.—Section 1905(r)(3) of the 2 Social Security Act (42 U.S.C. 1396d(r)(3)) is 3 amended— 4 (A) in subparagraph (A)(ii), by striking ‘‘; 5 and’’ and inserting a semicolon; 6 (B) in subparagraph (B), by striking the 7 period at the end and inserting ‘‘; and’’; and 8 (C) by adding at the end the following new 9 subparagraph: 10 ‘‘(C) which shall include mobile and port- 11 able oral health services (as defined by the Sec- 12 retary) that— 13 ‘‘(i) are provided for the purpose of 14 overcoming mobility, transportation, or ac- 15 cess barriers for children; and 16 ‘‘(ii) satisfy the standards and certifi- 17 cation requirements established under sec- 18 tion 1902(a)(82)(C) for the State in which 19 the services are provided.’’. 20 (e) ORAL HEALTH SERVICES AS AN ESSENTIAL 21 HEALTH BENEFIT.—Section 1302(b) of the Patient Pro- 22 tection and Affordable Care Act (42 U.S.C. 18022(b)) is 23 amended— 24 (1) in paragraph (1)— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00292 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 293 •HR 5942 IH (A) in subparagraph (J), by striking ‘‘oral 1 and’’; and 2 (B) by adding at the end the following: 3 ‘‘(K) Oral health services for children and 4 adults.’’; and 5 (2) by adding at the end the following: 6 ‘‘(6) ORAL HEALTH SERVICES.—For purposes 7 of paragraph (1)(K), the term ‘oral health services’ 8 means services (as defined by the Secretary), that 9 are necessary to prevent disease and promote oral 10 health, restore oral structures to health and func- 11 tion, and treat emergency conditions.’’. 12 (f) DEMONSTRATION PROGRAM ON TRAINING AND 13 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 14 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 15 VETERANS IN RURAL AND OTHER UNDERSERVED COM- 16 MUNITIES.— 17 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 18 The Secretary of Veterans Affairs may carry out a 19 demonstration program to establish programs to 20 train and employ alternative dental health care pro- 21 viders in order to increase access to dental health 22 care services for veterans who are entitled to such 23 services from the Department of Veterans Affairs 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00293 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 294 •HR 5942 IH and reside in rural and other underserved commu- 1 nities. 2 (2) TELEHEALTH.—For purposes of alternative 3 dental health care providers and other dental care 4 providers who are licensed to provide clinical care, 5 dental services provided under the demonstration 6 program under this section may be administered by 7 such providers through telehealth-enabled collabora- 8 tion and supervision when appropriate and feasible. 9 (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 10 VIDERS DEFINED.—In this section, the term ‘‘alter- 11 native dental health care providers’’ has the meaning 12 given that term in section 340G–1(a)(2) of the Pub- 13 lic Health Service Act (42 U.S.C. 256g–1(a)(2)). 14 (4) AUTHORIZATION OF APPROPRIATIONS.— 15 There are authorized to be appropriated such sums 16 as are necessary to carry out the demonstration pro- 17 gram under this subsection. 18 (g) DEMONSTRATION PROGRAM ON TRAINING AND 19 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 20 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 21 MEMBERS OF THE ARMED FORCES AND DEPENDENTS 22 LACKING READY ACCESS TO SUCH SERVICES.— 23 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 24 The Secretary of Defense may carry out a dem- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00294 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 295 •HR 5942 IH onstration program to establish programs to train 1 and employ alternative dental health care providers 2 in order to increase access to dental health care 3 services for members of the Armed Forces and their 4 dependents who lack ready access to such services, 5 including the following: 6 (A) Members and dependents who reside in 7 rural areas or areas otherwise underserved by 8 dental health care providers. 9 (B) Members of the National Guard and 10 Reserves in active status who are potentially 11 deployable. 12 (2) TELEHEALTH.—For purposes of alternative 13 dental health care providers and other dental care 14 providers who are licensed to provide clinical care, 15 dental services provided under the demonstration 16 program under this section may be administered by 17 such providers through telehealth-enabled collabora- 18 tion and supervision when appropriate and feasible. 19 (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 20 VIDERS DEFINED.—In this section, the term ‘‘alter- 21 native dental health care providers’’ has the meaning 22 given that term in section 340G–1(a)(2) of the Pub- 23 lic Health Service Act (42 U.S.C. 256g–1(a)(2)). 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00295 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 296 •HR 5942 IH (4) AUTHORIZATION OF APPROPRIATIONS.— 1 There are authorized to be appropriated such sums 2 as are necessary to carry out the demonstration pro- 3 gram under this subsection. 4 (h) DEMONSTRATION PROGRAM ON TRAINING AND 5 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 6 PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 7 PRISONERS WITHIN THE CUSTODY OF THE BUREAU OF 8 PRISONS.— 9 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 10 The Attorney General, acting through the Director 11 of the Bureau of Prisons, may carry out a dem- 12 onstration program to establish programs to train 13 and employ alternative dental health care providers 14 in order to increase access to dental health services 15 for prisoners within the custody of the Bureau of 16 Prisons. 17 (2) TELEHEALTH.—For purposes of alternative 18 dental health care providers and any other dental 19 care providers who are licensed to provide clinical 20 care, dental services provided under the demonstra- 21 tion program under this section may be administered 22 by such providers through telehealth-enabled collabo- 23 ration and supervision when deemed appropriate and 24 feasible. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00296 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 297 •HR 5942 IH (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 1 VIDERS DEFINED.—In this section, the term ‘‘alter- 2 native dental health care providers’’ has the meaning 3 given that term in section 340G–1(a)(2) of the Pub- 4 lic Health Service Act (42 U.S.C. 256g–1(a)(2)). 5 (4) AUTHORIZATION OF APPROPRIATIONS.— 6 There are authorized to be appropriated such sums 7 as are necessary to carry out the demonstration pro- 8 gram under this subsection. 9 (i) DEMONSTRATION PROGRAM ON TRAINING AND 10 EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 11 PROVIDERS FOR DENTAL HEALTH CARE SERVICES 12 UNDER THE INDIAN HEALTH SERVICE.— 13 (1) DEMONSTRATION PROGRAM AUTHORIZED.— 14 The Secretary of Health and Human Services, act- 15 ing through the Indian Health Service, may carry 16 out a demonstration program to establish programs 17 to train and employ alternative dental health care 18 providers in order to help eliminate oral health dis- 19 parities and increase access to dental services 20 through health programs operated by the Indian 21 Health Service, Indian Tribes, Tribal organizations, 22 and urban Indian organizations (as those terms are 23 defined in section 4 of the Indian Health Care Im- 24 provement Act (25 U.S.C. 1603)). 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00297 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 298 •HR 5942 IH (2) TELEHEALTH.—For purposes of alternative 1 dental health care providers and any other dental 2 care providers who are licensed to provide clinical 3 care, dental services provided under the demonstra- 4 tion program under this section may be administered 5 by such providers through telehealth-enabled collabo- 6 ration and supervision when deemed appropriate and 7 feasible. 8 (3) ALTERNATIVE DENTAL HEALTH CARE PRO- 9 VIDERS DEFINED.—In this section, the term ‘‘alter- 10 native dental health care providers’’ has the meaning 11 given that term in section 340G–1(a)(2) of the Pub- 12 lic Health Service Act (42 U.S.C. 256g–1(a)(2)). 13 (4) AUTHORIZATION OF APPROPRIATIONS.— 14 There are authorized to be appropriated such sums 15 as are necessary to carry out the demonstration pro- 16 gram under this subsection. 17 Subtitle C—Advancing Health Eq- 18 uity Through Payment and De- 19 livery Reform 20 SEC. 441. SENSE OF CONGRESS. 21 It is the Sense of Congress that the sustainability of 22 the U.S. health care system hinges on restructuring how 23 health care is paid for, shifting away from paying for the 24 volume of services provided to the value the services pro- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00298 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 299 •HR 5942 IH vide. High value care is care that provides higher quality 1 care more efficiently, achieving greater health improve- 2 ment and better health outcomes at lower cost (per patient 3 and overall). A high value health care system must deliver 4 timely, accessible, well-coordinated, high quality, culturally 5 centered, and language appropriate care to everyone. 6 Therefore, eliminating health disparities and achieving 7 health equity must be central to efforts to achieve a high 8 value health care system. This will require tailored inter- 9 ventions and targeted investments to address inequities in 10 health and health care to make sure that health care deliv- 11 ery and payment efforts are responsive to and inclusive 12 of the needs of communities of color and other commu- 13 nities experiencing disparities. New models of value-based 14 payment and care delivery should consider the holistic 15 needs of the patient population, including social deter- 16 minants of health and behavioral health needs. 17 SEC. 442. CENTERS FOR MEDICARE & MEDICAID SERVICES 18 QUALITY PAYMENT PROGRAM. 19 (a) IN GENERAL.—The Centers for Medicare & Med- 20 icaid Services Quality Payment Program, developed 21 through implementation of the Medicare Access and CHIP 22 Reauthorization Act of 2015, should explicitly integrate 23 ‘‘achieving health equity’’ across all measures and activi- 24 ties, including the Merit-based Payment Incentive System 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00299 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 300 •HR 5942 IH and Alternative Payment Models. In addition, CMS should 1 identify limited-English proficient (LEP) persons as a spe- 2 cific underserved group within the program and give high 3 weight to providing language services for non-English 4 speakers. Clinicians can demonstrate performance in this 5 category by developing language assistance plans, pro- 6 viding oral interpretation services, and providing trans- 7 lated documents for the population served or eligible to 8 be served. 9 (b) STRATIFIED DATA.—CMS should include an ex- 10 plicit reference that data stratification and reporting is 11 one way of working to achieve health equity. CMS should 12 require that in reporting this measure, clinicians should 13 stratify clinical quality measures by disparity variables, in- 14 cluding race, ethnicity, preferred language, disability sta- 15 tus, sexual orientation, and gender identity, psychological 16 and behavioral status. Clinicians can use existing demo- 17 graphic data collection fields in CEHRT to do this. Strati- 18 fied data can help clinicians identify and distinguish ef- 19 forts to improve quality from efforts to reduce disparities, 20 which may not correlate without dedicated work. All par- 21 ticipating entities in the Quality Payment Program should 22 adopt 2015 Certified Electronic Health Records Tech- 23 nology as a condition of participating in the program. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00300 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 301 •HR 5942 IH (c) QUALITY IMPROVEMENT ACTIVITIES.—Further, 1 CMS, upon yearly review of the Quality Payment Pro- 2 gram, should add quality improvement activities that im- 3 plement the Culturally and Linguistically Accessible 4 Standards (CLAS) standards as Improvement Activities. 5 SEC. 443. DEVELOPMENT AND TESTING OF DISPARITY RE- 6 DUCING DELIVERY AND PAYMENT MODELS. 7 (a) IN GENERAL.—The Center for Medicaid and 8 Medicare Innovation (CMMI) will establish a dedicated 9 fund to identify, pilot, evaluate and scale delivery and pay- 10 ment models that target health disparities among racial 11 and ethnic minorities, including models that support high- 12 value non-medical services that address socially-deter- 13 mined barriers to health including: English proficiency, 14 health literacy, case management, transportation and en- 15 rollment assistance which will help to reduce disparities 16 and impact the overall cost of care. 17 (b) PILOT PROGRAMS.—Pilot and demonstration pro- 18 grams that include partnerships with entities including 19 community based organizations or other non-profit entities 20 to help address socially determined barriers to health and 21 health care will be given priority. 22 (c) ALTERNATIVES.—Require all CMMI funded alter- 23 native delivery and payment models to include measures 24 to assess and track their impact on health disparities, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00301 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 302 •HR 5942 IH using existing measures such as, but not limited to, the 1 National Quality Forum Healthcare Disparities and Cul- 2 tural Competency Measures, and stratified by race, eth- 3 nicity, English proficiency, gender identity, sexual orienta- 4 tion, and disability status. 5 SEC. 444. SUPPORTING SAFETY NET AND COMMUNITY- 6 BASED PROVIDERS TO COMPETE IN VALUE- 7 BASED PAYMENT SYSTEMS. 8 (a) IN GENERAL.—All proposed pay for performance 9 and alternative payment models, developed and tested by 10 CMMI, or any other HHS agency should be assessed for 11 potential impact on safety net, community based, and crit- 12 ical access providers, including federally qualified health 13 centers. 14 (b) NEW MODELS.—The rollout of new payment 15 models should include training and additional up front re- 16 sources for community based and safety net providers to 17 enable them to participate in them. 18 Subtitle D—Health Empowerment 19 Zones 20 SEC. 451. SHORT TITLE. 21 This subtitle may be cited as the ‘‘Health Empower- 22 ment Zone Act of 2018’’. 23 SEC. 452. FINDINGS. 24 The Congress finds the following: 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00302 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 303 •HR 5942 IH (1) Numerous studies and reports, including 1 the 2015 National Healthcare Disparities Report of 2 the Administration on Healthcare Research and 3 Quality and the 2002 Unequal Treatment Report of 4 the Institute of Medicine, document the extensive- 5 ness to which health disparities exist across the 6 country. 7 (2) These studies have found that, on average, 8 racial and ethnic minorities are disproportionately 9 afflicted with chronic and acute conditions—such as 10 cancer, diabetes, musculoskeletal disease, obesity, 11 and hypertension—and suffer worse health out- 12 comes, worse health status, and higher mortality 13 rates than their White counterparts. 14 (3) Several recent studies also show that health 15 disparities are a function of not only access to health 16 care, but also the social determinants of health—in- 17 cluding the environment, the physical structure of 18 communities, nutrition and food options, educational 19 attainment and health literacy, employment, race, 20 ethnicity, immigration status, geography, and lan- 21 guage preference—that directly and indirectly affect 22 the health, health care, and wellness of individuals 23 and communities. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00303 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 304 •HR 5942 IH (4) Integrally involving and fully supporting the 1 communities most affected by health inequities in 2 the assessment, planning, launch, and evaluation of 3 health disparity elimination efforts are among the 4 leading recommendations made to adequately ad- 5 dress and ultimately reduce health disparities. 6 (5) Recommendations also include supporting 7 the efforts of community stakeholders from a broad 8 cross section—including, but not limited to local 9 businesses, local departments of commerce, edu- 10 cation, labor, urban planning, and transportation, 11 and community-based and other nonprofit organiza- 12 tions, including national and regional intermediaries 13 with demonstrated capacity to serve low-income 14 urban communities—to find areas of common 15 ground around health disparity elimination and col- 16 laborate to improve the overall health and wellness 17 of a community and its residents. 18 SEC. 453. DESIGNATION OF HEALTH EMPOWERMENT 19 ZONES. 20 (a) IN GENERAL.—At the request of an eligible com- 21 munity partnership, the Secretary may designate an eligi- 22 ble area as a health empowerment zone. 23 (b) ELIGIBILITY CRITERIA.— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00304 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 305 •HR 5942 IH (1) ELIGIBLE COMMUNITY PARTNERSHIP.—A 1 community partnership is eligible to submit a re- 2 quest under this section if the partnership— 3 (A) demonstrates widespread public sup- 4 port from key individuals and entities in the eli- 5 gible area, including members of the target 6 community, State and local governments, non- 7 profit organizations including national and re- 8 gional intermediaries with demonstrated capac- 9 ity to serve low-income urban communities, and 10 community and industry leaders, for designa- 11 tion of the eligible area as a health empower- 12 ment zone; and 13 (B) includes representatives of— 14 (i) a broad cross section of stake- 15 holders and residents from communities in 16 the eligible area experiencing dispropor- 17 tionate disparities in health status and 18 health care; and 19 (ii) organizations, facilities, and insti- 20 tutions that have a history of working 21 within and serving such communities. 22 (2) ELIGIBLE AREA.—An area is eligible to be 23 designated as a health empowerment zone under this 24 section if one or more communities in the area expe- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00305 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 306 •HR 5942 IH rience disproportionate disparities in health status 1 and health care. In determining whether a commu- 2 nity experiences such disparities, the Secretary shall 3 consider the data collected by the Department of 4 Health and Human Services focusing on the fol- 5 lowing areas: 6 (A) Access to affordable, high-quality 7 health services. 8 (B) The prevalence of disproportionate 9 rates of certain illnesses or diseases including 10 the following: 11 (i) Arthritis, osteoporosis, chronic 12 back conditions, and other musculoskeletal 13 diseases. 14 (ii) Cancer. 15 (iii) Chronic kidney disease. 16 (iv) Diabetes. 17 (v) Injury (intentional and uninten- 18 tional). 19 (vi) Violence (intimate and non- 20 intimate). 21 (vii) Maternal and paternal illnesses 22 and diseases. 23 (viii) Infant mortality. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00306 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 307 •HR 5942 IH (ix) Mental illness and other disabil- 1 ities. 2 (x) Substance abuse treatment and 3 prevention, including underage drinking. 4 (xi) Nutrition, obesity, and overweight 5 conditions. 6 (xii) Heart disease. 7 (xiii) Hypertension. 8 (xiv) Cerebrovascular disease or 9 stroke. 10 (xv) Tuberculosis. 11 (xvi) HIV/AIDS and other sexually 12 transmitted infections. 13 (xvii) Viral hepatitis. 14 (xviii) Asthma. 15 (xix) Tooth decay and other oral 16 health issues. 17 (C) Within the target community, the his- 18 torical and persistent presence of conditions 19 that have been found to contribute to health 20 disparities including any such conditions re- 21 specting the following: 22 (i) Poverty. 23 (ii) Educational status and the quality 24 of community schools. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00307 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 308 •HR 5942 IH (iii) Income. 1 (iv) Access to high-quality affordable 2 health care. 3 (v) Work and work environment. 4 (vi) Environmental conditions in the 5 community, including with respect to clean 6 water, clean air, and the presence or ab- 7 sence of pollutants. 8 (vii) Language and English pro- 9 ficiency. 10 (viii) Access to affordable healthy 11 food. 12 (ix) Access to ethnically and culturally 13 diverse health and human service providers 14 and practitioners. 15 (x) Access to culturally and linguis- 16 tically competent health and human serv- 17 ices and health and human service pro- 18 viders. 19 (xi) Health-supporting infrastructure. 20 (xii) Health insurance that is ade- 21 quate and affordable. 22 (xiii) Race, racism, and bigotry (con- 23 scious and unconscious). 24 (xiv) Sexual orientation. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00308 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 309 •HR 5942 IH (xv) Health literacy. 1 (xvi) Place of residence (such as 2 urban areas, rural areas, and Tribal res- 3 ervations). 4 (xvii) Stress. 5 (c) PROCEDURE.— 6 (1) REQUEST.—A request under subsection (a) 7 shall— 8 (A) describe the bounds of the area to be 9 designated as a health empowerment zone and 10 the process used to select those bounds; 11 (B) demonstrate that the partnership sub- 12 mitting the request is an eligible community 13 partnership described in subsection (b)(1); 14 (C) demonstrate that the area is an eligible 15 area described in subsection (b)(2); 16 (D) include a comprehensive assessment of 17 disparities in health status and health care ex- 18 perience by one or more communities in the 19 area; 20 (E) set forth— 21 (i) a vision and a set of values for the 22 area; and 23 (ii) a comprehensive and holistic set of 24 goals to be achieved in the area through 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00309 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 310 •HR 5942 IH designation as a health empowerment zone; 1 and 2 (F) include a strategic plan and an action 3 plan for achieving the goals described in sub- 4 paragraph (E)(ii). 5 (2) APPROVAL.—Not later than 60 days after 6 the receipt of a request for designation of an area 7 as a health empowerment zone under this section, 8 the Secretary shall approve or disapprove the re- 9 quest. 10 (d) MINIMUM NUMBER.—The Secretary— 11 (1) shall designate not more than 110 health 12 empowerment zones under this section; and 13 (2) shall designate at least one health empower- 14 ment zone in each of the several States, the District 15 of Columbia, and each territory or possession of the 16 United States. 17 SEC. 454. ASSISTANCE TO THOSE SEEKING DESIGNATION. 18 At the request of any organization or entity seeking 19 to submit a request under section 453(a), the Secretary 20 shall provide technical assistance, and may award a grant, 21 to assist such organization or entity— 22 (1) to form an eligible community partnership 23 described in section 453(b)(1); 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00310 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 311 •HR 5942 IH (2) to complete a health assessment, including 1 an assessment of health disparities under section 2 453(c)(1)(D); or 3 (3) to prepare and submit a request, including 4 a strategic plan, in accordance with section 453. 5 SEC. 455. BENEFITS OF DESIGNATION. 6 (a) PRIORITY.—In awarding any competitive grant, 7 a Federal official shall give priority to any applicant 8 that— 9 (1) meets the eligibility criteria for the grant; 10 (2) proposes to use the grant for activities in a 11 health empowerment zone; and 12 (3) demonstrates that such activities will di- 13 rectly and significantly further the goals of the stra- 14 tegic plan approved for such zone under section 453. 15 (b) GRANTS FOR INITIAL IMPLEMENTATION OF 16 STRATEGIC PLAN.— 17 (1) IN GENERAL.—Upon designating an eligible 18 area as a health empowerment zone at the request 19 of an eligible community partnership, the Secretary 20 shall, subject to the availability of appropriations, 21 make a grant to the community partnership for im- 22 plementation of the strategic plan for such zone. 23 (2) GRANT PERIOD.—A grant under paragraph 24 (1) for a health empowerment zone shall be for a pe- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00311 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 312 •HR 5942 IH riod of 2 years and may be renewed, except that the 1 total period of grants under paragraph (1) for such 2 zone may not exceed 10 years. 3 (3) LIMITATION.—In awarding grants under 4 this subsection, the Secretary shall not give less pri- 5 ority to an applicant or reduce the amount of a 6 grant because the Secretary rendered technical as- 7 sistance or made a grant to the same applicant 8 under section 454. 9 (4) REPORTING.—The Secretary shall establish 10 metrics for measuring the progress of grantees 11 under this subsection and, based on such metrics, 12 require each such grantee to report to the Secretary 13 not less than every 6 months on the progress in im- 14 plementing the strategic plan for the health em- 15 powerment zone. 16 SEC. 456. DEFINITION. 17 In this subtitle, the term ‘‘Secretary’’ means the Sec- 18 retary of Health and Human Services, acting through the 19 Administrator of the Health Resources and Services Ad- 20 ministration and the Deputy Assistant Secretary for Mi- 21 nority Health, and in cooperation with the Director of the 22 Office of Community Services and the Director of the Na- 23 tional Institute for Minority Health and Health Dispari- 24 ties. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00312 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 313 •HR 5942 IH SEC. 457. AUTHORIZATION OF APPROPRIATIONS. 1 To carry out this subtitle, there is authorized to be 2 appropriated $100,000,000 for fiscal year 2019. 3 Subtitle E—At-Risk Community 4 Coverage 5 SEC. 461. MEDICAID COVERAGE FOR CITIZENS OF FREELY 6 ASSOCIATED STATES. 7 (a) IN GENERAL.—Section 402(b)(2) of the Personal 8 Responsibility and Work Opportunity Reconciliation Act 9 of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at 10 the end the following new subparagraph: 11 ‘‘(G) MEDICAID EXCEPTION FOR CITIZENS 12 OF FREELY ASSOCIATED STATES.—With respect 13 to eligibility for benefits for the designated Fed- 14 eral program defined in paragraph (3)(C) (re- 15 lating to the Medicaid program), section 401(a) 16 and paragraph (1) shall not apply to any indi- 17 vidual who lawfully resides in 1 of the 50 States 18 or the District of Columbia in accordance with 19 the Compacts of Free Association between the 20 Government of the United States and the Gov- 21 ernments of the Federated States of Micro- 22 nesia, the Republic of the Marshall Islands, and 23 the Republic of Palau and shall not apply, at 24 the option of the Governor of Puerto Rico, the 25 Virgin Islands, Guam, the Northern Mariana 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00313 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 314 •HR 5942 IH Islands, or American Samoa as communicated 1 to the Secretary of Health and Human Services 2 in writing, to any individual who lawfully re- 3 sides in the respective territory in accordance 4 with such Compacts.’’. 5 (b) EXCEPTION TO 5-YEAR LIMITED ELIGIBILITY.— 6 Section 403(d) of such Act (8 U.S.C. 1613(d)) is amend- 7 ed— 8 (1) in paragraph (1), by striking ‘‘or’’ at the 9 end; 10 (2) in paragraph (2), 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 ‘‘(3) an individual described in section 15 402(b)(2)(G), but only with respect to the des- 16 ignated Federal program defined in section 17 402(b)(3)(C).’’. 18 (c) DEFINITION OF QUALIFIED ALIEN.—Section 19 431(b) of such Act (8 U.S.C. 1641(b)) is amended— 20 (1) in paragraph (6), by striking ‘‘; or’’ at the 21 end and inserting a comma; 22 (2) in paragraph (7), by striking the period at 23 the end and inserting ‘‘, or’’; and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00314 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 315 •HR 5942 IH (3) by adding at the end the following new 1 paragraph: 2 ‘‘(8) an individual who lawfully resides in the 3 United States in accordance with a Compact of Free 4 Association referred to in section 402(b)(2)(G), but 5 only with respect to the designated Federal program 6 defined in section 402(b)(3)(C) (relating to the Med- 7 icaid program).’’. 8 (d) CONFORMING AMENDMENTS.—Section 1108 of 9 the Social Security Act (42 U.S.C. 1308) is amended— 10 (1) in subsection (f), in the matter preceding 11 paragraph (1), by striking ‘‘subsection (g)’’ and in- 12 serting ‘‘subsections (g) and (h)’’; and 13 (2) by adding at the end the following: 14 ‘‘(h) Expenditures for medical assistance provided to 15 an individual described in section 431(b)(8) of the Per- 16 sonal Responsibility and Work Opportunity Reconciliation 17 Act of 1996 shall not be taken into account for purposes 18 of applying payment limits under subsections (f) and 19 (g).’’. 20 (e) EFFECTIVE DATE.—The amendments made by 21 this section shall apply to benefits for items and services 22 furnished on or after the date of the enactment of this 23 Act. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00315 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 316 •HR 5942 IH SEC. 462. AT-RISK YOUTH MEDICAID PROTECTION. 1 (a) IN GENERAL.—Section 1902 of the Social Secu- 2 rity Act (42 U.S.C. 1396a) is amended— 3 (1) in subsection (a)— 4 (A) by striking ‘‘and’’ at the end of para- 5 graph (82); 6 (B) by striking the period at the end of 7 paragraph (83) and inserting ‘‘; and’’; and 8 (C) by inserting after paragraph (83) the 9 following new paragraph: 10 ‘‘(84) provide that— 11 ‘‘(A) the State shall not terminate eligi- 12 bility for medical assistance under a State plan 13 for an individual who is an eligible juvenile (as 14 defined in subsection (nn)(2)) because the juve- 15 nile is an inmate of a public institution (as de- 16 fined in subsection (nn)(3)), but may suspend 17 coverage during the period the juvenile is such 18 an inmate; 19 ‘‘(B) the State shall restore coverage for 20 such medical assistance to such an individual 21 upon the individual’s release from any such 22 public institution, without requiring a new ap- 23 plication from the individual, unless (and until 24 such date as) there is a determination that the 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00316 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 317 •HR 5942 IH individual no longer meets the eligibility re- 1 quirements for such medical assistance; and 2 ‘‘(C) the State shall process any applica- 3 tion for medical assistance submitted by, or on 4 behalf of, a juvenile who is an inmate of a pub- 5 lic institution notwithstanding that the juvenile 6 is such an inmate.’’; and 7 (2) by adding at the end the following new sub- 8 section: 9 ‘‘(nn) JUVENILE; ELIGIBLE JUVENILE; PUBLIC IN- 10 STITUTION.—For purposes of subsection (a)(84) and this 11 subsection: 12 ‘‘(1) JUVENILE.—The term ‘juvenile’ means an 13 individual who is— 14 ‘‘(A) under 21 years of age; or 15 ‘‘(B) is described in subsection 16 (a)(10)(A)(i)(IX). 17 ‘‘(2) ELIGIBLE JUVENILE.—The term ‘eligible 18 juvenile’ means a juvenile who is an inmate of a 19 public institution and was eligible for medical assist- 20 ance under the State plan immediately before be- 21 coming an inmate of such a public institution or who 22 becomes eligible for such medical assistance while an 23 inmate of a public institution. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00317 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 318 •HR 5942 IH ‘‘(3) INMATE OF A PUBLIC INSTITUTION.—The 1 term ‘inmate of a public institution’ has the meaning 2 given such term for purposes of applying the sub- 3 division (A) following paragraph (29) of section 4 1905(a), taking into account the exception in such 5 subdivision for a patient of a medical institution.’’. 6 (b) NO CHANGE IN EXCLUSION FROM MEDICAL AS- 7 SISTANCE FOR INMATES OF PUBLIC INSTITUTIONS.— 8 Nothing in this section shall be construed as changing the 9 exclusion from medical assistance under the subdivision 10 (A) following paragraph (29) of section 1905(a) of the So- 11 cial Security Act (42 U.S.C. 1396d(a)), including any ap- 12 plicable restrictions on a State submitting claims for Fed- 13 eral financial participation under title XIX of such Act 14 for such assistance. 15 (c) NO CHANGE IN CONTINUITY OF ELIGIBILITY BE- 16 FORE ADJUDICATION OR SENTENCING.—Nothing in this 17 section shall be construed to mandate, encourage, or sug- 18 gest that a State suspend or terminate coverage for indi- 19 viduals before they have been adjudicated or sentenced. 20 (d) EFFECTIVE DATE.— 21 (1) IN GENERAL.—Except as provided in para- 22 graph (2), the amendments made by subsection (a) 23 shall apply to eligibility of juveniles who become in- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00318 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 319 •HR 5942 IH mates of public institutions on or after the date that 1 is 1 year after the date of the enactment of this Act. 2 (2) RULE FOR CHANGES REQUIRING STATE 3 LEGISLATION.—In the case of a State plan for med- 4 ical assistance under title XIX of the Social Security 5 Act which the Secretary of Health and Human Serv- 6 ices determines requires State legislation (other than 7 legislation appropriating funds) in order for the plan 8 to meet the additional requirements imposed by the 9 amendments made by subsection (a), the State plan 10 shall not be regarded as failing to comply with the 11 requirements of such title solely on the basis of its 12 failure to meet these additional requirements before 13 the first day of the first calendar quarter beginning 14 after the close of the first regular session of the 15 State legislature that begins after the date of the en- 16 actment of this Act. For purposes of the previous 17 sentence, in the case of a State that has a 2-year 18 legislative session, each year of such session shall be 19 deemed to be a separate regular session of the State 20 legislature. 21 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00319 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 320 •HR 5942 IH TITLE V—IMPROVING HEALTH 1 OUTCOMES FOR WOMEN, 2 CHILDREN, AND FAMILIES 3 Subtitle A—In General 4 SEC. 501. GRANTS TO PROMOTE HEALTH FOR UNDER- 5 SERVED COMMUNITIES. 6 Part Q of title III of the Public Health Service Act 7 (42 U.S.C. 280g et seq.) is amended by adding at the end 8 the following: 9 ‘‘SEC. 399Z–3. GRANTS TO PROMOTE HEALTH FOR UNDER- 10 SERVED COMMUNITIES. 11 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col- 12 laboration with the Administrator of the Health Resources 13 and Services Administration and other Federal officials 14 determined appropriate by the Secretary, is authorized to 15 award grants to eligible entities— 16 ‘‘(1) to promote health for underserved commu- 17 nities, with preference given to projects that benefit 18 racial and ethnic minority women, racial and ethnic 19 minority children, adolescents, and lesbian, gay, bi- 20 sexual, transgender, queer, or questioning commu- 21 nities; and 22 ‘‘(2) to strengthen health outreach initiatives in 23 medically underserved communities, including lin- 24 guistically isolated populations. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00320 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 321 •HR 5942 IH ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 1 subsection (a) may be used to support the activities of 2 community health workers, including such activities— 3 ‘‘(1) to educate and provide outreach regarding 4 enrollment in health insurance including the State 5 Children’s Health Insurance Program under title 6 XXI of the Social Security Act, Medicare under title 7 XVIII of such Act, and Medicaid under title XIX of 8 such Act; 9 ‘‘(2) to educate and provide outreach in a com- 10 munity setting regarding health problems prevalent 11 among underserved communities, and especially 12 among racial and ethnic minority women, racial and 13 ethnic minority children, adolescents, and lesbian, 14 gay, bisexual, transgender, queer, or questioning 15 communities; 16 ‘‘(3) to educate and provide experiential learn- 17 ing opportunities and target risk factors and healthy 18 behaviors that impede or contribute to achieving 19 positive health outcomes, including— 20 ‘‘(A) healthy nutrition; 21 ‘‘(B) physical activity; 22 ‘‘(C) overweight or obesity; 23 ‘‘(D) tobacco use; 24 ‘‘(E) alcohol and substance use; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00321 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 322 •HR 5942 IH ‘‘(F) injury and violence; 1 ‘‘(G) sexual health; 2 ‘‘(H) mental health; 3 ‘‘(I) musculoskeletal health and arthritis; 4 ‘‘(J) dental and oral health; 5 ‘‘(K) understanding informed consent; and 6 ‘‘(L) stigma; 7 ‘‘(4) to promote community wellness and aware- 8 ness; and 9 ‘‘(5) to educate and refer target populations to 10 appropriate health care agencies and community- 11 based programs and organizations in order to in- 12 crease access to quality health care services, includ- 13 ing preventive health services. 14 ‘‘(c) APPLICATION.— 15 ‘‘(1) IN GENERAL.—Each eligible entity that 16 desires to receive a grant under subsection (a) shall 17 submit an application to the Secretary, at such time, 18 in such manner, and accompanied by such additional 19 information as the Secretary may require. 20 ‘‘(2) CONTENTS.—Each application submitted 21 pursuant to paragraph (1) shall— 22 ‘‘(A) describe the activities for which as- 23 sistance under this section is sought; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00322 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 323 •HR 5942 IH ‘‘(B) contain an assurance that, with re- 1 spect to each community health worker pro- 2 gram receiving funds under the grant awarded, 3 such program provides in-language training and 4 supervision to community health workers to en- 5 able such workers to provide authorized pro- 6 gram activities in (at least) the most commonly 7 used languages within a particular geographic 8 region; 9 ‘‘(C) contain an assurance that the appli- 10 cant will evaluate the effectiveness of commu- 11 nity health worker programs receiving funds 12 under the grant; 13 ‘‘(D) contain an assurance that each com- 14 munity health worker program receiving funds 15 under the grant will provide culturally com- 16 petent services in the linguistic context most 17 appropriate for the individuals served by the 18 program; 19 ‘‘(E) contain a plan to document and dis- 20 seminate project descriptions and results to 21 other States and organizations as identified by 22 the Secretary; and 23 ‘‘(F) describe plans to enhance the capac- 24 ity of individuals to utilize health services and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00323 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 324 •HR 5942 IH health-related social services under Federal, 1 State, and local programs by— 2 ‘‘(i) assisting individuals in estab- 3 lishing eligibility under the programs and 4 in receiving the services or other benefits 5 of the programs; and 6 ‘‘(ii) providing other services, as the 7 Secretary determines to be appropriate, 8 which may include transportation and 9 translation services. 10 ‘‘(d) PRIORITY.—In awarding grants under sub- 11 section (a), the Secretary shall give priority to those appli- 12 cants— 13 ‘‘(1) who propose to target geographic areas 14 that— 15 ‘‘(A)(i) have a high percentage of residents 16 who are uninsured or underinsured (if the tar- 17 geted geographic area is located in a State that 18 has elected to make medical assistance available 19 under section 1902(a)(10)(A)(i)(VIII) of the 20 Social Security Act to individuals described in 21 such section); 22 ‘‘(ii) have a high percentage of under- 23 insured residents in a particular geographic 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00324 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 325 •HR 5942 IH area (if the targeted geographic area is located 1 in a State that has not so elected); or 2 ‘‘(iii) have a high number of households ex- 3 periencing extreme poverty; and 4 ‘‘(B) have a high percentage of families for 5 whom English is not their primary language or 6 including smaller limited-English-proficient 7 communities within the region that are not oth- 8 erwise reached by linguistically appropriate 9 health services; 10 ‘‘(2) with experience in providing health or 11 health-related social services to individuals who are 12 underserved with respect to such services; and 13 ‘‘(3) with documented community activity and 14 experience with community health workers. 15 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU- 16 TIONS.—The Secretary shall encourage community health 17 worker programs receiving funds under this section to col- 18 laborate with academic institutions, including minority- 19 serving institutions. Nothing in this section shall be con- 20 strued to require such collaboration. 21 ‘‘(f) QUALITY ASSURANCE AND COST EFFECTIVE- 22 NESS.—The Secretary shall establish guidelines for ensur- 23 ing the quality of the training and supervision of commu- 24 nity health workers under the programs funded under this 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00325 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 326 •HR 5942 IH section and for ensuring the cost effectiveness of such pro- 1 grams. 2 ‘‘(g) MONITORING.—The Secretary shall monitor 3 community health worker programs identified in approved 4 applications and shall determine whether such programs 5 are in compliance with the guidelines established under 6 subsection (f). 7 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 8 provide technical assistance to community health worker 9 programs identified in approved applications with respect 10 to planning, developing, and operating programs under the 11 grant. 12 ‘‘(i) REPORT TO CONGRESS.— 13 ‘‘(1) IN GENERAL.—Not later than 4 years 14 after the date on which the Secretary first awards 15 grants under subsection (a), the Secretary shall sub- 16 mit to Congress a report regarding the grant 17 project. 18 ‘‘(2) CONTENTS.—The report required under 19 paragraph (1) shall include the following: 20 ‘‘(A) A description of the programs for 21 which grant funds were used. 22 ‘‘(B) The number of individuals served. 23 ‘‘(C) An evaluation of— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00326 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 327 •HR 5942 IH ‘‘(i) the effectiveness of these pro- 1 grams; 2 ‘‘(ii) the cost of these programs; and 3 ‘‘(iii) the impact of the project on the 4 health outcomes of the community resi- 5 dents. 6 ‘‘(D) Recommendations for sustaining the 7 community health worker programs developed 8 or assisted under this section. 9 ‘‘(E) Recommendations regarding training 10 to enhance career opportunities for community 11 health workers. 12 ‘‘(j) DEFINITIONS.—In this section: 13 ‘‘(1) COMMUNITY HEALTH WORKER.—The term 14 ‘community health worker’ means an individual who 15 promotes health or nutrition within the community 16 in which the individual resides— 17 ‘‘(A) by serving as a liaison between com- 18 munities and health care agencies; 19 ‘‘(B) by providing guidance and social as- 20 sistance to community residents; 21 ‘‘(C) by enhancing community residents’ 22 ability to effectively communicate with health 23 care providers; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00327 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 328 •HR 5942 IH ‘‘(D) by providing culturally and linguis- 1 tically appropriate health or nutrition edu- 2 cation; 3 ‘‘(E) by advocating for individual and com- 4 munity health, including dental, oral, mental, 5 and environmental health, or nutrition needs; 6 ‘‘(F) by taking into consideration the 7 needs of the communities served, including the 8 prevalence rates of risk factors that impede 9 achieving positive healthy outcomes among 10 women and children, especially among racial 11 and ethnic minority women and children; and 12 ‘‘(G) by providing referral and followup 13 services. 14 ‘‘(2) COMMUNITY SETTING.—The term ‘commu- 15 nity setting’ means a home or a community organi- 16 zation that serves a population. 17 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en- 18 tity’ means— 19 ‘‘(A) a unit of State, territorial, local, or 20 Tribal government (including a federally recog- 21 nized Tribe or Alaska Native village); or 22 ‘‘(B) a community-based organization. 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00328 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 329 •HR 5942 IH ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 1 The term ‘medically underserved community’ means 2 a community— 3 ‘‘(A) that has a substantial number of in- 4 dividuals who are members of a medically un- 5 derserved population, as defined by section 6 330(b)(3); 7 ‘‘(B) a significant portion of which is a 8 health professional shortage area as designated 9 under section 332; and 10 ‘‘(C) that includes populations that are lin- 11 guistically isolated, such as geographic areas 12 with a shortage of health professionals able to 13 provide linguistically appropriate services. 14 ‘‘(5) SUPPORT.—The term ‘support’ means the 15 provision of training, supervision, and materials 16 needed to effectively deliver the services described in 17 subsection (b), reimbursement for services, and 18 other benefits. 19 ‘‘(6) TARGET POPULATION.—The term ‘target 20 population means’ women of reproductive age, per- 21 sons who identify as lesbian, gay, bisexual, 22 transgender, and/or queer, and people under age 25. 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00329 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 330 •HR 5942 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 2019 through 2023.’’. 3 SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NU- 4 TRITION ASSISTANCE FOR CHILDREN, PREG- 5 NANT PERSONS, 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00330 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 331 •HR 5942 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 persons 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 persons, 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00331 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 332 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00332 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 333 •HR 5942 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 ‘‘maternal’’ refers to persons who 19 are pregnant or breastfeeding of all gender identi- 20 ties. 21 (2) The term ‘‘pregnancy and breastfeeding in- 22 formation services’’ includes only— 23 (A) information services to provide accu- 24 rate, evidence-based, clinical information re- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00333 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 334 •HR 5942 IH garding maternal exposures during pregnancy 1 that may be associated with birth defects or 2 other health risks, such as exposures to medica- 3 tions, chemicals, infections, foodborne patho- 4 gens, illnesses, nutrition, or lifestyle factors; 5 (B) information services to provide accu- 6 rate, evidence-based, clinical information re- 7 garding maternal exposures during breast- 8 feeding that may be associated with health risks 9 to a breast-fed infant, such as exposures to 10 medications, chemicals, infections, foodborne 11 pathogens, illnesses, nutrition, or lifestyle fac- 12 tors; 13 (C) the provision of accurate, evidence- 14 based information weighing risks of exposures 15 during breastfeeding against the benefits of 16 breastfeeding; and 17 (D) the provision of information described 18 in subparagraph (A), (B), or (C) through coun- 19 selors, Web sites, fact sheets, telephonic or elec- 20 tronic communication, community outreach ef- 21 forts, or other appropriate means. 22 (3) The term ‘‘Secretary’’ means the Secretary 23 of Health and Human Services, acting through the 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00334 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 335 •HR 5942 IH Director of the Centers for Disease Control and Pre- 1 vention. 2 (c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 3 subsection (a), the Secretary shall conduct or support a 4 nationwide media campaign to increase awareness among 5 health care providers and at-risk populations about preg- 6 nancy and breastfeeding information services. 7 (d) GRANTS FOR PREGNANCY AND BREASTFEEDING 8 INFORMATION SERVICES.— 9 (1) IN GENERAL.—In carrying out subsection 10 (a), the Secretary shall award grants to State or re- 11 gional agencies or organizations for any of the fol- 12 lowing: 13 (A) INFORMATION SERVICES.—The provi- 14 sion of, or campaigns to increase awareness 15 about, pregnancy and breastfeeding information 16 services. 17 (B) SURVEILLANCE AND RESEARCH.—The 18 conduct or support of— 19 (i) surveillance of or research on— 20 (I) maternal exposures and ma- 21 ternal health conditions that may in- 22 fluence the risk of birth defects, pre- 23 maturity, or other adverse pregnancy 24 outcomes; and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00335 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 336 •HR 5942 IH (II) maternal exposures that may 1 influence health risks to a breastfed 2 infant; or 3 (ii) networking to facilitate surveil- 4 lance or research described in this sub- 5 paragraph. 6 (2) PREFERENCE FOR CERTAIN STATES.—The 7 Secretary, in making any grant under this sub- 8 section, shall give preference to States, otherwise 9 equally qualified, that have a pregnancy and 10 breastfeeding information service in place. 11 (3) MATCHING FUNDS.—The Secretary may 12 only award a grant under this subsection to a State 13 or regional agency or organization that agrees, with 14 respect to the costs to be incurred in carrying out 15 the grant activities, to make available (directly or 16 through donations from public or private entities) 17 non-Federal funds toward such costs in an amount 18 equal to not less than 25 percent of the amount of 19 the grant. 20 (4) COORDINATION.—The Secretary shall en- 21 sure that activities funded through a grant under 22 this subsection are coordinated, to the maximum ex- 23 tent practicable, with other birth defects prevention 24 and environmental health activities of the Federal 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00336 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 337 •HR 5942 IH Government, including with respect to pediatric envi- 1 ronmental health specialty units and children’s envi- 2 ronmental health centers. 3 (e) EVALUATION.—In furtherance of the program 4 under subsection (a), the Secretary shall provide for an 5 evaluation of pregnancy and breastfeeding information 6 services to identify efficient and effective models of— 7 (1) providing information; 8 (2) raising awareness and increasing knowledge 9 about birth defects prevention measures and tar- 10 geting education to at-risk groups; 11 (3) modifying risk behaviors; or 12 (4) other outcome measures as determined ap- 13 propriate by the Secretary. 14 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 15 out this section, there are authorized to be appropriated 16 $5,000,000 for fiscal year 2019, $6,000,000 for fiscal year 17 2020, $7,000,000 for fiscal year 2021, $8,000,000 for fis- 18 cal year 2022, and $9,000,000 for fiscal year 2023. 19 SEC. 505. PREVENTING MATERNAL DEATHS. 20 (a) PROGRAM AUTHORIZED.— 21 (1) IN GENERAL.—The Secretary of Health and 22 Human Services, through the Director of the Cen- 23 ters for Disease Control and Prevention, shall estab- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00337 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 338 •HR 5942 IH lish a grant program under which the Secretary may 1 make grants to States for the purpose of— 2 (A) carrying out the activities described in 3 subsection (b)(1); 4 (B) establishing and sustaining a State 5 maternal mortality review committee, in accord- 6 ance with subsection (b)(2); 7 (C) ensuring that the State department of 8 health carries out the activities described in 9 subsection (b)(3); 10 (D) disseminating the case abstraction 11 form developed under subsection (c); and 12 (E) providing for the public disclosure of 13 information, in accordance with subsection (d). 14 (2) CRITERIA.—The Secretary shall establish 15 criteria for determining eligibility for, and the 16 amount of a grant awarded to, a State under para- 17 graph (1). Such criteria shall provide that in the 18 case of a State that receives a grant under para- 19 graph (1) for a fiscal year and is determined by the 20 Secretary to have not used such grant in accordance 21 with this section, such State may not be eligible for 22 such a grant for any subsequent fiscal year. 23 (b) USE OF FUNDS.— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00338 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 339 •HR 5942 IH (1) REVIEW OF PREGNANCY-RELATED AND 1 PREGNANCY-ASSOCIATED DEATHS.—With respect to 2 a State that receives a grant under subsection 3 (a)(1), the following shall apply: 4 (A) PROCESS FOR MANDATORY REPORTING 5 OF PREGNANCY-RELATED AND PREGNANCY-AS- 6 SOCIATED DEATHS.— 7 (i) IN GENERAL.—The State, through 8 the State maternal mortality review com- 9 mittee established under subsection (a)(1), 10 shall develop a process that provides for 11 mandatory and confidential case reporting 12 to the State department of health by indi- 13 viduals and entities described in clause (ii) 14 with respect to pregnancy-related and 15 pregnancy-associated deaths. 16 (ii) INDIVIDUALS AND ENTITIES DE- 17 SCRIBED.—Individuals and entities de- 18 scribed in this clause include each of the 19 following: 20 (I) Health care professionals. 21 (II) Medical examiners. 22 (III) Medical coroners. 23 (IV) Hospitals. 24 (V) Birth centers. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00339 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 340 •HR 5942 IH (VI) Other health care facilities. 1 (VII) Other individuals respon- 2 sible for completing death records. 3 (VIII) Other appropriate individ- 4 uals or entities specified by the Sec- 5 retary. 6 (B) PROCESS FOR VOLUNTARY REPORTING 7 OF PREGNANCY-RELATED AND PREGNANCY-AS- 8 SOCIATED DEATHS.—The State, through the 9 State maternal mortality review committee es- 10 tablished under subsection (a)(1), shall develop 11 a process that provides for voluntary and con- 12 fidential case reporting to the State department 13 of health by family members of the deceased 14 and other individuals on possible pregnancy-re- 15 lated and pregnancy-associated deaths. Such 16 process shall include— 17 (i) making publicly available on the 18 website of the State department of health 19 a telephone number, Internet web link, and 20 email address for such reporting; and 21 (ii) publicizing to local professional or- 22 ganizations, community organizations, and 23 social services agencies the availability of 24 the telephone number, Internet web link, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00340 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 341 •HR 5942 IH and email address made available under 1 clause (i). 2 (C) IDENTIFICATION OF PREGNANCY-RE- 3 LATED AND PREGNANCY-ASSOCIATED DEATHS 4 BY STATE VITAL STATISTICS UNIT.—The State, 5 through the vital statistics unit of the State, 6 shall annually identify pregnancy-related and 7 pregnancy-associated deaths occurring in such 8 State in the year involved by— 9 (i) matching each death record of a 10 person in such year to a live birth certifi- 11 cate or an infant death record for the pur- 12 pose of identifying deaths of persons that 13 occurred during pregnancy and within one 14 year after the end of a pregnancy; 15 (ii) identifying each death of a person 16 reported during such year as having an un- 17 derlying or contributing cause of death re- 18 lated to pregnancy, regardless of the time 19 that has passed between the end of the 20 pregnancy and the death; 21 (iii) collecting data from medical ex- 22 aminer and coroner reports; and 23 (iv) using any other method the State 24 may devise to identify maternal deaths 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00341 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 342 •HR 5942 IH such as reviewing a random sample of re- 1 ported deaths of persons who could have 2 been pregnant to ascertain cases of preg- 3 nancy-related and pregnancy-associated 4 deaths that are not discernable from a re- 5 view of death records alone. 6 For purposes of effectively collecting and ob- 7 taining data on pregnancy-related and preg- 8 nancy-associated deaths, the State shall adopt 9 the most recent standardized birth and death 10 records, as issued by the National Center for 11 Vital Health Statistics, including the rec- 12 ommended checkbox section for pregnancy on 13 each death record. 14 (D) CASE INVESTIGATION AND DEVELOP- 15 MENT OF CASE SUMMARIES.— 16 (i) IN GENERAL.—Following the re- 17 ceipt of reports by the State department of 18 health pursuant to subparagraph (A) or 19 (B) and the collection of cases of preg- 20 nancy-related and pregnancy-associated 21 deaths by the vital statistics unit of the 22 State under subparagraph (C), the State, 23 through the State maternal mortality re- 24 view committee established under sub- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00342 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 343 •HR 5942 IH section (a)(1), shall investigate each case, 1 using the case abstraction form described 2 in subsection (c), and prepare a de-identi- 3 fied case summary for each case, which 4 shall be reviewed by the committee and in- 5 cluded in applicable reports. The State de- 6 partment of health or vital statistics unit 7 of the State, as the case may be, shall pro- 8 vide the State maternal mortality review 9 committee with access to the information 10 collected pursuant to subparagraph (A) or 11 (B), or under subparagraph (C), as nec- 12 essary to carry out this subparagraph. 13 (ii) MANDATORY DATA AND INFORMA- 14 TION.—Each case investigation under this 15 subparagraph shall, subject to availability, 16 include data and information obtained 17 through— 18 (I) medical examiner and autopsy 19 reports of the person involved; 20 (II) medical records of the per- 21 son, including such records related to 22 health care prior to pregnancy, pre- 23 natal and postnatal care, labor and 24 delivery care, emergency room care, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00343 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 344 •HR 5942 IH hospital discharge records, and any 1 care delivered up until the time of 2 death of the person; 3 (III) oral and written interviews 4 of individuals directly involved in the 5 maternal care of the person during 6 and immediately following the preg- 7 nancy of the person, including health 8 care, mental health, and social service 9 providers, as applicable; 10 (IV) socioeconomic and other rel- 11 evant background information about 12 the person; 13 (V) any information collected 14 under subparagraph (C)(i); and 15 (VI) any other information on 16 the cause of death of the person, such 17 as social services and child welfare re- 18 ports. 19 (iii) DISCRETIONARY DATA AND IN- 20 FORMATION.—Each case investigation 21 under this subparagraph may include data 22 and information obtained through oral or 23 written interviews of the family of the per- 24 son. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00344 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 345 •HR 5942 IH (2) STATE MATERNAL MORTALITY REVIEW 1 COMMITTEES.— 2 (A) MANDATORY ACTIVITIES.—A State 3 maternal mortality review committee established 4 under subsection (a)(1) shall carry out the fol- 5 lowing activities: 6 (i) Develop the processes described in 7 subparagraphs (A) and (B) of paragraph 8 (1). 9 (ii) Review the data and information 10 collected by the vital statistics unit of the 11 State under paragraph (1)(C) regarding 12 pregnancy-related and pregnancy-associ- 13 ated deaths to identify trends, patterns, 14 and disparities in adverse outcomes and 15 address medical, non-medical, and system- 16 related factors that may have contributed 17 to such pregnancy-related and pregnancy- 18 associated deaths and disparities. 19 (iii) Carry out the activities described 20 in paragraph (1)(D). 21 (iv) Develop recommendations, based 22 on the case summaries prepared under 23 paragraph (1)(D) and the data and infor- 24 mation collected under paragraph (1)(C), 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00345 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 346 •HR 5942 IH to improve maternal care, social and health 1 services, and public health policy and insti- 2 tutions, including improving access to ma- 3 ternal care and social and health services 4 and identifying disparities in maternal care 5 and outcomes. 6 (B) DISCRETIONARY ACTIVITIES.— 7 (i) IN GENERAL.—A State maternal 8 mortality review committee established 9 under subsection (a)(1) may, while subject 10 to confidentiality requirements, present 11 findings and recommendations based on 12 the case summaries prepared under para- 13 graph (1)(D) directly to a health care facil- 14 ity or its local or State professional organi- 15 zation for the purpose of— 16 (I) instituting policy changes, 17 educational activities, and improve- 18 ments in the quality of care provided 19 by the facility; and 20 (II) exploring and forming re- 21 gional collaborations. 22 (ii) INVESTIGATION OF CASES OF SE- 23 VERE MATERNAL MORBIDITY.—A State 24 maternal mortality review committee may 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00346 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 347 •HR 5942 IH investigate cases of severe maternal mor- 1 bidity and any such investigation may in- 2 clude data and information obtained 3 through— 4 (I) identified patient registries; 5 or 6 (II) oral or written interviews of 7 the person concerned and the family 8 of such person. 9 (C) COMPOSITION OF STATE MATERNAL 10 MORTALITY REVIEW COMMITTEES.— 11 (i) IN GENERAL.—A State maternal 12 mortality review committee established 13 under subsection (a)(1) shall be multidisci- 14 plinary and diverse. Membership on the 15 State maternal mortality review committee 16 shall be reviewed annually by the State de- 17 partment of health to ensure that member- 18 ship representation requirements are being 19 fulfilled in accordance with this subpara- 20 graph. 21 (ii) REQUIRED MEMBERSHIP.—Each 22 State maternal mortality review committee 23 shall include— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00347 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 348 •HR 5942 IH (I) representatives from medical 1 specialties providing care to pregnant 2 and postpartum patients, including 3 obstetricians (including generalists 4 and maternal fetal medicine special- 5 ists) and family practice physicians; 6 (II) certified nurse midwives, cer- 7 tified midwives, and advanced practice 8 nurses; 9 (III) hospital-based registered 10 nurses; 11 (IV) representatives of the ma- 12 ternal and child health department of 13 the State department of health; 14 (V) social service providers or so- 15 cial workers, including those with ex- 16 perience working with communities di- 17 verse with respect to race, ethnicity, 18 and limited-English proficiency; 19 (VI) chief medical examiners or 20 designees; 21 (VII) facility representatives, 22 such as from hospitals or birth cen- 23 ters; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00348 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 349 •HR 5942 IH (VIII) patient advocates, commu- 1 nity maternal health organizations, 2 and minority advocacy groups that 3 represent those diverse racial and eth- 4 nic communities within the State that 5 are the most affected by pregnancy- 6 related or pregnancy-associated deaths 7 and by a lack of access to maternal 8 health care services; and 9 (IX) representatives of the de- 10 partments of health or public health 11 of major cities in the State. 12 (iii) DISCRETIONARY MEMBERSHIP.— 13 Each State maternal mortality review com- 14 mittee may also include representatives 15 from other relevant academic, health, so- 16 cial service, or policy professions or com- 17 munity organizations on an ongoing basis, 18 or as needed, as determined beneficial by 19 the committee, including— 20 (I) anesthesiologists; 21 (II) emergency physicians; 22 (III) pathologists; 23 (IV) epidemiologists; 24 (V) intensivists; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00349 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 350 •HR 5942 IH (VI) nutritionists; 1 (VII) mental health professionals; 2 (VIII) substance use disorder 3 treatment specialists; 4 (IX) representatives of relevant 5 patient and provider advocacy groups; 6 (X) academics; 7 (XI) paramedics; and 8 (XII) risk management special- 9 ists. 10 (iv) STAFF.—Staff of each State ma- 11 ternal mortality review committee shall in- 12 clude— 13 (I) vital health statisticians, ma- 14 ternal child health statisticians, or 15 epidemiologists; 16 (II) a coordinator of the State 17 maternal mortality review committee, 18 to be designated by the State; and 19 (III) administrative staff. 20 (D) OPTION FOR STATES TO ESTABLISH 21 REGIONAL MATERNAL MORTALITY REVIEW COM- 22 MITTEES.—States may choose to partner with 23 one or more neighboring States to carry out the 24 activities required of a State maternal mortality 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00350 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 351 •HR 5942 IH review committee under this section. In such a 1 case, with respect to the States in such a part- 2 nership, any requirement under this section re- 3 lating to the reporting of information related to 4 such activities shall be deemed to be fulfilled by 5 each such State if a single such report is sub- 6 mitted for the partnership. 7 (E) TREATMENT AS PUBLIC HEALTH AU- 8 THORITY FOR PURPOSES OF HIPAA.—For pur- 9 poses of applying HIPAA privacy and security 10 law (as defined in section 3009(a)(2) of the 11 Public Health Service Act (42 U.S.C. 300jj– 12 19)), each State maternal mortality review com- 13 mittee and regional maternal mortality review 14 committee established under subsection (a)(1) 15 or subsection (b)(2)(D), as the case may be, 16 shall be deemed to be a public health authority 17 described in section 164.501 (and referenced in 18 section 164.512(b)(1)(i)) of title 45, Code of 19 Federal Regulations (or any successor regula- 20 tion), carrying out public health activities and 21 purposes described in such section 22 164.512(b)(1)(i) (or any such successor regula- 23 tion). 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00351 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 352 •HR 5942 IH (3) STATE DEPARTMENT OF HEALTH ACTIVI- 1 TIES.—With respect to a State that receives a grant 2 under subsection (a)(1), the State department of 3 health shall— 4 (A) in consultation with the State maternal 5 mortality review committee and in conjunction 6 with relevant professional organizations and pa- 7 tient advocacy organizations, develop a plan for 8 ongoing health care provider education, based 9 on the findings and recommendations of the 10 committee, in order to improve the quality of 11 maternal care; and 12 (B) take steps to widely disseminate the 13 findings and recommendations of the State ma- 14 ternal mortality review committee and imple- 15 ment the recommendations of the committee. 16 (c) CASE ABSTRACTION FORM.— 17 (1) DISSEMINATION.—The Director of the Cen- 18 ters for Disease Control and Prevention shall dis- 19 seminate a uniform case abstraction form to States 20 and State maternal mortality review committees for 21 the purpose of— 22 (A) ensuring that the data and information 23 collected and reviewed by such committees can 24 be pooled for review by the Department of 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00352 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 353 •HR 5942 IH Health and Human Services and its agencies; 1 and 2 (B) preserving the uniformity of the infor- 3 mation collected for Federal public health pur- 4 poses. 5 (2) PERMISSIBLE STATE MODIFICATION.—Each 6 State may modify the form developed under para- 7 graph (1) for implementation and use by such State 8 or by the State maternal mortality review committee 9 of such State by including on such form additional 10 information to be collected, but may not alter the 11 standard questions on such form, in order to ensure 12 that the information can be collected and reviewed 13 centrally at the Federal level. 14 (d) PUBLIC DISCLOSURE OF INFORMATION.— 15 (1) IN GENERAL.—For fiscal year 2019, or a 16 subsequent fiscal year, each State receiving a grant 17 under this section for such year shall, subject to 18 paragraph (3), provide for the public disclosure, and 19 submission to the information clearinghouse estab- 20 lished under paragraph (2), of the information in- 21 cluded in the report of the State under subsection 22 (f)(1) for such year. 23 (2) INFORMATION CLEARINGHOUSE.—The Sec- 24 retary shall establish an information clearinghouse, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00353 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 354 •HR 5942 IH to be administered by the Director of the Centers for 1 Disease Control and Prevention, that will maintain 2 findings and recommendations submitted pursuant 3 to paragraph (1) and provide such findings and rec- 4 ommendations for public review and research pur- 5 poses by State departments of health, State mater- 6 nal mortality review committees, health providers 7 and institutions, and national patient and provider 8 advocacy groups. 9 (3) CONFIDENTIALITY OF INFORMATION.—In 10 no case may any individually identifiable health in- 11 formation be provided to the public, or submitted to 12 the information clearinghouse, under this subsection. 13 (e) CONFIDENTIALITY OF PROCEEDINGS OF STATE 14 MATERNAL MORTALITY REVIEW COMMITTEES.— 15 (1) IN GENERAL.—All proceedings and activi- 16 ties of a State maternal mortality review committee 17 established under subsection (a)(1), opinions of 18 members of such a committee formed as a result of 19 such proceedings and activities, and records ob- 20 tained, created, or maintained pursuant to this sec- 21 tion, including records of interviews, written reports, 22 and statements procured by the Department of 23 Health and Human Services or by any other person, 24 agency, or organization acting jointly with the De- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00354 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 355 •HR 5942 IH partment, in connection with morbidity and mor- 1 tality reviews under this section, shall be confidential 2 and may not be subject to discovery, subpoena, or 3 introduction into evidence in any civil, criminal, leg- 4 islative, or other proceeding. Such records shall not 5 be open to public inspection. 6 (2) TESTIMONY OF MEMBERS OF COM- 7 MITTEE.— 8 (A) IN GENERAL.—Members of a State 9 maternal mortality review committee established 10 under subsection (a)(1) may not be questioned 11 in any civil, criminal, legislative, or other pro- 12 ceeding regarding information presented in, or 13 opinions formed as a result of, a meeting or 14 communication of the committee. 15 (B) CLARIFICATION.—Nothing in this sub- 16 section may be construed to prevent a member 17 of a State maternal mortality review committee 18 established under subsection (a)(1) from testi- 19 fying regarding information that was obtained 20 independent of such member’s participation on 21 the committee, or public information. 22 (3) AVAILABILITY OF INFORMATION FOR RE- 23 SEARCH PURPOSES.—Nothing in this subsection may 24 prohibit a State maternal mortality review com- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00355 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 356 •HR 5942 IH mittee established under subsection (a)(1) or the De- 1 partment of Health and Human Services from pub- 2 lishing statistical compilations and research reports 3 that— 4 (A) are based on confidential information, 5 relating to morbidity and mortality reviews 6 under this section; and 7 (B) do not contain identifying information 8 or any other information that could be used to 9 ultimately identify the individuals concerned. 10 (f) REPORTS.— 11 (1) STATE REPORTS.—Not later than one year 12 after the end of fiscal year 2019, and each subse- 13 quent fiscal year, each State maternal mortality re- 14 view committee established under subsection (a)(1) 15 and receiving a grant under this section for such 16 year, shall submit to the Director of the Centers for 17 Disease Control and Prevention a report on the find- 18 ings and recommendations of such committee and 19 information on the implementation of such rec- 20 ommendations during such year. 21 (2) ANNUAL REPORTS TO CONGRESS.—Not 22 later than 60 days after the deadline for State re- 23 ports under paragraph (1) for fiscal year 2019, and 24 each subsequent fiscal year, the Secretary of Health 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00356 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 357 •HR 5942 IH and Human Services shall submit to Congress a re- 1 port on— 2 (A) the findings, recommendations, and 3 implementation information submitted by any 4 State pursuant to paragraph (1); and 5 (B) the status of pregnancy-related and 6 pregnancy-associated deaths in the United 7 States, including recommendations on methods 8 to prevent such deaths in the United States. 9 (g) DEFINITIONS.—In this section: 10 (1) The term ‘‘pregnancy-associated death’’ 11 means the death of a person while pregnant or dur- 12 ing the one-year period following the date of the end 13 of pregnancy, irrespective of the cause of such death. 14 (2) The term ‘‘pregnancy-related death’’ means 15 the death of a person while pregnant or during the 16 one-year period following the date of the end of 17 pregnancy, irrespective of the duration of the preg- 18 nancy, from any cause related to, or aggravated by, 19 the pregnancy or its management, excluding any ac- 20 cidental or incidental cause. 21 (3) The term ‘‘severe maternal morbidity’’ 22 means the physical and psychological conditions that 23 result from, or are aggravated by, pregnancy and 24 have an adverse effect on the health of a person. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00357 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 358 •HR 5942 IH (4) The term ‘‘State’’ means each of the 50 1 States, the District of Columbia, and each of the 2 territories. 3 (5) The term ‘‘vital statistics unit’’ means the 4 entity that is responsible for maintaining vital 5 records for a State, including official records of live 6 births, deaths, fetal deaths, marriages, divorces, and 7 annulments. 8 (h) AUTHORIZATION OF APPROPRIATIONS.—There is 9 authorized to be appropriated to carry out this section 10 $7,000,000 for each of fiscal years 2019 through 2023. 11 SEC. 506. ELIMINATING DISPARITIES IN MATERNITY 12 HEALTH OUTCOMES. 13 Part B of title III of the Public Health Service Act 14 is amended by inserting after section 317V of such Act, 15 as added, the following new section: 16 ‘‘SEC. 317W. ELIMINATING DISPARITIES IN MATERNAL 17 HEALTH OUTCOMES. 18 ‘‘(a) IN GENERAL.—The Secretary shall, in consulta- 19 tion with relevant national stakeholder organizations, such 20 as national medical specialty organizations, national ma- 21 ternal child health organizations, national patient advo- 22 cacy organizations, and national health disparity organiza- 23 tions, carry out the following activities to eliminate dis- 24 parities in maternal health outcomes: 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00358 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 359 •HR 5942 IH ‘‘(1) Conduct research into the determinants 1 and the distribution of disparities in maternal care, 2 health risks, and health outcomes, and improve the 3 capacity of the performance measurement infrastruc- 4 ture to measure such disparities. 5 ‘‘(2) Expand access to health care services, re- 6 sources, and information that have been dem- 7 onstrated to improve the quality and outcomes of 8 maternity care for vulnerable populations. 9 ‘‘(3) Establish a demonstration project to com- 10 pare the effectiveness of interventions to reduce dis- 11 parities in maternity services and outcomes and to 12 implement and assess effective interventions. 13 ‘‘(b) SCOPE AND SELECTION OF STATES FOR DEM- 14 ONSTRATION PROJECT.—The demonstration project 15 under subsection (a)(3) shall be conducted in no more 16 than 8 States, which shall be selected by the Secretary 17 based on— 18 ‘‘(1) applications submitted by States, which 19 specify which regions and populations the State in- 20 volved will serve under the demonstration project; 21 ‘‘(2) criteria designed by the Secretary to en- 22 sure that, as a whole, the demonstration project is, 23 to the greatest extent possible, representative of the 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00359 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 360 •HR 5942 IH demographic and geographic composition of commu- 1 nities most affected by disparities; 2 ‘‘(3) criteria designed by the Secretary to en- 3 sure that a variety of models are tested through the 4 demonstration project and that such models include 5 interventions that have an existing evidence base for 6 effectiveness; and 7 ‘‘(4) criteria designed by the Secretary to en- 8 sure that the demonstration projects and models will 9 be carried out in consultation with local and regional 10 provider organizations, such as community health 11 centers, hospital systems, and medical societies rep- 12 resenting providers of maternity services. 13 ‘‘(c) DURATION OF DEMONSTRATION PROJECT.— 14 The demonstration project under subsection (a)(3) shall 15 begin on January 1, 2019, and end on December 31, 16 2022. 17 ‘‘(d) GRANTS FOR EVALUATION AND MONITORING.— 18 The Secretary may make grants to States and health care 19 providers participating in the demonstration project under 20 subsection (a)(3) for the purpose of collecting data nec- 21 essary for the evaluation and monitoring of such project. 22 ‘‘(e) REPORTS.— 23 ‘‘(1) STATE REPORTS.—Each State that par- 24 ticipates in the demonstration project under sub- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00360 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 361 •HR 5942 IH section (a)(3) shall report to the Secretary, in a 1 time, form, and manner specified by the Secretary, 2 the data necessary to— 3 ‘‘(A) monitor the— 4 ‘‘(i) outcomes of the project; 5 ‘‘(ii) costs of the project; and 6 ‘‘(iii) quality of maternity care pro- 7 vided under the project; and 8 ‘‘(B) evaluate the rationale for the selec- 9 tion of the items and services included in any 10 bundled payment made by the State under the 11 project. 12 ‘‘(2) FINAL REPORT.—Not later than December 13 31, 2022, the Secretary shall submit to Congress a 14 report on the results of the demonstration project 15 under subsection (a)(3).’’. 16 SEC. 507. DECREASING THE RISK FACTORS FOR SUDDEN 17 UNEXPECTED INFANT DEATH AND SUDDEN 18 UNEXPLAINED DEATH IN CHILDHOOD. 19 (a) ESTABLISHMENT.—The Secretary of Health and 20 Human Services, acting through the Administrator of the 21 Health Resources and Services Administration and in con- 22 sultation with the Director of the Centers for Disease Con- 23 trol and Prevention and the Director of the National Insti- 24 tutes of Health (in this section referred to as the ‘‘Sec- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00361 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 362 •HR 5942 IH retary’’), shall establish and implement a culturally and 1 linguistically competent public health awareness and edu- 2 cation campaign to provide information that is focused on 3 decreasing the risk factors for sudden unexpected infant 4 death and sudden unexplained death in childhood, includ- 5 ing educating individuals about safe sleep environments, 6 sleep positions, and reducing exposure to smoking during 7 pregnancy and after birth. 8 (b) TARGETED POPULATIONS.—The campaign under 9 subsection (a) shall be designed to reduce health dispari- 10 ties through the targeting of populations with high rates 11 of sudden unexpected infant death and sudden unex- 12 plained death in childhood. 13 (c) CONSULTATION.—In establishing and imple- 14 menting the campaign under subsection (a), the Secretary 15 shall consult with national organizations representing 16 health care providers, including nurses and physicians, 17 parents, child care providers, children’s advocacy and safe- 18 ty organizations, maternal and child health programs, nu- 19 trition professionals focusing on women, infants, and chil- 20 dren, and other individuals and groups determined nec- 21 essary by the Secretary for such establishment and imple- 22 mentation. 23 (d) GRANTS.— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00362 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 363 •HR 5942 IH (1) IN GENERAL.—In carrying out the cam- 1 paign under subsection (a), the Secretary shall 2 award grants to national organizations, State and 3 local health departments, and community-based or- 4 ganizations for the conduct of education and out- 5 reach programs for nurses, parents, child care pro- 6 viders, public health agencies, and community orga- 7 nizations. 8 (2) APPLICATION.—To be eligible to receive a 9 grant under paragraph (1), an entity shall submit to 10 the Secretary an application at such time, in such 11 manner, and containing such information as the Sec- 12 retary may require. 13 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 14 authorized to be appropriated to carry out this section 15 such sums as may be necessary for each of fiscal years 16 2019 through 2023. 17 SEC. 508. REDUCING UNINTENDED TEENAGE PREG- 18 NANCIES. 19 Title III of the Public Health Service Act (42 U.S.C. 20 241 et seq.) is amended by adding at the end the following 21 new part: 22 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00363 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 364 •HR 5942 IH ‘‘PART W—YOUTH ACCESS TO SEXUAL HEALTH 1 SERVICES 2 ‘‘SEC. 399OO. AUTHORIZATION OF GRANTS TO SUPPORT 3 THE ACCESS OF MARGINALIZED YOUTH TO 4 SEXUAL HEALTH SERVICES. 5 ‘‘(a) GRANTS.—The Secretary of Health and Human 6 Services may award grants on a competitive basis to eligi- 7 ble entities to support the access of marginalized youth 8 to sexual health services. 9 ‘‘(b) USE OF FUNDS.—An eligible entity that is 10 awarded a grant under subsection (a) may use the funds 11 to— 12 ‘‘(1) provide medically accurate and complete 13 and age-, developmentally, and culturally appro- 14 priate sexual health information to marginalized 15 youth, including information on how to access sexual 16 health services; 17 ‘‘(2) promote effective communication regarding 18 sexual health among marginalized youth; 19 ‘‘(3) promote and support better health, edu- 20 cation, and economic opportunities for school-age 21 parents; and 22 ‘‘(4) train individuals who work with 23 marginalized youth to promote— 24 ‘‘(A) the prevention of unintended preg- 25 nancy; 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00364 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 365 •HR 5942 IH ‘‘(B) the prevention of sexually transmitted 1 infections, including the human immuno- 2 deficiency virus (HIV); 3 ‘‘(C) healthy relationships; and 4 ‘‘(D) the development of safe and sup- 5 portive environments. 6 ‘‘(c) APPLICATION.—To be awarded a grant under 7 subsection (a), an eligible entity shall submit an applica- 8 tion to the Secretary at such time, in such manner, and 9 containing such information as the Secretary may require. 10 ‘‘(d) PRIORITY.—In awarding grants under sub- 11 section (a), the Secretary shall give priority to eligible enti- 12 ties— 13 ‘‘(1) with a history of supporting the access of 14 marginalized youth to sexuality education or sexual 15 health services; and 16 ‘‘(2) that plan to serve marginalized youth that 17 are not served by Federal adolescent programs for 18 the prevention of pregnancy, HIV, and other sexu- 19 ally transmitted infections. 20 ‘‘(e) REQUIREMENTS.—The Secretary may not award 21 a grant under subsection (a) to an eligible entity unless— 22 ‘‘(1) such eligible entity has formed a partner- 23 ship with a community organization; and 24 ‘‘(2) such eligible entity agrees— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00365 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 366 •HR 5942 IH ‘‘(A) to employ a scientifically effective 1 strategy; 2 ‘‘(B) that all information provided to 3 marginalized youth will be— 4 ‘‘(i) age- and developmentally appro- 5 priate; 6 ‘‘(ii) medically accurate and complete; 7 ‘‘(iii) scientifically based; and 8 ‘‘(iv) provided in the language and 9 cultural context that is most appropriate 10 for the individuals served by the eligible 11 entity; and 12 ‘‘(C) that for each year the eligible entity 13 receives grant funds under subsection (a), the 14 eligible entity will submit to the Secretary an 15 annual report that includes— 16 ‘‘(i) the use of grant funds by the eli- 17 gible entity; 18 ‘‘(ii) how the use of grant funds has 19 increased the access of marginalized youth 20 to sexual health services; and 21 ‘‘(iii) such other information as the 22 Secretary may require. 23 ‘‘(f) PUBLICATION AND EVALUATIONS.— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00366 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 367 •HR 5942 IH ‘‘(1) EVALUATIONS.—Not less than once every 1 two years after the date of the enactment of this 2 Act, the Secretary shall evaluate the effectiveness of 3 whichever of the following is greater: 4 ‘‘(A) Eight grants awarded under sub- 5 section (a). 6 ‘‘(B) Ten percent of the grants awarded 7 under subsection (a). 8 ‘‘(2) PUBLICATION.—The Secretary shall make 9 available to the public— 10 ‘‘(A) the evaluations required under para- 11 graph (1); and 12 ‘‘(B) the reports required under subsection 13 (e)(2)(C). 14 ‘‘(g) LIMITATIONS.—No funds made available to an 15 eligible entity under this section may be used by such enti- 16 ty to provide access to sexual health services that— 17 ‘‘(1) withhold sexual health-promoting or life- 18 saving information; 19 ‘‘(2) are medically inaccurate or have been sci- 20 entifically shown to be ineffective; 21 ‘‘(3) promote gender stereotypes; 22 ‘‘(4) are insensitive or unresponsive to the 23 needs of young people, including— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00367 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 368 •HR 5942 IH ‘‘(A) youth with varying gender identities, 1 gender expressions, and sexual orientations; 2 ‘‘(B) sexually active youth; 3 ‘‘(C) pregnant or parenting youth; 4 ‘‘(D) survivors of sexual abuse or assault; 5 and 6 ‘‘(E) youth of all physical, developmental, 7 and mental abilities; or 8 ‘‘(5) are inconsistent with the ethical impera- 9 tives of medicine and public health. 10 ‘‘(h) TRANSFER OF FUNDS.—Any unobligated bal- 11 ance of funds made available under section 510(d) of the 12 Social Security Act (42 U.S.C. 710(d)) (as in effect on 13 the day before the date of the enactment of this Act) are 14 hereby transferred and made available to the Secretary to 15 carry out this Act. The amounts transferred and made 16 available to carry out this Act shall remain available until 17 expended. 18 ‘‘(i) DEFINITIONS.—In this section: 19 ‘‘(1) COMMUNITY ORGANIZATION.—The term 20 ‘community organization’ includes a State or local 21 health or education agency, public school, youth-fo- 22 cused organization that is faith-based and commu- 23 nity-based, juvenile justice entity, or other organiza- 24 tion that provides confidential and appropriate sexu- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00368 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 369 •HR 5942 IH ality education or sexual health services to 1 marginalized youth. 2 ‘‘(2) ELIGIBLE ENTITY.—The term ‘eligible en- 3 tity’ includes a State or local health or education 4 agency, public school, nonprofit organization, hos- 5 pital, or an Indian Tribe or Tribal organization (as 6 such terms are defined in section 4 of the Indian 7 Self-Determination and Education Assistance Act 8 (25 U.S.C. 5304)). 9 ‘‘(3) MARGINALIZED YOUTH.—The term 10 ‘marginalized youth’ means a person under the age 11 of 26 that is disadvantaged by underlying structural 12 barriers and social inequity. 13 ‘‘(4) MEDICALLY ACCURATE AND COMPLETE.— 14 The term ‘medically accurate and complete’, when 15 used with respect to information, means information 16 that— 17 ‘‘(A) is supported by research and recog- 18 nized as accurate, objective, and complete by 19 leading medical, psychological, psychiatric, or 20 public health organizations and agencies; and 21 ‘‘(B) does not withhold any information re- 22 lating to the effectiveness and benefits of cor- 23 rect and consistent use of condoms or other 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00369 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 370 •HR 5942 IH contraceptives and pregnancy prevention meth- 1 ods. 2 ‘‘(5) SCIENTIFICALLY EFFECTIVE STRATEGY.— 3 The term ‘scientifically effective strategy’ means a 4 strategy that— 5 ‘‘(A) is widely recognized by leading med- 6 ical and public health agencies as effective in 7 promoting sexual health awareness and healthy 8 behavior; and 9 ‘‘(B) either— 10 ‘‘(i) has been demonstrated to be ef- 11 fective on the basis of rigorous scientific 12 research; or 13 ‘‘(ii) incorporates characteristics of ef- 14 fective programs. 15 ‘‘(6) SECRETARY.—The term ‘Secretary’ means 16 the Secretary of Health and Human Services. 17 ‘‘(7) SEXUAL HEALTH SERVICES.—The term 18 ‘sexual health services’ includes— 19 ‘‘(A) sexual health information, education, 20 and counseling; 21 ‘‘(B) contraception; 22 ‘‘(C) emergency contraception; 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00370 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 371 •HR 5942 IH ‘‘(D) condoms and other barrier methods 1 to prevent pregnancy or sexually transmitted in- 2 fections; 3 ‘‘(E) routine gynecological care, including 4 human papillomavirus (HPV) vaccines and can- 5 cer screenings; 6 ‘‘(F) pre-exposure prophylaxis or post-ex- 7 posure prophylaxis; 8 ‘‘(G) mental health services; 9 ‘‘(H) sexual assault survivor services; and 10 ‘‘(I) other prevention, care, or treatment.’’. 11 SEC. 509. GESTATIONAL DIABETES. 12 Part B of title III of the Public Health Service Act 13 (42 U.S.C. 243 et seq.) is amended by adding after section 14 317H the following: 15 ‘‘SEC. 317H–1. GESTATIONAL DIABETES. 16 ‘‘(a) UNDERSTANDING AND MONITORING GESTA- 17 TIONAL DIABETES.— 18 ‘‘(1) IN GENERAL.—The Secretary, acting 19 through the Director of the Centers for Disease 20 Control and Prevention, in consultation with the Di- 21 abetes Mellitus Interagency Coordinating Committee 22 established under section 429 and representatives of 23 appropriate national health organizations, shall de- 24 velop a multisite gestational diabetes research 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00371 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 372 •HR 5942 IH project within the diabetes program of the Centers 1 for Disease Control and Prevention to expand and 2 enhance surveillance data and public health research 3 on gestational diabetes. 4 ‘‘(2) AREAS TO BE ADDRESSED.—The research 5 project developed under paragraph (1) shall ad- 6 dress— 7 ‘‘(A) procedures to establish accurate and 8 efficient systems for the collection of gestational 9 diabetes data within each State and common- 10 wealth, territory, or possession of the United 11 States; 12 ‘‘(B) the progress of collaborative activities 13 with the National Vital Statistics System, the 14 National Center for Health Statistics, and 15 State health departments with respect to the 16 standard birth certificate, in order to improve 17 surveillance of gestational diabetes; 18 ‘‘(C) postpartum methods of tracking indi- 19 viduals with gestational diabetes after delivery 20 as well as targeted interventions proven to 21 lower the incidence of type 2 diabetes in that 22 population; 23 ‘‘(D) variations in the distribution of diag- 24 nosed and undiagnosed gestational diabetes, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00372 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 373 •HR 5942 IH and of impaired fasting glucose tolerance and 1 impaired fasting glucose, within and among 2 groups of pregnant individuals; and 3 ‘‘(E) factors and culturally sensitive inter- 4 ventions that influence risks and reduce the in- 5 cidence of gestational diabetes and related com- 6 plications during childbirth, including cultural, 7 behavioral, racial, ethnic, geographic, demo- 8 graphic, socioeconomic, and genetic factors. 9 ‘‘(3) REPORT.—Not later than 2 years after the 10 date of the enactment of this section, and annually 11 thereafter, the Secretary shall generate a report on 12 the findings and recommendations of the research 13 project including prevalence of gestational diabetes 14 in the multisite area and disseminate the report to 15 the appropriate Federal and non-Federal agencies. 16 ‘‘(b) EXPANSION OF GESTATIONAL DIABETES RE- 17 SEARCH.— 18 ‘‘(1) IN GENERAL.—The Secretary shall expand 19 and intensify public health research regarding gesta- 20 tional diabetes. Such research may include— 21 ‘‘(A) developing and testing novel ap- 22 proaches for improving postpartum diabetes 23 testing or screening and for preventing type 2 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00373 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 374 •HR 5942 IH diabetes in individuals who can become preg- 1 nant with a history of gestational diabetes; and 2 ‘‘(B) conducting public health research to 3 further understanding of the epidemiologic, 4 socioenvironmental, behavioral, translation, and 5 biomedical factors and health systems that in- 6 fluence the risk of gestational diabetes and the 7 development of type 2 diabetes in individuals 8 who can become pregnant with a history of ges- 9 tational 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 2019 through 2023. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00374 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 375 •HR 5942 IH abetes in individuals who can become pregnant with 1 a history of gestational diabetes. 2 ‘‘(2) PRIORITY.—In making grants under this 3 subsection, the Secretary shall give priority to 4 projects focusing on— 5 ‘‘(A) helping individuals who can become 6 pregnant who have 1 or more risk factors for 7 developing gestational diabetes; 8 ‘‘(B) working with individuals who can be- 9 come pregnant with a history of gestational dia- 10 betes during a previous pregnancy; 11 ‘‘(C) providing postpartum care for indi- 12 viduals who can become pregnant with gesta- 13 tional diabetes; 14 ‘‘(D) tracking cases where individuals who 15 can become pregnant with a history of gesta- 16 tional diabetes developed type 2 diabetes; 17 ‘‘(E) educating mothers with a history of 18 gestational diabetes about the increased risk of 19 their child developing diabetes; 20 ‘‘(F) working to prevent gestational diabe- 21 tes and prevent or delay the development of 22 type 2 diabetes in individuals who can become 23 pregnant with a history of gestational diabetes; 24 and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00375 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 376 •HR 5942 IH ‘‘(G) achieving outcomes designed to assess 1 the efficacy and cost-effectiveness of interven- 2 tions that can inform decisions on long-term 3 sustainability, including third-party reimburse- 4 ment. 5 ‘‘(3) APPLICATION.—An eligible entity desiring 6 to receive a grant under this subsection shall submit 7 to the Secretary— 8 ‘‘(A) an application at such time, in such 9 manner, and containing such information as the 10 Secretary may require; and 11 ‘‘(B) a plan to— 12 ‘‘(i) lower the rate of gestational dia- 13 betes during pregnancy; or 14 ‘‘(ii) develop methods of tracking indi- 15 viduals who can become pregnant with a 16 history of gestational diabetes and develop 17 effective interventions to lower the inci- 18 dence of the recurrence of gestational dia- 19 betes in subsequent pregnancies and the 20 development of type 2 diabetes. 21 ‘‘(4) USES OF FUNDS.—An eligible entity re- 22 ceiving a grant under this subsection shall use the 23 grant funds to carry out demonstration projects de- 24 scribed in paragraph (1), including— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00376 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 377 •HR 5942 IH ‘‘(A) expanding community-based health 1 promotion education, activities, and incentives 2 focused on the prevention of gestational diabe- 3 tes and development of type 2 diabetes in indi- 4 viduals who can become pregnant with a history 5 of gestational diabetes; 6 ‘‘(B) aiding State- and Tribal-based diabe- 7 tes prevention and control programs to collect, 8 analyze, disseminate, and report surveillance 9 data on individuals who can become pregnant 10 with, and at risk for, gestational diabetes, the 11 recurrence of gestational diabetes in subsequent 12 pregnancies, and, for individuals who can be- 13 come pregnant with a history of gestational dia- 14 betes, the development of type 2 diabetes; and 15 ‘‘(C) training and encouraging health care 16 providers— 17 ‘‘(i) to promote risk assessment, high- 18 quality care, and self-management for ges- 19 tational diabetes and the recurrence of ges- 20 tational diabetes in subsequent preg- 21 nancies; and 22 ‘‘(ii) to prevent the development of 23 type 2 diabetes in individuals who can be- 24 come pregnant with a history of gesta- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00377 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 378 •HR 5942 IH tional diabetes, and its complications in the 1 practice settings of the health care pro- 2 viders. 3 ‘‘(5) REPORT.—Not later than 4 years after the 4 date of the enactment of this section, the Secretary 5 shall prepare and submit to the Congress a report 6 concerning the results of the demonstration projects 7 conducted through the grants awarded under this 8 subsection. 9 ‘‘(6) DEFINITION OF ELIGIBLE ENTITY.—In 10 this subsection, the term ‘eligible entity’ means a 11 nonprofit organization (such as a nonprofit academic 12 center or community health center) or a State, Trib- 13 al, or local health agency. 14 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 15 There is authorized to be appropriated to carry out 16 this subsection $5,000,000 for each of fiscal years 17 2019 through 2023. 18 ‘‘(d) POSTPARTUM FOLLOWUP REGARDING GESTA- 19 TIONAL DIABETES.—The Secretary, acting through the 20 Director of the Centers for Disease Control and Preven- 21 tion, shall work with the State- and Tribal-based diabetes 22 prevention and control programs assisted by the Centers 23 to encourage postpartum followup after gestational diabe- 24 tes, as medically appropriate, for the purpose of reducing 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00378 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 379 •HR 5942 IH the incidence of gestational diabetes, the recurrence of 1 gestational diabetes in subsequent pregnancies, the devel- 2 opment of type 2 diabetes in individuals with a history 3 of gestational diabetes, and related complications.’’. 4 SEC. 510. EMERGENCY CONTRACEPTION EDUCATION AND 5 INFORMATION PROGRAMS. 6 (a) EMERGENCY CONTRACEPTION PUBLIC EDU- 7 CATION PROGRAM.— 8 (1) IN GENERAL.—The Secretary, acting 9 through the Director of the Centers for Disease 10 Control and Prevention, shall develop and dissemi- 11 nate to the public medically accurate and complete 12 information on emergency contraception. 13 (2) DISSEMINATION.—The Secretary may dis- 14 seminate medically accurate and complete informa- 15 tion under paragraph (1) directly or through ar- 16 rangements with nonprofit organizations, community 17 health workers including promotoras, consumer 18 groups, institutions of higher education, clinics, the 19 media, and Federal, State, and local agencies. 20 (3) INFORMATION.—The information dissemi- 21 nated under paragraph (1) shall— 22 (A) include, at a minimum, a description 23 of emergency contraception and an explanation 24 of the use, safety, efficacy, and availability of 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00379 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 380 •HR 5942 IH such contraception and options for no-copay ac- 1 cess through insurance; and 2 (B) be pilot tested for consumer com- 3 prehension, cultural and linguistic appropriate- 4 ness, and acceptance of the messages across 5 geographically, racially, ethnically, and linguis- 6 tically diverse populations. 7 (b) EMERGENCY CONTRACEPTION INFORMATION 8 PROGRAM FOR HEALTH CARE PROVIDERS.— 9 (1) IN GENERAL.—The Secretary, acting 10 through the Administrator of the Health Resources 11 and Services Administration and in consultation 12 with major medical and public health organizations, 13 shall develop and disseminate to health care pro- 14 viders information on emergency contraception. 15 (2) INFORMATION.—The information dissemi- 16 nated under paragraph (1) shall include, at a min- 17 imum— 18 (A) information describing the use, safety, 19 efficacy, availability of emergency contraception, 20 and options for no-copay access through insur- 21 ance; 22 (B) a recommendation regarding the use of 23 such contraception; and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00380 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 381 •HR 5942 IH (C) information explaining how to obtain 1 copies of the information developed under sub- 2 section (a) for distribution to the patients of 3 the providers. 4 (c) DEFINITIONS.—In this section: 5 (1) EMERGENCY CONTRACEPTION.—The term 6 ‘‘emergency contraception’’ means a drug or device 7 (as the terms are defined in section 201 of the Fed- 8 eral Food, Drug, and Cosmetic Act (21 U.S.C. 321)) 9 or a drug regimen that— 10 (A) is used postcoitally; 11 (B) prevents pregnancy primarily by pre- 12 venting or delaying ovulation, and does not ter- 13 minate an established pregnancy; and 14 (C) is approved by the Food and Drug Ad- 15 ministration. 16 (2) HEALTH CARE PROVIDER.—The term 17 ‘‘health care provider’’ means an individual who is li- 18 censed or certified under State law to provide health 19 care services and who is operating within the scope 20 of such license. Such term shall include a phar- 21 macist. 22 (3) INSTITUTION OF HIGHER EDUCATION.—The 23 term ‘‘institution of higher education’’ has the same 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00381 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 382 •HR 5942 IH meaning given such term in section 101(a) of the 1 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 2 (4) MEDICALLY ACCURATE AND COMPLETE.— 3 The term ‘‘medically accurate and complete’’ means, 4 with respect to information, activities, or services 5 verified or supported by the weight of research con- 6 ducted in compliance with accepted scientific meth- 7 ods and— 8 (A) published in peer-reviewed journals, 9 where applicable; or 10 (B) comprising information that leading 11 professional organizations and agencies with 12 relevant expertise in the field recognize as accu- 13 rate, objective, and complete. 14 (5) SECRETARY.—The term ‘‘Secretary’’ means 15 the Secretary of Health and Human Services. 16 (d) AUTHORIZATION OF APPROPRIATIONS.—There 17 are authorized to be appropriated to carry out this section 18 such sums as may be necessary for each of the fiscal years 19 2019 through 2023. 20 SEC. 511. COMPREHENSIVE SEX EDUCATION PROGRAMS. 21 (a) PURPOSES; FINDING; SENSE OF CONGRESS.— 22 (1) PURPOSES.—The purposes of this Act are 23 to provide young people with comprehensive sex edu- 24 cation programs that— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00382 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 383 •HR 5942 IH (A) promote and uphold the rights of 1 young people to information in order to make 2 healthy decisions about their sexual health; 3 (B) provide the information and skills all 4 young people need to make informed, respon- 5 sible, and healthy decisions in order to become 6 sexually healthy adults and have healthy rela- 7 tionships; 8 (C) provide information about the preven- 9 tion of unintended pregnancy, sexually trans- 10 mitted infections, including HIV, dating vio- 11 lence, sexual assault, bullying, and harassment; 12 and 13 (D) provide resources and information on 14 topics ranging from gender stereotyping and 15 gender roles and stigma and socio-cultural in- 16 fluences surrounding sex and sexuality. 17 (2) FINDING ON REQUIRED RESOURCES.—In 18 order to provide the comprehensive sex education de- 19 scribed in paragraph (1), Congress finds that in- 20 creased resources are required for sex education pro- 21 grams that— 22 (A) substantially incorporate elements of 23 evidence-based programs or characteristics of 24 effective programs; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00383 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 384 •HR 5942 IH (B) cover a broad range of topics, includ- 1 ing medically accurate and complete informa- 2 tion that is age and developmentally appro- 3 priate about all the aspects of sex, sexual 4 health, and sexuality; 5 (C) are gender and gender identity-sen- 6 sitive, emphasizing the importance of equality 7 and the social environment for achieving sexual 8 and reproductive health and overall well-being; 9 (D) promote educational achievement, crit- 10 ical thinking, decisionmaking, self-esteem, and 11 self-efficacy; 12 (E) help develop healthy attitudes and in- 13 sights necessary for understanding relationships 14 between oneself and others and society; 15 (F) foster leadership skills and community 16 engagement by— 17 (i) promoting principles of fairness, 18 human dignity, and respect; and 19 (ii) engaging young people as partners 20 in their communities; and 21 (G) are culturally and linguistically appro- 22 priate, reflecting the diverse circumstances and 23 realities of young people. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00384 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 385 •HR 5942 IH (3) SENSE OF CONGRESS.—It is the sense of 1 Congress that— 2 (A) federally funded sex education pro- 3 grams should aim to— 4 (i) provide information about a range 5 of human sexuality topics, including— 6 (I) human development, healthy 7 relationships, personal skills; 8 (II) sexual behavior including ab- 9 stinence; 10 (III) sexual health including pre- 11 venting unintended pregnancy; 12 (IV) sexually transmitted infec- 13 tions including HIV; and 14 (V) society and culture; 15 (ii) promote safe and healthy relation- 16 ships; 17 (iii) promote gender equity; 18 (iv) use, and be informed by, the best 19 scientific information available; 20 (v) be culturally appropriate and in- 21 clusive of youth with varying gender identi- 22 ties, gender expressions, and sexual ori- 23 entations; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00385 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 386 •HR 5942 IH (vi) be built on characteristics of ef- 1 fective programs; 2 (vii) expand the existing body of re- 3 search on comprehensive sex education 4 programs through program evaluation; 5 (viii) expand training programs for 6 teachers of comprehensive sex education; 7 (ix) build on programs funded under 8 section 513 of the Social Security Act (42 9 U.S.C. 713) and the Office of Adolescent 10 Health’s Teen Pregnancy Prevention Pro- 11 gram, funded under title II of the Consoli- 12 dated Appropriations Act, 2010 (Public 13 Law 111–117; 123 Stat.), and on pro- 14 grams supported through the Centers for 15 Disease Control and Prevention (CDC); 16 and 17 (x) promote and uphold the rights of 18 young people to information in order to 19 make healthy and autonomous decisions 20 about their sexual health; and 21 (B) no Federal funds should be used for 22 health education programs that— 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00386 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 387 •HR 5942 IH (i) withhold health-promoting or life- 1 saving information about sexuality-related 2 topics, including HIV; 3 (ii) are medically inaccurate or have 4 been scientifically shown to be ineffective; 5 (iii) promote gender or racial stereo- 6 types; 7 (iv) are insensitive and unresponsive 8 to the needs of sexually active young peo- 9 ple; 10 (v) are insensitive and unresponsive to 11 the needs of survivors of sexual violence; 12 (vi) are insensitive and unresponsive 13 to the needs of youth of all physical, devel- 14 opmental, and mental abilities; 15 (vii) are insensitive and unresponsive 16 to the needs of youth with varying gender 17 identities, gender expressions, and sexual 18 orientations; or 19 (viii) are inconsistent with the ethical 20 imperatives of medicine and public health. 21 (b) GRANTS FOR COMPREHENSIVE SEX EDUCATION 22 FOR ADOLESCENTS.— 23 (1) PROGRAM AUTHORIZED.—The Secretary of 24 Health and Human Services, in coordination with 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00387 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 388 •HR 5942 IH the Associate Commissioner of the Family and 1 Youth Services Bureau of the Administration on 2 Children, Youth, and Families of the Department of 3 Health and Human Services, the Director of the Of- 4 fice of Adolescent Health, the Director of the Divi- 5 sion of Adolescent and School Health within the 6 Centers for Disease Control and Prevention and the 7 Secretary of Education, shall award grants, on a 8 competitive basis, to eligible entities to enable such 9 eligible entities to carry out programs that provide 10 adolescents with comprehensive sex education, as de- 11 scribed in paragraph (6). 12 (2) DURATION.—Grants awarded under this 13 section shall be for a period of 5 years. 14 (3) ELIGIBLE ENTITY.—In this section, the 15 term ‘‘eligible entity’’ means a public or private enti- 16 ty that focuses on adolescent health and education 17 or has experience working with adolescents. 18 (4) APPLICATIONS.—An eligible entity desiring 19 a grant under this section shall submit an applica- 20 tion to the Secretary at such time, in such manner, 21 and containing such information as the Secretary 22 may require, including an assurance to participate in 23 the evaluation described in subsection (e). 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00388 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 389 •HR 5942 IH (5) PRIORITY.—In awarding grants under this 1 section, the Secretary shall give priority to eligible 2 entities that— 3 (A) are State or local public entities; 4 (B) are entities not currently receiving 5 funds under— 6 (i) section 513 of the Social Security 7 Act (42 U.S.C. 713); 8 (ii) the Office of Adolescent Health’s 9 Teen Pregnancy Prevention Program, 10 funded under title II of the Consolidated 11 Appropriations Act, 2010 (Public Law– 12 117; 123 Stat. 3253), or any substantially 13 similar successive program; or 14 (iii) the Centers for Disease Control 15 and Prevention’s Division of Adolescent 16 and School Health; and 17 (C) address health inequities among young 18 people that face systemic barriers resulting in 19 disproportionate rates of not less than one of 20 the following: 21 (i) Unintended pregnancies. 22 (ii) Sexually transmitted infections, 23 including HIV. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00389 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 390 •HR 5942 IH (iii) Dating violence and sexual vio- 1 lence. 2 (6) USE OF FUNDS.— 3 (A) IN GENERAL.—Each eligible entity 4 that receives a grant under this section shall 5 use the grant funds to carry out an education 6 program that provides adolescents with com- 7 prehensive sex education that— 8 (i) is age and developmentally appro- 9 priate; 10 (ii) is medically accurate and com- 11 plete; 12 (iii) substantially incorporates ele- 13 ments of evidence-based sex education in- 14 struction; or 15 (iv) creates a demonstration project 16 based on characteristics of effective pro- 17 grams. 18 (B) CONTENTS OF COMPREHENSIVE SEX 19 EDUCATION PROGRAMS.—The comprehensive 20 sex education programs funded under this sec- 21 tion shall include instruction and materials that 22 address— 23 (i) the physical, social, and emotional 24 changes of human development including, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00390 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 391 •HR 5942 IH human anatomy, reproduction, and sexual 1 development; 2 (ii) healthy relationships, including 3 friendships, within families, and society, 4 that are based on mutual respect, and the 5 ability to distinguish between healthy and 6 unhealthy relationships, including— 7 (I) effective communication, ne- 8 gotiation and refusal skills, including 9 the skills to recognize and report in- 10 appropriate or abusive sexual ad- 11 vances; 12 (II) bodily autonomy, setting and 13 respecting personal boundaries, prac- 14 ticing personal safety, and consent; 15 and 16 (III) the limitations and harm of 17 gender-role stereotypes, violence, coer- 18 cion, bullying, harassment, and intimi- 19 dation in relationships; 20 (iii) healthy decisionmaking skills 21 about sexuality and relationships that in- 22 clude— 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00391 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 392 •HR 5942 IH (I) critical thinking, problem 1 solving, self-efficacy, stress-manage- 2 ment, self-care, and decisionmaking; 3 (II) individual values and atti- 4 tudes; 5 (III) the promotion of positive 6 body images; 7 (IV) developing an understanding 8 that there are a range of body types 9 and encouraging positive feeling about 10 students’ own body types; 11 (V) information on how to re- 12 spect others and ensure safety on the 13 internet and when using other forms 14 of digital communication; 15 (VI) information on local services 16 and resources where students can ob- 17 tain additional information related to 18 bullying, harassment, dating violence 19 and sexual assault, suicide prevention, 20 and other related care; 21 (VII) encouragement for youth to 22 communicate with their parents or 23 guardians, health and social service 24 professionals, and other trusted adults 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00392 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 393 •HR 5942 IH about sexuality and intimate relation- 1 ships; 2 (VIII) information on how to cre- 3 ate a safe environment for all stu- 4 dents and others in society; 5 (IX) examples of varying types of 6 relationships, couples, and family 7 structures; and 8 (X) affirmative representation of 9 varying gender identities, gender ex- 10 pressions, and sexual orientations, in- 11 cluding individuals and relationships 12 between same sex couples and their 13 families; 14 (iv) abstinence, delaying age of first 15 sexual activity, the use of condoms, preven- 16 tive medication, vaccination, birth control, 17 and other sexually transmitted infection 18 prevention measures, and the options for 19 pregnancy, including parenting, adoption, 20 and abortion, including— 21 (I) the importance of effectively 22 using condoms, preventive medication, 23 and applicable vaccinations to protect 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00393 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 394 •HR 5942 IH against sexually transmitted infec- 1 tions, including HIV; 2 (II) the benefits of effective con- 3 traceptive and condom use in avoiding 4 unintended pregnancy; 5 (III) the relationship between 6 substance use and sexual health and 7 behaviors; and 8 (IV) information about local 9 health services where students can ob- 10 tain additional information and serv- 11 ices related to sexual and reproductive 12 health and other related care; 13 (v) through affirmative recognition, 14 the roles that traditions, values, religion, 15 norms, gender roles, acculturation, family 16 structure, health beliefs, and political 17 power play in how students make decisions 18 that affect their sexual health, using exam- 19 ples of various types of races, ethnicities, 20 cultures, and families, including single-par- 21 ent households and young families; 22 (vi) information about gender identity, 23 gender expression, and sexual orientation 24 for all students, including— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00394 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 395 •HR 5942 IH (I) affirmative recognition that 1 people have different gender identi- 2 ties, gender expressions, and sexual 3 orientations; and 4 (II) community resources that 5 can provide additional support for in- 6 dividuals with varying gender identi- 7 ties, gender expressions, and sexual 8 orientations; and 9 (vii) opportunities to explore the roles 10 that race, ethnicity, immigration status, 11 disability status, economic status, home- 12 lessness, foster care status, and language 13 within different communities affect sexual 14 attitudes in society and culture and how 15 this may impact student sexual health. 16 (c) GRANTS FOR COMPREHENSIVE SEX EDUCATION 17 AT INSTITUTIONS OF HIGHER EDUCATION.— 18 (1) PROGRAM AUTHORIZED.—The Secretary, in 19 coordination with the Secretary of Education, shall 20 award grants, on a competitive basis, to institutions 21 of higher education or consortia of such institutions 22 to enable such institutions to provide young people 23 with comprehensive sex education, described in para- 24 graph (5)(B). 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00395 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 396 •HR 5942 IH (2) DURATION.—Grants awarded under this 1 section shall be for a period of 5 years. 2 (3) APPLICATIONS.—An institution of higher 3 education or consortia of such institutions desiring a 4 grant under this section shall submit an application 5 to the Secretary at such time, in such manner, and 6 containing such information as the Secretary may 7 require, including an assurance to participate in the 8 evaluation described in subsection (e). 9 (4) PRIORITY.—In awarding grants under this 10 section, the Secretary shall give priority to an insti- 11 tution of higher education that— 12 (A) has an enrollment of needy students as 13 defined in section 318(b) of the Higher Edu- 14 cation Act of 1965 (20 U.S.C. 1059e(b)); 15 (B) is a Hispanic-serving institution, as 16 defined in section 502(a) of such Act (20 17 U.S.C. 1101a(a)); 18 (C) is a Tribal College or University, as 19 defined in section 316(b) of such Act (20 20 U.S.C. 1059c(b)); 21 (D) is an Alaska Native-serving institution, 22 as defined in section 317(b) of such Act (20 23 U.S.C. 1059d(b)); 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00396 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 397 •HR 5942 IH (E) is a Native Hawaiian-serving institu- 1 tion, as defined in section 317(b) of such Act 2 (20 U.S.C. 1059d(b)); 3 (F) is a Predominately Black Institution, 4 as defined in section 318(b) of such Act (20 5 U.S.C. 1059e(b)); 6 (G) is a Native American-serving, non- 7 tribal institution, as defined in section 319(b) 8 of such Act (20 U.S.C. 1059f(b)); 9 (H) is an Asian American and Native 10 American Pacific Islander-serving institution, as 11 defined in section 320(b) of such Act (20 12 U.S.C. 1059g(b)); or 13 (I) is a minority institution, as defined in 14 section 365 of such Act (20 U.S.C. 1067k), 15 with an enrollment of needy students, as de- 16 fined in section 312 of such Act (20 U.S.C. 17 1058). 18 (5) USES OF FUNDS.— 19 (A) IN GENERAL.—An institution of higher 20 education receiving a grant under this section 21 shall use grant funds to integrate issues relat- 22 ing to comprehensive sex education into institu- 23 tion of higher education in order to reach a 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00397 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 398 •HR 5942 IH large number of students, by carrying out one 1 or more of the following activities: 2 (i) Developing or adopting educational 3 content for issues relating to comprehen- 4 sive sex education that will be incorporated 5 into student orientation, general education, 6 or core courses. 7 (ii) Developing or adopting, and im- 8 plementing schoolwide educational pro- 9 gramming outside of class that delivers ele- 10 ments of comprehensive sex education pro- 11 grams to students, faculty, and staff. 12 (iii) Developing or adopting innovative 13 technology-based approaches to deliver sex 14 education to students, faculty, and staff. 15 (iv) Developing or adopting, and im- 16 plementing peer-outreach and education 17 programs to generate discussion, educate, 18 and raise awareness among students about 19 issues relating to comprehensive sex edu- 20 cation. 21 (B) CONTENTS OF SEX EDUCATION PRO- 22 GRAMS.—Each institution of higher education’s 23 program of comprehensive sex education funded 24 under this section shall include instruction and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00398 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 399 •HR 5942 IH materials that address the requirements under 1 paragraph 6. 2 (d) GRANTS FOR PRE-SERVICE AND IN-SERVICE 3 TEACHER TRAINING.— 4 (1) PROGRAM AUTHORIZED.—The Secretary, in 5 coordination with the Director of the Centers for 6 Disease Control and Prevention and the Secretary of 7 Education, shall award grants, on a competitive 8 basis, to eligible entities to enable such eligible enti- 9 ties to carry out the activities described in para- 10 graph (5). 11 (2) DURATION.—Grants awarded under this 12 section shall be for a period of 5 years. 13 (3) ELIGIBLE ENTITY.—In this section, the 14 term ‘‘eligible entity’’ means— 15 (A) a State educational agency, as defined 16 in section 8101 of the Elementary and Sec- 17 ondary Education of 1965 (20 U.S.C. 7801); 18 (B) a local educational agency, as defined 19 in section 8101 of the Elementary and Sec- 20 ondary Education of 1965 (20 U.S.C. 7801); 21 (C) a Tribe or Tribal organization, as de- 22 fined in section 4 of the Indian Self-Determina- 23 tion and Education Assistance Act (25 U.S.C. 24 5304); 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00399 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 400 •HR 5942 IH (D) a State or local department of health; 1 (E) a State or local department of edu- 2 cation; 3 (F) an educational service agency, as de- 4 fined in section 8101 of the Elementary and 5 Secondary Education of 1965 (20 U.S.C. 6 7801); 7 (G) a nonprofit institution of higher edu- 8 cation, as defined in section 101 of the Higher 9 Education Act of 1965 (20 U.S.C. 1001); 10 (H) a national or statewide nonprofit orga- 11 nization that has as its primary purpose the im- 12 provement of provision of comprehensive sex 13 education through training and effective teach- 14 ing of comprehensive sex education; or 15 (I) a consortium of nonprofit organizations 16 that has as its primary purpose the improve- 17 ment of provision of comprehensive sex edu- 18 cation through training and effective teaching 19 of comprehensive sex education. 20 (4) APPLICATION.—An eligible entity desiring a 21 grant under this section shall submit an application 22 to the Secretary at such time, in such manner, and 23 containing such information as the Secretary may 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00400 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 401 •HR 5942 IH require, including an assurance to participate in the 1 evaluation described in subsection (e). 2 (5) AUTHORIZED ACTIVITIES.— 3 (A) REQUIRED ACTIVITY.—Each eligible 4 entity receiving a grant under this section shall 5 use grant funds for professional development 6 and training of relevant faculty, school adminis- 7 trators, teachers, and staff, in order to increase 8 effective teaching of comprehensive sex edu- 9 cation students. 10 (B) PERMISSIBLE ACTIVITIES.—Each eligi- 11 ble entity receiving a grant under this section 12 may use grant funds to— 13 (i) provide research-based training of 14 teachers for comprehensive sex education 15 for adolescents as a means of broadening 16 student knowledge about issues related to 17 human development, healthy relationships, 18 personal skills, and sexual behavior, includ- 19 ing abstinence, sexual health, and society 20 and culture; 21 (ii) support the dissemination of infor- 22 mation on effective practices and research 23 findings concerning the teaching of com- 24 prehensive sex education; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00401 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 402 •HR 5942 IH (iii) support research on— 1 (I) effective comprehensive sex 2 education teaching practices; and 3 (II) the development of assess- 4 ment instruments and strategies to 5 document— 6 (aa) student understanding 7 of comprehensive sex education; 8 and 9 (bb) the effects of com- 10 prehensive sex education; 11 (iv) convene national conferences on 12 comprehensive sex education, in order to 13 effectively train teachers in the provision of 14 comprehensive sex education; and 15 (v) develop and disseminate appro- 16 priate research-based materials to foster 17 comprehensive sex education. 18 (C) SUBGRANTS.—Each eligible entity re- 19 ceiving a grant under this section may award 20 subgrants to nonprofit organizations that pos- 21 sess a demonstrated record of providing train- 22 ing to faculty, school administrators, teachers, 23 and staff on comprehensive sex education to— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00402 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 403 •HR 5942 IH (i) train teachers in comprehensive 1 sex education; 2 (ii) support Internet or distance learn- 3 ing related to comprehensive sex education; 4 (iii) promote rigorous academic stand- 5 ards and assessment techniques to guide 6 and measure student performance in com- 7 prehensive sex education; 8 (iv) encourage replication of best 9 practices and model programs to promote 10 comprehensive sex education; 11 (v) develop and disseminate effective, 12 research-based comprehensive sex edu- 13 cation learning materials; 14 (vi) develop academic courses on the 15 pedagogy of sex education at institutions 16 of higher education; or 17 (vii) convene State-based conferences 18 to train teachers in comprehensive sex edu- 19 cation and to identify strategies for im- 20 provement. 21 (e) IMPACT EVALUATION AND REPORTING.— 22 (1) MULTI-YEAR EVALUATION.— 23 (A) IN GENERAL.—Not later than 6 24 months after the date of the enactment of this 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00403 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 404 •HR 5942 IH Act, the Secretary shall enter into a contract 1 with a nonprofit organization with experience in 2 conducting impact evaluations, to conduct a 3 multi-year evaluation on the impact of the 4 grants under subsections (b), (c), and (d), and 5 to report to Congress and the Secretary on the 6 findings of such evaluation. 7 (B) EVALUATION.—The evaluation con- 8 ducted under this subsection shall— 9 (i) be conducted in a manner con- 10 sistent with relevant, nationally recognized 11 professional and technical evaluation 12 standards; 13 (ii) use sound statistical methods and 14 techniques relating to the behavioral 15 sciences, including quasi-experimental de- 16 signs, inferential statistics, and other 17 methodologies and techniques that allow 18 for conclusions to be reached; 19 (iii) be carried out by an independent 20 organization that has not received a grant 21 under subsection (b), (c), or (d); and 22 (iv) be designed to provide informa- 23 tion on— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00404 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 405 •HR 5942 IH (I) output measures, such as the 1 number of individuals served under 2 the grant and the number of hours of 3 instruction; 4 (II) outcome measures, including 5 measures relating to— 6 (aa) the knowledge that in- 7 dividuals participating in the 8 grant program have gained in 9 each of the following age and de- 10 velopmentally appropriate 11 areas— 12 (AA) growth and devel- 13 opment; 14 (BB) relationship dy- 15 namics; 16 (CC) ways to prevent 17 unintended pregnancy and 18 sexually transmitted infec- 19 tions, including HIV; and 20 (DD) sexual health; 21 (bb) the age and develop- 22 mentally appropriate skills that 23 individuals participating in the 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00405 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 406 •HR 5942 IH grant program have gained re- 1 garding— 2 (AA) negotiation and 3 communication; 4 (BB) decisionmaking 5 and goal-setting; 6 (CC) interpersonal 7 skills and healthy relation- 8 ships; and 9 (DD) condom use; and 10 (cc) the behaviors of adoles- 11 cents participating in the grant 12 program, including data about— 13 (AA) age of first inter- 14 course; 15 (BB) condom and con- 16 traceptive use at first inter- 17 course; 18 (CC) recent condom 19 and contraceptive use; 20 (DD) substance use; 21 (EE) dating abuse and 22 lifetime history of sexual as- 23 sault, dating violence, bul- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00406 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 407 •HR 5942 IH lying, harassment, stalking; 1 and 2 (FF) academic per- 3 formance; and 4 (III) other measures necessary to 5 evaluate the impact of the grant pro- 6 gram. 7 (C) REPORT.—Not later than 6 years after 8 the date of enactment of this Act, the organiza- 9 tion conducting the evaluation under this sub- 10 section shall prepare and submit to the appro- 11 priate committees of Congress and the Sec- 12 retary an evaluation report. Such report shall 13 be made publicly available, including on the 14 website of the Department of Health and 15 Human Services. 16 (2) SECRETARY’S REPORT TO CONGRESS.—Not 17 later than 1 year after the date of the enactment of 18 this Act, and annually thereafter for a period of 5 19 years, the Secretary shall prepare and submit to the 20 appropriate committees of Congress a report on the 21 activities to provide adolescents and young people 22 with comprehensive sex education and pre-service 23 and in-service teacher training funded under this 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00407 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 408 •HR 5942 IH Act. The Secretary’s report to Congress shall in- 1 clude— 2 (A) a statement of how grants awarded by 3 the Secretary meet the purposes described in 4 subsection (a)(1); and 5 (B) information about— 6 (i) the number of eligible entities and 7 institutions of higher education that are 8 receiving grant funds under subsections 9 (b), (c), and (d); 10 (ii) the specific activities supported by 11 grant funds awarded under subsections 12 (b), (c), and (d); 13 (iii) the number of adolescents served 14 by grant programs funded under sub- 15 section (b); 16 (iv) the number of young people 17 served by grant programs funded under 18 subsection (c); 19 (v) the number of faculty, school ad- 20 ministrators, teachers, and staff trained 21 under subsection (d); and 22 (vi) the status of the evaluation re- 23 quired under paragraph (1). 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00408 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 409 •HR 5942 IH (f) NONDISCRIMINATION.—Programs funded under 1 this Act shall not discriminate on the basis of actual or 2 perceived sex, race, color, ethnicity, national origin, dis- 3 ability, sexual orientation, gender identity, or religion. 4 Nothing in this Act shall be construed to invalidate or 5 limit rights, remedies, procedures, or legal standards avail- 6 able under any other Federal law or any law of a State 7 or a political subdivision of a State, including the Civil 8 Rights Act of 1964 (42 U.S.C. 2000a et seq.), title IX 9 of the Education Amendments of 1972 (20 U.S.C. 1681 10 et seq.), section 504 of the Rehabilitation Act of 1973 (29 11 U.S.C. 794), the Americans with Disabilities Act of 1990 12 (42 U.S.C. 12101 et seq.), and section 1557 of the Patient 13 Protection and Affordable Care Act (42 U.S.C. 18116). 14 (g) LIMITATION.—No Federal funds provided under 15 this Act may be used for health education programs 16 that— 17 (1) withhold health-promoting or life-saving in- 18 formation about sexuality-related topics, including 19 HIV; 20 (2) are medically inaccurate or have been sci- 21 entifically shown to be ineffective; 22 (3) promote gender or racial stereotypes; 23 (4) are insensitive and unresponsive to the 24 needs of sexually active young people; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00409 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 410 •HR 5942 IH (5) are insensitive and unresponsive to the 1 needs of pregnant or parenting young people; 2 (6) are insensitive and unresponsive to the 3 needs of survivors of sexual abuse or assault; 4 (7) are insensitive and unresponsive to the 5 needs of youth of all physical, developmental, or 6 mental abilities; 7 (8) are insensitive and unresponsive to individ- 8 uals with varying gender identities, gender expres- 9 sions, and sexual orientations; or 10 (9) are inconsistent with the ethical imperatives 11 of medicine and public health. 12 (h) AMENDMENTS TO OTHER LAWS.— 13 (1) AMENDMENT TO THE PUBLIC HEALTH 14 SERVICE ACT.—Section 2500 of the Public Health 15 Service Act (42 U.S.C. 300ee) is amended by strik- 16 ing subsections (b) through (d) and inserting the fol- 17 lowing: 18 ‘‘(b) CONTENTS OF PROGRAMS.—All programs of 19 education and information receiving funds under this sub- 20 chapter shall include information about the potential ef- 21 fects of intravenous substance abuse.’’. 22 (2) AMENDMENTS TO THE ELEMENTARY AND 23 SECONDARY EDUCATION ACT OF 1965.—Section 8526 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00410 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 411 •HR 5942 IH of the Elementary and Secondary Education Act of 1 (20 U.S.C. 7906) is amended— 2 (A) by striking paragraph (3); 3 (B) by redesignating paragraphs (4) and 4 (5) as paragraphs (3) and (4), respectively; 5 (C) in paragraph (4), by inserting ‘‘or’’ 6 after the semicolon; 7 (D) in paragraph (5), by striking ‘‘; or’’ 8 and inserting a period; and 9 (E) by striking paragraph (6). 10 (i) DEFINITIONS.—In this section: 11 (1) ADOLESCENTS.—The term ‘‘adolescents’’ 12 means individuals who are ages 10 through 19 at 13 the time of commencement of participation in a pro- 14 gram supported under this section. 15 (2) AGE AND DEVELOPMENTALLY APPRO- 16 PRIATE.—The term ‘‘age and developmentally appro- 17 priate’’ means topics, messages, and teaching meth- 18 ods suitable to particular age, age group of children 19 and adolescents, or developmental levels, based on 20 cognitive, emotional, social, and behavioral capacity 21 of most students at that age level. 22 (3) APPROPRIATE COMMITTEES OF CON- 23 GRESS.—The term ‘‘appropriate committees of Con- 24 gress’’ means the Committee on Health, Education, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00411 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 412 •HR 5942 IH Labor, and Pensions of the Senate, the Committee 1 on Appropriations of the Senate, the Committee on 2 Energy and Commerce of the House of Representa- 3 tives, the Committee on Education and the Work- 4 force of the House of Representatives, and the Com- 5 mittee on Appropriations of the House of Represent- 6 atives. 7 (4) CHARACTERISTICS OF EFFECTIVE PRO- 8 GRAMS.—The term ‘‘characteristics of effective pro- 9 grams’’ means the aspects of evidence-based pro- 10 grams, including development, content, and imple- 11 mentation of such programs, that— 12 (A) have been shown to be effective in 13 terms of increasing knowledge, clarifying values 14 and attitudes, increasing skills, and impacting 15 upon behavior; and 16 (B) are widely recognized by leading med- 17 ical and public health agencies to be effective in 18 changing sexual behaviors that lead to sexually 19 transmitted infections, including HIV, unin- 20 tended pregnancy, and dating violence and sex- 21 ual assault among young people. 22 (5) COMPREHENSIVE SEX EDUCATION.—The 23 term ‘‘comprehensive sex education’’ means instruc- 24 tional part of a comprehensive school health edu- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00412 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 413 •HR 5942 IH cation approach which addresses the physical, men- 1 tal, emotional, and social dimensions of human sexu- 2 ality; designed to motivate and assist students to 3 maintain and improve their sexual health, prevent 4 disease and reduce sexual health-related risk behav- 5 iors; and enable and empower students to develop 6 and demonstrate age and developmentally appro- 7 priate sexuality and sexual health-related knowledge, 8 attitudes, skills, and practices. 9 (6) CONSENT.—The term ‘‘consent’’ means af- 10 firmative, conscious, and voluntary agreement to en- 11 gage in interpersonal, physical, or sexual activity. 12 (7) CULTURALLY APPROPRIATE.—The term 13 ‘‘culturally appropriate’’ means materials and in- 14 struction that respond to culturally diverse individ- 15 uals, families and communities in an inclusive, re- 16 spectful and effective manner; including materials 17 and instruction that are inclusive of race, ethnicity, 18 languages, cultural background, religion, sex, gender 19 identity, sexual orientation, and different abilities. 20 (8) EVIDENCE-BASED.—The term ‘‘evidence- 21 based’’, when used with respect to sex education in- 22 struction means a sex education program that has 23 been proven through rigorous evaluation to be effec- 24 tive in changing sexual behavior or incorporates ele- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00413 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 414 •HR 5942 IH ments of other programs that have been proven to 1 be effective in changing sexual behavior. 2 (9) GENDER EXPRESSION.—The term ‘‘gender 3 expression’’, when used with respect to a sex edu- 4 cation program, means the expression of one’s gen- 5 der, such as through behavior, clothing, haircut, or 6 voice, and which may or may not conform to socially 7 defined behaviors and characteristics typically asso- 8 ciated with being either masculine or feminine. 9 (10) GENDER IDENTITY.—Except with respect 10 to section 7, the term ‘‘gender identity’’, when used 11 with respect to a sex education program, means the 12 gender-related identity, appearance, mannerisms, or 13 other gender-related characteristics of an individual, 14 regardless of the individual’s designated sex at birth 15 including a person’s deeply held sense or knowledge 16 of their own gender; such as male, female, both or 17 neither. 18 (11) INCLUSIVE.—The term ‘‘inclusive’’, when 19 used with respect to a sex education program, means 20 curriculum that ensures that students from histori- 21 cally marginalized communities are reflected in 22 classroom materials and lessons. 23 (12) INSTITUTION OF HIGHER EDUCATION.— 24 The term ‘‘institution of higher education’’ has the 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00414 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 415 •HR 5942 IH meaning given the term in section 101 of the Higher 1 Education Act of 1965 (20 U.S.C. 1001). 2 (13) MEDICALLY ACCURATE AND COMPLETE.— 3 The term ‘‘medically accurate and complete’’, when 4 used with respect to a sex education program, means 5 that— 6 (A) the information provided through the 7 program is verified or supported by the weight 8 of research conducted in compliance with ac- 9 cepted scientific methods and is published in 10 peer-reviewed journals, where applicable; or 11 (B)(i) the program contains information 12 that leading professional organizations and 13 agencies with relevant expertise in the field rec- 14 ognize as accurate, objective, and complete; and 15 (ii) the program does not withhold infor- 16 mation about the effectiveness and benefits of 17 correct and consistent use of condoms and 18 other contraceptives. 19 (14) SECRETARY.—The term ‘‘Secretary’’ 20 means the Secretary of Health and Human Services. 21 (15) SEXUAL DEVELOPMENT.—The term ‘‘sex- 22 ual development’’ means the lifelong process of phys- 23 ical, behavioral, cognitive, and emotional growth and 24 change as it relates to an individual’s sexuality and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00415 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 416 •HR 5942 IH sexual maturation, including puberty, identity devel- 1 opment, socio-cultural influences, and sexual behav- 2 iors. 3 (16) SEXUAL ORIENTATION.—Except with re- 4 spect to subsection (g), the term ‘‘sexual orienta- 5 tion’’, when used with respect to a sex education 6 program, means an individual’s attraction, including 7 physical or emotional, to the same or different gen- 8 der. 9 (17) YOUNG PEOPLE.—The term ‘‘young peo- 10 ple’’ means individuals who are ages 10 through 24 11 at the time of commencement of participation in a 12 program supported under this Act. 13 (j) FUNDING.— 14 (1) APPROPRIATION.—For the purpose of car- 15 rying out this Act, there is appropriated 16 $75,000,000 for each of fiscal years 2019 through 17 2024. Amounts appropriated under this subsection 18 shall remain available until expended. 19 (2) RESERVATIONS OF FUNDS.— 20 (A) The Secretary shall reserve 50 percent 21 of the amount appropriated under paragraph 22 (1) for the purposes of awarding grants for 23 comprehensive sex education for adolescents 24 under subsection (c). 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00416 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 417 •HR 5942 IH (B) The Secretary shall reserve 25 percent 1 of the amount appropriated under paragraph 2 (1) for the purposes of awarding grants for 3 comprehensive sex education at institutes of 4 higher education under subsection (d). 5 (C) The Secretary shall reserve 20 percent 6 of the amount appropriated under paragraph 7 (1) for the purposes of awarding grants for pre- 8 service and in-service teacher training under 9 subsection (e). 10 (D) The Secretary shall reserve 2 percent 11 of the amount appropriated under paragraph 12 (1) for the purpose of carrying out the impact 13 evaluation and reporting required under sub- 14 section (a). 15 (3) SECRETARIAL RESPONSIBILITIES.—The 16 Secretary shall reserve 3 percent of the amount ap- 17 propriated under subsection (a) for each fiscal year 18 for expenditures by the Secretary to provide, directly 19 or through a competitive grant process, research, 20 training, and technical assistance, including dissemi- 21 nation of research and information regarding effec- 22 tive and promising practices, providing consultation 23 and resources, and developing resources and mate- 24 rials to support the activities of recipients of grants. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00417 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 418 •HR 5942 IH In carrying out such functions, the Secretary shall 1 collaborate with a variety of entities that have exper- 2 tise in adolescent sexual health development, edu- 3 cation, and promotion. 4 (4) REPROGRAMMING OF ABSTINENCE ONLY 5 UNTIL MARRIAGE PROGRAM FUNDING.—The unobli- 6 gated balance of funds made available to carry out 7 section 510 of the Social Security Act (42 U.S.C. 8 710) (as in effect on the day before the date of en- 9 actment of this Act) are hereby transferred and shall 10 be used by the Secretary to carry out this Act. The 11 amounts transferred and made available to carry out 12 this Act shall remain available until expended. 13 (5) REPEAL OF ABSTINENCE ONLY UNTIL MAR- 14 RIAGE PROGRAM.—Section 510 of the Social Secu- 15 rity Act (42 U.S.C. 710 et seq.) is repealed. 16 SEC. 512. COMPASSIONATE ASSISTANCE FOR RAPE EMER- 17 GENCIES. 18 (a) MEDICARE.— 19 (1) LIMITATION ON PAYMENT.—Section 20 1866(a)(1) of the Social Security Act (42 U.S.C. 21 1395cc(a)(1)) is amended— 22 (A) in the subparagraph (W) added by sec- 23 tion 3005(1)(C) of Public Law 111–148— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00418 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 419 •HR 5942 IH (i) by striking the period at the end 1 and inserting a comma; 2 (ii) by moving the indentation 2 ems 3 to the left; and 4 (iii) by moving such subparagraph to 5 immediately follow subparagraph (V); 6 (B) in the subparagraph (W) added by sec- 7 tion 6406(b)(3) of Public Law 111–148— 8 (i) by striking the period at the end 9 and inserting ‘‘, and’’; 10 (ii) by moving the indentation 2 ems 11 to the left; 12 (iii) by redesignating such subpara- 13 graph as subparagraph (X); and 14 (iv) by moving such subparagraph to 15 immediately follow subparagraph (W), as 16 moved under paragraph (2)(C); and 17 (C) by inserting after the subparagraph 18 (X), as redesignated and moved under para- 19 graph (3), the following: 20 ‘‘(Y) in the case of a hospital or critical ac- 21 cess hospital, to adopt and enforce a policy to 22 ensure compliance with the requirements of 23 subsection (l) and to meet the requirements of 24 such subsection.’’. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00419 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 420 •HR 5942 IH (2) ASSISTANCE TO VICTIMS.—Section 1866 of 1 the Social Security Act (42 U.S.C. 1395cc) is 2 amended by adding at the end the following new 3 subsection: 4 ‘‘(l) COMPASSIONATE ASSISTANCE FOR RAPE EMER- 5 GENCIES.— 6 ‘‘(1) IN GENERAL.—For purposes of section 7 1866(a)(1)(Y), a hospital meets the requirements of 8 this subsection if the hospital provides each of the 9 services described in paragraph (2) to each indi- 10 vidual, whether or not eligible for benefits under this 11 title or under any other form of health insurance. 12 who comes to the hospital on or after January 1, 13 2019, and— 14 ‘‘(A) who states to hospital personnel that 15 they are victims of sexual assault; 16 ‘‘(B) who is accompanied by an individual 17 who states to hospital personnel that the indi- 18 vidual is a victim of sexual assault; or 19 ‘‘(C) whom hospital personnel, during the 20 course of treatment and care for the individual, 21 have reason to believe is a victim of sexual as- 22 sault. 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00420 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 421 •HR 5942 IH ‘‘(2) REQUIRED SERVICES DESCRIBED.—For 1 purposes of paragraph (1), the services described in 2 this subparagraph are the following: 3 ‘‘(A) Provision of medically and factually 4 accurate and unbiased written and oral infor- 5 mation about emergency contraception that— 6 ‘‘(i) is written in clear and concise 7 language; 8 ‘‘(ii) is readily comprehensible; 9 ‘‘(iii) includes an explanation that— 10 ‘‘(I) emergency contraception has 11 been approved by the Food and Drug 12 Administration as an over-the-counter 13 or prescription medication for individ- 14 uals, and is a safe and effective way 15 to prevent pregnancy after unpro- 16 tected intercourse or contraceptive 17 failure if taken in a timely manner; 18 ‘‘(II) emergency contraception is 19 more effective the sooner it is taken; 20 and 21 ‘‘(III) emergency contraception 22 does not cause an abortion and cannot 23 interrupt an established pregnancy; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00421 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 422 •HR 5942 IH ‘‘(iv) meets such conditions regarding 1 the provision of such information in lan- 2 guages other than English as the Secretary 3 may establish; and 4 ‘‘(v) is provided without regard to the 5 ability of the individual or their family to 6 pay costs associated with the provision of 7 such information to the individual. 8 ‘‘(B) Immediate offer to provide emergency 9 contraception to the individual at the hospital 10 and, in the case that the individual accepts such 11 offer, immediate provision to the individual of 12 such contraception on the same day it is re- 13 quested without regard to the inability of the 14 individual or their family to pay costs associ- 15 ated with the offer and provision of such con- 16 traception. 17 ‘‘(C) Development and implementation of a 18 written policy to ensure that an individual is 19 present at the hospital, or on-call, who— 20 ‘‘(i) has authority to dispense or pre- 21 scribe emergency contraception, independ- 22 ently, or under a protocol prepared by a 23 physician for the administration of emer- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00422 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 423 •HR 5942 IH gency contraception at the hospital to a 1 victim of sexual assault; and 2 ‘‘(ii) is trained to comply with the re- 3 quirements of this section. 4 ‘‘(D) Provision of medically and factually 5 accurate and unbiased written and oral infor- 6 mation and counseling about post-exposure pro- 7 phylaxis (PEP) protocol for the prevention of 8 HIV. 9 ‘‘(E) Immediately offer to begin PEP to 10 the individual at the hospital except in cases 11 where the medical professional’s best judgement 12 is that further evaluation is required or that 13 such a regimen will be substantially detrimental 14 to the individual’s health. Such provision shall 15 be offered regardless of the individual’s ability 16 to pay. Hospitals shall be responsible for ensur- 17 ing adequate supply of PEP medications to pro- 18 vide to patients. 19 ‘‘(3) DEFINITIONS.—For purposes of this para- 20 graph: 21 ‘‘(A) The term ‘emergency contraception’ 22 means a drug or device (as such terms are de- 23 fined in section 201 of the Federal Food, Drug, 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00423 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 424 •HR 5942 IH and Cosmetic Act (21 U.S.C. 321)) or a drug 1 regimen that— 2 ‘‘(i) is used postcoitally; 3 ‘‘(ii) prevents pregnancy primarily by 4 preventing or delaying ovulation, and does 5 not terminate an established pregnancy; 6 and 7 ‘‘(iii) is approved by the Food and 8 Drug Administration. 9 ‘‘(B) The term ‘hospital’ includes a critical 10 access hospital, as defined in section 11 1861(mm)(1). 12 ‘‘(C) The term ‘sexual assault’ means co- 13 itus in which the individual involved does not 14 consent or lacks the legal capacity to consent.’’. 15 (b) LIMITATION ON PAYMENT UNDER MEDICAID.— 16 Section 1903(i) of the Social Security Act (42 U.S.C. 17 1396b(i)) is amended by inserting after paragraph (11) 18 the following new paragraph: 19 ‘‘(12) with respect to any amount expended for 20 care or services furnished under the plan by a hos- 21 pital on or after January 1, 2017, unless such hos- 22 pital meets the requirements specified in section 23 1866(l) for purposes of title XVIII.’’. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00424 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 425 •HR 5942 IH SEC. 513. ACCESS TO BIRTH CONTROL DUTIES OF PHAR- 1 MACIES TO ENSURE PROVISION OF FDA-AP- 2 PROVED CONTRACEPTION. 3 Part B of title II of the Public Health Service Act 4 (42 U.S.C. 238 et seq.) is amended by adding at the end 5 the following: 6 ‘‘SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION 7 OF FDA-APPROVED CONTRACEPTION. 8 ‘‘(a) IN GENERAL.—Subject to subsection (c), a 9 pharmacy that receives Food and Drug Administration- 10 approved drugs or devices in interstate commerce shall 11 maintain compliance with the following: 12 ‘‘(1) If a customer requests a contraceptive, in- 13 cluding emergency contraception, that is in stock, 14 the pharmacy shall ensure that the contraceptive is 15 provided to the customer— 16 ‘‘(A) without delay; 17 ‘‘(B) without regard to the customer’s age, 18 gender, gender identity, or sexual orientation; 19 ‘‘(C) without a requirement that identifica- 20 tion be presented; and 21 ‘‘(D) despite any conflicts of employees to 22 filling a prescription and dispensing a par- 23 ticular prescription drug or device due to sin- 24 cerely held moral, philosophical, or religious be- 25 liefs. 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00425 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 426 •HR 5942 IH ‘‘(2) If a customer requests a contraceptive that 1 is not in stock and the pharmacy in the normal 2 course of business stocks contraception, the phar- 3 macy shall immediately inform the customer that the 4 contraceptive is not in stock and without delay offer 5 the customer the following options: 6 ‘‘(A) If the customer prefers to obtain the 7 contraceptive through a referral or transfer, the 8 pharmacy shall— 9 ‘‘(i) locate a pharmacy of the cus- 10 tomer’s choice or the closest pharmacy 11 confirmed to have the contraceptive in 12 stock; and 13 ‘‘(ii) refer the customer or transfer 14 the prescription to that pharmacy. 15 ‘‘(B) If the customer prefers for the phar- 16 macy to order the contraceptive, the pharmacy 17 shall obtain the contraceptive under the phar- 18 macy’s standard procedure for expedited order- 19 ing of medication and notify the customer when 20 the contraceptive arrives. 21 ‘‘(3) The pharmacy shall ensure that its em- 22 ployees do not— 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00426 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 427 •HR 5942 IH ‘‘(A) intimidate, threaten, or harass cus- 1 tomers in the delivery of services relating to a 2 request for contraception; 3 ‘‘(B) interfere with or obstruct the delivery 4 of services relating to a request for contracep- 5 tion; 6 ‘‘(C) intentionally misrepresent or deceive 7 customers about the availability of contracep- 8 tion or its mechanism of action; 9 ‘‘(D) breach medical confidentiality with 10 respect to a request for contraception or threat- 11 en to breach such confidentiality; or 12 ‘‘(E) refuse to return a valid, lawful pre- 13 scription for contraception upon customer re- 14 quest. 15 ‘‘(b) CONTRACEPTIVES NOT ORDINARILY 16 STOCKED.—Nothing in subsection (a)(2) shall be con- 17 strued to require any pharmacy to comply with such sub- 18 section if the pharmacy does not ordinarily stock contra- 19 ceptives in the normal course of business. 20 ‘‘(c) REFUSALS PURSUANT TO STANDARD PHAR- 21 MACY PRACTICE.—This section does not prohibit a phar- 22 macy from refusing to provide a contraceptive to a cus- 23 tomer in accordance with any of the following: 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00427 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 428 •HR 5942 IH ‘‘(1) If it is unlawful to dispense the contracep- 1 tive to the customer without a valid, lawful prescrip- 2 tion and no such prescription is presented. 3 ‘‘(2) If the customer is unable to pay for the 4 contraceptive. 5 ‘‘(3) If the employee of the pharmacy refuses to 6 provide the contraceptive on the basis of a profes- 7 sional clinical judgment. 8 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec- 9 tion shall be construed to invalidate or limit rights, rem- 10 edies, procedures, or legal standards under title VII of the 11 Civil Rights Act of 1964. 12 ‘‘(e) PREEMPTION.—This section does not preempt 13 any provision of State law or any professional obligation 14 made applicable by a State board or other entity respon- 15 sible for licensing or discipline of pharmacies or phar- 16 macists, to the extent that such State law or professional 17 obligation provides protections for customers that are 18 greater than the protections provided by this section. 19 ‘‘(f) ENFORCEMENT.— 20 ‘‘(1) CIVIL PENALTY.—A pharmacy that vio- 21 lates a requirement of subsection (a) is liable to the 22 United States for a civil penalty in an amount not 23 exceeding $1,000 per day of violation, not to exceed 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00428 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 429 •HR 5942 IH $100,000 for all violations adjudicated in a single 1 proceeding. 2 ‘‘(2) PRIVATE CAUSE OF ACTION.—Any person 3 aggrieved as a result of a violation of a requirement 4 of subsection (a) may, in any court of competent ju- 5 risdiction, commence a civil action against the phar- 6 macy involved to obtain appropriate relief, including 7 actual and punitive damages, injunctive relief, and a 8 reasonable attorney’s fee and cost. 9 ‘‘(3) LIMITATIONS.—A civil action under para- 10 graph (1) or (2) may not be commenced against a 11 pharmacy after the expiration of the 5-year period 12 beginning on the date on which the pharmacy alleg- 13 edly engaged in the violation involved. 14 ‘‘(g) DEFINITIONS.—In this section: 15 ‘‘(1) The term ‘contraception’ or ‘contraceptive’ 16 means any drug or device approved by the Food and 17 Drug Administration to prevent pregnancy. 18 ‘‘(2) The term ‘employee’ means a person hired, 19 by contract or any other form of an agreement, by 20 a pharmacy. 21 ‘‘(3) The term ‘pharmacy’ means an entity 22 that— 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00429 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 430 •HR 5942 IH ‘‘(A) is authorized by a State to engage in 1 the business of selling prescription drugs at re- 2 tail; and 3 ‘‘(B) employs one or more employees. 4 ‘‘(4) The term ‘product’ means a Food and 5 Drug Administration-approved drug or device. 6 ‘‘(5) The term ‘professional clinical judgment’ 7 means the use of professional knowledge and skills 8 to form a clinical judgment, in accordance with pre- 9 vailing medical standards. 10 ‘‘(6) The term ‘without delay’, with respect to 11 a pharmacy providing, providing a referral for, or 12 ordering contraception, or transferring the prescrip- 13 tion for contraception, means within the usual and 14 customary timeframe at the pharmacy for providing, 15 providing a referral for, or ordering other products, 16 or transferring the prescription for other products, 17 respectively. 18 ‘‘(h) EFFECTIVE DATE.—This section shall take ef- 19 fect on the 31st day after the date of the enactment of 20 this section, without regard to whether the Secretary has 21 issued any guidance or final rule regarding this section.’’. 22 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00430 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 431 •HR 5942 IH SEC. 514. ADDITIONAL FOCUS AREA FOR THE OFFICE ON 1 WOMEN’S HEALTH. 2 Section 229(b) of the Public Health Service Act (42 3 U.S.C. 237a(b)) is amended— 4 (1) in paragraph (6), at the end, by striking 5 ‘‘and’’; 6 (2) in paragraph (7), at the end, by striking the 7 period and inserting a semicolon; and 8 (3) by adding at the end the following new 9 paragraph: 10 ‘‘(8) facilitate policymakers, health system lead- 11 ers and providers, consumers, and other stake- 12 holders in understanding optimal maternity care and 13 support for the provision of such care, including the 14 priorities of— 15 ‘‘(A) protecting, promoting, and supporting 16 the innate capacities of childbearing individuals 17 and their newborns for childbirth, 18 breastfeeding, and attachment; 19 ‘‘(B) using obstetric interventions only 20 when such interventions are supported by 21 strong, high-quality evidence, and minimizing 22 overuse of maternity practices that have been 23 shown to have benefit in limited situations and 24 that can expose women, infants, or both to risk 25 of harm if used routinely and indiscriminately, 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00431 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 432 •HR 5942 IH including continuous electronic fetal monitoring, 1 labor induction, epidural analgesia, primary ce- 2 sarean section, and routine repeat cesarean 3 birth; 4 ‘‘(C) reliably incorporating noninvasive, 5 evidence-based practices that have documented 6 correlation with considerable improvement in 7 outcomes with no detrimental side effects, such 8 as smoking cessation programs in pregnancy 9 and proven models of group prenatal care that 10 integrate health assessment, education, and 11 support into a unified program and supporting 12 evidence-based breastfeeding promotion efforts 13 with respect for a breastfeeding individual’s 14 personal decisionmaking; 15 ‘‘(D) a shared understanding of the quali- 16 fications of licensed providers of maternity care 17 and the best evidence about the safety, satisfac- 18 tion, outcomes, and costs of their care, and ap- 19 propriate deployment of such caregivers within 20 the maternity care workforce to address the 21 needs of childbearing individuals and newborns 22 and the growing shortage of maternity care- 23 givers; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00432 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 433 •HR 5942 IH ‘‘(E) a shared understanding of the results 1 of the best available research comparing hos- 2 pital, birth center, and planned home births, in- 3 cluding information about each setting’s safety, 4 satisfaction, outcomes, and costs; and 5 ‘‘(F) high-quality, evidence-based child- 6 birth education that promotes a natural, 7 healthy, and safe approach to pregnancy, child- 8 birth, and early parenting; is taught by certified 9 educators, peer counselors, and health profes- 10 sionals; and promotes informed decisionmaking 11 by childbearing individual;’’. 12 SEC. 515. INTERAGENCY COORDINATING COMMITTEE ON 13 THE PROMOTION OF OPTIMAL MATERNITY 14 OUTCOMES. 15 (a) IN GENERAL.—Part A of title II of the Public 16 Health Service Act (42 U.S.C. 202 et seq.) is amended 17 by adding at the end the following new section: 18 ‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 19 THE PROMOTION OF OPTIMAL MATERNITY 20 OUTCOMES. 21 ‘‘(a) IN GENERAL.—The Secretary of Health and 22 Human Services, acting through the Deputy Assistant 23 Secretary for Women’s Health under section 229 and in 24 collaboration with the Federal officials specified in sub- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00433 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 434 •HR 5942 IH section (b), shall establish the Interagency Coordinating 1 Committee on the Promotion of Optimal Maternity Out- 2 comes (referred to in this subsection as the ‘ICCPOM’). 3 ‘‘(b) OTHER AGENCIES.—The officials specified in 4 this subsection are the Secretary of Labor, the Secretary 5 of Defense, the Secretary of Veterans Affairs, the Surgeon 6 General, the Director of the Centers for Disease Control 7 and Prevention, the Administrator of the Health Re- 8 sources and Services Agency, the Administrator of the 9 Centers for Medicare & Medicaid Services, the Director 10 of the Indian Health Service, the Administrator of the 11 Substance Abuse and Mental Health Services Administra- 12 tion, the Director of the National Institute on Child 13 Health and Development, the Director of the Agency for 14 Healthcare Research and Quality, the Assistant Secretary 15 for Children and Families, the Deputy Assistant Secretary 16 for Minority Health, the Director of the Office of Per- 17 sonnel Management, and such other Federal officials as 18 the Secretary of Health and Human Services determines 19 to be appropriate. 20 ‘‘(c) CHAIR.—The Deputy Assistant Secretary for 21 Women’s Health shall serve as the chair of the ICCPOM. 22 ‘‘(d) DUTIES.—The ICCPOM shall guide policy and 23 program development across the Federal Government with 24 respect to promotion of optimal maternity care, provided, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00434 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 435 •HR 5942 IH however, that nothing in this section shall be construed 1 as transferring regulatory or program authority from an 2 agency to the ICCPOM. 3 ‘‘(e) CONSULTATIONS.—The ICCPOM shall actively 4 seek the input of, and shall consult with, all appropriate 5 and interested stakeholders, including State health depart- 6 ments, public health research and interest groups, founda- 7 tions, childbearing individuals and their advocates, and 8 maternity care professional associations and organiza- 9 tions, reflecting racially, ethnically, demographically, and 10 geographically diverse communities. 11 ‘‘(f) ANNUAL REPORT.— 12 ‘‘(1) IN GENERAL.—The Secretary, on behalf of 13 the ICCPOM, shall annually submit to Congress a 14 report that summarizes— 15 ‘‘(A) all programs and policies of Federal 16 agencies (including the Medicare Program 17 under title XVIII of the Social Security Act and 18 the Medicaid program under title XIX of such 19 Act) designed to promote optimal maternity 20 care, focusing particularly on programs and 21 policies that support the adoption of evidence 22 based maternity care, as defined by timely, sci- 23 entifically sound systematic reviews; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00435 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 436 •HR 5942 IH ‘‘(B) all programs and policies of Federal 1 agencies (including the Medicare Program 2 under title XVIII of the Social Security Act and 3 the Medicaid program under title XIX of such 4 Act) designed to address the problems of mater- 5 nal mortality and morbidity, infant mortality, 6 prematurity, and low birth weight, including 7 such programs and policies designed to address 8 racial and ethnic disparities with respect to 9 each of such problems; 10 ‘‘(C) the extent of progress in reducing 11 maternal mortality and infant mortality, low 12 birth weight, and prematurity at State and na- 13 tional levels; and 14 ‘‘(D) such other information regarding op- 15 timal maternity care as the Secretary deter- 16 mines to be appropriate. 17 The information specified in subparagraph (C) shall 18 be included in each such report in a manner that 19 disaggregates such information by race, ethnicity, 20 and indigenous status in order to determine the ex- 21 tent of progress in reducing racial and ethnic dis- 22 parities and disparities related to indigenous status. 23 ‘‘(2) CERTAIN INFORMATION.—Each report 24 under paragraph (1) shall include information 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00436 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 437 •HR 5942 IH (disaggregated by race, ethnicity, and indigenous 1 status, as applicable) on the following rates and 2 costs by State: 3 ‘‘(A) The rate of primary cesarean deliv- 4 eries and repeat cesarean deliveries. 5 ‘‘(B) The rate of vaginal births after cesar- 6 ean. 7 ‘‘(C) The rate of vaginal breech births. 8 ‘‘(D) The rate of induction of labor. 9 ‘‘(E) The rate of freestanding birth center 10 births. 11 ‘‘(F) The rate of planned and unplanned 12 home birth. 13 ‘‘(G) The rate of attended births by pro- 14 vider, including by an obstetrician-gynecologist, 15 family practice physician, obstetrician-gyne- 16 cologist physician assistant, certified nurse-mid- 17 wife, certified midwife, and certified profes- 18 sional midwife. 19 ‘‘(H) The cost of maternity care 20 disaggregated by place of birth and provider of 21 care, including— 22 ‘‘(i) uncomplicated vaginal birth; 23 ‘‘(ii) complicated vaginal birth; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00437 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 438 •HR 5942 IH ‘‘(iii) uncomplicated cesarean birth; 1 and 2 ‘‘(iv) complicated cesarean birth. 3 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 4 is authorized to be appropriated, in addition to amounts 5 authorized to be appropriated under section 229(e), to 6 carry out this section $1,000,000 for each of the fiscal 7 years 2019 through 2023.’’. 8 (b) CONFORMING AMENDMENTS.— 9 (1) INCLUSION AS DUTY OF HHS OFFICE ON 10 WOMEN’S HEALTH.—Section 229(b) of such Act (42 11 U.S.C. 237a(b)), as amended by section 514, is fur- 12 ther amended by adding at the end the following 13 new paragraph: 14 ‘‘(9) establish the Interagency Coordinating 15 Committee on the Promotion of Optimal Maternity 16 Outcomes in accordance with section 229A; and’’. 17 (2) TREATMENT OF BIENNIAL REPORTS.—Sec- 18 tion 229(d) of such Act (42 U.S.C. 237a(d)) is 19 amended by inserting ‘‘(other than under subsection 20 (b)(9))’’ after ‘‘under this section’’. 21 SEC. 516. CONSUMER EDUCATION CAMPAIGN. 22 Section 229(b) of the Public Health Service Act (42 23 U.S.C. 237a(b)), as amended, is further amended by add- 24 ing at the end the following new paragraph: 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00438 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 439 •HR 5942 IH ‘‘(10) not later than one year after the date of 1 the enactment of the Health Equity and Account- 2 ability Act of 2018, develop and implement a 4-year 3 culturally and linguistically appropriate multimedia 4 consumer education campaign that is designed to 5 promote understanding and acceptance of evidence- 6 based maternity practices and models of care for op- 7 timal maternity outcomes among individuals of 8 childbearing ages and families of such individuals 9 and that— 10 ‘‘(A) highlights the importance of pro- 11 tecting, promoting, and supporting the innate 12 capacities of childbearing individuals and their 13 newborns for childbirth, breastfeeding, and at- 14 tachment; 15 ‘‘(B) promotes understanding of the impor- 16 tance of using obstetric interventions when 17 medically necessary and when supported by 18 strong, high-quality evidence; 19 ‘‘(C) highlights the widespread overuse of 20 maternity practices that have been shown to 21 have benefit when used appropriately in situa- 22 tions of medical necessity, but which can expose 23 pregnant individuals, infants, or both to risk of 24 harm if used routinely and indiscriminately, in- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00439 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 440 •HR 5942 IH cluding continuous fetal monitoring, labor in- 1 duction, epidural anesthesia, elective primary 2 cesarean section, and repeat cesarean delivery; 3 ‘‘(D) emphasizes the noninvasive maternity 4 practices that have strong proven correlation or 5 may be associated with considerable improve- 6 ment in outcomes with no detrimental side ef- 7 fects, and are significantly underused in the 8 United States, including smoking cessation pro- 9 grams in pregnancy, group model prenatal care, 10 continuous labor support, nonsupine positions 11 for birth, and external version to turn breech 12 babies at term; 13 ‘‘(E) educates consumers about the quali- 14 fications of licensed providers of maternity care 15 and the best evidence about their safety, satis- 16 faction, outcomes, and costs; 17 ‘‘(F) informs consumers about the best 18 available research comparing birth center 19 births, planned home births, and hospital 20 births, including information about each set- 21 ting’s safety, satisfaction, outcomes, and costs; 22 ‘‘(G) fosters participation in high-quality, 23 evidence-based childbirth education that pro- 24 motes a natural, healthy, and safe approach to 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00440 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 441 •HR 5942 IH pregnancy, childbirth, and early parenting; is 1 taught by certified educators, peer counselors, 2 and health professionals; and promotes in- 3 formed decisionmaking by childbearing individ- 4 uals; and 5 ‘‘(H) is pilot tested for consumer com- 6 prehension, cultural sensitivity, and acceptance 7 of the messages across geographically, racially, 8 ethnically, and linguistically diverse popu- 9 lations.’’. 10 SEC. 517. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE- 11 VIEWS FOR CARE OF CHILDBEARING INDI- 12 VIDUALS AND NEWBORNS. 13 (a) IN GENERAL.—Not later than one year after the 14 date of the enactment of this Act, the Secretary of Health 15 and Human Services, through the Agency for Healthcare 16 Research and Quality, shall— 17 (1) make publicly available an online biblio- 18 graphic database identifying systematic reviews, in- 19 cluding an explanation of the level and quality of 20 evidence, for care of childbearing individuals and 21 newborns; and 22 (2) initiate regular updates that incorporate 23 newly issued and updated systematic reviews. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00441 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 442 •HR 5942 IH (b) SOURCES.—To aim for a comprehensive inventory 1 of systematic reviews relevant to maternal and newborn 2 care, the database shall identify reviews from diverse 3 sources, including— 4 (1) scientific peer-reviewed journals; 5 (2) databases, including Cochrane Database of 6 Systematic Reviews, Clinical Evidence, and Data- 7 base of Abstracts of Reviews of Effects; and 8 (3) Internet Web sites of agencies and organi- 9 zations throughout the world that produce such sys- 10 tematic reviews. 11 (c) FEATURES.—The database shall— 12 (1) provide bibliographic citations for each 13 record within the database, and for each such cita- 14 tion include an explanation of the level and quality 15 of evidence; 16 (2) include abstracts, as available; 17 (3) provide reference to companion documents 18 as may exist for each review, such as evidence tables 19 and guidelines or consumer educational materials de- 20 veloped from the review; 21 (4) provide links to the source of the full review 22 and to any companion documents; 23 (5) provide links to the source of a previous 24 version or update of the review; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00442 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 443 •HR 5942 IH (6) be searchable by intervention or other topic 1 of the review, reported outcomes, author, title, and 2 source; and 3 (7) offer to users periodic electronic notification 4 of database updates relating to users’ topics of inter- 5 est. 6 (d) OUTREACH.—Not later than the first date the 7 database is made publicly available and periodically there- 8 after, the Secretary of Health and Human Services shall 9 publicize the availability, features, and uses of the data- 10 base under this section to the stakeholders described in 11 subsection (e). 12 (e) CONSULTATION.—For purposes of developing the 13 database under this section and maintaining and updating 14 such database, the Secretary of Health and Human Serv- 15 ices shall convene and consult with an advisory committee 16 composed of relevant stakeholders, including— 17 (1) Federal Medicaid administrators and State 18 agencies administrating State plans under title XIX 19 of the Social Security Act pursuant to section 20 1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)); 21 (2) providers of maternity and newborn care 22 from both academic and community-based settings, 23 including obstetrician-gynecologists, family physi- 24 cians, certified nurse midwives, certified midwives, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00443 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 444 •HR 5942 IH certified professional midwives, physician assistants, 1 perinatal nurses, pediatricians, and nurse practi- 2 tioners; 3 (3) maternal-fetal medicine specialists; 4 (4) neonatologists; 5 (5) childbearing individuals and advocates for 6 such individuals, including childbirth educators cer- 7 tified by a nationally accredited program, rep- 8 resenting communities that are diverse in terms of 9 race, ethnicity, indigenous status, and geographic 10 area; 11 (6) employers and purchasers; 12 (7) health facility and system leaders, including 13 both hospital and birth center facilities; 14 (8) journalists; and 15 (9) bibliographic informatics specialists. 16 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 17 authorized to be appropriated $2,500,000 for each of the 18 fiscal years 2019 through 2021 for the purpose of devel- 19 oping the database and such sums as may be necessary 20 for each subsequent fiscal year for updating the database 21 and providing outreach and notification to users, as de- 22 scribed in this section. 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00444 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 445 •HR 5942 IH SEC. 518. MATERNITY CARE HEALTH PROFESSIONAL 1 SHORTAGE AREAS. 2 Section 332 of the Public Health Service Act (42 3 U.S.C. 254e) is amended by adding at the end the fol- 4 lowing new subsection: 5 ‘‘(k)(1) The Secretary, acting through the Adminis- 6 trator of the Health Resources and Services Administra- 7 tion, shall designate maternity care health professional 8 shortage areas in the States, publish a descriptive list of 9 the area’s population groups, medical facilities, and other 10 public facilities so designated, and at least annually review 11 and, as necessary, revise such designations. 12 ‘‘(2) For purposes of paragraph (1), a complete de- 13 scriptive list shall be published in the Federal Register not 14 later than one year after the date of the enactment of the 15 Health Equity and Accountability Act of 2018 and annu- 16 ally thereafter. 17 ‘‘(3) The provisions of subsections (b), (c), (e), (f), 18 (g), (h), (i), and (j) (other than (j)(1)(B)) of this section 19 shall apply to the designation of a maternity care health 20 professional shortage area in a similar manner and extent 21 as such provisions apply to the designation of health pro- 22 fessional shortage areas, except in applying subsection 23 (b)(3), the reference in such subsection to ‘physicians’ 24 shall be deemed to be a reference to nationally certified 25 and State licensed obstetricians, family practice physicians 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00445 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 446 •HR 5942 IH who practice full-scope maternity care, certified nurse 1 midwives, certified midwives, certified professional mid- 2 wives, and physician’s assistants who practice full scope 3 maternity care. 4 ‘‘(4) For purposes of this subsection, the term ‘ma- 5 ternity care health professional shortage area’ means— 6 ‘‘(A) an area in an urban or rural area (which 7 need not conform to the geographic boundaries of a 8 political subdivision and which is a rational area for 9 the delivery of health services) which the Secretary 10 determines has a shortage of providers of maternity 11 care health services including those referenced in 12 paragraph (3) or an urban or rural area that the 13 Secretary determines has lost a significant number 14 of such providers during the 10-year period begin- 15 ning with 2004 or has no obstetrical providers li- 16 censed to provide operative obstetrical services; 17 ‘‘(B) an area in an urban or rural area (which 18 need not conform to the geographic boundaries of a 19 political subdivision and which is a rational area for 20 the delivery of health services) which the Secretary 21 determines has a shortage of hospital or labor and 22 delivery units, hospital birth center units, or free- 23 standing birth centers or an area that lost a signifi- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00446 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 447 •HR 5942 IH cant number of these units during the 10-year pe- 1 riod beginning with 2004; or 2 ‘‘(C) a population group which the Secretary 3 determines has such a shortage of providers or fa- 4 cilities.’’. 5 SEC. 519. EXPANSION OF CDC PREVENTION RESEARCH 6 CENTERS PROGRAM TO INCLUDE CENTERS 7 ON OPTIMAL MATERNITY OUTCOMES. 8 (a) IN GENERAL.—Not later than one year after the 9 date of the enactment of this Act, the Secretary of Health 10 and Human Services, shall support the establishment of 11 additional Prevention Research Centers under the Preven- 12 tion Research Center Program administered by the Cen- 13 ters for Disease Control and Prevention. Such additional 14 centers shall each be known as a Center for Excellence 15 on Optimal Maternity Outcomes. 16 (b) RESEARCH.—Each Center for Excellence on Opti- 17 mal Maternity Outcomes shall— 18 (1) conduct at least one focused program of re- 19 search to improve maternity outcomes, including the 20 reduction of cesarean birth rates, elective inductions, 21 prematurity rates, and low birth weight rates within 22 an underserved population that has a disproportion- 23 ately large burden of suboptimal maternity out- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00447 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 448 •HR 5942 IH comes, including maternal mortality and morbidity, 1 infant mortality, prematurity, or low birth weight; 2 (2) work with partners on special interest 3 projects, as specified by the Centers for Disease 4 Control and Prevention and other relevant agencies 5 within the Department of Health and Human Serv- 6 ices, and on projects funded by other sources; and 7 (3) involve a minimum of two distinct birth set- 8 ting models, such as a hospital labor and delivery 9 model and freestanding birth center model; or a hos- 10 pital labor and delivery model and planned home 11 birth model. 12 (c) INTERDISCIPLINARY PROVIDERS.—Each Center 13 for Excellence on Optimal Maternity Outcomes shall in- 14 clude the following interdisciplinary providers of maternity 15 care: 16 (1) Obstetrician-gynecologists. 17 (2) At least two of the following providers: 18 (A) Family practice physicians. 19 (B) Nurse practitioners. 20 (C) Physician assistants. 21 (D) Certified professional midwives. 22 (d) SERVICES.—Research conducted by each Center 23 for Excellence on Optimal Maternity Outcomes shall in- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00448 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 449 •HR 5942 IH clude at least 2 (and preferably more) of the following sup- 1 portive provider services: 2 (1) Mental health. 3 (2) Doula labor support. 4 (3) Nutrition education. 5 (4) Childbirth education. 6 (5) Social work. 7 (6) Physical therapy or occupation therapy. 8 (7) Substance abuse services. 9 (8) Home visiting. 10 (e) COORDINATION.—The programs of research at 11 each of the two Centers of Excellence on Optimal Mater- 12 nity Outcomes shall compliment and not replicate the 13 work of the other. 14 (f) AUTHORIZATION OF APPROPRIATIONS.—There is 15 authorized to be appropriated to carry out this section 16 $2,000,000 for each of the fiscal years 2019 through 17 2023. 18 SEC. 520. EXPANDING MODELS ALLOWED TO BE TESTED BY 19 CENTER FOR MEDICARE & MEDICAID INNO- 20 VATION TO INCLUDE MATERNITY CARE MOD- 21 ELS. 22 Section 1115A(b)(2)(B) of the Social Security Act 23 (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the 24 end the following new clause: 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00449 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 450 •HR 5942 IH ‘‘(xxv) Promoting evidence-based mod- 1 els of care that have been associated with 2 reductions in maternal and infant health 3 disparities, including incorporating the use 4 of doula and promotoras support for preg- 5 nant and childbearing individuals into evi- 6 dence-based models of prenatal care, labor 7 and delivery, and postpartum care, and 8 supporting the appropriate use of out-of- 9 hospital birth models, including births at 10 home and in freestanding birth centers.’’. 11 SEC. 521. DEVELOPMENT OF INTERPROFESSIONAL MATER- 12 NITY CARE EDUCATIONAL MODELS AND 13 TOOLS. 14 (a) IN GENERAL.—Not later than 6 months after the 15 date of the enactment of this Act, the Secretary of Health 16 and Human Services, acting in conjunction with the Ad- 17 ministrator of Health Resources and Services Administra- 18 tion, shall convene, for a 1-year period, an Interprofes- 19 sional Maternity Provider Education Commission to dis- 20 cuss and make recommendations for— 21 (1) a consensus standard physiologic maternity 22 care curriculum that takes into account the core 23 competencies for basic midwifery practice such as 24 those developed by the American College of Nurse 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00450 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 451 •HR 5942 IH Midwives and the North American Registry of Mid- 1 wives, and the educational objectives for physicians 2 practicing in obstetrics and gynecology as deter- 3 mined by the Council on Resident Education in Ob- 4 stetrics and Gynecology; 5 (2) suggestions for multidisciplinary use of the 6 consensus physiologic curriculum; 7 (3) strategies to integrate and coordinate edu- 8 cation across maternity care disciplines, including 9 recommendations to increase medical and midwifery 10 student exposure to out-of-hospital birth; and 11 (4) pilot demonstrations of interprofessional 12 educational models. 13 (b) PARTICIPANTS.—The Commission shall include 14 maternity care educators, curriculum developers, service 15 leaders, certification leaders, and accreditation leaders 16 from the various professions that provide maternity care 17 in this country. Such professions shall include obstetrician 18 gynecologists, certified nurse midwives or certified mid- 19 wives, family practice physicians, nurse practitioners, phy- 20 sician assistants, certified professional midwives, and 21 perinatal nurses. Additionally, the Commission shall in- 22 clude representation from maternity care consumer advo- 23 cates. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00451 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 452 •HR 5942 IH (c) CURRICULUM.—The consensus standard physio- 1 logic maternity care curriculum described in subsection 2 (a)(1) shall— 3 (1) have a public health focus with a foundation 4 in health promotion and disease prevention; 5 (2) foster physiologic childbearing and woman 6 and family centered care; 7 (3) integrate strategies to reduce maternal and 8 infant morbidity and mortality; 9 (4) incorporate recommendations to ensure re- 10 spectful, safe, and seamless consultation, referral, 11 transport, and transfer of care when necessary; and 12 (5) include cultural sensitivity and strategies to 13 decrease disparities in maternity outcomes. 14 (d) REPORT.—Not later than 6 months after the final 15 meeting of the Commission, the Secretary of Health and 16 Human Services shall— 17 (1) submit to Congress a report containing the 18 recommendations made by the Commission under 19 this section; and 20 (2) make such report publicly available. 21 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 22 authorized to be appropriated to carry out this section 23 $1,000,000 for each of the fiscal years 2019 and 2020, 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00452 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 453 •HR 5942 IH and such sums as are necessary for each of the fiscal years 1 2021 through 2023. 2 SEC. 522. INCLUDING WITHIN INPATIENT HOSPITAL SERV- 3 ICES UNDER MEDICARE SERVICES FUR- 4 NISHED BY CERTAIN STUDENTS, INTERNS, 5 AND RESIDENTS SUPERVISED BY CERTIFIED 6 NURSE MIDWIVES. 7 (a) IN GENERAL.—Section 1861(b) of the Social Se- 8 curity Act (42 U.S.C. 1395x(b)) is amended— 9 (1) in paragraph (6), by striking ‘‘; or’’ and in- 10 serting ‘‘, or in the case of services in a hospital or 11 osteopathic hospital by a student midwife or an in- 12 tern or resident-in-training under a teaching pro- 13 gram previously described in this paragraph who is 14 in the field of obstetrics and gynecology, if such stu- 15 dent midwife, intern, or resident-in-training is super- 16 vised by a certified nurse-midwife to the extent per- 17 mitted under applicable State law and as may be au- 18 thorized by the hospital;’’; 19 (2) in paragraph (7), by striking the period at 20 the end and inserting ‘‘; or’’; and 21 (3) by adding at the end the following new 22 paragraph: 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00453 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 454 •HR 5942 IH ‘‘(8) a certified nurse-midwife where the hos- 1 pital has a teaching program approved as specified 2 in paragraph (6), if— 3 ‘‘(A) the hospital elects to receive any pay- 4 ment due under this title for reasonable costs of 5 such services; and 6 ‘‘(B) all certified nurse-midwives in such 7 hospital agree not to bill charges for profes- 8 sional services rendered in such hospital to indi- 9 viduals covered under the insurance program 10 established by this title.’’. 11 (b) EFFECTIVE DATE.—The amendments made by 12 subsection (a) shall apply to services furnished on or after 13 the date of the enactment of this Act. 14 SEC. 523. GRANTS TO PROFESSIONAL ORGANIZATIONS TO 15 INCREASE DIVERSITY IN MATERNAL, REPRO- 16 DUCTIVE, AND SEXUAL HEALTH PROFES- 17 SIONALS. 18 (a) IN GENERAL.—The Secretary of Health and 19 Human Services, through the Administrator of the Health 20 Resources and Services Administration, shall carry out a 21 grant program under which the Secretary may make to 22 eligible health professional organizations— 23 (1) for fiscal year 2019, planning grants de- 24 scribed in subsection (b); and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00454 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 455 •HR 5942 IH (2) for the subsequent 4-year period, implemen- 1 tation grants described in subsection (c). 2 (b) PLANNING GRANTS.— 3 (1) IN GENERAL.—Planning grants described in 4 this subsection are grants for the following purposes: 5 (A) To collect data and identify any work- 6 force disparities, with respect to a health pro- 7 fession, at each of the following areas along the 8 health professional continuum: 9 (i) Pipeline availability with respect to 10 students at the high school and college or 11 university levels considering and working 12 toward entrance in the profession. 13 (ii) Entrance into the training pro- 14 gram for the profession. 15 (iii) Graduation from such training 16 program. 17 (iv) Entrance into practice. 18 (v) Retention in practice for more 19 than a 5-year period. 20 (B) To develop one or more strategies to 21 address the workforce disparities within the 22 health profession, as identified under (and in 23 response to the findings pursuant to) subpara- 24 graph (A). 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00455 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 456 •HR 5942 IH (2) APPLICATION.—To be eligible to receive a 1 grant under this subsection, an eligible health pro- 2 fessional organization shall submit to the Secretary 3 of Health and Human Services an application in 4 such form and manner and containing such informa- 5 tion as specified by the Secretary. 6 (3) AMOUNT.—Each grant awarded under this 7 subsection shall be for an amount not to exceed 8 $300,000. 9 (4) REPORT.—Each recipient of a grant under 10 this subsection shall submit to the Secretary of 11 Health and Human Services a report containing— 12 (A) information on the extent and distribu- 13 tion of workforce disparities identified through 14 the grant; and 15 (B) reasonable objectives and strategies 16 developed to address such disparities within a 17 5-, 10-, and 25-year period. 18 (c) IMPLEMENTATION GRANTS.— 19 (1) IN GENERAL.—Implementation grants de- 20 scribed in this subsection are grants to implement 21 one or more of the strategies developed pursuant to 22 a planning grant awarded under subsection (b). 23 (2) APPLICATION.—To be eligible to receive a 24 grant under this subsection, an eligible health pro- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00456 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 457 •HR 5942 IH fessional organization shall submit to the Secretary 1 of Health and Human Services an application in 2 such form and manner as specified by the Secretary. 3 Each such application shall contain information on 4 the capability of the organization to carry out a 5 strategy described in paragraph (1), involvement of 6 partners or coalitions, plans for developing sustain- 7 ability of the efforts after the culmination of the 8 grant cycle, and any other information specified by 9 the Secretary. 10 (3) AMOUNT.—Each grant awarded under this 11 subsection shall be for an amount not to exceed 12 $500,000 each year during the 4-year period of the 13 grant. 14 (4) REPORTS.—For each of the first 3 years for 15 which an eligible health professional organization is 16 awarded a grant under this subsection, the organiza- 17 tion shall submit to the Secretary of Health and 18 Human Services a report on the activities carried 19 out by such organization through the grant during 20 such year and objectives for the subsequent year. 21 For the fourth year for which an eligible health pro- 22 fessional organization is awarded a grant under this 23 subsection, the organization shall submit to the Sec- 24 retary a report that includes an analysis of all the 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00457 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 458 •HR 5942 IH activities carried out by the organization through the 1 grant and a detailed plan for continuation of out- 2 reach efforts. 3 (d) ELIGIBLE HEALTH PROFESSIONAL ORGANIZA- 4 TION DEFINED.—For purposes of this section, the term 5 ‘‘eligible health professional organization’’ means a profes- 6 sional organization representing obstetrician-gyne- 7 cologists, certified nurse midwives, certified midwives, 8 family practice physicians, nurse practitioners whose scope 9 of practice includes maternity or sexual and reproductive 10 health care, physician assistants whose scope of practice 11 includes obstetrical or sexual and reproductive health care, 12 or certified professional midwives adolescent medicine spe- 13 cialists, and pediatricians who provide sexual and repro- 14 ductive health care. 15 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 16 authorized to be appropriated to carry out this section 17 $2,000,000 for fiscal year 2019 and $3,000,000 for each 18 of the fiscal years 2020 through 2023. 19 SEC. 524. INTERAGENCY UPDATE TO THE QUALITY FAMILY 20 PLANNING GUIDELINES. 21 (a) IN GENERAL.—Not later than six months after 22 the date of enactment of this Act, the Director of the Cen- 23 ters for Disease Control and Prevention and the Office 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00458 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 459 •HR 5942 IH of Population Affairs shall review and expand the 2014 1 Quality Family Planning Guidelines to address— 2 (1) health disparities; and 3 (2) the importance of patient-directed contra- 4 ceptive decisionmaking. 5 (b) CONSULTATION.—In carrying out subsection (a), 6 the Director of the Centers for Disease Control and Pre- 7 vention and the Office of Population Affairs shall convene 8 a meeting, and solicit the views of, stakeholders including 9 experts on health disparities, experts on reproductive coer- 10 cion, representatives of provider organizations, patient ad- 11 vocates, reproductive justice organizations, organizations 12 that represent racial and ethnic minority communities, or- 13 ganizations that represent people with disabilities, organi- 14 zations that represent LGBTQ persons, and organizations 15 that represent people with limited-English proficiency. 16 SEC. 525. DISSEMINATION OF THE QUALITY FAMILY PLAN- 17 NING GUIDELINES. 18 (a) IN GENERAL.—Not later than six months after 19 the date of enactment of this Act, the Secretary of Health 20 and Human Services and the Director of the Centers for 21 Disease Control and Prevention shall— 22 (1) develop a plan for outreach to publicly fund- 23 ed health care providers, including federally qualified 24 health centers and branches of the Indian Health 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00459 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 460 •HR 5942 IH Service, about the quality family planning guidelines 1 referred to in section 524; and 2 (2) award grants to eligible entities to imple- 3 ment these guidelines for all patients seeking family 4 planning services. 5 (b) DEFINITION.—In this section, the term ‘‘eligible 6 entity’’ means a publicly funded health care provider that 7 serves persons of reproductive age. 8 Subtitle B—Pregnancy Screening 9 SEC. 531. PREGNANCY INTENTION SCREENING INITIATIVE 10 DEMONSTRATION PROGRAM. 11 Part P of title III of the Public Health Service Act 12 (42 U.S.C. 280g et seq.) is amended by adding at the end 13 the following new sections: 14 ‘‘SEC. 399V–7. PREGNANCY INTENTION SCREENING INITIA- 15 TIVE DEMONSTRATION PROGRAM. 16 ‘‘(a) PROGRAM ESTABLISHMENT.—The Secretary, 17 acting through the Director of the Centers for Disease 18 Control and Prevention, shall establish a demonstration 19 program to facilitate the clinical adoption of pregnancy in- 20 tention screening initiatives by health care providers. 21 ‘‘(b) GRANTS.—The Secretary may carry out the 22 demonstration program through awarding grants to eligi- 23 ble entities to implement pregnancy intention screening 24 initiatives, collect data, and evaluate such initiatives. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00460 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 461 •HR 5942 IH ‘‘(c) ELIGIBLE ENTITIES.— 1 ‘‘(1) IN GENERAL.—An eligible entity under 2 this section is an entity described in paragraph (2) 3 that provides non-directive, comprehensive, medically 4 accurate information. 5 ‘‘(2) ENTITIES DESCRIBED.—For purposes of 6 paragraph (1), an entity described in this paragraph 7 is a community-based organization, voluntary health 8 organization, public health department, community 9 health center, or other interested public or private 10 health care provider or organization. 11 ‘‘(d) PREGNANCY INTENTION SCREENING INITIA- 12 TIVE.—For purposes of this section, the term ‘pregnancy 13 intention screening initiative’ means any initiative by a 14 health care provider to routinely screen women with re- 15 spect to their pregnancy intentions and goals to either pre- 16 vent unintended pregnancies or improve the likelihood of 17 healthy pregnancies, in order to better provide health care 18 that meets the contraceptive or pre-pregnancy needs of 19 such women. 20 ‘‘(e) EVALUATION.— 21 ‘‘(1) IN GENERAL.—The Secretary, acting 22 through the Director of the Centers for Disease 23 Control and Prevention, shall, by grant or contract, 24 and after consultation as described in paragraph (2), 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00461 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 462 •HR 5942 IH conduct an evaluation of the demonstration pro- 1 gram, with respect to pregnancy intention screening 2 initiatives, conducted under this section. The evalua- 3 tion shall include: 4 ‘‘(A) Assessment of the implementation of 5 pregnancy intention screening protocols among 6 a diverse group of patients and providers, in- 7 cluding collecting data on the experiences and 8 outcomes for diverse patient populations in a 9 variety of clinical settings. 10 ‘‘(B) Analysis of outcome measures that 11 will facilitate effective and widespread adoption 12 of such protocols by health care providers for 13 inquiring about and responding to pregnancy 14 intentions of women with both contraceptive 15 and pre-pregnancy care. 16 ‘‘(C) Consideration of health disparities 17 among the population served. 18 ‘‘(D) Assessment of the equitable and vol- 19 untary application of such initiatives to minor- 20 ity and medically underserved communities. 21 ‘‘(E) Assessment of the training, capacity, 22 and ongoing technical assistance needed for 23 providers to effectively implement such preg- 24 nancy intention screening protocols. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00462 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 463 •HR 5942 IH ‘‘(F) Assessment of whether referral sys- 1 tems for selected protocols follow evidence-based 2 standards that ensure access to comprehensive 3 health services and appropriate follow-up care. 4 ‘‘(2) INDEPENDENT, EXPERT ADVISORY 5 PANEL.—In conducting the evaluation under para- 6 graph (1), the Director of the Centers for Disease 7 Control and Prevention shall consult with physi- 8 cians, physician assistants, and nurses who spe- 9 cialize in women’s health, and other experts in clin- 10 ical practice, program evaluation, and research. 11 ‘‘(3) REPORT.—Not later than one year after 12 the last day of the demonstration program under 13 this section, the Director of the Centers for Disease 14 Control and Prevention shall submit to Congress a 15 report on the results of the evaluation conducted 16 under paragraph (1) and shall make the report pub- 17 licly available. 18 ‘‘(f) FUNDING.— 19 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 20 To carry out this section, there is authorized to be 21 appropriated $5,000,000 for each of fiscal years 22 2019 through 2021. 23 ‘‘(2) LIMITATION.—Not more than 25 percent 24 of funds appropriated to carry out this section pur- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00463 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 464 •HR 5942 IH suant to paragraph (1) for a fiscal year may be used 1 for purposes of the evaluation under subsection 2 (e).’’. 3 TITLE VI—MENTAL HEALTH 4 SEC. 601. MENTAL HEALTH FINDINGS. 5 Congress finds the following: 6 (1) Despite the existence of effective treat- 7 ments, disparities lie in the availability, accessibility, 8 and quality of mental health services for racial and 9 ethnic minorities. 10 (2) These disparities have powerful significance 11 for minority groups and for society as a whole. 12 (3) Racial and ethnic minorities bear a greater 13 burden from unmet mental health needs and thus 14 suffer a greater loss to their overall health and pro- 15 ductivity. 16 (4) The foremost barriers include the cost of 17 care, societal stigma, and the fragmented organiza- 18 tion of services. 19 (5) African American attitudes toward mental 20 illness are another barrier to seeking mental health 21 care. 22 (6) Mental illness retains considerable stigma, 23 and seeking treatment is not always encouraged. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00464 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 465 •HR 5942 IH (7) Mental illness is highly stigmatizing in 1 many Asian cultures. 2 (8) Addressing mental health stigma in commu- 3 nities will help increase utilization of mental health 4 services and reduce the burden of mental illness 5 SEC. 602. COVERAGE OF MARRIAGE AND FAMILY THERA- 6 PIST SERVICES, MENTAL HEALTH COUN- 7 SELOR SERVICES, AND SUBSTANCE ABUSE 8 COUNSELOR SERVICES UNDER PART B OF 9 THE MEDICARE PROGRAM. 10 (a) COVERAGE OF SERVICES.— 11 (1) IN GENERAL.—Section 1861(s)(2) of the 12 Social Security Act (42 U.S.C. 1395x(s)(2)), as 13 amended by section 450, is amended— 14 (A) in subparagraph (FF), by striking 15 ‘‘and’’ at the end; 16 (B) in subparagraph (GG), by inserting 17 ‘‘and’’ at the end; and 18 (C) by adding at the end the following new 19 subparagraph: 20 ‘‘(HH) marriage and family therapist services 21 (as defined in subsection (lll)(1)) and mental health 22 counselor services (as defined in subsection (lll)(3)) 23 and substance abuse counselor services (as defined 24 in subsection (lll)(5));’’. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00465 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 466 •HR 5942 IH (2) DEFINITIONS.—Section 1861 of such Act 1 (42 U.S.C. 1395x), as amended by sections 413(a) 2 and 470(a), is amended by adding at the end the 3 following new subsection: 4 ‘‘Marriage and Family Therapist Services; Marriage and 5 Family Therapist; Mental Health Counselor Serv- 6 ices; Mental Health Counselor 7 ‘‘(lll)(1) The term ‘marriage and family therapist 8 services’ means services performed by a marriage and 9 family therapist (as defined in paragraph (2)) for the diag- 10 nosis and treatment of mental illnesses, which the mar- 11 riage and family therapist is legally authorized to perform 12 under State law (or the State regulatory mechanism pro- 13 vided by State law) of the State in which such services 14 are performed, as would otherwise be covered if furnished 15 by a physician or as an incident to a physician’s profes- 16 sional service, but only if no facility or other provider 17 charges or is paid any amounts with respect to the fur- 18 nishing of such services. 19 ‘‘(2) The term ‘marriage and family therapist’ means 20 an individual who— 21 ‘‘(A) possesses a master’s or doctoral degree 22 which qualifies for licensure or certification as a 23 marriage and family therapist pursuant to State 24 law; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00466 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 467 •HR 5942 IH ‘‘(B) after obtaining such degree has performed 1 at least 2 years of clinical supervised experience in 2 marriage and family therapy; and 3 ‘‘(C) in the case of an individual performing 4 services in a State that provides for licensure or cer- 5 tification of marriage and family therapists, is li- 6 censed or certified as a marriage and family thera- 7 pist in such State. 8 ‘‘(3) The term ‘mental health counselor services’ 9 means services performed by a mental health counselor (as 10 defined in paragraph (4)) for the diagnosis and treatment 11 of mental illnesses which the mental health counselor is 12 legally authorized to perform under State law (or the 13 State regulatory mechanism provided by the State law) of 14 the State in which such services are performed, as would 15 otherwise be covered if furnished by a physician or as inci- 16 dent to a physician’s professional service, but only if no 17 facility or other provider charges or is paid any amounts 18 with respect to the furnishing of such services. 19 ‘‘(4) The term ‘mental health counselor’ means an 20 individual who— 21 ‘‘(A) possesses a master’s or doctor’s degree in 22 mental health counseling or a related field; 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00467 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 468 •HR 5942 IH ‘‘(B) after obtaining such a degree has per- 1 formed at least 2 years of supervised mental health 2 counselor practice; and 3 ‘‘(C) in the case of an individual performing 4 services in a State that provides for licensure or cer- 5 tification of mental health counselors or professional 6 counselors, is licensed or certified as a mental health 7 counselor or professional counselor in such State. 8 ‘‘(5) The term ‘substance abuse counselor services’ 9 means services performed by a substance abuse counselor 10 (as defined in paragraph (6)) for the diagnosis and treat- 11 ment of substance abuse and addiction which the sub- 12 stance abuse counselor is legally authorized to perform 13 under State law (or the State regulatory mechanism pro- 14 vided by the State law) of the State in which such services 15 are performed, as would otherwise be covered if furnished 16 by a physician or as incident to a physician’s professional 17 service, but only if no facility or other provider charges 18 or is paid any amounts with respect to the furnishing of 19 such services. 20 ‘‘(6) The term ‘substance abuse counselor’ means an 21 individual who— 22 ‘‘(A) has performed at least 2 years of super- 23 vised substance abuse counselor practice; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00468 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 469 •HR 5942 IH ‘‘(B) in the case of an individual performing 1 services in a State that provides for licensure or cer- 2 tification of substance abuse counselors or profes- 3 sional counselors, is licensed or certified as a sub- 4 stance abuse counselor or professional counselor in 5 such State; or 6 ‘‘(C) is a drug and alcohol counselor as defined 7 in section 40.281 of title 49, Code of Federal Regu- 8 lations.’’. 9 (3) PROVISION FOR PAYMENT UNDER PART 10 B.—Section 1832(a)(2)(B) of such Act (42 U.S.C. 11 1395k(a)(2)(B)) is amended— 12 (A) by striking ‘‘and’’ at the end of clause 13 (iv); and 14 (B) by adding at the end the following new 15 clause: 16 ‘‘(v) marriage and family therapist 17 services, mental health counselor services, 18 and substance abuse counselor services; 19 and’’. 20 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 21 of such Act (42 U.S.C. 1395l(a)(1)), as amended by 22 section 431(c)(3), is amended— 23 (A) by striking ‘‘and (AA)’’ and inserting 24 ‘‘(AA)’’; and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00469 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 470 •HR 5942 IH (B) by inserting before the semicolon at 1 the end the following: ‘‘, and (BB) with respect 2 to marriage and family therapist services, men- 3 tal health counselor services, and substance 4 abuse counselor services under section 5 1861(s)(2)(HH), the amounts paid shall be 80 6 percent of the lesser of the actual charge for 7 the services or 75 percent of the amount deter- 8 mined for payment of a psychologist under sub- 9 paragraph (L)’’. 10 (5) EXCLUSION OF MARRIAGE AND FAMILY 11 THERAPIST SERVICES AND MENTAL HEALTH COUN- 12 SELOR SERVICES FROM SKILLED NURSING FACILITY 13 PROSPECTIVE PAYMENT SYSTEM.—Section 14 1888(e)(2)(A)(ii) of such Act (42 U.S.C. 15 1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar- 16 riage and family therapist services (as defined in 17 section 1861(lll)(1)), mental health counselor serv- 18 ices (as defined in section 1861(lll)(3)),’’ after 19 ‘‘qualified psychologist services,’’. 20 (6) INCLUSION OF MARRIAGE AND FAMILY 21 THERAPISTS, MENTAL HEALTH COUNSELORS, AND 22 SUBSTANCE ABUSE COUNSELORS AS PRACTITIONERS 23 FOR ASSIGNMENT OF CLAIMS.—Section 24 1842(b)(18)(C) of such Act (42 U.S.C. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00470 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 471 •HR 5942 IH 1395u(b)(18)(C)) is amended by adding at the end 1 the following new clauses: 2 ‘‘(vii) A marriage and family therapist (as de- 3 fined in section 1861(lll)(2)). 4 ‘‘(viii) A mental health counselor (as defined in 5 section 1861(lll)(4)). 6 ‘‘(ix) A substance abuse counselor (as defined 7 in section 1861 (lll)(6)).’’. 8 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV- 9 ICES PROVIDED IN CERTAIN SETTINGS.— 10 (1) RURAL HEALTH CLINICS AND FEDERALLY 11 QUALIFIED HEALTH CENTERS.—Section 12 1861(aa)(1)(B) of the Social Security Act (42 13 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 14 by a clinical social worker (as defined in subsection 15 (hh)(1)),’’ and inserting ‘‘, by a clinical social worker 16 (as defined in subsection (hh)(1)), by a marriage 17 and family therapist (as defined in subsection 18 (lll)(2)), or by a mental health counselor (as defined 19 in subsection (lll)(4)), or by a substance abuse coun- 20 selor (as defined in section 1861 (lll)(6)).’’. 21 (2) HOSPICE PROGRAMS.—Section 22 1861(dd)(2)(B)(i)(III) of such Act (42 U.S.C. 23 1395x(dd)(2)(B)(i)(III)) is amended by inserting ‘‘or 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00471 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 472 •HR 5942 IH one marriage and family therapist (as defined in 1 subsection (lll)(2))’’ after ‘‘social worker’’. 2 (c) AUTHORIZATION OF MARRIAGE AND FAMILY 3 THERAPISTS TO DEVELOP DISCHARGE PLANS FOR 4 POSTHOSPITAL SERVICES.—Section 1861(ee)(2)(G) of 5 the Social Security Act (42 U.S.C. 1395x(ee)(2)(G)) is 6 amended by inserting ‘‘marriage and family therapist (as 7 defined in subsection (lll)(2)),’’ after ‘‘social worker,’’. 8 (d) EFFECTIVE DATE.—The amendments made by 9 this section shall apply with respect to services furnished 10 on or after January 1, 2019. 11 SEC. 603. INTEGRATED HEALTH CARE DEMONSTRATION 12 PROGRAM. 13 Part D of title V of the Public Health Service Act 14 (42 U.S.C. 290dd et seq.) is amended by adding at the 15 end the following: 16 ‘‘SEC. 550. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 17 PROVISION OF BEHAVIORAL HEALTH CARE 18 IN PRIMARY CARE SETTINGS. 19 ‘‘(a) GRANTS.—The Secretary, acting through the 20 Assistant Secretary for Mental Health and Substance 21 Abuse, shall award grants to eligible entities for the pur- 22 pose of establishing interprofessional health care teams 23 that provide behavioral health care. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00472 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 473 •HR 5942 IH ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 1 a grant under this section, an entity shall be a federally 2 qualified health center (as defined in section 1861(aa) of 3 the Social Security Act), rural health clinic, or behavioral 4 health program, serving a high proportion of individuals 5 from racial and ethnic minority groups (as defined in sec- 6 tion 1707(g)). 7 ‘‘(c) SCIENTIFICALLY BASED.—Integrated health 8 care funded through this section shall be scientifically 9 based, taking into consideration the results of the most 10 recent peer-reviewed research available. 11 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—To 12 carry out this section, there is authorized to be appro- 13 priated $20,000,000 for each of fiscal years 2019 through 14 2024.’’. 15 SEC. 604. ADDRESSING RACIAL AND ETHNIC MINORITY 16 MENTAL HEALTH DISPARITIES RESEARCH 17 GAPS. 18 Not later than 6 months after the date of the enact- 19 ment of this Act, the Director of the National Institute 20 on Minority Health and Health Disparities shall enter into 21 an arrangement with the National Academy of Sciences 22 (or, if the National Academy of Sciences declines to enter 23 into such an arrangement, an arrangement with the Insti- 24 tute of Medicine, the Patient Centered Outcomes Research 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00473 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 474 •HR 5942 IH Institute, the Agency for Healthcare Quality, or another 1 appropriate entity)— 2 (1) to conduct a study with respect to mental 3 health disparities in racial and ethnic minority 4 groups (as defined in section 1707(g) of the Public 5 Health Service Act (42 U.S.C. 300u–6(g)); and 6 (2) to submit to the Congress a report on the 7 results of such study, including— 8 (A) a compilation of information on the dy- 9 namics of mental disorders in such racial and 10 ethnic minority groups; and 11 (B) a compilation of information on the 12 impact of exposure to community violence, ad- 13 verse childhood experiences, and other psycho- 14 logical traumas on mental disorders in such ra- 15 cial and minority groups. 16 SEC. 605. HEALTH PROFESSIONS COMPETENCIES TO AD- 17 DRESS RACIAL AND ETHNIC MINORITY MEN- 18 TAL HEALTH DISPARITIES. 19 (a) IN GENERAL.—The Secretary of Health and 20 Human Services, acting through the Assistant Secretary 21 for Mental Health and Substance Use, shall award grants 22 to qualified national organizations for the purposes of— 23 (1) developing, and disseminating to health pro- 24 fessional educational programs curricula or core 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00474 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 475 •HR 5942 IH competencies addressing mental health disparities 1 among racial and ethnic minority groups for use in 2 the training of students in the professions of social 3 work, psychology, psychiatry, marriage and family 4 therapy, mental health counseling, and substance 5 abuse counseling; and 6 (2) certifying community health workers and 7 peer wellness specialists with respect to such cur- 8 ricula and core competencies and integrating and ex- 9 panding the use of such workers and specialists into 10 health care to address mental health disparities 11 among racial and ethnic minority groups. 12 (b) CURRICULA; CORE COMPETENCIES.—Organiza- 13 tions receiving funds under subsection (a) may use the 14 funds to engage in the following activities related to the 15 development and dissemination of curricula or core com- 16 petencies described in subsection (a)(1): 17 (1) Formation of committees or working groups 18 comprised of experts from accredited health profes- 19 sions schools to identify core competencies relating 20 to mental health disparities among racial and ethnic 21 minority groups. 22 (2) Planning of workshops in national fora to 23 allow for public input into the educational needs as- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00475 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 476 •HR 5942 IH sociated with mental health disparities among racial 1 and ethnic minority groups. 2 (3) Dissemination and promotion of the use of 3 curricula or core competencies in undergraduate and 4 graduate health professions training programs na- 5 tionwide. 6 (4) Establishing external stakeholder advisory 7 boards to provide meaningful input into policy and 8 program development and best practices to reduce 9 mental health disparities among racial and ethnic 10 minority groups. 11 (c) DEFINITIONS.—In this section: 12 (1) QUALIFIED NATIONAL ORGANIZATION.—The 13 term ‘‘qualified national organization’’ means a na- 14 tional organization that focuses on the education of 15 students in programs of social work, psychology, 16 psychiatry, and marriage and family therapy. 17 (2) RACIAL AND ETHNIC MINORITY GROUP.— 18 The term ‘‘racial and ethnic minority group’’ has the 19 meaning given to such term in section 1707(g) of 20 the Public Health Service Act (42 U.S.C. 300u– 21 6(g)). 22 (d) AUTHORIZATION OF APPROPRIATIONS.—There 23 are authorized to be appropriated to carry out this section 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00476 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 477 •HR 5942 IH such sums as may be necessary for each of fiscal years 1 2019 through 2024. 2 SEC. 606. ASIAN AMERICAN, NATIVE HAWAIIAN, AND PA- 3 CIFIC ISLANDER BEHAVIORAL AND MENTAL 4 HEALTH OUTREACH AND EDUCATION STRAT- 5 EGIES. 6 Part D of title V of the Public Health Service Act 7 (42 U.S.C. 290dd et seq.) is amended by adding at the 8 end the following new section: 9 ‘‘SEC. 544. BEHAVIORAL AND MENTAL HEALTH OUTREACH 10 AND EDUCATION STRATEGIES. 11 ‘‘(a) IN GENERAL.—The Secretary, acting through 12 the Administrator of the Substance Abuse and Mental 13 Health Services Administration, shall, in coordination with 14 advocacy and behavioral and mental health organizations 15 serving populations of Asian American, Native Hawaiian, 16 and Pacific Islander individuals or communities, develop 17 and implement an outreach and education strategy to pro- 18 mote behavioral and mental health and reduce stigma as- 19 sociated with mental health conditions and substance 20 abuse among the Asian American, Native Hawaiian, and 21 Pacific Islander populations. Such strategy shall— 22 ‘‘(1) be designed to— 23 ‘‘(A) meet the diverse cultural and lan- 24 guage needs of the various Asian American, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00477 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 478 •HR 5942 IH Native Hawaiian, and Pacific Islander popu- 1 lations; and 2 ‘‘(B) ensure such strategies are develop- 3 mentally and age appropriate; 4 ‘‘(2) increase awareness of symptoms of mental 5 illnesses common among such populations, taking 6 into account differences within subgroups, such as 7 gender, gender identity, age, sexual orientation, or 8 ethnicity, of such populations; 9 ‘‘(3) provide information on evidence-based, cul- 10 turally and linguistically appropriate and adapted 11 interventions and treatments; 12 ‘‘(4) ensure full participation of, and engage, 13 both consumers and community members in the de- 14 velopment and implementation of materials; and 15 ‘‘(5) seek to broaden the perspective among 16 both individuals in these communities and stake- 17 holders serving these communities to use a com- 18 prehensive public health approach to promoting be- 19 havioral health that addresses a holistic view of 20 health by focusing on the intersection between be- 21 havioral and physical health. 22 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 23 is authorized to be appropriated to carry out this section 24 $300,000 for fiscal year 2019.’’. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00478 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 479 •HR 5942 IH SEC. 607. MENTAL HEALTH IN SCHOOLS. 1 (a) PURPOSE.—It is the purpose of this section to— 2 (1) revise, increase funding for, and expand the 3 scope of the Project AWARE State Educational 4 Agency Grant Program carried out by the Secretary 5 of Health and Human Services, in order to provide 6 access to more comprehensive school-based mental 7 health services and supports; 8 (2) provide for comprehensive staff development 9 for school and community service personnel working 10 in the school; and 11 (3) provide for comprehensive training for chil- 12 dren with mental health disorders, for parents, sib- 13 lings, and other family members of such children, 14 and for concerned members of the community. 15 (b) TECHNICAL AMENDMENTS.—The second part G 16 (relating to services provided through religious organiza- 17 tions) of title V of the Public Health Service Act (42 18 U.S.C. 290kk et seq.) is amended— 19 (1) by redesignating such part as part J; and 20 (2) by redesignating sections 581 through 584 21 as sections 596 through 596C, respectively. 22 (c) SCHOOL-BASED MENTAL HEALTH AND CHIL- 23 DREN AND VIOLENCE.—Section 581 of the Public Health 24 Service Act (42 U.S.C. 290hh) is amended to read as fol- 25 lows: 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00479 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 480 •HR 5942 IH ‘‘SEC. 581. SCHOOL-BASED MENTAL HEALTH AND CHIL- 1 DREN AND VIOLENCE. 2 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 3 with the Secretary of Education and in consultation with 4 the Attorney General, shall, directly or through grants, 5 contracts, or cooperative agreements awarded to eligible 6 entities described in subsection (c), assist local commu- 7 nities and schools (including schools funded by the Bureau 8 of Indian Education) in applying a public health approach 9 to mental health services both in schools and in the com- 10 munity. Such approach should provide comprehensive age 11 appropriate services and supports, be linguistically and 12 culturally appropriate, be trauma-informed, and incor- 13 porate age appropriate strategies of positive behavioral 14 interventions and supports. A comprehensive school men- 15 tal health program funded under this section shall assist 16 children in dealing with trauma and violence. 17 ‘‘(b) ACTIVITIES.—Under the program under sub- 18 section (a), the Secretary may— 19 ‘‘(1) provide financial support to enable local 20 communities to implement a comprehensive cul- 21 turally and linguistically appropriate, trauma-in- 22 formed, and age-appropriate, school-based mental 23 health program that— 24 ‘‘(A) builds awareness of trauma; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00480 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 481 •HR 5942 IH ‘‘(B) trains appropriate staff to identify 1 signs of trauma or mental health disorders; and 2 ‘‘(C) incorporates positive behavioral inter- 3 ventions, family engagement, student treatment, 4 and multi-generational supports to foster the 5 health and development of children; 6 ‘‘(2) provide technical assistance to local com- 7 munities with respect to the development of pro- 8 grams described in paragraph (1); 9 ‘‘(3) provide assistance to local communities in 10 the development of policies to address child and ado- 11 lescent trauma and mental health issues and violence 12 when and if it occurs; 13 ‘‘(4) facilitate community partnerships among 14 families, students, law enforcement agencies, edu- 15 cation systems, mental health and substance use dis- 16 order service systems, family-based mental health 17 service systems, child welfare agencies, health care 18 service systems (including primary care physicians), 19 faith-based programs, trauma networks, and other 20 community-based systems; and 21 ‘‘(5) establish mechanisms for children and ado- 22 lescents to report incidents of violence or plans by 23 other children, adolescents, or adults to commit vio- 24 lence. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00481 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 482 •HR 5942 IH ‘‘(c) REQUIREMENTS.— 1 ‘‘(1) IN GENERAL.—To be eligible for a grant, 2 contract, or cooperative agreement under subsection 3 (a), an entity shall— 4 ‘‘(A) be a partnership that— 5 ‘‘(i) shall include a State educational 6 agency and one or more local educational 7 agencies, with a local educational agency 8 serving as the lead partner; and 9 ‘‘(ii) may include, in accordance with 10 paragraph (2)(A)(i), appropriate public or 11 private entities that use evidence-based 12 interventions, as defined in section 8101 of 13 the Elementary and Secondary Education 14 Act of 1965 (20 U.S.C. 7801); and 15 ‘‘(B) submit an application, that is en- 16 dorsed by all members of the partnership, that 17 contains the assurances described in paragraph 18 (2). 19 ‘‘(2) REQUIRED ASSURANCES.—An application 20 under paragraph (1) shall contain assurances as fol- 21 lows: 22 ‘‘(A) That the eligible entity will ensure 23 that, in carrying out activities under this sec- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00482 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 483 •HR 5942 IH tion, the eligible entity will enter into a memo- 1 randum of understanding— 2 ‘‘(i) with at least 1 public or private 3 mental health entity, health care entity, 4 law enforcement or juvenile justice entity, 5 child welfare agency, family-based mental 6 health entity, trauma network, or other 7 community-based entity; and 8 ‘‘(ii) that clearly states— 9 ‘‘(I) the responsibilities of each 10 partner with respect to the activities 11 to be carried out, including how fam- 12 ily engagement will be incorporated in 13 the activities; 14 ‘‘(II) how school-employed and 15 school-based mental health profes- 16 sionals will be utilized for carrying out 17 such responsibilities; 18 ‘‘(III) how each such partner will 19 be accountable for carrying out such 20 responsibilities; and 21 ‘‘(IV) the amount of non-Federal 22 funding or in-kind contributions that 23 each such partner will contribute in 24 order to sustain the program. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00483 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 484 •HR 5942 IH ‘‘(B) That the comprehensive school-based 1 mental health program carried out under this 2 section supports the flexible use of funds to ad- 3 dress— 4 ‘‘(i) the promotion of the social, emo- 5 tional, and behavioral health of all students 6 in an environment that is conducive to 7 learning; 8 ‘‘(ii) the reduction in the likelihood of 9 at risk students developing social, emo- 10 tional, behavioral health problems, or sub- 11 stance use disorders; 12 ‘‘(iii) the early identification of social, 13 emotional, behavioral problems, or sub- 14 stance use disorders and the provision of 15 early intervention services; 16 ‘‘(iv) the treatment or referral for 17 treatment of students with existing social, 18 emotional, behavioral health problems, or 19 substance use disorders; and 20 ‘‘(v) the development and implementa- 21 tion of programs to assist children in deal- 22 ing with trauma and violence, including 23 program curricula, school supports, and 24 after-school programs. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00484 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 485 •HR 5942 IH ‘‘(C) That the comprehensive school-based 1 mental health program carried out under this 2 section will provide for in-service training of all 3 school personnel, including ancillary staff and 4 volunteers, in— 5 ‘‘(i) the techniques and supports need- 6 ed to identify early children with trauma 7 histories and children with, or at risk of, 8 mental illness; 9 ‘‘(ii) the use of referral mechanisms 10 that effectively link such children to appro- 11 priate treatment and intervention services 12 in the school and in the community and to 13 follow-up when services are not available; 14 ‘‘(iii) strategies that promote a school- 15 wide positive environment; 16 ‘‘(iv) strategies for promoting the so- 17 cial, emotional, mental, and behavioral 18 health of all students; and 19 ‘‘(v) strategies to increase the knowl- 20 edge and skills of school and community 21 leaders about the impact of trauma and vi- 22 olence and on the application of a public 23 health approach to comprehensive school- 24 based mental health programs. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00485 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 486 •HR 5942 IH ‘‘(D) That the comprehensive school-based 1 mental health program carried out under this 2 section will include comprehensive training for 3 parents, siblings, and other family members of 4 children with mental health disorders, and for 5 concerned members of the community in— 6 ‘‘(i) the techniques and supports need- 7 ed to identify early children with trauma 8 histories, and children with, or at risk of, 9 mental illness; 10 ‘‘(ii) the use of referral mechanisms 11 that effectively link such children to appro- 12 priate treatment and intervention services 13 in the school and in the community and 14 follow-up when such services are not avail- 15 able; and 16 ‘‘(iii) strategies that promote a school- 17 wide positive environment. 18 ‘‘(E) That the comprehensive school-based 19 mental health program carried out under this 20 section will demonstrate the measures to be 21 taken to sustain the program after funding 22 under this section terminates (which may in- 23 clude seeking funding for the program under a 24 State Medicaid plan under title XIX of the So- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00486 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 487 •HR 5942 IH cial Security Act (42 U.S.C. 1396 et seq.) or a 1 waiver of such a plan). 2 ‘‘(F) That the eligible entity is supported 3 by the State agency with primary responsibility 4 for behavioral health to ensure that the sustain- 5 ability of the programs is established after 6 funding under this section terminates. 7 ‘‘(G) That the comprehensive school-based 8 mental health program carried out under this 9 section will be based on trauma-informed and 10 evidence-based practices. 11 ‘‘(H) That the comprehensive school-based 12 mental health program carried out under this 13 section will be coordinated with early inter- 14 vening activities carried out under the Individ- 15 uals with Disabilities Education Act. 16 ‘‘(I) That the comprehensive school-based 17 mental health program carried out under this 18 section will be trauma-informed and culturally 19 and linguistically appropriate. 20 ‘‘(J) That the comprehensive school-based 21 mental health program carried out under this 22 section will include a broad needs assessment of 23 youth who drop out of school due to policies of 24 ‘zero tolerance’ with respect to drugs, alcohol, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00487 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 488 •HR 5942 IH or weapons and an inability to obtain appro- 1 priate services. 2 ‘‘(K) That the mental health services pro- 3 vided through the comprehensive school-based 4 mental health program carried out under this 5 section will be provided by qualified mental and 6 behavioral health professionals who are certified 7 or licensed by the State involved and practicing 8 within their area of expertise. 9 ‘‘(3) COORDINATOR.—Any entity that is a 10 member of a partnership described in paragraph 11 (1)(A) may serve as the coordinator of funding and 12 activities under the grant if all members of the part- 13 nership agree. 14 ‘‘(4) COMPLIANCE WITH HIPAA.—A grantee 15 under this section shall be deemed to be a covered 16 entity for purposes of compliance with the regula- 17 tions promulgated under section 264(c) of the 18 Health Insurance Portability and Accountability Act 19 of 1996 with respect to any patient records devel- 20 oped through activities under the grant. 21 ‘‘(d) GEOGRAPHICAL DISTRIBUTION.—The Secretary 22 shall ensure that grants, contracts, or cooperative agree- 23 ments under subsection (a) will be distributed equitably 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00488 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 489 •HR 5942 IH among the regions of the country and among urban and 1 rural areas. 2 ‘‘(e) DURATION OF AWARDS.—With respect to a 3 grant, contract, or cooperative agreement under sub- 4 section (a), the period during which payments under such 5 an award will be made to the recipient shall be 5 years. 6 An eligible entity described in subsection (c) may receive 7 only one award under this section, except that an eligible 8 entity that is providing services and supports on a regional 9 basis may receive additional funding after the expiration 10 of the preceding grant period. 11 ‘‘(f) EVALUATION AND MEASURES OF OUTCOMES.— 12 ‘‘(1) DEVELOPMENT OF PROCESS.—The Ad- 13 ministrator shall develop a fiscally appropriate proc- 14 ess for evaluating activities carried out under this 15 section. Such process shall include— 16 ‘‘(A) the development of guidelines for the 17 submission of program data by grant, contract, 18 or cooperative agreement recipients; 19 ‘‘(B) the development of measures of out- 20 comes (in accordance with paragraph (2)) to be 21 applied by such recipients in evaluating pro- 22 grams carried out under this section; and 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00489 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 490 •HR 5942 IH ‘‘(C) the submission of annual reports by 1 such recipients concerning the effectiveness of 2 programs carried out under this section. 3 ‘‘(2) MEASURES OF OUTCOMES.— 4 ‘‘(A) IN GENERAL.—The Administrator 5 shall develop measures of outcomes to be ap- 6 plied by recipients of assistance under this sec- 7 tion, and the Administrator, in evaluating the 8 effectiveness of programs carried out under this 9 section. Such measures shall include student 10 and family measures as provided for in sub- 11 paragraph (B) and local educational measures 12 as provided for under subparagraph (C). 13 ‘‘(B) STUDENT AND FAMILY MEASURES OF 14 OUTCOMES.—The measures of outcomes devel- 15 oped under paragraph (1)(B) relating to stu- 16 dents and families shall, with respect to activi- 17 ties carried out under a program under this 18 section, at a minimum include provisions to 19 evaluate whether the program is effective in— 20 ‘‘(i) increasing social and emotional 21 competency; 22 ‘‘(ii) increasing academic competency 23 (as defined by the Secretary); 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00490 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 491 •HR 5942 IH ‘‘(iii) reducing disruptive and aggres- 1 sive behaviors; 2 ‘‘(iv) improving child functioning; 3 ‘‘(v) reducing substance use disorders; 4 ‘‘(vi) reducing suspensions, truancy, 5 expulsions, and violence; 6 ‘‘(vii) increasing high school gradua- 7 tion rates, calculated using the four-year 8 adjusted cohort graduation rate or the ex- 9 tended-year adjusted cohort graduation 10 rate (as such terms are defined in section 11 8101 of the Elementary and Secondary 12 Education Act of 1965 (20 U.S.C. 7801)); 13 and 14 ‘‘(viii) improving access to care for 15 mental health disorders. 16 ‘‘(C) LOCAL EDUCATIONAL OUTCOMES.— 17 The outcome measures developed under para- 18 graph (1)(B) relating to local educational sys- 19 tems shall, with respect to activities carried out 20 under a program under this section, at a min- 21 imum include provisions to evaluate— 22 ‘‘(i) the effectiveness of comprehensive 23 school mental health programs established 24 under this section; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00491 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 492 •HR 5942 IH ‘‘(ii) the effectiveness of formal part- 1 nership linkages among child and family 2 serving institutions, community support 3 systems, and the educational system; 4 ‘‘(iii) the progress made in sustaining 5 the program once funding under the grant 6 has expired; 7 ‘‘(iv) the effectiveness of training and 8 professional development programs for all 9 school personnel that incorporate indica- 10 tors that measure cultural and linguistic 11 competencies under the program in a man- 12 ner that incorporates appropriate cultural 13 and linguistic training; 14 ‘‘(v) the improvement in perception of 15 a safe and supportive learning environment 16 among school staff, students, and parents; 17 ‘‘(vi) the improvement in case-finding 18 of students in need of more intensive serv- 19 ices and referral of identified students to 20 early intervention and clinical services; 21 ‘‘(vii) the improvement in the imme- 22 diate availability of clinical assessment and 23 treatment services within the context of 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00492 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 493 •HR 5942 IH the local community to students posing a 1 danger to themselves or others; 2 ‘‘(viii) the increased successful matric- 3 ulation to postsecondary school; and 4 ‘‘(ix) reduced referrals to juvenile jus- 5 tice. 6 ‘‘(3) SUBMISSION OF ANNUAL DATA.—An eligi- 7 ble entity described in subsection (c) that receives a 8 grant, contract, or cooperative agreement under this 9 section shall annually submit to the Administrator a 10 report that includes data to evaluate the success of 11 the program carried out by the entity based on 12 whether such program is achieving the purposes of 13 the program. Such reports shall utilize the measures 14 of outcomes under paragraph (2) in a reasonable 15 manner to demonstrate the progress of the program 16 in achieving such purposes. 17 ‘‘(4) EVALUATION BY ADMINISTRATOR.—Based 18 on the data submitted under paragraph (3), the Ad- 19 ministrator shall annually submit to Congress a re- 20 port concerning the results and effectiveness of the 21 programs carried out with assistance received under 22 this section. 23 ‘‘(5) LIMITATION.—An eligible entity shall use 24 not more than 10 percent of amounts received under 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00493 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 494 •HR 5942 IH a grant under this section to carry out evaluation 1 activities under this subsection. 2 ‘‘(g) INFORMATION AND EDUCATION.—The Sec- 3 retary shall establish comprehensive information and edu- 4 cation programs to disseminate the findings of the knowl- 5 edge development and application under this section to the 6 general public and to health care professionals. 7 ‘‘(h) AMOUNT OF GRANTS AND AUTHORIZATION OF 8 APPROPRIATIONS.— 9 ‘‘(1) AMOUNT OF GRANTS.—A grant under this 10 section shall be in an amount that is not more than 11 $2,000,000 for each of fiscal years 2019 through 12 2023. The Secretary shall determine the amount of 13 each such grant based on the population of children 14 up to age 21 of the area to be served under the 15 grant. 16 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 17 There is authorized to be appropriated to carry out 18 this section, $200,000,000 for each of fiscal years 19 2019 through 2023.’’. 20 (d) CONFORMING AMENDMENT.—Part G of title V 21 of the Public Health Service Act (42 U.S.C. 290hh et 22 seq.), as amended by this section, is further amended by 23 striking the part heading and inserting the following: 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00494 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 495 •HR 5942 IH ‘‘PART G—SCHOOL-BASED MENTAL HEALTH’’. 1 SEC. 608. GEO-ACCESS STUDY. 2 The Administrator of the Substance Abuse and Men- 3 tal Health Services Administration shall— 4 (1) conduct a study to— 5 (A) determine which geographic areas of 6 the United States have shortages of specialty 7 mental health providers; and 8 (B) assess the preparedness of speciality 9 mental health providers to deliver culturally and 10 linguistically appropriate, affordable, and acces- 11 sible services; and 12 (2) submit a report to the Congress on the re- 13 sults of such study. 14 TITLE VII—ADDRESSING HIGH 15 IMPACT MINORITY DISEASES 16 Subtitle A—Cancer 17 SEC. 701. LUNG CANCER MORTALITY REDUCTION. 18 (a) SHORT TITLE.—This section may be cited as the 19 ‘‘Lung Cancer Mortality Reduction Act of 2018’’. 20 (b) FINDINGS.—Congress makes the following find- 21 ings: 22 (1) Lung cancer is the leading cause of cancer 23 death for both men and women, accounting for 28 24 percent of all cancer deaths. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00495 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 496 •HR 5942 IH (2) Lung cancer kills more people annually 1 than breast cancer, prostate cancer, colon cancer, 2 liver cancer, melanoma, and kidney cancer combined. 3 (3) Since the National Cancer Act of 1971 4 (Public Law 92–218; 85 Stat. 778), coordinated and 5 comprehensive research has raised the 5-year sur- 6 vival rates for breast cancer to 88 percent, for pros- 7 tate cancer to 99 percent, and for colon cancer to 8 64 percent. 9 (4) The 5-year survival rate for lung cancer is 10 still only 15 percent, and a similar coordinated and 11 comprehensive research effort is required to achieve 12 increases in lung cancer survivability rates. 13 (5) Sixty percent of lung cancer cases are now 14 diagnosed as nonsmokers or former smokers. 15 (6) Two-thirds of nonsmokers diagnosed with 16 lung cancer are women. 17 (7) Certain minority populations, such as Afri- 18 can American males, have disproportionately high 19 rates of lung cancer incidence and mortality, not- 20 withstanding their similar smoking rate. 21 (8) Members of the baby boomer generation are 22 entering their sixties, the most common age at which 23 people develop lung cancer. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00496 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 497 •HR 5942 IH (9) Tobacco addiction and exposure to other 1 lung cancer carcinogens such as Agent Orange and 2 other herbicides and battlefield emissions are serious 3 problems among military personnel and war vet- 4 erans. 5 (10) Significant and rapid improvements in 6 lung cancer mortality can be expected through great- 7 er use and access to lung cancer screening tests for 8 at-risk individuals. 9 (11) Recent research has shown that screening 10 with low-dose computed tomography (CT) scan im- 11 proved lung cancer death mortality by 20 percent for 12 those with a high risk of lung cancer through early 13 detection. The Centers for Medicare & Medicaid 14 Services supports annual lung cancer screening for 15 high-risk patients with low-dose computed tomog- 16 raphy. 17 (12) Additional strategies are necessary to fur- 18 ther enhance the existing tests and therapies avail- 19 able to diagnose and treat lung cancer in the future. 20 (13) The August 2001 Report of the Lung 21 Cancer Progress Review Group of the National Can- 22 cer Institute stated that funding for lung cancer re- 23 search was ‘‘far below the levels characterized for 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00497 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 498 •HR 5942 IH other common malignancies and far out of propor- 1 tion to its massive health impact’’. 2 (14) The Report of the Lung Cancer Progress 3 Review Group identified as its ‘‘highest priority’’ the 4 creation of integrated, multidisciplinary, multi-insti- 5 tutional research consortia organized around the 6 problem of lung cancer rather than around specific 7 research disciplines. 8 (15) The United States must enhance its re- 9 sponse to the issues raised in the Report of the 10 Lung Cancer Progress Review Group, and this can 11 be accomplished through the establishment of a co- 12 ordinated effort designed to reduce the lung cancer 13 mortality rate by 50 percent by 2020 and targeted 14 funding to support this coordinated effort. 15 (c) SENSE OF CONGRESS CONCERNING INVESTMENT 16 IN LUNG CANCER RESEARCH.—It is the sense of the Con- 17 gress that— 18 (1) lung cancer mortality reduction should be 19 made a national public health priority; and 20 (2) a comprehensive mortality reduction pro- 21 gram coordinated by the Secretary of Health and 22 Human Services is justified and necessary to ade- 23 quately address and reduce lung cancer mortality. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00498 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 499 •HR 5942 IH (d) LUNG CANCER MORTALITY REDUCTION PRO- 1 GRAM.— 2 (1) IN GENERAL.—Subpart 1 of part C of title 3 IV of the Public Health Service Act (42 U.S.C. 285 4 et seq.) is amended by adding at the end the fol- 5 lowing: 6 ‘‘SEC. 417H. LUNG CANCER MORTALITY REDUCTION PRO- 7 GRAM. 8 ‘‘(a) IN GENERAL.—Not later than 6 months after 9 the date of the enactment of this section, the Secretary, 10 in consultation with the Secretary of Defense, the Sec- 11 retary of Veterans Affairs, the Director of the National 12 Institutes of Health, the Director of the Centers for Dis- 13 ease Control and Prevention, the Commissioner of Food 14 and Drugs, the Administrator of the Centers for Medicare 15 & Medicaid Services, the Director of the National Institute 16 on Minority Health and Health Disparities, and other 17 members of the Lung Cancer Advisory Board established 18 under section 701 of the Health Equity and Accountability 19 Act of 2018, shall implement a comprehensive program, 20 to be known as the Lung Cancer Mortality Reduction Pro- 21 gram, to achieve a reduction of at least 25 percent in the 22 mortality rate of lung cancer by 2020. 23 ‘‘(b) REQUIREMENTS.—The Program shall include at 24 least the following: 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00499 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 500 •HR 5942 IH ‘‘(1) With respect to the National Institutes of 1 Health— 2 ‘‘(A) a strategic review and prioritization 3 by the National Cancer Institute of research 4 grants to achieve the goal of the Lung Cancer 5 Mortality Reduction Program in reducing lung 6 cancer mortality; 7 ‘‘(B) the provision of funds to enable the 8 Airway Biology and Disease Branch of the Na- 9 tional Heart, Lung, and Blood Institute to ex- 10 pand its research programs to include pre- 11 dispositions to lung cancer, the interrelationship 12 between lung cancer and other pulmonary and 13 cardiac disease, and the diagnosis and treat- 14 ment of these interrelationships; 15 ‘‘(C) the provision of funds to enable the 16 National Institute of Biomedical Imaging and 17 Bioengineering to expedite the development of 18 computer-assisted diagnostic, surgical, treat- 19 ment, and drug-testing innovations to reduce 20 lung cancer mortality, such as through expan- 21 sion of the Institute’s Quantum Grant Program 22 and Image-Guided Interventions programs; and 23 ‘‘(D) the provision of funds to enable the 24 National Institute of Environmental Health 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00500 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 501 •HR 5942 IH Sciences to implement research programs rel- 1 ative to the lung cancer incidence. 2 ‘‘(2) With respect to the Food and Drug Ad- 3 ministration— 4 ‘‘(A) activities under section 530 of the 5 Federal Food, Drug, and Cosmetic Act; and 6 ‘‘(B) activities under section 561 of the 7 Federal Food, Drug, and Cosmetic Act to ex- 8 pand access to investigational drugs and devices 9 for the diagnosis, monitoring, or treatment of 10 lung cancer. 11 ‘‘(3) With respect to the Centers for Disease 12 Control and Prevention, the establishment of an 13 early disease research and management program 14 under section 1511. 15 ‘‘(4) With respect to the Agency for Healthcare 16 Research and Quality, the conduct of a biannual re- 17 view of lung cancer screening, diagnostic, and treat- 18 ment protocols, and the issuance of updated guide- 19 lines. 20 ‘‘(5) The promotion (including education) of 21 lung cancer screening within minority and rural pop- 22 ulations and the study of the effectiveness of efforts 23 to increase such screening. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00501 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 502 •HR 5942 IH ‘‘(6) The cooperation and coordination of all 1 minority and health disparity programs within the 2 Department of Health and Human Services to en- 3 sure that all aspects of the Lung Cancer Mortality 4 Reduction Program under this section adequately 5 address the burden of lung cancer on minority and 6 rural populations. 7 ‘‘(7) The cooperation and coordination of all to- 8 bacco control and cessation programs within agen- 9 cies of the Department of Health and Human Serv- 10 ices to achieve the goals of the Lung Cancer Mor- 11 tality Reduction Program under this section with 12 particular emphasis on the coordination of drug and 13 other cessation treatments with early detection pro- 14 tocols.’’. 15 (2) FEDERAL FOOD, DRUG, AND COSMETIC 16 ACT.—Subchapter B of chapter V of the Federal 17 Food, Drug, and Cosmetic Act (21 U.S.C. 360aaa et 18 seq.) is amended by adding at the end the following: 19 ‘‘DRUGS RELATING TO LUNG CANCER 20 ‘‘SEC. 530. (a) IN GENERAL.—The provisions of this 21 subchapter shall apply to a drug described in subsection 22 (b) to the same extent and in the same manner as such 23 provisions apply to a drug for a rare disease or condition. 24 ‘‘(b) QUALIFIED DRUGS.—A drug described in this 25 subsection is— 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00502 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 503 •HR 5942 IH ‘‘(1) a chemoprevention drug for precancerous 1 conditions of the lung; 2 ‘‘(2) a drug for targeted therapeutic treat- 3 ments, including any vaccine, for lung cancer; and 4 ‘‘(3) a drug to curtail or prevent nicotine addic- 5 tion. 6 ‘‘(c) BOARD.—The Board established under the 7 Health Equity and Accountability Act of 2018 shall mon- 8 itor the program implemented under this section.’’. 9 (3) ACCESS TO UNAPPROVED THERAPIES.—Sec- 10 tion 561(e) of the Federal Food, Drug, and Cos- 11 metic Act (21 U.S.C. 360bbb(e)) is amended by in- 12 serting before the period the following: ‘‘and shall 13 include expanding access to drugs under section 14 530, with substantial consideration being given to 15 whether the totality of information available to the 16 Secretary regarding the safety and effectiveness of 17 an investigational drug, as compared to the risk of 18 morbidity and death from the disease, indicates that 19 a patient may obtain more benefit than risk if treat- 20 ed with the drug’’. 21 (4) CDC.—Title XV of the Public Health Serv- 22 ice Act (42 U.S.C. 300k et seq.) is amended by add- 23 ing at the end the following: 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00503 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 504 •HR 5942 IH ‘‘SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT 1 PROGRAM. 2 ‘‘The Secretary shall establish and implement an 3 early disease research and management program targeted 4 at the high incidence and mortality rates of lung cancer 5 among minority and low-income populations.’’. 6 (e) DEPARTMENT OF DEFENSE AND THE DEPART- 7 MENT OF VETERANS AFFAIRS.—The Secretary of Defense 8 and the Secretary of Veterans Affairs shall coordinate 9 with the Secretary of Health and Human Services— 10 (1) in the development of the Lung Cancer 11 Mortality Reduction Program under section 417H; 12 (2) in the implementation within the Depart- 13 ment of Defense and the Department of Veterans 14 Affairs of an early detection and disease manage- 15 ment research program for military personnel and 16 veterans whose smoking history and exposure to car- 17 cinogens during active duty service has increased 18 their risk for lung cancer; and 19 (3) in the implementation of coordinated care 20 programs for military personnel and veterans diag- 21 nosed with lung cancer. 22 (f) LUNG CANCER ADVISORY BOARD.— 23 (1) IN GENERAL.—The Secretary of Health and 24 Human Services shall convene a Lung Cancer Advi- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00504 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 505 •HR 5942 IH sory Board (referred to in this section as the 1 ‘‘Board’’)— 2 (A) to monitor the programs established 3 under this section (and the amendments made 4 by this section); and 5 (B) to provide annual reports to the Con- 6 gress concerning benchmarks, expenditures, 7 lung cancer statistics, and the public health im- 8 pact of such programs. 9 (2) COMPOSITION.—The Board shall be com- 10 posed of— 11 (A) the Secretary of Health and Human 12 Services; 13 (B) the Secretary of Defense; 14 (C) the Secretary of Veterans Affairs; and 15 (D) two representatives each from the 16 fields of clinical medicine focused on lung can- 17 cer, lung cancer research, imaging, drug devel- 18 opment, and lung cancer advocacy, to be ap- 19 pointed by the Secretary of Health and Human 20 Services. 21 (g) AUTHORIZATION OF APPROPRIATIONS.— 22 (1) IN GENERAL.—To carry out this section 23 (and the amendments made by this section), there 24 are authorized to be appropriated such sums as may 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00505 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 506 •HR 5942 IH be necessary for each of fiscal years 2019 through 1 2023. 2 (2) LUNG CANCER MORTALITY REDUCTION PRO- 3 GRAM.—Of the amounts authorized to be appro- 4 priated by subsection (a), there are authorized to be 5 appropriated— 6 (A) $25,000,000 for fiscal year 2019, and 7 such sums as may be necessary for each of fis- 8 cal years 2020 through 2023, for the activities 9 described in section 417H(b)(1)(B) of the Pub- 10 lic Health Service Act, as added by subsection 11 (d)(1); 12 (B) $25,000,000 for fiscal year 2019, and 13 such sums as may be necessary for each of fis- 14 cal years 2020 through 2023, for the activities 15 described in section 417H(b)(1)(C) of such Act; 16 (C) $10,000,000 for fiscal year 2019, and 17 such sums as may be necessary for each of fis- 18 cal years 2020 through 2023, for the activities 19 described in section 417H(b)(1)(D) of such Act; 20 and 21 (D) $15,000,000 for fiscal year 2019, and 22 such sums as may be necessary for each of fis- 23 cal years 2020 through 2023, for the activities 24 described in section 417H(b)(3) of such Act. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00506 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 507 •HR 5942 IH SEC. 702. EXPANDING PROSTATE CANCER RESEARCH, OUT- 1 REACH, SCREENING, TESTING, ACCESS, AND 2 TREATMENT EFFECTIVENESS. 3 (a) SHORT TITLE.—This section may be cited as the 4 ‘‘Prostate Research, Outreach, Screening, Testing, Access, 5 and Treatment Effectiveness Act of 2018’’ or the ‘‘PROS- 6 TATE Act’’. 7 (b) FINDINGS.—Congress makes the following find- 8 ings: 9 (1) Prostate cancer is the second leading cause 10 of cancer death among men. 11 (2) In 2010, more than 217,730 new patients 12 were diagnosed with prostate cancer and more than 13 32,000 men died from this disease. 14 (3) Roughly 2,000,000 Americans are living 15 with a diagnosis of prostate cancer and its con- 16 sequences. 17 (4) While prostate cancer generally affects older 18 individuals, younger men are also at risk for the dis- 19 ease, and when prostate cancer appears in early 20 middle age, it frequently takes on a more aggressive 21 form. 22 (5) There are significant racial and ethnic dis- 23 parities that demand attention, namely African 24 Americans have prostate cancer mortality rates that 25 are more than double those in the White population. 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00507 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 508 •HR 5942 IH (6) Underserved rural populations have higher 1 rates of mortality compared to their urban counter- 2 parts, and innovative and cost-efficient methods to 3 improve rural access to high-quality care should take 4 advantage of advances in telehealth to diagnose and 5 treat prostate cancer when appropriate. 6 (7) Certain veterans populations may have 7 nearly twice the incidence of prostate cancer as the 8 general population of the United States. 9 (8) Urologists may constitute the specialists 10 who diagnose and treat the vast majority of prostate 11 cancer patients. 12 (9) Although much basic and translational re- 13 search has been completed and much is currently 14 known, there are still many unanswered questions. 15 For example, it is not fully understood how much of 16 known disparities are attributable to disease eti- 17 ology, access to care, or education and awareness in 18 the community. 19 (10) Causes of prostate cancer are not known. 20 There is not good information regarding how to dif- 21 ferentiate accurately, early on, between aggressive 22 and indolent forms of the disease. As a result, there 23 is significant overtreatment in prostate cancer. 24 There are no treatments that can durably arrest 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00508 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 509 •HR 5942 IH growth or cure prostate cancer once it has metasta- 1 sized. 2 (11) A significant proportion (roughly 23 to 54 3 percent) of cases may be clinically indolent and 4 ‘‘overdiagnosed’’, resulting in significant overtreat- 5 ment. More accurate tests will allow men and their 6 families to face less physical, psychological, financial, 7 and emotional trauma, and billions of dollars could 8 be saved in private and public health care systems 9 in an area that has been identified by the Medicare 10 Program as one of eight high-volume, high-cost 11 areas in the Resource Utilization Report Program 12 authorized by Congress under the Medicare Im- 13 provements for Patients and Providers Act of 2008. 14 (12) Prostate cancer research and health care 15 programs across Federal agencies should be coordi- 16 nated to improve accountability and actively encour- 17 age the translation of research into practice, to iden- 18 tify and implement best practices, in order to foster 19 an integrated and consistent focus on effective pre- 20 vention, diagnosis, and treatment of this disease. 21 (c) PROSTATE CANCER COORDINATION AND EDU- 22 CATION.— 23 (1) INTERAGENCY PROSTATE CANCER COORDI- 24 NATION AND EDUCATION TASK FORCE.—Not later 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00509 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 510 •HR 5942 IH than 180 days after the date of the enactment of 1 this section, the Secretary of Veterans Affairs, in co- 2 operation with the Secretary of Defense and the Sec- 3 retary of Health and Human Services, shall estab- 4 lish an Interagency Prostate Cancer Coordination 5 and Education Task Force (in this section referred 6 to as the ‘‘Prostate Cancer Task Force’’). 7 (2) DUTIES.—The Prostate Cancer Task Force 8 shall— 9 (A) develop a summary of advances in 10 prostate cancer research supported or con- 11 ducted by Federal agencies relevant to the diag- 12 nosis, prevention, and treatment of prostate 13 cancer, including psychosocial impairments re- 14 lated to prostate cancer treatment, and compile 15 a list of best practices that warrant broader 16 adoption in health care programs; 17 (B) consider establishing, and advocating 18 for, a guidance to enable physicians to allow 19 screening of men who are over age 74, on a 20 case-by-case basis, taking into account quality 21 of life and family history of prostate cancer; 22 (C) share and coordinate information on 23 Federal research and health care program ac- 24 tivities, including activities related to— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00510 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 511 •HR 5942 IH (i) determining how to improve re- 1 search and health care programs, including 2 psychosocial impairments related to pros- 3 tate cancer treatment; 4 (ii) identifying any gaps in the overall 5 research inventory and in health care pro- 6 grams; 7 (iii) identifying opportunities to pro- 8 mote translation of research into practice; 9 and 10 (iv) maximizing the effects of Federal 11 efforts by identifying opportunities for col- 12 laboration and leveraging of resources in 13 research and health care programs that 14 serve those susceptible to or diagnosed 15 with prostate cancer; 16 (D) develop a comprehensive interagency 17 strategy and advise relevant Federal agencies in 18 the solicitation of proposals for collaborative, 19 multidisciplinary research and health care pro- 20 grams, including proposals to evaluate factors 21 that may be related to the etiology of prostate 22 cancer, that would— 23 (i) result in innovative approaches to 24 study emerging scientific opportunities or 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00511 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 512 •HR 5942 IH eliminate knowledge gaps in research to 1 improve the prostate cancer research port- 2 folio of the Federal Government; 3 (ii) outline key research questions, 4 methodologies, and knowledge gaps; and 5 (iii) ensure consistent action, as out- 6 lined by section 402(b) of the Public 7 Health Service Act; 8 (E) develop a coordinated message related 9 to screening and treatment for prostate cancer 10 to be reflected in educational and beneficiary 11 materials for Federal health programs as such 12 documents are updated; and 13 (F) not later than 2 years after the date 14 of the establishment of the Prostate Cancer 15 Task Force, submit to the Expert Advisory 16 Panel to be reviewed and returned within 30 17 days, and then within 90 days submitted to 18 Congress recommendations— 19 (i) regarding any appropriate changes 20 to research and health care programs, in- 21 cluding recommendations to improve the 22 research portfolio of the Department of 23 Veterans Affairs, the Department of De- 24 fense, National Institutes of Health, and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00512 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 513 •HR 5942 IH other Federal agencies to ensure that sci- 1 entifically based strategic planning is im- 2 plemented in support of research and 3 health care program priorities; 4 (ii) designed to ensure that the re- 5 search and health care programs and ac- 6 tivities of the Department of Veterans Af- 7 fairs, the Department of Defense, the De- 8 partment of Health and Human Services, 9 and other Federal agencies are free of un- 10 necessary duplication; 11 (iii) regarding public participation in 12 decisions relating to prostate cancer re- 13 search and health care programs to in- 14 crease the involvement of patient advo- 15 cates, community organizations, and med- 16 ical associations representing a broad geo- 17 graphical area; 18 (iv) on how to best disseminate infor- 19 mation on prostate cancer research and 20 progress achieved by health care programs; 21 (v) about how to expand partnerships 22 between public entities, including Federal 23 agencies, and private entities to encourage 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00513 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 514 •HR 5942 IH collaborative, cross-cutting research and 1 health care delivery; 2 (vi) assessing any cost savings and ef- 3 ficiencies realized through the efforts iden- 4 tified and supported in this section and 5 recommending expansion of those efforts 6 that have proved most promising while also 7 ensuring against any conflicts in directives 8 from other congressional or statutory man- 9 dates or enabling statutes; 10 (vii) identifying key priority action 11 items from among the recommendations; 12 and 13 (viii) with respect to the level of fund- 14 ing needed by each agency to implement 15 the recommendations contained in the re- 16 port. 17 (3) MEMBERS OF THE PROSTATE CANCER TASK 18 FORCE.—The Prostate Cancer Task Force described 19 in this subsection shall be composed of representa- 20 tives from such Federal agencies, as each Secretary 21 determines necessary, to coordinate a uniform mes- 22 sage relating to prostate cancer screening and treat- 23 ment where appropriate, including representatives of 24 the following: 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00514 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 515 •HR 5942 IH (A) The Department of Veterans Affairs, 1 including representatives of each relevant pro- 2 gram area of the Department of Veterans Af- 3 fairs. 4 (B) The Prostate Cancer Research Pro- 5 gram of the Congressionally Directed Medical 6 Research Program of the Department of De- 7 fense. 8 (C) The Department of Health and 9 Human Services, including at a minimum rep- 10 resentatives of the following: 11 (i) The National Institutes of Health. 12 (ii) National research institutes and 13 centers, including the National Cancer In- 14 stitute, the National Institute of Allergy 15 and Infectious Diseases, and the Office of 16 Minority Health. 17 (iii) The Centers for Medicare & Med- 18 icaid Services. 19 (iv) The Food and Drug Administra- 20 tion. 21 (v) The Centers for Disease Control 22 and Prevention. 23 (vi) The Agency for Healthcare Re- 24 search and Quality. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00515 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 516 •HR 5942 IH (vii) The Health Resources and Serv- 1 ices Administration. 2 (4) APPOINTING EXPERT ADVISORY PANELS.— 3 The Prostate Cancer Task Force shall appoint ex- 4 pert advisory panels, as determined appropriate, to 5 provide input and concurrence from individuals and 6 organizations from the medical, prostate cancer pa- 7 tient and advocate, research, and delivery commu- 8 nities with expertise in prostate cancer diagnosis, 9 treatment, and research, including practicing urolo- 10 gists, primary care providers, and others and indi- 11 viduals with expertise in education and outreach to 12 underserved populations affected by prostate cancer. 13 (5) MEETINGS.—The Prostate Cancer Task 14 Force shall convene not less than twice a year, or 15 more frequently as the Secretary determines to be 16 appropriate. 17 (6) FEDERAL ADVISORY COMMITTEE ACT.— 18 (A) IN GENERAL.—Except as provided in 19 subparagraph (B), the Federal Advisory Com- 20 mittee Act (5 U.S.C. App.) shall apply to the 21 Prostate Cancer Task Force. 22 (B) EXCEPTION.—Section 14(a)(2)(B) of 23 such Act (relating to the termination of advi- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00516 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 517 •HR 5942 IH sory committees) shall not apply to the Prostate 1 Cancer Task Force. 2 (7) SUNSET DATE.—The Prostate Cancer Task 3 Force shall terminate at the end of fiscal year 2021. 4 (d) PROSTATE CANCER RESEARCH.— 5 (1) RESEARCH COORDINATION.—The Secretary 6 of Veterans Affairs, in coordination with the Secre- 7 taries of Defense and of Health and Human Serv- 8 ices, shall establish and carry out a program to co- 9 ordinate and intensify prostate cancer research as 10 needed. Specifically, such research program shall— 11 (A) develop advances in diagnostic and 12 prognostic methods and tests, including bio- 13 markers and an improved prostate cancer 14 screening blood test, including improvements or 15 alternatives to the prostate specific antigen test 16 and additional tests to distinguish indolent from 17 aggressive disease; 18 (B) better understand the etiology of the 19 disease (including an analysis of lifestyle factors 20 proven to be involved in higher rates of prostate 21 cancer, such as obesity and diet, and in dif- 22 ferent ethnic, racial, and socioeconomic groups, 23 such as the African-American, Latino or His- 24 panic, and American Indian populations and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00517 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 518 •HR 5942 IH men with a family history of prostate cancer) to 1 improve prevention efforts; 2 (C) expand basic research into prostate 3 cancer, including studies of fundamental molec- 4 ular and cellular mechanisms; 5 (D) identify and provide clinical testing of 6 novel agents for the prevention and treatment 7 of prostate cancer; 8 (E) establish clinical registries for prostate 9 cancer; 10 (F) use the National Institute of Bio- 11 medical Imaging and Bioengineering and the 12 National Cancer Institute for assessment of ap- 13 propriate imaging modalities; and 14 (G) address such other matters relating to 15 prostate cancer research as may be identified by 16 the Federal agencies participating in the pro- 17 gram under this section. 18 (2) PROSTATE CANCER ADVISORY BOARD.— 19 There is established in the Office of the Chief Sci- 20 entist of the Food and Drug Administration a Pros- 21 tate Cancer Scientific Advisory Board. Such board 22 shall be responsible for accelerating real-time shar- 23 ing of the latest research data and accelerating 24 movement of new medicines to patients. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00518 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 519 •HR 5942 IH (3) UNDERSERVED MINORITY GRANT PRO- 1 GRAM.—In carrying out such program, the Secretary 2 shall— 3 (A) award grants to eligible entities to 4 carry out components of the research outlined 5 in paragraph (1); 6 (B) integrate and build upon existing 7 knowledge gained from comparative effective- 8 ness research; and 9 (C) recognize and address— 10 (i) the racial and ethnic disparities in 11 the incidence and mortality rates of pros- 12 tate cancer and men with a family history 13 of prostate cancer; 14 (ii) any barriers in access to care and 15 participation in clinical trials that are spe- 16 cific to racial, ethnic, and other under- 17 served minorities and men with a family 18 history of prostate cancer; 19 (iii) needed outreach and educational 20 efforts to raise awareness in these commu- 21 nities; and 22 (iv) appropriate access and utilization 23 of imaging modalities. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00519 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 520 •HR 5942 IH (e) TELEHEALTH AND RURAL ACCESS PILOT 1 PROJECTS.— 2 (1) IN GENERAL.—The Secretary of Veterans 3 Affairs, the Secretary of Defense, and the Secretary 4 of Health and Human Services (in this section re- 5 ferred to as the ‘‘Secretaries’’) shall establish 4-year 6 telehealth pilot projects for the purpose of analyzing 7 the clinical outcomes and cost-effectiveness associ- 8 ated with telehealth services in a variety of geo- 9 graphic areas that contain high proportions of medi- 10 cally underserved populations, including African 11 Americans, Latinos or Hispanics, American Indians 12 or Alaska Natives, and those in rural areas. Such 13 projects shall promote efficient use of specialist care 14 through better coordination of primary care and 15 physician extender teams in underserved areas and 16 more effectively employ tumor boards to better coun- 17 sel patients. 18 (2) ELIGIBLE ENTITIES.— 19 (A) IN GENERAL.—The Secretaries shall 20 select eligible entities to participate in the pilot 21 projects under this section. 22 (B) PRIORITY.—In selecting eligible enti- 23 ties to participate in the pilot projects under 24 this section, the Secretaries shall give priority 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00520 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 521 •HR 5942 IH to such entities located in medically under- 1 served areas, particularly those that include Af- 2 rican Americans, Latinos and Hispanics, and 3 facilities of the Indian Health Service, including 4 Indian Health Service-operated facilities, trib- 5 ally operated facilities, and Urban Indian Clin- 6 ics, and those in rural areas. 7 (3) EVALUATION.—The Secretaries shall, 8 through the pilot projects, evaluate— 9 (A) the effective and economic delivery of 10 care in diagnosing and treating prostate cancer 11 with the use of telehealth services in medically 12 underserved and Tribal areas including collabo- 13 rative uses of health professionals and integra- 14 tion of the range of telehealth and other tech- 15 nologies; 16 (B) the effectiveness of improving the ca- 17 pacity of nonmedical providers and nonspecial- 18 ized medical providers to provide health services 19 for prostate cancer in medically underserved 20 and Tribal areas, including the exploration of 21 innovative medical home models with collabora- 22 tion between urologists, other relevant medical 23 specialists, including oncologists, radiologists, 24 and primary care teams and coordination of 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00521 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 522 •HR 5942 IH care through the efficient use of primary care 1 teams and physician extenders; and 2 (C) the effectiveness of using telehealth 3 services to provide prostate cancer treatment in 4 medically underserved areas, including the use 5 of tumor boards to facilitate better patient 6 counseling. 7 (4) REPORT.—Not later than 12 months after 8 the completion of the pilot projects under this sub- 9 section, the Secretaries shall submit to Congress a 10 report describing the outcomes of such pilot projects, 11 including any cost savings and efficiencies realized, 12 and providing recommendations, if any, for expand- 13 ing the use of telehealth services. 14 (f) EDUCATION AND AWARENESS.— 15 (1) IN GENERAL.—The Secretary of Veterans 16 Affairs shall develop a national education campaign 17 for prostate cancer. Such campaign shall involve the 18 use of written educational materials and public serv- 19 ice announcements consistent with the findings of 20 the Prostate Cancer Task Force under subsection 21 (c), that are intended to encourage men to seek 22 prostate cancer screening when appropriate. 23 (2) RACIAL DISPARITIES AND THE POPULATION 24 OF MEN WITH A FAMILY HISTORY OF PROSTATE 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00522 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 523 •HR 5942 IH CANCER.—In developing the national campaign 1 under paragraph (1), the Secretary shall ensure that 2 such educational materials and public service an- 3 nouncements are more readily available in commu- 4 nities experiencing racial disparities in the incidence 5 and mortality rates of prostate cancer and by men 6 of any race classification with a family history of 7 prostate cancer. 8 (3) GRANTS.—In carrying out the national 9 campaign under this section, the Secretary shall 10 award grants to nonprofit private entities to enable 11 such entities to test alternative outreach and edu- 12 cation strategies. 13 (g) AUTHORIZATION OF APPROPRIATIONS.— 14 (1) IN GENERAL.—There is authorized to be 15 appropriated to carry out this section for the period 16 of fiscal years 2019 through 2023 an amount equal 17 to the savings described in paragraph (2). 18 (2) CORRESPONDING REDUCTION.—The 19 amount authorized to be appropriated by provisions 20 of law other than this section for the period of fiscal 21 years 2019 through 2023 for Federal research and 22 health care program activities related to prostate 23 cancer is reduced by the amount of Federal savings 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00523 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 524 •HR 5942 IH projected to be achieved over such period by imple- 1 mentation of this section. 2 SEC. 703. IMPROVED MEDICAID COVERAGE FOR CERTAIN 3 BREAST AND CERVICAL CANCER PATIENTS 4 IN THE TERRITORIES. 5 (a) ELIMINATION OF FUNDING LIMITATIONS.— 6 (1) IN GENERAL.—Section 1108(g)(4) of the 7 Social Security Act (42 U.S.C. 1308(g)(4)) is 8 amended by adding at the end the following: ‘‘With 9 respect to fiscal years beginning with fiscal year 10 2019, payment for medical assistance for individuals 11 who are eligible for such assistance only on the basis 12 of section 1902(a)(10)(A)(ii)(XVIII) shall not be 13 taken into account in applying subsection (f) (as in- 14 creased in accordance with paragraphs (1), (2), (3), 15 and (5) of this subsection) to such commonwealth or 16 territory for such fiscal year.’’. 17 (2) TECHNICAL AMENDMENT.—Such section is 18 further amended by striking ‘‘(3), and (4)’’ and in- 19 serting ‘‘(3), and (5)’’. 20 (b) APPLICATION OF ENHANCED FMAP FOR HIGH- 21 EST STATE.—Section 1905(b) of such Act (42 U.S.C. 22 1396d(b)) is amended by adding at the end the following: 23 ‘‘Notwithstanding the first sentence of this subsection, 24 with respect to medical assistance described in clause (4) 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00524 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 525 •HR 5942 IH of such sentence that is furnished in Puerto Rico, the 1 United States Virgin Islands, Guam, the Commonwealth 2 of the Northern Mariana Islands, or American Samoa in 3 a fiscal year, the Federal medical assistance percentage 4 is equal to the highest such percentage applied under such 5 clause for such fiscal year for any of the 50 States or the 6 District of Columbia that provides such medical assistance 7 for any portion of such fiscal year.’’ 8 (c) EFFECTIVE DATE.—The amendments made by 9 this section shall apply to payment for medical assistance 10 for items and services furnished on or after October 1, 11 2016. 12 SEC. 704. CANCER PREVENTION AND TREATMENT DEM- 13 ONSTRATION FOR ETHNIC AND RACIAL MI- 14 NORITIES. 15 (a) DEMONSTRATION.— 16 (1) IN GENERAL.—The Secretary of Health and 17 Human Services (in this section referred to as the 18 ‘‘Secretary’’) shall conduct demonstration projects 19 (in this section referred to as ‘‘demonstration 20 projects’’) for the purpose of developing models and 21 evaluating methods that— 22 (A) improve the quality of items and serv- 23 ices provided to target individuals in order to 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00525 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 526 •HR 5942 IH facilitate reduced disparities in early detection 1 and treatment of cancer; 2 (B) improve clinical outcomes, satisfaction, 3 quality of life, appropriate use of items and 4 services covered under the Medicare Program 5 under title XVIII of the Social Security Act (42 6 U.S.C. 1395 et seq.), and referral patterns with 7 respect to target individuals with cancer; 8 (C) eliminate disparities in the rate of pre- 9 ventive cancer screening measures, such as Pap 10 smears, prostate cancer screenings, colon cancer 11 screenings, breast cancer screenings, and com- 12 puted tomography (CT) scans, for lung cancer 13 among target individuals; 14 (D) promote collaboration with community- 15 based organizations to ensure cultural com- 16 petency of health care professionals and lin- 17 guistic access for target individuals who are 18 persons with limited-English proficiency; and 19 (E) encourage the incorporation of commu- 20 nity health workers to increase the efficiency 21 and appropriateness of cancer screening pro- 22 grams. 23 (2) COMMUNITY HEALTH WORKER DEFINED.— 24 In this section, the term ‘‘community health worker’’ 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00526 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 527 •HR 5942 IH includes a community health advocate, a lay health 1 worker, a community health representative, a peer 2 health promoter, a community health outreach work- 3 er, and a promotore de salud, who promotes health 4 or nutrition within the community in which the indi- 5 vidual resides. 6 (3) TARGET INDIVIDUAL DEFINED.—In this 7 section, the term ‘‘target individual’’ means an indi- 8 vidual of a racial and ethnic minority group, as de- 9 fined in section 1707(g)(1) of the Public Health 10 Service Act (42 U.S.C. 300u–6(g)(1)), who is enti- 11 tled to benefits under part A, and enrolled under 12 part B, of title XVIII of the Social Security Act. 13 (b) PROGRAM DESIGN.— 14 (1) INITIAL DESIGN.—Not later than 1 year 15 after the date of the enactment of this Act, the Sec- 16 retary shall evaluate best practices in the private 17 sector, community programs, and academic research 18 of methods that reduce disparities among individuals 19 of racial and ethnic minority groups in the preven- 20 tion and treatment of cancer and shall design the 21 demonstration projects based on such evaluation. 22 (2) NUMBER AND PROJECT AREAS.—Not later 23 than 2 years after the date of the enactment of this 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00527 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 528 •HR 5942 IH Act, the Secretary shall implement at least nine 1 demonstration projects, including the following: 2 (A) Two projects, each of which shall tar- 3 get different ethnic subpopulations, for each of 4 the four following major racial and ethnic mi- 5 nority groups: 6 (i) American Indians and Alaska Na- 7 tives, Eskimos and Aleuts. 8 (ii) Asian Americans. 9 (iii) Blacks/African Americans. 10 (iv) Latinos or Hispanics. 11 (v) Native Hawaiians and other Pa- 12 cific Islanders. 13 (B) One project within the Pacific Islands 14 or United States insular areas. 15 (C) At least one project each in a rural 16 area and inner-city area. 17 (3) EXPANSION OF PROJECTS; IMPLEMENTA- 18 TION OF DEMONSTRATION PROJECT RESULTS.—If 19 the initial report under subsection (c) contains an 20 evaluation that demonstration projects— 21 (A) reduce expenditures under the Medi- 22 care Program under title XVIII of the Social 23 Security Act (42 U.S.C. 1395 et seq.); or 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00528 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 529 •HR 5942 IH (B) do not increase expenditures under the 1 Medicare Program and reduce racial and ethnic 2 health disparities in the quality of health care 3 services provided to target individuals and in- 4 crease satisfaction of Medicare beneficiaries and 5 health care providers; 6 the Secretary shall continue the existing demonstra- 7 tion projects and may expand the number of dem- 8 onstration projects. 9 (c) REPORT TO CONGRESS.— 10 (1) IN GENERAL.—Not later than 2 years after 11 the date the Secretary implements the initial dem- 12 onstration projects, and biannually thereafter, the 13 Secretary shall submit to Congress a report regard- 14 ing the demonstration projects. 15 (2) CONTENTS OF REPORT.—Each report under 16 paragraph (1) shall include the following: 17 (A) A description of the demonstration 18 projects. 19 (B) An evaluation of— 20 (i) the cost-effectiveness of the dem- 21 onstration projects; 22 (ii) the quality of the health care serv- 23 ices provided to target individuals under 24 the demonstration projects; and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00529 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 530 •HR 5942 IH (iii) beneficiary and health care pro- 1 vider satisfaction under the demonstration 2 projects. 3 (C) Any other information regarding the 4 demonstration projects that the Secretary de- 5 termines to be appropriate. 6 (d) WAIVER AUTHORITY.—The Secretary shall waive 7 compliance with the requirements of title XVIII of the So- 8 cial Security Act (42 U.S.C. 1395 et seq.) to such extent 9 and for such period as the Secretary determines is nec- 10 essary to conduct demonstration projects. 11 SEC. 705. REDUCING CANCER DISPARITIES WITHIN MEDI- 12 CARE. 13 (a) DEVELOPMENT OF MEASURES OF DISPARITIES 14 IN QUALITY OF CANCER CARE.— 15 (1) DEVELOPMENT OF MEASURES.—The Sec- 16 retary of Health and Human Services (in this sec- 17 tion referred to as the ‘‘Secretary’’) shall enter into 18 an agreement with an entity that specializes in de- 19 veloping quality measures for cancer care under 20 which the entity shall develop a uniform set of meas- 21 ures to evaluate disparities in the quality of cancer 22 care and annually update such set of measures. 23 (2) MEASURES TO BE INCLUDED.—Such set of 24 measures shall include, with respect to the treatment 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00530 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 531 •HR 5942 IH of cancer, measures of patient outcomes, the process 1 for delivering medical care related to such treat- 2 ment, patient counseling and engagement in deci- 3 sionmaking, patient experience of care, resource use, 4 and practice capabilities, such as care coordination. 5 (b) ESTABLISHMENT OF REPORTING PROCESS.— 6 (1) IN GENERAL.—The Secretary shall establish 7 a reporting process that requires and provides for a 8 method for health care providers specified under 9 paragraph (2) to submit to the Secretary and make 10 public data on the performance of such providers 11 during each reporting period through use of the 12 measures developed pursuant to subsection (a). Such 13 data shall be submitted in a form and manner and 14 at a time specified by the Secretary. 15 (2) SPECIFICATION OF PROVIDERS TO REPORT 16 ON MEASURES.—The Secretary shall specify the 17 classes of Medicare providers of services and sup- 18 pliers, including hospitals, cancer centers, physi- 19 cians, primary care providers, and specialty pro- 20 viders, that will be required under such process to 21 publicly report on the measures specified under sub- 22 section (a). 23 (3) ASSESSMENT OF CHANGES.—Under such 24 reporting process, the Secretary shall establish a for- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00531 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 532 •HR 5942 IH mat that assesses changes in both the absolute and 1 relative disparities in cancer care over time. These 2 measures shall be presented in an easily comprehen- 3 sible format, such as those presented in the final 4 publications relating to Healthy People 2010 or the 5 National Healthcare Disparities Report. 6 (4) INITIAL IMPLEMENTATION.—The Secretary 7 shall implement the reporting process under this 8 subsection for reporting periods beginning not later 9 than 6 months after the date that measures are first 10 established under subsection (a). 11 Subtitle B—Viral Hepatitis and 12 Liver Cancer Control and Pre- 13 vention 14 SEC. 711. VIRAL HEPATITIS AND LIVER CANCER CONTROL 15 AND PREVENTION. 16 (a) SHORT TITLE.—This subtitle may be cited as the 17 ‘‘Viral Hepatitis and Liver Cancer Control and Prevention 18 Act of 2018’’. 19 (b) FINDINGS.—Congress finds the following: 20 (1) In the United States, as many as 4,400,000 21 persons are living with the hepatitis B virus (re- 22 ferred to in this section as ‘‘HBV’’) or the hepatitis 23 C virus (referred to in this section as ‘‘HCV’’). 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00532 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 533 •HR 5942 IH (2) In the United States, chronic HBV and 1 HCV are the most common cause of liver cancer, 2 one of the most lethal and fastest growing cancers 3 in this country. It is the most common cause of 4 chronic liver disease, liver cirrhosis, and the most 5 common indication for liver transplantation. At least 6 21,000 deaths per year in the United States can be 7 attributed to chronic HBV and HCV. Chronic HCV 8 is also a leading cause of death in Americans living 9 with HIV/AIDS; many of those living with HIV/ 10 AIDS are coinfected with chronic HBV, chronic 11 HCV, or both. 12 (3) According to the Centers for Disease Con- 13 trol and Prevention (referred to in this section as 14 the ‘‘CDC’’), approximately 2 percent of the popu- 15 lation of the United States is living with chronic 16 HBV, chronic HCV, or both. The CDC has recog- 17 nized HCV as the Nation’s most common chronic 18 bloodborne virus infection and HBV as the deadliest 19 vaccine-preventable disease. 20 (4) HBV is easily transmitted and is 100 times 21 more infectious than HIV. According to the CDC, 22 HBV is transmitted through contact with infectious 23 blood, semen, or other body fluids. HCV is trans- 24 mitted by contact with infectious blood, particularly 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00533 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 534 •HR 5942 IH through percutaneous exposures (i.e. puncture 1 through the skin). 2 (5) The CDC estimates that in 2015, approxi- 3 mately 33,900 Americans were newly infected with 4 HCV and approximately 21,900 Americans were 5 newly infected with HBV. These estimates could be 6 much higher due to many reasons, including lack of 7 screening education and awareness, and perceived 8 marginalization of the populations at risk. 9 (6) In 2012, CDC released new guidelines rec- 10 ommending every person born between 1945 and 11 1965 receive a one-time test. Among the estimated 12 102 million (1.6 million chronically HCV-infected) 13 eligible for screening, birth-cohort screening leads to 14 84,000 fewer cases of decompensated cirrhosis, 15 46,000 fewer cases of hepatocellular carcinoma, 16 10,000 fewer liver transplants, and 78,000 fewer 17 HCV-related deaths gained versus risk-based screen- 18 ing. 19 (7) In 2013, the United States Preventive Serv- 20 ices Task Force (USPSTF) issued a Grade B rating 21 for screening for the hepatitis C virus (HCV) infec- 22 tion in persons at high risk for infection and adults 23 born between 1945 and 1965. In 2014, the 24 USPSTF issued a Grade B for screening for the 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00534 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 535 •HR 5942 IH hepatitis B virus (HBV) in persons at high-risk of 1 hepatitis B infection. In 2009, the USPSTF issued 2 a Grade A for screening pregnant women for the 3 hepatitis B virus (HBV) during their first prenatal 4 visit. 5 (8) There were 59 outbreaks (24 of HBV and 6 36 of HCV, including one of both HBV and HCV) 7 reported to CDC for investigation from 2008 8 through 2016 related to healthcare-associated infec- 9 tion of HBV and HCV, 56 of which occurred in non- 10 hospital settings. There were more than 115,983 pa- 11 tients potentially exposed to one of the viruses. 12 (9) Chronic HBV and chronic HCV usually do 13 not cause symptoms early in the course of the dis- 14 ease, but after many years of a clinically ‘‘silent’’ 15 phase, CDC estimates show more than 33 percent of 16 infected individuals will develop cirrhosis, end-stage 17 liver disease, or liver cancer. Since most individuals 18 with chronic HBV, HCV, or both are unaware of 19 their infection, they do not know to take precautions 20 to prevent the spread of their infection and can un- 21 knowingly exacerbate their own disease progression. 22 (10) HBV and HCV disproportionately affect 23 certain populations in the United States. Although 24 representing only about 5 percent of the population, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00535 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 536 •HR 5942 IH Asian Americans and Pacific Islanders account for 1 over half of all chronic HBV cases in the United 2 States. Baby boomers (those born between 1945 and 3 1965) account for approximately 75 percent of do- 4 mestic chronic hepatitis C cases. In addition, African 5 Americans, Latinos (Latinas), and American Indian/ 6 Native Alaskans are among the groups which have 7 disproportionately high rates of HBV and/or HCV 8 infections in the United States. 9 (11) For both chronic HBV and chronic HCV, 10 behavioral changes can slow disease progression if 11 diagnosis is made early. Early diagnosis, which is 12 determined through simple blood tests, can reduce 13 the risk of transmission and disease progression 14 through education and vaccination of household 15 members and other susceptible persons at risk. 16 (12) Advancements have led to the development 17 of improved diagnostic tests for viral hepatitis. 18 These tests, including rapid, point of care testing 19 and others in development, can facilitate testing, no- 20 tification of results and post-test counseling, and re- 21 ferral to care at the time of the testing visit. In par- 22 ticular, these tests are also advantageous because 23 they can be used simultaneously with HIV rapid 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00536 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 537 •HR 5942 IH testing for persons at risk for both HCV and HIV 1 infections. 2 (13) For those chronically infected with HBV 3 or HCV, regular monitoring can lead to the early de- 4 tection of liver cancer at a stage where a cure is still 5 possible. Liver cancer is the second deadliest cancer 6 in the United States; however, liver cancer has re- 7 ceived little funding for research, prevention, or 8 treatment. 9 (14) Treatment for chronic HCV can eradicate 10 the disease in approximately 90 percent of those cur- 11 rently treated. The treatment of chronic HBV can 12 effectively suppress viral replication in the over- 13 whelming majority (over 80 percent) of those treat- 14 ed, thereby reducing the risk of transmission and 15 progression to liver scarring or liver cancer, even 16 though a complete cure is much less common than 17 for HCV. 18 (15) To combat the viral hepatitis epidemic in 19 the United States, in February 2017, the Depart- 20 ment of Health and Human Services released its 21 ‘‘National Viral Hepatitis Action Plan 2017–2020’’ 22 (hereafter referred to as the ‘‘HHS Action Plan’’). 23 In March 2017, the National Academies of Sciences, 24 Engineering, and Medicine (NASEM) released ‘‘A 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00537 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 538 •HR 5942 IH National Strategy for the Elimination of Hepatitis B 1 and C: Phase Two Report’’, recommending specific 2 actions to eliminate viral hepatitis as public health 3 problems in the United States by 2030. 4 (16) The annual health care costs attributable 5 to HBV and HCV in the United States are signifi- 6 cant. For HBV, it is estimated to be approximately 7 $2,500,000,000 ($2,000 per infected person). In 8 2000, the lifetime cost of HBV—before the avail- 9 ability of most current therapies—was approximately 10 $80,000 per chronically infected person, totaling 11 more than $100,000,000,000. For HCV, medical 12 costs for patients are expected to increase from 13 $30,000,000,000 in 2009 to over $85,000,000,000 14 in 2024. Avoiding these costs by screening and diag- 15 nosing individuals earlier—and connecting them to 16 appropriate treatment and care, will save lives and 17 critical health care dollars. Currently, without a 18 comprehensive screening, testing, and diagnosis pro- 19 gram, most patients are diagnosed too late when 20 they need a liver transplant costing at least 21 $314,000 for uncomplicated cases or when they have 22 liver cancer or end-stage liver disease which costs 23 $30,980 to $110,576 per hospital admission. As 24 health care costs continue to grow, it is critical that 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00538 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 539 •HR 5942 IH the Federal Government invests in effective mecha- 1 nisms to avoid documented cost drivers. 2 (17) According to the IOM report in 2010, 3 chronic HBV and HCV infections cause substantial 4 morbidity and mortality despite being preventable 5 and treatable. Deficiencies in the implementation of 6 established guidelines for the prevention, diagnosis, 7 and medical management of chronic HBV and HCV 8 infections perpetuate personal and economic bur- 9 dens. Existing grants are not sufficient for the scale 10 of the health burden presented by HBV and HCV. 11 (18) Screening and testing for HBV and HCV 12 is aligned with the Healthy People 2020 goal to in- 13 crease immunization rates and reduce preventable 14 infectious diseases. Awareness of disease and access 15 to prevention and treatment remain essential compo- 16 nents for reducing infectious disease transmission. 17 (19) Federal support is necessary to increase 18 knowledge and awareness of HBV and HCV and to 19 assist State and local prevention and control efforts 20 in reducing the morbidity and mortality of these 21 epidemics. 22 (20) The Secretary of Health and Human Serv- 23 ices has the discretion to carry out this Act directly 24 and through whichever of the agencies of the Public 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00539 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 540 •HR 5942 IH Health Service the Secretary determines to be ap- 1 propriate, which may (in the Secretary’s discretion) 2 include the Centers for Disease Control and Preven- 3 tion, the Health Resources and Services Administra- 4 tion, the Substance Abuse and Mental Health Serv- 5 ices Administration, the National Institutes of 6 Health (including the National Institute on Minority 7 Health and Health Disparities), and other agencies 8 of such Service. 9 (21) The Centers for Disease Control and Pre- 10 vention reported a 151 percent increase in hepatitis 11 C cases from 2010–2013, stemming from the opioid, 12 heroin, and overdose epidemics affecting commu- 13 nities nationwide. For the first time since 2006, the 14 number of reported cases of acute hepatitis B infec- 15 tion in the United States is rising; it increased by 16 20.7 percent in 2015 alone, which is also largely due 17 to the opioid epidemic. 18 (c) BIENNIAL ASSESSMENT OF HHS HEPATITIS B 19 AND HEPATITIS C PREVENTION, EDUCATION, RESEARCH, 20 AND MEDICAL MANAGEMENT PLAN.—Title III of the 21 Public Health Service Act (42 U.S.C. 241 et seq.) is 22 amended— 23 (1) by striking section 317N (42 U.S.C. 247b– 24 15); and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00540 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 541 •HR 5942 IH (2) by adding at the end the following: 1 ‘‘PART X—BIENNIAL ASSESSMENT OF HHS HEPA- 2 TITIS B AND HEPATITIS C PREVENTION, EDU- 3 CATION, RESEARCH, AND MEDICAL MANAGE- 4 MENT PLAN 5 ‘‘SEC. 399PP. BIENNIAL UPDATE OF THE PLAN. 6 ‘‘(a) IN GENERAL.—The Secretary shall conduct a bi- 7 ennial assessment of the Secretary’s plan for the preven- 8 tion, control, and medical management of, and education 9 and research relating to, hepatitis B and hepatitis C, for 10 the purposes of— 11 ‘‘(1) incorporating into such plan new knowl- 12 edge or observations relating to hepatitis B and hep- 13 atitis C (such as knowledge and observations that 14 may be derived from clinical, laboratory, and epide- 15 miological research and disease detection, preven- 16 tion, and surveillance outcomes); 17 ‘‘(2) addressing gaps in the coverage or effec- 18 tiveness of the plan; and 19 ‘‘(3) evaluating and, if appropriate, updating 20 recommendations, guidelines, or educational mate- 21 rials of the Centers for Disease Control and Preven- 22 tion or the National Institutes of Health for health 23 care providers or the public on viral hepatitis in 24 order to be consistent with the plan. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00541 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 542 •HR 5942 IH ‘‘(b) PUBLICATION OF NOTICE OF ASSESSMENTS.— 1 Not later than October 1 of the first even-numbered year 2 beginning after the date of the enactment of this part, 3 and October 1 of each even-numbered year thereafter, the 4 Secretary shall publish in the Federal Register a notice 5 of the results of the assessments conducted under para- 6 graph (1). Such notice shall include— 7 ‘‘(1) a description of any revisions to the plan 8 referred to in subsection (a) as a result of the as- 9 sessment; 10 ‘‘(2) an explanation of the basis for any such 11 revisions, including the ways in which such revisions 12 can reasonably be expected to further promote the 13 original goals and objectives of the plan; and 14 ‘‘(3) in the case of a determination by the Sec- 15 retary that the plan does not need revision, an expla- 16 nation of the basis for such determination. 17 ‘‘SEC. 399PP–1. ELEMENTS OF PROGRAM. 18 ‘‘(a) EDUCATION AND AWARENESS PROGRAMS.—The 19 Secretary, acting through the Director of the Centers for 20 Disease Control and Prevention, the Administrator of the 21 Health Resources and Services Administration, and the 22 Administrator of the Substance Abuse and Mental Health 23 Services Administration, and in accordance with the plan 24 referred to in section 399PP(a), shall implement programs 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00542 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 543 •HR 5942 IH to increase awareness and enhance knowledge and under- 1 standing of hepatitis B and hepatitis C. Such programs 2 shall include— 3 ‘‘(1) the conduct of culturally and language ap- 4 propriate health education in primary and secondary 5 schools, college campuses, public awareness cam- 6 paigns, and community outreach activities (especially 7 to the ethnic communities with high rates of chronic 8 hepatitis B and chronic hepatitis C and other high- 9 risk groups) to promote public awareness and knowl- 10 edge about the value of hepatitis A and hepatitis B 11 immunization, risk factors, the transmission and 12 prevention of hepatitis B and hepatitis C, the value 13 of screening for the early detection of hepatitis B 14 and hepatitis C, and options available for the treat- 15 ment of chronic hepatitis B and chronic hepatitis C; 16 ‘‘(2) the promotion of immunization programs 17 that increase awareness and access to hepatitis A 18 and hepatitis B vaccines for susceptible adults and 19 children; 20 ‘‘(3) the training of health care professionals 21 regarding the importance of vaccinating individuals 22 infected with hepatitis C and individuals who are at 23 risk for hepatitis C infection against hepatitis A and 24 hepatitis B; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00543 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 544 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00544 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 545 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00545 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 546 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00546 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 547 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00547 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 548 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00548 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 549 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00549 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 550 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00550 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 551 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00551 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 552 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00552 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 553 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00553 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 554 •HR 5942 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. 399PP–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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00554 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 555 •HR 5942 IH ‘‘SEC. 399PP–3. AUTHORIZATION OF APPROPRIATIONS. 1 ‘‘There are authorized to be appropriated to carry out 2 this part $90,000,000 for fiscal year 2019, $90,000,000 3 for fiscal year 2020, $110,000,000 for fiscal year 2021, 4 $130,000,000 for fiscal year 2022, and $150,000,000 for 5 fiscal year 2023.’’. 6 Subtitle C—Acquired Bone Marrow 7 Failure Diseases 8 SEC. 721. ACQUIRED BONE MARROW FAILURE DISEASES. 9 (a) SHORT TITLE.—This subtitle may be cited as the 10 ‘‘Bone Marrow Failure Disease Research and Treatment 11 Act of 2018’’. 12 (b) FINDINGS.—The Congress finds the following: 13 (1) Between 20,000 and 30,000 Americans are 14 diagnosed each year with myelodysplastic syndromes, 15 aplastic anemia, paroxysmal nocturnal hemo- 16 globinuria, and other acquired bone marrow failure 17 diseases. 18 (2) Acquired bone marrow failure diseases have 19 a debilitating and often fatal impact on those diag- 20 nosed with these diseases. 21 (3) While some treatments for acquired bone 22 marrow failure diseases can prolong and improve the 23 quality of patients’ lives, there is no single cure for 24 these diseases. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00555 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 556 •HR 5942 IH (4) The prevalence of acquired bone marrow 1 failure diseases in the United States will continue to 2 grow as the general public ages. 3 (5) Evidence exists suggesting that acquired 4 bone marrow failure diseases occur more often in 5 minority populations, particularly in Asian-American 6 and Latino or Hispanic populations. 7 (6) The National Heart, Lung, and Blood Insti- 8 tute and the National Cancer Institute have con- 9 ducted important research into the causes of and 10 treatments for acquired bone marrow failure dis- 11 eases. 12 (7) The National Marrow Donor Program Reg- 13 istry has made significant contributions to the fight 14 against bone marrow failure diseases by connecting 15 millions of potential marrow donors with individuals 16 and families suffering from these conditions. 17 (8) Despite these advances, a more comprehen- 18 sive Federal strategic effort among numerous Fed- 19 eral agencies is needed to discover a cure for ac- 20 quired bone marrow failure disorders. 21 (9) Greater Federal surveillance of acquired 22 bone marrow failure diseases is needed to gain a bet- 23 ter understanding of the causes of acquired bone 24 marrow failure diseases. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00556 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 557 •HR 5942 IH (10) The Federal Government should increase 1 its research support for and engage with public and 2 private organizations in developing a comprehensive 3 approach to combat and cure acquired bone marrow 4 failure diseases. 5 (c) NATIONAL ACQUIRED BONE MARROW FAILURE 6 DISEASE REGISTRY.—Part B of the Public Health Service 7 Act (42 U.S.C. 311 et seq.) is amended by inserting after 8 section 317W, as added, the following: 9 ‘‘SEC. 317X. NATIONAL ACQUIRED BONE MARROW FAILURE 10 DISEASE REGISTRY. 11 ‘‘(a) ESTABLISHMENT OF REGISTRY.— 12 ‘‘(1) IN GENERAL.—Not later than 6 months 13 after the date of the enactment of this section, the 14 Secretary, acting through the Director of the Cen- 15 ters for Disease Control and Prevention, shall— 16 ‘‘(A) develop a system to collect data on 17 acquired bone marrow failure diseases; and 18 ‘‘(B) establish and maintain a national and 19 publicly available registry, to be known as the 20 National Acquired Bone Marrow Failure Dis- 21 ease Registry, in accordance with paragraph 22 (3). 23 ‘‘(2) RECOMMENDATIONS OF ADVISORY COM- 24 MITTEE.—In carrying out this subsection, the Sec- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00557 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 558 •HR 5942 IH retary shall take into consideration the recommenda- 1 tions of the Advisory Committee on Acquired Bone 2 Marrow Failure Diseases established under sub- 3 section (b). 4 ‘‘(3) PURPOSES OF REGISTRY.—The National 5 Acquired Bone Marrow Failure Disease Registry— 6 ‘‘(A) shall identify the incidence and preva- 7 lence of acquired bone marrow failure diseases 8 in the United States; 9 ‘‘(B) shall be used to collect and store data 10 on acquired bone marrow failure diseases, in- 11 cluding data concerning— 12 ‘‘(i) the age, race or ethnicity, general 13 geographic location, sex, and family history 14 of individuals who are diagnosed with ac- 15 quired bone marrow failure diseases, and 16 any other characteristics of such individ- 17 uals determined appropriate by the Sec- 18 retary; 19 ‘‘(ii) the genetic and environmental 20 factors that may be associated with devel- 21 oping acquired bone marrow failure dis- 22 eases; 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00558 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 559 •HR 5942 IH ‘‘(iii) treatment approaches for deal- 1 ing with acquired bone marrow failure dis- 2 eases; 3 ‘‘(iv) outcomes for individuals treated 4 for acquired bone marrow failure diseases, 5 including outcomes for recipients of stem 6 cell therapeutic products as contained in 7 the database established pursuant to sec- 8 tion 379A; and 9 ‘‘(v) any other factors pertaining to 10 acquired bone marrow failure diseases de- 11 termined appropriate by the Secretary; and 12 ‘‘(C) shall be made available— 13 ‘‘(i) to the general public; and 14 ‘‘(ii) to researchers to facilitate fur- 15 ther research into the causes of, and treat- 16 ments for, acquired bone marrow failure 17 diseases in accordance with standard prac- 18 tices of the Centers for Disease Control 19 and Preventions. 20 ‘‘(b) ADVISORY COMMITTEE.— 21 ‘‘(1) ESTABLISHMENT.—Not later than 6 22 months after the date of the enactment of this sec- 23 tion, the Secretary, acting through the Director of 24 the Centers for Disease Control and Prevention, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00559 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 560 •HR 5942 IH shall establish an advisory committee, to be known 1 as the Advisory Committee on Acquired Bone Mar- 2 row Failure Diseases. 3 ‘‘(2) MEMBERS.—The members of the Advisory 4 Committee on Acquired Bone Marrow Failure Dis- 5 eases shall be appointed by the Secretary, acting 6 through the Director of the Centers for Disease 7 Control and Prevention, and shall include at least 8 one representative from each of the following: 9 ‘‘(A) A national patient advocacy organiza- 10 tion with experience advocating on behalf of pa- 11 tients suffering from acquired bone marrow 12 failure diseases. 13 ‘‘(B) The National Institutes of Health, in- 14 cluding at least one representative from each 15 of— 16 ‘‘(i) the National Cancer Institute; 17 ‘‘(ii) the National Heart, Lung, and 18 Blood Institute; and 19 ‘‘(iii) the Office of Rare Diseases. 20 ‘‘(C) The Centers for Disease Control and 21 Prevention. 22 ‘‘(D) Clinicians with experience in— 23 ‘‘(i) diagnosing or treating acquired 24 bone marrow failure diseases; and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00560 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 561 •HR 5942 IH ‘‘(ii) medical data registries. 1 ‘‘(E) Epidemiologists who have experience 2 with data registries. 3 ‘‘(F) Publicly or privately funded research- 4 ers who have experience researching acquired 5 bone marrow failure diseases. 6 ‘‘(G) The entity operating the C.W. Bill 7 Young Cell Transplantation Program estab- 8 lished pursuant to section 379 and the entity 9 operating the C.W. Bill Young Cell Transplan- 10 tation Program Outcomes Database. 11 ‘‘(3) RESPONSIBILITIES.—The Advisory Com- 12 mittee on Acquired Bone Marrow Failure Diseases 13 shall provide recommendations to the Secretary on 14 the establishment and maintenance of the National 15 Acquired Bone Marrow Failure Disease Registry, in- 16 cluding recommendations on the collection, mainte- 17 nance, and dissemination of data. 18 ‘‘(4) PUBLIC AVAILABILITY.—The Secretary 19 shall make the recommendations of the Advisory 20 Committee on Acquired Bone Marrow Failure Dis- 21 ease publicly available. 22 ‘‘(c) GRANTS.—The Secretary, acting through the 23 Director of the Centers for Disease Control and Preven- 24 tion, may award grants to, and enter into contracts and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00561 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 562 •HR 5942 IH cooperative agreements with, public or private nonprofit 1 entities for the management of, as well as the collection, 2 analysis, and reporting of data to be included in, the Na- 3 tional Acquired Bone Marrow Failure Disease Registry. 4 ‘‘(d) DEFINITION.—In this section, the term ‘ac- 5 quired 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 has pro- 12 gressed from myelodysplastic syndromes; or 13 ‘‘(6) large granular lymphocytic leukemia. 14 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 15 is authorized to be appropriated to carry out this section 16 $3,000,000 for each of fiscal years 2019 through 2023.’’. 17 (d) PILOT STUDIES THROUGH THE AGENCY FOR 18 TOXIC SUBSTANCES AND DISEASE REGISTRY.— 19 (1) PILOT STUDIES.—The Secretary of Health 20 and Human Services, acting through the Adminis- 21 trator of the Agency for Toxic Substances and Dis- 22 ease Registry, shall conduct pilot studies to deter- 23 mine which environmental factors, including expo- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00562 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 563 •HR 5942 IH sure to toxins, may cause acquired bone marrow fail- 1 ure diseases. 2 (2) COLLABORATION WITH THE RADIATION IN- 3 JURY TREATMENT NETWORK.—In carrying out the 4 directives of this section, the Secretary may collabo- 5 rate with the Radiation Injury Treatment Network 6 of the C.W. Bill Young Cell Transplantation Pro- 7 gram established pursuant to section 379 of the 8 Public Health Service Act (42 U.S.C. 274j) to— 9 (A) augment data for the pilot studies au- 10 thorized by this section; 11 (B) access technical assistance that may be 12 provided by the Radiation Injury Treatment 13 Network; or 14 (C) perform joint research projects. 15 (3) AUTHORIZATION OF APPROPRIATIONS.— 16 There is authorized to be appropriated to carry out 17 this section $1,000,000 for each of fiscal years 2019 18 through 2023. 19 (e) MINORITY-FOCUSED PROGRAMS ON ACQUIRED 20 BONE MARROW FAILURE DISEASES.—Title XVII of the 21 Public Health Service Act (42 U.S.C. 300u et seq.) is 22 amended by inserting after section 1707A the following: 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00563 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 564 •HR 5942 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 website, 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00564 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 565 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00565 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 566 •HR 5942 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 2019 through 2023.’’. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00566 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 567 •HR 5942 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 2019 3 through 2023. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00567 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 568 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00568 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 569 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00569 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 570 •HR 5942 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 2019 through 2023. 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 2019, 21 $25,300,000 for fiscal year 2020, $27,800,000 for 22 fiscal year 2021, $30,800,000 for fiscal year 2022, 23 and $34,000,000 for fiscal year 2023.’’. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00570 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 571 •HR 5942 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.), as amended, is further amended 4 by adding at the end the following: 5 ‘‘SEC. 399V–8. REPORT ON CARDIOVASCULAR CARE FOR 6 WOMEN AND MINORITIES. 7 ‘‘Not later than September 30, 2019, 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 PRI- 19 VATE HEALTH INSURANCE. 20 (a) REQUIRING MEDICAID COVERAGE OF COUN- 21 SELING AND PHARMACOTHERAPY FOR CESSATION OF TO- 22 BACCO USE.—Section 1905 of the Social Security Act (42 23 U.S.C. 1396d) is amended— 24 (1) in subsection (a)(4)(D), by striking ‘‘by 25 pregnant women’’; and 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00571 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 572 •HR 5942 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— 12 (1) by striking ‘‘in the case of pregnant 13 women’’; and 14 (2) by striking ‘‘under the over-the-counter 15 monograph process’’. 16 (c) STATE MONITORING AND PROMOTING OF COM- 17 PREHENSIVE TOBACCO CESSATION SERVICES UNDER 18 MEDICAID.—Section 1902(a) of the Social Security Act 19 (42 U.S.C. 1396a(a)), as amended by section 450(c), is 20 amended— 21 (1) by striking ‘‘and’’ at the end of paragraph 22 (82); 23 (2) by striking the period at the end of para- 24 graph (83) and inserting ‘‘; and’’; and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00572 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 573 •HR 5942 IH (3) by inserting after paragraph (83) the fol- 1 lowing new paragraph: 2 ‘‘(84) provide for the State to monitor and pro- 3 mote the use of comprehensive tobacco cessation 4 services under the State plan, including conducting 5 an outreach campaign to increase awareness of, and 6 the benefits of using, such services among— 7 ‘‘(A) individuals entitled to medical assist- 8 ance under the State plan who use tobacco 9 products; and 10 ‘‘(B) clinicians and others who provide 11 services to individuals entitled to medical assist- 12 ance under the State plan.’’. 13 (d) FEDERAL REIMBURSEMENT FOR MEDICAID OUT- 14 REACH CAMPAIGN TO INCREASE AWARENESS.—Section 15 1903(a) of the Social Security Act (42 U.S.C. 1396b(a)) 16 is amended— 17 (1) by striking the period at the end of para- 18 graph (7) and inserting ‘‘; plus’’; and 19 (2) by inserting after paragraph (7) the fol- 20 lowing new paragraph: 21 ‘‘(8) an amount equal to 90 percent of the 22 sums expended during each quarter which are attrib- 23 utable to the development, implementation, and eval- 24 uation of an outreach campaign to— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00573 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 574 •HR 5942 IH ‘‘(A) increase awareness of comprehensive 1 tobacco cessation services covered in the State 2 plan among— 3 ‘‘(i) individuals who are likely to be el- 4 igible for medical assistance under the 5 State plan; and 6 ‘‘(ii) clinicians and others who provide 7 services to individuals who are likely to be 8 eligible for medical assistance under the 9 State plan; and 10 ‘‘(B) increase awareness of the benefits of 11 using comprehensive tobacco cessation services 12 covered in the State plan among— 13 ‘‘(i) individuals who are likely to be el- 14 igible for medical assistance under the 15 State plan; and 16 ‘‘(ii) clinicians and others who provide 17 services to individuals who are likely to be 18 eligible for medical assistance under the 19 State plan about the benefits of using com- 20 prehensive tobacco cessation services.’’. 21 (e) REMOVAL OF COST SHARING FOR COUNSELING 22 AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO 23 USE UNDER MEDICAID.— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00574 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 575 •HR 5942 IH (1) GENERAL COST SHARING LIMITATIONS.— 1 Section 1916 of the Social Security Act (42 U.S.C. 2 1396o) is amended— 3 (A) in subsections (a)(2)(B) and (b)(2)(B), 4 by striking ‘‘and counseling and 5 pharmacotherapy for cessation of tobacco use 6 by pregnant women (as defined in section 7 1396d(bb) of this title) and covered outpatient 8 drugs (as defined in subsection (k)(2) of section 9 1396r–8 of this title and including nonprescrip- 10 tion drugs described in subsection (d)(2) of 11 such section) that are prescribed for purposes 12 of promoting, and when used to promote, to- 13 bacco cessation by pregnant women in accord- 14 ance with the Guideline referred to in section 15 1396d(bb)(2)(A) of this title’’ each place it ap- 16 pears; and 17 (B) in each of subsections (a)(2)(D) and 18 (b)(2)(D) by inserting ‘‘and counseling and 19 pharmacotherapy for cessation of tobacco use 20 (as defined in section 1396d(bb) of this title) 21 and covered outpatient drugs (as defined in 22 subsection (k)(2) of section 1396r–8 of this 23 title and including nonprescription drugs de- 24 scribed in subsection (d)(2) of such section) 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00575 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 576 •HR 5942 IH that are prescribed for purposes of promoting, 1 and when used to promote, tobacco cessation in 2 accordance with the Guideline referred to in 3 section 1396d(bb)(2)(A) of this title,’’ after 4 ‘‘(or at the option of the State, any services fur- 5 nished to pregnant women’’. 6 (2) APPLICATION TO ALTERNATIVE COST SHAR- 7 ING.—Section 1916A(b)(3)(B) of such Act (42 8 U.S.C. 1396o–1(b)(3)(B)) is amended— 9 (A) in clause (iii), by striking ‘‘, and coun- 10 seling and pharmacotherapy for cessation of to- 11 bacco use by pregnant women (as defined in 12 section 1396d of this title)’’; and 13 (B) by adding at the end the following: 14 ‘‘(xi) Counseling and 15 pharmacotherapy for cessation of tobacco 16 use (as defined in section 1905(bb)) and 17 covered outpatient drugs (as defined in 18 subsection (k)(2) of section 1396r–8 of 19 this title and including nonprescription 20 drugs described in subsection (d)(2) of 21 such section) that are prescribed for pur- 22 poses of promoting, and when used to pro- 23 mote, tobacco cessation in accordance with 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00576 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 577 •HR 5942 IH the Guideline referred to in section 1396d 1 (bb)(2)(A) of this title.’’. 2 (f) NO PRIOR AUTHORIZATION FOR TOBACCO CES- 3 SATION DRUGS UNDER MEDICAID.—Section 1927(d) of 4 the Social Security Act (42 U.S.C. 1396r–8) is amended— 5 (1) by striking in paragraph (1)(A) ‘‘A State’’ 6 and inserting ‘‘Except as otherwise provided in para- 7 graph (6), a State’’; 8 (2) by inserting after paragraph (5) the fol- 9 lowing new paragraph: 10 ‘‘(6) NO PRIOR AUTHORIZATION PROGRAMS FOR 11 TOBACCO CESSATION DRUGS.—A State plan under 12 this subchapter shall not require, as a condition of 13 coverage or payment for a covered outpatient drug 14 for which Federal financial participation is available 15 in accordance with this section, the approval of an 16 agent when used to promote smoking cessation, in- 17 cluding agents approved by the Food and Drug Ad- 18 ministration for the purposes of promoting, and 19 when used to promote, tobacco cessation.’’. 20 (3) by redesignating paragraphs (6) and (7) as 21 paragraphs (7) and (8). 22 (g) COMPREHENSIVE COVERAGE OF TOBACCO CES- 23 SATION COVERAGE IN PRIVATE HEALTH INSURANCE.— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00577 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 578 •HR 5942 IH (1) NO PRIOR AUTHORIZATION FOR TOBACCO 1 CESSATION COVERAGE.—Section 2713 of the Public 2 Health Service Act (42 U.S.C. 300gg–3) is amended 3 by inserting after subsection (c) a new subsection: 4 ‘‘(d) NO PRIOR AUTHORIZATION.—A group health 5 plan and a health insurance issuer offering group or indi- 6 vidual health insurance coverage shall not impose any 7 prior authorization requirement for tobacco cessation 8 counseling and pharmacotherapy that has in effect a rat- 9 ing of ‘A’ or ‘B’ in the current recommendations of the 10 United States Preventive Services Task Force.’’. 11 (2) NO COST SHARING.—Section 1302(c) of the 12 Patient Protection and Affordable Care Act (42 13 U.S.C. 18022(c)) is amended by inserting after 14 paragraph (1) the following new paragraph: 15 ‘‘(2) NO COST SHARING OR PRIOR AUTHORIZA- 16 TION FOR COMPREHENSIVE TOBACCO CESSATION 17 COVERAGE.—There shall be no cost sharing or prior 18 authorization requirement imposed with respect to 19 services described in subsection (b)(1)(K).’’. 20 (h) EFFECTIVE DATE.—The amendments made by 21 this section shall apply to items and services furnished on 22 or after January 1, 2019. 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00578 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 579 •HR 5942 IH SEC. 735. CLINICAL RESEARCH FUNDING FOR ORAL 1 HEALTH. 2 (a) IN GENERAL.—The Secretary of Health and 3 Human Services shall expand and intensify the conduct 4 and support of the research activities of the National In- 5 stitutes of Health and the National Institute of Dental 6 and Craniofacial Research to improve the oral health of 7 the population through the prevention and management 8 of oral diseases and conditions. 9 (b) INCLUDED RESEARCH ACTIVITIES.—Research 10 activities under subsection (a) shall include— 11 (1) comparative effectiveness research and clin- 12 ical disease management research addressing early 13 childhood caries and oral cancer; and 14 (2) awarding of grants and contracts to support 15 the training and development of health services re- 16 searchers, comparative effectiveness researchers, and 17 clinical researchers whose research improves the oral 18 health of the population. 19 SEC. 736. PARTICIPATION BY MEDICAID BENEFICIARIES IN 20 APPROVED CLINICAL TRIALS. 21 (a) IN GENERAL.—Title XIX of the Social Security 22 Act (42 U.S.C. 1396 et seq.) is amended by inserting after 23 section 1943 the following new section: 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00579 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 580 •HR 5942 IH ‘‘SEC. 1944. PARTICIPATION IN AN APPROVED CLINICAL 1 TRIAL. 2 ‘‘(a) COVERAGE OF ROUTINE PATIENT COSTS ASSO- 3 CIATED WITH APPROVED CLINICAL TRIALS.— 4 ‘‘(1) INCLUSION.—Subject to paragraph (2), 5 routine patient costs shall include all items and serv- 6 ices consistent with the medical assistance provided 7 under the State plan that would otherwise be pro- 8 vided to the individual under such State plan if such 9 individual was not enrolled in an approved clinical 10 trial, including any items or services related to the 11 prevention, detection, and treatment of any medical 12 complications that arise as a result of participation 13 in the approved clinical trial. 14 ‘‘(2) EXCLUSION.—For purposes of paragraph 15 (1), routine patient costs does not include— 16 ‘‘(A) the investigational item, device, or 17 service itself; 18 ‘‘(B) items and services that are provided 19 solely to satisfy data collection and analysis 20 needs and that are not used in the direct clin- 21 ical management of the patient; or 22 ‘‘(C) a service that is clearly inconsistent 23 with widely accepted and established standards 24 of care for a particular diagnosis. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00580 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 581 •HR 5942 IH ‘‘(3) INFORMATION CONCERNING CLINICAL 1 TRIALS.— 2 ‘‘(A) IN GENERAL.—Subject to subpara- 3 graph (B), the Secretary, in consultation with 4 relevant stakeholders, shall develop a single 5 standardized electronic form for use by the indi- 6 vidual or the referring health care provider to 7 submit to the State agency administering the 8 State plan in order to verify that the clinical 9 trial meets the conditions established for an ap- 10 proved clinical trial (as defined in subsection 11 (c)). 12 ‘‘(B) EXCLUDED INFORMATION.—For pur- 13 poses of subparagraph (A) or any such request 14 by the State agency for information regarding 15 a clinical trial, an individual or referring health 16 care provider shall not be required to submit— 17 ‘‘(i) the clinical protocol document for 18 the clinical trial; or 19 ‘‘(ii) subject to subparagraph (C), any 20 additional information other than such in- 21 formation as is required pursuant to the 22 form described in subparagraph (A). 23 ‘‘(C) OPTIONAL INFORMATION.—For pur- 24 poses of subparagraphs (A) and (B)(ii), the 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00581 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 582 •HR 5942 IH form may include a requirement that the refer- 1 ring health care provider attest that the indi- 2 vidual is eligible to participate in the clinical 3 trial pursuant to the trial protocol and that in- 4 dividual participation in such trial would be ap- 5 propriate. 6 ‘‘(D) REVIEW OF INFORMATION.— 7 ‘‘(i) IN GENERAL.—A State plan 8 under this title shall establish a process for 9 timely review by the State agency of the 10 form and information submitted pursuant 11 to subparagraph (A) and, not later than 12 48 hours after receipt of such form, con- 13 firmation that the information provided in 14 such form satisfies the requirements estab- 15 lished under such subparagraph, with such 16 process to include establishment and oper- 17 ation of a 24-hour, toll-free telephone num- 18 ber and email address to provide for expe- 19 dited communication. 20 ‘‘(ii) FAILURE TO RESPOND.—If an 21 individual or the referring health care pro- 22 vider does not receive a response or re- 23 quest for additional information from the 24 State agency following the 48-hour period 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00582 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 583 •HR 5942 IH described in clause (i), the information 1 provided in the form may be presumed to 2 satisfy the requirements established under 3 this paragraph. 4 ‘‘(b) ENCOURAGEMENT OF PARTICIPATION IN AP- 5 PROVED CLINICAL TRIALS.— 6 ‘‘(1) REASONABLY ACCESSIBLE PROVIDER.— 7 For purposes of participation in an approved clinical 8 trial by an individual eligible for medical assistance 9 under this title, the State agency administering the 10 State plan shall make reasonable efforts to ensure 11 that the individual is provided with access to a pro- 12 vider who is— 13 ‘‘(A) participating in the approved clinical 14 trial; 15 ‘‘(B) located not more than 25 miles from 16 the residence of the individual (or, if no such 17 provider is available, as close as possible to the 18 residence of the individual); and 19 ‘‘(C) a participating provider under the 20 State plan or has been deemed to be a partici- 21 pating provider under the State plan for pur- 22 poses of providing medical assistance to the in- 23 dividual during their participation in the ap- 24 proved clinical trial. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00583 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 584 •HR 5942 IH ‘‘(2) INFORMATIONAL MATERIALS.—The State 1 agency administering the plan approved under this 2 title shall develop informational materials and pro- 3 grams to encourage participating providers to make 4 appropriate referrals to physicians and other appro- 5 priate health care professionals who can provide in- 6 dividuals with access to approved clinical trials. 7 ‘‘(c) DEFINITION OF APPROVED CLINICAL TRIAL.— 8 The term ‘approved clinical trial’ has the same meaning 9 as provided under section 2709(d) of the Public Health 10 Service Act.’’. 11 (b) CONFORMING AMENDMENT.—Section 1902(a) of 12 the Social Security Act (42 U.S.C. 1396a(a)) is amended 13 by inserting after paragraph (77) the following new para- 14 graph: 15 ‘‘(78) provide that participation in an approved 16 clinical trial and coverage of routine patient costs 17 associated with such trial for an individual eligible 18 for medical assistance under this title is conducted 19 in accordance with the requirements under section 20 1944;’’. 21 (c) EFFECTIVE DATE.— 22 (1) IN GENERAL.—Except as provided in para- 23 graph (2), the amendments made by this section 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00584 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 585 •HR 5942 IH shall apply to calendar quarters beginning on or 1 after October 1, 2018. 2 (2) DELAY PERMITTED FOR STATE PLAN 3 AMENDMENT.—In the case of a State plan for med- 4 ical assistance under title XIX of the Social Security 5 Act which the Secretary of Health and Human Serv- 6 ices determines requires State legislation (other than 7 legislation appropriating funds) in order for the plan 8 to meet the additional requirements imposed by the 9 amendments made by this section, the State plan 10 shall not be regarded as failing to comply with the 11 requirements of such title solely on the basis of its 12 failure to meet these additional requirements before 13 the first day of the first calendar quarter beginning 14 after the close of the first regular session of the 15 State legislature that begins after the date of enact- 16 ment of this Act. For purposes of the previous sen- 17 tence, in the case of a State that has a 2-year legis- 18 lative session, each year of such session shall be 19 deemed to be a separate regular session of the State 20 legislature. 21 Subtitle E—HIV/AIDS 22 SEC. 741. STATEMENT OF POLICY. 23 It is the policy of the United States to achieve an 24 AIDS-free generation, and to— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00585 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 586 •HR 5942 IH (1) expand access to lifesaving antiretroviral 1 therapy for people living with HIV/AIDS and imme- 2 diately link people to continuous and coordinated 3 high-quality care when they learn they are infected 4 with HIV; 5 (2) expand targeted efforts to prevent HIV in- 6 fection using a combination of effective, evidence- 7 based approaches, including routine HIV screening, 8 and universal access to HIV prevention tools in the 9 communities where HIV/AIDS is most heavily con- 10 centrated, particularly communities of color; 11 (3) ensure laws, policies, and regulations do not 12 impede access to prevention, treatment, and care for 13 people living with HIV/AIDS or at risk for acquiring 14 HIV; 15 (4) accelerate research for more efficacious HIV 16 prevention and treatments tools, a cure, and a vac- 17 cine; and 18 (5) respect the human rights and dignity of 19 persons living with HIV/AIDS. 20 SEC. 742. FINDINGS. 21 The Congress finds the following: 22 (1) Over one million people are estimated to be 23 living with HIV in the United States according to 24 the Centers for Disease Control and Prevention, 15 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00586 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 587 •HR 5942 IH percent of whom are unaware of their HIV-positive 1 status. 2 (2) Annually there are about 37,600 new HIV 3 infections and 20,000 deaths in people with an HIV 4 diagnoses in 50 States and 6 dependent areas of the 5 United States. 6 (3) The Centers for Disease Control and Pre- 7 vention estimates that, in 2015, there were approxi- 8 mately 37,600 people newly diagnosed with HIV. 9 The estimated number of annual new HIV infections 10 declined 10 percent from 2010 to 2014. However, 11 the number of new infections is increasing among 12 certain populations, such as Latino gay and bisexual 13 men, where annual infections increase 14 percent. 14 New infections among Black gay or bisexual men 15 are remaining stable. 16 (4) HIV disproportionately affects certain popu- 17 lations in the United States. Though African Ameri- 18 cans represent approximately 12 percent of the pop- 19 ulation, African Americans account for almost half 20 (45 percent) of all people living with HIV in the 21 United States. Men who have sex with men (MSM) 22 account for 67 percent of all new HIV infections and 23 are the only risk group in which HIV infections con- 24 tinue to increase. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00587 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 588 •HR 5942 IH (5) Disparities exist among Latinos/Hispanics; 1 they make up 18 percent of the United States popu- 2 lation and 24 percent of new infections (2015). 3 (6) Though the rate of new infections among 4 American Indians/Alaska Native (AI/AN) is propor- 5 tional to their population size, from 2005 to 2014, 6 the annual number of HIV diagnoses increased 19 7 percent among AIs/ANs overall and 63 percent 8 among AI/AN gay and bisexual men. 9 (7) Asian Americans account for about 2 per- 10 cent of new HIV infections, but in 2013, 22 percent 11 were undiagnosed, the highest rate of undiagnosed 12 HIV among any race/ethnicity. 13 (8) The latest data from the CDC (2015) indi- 14 cate that new infections among women declined 20 15 percent. 16 (9) The history of HIV shows that culturally 17 relevant and gender-responsive supportive services, 18 including psychosocial support, treatment literacy, 19 case management, and transportation are necessary 20 strategies to reach and engage women and girls in 21 medical care. 22 (10) The limited data available on transgender 23 individuals point to a disproportionate burden of 24 HIV infection. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00588 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 589 •HR 5942 IH (11) Stigma and discrimination contribute to 1 these disparities. 2 (12) The Centers for Disease Control and Pre- 3 vention has determined that increasing the propor- 4 tion of people who know their HIV status is an es- 5 sential component of comprehensive HIV/AIDS 6 treatment and prevention efforts and that early di- 7 agnosis is critical in order for people with HIV/ 8 AIDS to receive life-extending therapy. Additionally, 9 the Centers for Disease Control and Prevention rec- 10 ommend routine HIV screening in health care set- 11 tings for all patients aged 13 to 64, regardless of 12 risk. 13 (13) In 1998, Congress created the National 14 Minority AIDS Initiative to provide technical assist- 15 ance, build capacity, and strengthen outreach efforts 16 among local institutions and community-based orga- 17 nizations that serve racial and ethnic minorities liv- 18 ing with or vulnerable to HIV/AIDS. 19 (14) To combat the HIV epidemic in the United 20 States, the National HIV/AIDS Strategy (NHAS) 21 provides a framework of increasing access to care, 22 reducing new infections, and eliminating HIV-re- 23 lated health disparities. The vision of NHAS is ‘‘The 24 United States will become a place where new HIV 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00589 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 590 •HR 5942 IH infections are rare and when they do occur, every 1 person, regardless of age, gender, race/ethnicity, 2 gender identity, or socioeconomic circumstance, will 3 have unfettered access to high quality, life-extending 4 care, free from stigma and discrimination.’’. 5 (15) At present, many States and United 6 States territories have criminal statutes based on 7 ‘‘exposure’’ to HIV. Most of these laws were adopted 8 before the availability of effective antiretroviral 9 treatment for HIV/AIDS. 10 (16) Research shows that stable housing leads 11 to better health outcomes for those living with HIV. 12 Inadequate or unstable housing is not only a barrier 13 to effective treatment, but also increases the likeli- 14 hood of engaging in risky behaviors leading to HIV 15 infection. Insecure housing puts people with HIV/ 16 AIDS at risk of premature death from exposure to 17 other diseases, poor nutrition, and lack of medical 18 care. 19 (17) Due to advances in treatment, many peo- 20 ple living with HIV/AIDS (PLWHA) today are liv- 21 ing healthy lives and have the ability and desire to 22 fully participate in all aspects of community life, in- 23 cluding employment. Research associates being em- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00590 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 591 •HR 5942 IH ployed with tremendous economic, social, and health 1 benefits for many people living with HIV/AIDS. 2 (18) The common benefits associated with em- 3 ployment include income, autonomy, productivity, 4 and status within society, daily structure, making a 5 contribution to one’s community, and increased skills 6 and self-esteem. Research also indicates that many 7 people with disabilities, including PLWHA, report 8 perceiving themselves as being less disabled or not 9 disabled at all, when working. Furthermore, some 10 studies link working with better physical and mental 11 health outcomes for PLWHA when compared to 12 those who are not working. Preliminary data also 13 suggest that transitioning to employment is associ- 14 ated with reduced HIV-related health risk behavior 15 for many people. 16 (19) On July 16, 2012, the Food and Drug Ad- 17 ministration approved the first drug to reduce the 18 risk of HIV infection in uninfected individuals who 19 are at high risk of HIV infection and who may en- 20 gage in sexual activity with HIV-infected partners. 21 (20) Syringe service programs (SSPs) have 22 been associated with lowered HIV infections, lower 23 hepatitis C infections, and increased linkage to sub- 24 stance use treatment. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00591 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 592 •HR 5942 IH (21) There is now conclusive scientific evidence 1 that a person living with HIV who is on 2 antiretroviral therapy (ART) and is durably virally 3 suppressed (defined as having a consistent viral load 4 of less than 200 copies/ml) does not sexually trans- 5 mit HIV. The conclusive evidence about the highly 6 effective preventative benefits of ART provides an 7 unprecedented opportunity to improve the lives of 8 people living with HIV, improve treatment uptake 9 and adherence, and advocate for expanded access to 10 treatment and care. 11 SEC. 743. ADDITIONAL FUNDING FOR AIDS DRUG ASSIST- 12 ANCE PROGRAM TREATMENTS. 13 Section 2623 of the Public Health Service Act (42 14 U.S.C. 300ff–31b) is amended by adding at the end the 15 following: 16 ‘‘(c) ADDITIONAL FUNDING FOR AIDS DRUG AS- 17 SISTANCE PROGRAM TREATMENTS.—In addition to 18 amounts otherwise authorized to be appropriated for car- 19 rying out this subpart, there are authorized to be appro- 20 priated such sums as may be necessary to carry out sec- 21 tions 2612(b)(3)(B) and 2616 for each of fiscal years 22 2019 through 2022.’’. 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00592 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 593 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00593 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 594 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00594 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 595 •HR 5942 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 2019 through 2023. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00595 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 596 •HR 5942 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 2019 20 through 2023. 21 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00596 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 597 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00597 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 598 •HR 5942 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; 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 and 17 (7) to increase knowledge of Undetectable = 18 Untransmittable (U=U) a person living with HIV 19 who is on antiretroviral therapy (ART) and is dura- 20 bly virally suppressed (defined as having a consistent 21 viral load of less than 200 copies/ml) cannot sexually 22 transmit HIV. 23 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 24 out this section, there are authorized to be appropriated 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00598 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 599 •HR 5942 IH such sums as may be necessary for fiscal years 2019 1 through 2023. 2 SEC. 747. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND 3 ETHNIC MINORITY COMMUNITIES. 4 (a) IN GENERAL.—For the purpose of reducing HIV/ 5 AIDS in racial and ethnic minority communities, the Sec- 6 retary, acting through the Deputy Assistant Secretary for 7 Minority Health, may make grants to public health agen- 8 cies and faith-based organizations to conduct— 9 (1) outreach activities related to HIV/AIDS 10 prevention and testing activities; 11 (2) HIV/AIDS prevention activities; and 12 (3) HIV/AIDS testing activities. 13 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 14 out this section, there are authorized to be appropriated 15 such sums as may be necessary for fiscal years 2019 16 through 2023. 17 SEC. 748. MINORITY AIDS INITIATIVE. 18 (a) EXPANDED FUNDING.—The Secretary, in col- 19 laboration with the Deputy Assistant Secretary for Minor- 20 ity Health, the Director of the Centers for Disease Control 21 and Prevention, the Administrator of the Health Re- 22 sources and Services Administration, and the Adminis- 23 trator of the Substance Abuse and Mental Health Services 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00599 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 600 •HR 5942 IH Administration, shall provide funds and carry out activi- 1 ties to expand the Minority HIV/AIDS Initiative. 2 (b) USE OF FUNDS.—The additional funds made 3 available under this section may be used, through the Mi- 4 nority AIDS Initiative, to support the following activities: 5 (1) Providing technical assistance and infra- 6 structure support to reduce HIV/AIDS in minority 7 populations. 8 (2) Increasing minority populations’ access to 9 HIV/AIDS prevention and care services. 10 (3) Building strong community programs and 11 partnerships to address HIV prevention and the 12 health care needs of specific racial and ethnic minor- 13 ity populations. 14 (c) PRIORITY INTERVENTIONS.—Within the racial 15 and ethnic minority populations referred to in subsection 16 (b), priority in conducting intervention services shall be 17 given to— 18 (1) men who have sex with men; 19 (2) youth; 20 (3) persons who engage in intravenous drug 21 abuse; 22 (4) women; 23 (5) homeless individuals; and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00600 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 601 •HR 5942 IH (6) individuals incarcerated or in the penal sys- 1 tem. 2 (d) AUTHORIZATION OF APPROPRIATIONS.—For car- 3 rying out this section, there are authorized to be appro- 4 priated $610,000,000 for fiscal year 2019 and such sums 5 as may be necessary for each of fiscal years 2020 through 6 2023. 7 SEC. 749. HEALTH CARE PROFESSIONALS TREATING INDI- 8 VIDUALS WITH HIV/AIDS. 9 (a) IN GENERAL.—The Secretary of Health and 10 Human Services, acting through the Administrator of the 11 Health Resources and Services Administration, shall ex- 12 pand, intensify, and coordinate workforce initiatives of the 13 Health Resources and Services Administration to increase 14 the capacity of the health workforce focusing primarily on 15 HIV/AIDS to meet the demand for culturally competent 16 care, and may award grants for any of the following: 17 (1) Development of curricula for training pri- 18 mary care providers in HIV/AIDS prevention and 19 care, including routine HIV testing. 20 (2) Support to expand access to culturally and 21 linguistically accessible benefits counselors, trained 22 peer navigators, and mental and behavioral health 23 professionals with expertise in HIV/AIDS. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00601 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 602 •HR 5942 IH (3) Training health care professionals to pro- 1 vide care to individuals with HIV/AIDS. 2 (4) Development by grant recipients under title 3 XXVI of the Public Health Service Act (42 U.S.C. 4 300ff–11 et seq.; commonly referred to as the ‘‘Ryan 5 White HIV/AIDS Program’’) and other persons, of 6 policies for providing culturally relevant and sen- 7 sitive treatment to individuals with HIV/AIDS, with 8 particular emphasis on treatment to racial and eth- 9 nic minorities, men who have sex with men, and 10 women, young people, and children with HIV/AIDS. 11 (5) Development and implementation of pro- 12 grams to increase the use of telehealth to respond to 13 HIV/AIDS-specific health care needs in rural and 14 minority communities, with particular emphasis 15 given to medically underserved communities and in- 16 sular areas. 17 (6) Evaluating interdisciplinary medical pro- 18 vider care team models that promote high-quality 19 care, with particular emphasis on care to racial and 20 ethnic minorities. 21 (7) Training health care professionals to make 22 them aware of the high rates of chronic hepatitis B 23 and chronic hepatitis C in adult racial and ethnic 24 populations, and the importance of prevention, de- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00602 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 603 •HR 5942 IH tection, and medical management of hepatitis B and 1 hepatitis C and of liver cancer screening. 2 (8) Development of curricula for training pri- 3 mary care providers that HIV/AIDS and tuber- 4 culosis are significant mutual comorbidities, and 5 that a patient who tests positive for one disease 6 should be offered and encouraged to receive testing 7 for the other. 8 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 9 out this section, there are authorized to be appropriated 10 such sums as may be necessary for fiscal years 2019 11 through 2023. 12 SEC. 750. HIV/AIDS PROVIDER LOAN REPAYMENT PRO- 13 GRAM. 14 (a) IN GENERAL.—The Secretary may enter into an 15 agreement with any physician, nurse practitioner, or phy- 16 sician assistant under which— 17 (1) the physician, nurse practitioner, or physi- 18 cian assistant agrees to serve as a medical provider 19 for a period of not less than 2 years— 20 (A) at a Ryan White-funded or title X- 21 funded facility with a critical shortage of doc- 22 tors (as determined by the Secretary); or 23 (B) in an area with a high incidence of 24 HIV/AIDS; and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00603 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 604 •HR 5942 IH (2) the Secretary agrees to make payments in 1 accordance with subsection (b) on the professional 2 education loans of the physician, nurse practitioner, 3 or physician assistant. 4 (b) MANNER OF PAYMENTS.—The payments de- 5 scribed in subsection (a) shall be made by the Secretary 6 as follows: 7 (1) Upon completion by the physician, nurse 8 practitioner, or physician assistant for whom the 9 payments are to be made of the first year of the 10 service specified in the agreement entered into with 11 the Secretary under subsection (a), the Secretary 12 shall pay 30 percent of the principal of and the in- 13 terest on the individual’s professional education 14 loans. 15 (2) Upon completion by the physician, nurse 16 practitioner, or physician assistant of the second 17 year of such service, the Secretary shall pay another 18 30 percent of the principal of and the interest on 19 such loans. 20 (3) Upon completion by that individual of a 21 third year of such service, the Secretary shall pay 22 another 25 percent of the principal of and the inter- 23 est on such loans. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00604 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 605 •HR 5942 IH (c) APPLICABILITY OF CERTAIN PROVISIONS.—The 1 provisions of subpart III of part D of title III of the Public 2 Health Service Act (42 U.S.C. 254l et seq.) shall, except 3 as inconsistent with this section, apply to the program car- 4 ried out under this section in the same manner and to 5 the same extent as such provisions apply to the National 6 Health Service Corps Loan Repayment Program. 7 (d) REPORTS.—Not later than 18 months after the 8 date of the enactment of this Act, and annually thereafter, 9 the Secretary shall prepare and submit to the Congress 10 a report describing the program carried out under this sec- 11 tion, including statements regarding the following: 12 (1) The number of physicians, nurse practi- 13 tioners, and physician assistants enrolled in the pro- 14 gram. 15 (2) The number and amount of loan repay- 16 ments. 17 (3) The placement location of loan repayment 18 recipients at facilities described in subsection (a)(1). 19 (4) The default rate and actions required. 20 (5) The amount of outstanding default funds. 21 (6) To the extent that it can be determined, the 22 reason for the default. 23 (7) The demographics of individuals partici- 24 pating in the program. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00605 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 606 •HR 5942 IH (8) An evaluation of the overall costs and bene- 1 fits of the program. 2 (e) DEFINITIONS.—In this section: 3 (1) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means 4 human immunodeficiency virus and acquired im- 5 mune deficiency syndrome. 6 (2) NURSE PRACTITIONER.—The term ‘‘nurse 7 practitioner’’ means a registered nurse who has com- 8 pleted an accredited graduate degree program in ad- 9 vanced nurse practice and has successfully passed a 10 national certification exam. 11 (3) PHYSICIAN.—The term ‘‘physician’’ means 12 a graduate of a school of medicine who has com- 13 pleted postgraduate training in general or pediatric 14 medicine. 15 (4) PHYSICIAN ASSISTANT.—The term ‘‘physi- 16 cian assistant’’ means a medical provider who com- 17 pleted an accredited physician assistant training pro- 18 gram and successfully passed the Physician Assist- 19 ant National Certifying Examination. 20 (5) PROFESSIONAL EDUCATION LOAN.—The 21 term ‘‘professional education loan’’— 22 (A) means a loan that is incurred for the 23 cost of attendance (including tuition, other rea- 24 sonable educational expenses, and reasonable 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00606 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 607 •HR 5942 IH living costs) at a school of medicine, nursing, or 1 physician assistant training program; and 2 (B) includes only the portion of the loan 3 that is outstanding on the date the physician, 4 nurse practitioner, or physician assistant in- 5 volved begins the service specified in the agree- 6 ment under subsection (a). 7 (6) RYAN WHITE-FUNDED.—The term ‘‘Ryan 8 White-funded’’ means, with respect to a facility, re- 9 ceiving funds under title XXVI of the Public Health 10 Service Act (42 U.S.C. 300ff–11 et seq.). 11 (7) SECRETARY.—The term ‘‘Secretary’’ means 12 the Secretary of Health and Human Services. 13 (8) SCHOOL OF MEDICINE.—The term ‘‘school 14 of medicine’’ has the meaning given to that term in 15 section 799B of the Public Health Service Act (42 16 U.S.C. 295p). 17 (9) TITLE X-FUNDED.—The term ‘‘title X-fund- 18 ed’’ means, with respect to a facility, receiving funds 19 under title X of the Public Health Service Act (42 20 U.S.C. 300 et seq.). 21 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 22 out this section, there are authorized to be appropriated 23 such sums as may be necessary for fiscal years 2019 24 through 2023. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00607 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 608 •HR 5942 IH SEC. 751. DENTAL EDUCATION LOAN REPAYMENT PRO- 1 GRAM. 2 (a) IN GENERAL.—The Secretary of Health and 3 Human Services may enter into an agreement with any 4 dentist under which— 5 (1) the dentist agrees to serve as a dentist for 6 a period of not less than 2 years at a facility with 7 a critical shortage of dentists (as determined by the 8 Secretary) in an area with a high incidence of HIV/ 9 AIDS; and 10 (2) the Secretary agrees to make payments in 11 accordance with subsection (b) on the dental edu- 12 cation loans of the dentist. 13 (b) MANNER OF PAYMENTS.—The payments de- 14 scribed in subsection (a) shall be made by the Secretary 15 as follows: 16 (1) Upon completion by the dentist for whom 17 the payments are to be made of the first year of the 18 service specified in the agreement entered into with 19 the Secretary under subsection (a), the Secretary 20 shall pay 30 percent of the principal of and the in- 21 terest on the dental education loans of the dentist. 22 (2) Upon completion by the dentist of the sec- 23 ond year of such service, the Secretary shall pay an- 24 other 30 percent of the principal of and the interest 25 on such loans. 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00608 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 609 •HR 5942 IH (3) Upon completion by that individual of a 1 third year of such service, the Secretary shall pay 2 another 25 percent of the principal of and the inter- 3 est on such loans. 4 (c) APPLICABILITY OF CERTAIN PROVISIONS.—The 5 provisions of subpart III of part D of title III of the Public 6 Health Service Act (42 U.S.C. 254l et seq.) shall, except 7 as inconsistent with this section, apply to the program car- 8 ried out under this section in the same manner and to 9 the same extent as such provisions apply to the National 10 Health Service Corps Loan Repayment Program. 11 (d) REPORTS.—Not later than 18 months after the 12 date of the enactment of this Act, and annually thereafter, 13 the Secretary shall prepare and submit to the Congress 14 a report describing the program carried out under this sec- 15 tion, including statements regarding the following: 16 (1) The number of dentists enrolled in the pro- 17 gram. 18 (2) The number and amount of loan repay- 19 ments. 20 (3) The placement location of loan repayment 21 recipients at facilities described in subsection (a)(1). 22 (4) The default rate and actions required. 23 (5) The amount of outstanding default funds. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00609 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 610 •HR 5942 IH (6) To the extent that it can be determined, the 1 reason for the default. 2 (7) The demographics of individuals partici- 3 pating in the program. 4 (8) An evaluation of the overall costs and bene- 5 fits of the program. 6 (e) DEFINITIONS.—In this section: 7 (1) DENTAL EDUCATION LOAN.—The term 8 ‘‘dental 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 dentistry; and 13 (B) includes only the portion of the loan 14 that is outstanding on the date the dentist in- 15 volved begins the service specified in the agree- 16 ment under subsection (a). 17 (2) DENTIST.—The term ‘‘dentist’’ means a 18 graduate of a school of dentistry who has completed 19 postgraduate training in general or pediatric den- 20 tistry. 21 (3) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means 22 human immunodeficiency virus and acquired im- 23 mune deficiency syndrome. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00610 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 611 •HR 5942 IH (4) SCHOOL OF DENTISTRY.—The term ‘‘school 1 of dentistry’’ has the meaning given to that term in 2 section 799B of the Public Health Service Act (42 3 U.S.C. 295p). 4 (5) SECRETARY.—The term ‘‘Secretary’’ means 5 the Secretary of Health and Human Services. 6 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 7 out this section, there are authorized to be appropriated 8 such sums as may be necessary for each of fiscal years 9 2019 through 2023. 10 SEC. 752. REDUCING NEW HIV INFECTIONS AMONG INJECT- 11 ING DRUG USERS. 12 (a) SENSE OF CONGRESS.—It is the sense of the Con- 13 gress that providing sterile syringes and sterilized equip- 14 ment to injecting drug users substantially reduces risk of 15 HIV infection, increases the probability that they will ini- 16 tiate drug treatment, and does not increase drug use. 17 (b) IN GENERAL.—The Secretary of Health and 18 Human Services may provide grants and technical assist- 19 ance for the purpose of reducing the rate of HIV infections 20 among injecting drug users through a comprehensive 21 package of services for such users, including the provision 22 of sterile syringes, education and outreach, access to infec- 23 tious disease testing, overdose prevention, and treatment 24 for drug dependence. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00611 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 612 •HR 5942 IH (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 1 out this section, there are authorized to be appropriated 2 such sums as may be necessary for fiscal years 2019 3 through 2023. 4 SEC. 753. REPORT ON IMPACT OF HIV/AIDS IN VULNERABLE 5 POPULATIONS. 6 (a) IN GENERAL.—The Secretary shall submit to the 7 Congress and the President an annual report on the im- 8 pact of HIV/AIDS for racial and ethnic minority commu- 9 nities, women, and youth aged 24 and younger. 10 (b) CONTENTS.—The report under subsection (a) 11 shall include information on the— 12 (1) progress that has been made in reducing 13 the impact of HIV/AIDS in such communities; 14 (2) opportunities that exist to make additional 15 progress in reducing the impact of HIV/AIDS in 16 such communities; 17 (3) challenges that may impede such additional 18 progress; and 19 (4) Federal funding necessary to achieve sub- 20 stantial reductions in HIV/AIDS in racial and ethnic 21 minority communities. 22 SEC. 754. NATIONAL HIV/AIDS OBSERVANCE DAYS. 23 (a) NATIONAL OBSERVANCE DAYS.—It is the sense 24 of the Congress that national observance days highlighting 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00612 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 613 •HR 5942 IH the impact of HIV/AIDS on communities of color include 1 the following: 2 (1) National Black HIV/AIDS Awareness Day. 3 (2) National Latino AIDS Awareness Day. 4 (3) National Asian and Pacific Islander HIV/ 5 AIDS Awareness Day. 6 (4) National Native American HIV/AIDS 7 Awareness Day. 8 (5) National Youth HIV/AIDS Awareness Day. 9 (b) CALL TO ACTION.—It is the sense of the Con- 10 gress that the President should call on members of com- 11 munities of color— 12 (1) to become involved at the local community 13 level in HIV/AIDS testing, policy, and advocacy; 14 (2) to become aware, engaged, and empowered 15 on the HIV/AIDS epidemic within their commu- 16 nities; and 17 (3) to urge members of their communities to re- 18 duce risk factors, practice safe sex and other preven- 19 tive measures, be tested for HIV/AIDS, and seek 20 care when appropriate. 21 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00613 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 614 •HR 5942 IH SEC. 755. REVIEW OF ALL FEDERAL AND STATE LAWS, 1 POLICIES, AND REGULATIONS REGARDING 2 THE CRIMINAL PROSECUTION OF INDIVID- 3 UALS FOR HIV-RELATED OFFENSES. 4 (a) DEFINITIONS.— 5 (1) HIV AND HIV/AIDS.—The terms ‘‘HIV’’ and 6 ‘‘HIV/AIDS’’ have the meanings given to such terms 7 in section 2689 of the Public Health Service Act (42 8 U.S.C. 300ff–88). 9 (2) STATE.—The term ‘‘State’’ includes the 10 District of Columbia, American Samoa, the Com- 11 monwealth of the Northern Mariana Islands, Guam, 12 Puerto Rico, and the United States Virgin Islands. 13 (b) SENSE OF CONGRESS REGARDING LAWS OR REG- 14 ULATIONS DIRECTED AT PEOPLE LIVING WITH HIV/ 15 AIDS.—It is the sense of the Congress that Federal and 16 State laws, policies, and regulations regarding people liv- 17 ing with HIV/AIDS— 18 (1) should not place unique or additional bur- 19 dens on such individuals solely as a result of their 20 HIV status; and 21 (2) should instead demonstrate a public health- 22 oriented, evidence-based, medically accurate, and 23 contemporary understanding of— 24 (A) the multiple factors that lead to HIV 25 transmission; 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00614 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 615 •HR 5942 IH (B) the relative risk of HIV transmission 1 routes; 2 (C) the current health implications of liv- 3 ing with HIV; 4 (D) the associated benefits of treatment 5 and support services for people living with HIV; 6 and 7 (E) the impact of punitive HIV-specific 8 laws and policies on public health, on people liv- 9 ing with or affected by HIV, and on their fami- 10 lies and communities. 11 (c) REVIEW OF ALL FEDERAL AND STATE LAWS, 12 POLICIES, AND REGULATIONS REGARDING THE CRIMINAL 13 PROSECUTION OF INDIVIDUALS FOR HIV-RELATED OF- 14 FENSES.— 15 (1) REVIEW OF FEDERAL AND STATE LAWS.— 16 (A) IN GENERAL.—No later than 90 days 17 after the date of the enactment of this Act, the 18 Attorney General, the Secretary of Health and 19 Human Services, and the Secretary of Defense 20 acting jointly (in this paragraph and paragraph 21 (2) referred to as the ‘‘designated officials’’) 22 shall initiate a national review of Federal and 23 State laws, policies, regulations, and judicial 24 precedents and decisions regarding criminal and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00615 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 616 •HR 5942 IH related civil commitment cases involving people 1 living with HIV/AIDS, including in regards to 2 the Uniform Code of Military Justice. 3 (B) CONSULTATION.—In carrying out the 4 review under subparagraph (A), the designated 5 officials shall ensure diverse participation and 6 consultation from each State, including with— 7 (i) State attorneys general (or their 8 representatives); 9 (ii) State public health officials (or 10 their representatives); 11 (iii) State judicial and court system 12 officers, including judges, district attor- 13 neys, prosecutors, defense attorneys, law 14 enforcement, and correctional officers; 15 (iv) members of the United States 16 Armed Forces, including members of other 17 Federal services subject to the Uniform 18 Code of Military Justice; 19 (v) people living with HIV/AIDS, par- 20 ticularly those who have been subject to 21 HIV-related prosecution or who are from 22 communities whose members have been 23 disproportionately subject to HIV-specific 24 arrests and prosecutions; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00616 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 617 •HR 5942 IH (vi) legal advocacy and HIV/AIDS 1 service organizations that work with people 2 living with HIV/AIDS; 3 (vii) nongovernmental health organi- 4 zations that work on behalf of people living 5 with HIV/AIDS; and 6 (viii) trade organizations or associa- 7 tions representing persons or entities de- 8 scribed in clauses (i) through (vii). 9 (C) RELATION TO OTHER REVIEWS.—In 10 carrying out the review under subparagraph 11 (A), the designated officials may utilize other 12 existing reviews of criminal and related civil 13 commitment cases involving people living with 14 HIV/AIDS, including any such review con- 15 ducted by any Federal or State agency or any 16 public health, legal advocacy, or trade organiza- 17 tion or association if the designated officials de- 18 termine that such reviews were conducted in ac- 19 cordance with the principles set forth in sub- 20 section (b). 21 (2) REPORT.—No later than 180 days after ini- 22 tiating the review required by paragraph (1), the At- 23 torney General shall transmit to the Congress and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00617 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 618 •HR 5942 IH make publicly available a report containing the re- 1 sults of the review, which includes the following: 2 (A) For each State and for the Uniform 3 Code of Military Justice, a summary of the rel- 4 evant laws, policies, regulations, and judicial 5 precedents and decisions regarding criminal 6 cases involving people living with HIV/AIDS, 7 including, if applicable, the following: 8 (i) A determination of whether such 9 laws, policies, regulations, and judicial 10 precedents and decisions place any unique 11 or additional burdens upon people living 12 with HIV/AIDS. 13 (ii) A determination of whether such 14 laws, policies, regulations, and judicial 15 precedents and decisions demonstrate a 16 public health-oriented, evidence-based, 17 medically accurate, and contemporary un- 18 derstanding of— 19 (I) the multiple factors that lead 20 to HIV transmission; 21 (II) the relative risk of HIV 22 transmission routes; 23 (III) the current health implica- 24 tions of living with HIV; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00618 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 619 •HR 5942 IH (IV) the associated benefits of 1 treatment and support services for 2 people living with HIV; and 3 (V) the impact of punitive HIV- 4 specific laws and policies on public 5 health, on people living with or af- 6 fected by HIV, and on their families 7 and communities. 8 (iii) An analysis of the public health 9 and legal implications of such laws, poli- 10 cies, regulations, and judicial precedents, 11 including an analysis of the consequences 12 of having a similar penal scheme applied to 13 comparable situations involving other com- 14 municable diseases. 15 (iv) An analysis of the proportionality 16 of punishments imposed under HIV-spe- 17 cific laws, policies, regulations, and judicial 18 precedents, taking into consideration pen- 19 alties attached to violation of State laws 20 against similar degrees of endangerment or 21 harm, such as driving while intoxicated 22 (DWI) or transmission of other commu- 23 nicable diseases, or more serious harms, 24 such as vehicular manslaughter offenses. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00619 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 620 •HR 5942 IH (B) An analysis of common elements 1 shared among State laws, policies, regulations, 2 and judicial precedents. 3 (C) A set of best practice recommendations 4 directed to State governments, including State 5 attorneys general, public health officials, and 6 judicial officers, in order to ensure that laws, 7 policies, regulations, and judicial precedents re- 8 garding people living with HIV/AIDS are in ac- 9 cordance with the principles set forth in sub- 10 section (b). 11 (D) Recommendations for adjustments to 12 the Uniform Code of Military Justice, as may 13 be necessary, in order to ensure that laws, poli- 14 cies, regulations, and judicial precedents re- 15 garding people living with HIV/AIDS are in ac- 16 cordance with the principles set forth in sub- 17 section (b). 18 (3) GUIDANCE.—Within 90 days of the release 19 of the report required by paragraph (2), the Attor- 20 ney General and the Secretary of Health and 21 Human Services, acting jointly, shall develop and 22 publicly release updated guidance for States based 23 on the set of best practice recommendations required 24 by paragraph (2)(C) in order to assist States dealing 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00620 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 621 •HR 5942 IH with criminal and related civil commitment cases re- 1 garding people living with HIV/AIDS. 2 (4) MONITORING AND EVALUATION SYSTEM.— 3 Within 60 days of the release of the guidance re- 4 quired by paragraph (3), the Attorney General and 5 the Secretary of Health and Human Services, acting 6 jointly, shall establish an integrated monitoring and 7 evaluation system which includes, where appropriate, 8 objective and quantifiable performance goals and in- 9 dicators to measure progress toward statewide im- 10 plementation in each State of the best practice rec- 11 ommendations required in paragraph (2)(C), includ- 12 ing to monitor, track, and evaluate the effectiveness 13 of assistance provided pursuant to subsection (d). 14 (5) ADJUSTMENTS TO FEDERAL LAWS, POLI- 15 CIES, OR REGULATIONS.—Within 90 days of the re- 16 lease of the report required by paragraph (2), the 17 Attorney General, the Secretary of Health and 18 Human Services, and the Secretary of Defense, act- 19 ing jointly, shall develop and transmit to the Presi- 20 dent and the Congress, and make publicly available, 21 such proposals as may be necessary to implement 22 adjustments to Federal laws, policies, or regulations, 23 including to the Uniform Code of Military Justice, 24 based on the recommendations required by para- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00621 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 622 •HR 5942 IH graph (2)(D), either through Executive order or 1 through changes to statutory law. 2 (6) AUTHORIZATION OF APPROPRIATIONS.— 3 (A) IN GENERAL.—There are authorized to 4 be appropriated such sums as may be necessary 5 for the purpose of carrying out this subsection. 6 Amounts authorized to be appropriated by the 7 preceding sentence are in addition to amounts 8 otherwise authorized to be appropriated for 9 such purpose. 10 (B) AVAILABILITY OF FUNDS.—Amounts 11 appropriated pursuant to the authorization of 12 appropriations in subparagraph (A) are author- 13 ized to remain available until expended. 14 (d) AUTHORIZATION TO PROVIDE GRANTS.— 15 (1) GRANTS BY ATTORNEY GENERAL.— 16 (A) IN GENERAL.—The Attorney General 17 may provide assistance to eligible State and 18 local entities and eligible nongovernmental orga- 19 nizations for the purpose of incorporating the 20 best practice recommendations developed under 21 subsection (c)(2)(C) within relevant State laws, 22 policies, regulations, and judicial decisions re- 23 garding people living with HIV/AIDS. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00622 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 623 •HR 5942 IH (B) AUTHORIZED ACTIVITIES.—The assist- 1 ance authorized by subparagraph (A) may in- 2 clude— 3 (i) direct technical assistance to eligi- 4 ble State and local entities in order to de- 5 velop, disseminate, or implement State 6 laws, policies, regulations, or judicial deci- 7 sions that conform with the best practice 8 recommendations developed under sub- 9 section (c)(2)(C); 10 (ii) direct technical assistance to eligi- 11 ble nongovernmental organizations in order 12 to provide education and training, includ- 13 ing through classes, conferences, meetings, 14 and other educational activities, to eligible 15 State and local entities; and 16 (iii) subcontracting authority to allow 17 eligible State and local entities and eligible 18 nongovernmental organizations to seek 19 technical assistance from legal and public 20 health experts with a demonstrated under- 21 standing of the principles underlying the 22 best practice recommendations developed 23 under subsection (c)(2)(C). 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00623 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 624 •HR 5942 IH (2) GRANTS BY SECRETARY OF HEALTH AND 1 HUMAN SERVICES.— 2 (A) IN GENERAL.—The Secretary of 3 Health and Human Services, acting through the 4 Director of the Centers for Disease Control and 5 Prevention, may provide assistance to State and 6 local public health departments and eligible 7 nongovernmental organizations for the purpose 8 of supporting eligible State and local entities to 9 incorporate the best practice recommendations 10 developed under subsection (c)(2)(C) within rel- 11 evant State laws, policies, regulations, and judi- 12 cial decisions regarding people living with HIV/ 13 AIDS. 14 (B) AUTHORIZED ACTIVITIES.—The assist- 15 ance authorized by subparagraph (A) may in- 16 clude— 17 (i) direct technical assistance to State 18 and local public health departments in 19 order to support the development, dissemi- 20 nation, or implementation of State laws, 21 policies, regulations, or judicial decisions 22 that conform with the set of best practice 23 recommendations developed under sub- 24 section (c)(2)(C); 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00624 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 625 •HR 5942 IH (ii) direct technical assistance to eligi- 1 ble nongovernmental organizations in order 2 to provide education and training, includ- 3 ing through classes, conferences, meetings, 4 and other educational activities, to State 5 and local public health departments; and 6 (iii) subcontracting authority to allow 7 State and local public health departments 8 and eligible nongovernmental organizations 9 to seek technical assistance from legal and 10 public health experts with a demonstrated 11 understanding of the principles underlying 12 the best practice recommendations devel- 13 oped under subsection (c)(2)(C). 14 (3) LIMITATION.—As a condition of receiving 15 assistance through this subsection, eligible State and 16 local entities, State and local public health depart- 17 ments, and eligible nongovernmental organizations 18 shall agree— 19 (A) not to place any unique or additional 20 burdens on people living with HIV/AIDS solely 21 as a result of their HIV status; and 22 (B) that if the entity, department, or orga- 23 nization promulgates any laws, policies, regula- 24 tions, or judicial decisions regarding people liv- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00625 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 626 •HR 5942 IH ing with HIV/AIDS, such actions shall dem- 1 onstrate a public health-oriented, evidence- 2 based, medically accurate, and contemporary 3 understanding of— 4 (i) the multiple factors that lead to 5 HIV transmission; 6 (ii) the relative risk of HIV trans- 7 mission routes; 8 (iii) the current health implications of 9 living with HIV; 10 (iv) the associated benefits of treat- 11 ment and support services for people living 12 with HIV; and 13 (v) the impact of punitive HIV-spe- 14 cific laws and policies on public health, on 15 people living with or affected by HIV, and 16 on their families and communities. 17 (4) REPORT.—No later than 1 year after the 18 date of the enactment of this Act, and annually 19 thereafter, the Attorney General and the Secretary 20 of Health and Human Services, acting jointly, shall 21 transmit to Congress and make publicly available a 22 report describing, for each State, the impact and ef- 23 fectiveness of the assistance provided through this 24 Act. Each such report shall include— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00626 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 627 •HR 5942 IH (A) a detailed description of the progress 1 each State has made, if any, in implementing 2 the best practice recommendations developed 3 under subsection (c)(2)(C) as a result of the as- 4 sistance provided under this subsection, and 5 based on the performance goals and indicators 6 established as part of the monitoring and eval- 7 uation system in subsection (c)(4); 8 (B) a brief summary of any outreach ef- 9 forts undertaken during the prior year by the 10 Attorney General and the Secretary of Health 11 and Human Services to encourage States to 12 seek assistance under this subsection in order 13 to implement the best practice recommenda- 14 tions developed under subsection (c)(2)(C); 15 (C) a summary of how assistance provided 16 through this subsection is being utilized by eli- 17 gible State and local entities, State and local 18 public health departments, and eligible non- 19 governmental organizations and, if applicable, 20 any contractors, including with respect to non- 21 governmental organizations, the type of tech- 22 nical assistance provided, and an evaluation of 23 the impact of such assistance on eligible State 24 and local entities; and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00627 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 628 •HR 5942 IH (D) a summary and description of eligible 1 State and local entities, State and local public 2 health departments, and eligible nongovern- 3 mental organizations receiving assistance 4 through this subsection, including if applicable, 5 a summary and description of any contractors 6 selected to assist in implementing such assist- 7 ance. 8 (5) DEFINITIONS.—For the purposes of this 9 subsection: 10 (A) ELIGIBLE STATE AND LOCAL ENTI- 11 TIES.—The term ‘‘eligible State and local enti- 12 ties’’ means the relevant individuals, offices, or 13 organizations that directly participate in the de- 14 velopment, dissemination, or implementation of 15 State laws, policies, regulations, or judicial deci- 16 sions, including— 17 (i) State governments, including State 18 attorneys general, State departments of 19 justice, and State National Guards, or 20 their equivalents; 21 (ii) State judicial and court systems, 22 including trial courts, appellate courts, 23 State supreme courts and courts of appeal, 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00628 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 629 •HR 5942 IH and State correctional facilities, or their 1 equivalents; and 2 (iii) local governments, including city 3 and county governments, district attorneys, 4 and local law enforcement departments, or 5 their equivalents. 6 (B) STATE AND LOCAL PUBLIC HEALTH 7 DEPARTMENTS.—The term ‘‘State and local 8 public health departments’’ means the fol- 9 lowing: 10 (i) State public health departments, or 11 their equivalents, including the chief officer 12 of such departments and infectious disease 13 and communicable disease specialists with- 14 in such departments. 15 (ii) Local public health departments, 16 or their equivalents, including city and 17 county public health departments, the chief 18 officer of such departments, and infectious 19 disease and communicable disease special- 20 ists within such departments. 21 (iii) Public health departments or offi- 22 cials, or their equivalents, within State or 23 local correctional facilities. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00629 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 630 •HR 5942 IH (iv) Public health departments or offi- 1 cials, or their equivalents, within State Na- 2 tional Guards. 3 (v) Any other recognized State or 4 local public health organization or entity 5 charged with carrying out official State or 6 local public health duties. 7 (C) ELIGIBLE NONGOVERNMENTAL ORGA- 8 NIZATIONS.—The term ‘‘eligible nongovern- 9 mental organizations’’ means the following: 10 (i) Nongovernmental organizations, 11 including trade organizations or associa- 12 tions that represent— 13 (I) State attorneys general, or 14 their equivalents; 15 (II) State public health officials, 16 or their equivalents; 17 (III) State judicial and court offi- 18 cers, including judges, district attor- 19 neys, prosecutors, defense attorneys, 20 law enforcement, and correctional offi- 21 cers; 22 (IV) State National Guards; 23 (V) people living with HIV/AIDS; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00630 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 631 •HR 5942 IH (VI) legal advocacy and HIV/ 1 AIDS service organizations that work 2 with people living with HIV/AIDS; 3 and 4 (VII) nongovernmental health or- 5 ganizations that work on behalf of 6 people living with HIV/AIDS. 7 (ii) Nongovernmental organizations, 8 including trade organizations or associa- 9 tions that demonstrate a public-health ori- 10 ented, evidence-based, medically accurate, 11 and contemporary understanding of— 12 (I) the multiple factors that lead 13 to HIV transmission; 14 (II) the relative risk of HIV 15 transmission routes; 16 (III) the current health implica- 17 tions of living with HIV; 18 (IV) the associated benefits of 19 treatment and support services for 20 people living with HIV; and 21 (V) the impact of punitive HIV- 22 specific laws and policies on public 23 health, on people living with or af- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00631 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 632 •HR 5942 IH fected by HIV, and on their families 1 and communities. 2 (6) AUTHORIZATION OF APPROPRIATIONS.— 3 (A) IN GENERAL.—In addition to amounts 4 otherwise made available, there are authorized 5 to be appropriated to the Attorney General and 6 the Secretary of Health and Human Services 7 such sums as may be necessary to carry out 8 this subsection for each of the fiscal years 2019 9 through 2023. 10 (B) AVAILABILITY OF FUNDS.—Amounts 11 appropriated pursuant to the authorizations of 12 appropriations in subparagraph (A) are author- 13 ized to remain available until expended. 14 SEC. 756. EXPANDING SUPPORT FOR CONDOMS IN PRIS- 15 ONS. 16 (a) AUTHORITY TO ALLOW COMMUNITY ORGANIZA- 17 TIONS TO PROVIDE STI COUNSELING, STI PREVENTION 18 EDUCATION, AND SEXUAL BARRIER PROTECTION DE- 19 VICES IN FEDERAL CORRECTIONAL FACILITIES.— 20 (1) DIRECTIVE TO ATTORNEY GENERAL.—Not 21 later than 30 days after the date of enactment of 22 this Act, the Attorney General shall direct the Bu- 23 reau of Prisons to allow community organizations to 24 distribute sexual barrier protection devices and to 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00632 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 633 •HR 5942 IH engage in STI counseling and STI prevention edu- 1 cation in Federal correctional facilities. These activi- 2 ties shall be subject to all relevant Federal laws and 3 regulations which govern visitation in correctional 4 facilities. 5 (2) INFORMATION REQUIREMENT.—Any com- 6 munity organization permitted to distribute sexual 7 barrier protection devices under paragraph (1) shall 8 ensure that the persons to whom the devices are dis- 9 tributed are informed about the proper use and dis- 10 posal of sexual barrier protection devices in accord- 11 ance with established public health practices. Any 12 community organization conducting STI counseling 13 or STI prevention education under paragraph (1) 14 shall offer comprehensive sexuality education. 15 (3) POSSESSION OF DEVICE PROTECTED.—No 16 Federal correctional facility may, because of the pos- 17 session or use of a sexual barrier protection device— 18 (A) take adverse action against an incar- 19 cerated person; or 20 (B) consider possession or use as evidence 21 of prohibited activity for the purpose of any 22 Federal correctional facility administrative pro- 23 ceeding. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00633 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 634 •HR 5942 IH (4) IMPLEMENTATION.—The Attorney General 1 and Bureau of Prisons shall implement this section 2 according to established public health practices in a 3 manner that protects the health, safety, and privacy 4 of incarcerated persons and of correctional facility 5 staff. 6 (b) SENSE OF CONGRESS REGARDING DISTRIBUTION 7 OF SEXUAL BARRIER PROTECTION DEVICES IN STATE 8 PRISON SYSTEMS.—It is the sense of the Congress that 9 States should allow for the legal distribution of sexual bar- 10 rier protection devices in State correctional facilities to re- 11 duce the prevalence and spread of STIs in those facilities. 12 (c) SURVEY OF AND REPORT ON CORRECTIONAL FA- 13 CILITY PROGRAMS AIMED AT REDUCING THE SPREAD OF 14 STIS.— 15 (1) SURVEY.—The Attorney General, after con- 16 sulting with the Secretary of Health and Human 17 Services, State officials, and community organiza- 18 tions, shall, to the maximum extent practicable, con- 19 duct a survey of all Federal and State correctional 20 facilities, not later than 180 days after the date of 21 enactment of this Act and annually thereafter for 5 22 years, to determine the following: 23 (A) COUNSELING, TREATMENT, AND SUP- 24 PORTIVE SERVICES.—Whether the correctional 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00634 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 635 •HR 5942 IH facility requires incarcerated persons to partici- 1 pate in counseling, treatment, and supportive 2 services related to STIs, or whether it offers 3 such programs to incarcerated persons. 4 (B) ACCESS TO SEXUAL BARRIER PROTEC- 5 TION DEVICES.—Whether incarcerated persons 6 can— 7 (i) possess sexual barrier protection 8 devices; 9 (ii) purchase sexual barrier protection 10 devices; 11 (iii) purchase sexual barrier protection 12 devices at a reduced cost; and 13 (iv) obtain sexual barrier protection 14 devices without cost. 15 (C) INCIDENCE OF SEXUAL VIOLENCE.— 16 The incidence of sexual violence and assault 17 committed by incarcerated persons and by cor- 18 rectional facility staff. 19 (D) PREVENTION EDUCATION OFFERED.— 20 The type of prevention education, information, 21 or training offered to incarcerated persons and 22 correctional facility staff regarding sexual vio- 23 lence and the spread of STIs, including whether 24 such education, information, or training— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00635 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 636 •HR 5942 IH (i) constitutes comprehensive sexuality 1 education; 2 (ii) is compulsory for new incarcerated 3 persons and for new staff; and 4 (iii) is offered on an ongoing basis. 5 (E) STI TESTING.—Whether the correc- 6 tional facility tests incarcerated persons for 7 STIs or gives them the option to undergo such 8 testing— 9 (i) at intake; 10 (ii) on a regular basis; and 11 (iii) prior to release. 12 (F) STI TEST RESULTS.—The number of 13 incarcerated persons who are tested for STIs 14 and the outcome of such tests at each correc- 15 tional facility, disaggregated to include results 16 for— 17 (i) the type of sexually transmitted in- 18 fection tested for; 19 (ii) the race and/or ethnicity of indi- 20 viduals tested; 21 (iii) the age of individuals tested; and 22 (iv) the gender of individuals tested. 23 (G) PRERELEASE REFERRAL POLICY.— 24 Whether incarcerated persons are informed 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00636 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 637 •HR 5942 IH prior to release about STI-related services or 1 other health services in their communities, in- 2 cluding free and low-cost counseling and treat- 3 ment options. 4 (H) PRERELEASE REFERRALS MADE.— 5 The number of referrals to community-based 6 organizations or public health facilities offering 7 STI-related or other health services provided to 8 incarcerated persons prior to release, and the 9 type of counseling or treatment for which the 10 referral was made. 11 (I) REINSTATEMENT OF MEDICAID BENE- 12 FITS.—Whether the correctional facility assists 13 incarcerated persons that were enrolled in the 14 State Medicaid program prior to their incarcer- 15 ation, in reinstating their enrollment upon re- 16 lease and whether such individuals receive refer- 17 rals as provided by subparagraph (G) to entities 18 that accept the State Medicaid program, includ- 19 ing if applicable— 20 (i) the number of such individuals, in- 21 cluding those diagnosed with the human 22 immunodeficiency virus, that have been re- 23 instated; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00637 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 638 •HR 5942 IH (ii) a list of obstacles to reinstating 1 enrollment or to making determinations of 2 eligibility for reinstatement, if any; and 3 (iii) the number of individuals denied 4 enrollment. 5 (J) OTHER ACTIONS TAKEN.—Whether the 6 correctional facility has taken any other action, 7 in conjunction with community organizations or 8 otherwise, to reduce the prevalence and spread 9 of STIs in that facility. 10 (2) PRIVACY.—In conducting the survey, the 11 Attorney General shall not request or retain the 12 identity of any person who has sought or been of- 13 fered counseling, treatment, testing, or prevention 14 education information regarding an STI (including 15 information about sexual barrier protection devices), 16 or who has tested positive for an STI. 17 (3) REPORT.—The Attorney General shall 18 transmit to Congress and make publicly available 19 the results of the survey required under paragraph 20 (1), both for the Nation as a whole and 21 disaggregated as to each State and each correctional 22 facility. To the maximum extent possible, the Attor- 23 ney General shall issue the first report no later than 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00638 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 639 •HR 5942 IH 1 year after the date of enactment of this Act and 1 shall issue reports annually thereafter for 5 years. 2 (d) STRATEGY.— 3 (1) DIRECTIVE TO ATTORNEY GENERAL.—The 4 Attorney General, in consultation with the Secretary 5 of Health and Human Services, State officials, and 6 community organizations, shall develop and imple- 7 ment a 5-year strategy to reduce the prevalence and 8 spread of STIs in Federal and State correctional fa- 9 cilities. To the maximum extent possible, the strat- 10 egy shall be developed, transmitted to Congress, and 11 made publicly available no later than 180 days after 12 the transmission of the first report required under 13 subsection (c)(3). 14 (2) CONTENTS OF STRATEGY.—The strategy 15 shall include the following: 16 (A) PREVENTION EDUCATION.—A plan for 17 improving prevention education, information, 18 and training offered to incarcerated persons 19 and correctional facility staff, including infor- 20 mation and training on sexual violence and the 21 spread of STIs, and comprehensive sexuality 22 education. 23 (B) SEXUAL BARRIER PROTECTION DEVICE 24 ACCESS.—A plan for expanding access to sexual 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00639 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 640 •HR 5942 IH barrier protection devices in correctional facili- 1 ties. 2 (C) SEXUAL VIOLENCE REDUCTION.—A 3 plan for reducing the incidence of sexual vio- 4 lence among incarcerated persons and correc- 5 tional facility staff, developed in consultation 6 with the National Prison Rape Elimination 7 Commission. 8 (D) COUNSELING AND SUPPORTIVE SERV- 9 ICES.—A plan for expanding access to coun- 10 seling and supportive services related to STIs in 11 correctional facilities. 12 (E) TESTING.—A plan for testing incarcer- 13 ated persons for STIs during intake, during 14 regular health exams, and prior to release, and 15 that— 16 (i) is conducted in accordance with 17 guidelines established by the Centers for 18 Disease Control and Prevention; 19 (ii) includes pretest counseling; 20 (iii) requires that incarcerated persons 21 are notified of their option to decline test- 22 ing at any time; 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00640 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 641 •HR 5942 IH (iv) requires that incarcerated persons 1 are confidentially notified of their test re- 2 sults in a timely manner; and 3 (v) ensures that incarcerated persons 4 testing positive for STIs receive post-test 5 counseling, care, treatment, and supportive 6 services. 7 (F) TREATMENT.—A plan for ensuring 8 that correctional facilities have the necessary 9 medicine and equipment to treat and monitor 10 STIs and for ensuring that incarcerated per- 11 sons living with or testing positive for STIs re- 12 ceive and have access to care and treatment 13 services. 14 (G) STRATEGIES FOR DEMOGRAPHIC 15 GROUPS.—A plan for developing and imple- 16 menting culturally appropriate, sensitive, and 17 specific strategies to reduce the spread of STIs 18 among demographic groups heavily impacted by 19 STIs. 20 (H) LINKAGES WITH COMMUNITIES AND 21 FACILITIES.—A plan for establishing and 22 strengthening linkages to local communities and 23 health facilities that— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00641 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 642 •HR 5942 IH (i) provide counseling, testing, care, 1 and treatment services; 2 (ii) may receive persons recently re- 3 leased from incarceration who are living 4 with STIs; and 5 (iii) accept payment through the State 6 Medicaid program. 7 (I) ENROLLMENT IN STATE MEDICAID 8 PROGRAMS.—Plans to ensure that incarcerated 9 persons who were— 10 (i) enrolled in their State Medicaid 11 program prior to incarceration in a correc- 12 tional facility are automatically reenrolled 13 in such program upon their release; and 14 (ii) not enrolled in their State Med- 15 icaid program prior to incarceration, but 16 who are diagnosed with the human im- 17 munodeficiency virus while incarcerated in 18 a correctional facility, are automatically 19 enrolled in such program upon their re- 20 lease. 21 (J) OTHER PLANS.—Any other plans de- 22 veloped by the Attorney General for reducing 23 the spread of STIs or improving the quality of 24 health care in correctional facilities. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00642 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 643 •HR 5942 IH (K) MONITORING SYSTEM.—A monitoring 1 system that establishes performance goals re- 2 lated to reducing the prevalence and spread of 3 STIs in correctional facilities and which, where 4 feasible, expresses such goals in quantifiable 5 form. 6 (L) MONITORING SYSTEM PERFORMANCE 7 INDICATORS.—Performance indicators that 8 measure or assess the achievement of the per- 9 formance goals described in subparagraph (K). 10 (M) COST ESTIMATE.—A detailed estimate 11 of the funding necessary to implement the 12 strategy at the Federal and State levels for all 13 5 years, including the amount of funds required 14 by community organizations to implement the 15 parts of the strategy in which they take part. 16 (3) REPORT.—The Attorney General shall 17 transmit to Congress and make publicly available an 18 annual progress report regarding the implementation 19 and effectiveness of the strategy described in para- 20 graph (1). The progress report shall include an eval- 21 uation of the implementation of the strategy using 22 the monitoring system and performance indicators 23 provided for in subparagraphs (K) and (L) of para- 24 graph (2). 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00643 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 644 •HR 5942 IH (e) AUTHORIZATION OF APPROPRIATIONS.— 1 (1) IN GENERAL.—There are authorized to be 2 appropriated such sums as may be necessary to 3 carry out this section for each of fiscal years 2019 4 through 2023. 5 (2) AVAILABILITY OF FUNDS.—Amounts made 6 available under paragraph (1) are authorized to re- 7 main available until expended. 8 (f) DEFINITIONS.—For the purposes of this section: 9 (1) COMMUNITY ORGANIZATION.—The term 10 ‘‘community organization’’ means a public health 11 care facility or a nonprofit organization which pro- 12 vides health- or STI-related services according to es- 13 tablished public health standards. 14 (2) COMPREHENSIVE SEXUALITY EDUCATION.— 15 The term ‘‘comprehensive sexuality education’’ 16 means sexuality education that includes information 17 about abstinence and about the proper use and dis- 18 posal of sexual barrier protection devices and which 19 is— 20 (A) evidence-based; 21 (B) medically accurate; 22 (C) age and developmentally appropriate; 23 (D) gender and identity sensitive; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00644 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 645 •HR 5942 IH (E) culturally and linguistically appro- 1 priate; and 2 (F) structured to promote critical thinking, 3 self-esteem, respect for others, and the develop- 4 ment of healthy attitudes and relationships. 5 (3) CORRECTIONAL FACILITY.—The term ‘‘cor- 6 rectional facility’’ means any prison, penitentiary, 7 adult detention facility, juvenile detention facility, 8 jail, or other facility to which persons may be sent 9 after conviction of a crime or act of juvenile delin- 10 quency within the United States. 11 (4) INCARCERATED PERSON.—The term ‘‘incar- 12 cerated person’’ means any person who is serving a 13 sentence in a correctional facility after conviction of 14 a crime. 15 (5) SEXUALLY TRANSMITTED INFECTION.—The 16 term ‘‘sexually transmitted infection’’ or ‘‘STI’’ 17 means any disease or infection that is commonly 18 transmitted through sexual activity, including HIV/ 19 AIDS, gonorrhea, chlamydia, syphilis, genital her- 20 pes, viral hepatitis, and human papillomavirus. 21 (6) SEXUAL BARRIER PROTECTION DEVICE.— 22 The term ‘‘sexual barrier protection device’’ means 23 any FDA-approved physical device which has not 24 been tampered with and which reduces the prob- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00645 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 646 •HR 5942 IH ability of STI transmission or infection between sex- 1 ual partners, including female condoms, male 2 condoms, and dental dams. 3 (7) STATE.—The term ‘‘State’’ includes the 4 District of Columbia, American Samoa, the Com- 5 monwealth of the Northern Mariana Islands, Guam, 6 Puerto Rico, and the United States Virgin Islands. 7 SEC. 757. AUTOMATIC REINSTATEMENT OR ENROLLMENT 8 IN MEDICAID FOR PEOPLE WHO TEST POSI- 9 TIVE FOR HIV BEFORE REENTERING COMMU- 10 NITIES. 11 (a) IN GENERAL.—Section 1902(e) of the Social Se- 12 curity Act (42 U.S.C. 1396a(e)) is amended by adding at 13 the end the following: 14 ‘‘(15) ENROLLMENT OF EX-OFFENDERS.— 15 ‘‘(A) AUTOMATIC ENROLLMENT OR REIN- 16 STATEMENT.— 17 ‘‘(i) IN GENERAL.—The State plan 18 shall provide for the automatic enrollment 19 or reinstatement of enrollment of an eligi- 20 ble individual— 21 ‘‘(I) if such individual is sched- 22 uled to be released from a public insti- 23 tution due to the completion of sen- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00646 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 647 •HR 5942 IH tence, not less than 30 days prior to 1 the scheduled date of the release; and 2 ‘‘(II) if such individual is to be 3 released from a public institution on 4 parole or on probation, as soon as 5 possible after the date on which the 6 determination to release such indi- 7 vidual was made, and before the date 8 such individual is released. 9 ‘‘(ii) EXCEPTION.—If a State makes a 10 determination that an individual is not eli- 11 gible to be enrolled under the State plan— 12 ‘‘(I) on or before the date by 13 which the individual would be enrolled 14 under clause (i), such clause shall not 15 apply to such individual; or 16 ‘‘(II) after such date, the State 17 may terminate the enrollment of such 18 individual. 19 ‘‘(B) RELATIONSHIP OF ENROLLMENT TO 20 PAYMENT FOR SERVICES.— 21 ‘‘(i) IN GENERAL.—Subject to sub- 22 paragraph (A)(ii), an eligible individual 23 who is enrolled, or whose enrollment is re- 24 instated, under subparagraph (A) shall be 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00647 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 648 •HR 5942 IH eligible for medical assistance that is pro- 1 vided after the date that the eligible indi- 2 vidual is released from the public institu- 3 tion. 4 ‘‘(ii) RELATIONSHIP TO PAYMENT 5 PROHIBITION FOR INMATES.—No provision 6 of this paragraph may be construed to per- 7 mit payment for care or services for which 8 payment is excluded under section 9 1905(a)(3)(A). 10 ‘‘(C) TREATMENT OF CONTINUOUS ELIGI- 11 BILITY.— 12 ‘‘(i) SUSPENSION FOR INMATES.—Any 13 period of continuous eligibility under this 14 title shall be suspended on the date an in- 15 dividual enrolled under this title becomes 16 an inmate of a public institution (except as 17 a patient of a medical institution). 18 ‘‘(ii) DETERMINATION OF REMAINING 19 PERIOD.—Notwithstanding any changes to 20 State law related to continuous eligibility 21 during the time that an individual is an in- 22 mate of a public institution (except as a 23 patient of a medical institution), subject to 24 clause (iii), with respect to an eligible indi- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00648 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 649 •HR 5942 IH vidual who was subject to a suspension 1 under clause (i), on the date that such in- 2 dividual is released from a public institu- 3 tion the suspension of continuous eligibility 4 under such clause shall be lifted for a pe- 5 riod that is equal to the time remaining in 6 the period of continuous eligibility for such 7 individual on the date that such period was 8 suspended under such clause. 9 ‘‘(iii) EXCEPTION.—If a State makes 10 a determination that an individual is not 11 eligible to be enrolled under the State 12 plan— 13 ‘‘(I) on or before the date that 14 the suspension of continuous eligibility 15 is lifted under clause (ii), such clause 16 shall not apply to such individual; or 17 ‘‘(II) after such date, the State 18 may terminate the enrollment of such 19 individual. 20 ‘‘(D) AUTOMATIC ENROLLMENT OR REIN- 21 STATEMENT OF ENROLLMENT DEFINED.—For 22 purposes of this paragraph, the term ‘automatic 23 enrollment or reinstatement of enrollment’ 24 means that the State determines eligibility for 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00649 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 650 •HR 5942 IH medical assistance under the State plan without 1 a program application from, or on behalf of, the 2 eligible individual, but an individual can only be 3 automatically enrolled in the State Medicaid 4 plan if the individual affirmatively consents to 5 being enrolled through affirmation in writing, 6 by telephone, orally, through electronic signa- 7 ture, or through any other means specified by 8 the Secretary. 9 ‘‘(E) ELIGIBLE INDIVIDUAL DEFINED.— 10 For purposes of this paragraph, the term ‘eligi- 11 ble individual’ means an individual who is an 12 inmate of a public institution (except as a pa- 13 tient in a medical institution)— 14 ‘‘(i) who was enrolled under the State 15 plan for medical assistance immediately be- 16 fore becoming an inmate of such an insti- 17 tution; or 18 ‘‘(ii) who is diagnosed with human im- 19 munodeficiency virus.’’. 20 (b) SUPPLEMENTAL FUNDING FOR STATE IMPLE- 21 MENTATION OF AUTOMATIC REINSTATEMENT OF MED- 22 ICAID BENEFITS.— 23 (1) IN GENERAL.—Subject to paragraph (6), 24 for each State for which the Secretary of Health and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00650 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 651 •HR 5942 IH Human Services has approved an application under 1 paragraph (3), the Federal matching payments (in- 2 cluding payments based on the Federal medical as- 3 sistance percentage) made to such State under sec- 4 tion 1903 of the Social Security Act (42 U.S.C. 5 1396b) shall be increased by 5.0 percentage points 6 for payments to the State for the activities per- 7 mitted under paragraph (2) or a period of one year. 8 (2) USE OF FUNDS.—A State may only use in- 9 creased matching payments authorized under para- 10 graph (1)— 11 (A) to strengthen the State’s enrollment 12 and administrative resources for the purpose of 13 improving processes for enrolling (or reinstating 14 the enrollment of) eligible individuals (as such 15 term is defined in subparagraph (E) of para- 16 graph (15) of section 1902(e) of the Social Se- 17 curity Act (as amended by subsection (a))); and 18 (B) for medical assistance (as such term is 19 defined in section 1905(a) of the Social Secu- 20 rity Act) provided to such eligible individuals. 21 (3) APPLICATION AND AGREEMENT.—The Sec- 22 retary may only make payments to a State in the in- 23 creased amount if— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00651 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 652 •HR 5942 IH (A) the State has amended the State plan 1 under section 1902(e) of the Social Security 2 Act to incorporate the requirements of para- 3 graph (15) of such section (as added by sub- 4 section (a)); 5 (B) the State has submitted an application 6 to the Secretary that includes a plan for imple- 7 menting the requirements of section 8 1902(e)(15) of the Social Security Act under 9 the State’s amended State plan before the end 10 of the 90-day period beginning on the date that 11 the State receives increased matching payments 12 under paragraph (1); 13 (C) the State’s application meets the satis- 14 faction of the Secretary; and 15 (D) the State enters an agreement with 16 the Secretary that states that— 17 (i) the State will only use the in- 18 creased matching funds for the uses per- 19 mitted under paragraph (2); and 20 (ii) at the end of the period under 21 paragraph (1), the State will submit to the 22 Secretary, and make publicly available, a 23 report that contains the information re- 24 quired under paragraph (4). 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00652 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 653 •HR 5942 IH (4) REQUIRED REPORT INFORMATION.—The in- 1 formation that is required in the report under para- 2 graph (3)(D)(ii) includes— 3 (A) the results of an evaluation of the im- 4 pact of the implementation of the requirements 5 of section 1902(e)(15) of the Social Security 6 Act on improving the State’s processes for en- 7 rolling of individuals who are released from 8 public institutions into the Medicaid program; 9 (B) the number of individuals who were 10 automatically enrolled (or whose enrollment is 11 reinstated) under such section 1902(e)(15) dur- 12 ing the period under paragraph (1); and 13 (C) any other information that is required 14 by the Secretary. 15 (5) INCREASE IN CAP ON MEDICAID PAYMENTS 16 TO TERRITORIES.—Subject to paragraph (6), the 17 amounts otherwise determined for Puerto Rico, the 18 United States Virgin Islands, Guam, the Northern 19 Mariana Islands, and American Samoa under sub- 20 sections (f) and (g) of section 1108 of the Social Se- 21 curity Act (42 U.S.C. 1308) shall each be increased 22 by the necessary amount to allow for the increase in 23 the Federal matching payments under paragraph 24 (1), but only for the period under such paragraph 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00653 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 654 •HR 5942 IH for such State. In the case of such an increase for 1 a territory, subsection (a)(1) of such section 1108 2 shall be applied without regard to any increase in 3 payment made to the territory under part E of title 4 IV of such Act that is attributable to the increase 5 in Federal medical assistance percentage effected 6 under paragraph (1) for the territory. 7 (6) LIMITATIONS.— 8 (A) TIMING.—With respect to a State, at 9 the end of the period under paragraph (1), no 10 increased matching payments may be made to 11 such State under this subsection. 12 (B) MAINTENANCE OF ELIGIBILITY.— 13 (i) IN GENERAL.—Subject to clause 14 (ii), a State is not eligible for an increase 15 in its Federal matching payments under 16 paragraph (1), or an increase in a cap 17 amount under paragraph (5), if eligibility 18 standards, methodologies, or procedures 19 under its State plan under title XIX of the 20 Social Security Act (including any waiver 21 under such title or under section 1115 of 22 such Act (42 U.S.C. 1315)) are more re- 23 strictive than the eligibility standards, 24 methodologies, or procedures, respectively, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00654 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 655 •HR 5942 IH under such plan (or waiver) as in effect on 1 the date of enactment of this Act. 2 (ii) STATE REINSTATEMENT OF ELIGI- 3 BILITY PERMITTED.—A State that has re- 4 stricted eligibility standards, methodolo- 5 gies, or procedures under its State plan 6 under title XIX of the Social Security Act 7 (including any waiver under such title or 8 under section 1115 of such Act (42 U.S.C. 9 1315)) after the date of enactment of this 10 Act, is no longer ineligible under subpara- 11 graph (A) beginning with the first calendar 12 quarter in which the State has reinstated 13 eligibility standards, methodologies, or pro- 14 cedures that are no more restrictive than 15 the eligibility standards, methodologies, or 16 procedures, respectively, under such plan 17 (or waiver) as in effect on such date. 18 (C) NO WAIVER AUTHORITY.—The Sec- 19 retary may not waive the application of this 20 subsection under section 1115 of the Social Se- 21 curity Act or otherwise. 22 (D) LIMITATION OF MATCHING PAYMENTS 23 TO 100 PERCENT.—In no case shall an increase 24 in Federal matching payments under this sub- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00655 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 656 •HR 5942 IH section result in Federal matching payments 1 that exceed 100 percent. 2 (c) EFFECTIVE DATE.— 3 (1) IN GENERAL.—Except as provided in para- 4 graph (2), the amendments made by subsection (a) 5 shall take effect 180 days after the date of the en- 6 actment of this Act and shall apply to services fur- 7 nished on or after such date. 8 (2) RULE FOR CHANGES REQUIRING STATE 9 LEGISLATION.—In the case of a State plan for med- 10 ical assistance under title XIX of the Social Security 11 Act which the Secretary of Health and Human Serv- 12 ices determines requires State legislation (other than 13 legislation appropriating funds) in order for the plan 14 to meet the additional requirement imposed by the 15 amendments made by this section, the State plan 16 shall not be regarded as failing to comply with the 17 requirements of such title solely on the basis of its 18 failure to meet this additional requirement before 19 the first day of the first calendar quarter beginning 20 after the close of the first regular session of the 21 State legislature that begins after the date of the en- 22 actment of this Act. For purposes of the previous 23 sentence, in the case of a State that has a 2-year 24 legislative session, each year of such session shall be 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00656 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 657 •HR 5942 IH deemed to be a separate regular session of the State 1 legislature. 2 SEC. 758. STOP AIDS IN PRISON. 3 (a) SHORT TITLE.—This section may be cited as the 4 ‘‘Stop AIDS in Prison Act’’. 5 (b) IN GENERAL.—The Bureau of Prisons (herein- 6 after in this section referred to as the ‘‘Bureau’’) shall 7 develop a comprehensive policy to provide HIV testing, 8 treatment, and prevention for inmates within the correc- 9 tional setting and upon reentry. 10 (c) PURPOSE.—The purposes of this policy shall be 11 as follows: 12 (1) To stop the spread of HIV/AIDS among in- 13 mates. 14 (2) To protect prison guards and other per- 15 sonnel from HIV/AIDS infection. 16 (3) To provide comprehensive medical treat- 17 ment to inmates who are living with HIV/AIDS. 18 (4) To promote HIV/AIDS awareness and pre- 19 vention among inmates. 20 (5) To encourage inmates to take personal re- 21 sponsibility for their health. 22 (6) To reduce the risk that inmates will trans- 23 mit HIV/AIDS to other persons in the community 24 following their release from prison. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00657 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 658 •HR 5942 IH (d) CONSULTATION.—The Bureau shall consult with 1 appropriate officials of the Department of Health and 2 Human Services, the Office of National Drug Control Pol- 3 icy, the Office of National AIDS Policy, and the Centers 4 for Disease Control and Prevention regarding the develop- 5 ment of this policy. 6 (e) TIME LIMIT.—The Bureau shall draft appro- 7 priate regulations to implement this policy not later than 8 1 year after the date of the enactment of this Act. 9 (f) REQUIREMENTS FOR POLICY.—The policy created 10 under subsection (b) shall provide for the following: 11 (1) TESTING AND COUNSELING UPON IN- 12 TAKE.— 13 (A) Health care personnel shall provide 14 routine HIV testing to all inmates as a part of 15 a comprehensive medical examination imme- 16 diately following admission to a facility. Health 17 care personnel need not provide routine HIV 18 testing to an inmate who is transferred to a fa- 19 cility from another facility if the inmate’s med- 20 ical records are transferred with the inmate and 21 indicate that the inmate has been tested pre- 22 viously. 23 (B) To all inmates admitted to a facility 24 prior to the effective date of this policy, health 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00658 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 659 •HR 5942 IH care personnel shall provide routine HIV testing 1 within no more than 6 months. HIV testing for 2 these inmates may be performed in conjunction 3 with other health services provided to these in- 4 mates by health care personnel. 5 (C) All HIV tests under this paragraph 6 shall comply with the opt-out provision. 7 (2) PRE-TEST AND POST-TEST COUNSELING.— 8 Health care personnel shall provide confidential pre- 9 test and post-test counseling to all inmates who are 10 tested for HIV. Counseling may be included with 11 other general health counseling provided to inmates 12 by health care personnel. 13 (3) HIV/AIDS PREVENTION EDUCATION.— 14 (A) Health care personnel shall improve 15 HIV/AIDS awareness through frequent edu- 16 cational programs for all inmates. HIV/AIDS 17 educational programs may be provided by com- 18 munity-based organizations, local health depart- 19 ments, and inmate peer educators. 20 (B) HIV/AIDS educational materials shall 21 be made available to all inmates at orientation, 22 at health care clinics, at regular educational 23 programs, and prior to release. Both written 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00659 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 660 •HR 5942 IH and audiovisual materials shall be made avail- 1 able to all inmates. 2 (C)(i) The HIV/AIDS educational pro- 3 grams and materials under this paragraph shall 4 include information on— 5 (I) modes of transmission, including 6 transmission through tattooing, sexual con- 7 tact, and intravenous drug use; 8 (II) prevention methods; 9 (III) treatment; and 10 (IV) disease progression. 11 (ii) The programs and materials shall be 12 culturally sensitive, written or designed for low- 13 literacy levels, available in a variety of lan- 14 guages, and present scientifically accurate in- 15 formation in a clear and understandable man- 16 ner. 17 (4) HIV TESTING UPON REQUEST.— 18 (A) Health care personnel shall allow in- 19 mates to obtain HIV tests upon request once 20 per year or whenever an inmate has a reason to 21 believe the inmate may have been exposed to 22 HIV. Health care personnel shall, both orally 23 and in writing, inform inmates, during orienta- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00660 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 661 •HR 5942 IH tion and periodically throughout incarceration, 1 of their right to obtain HIV tests. 2 (B) Health care personnel shall encourage 3 inmates to request HIV tests if the inmate is 4 sexually active, has been raped, uses intra- 5 venous drugs, receives a tattoo, or if the inmate 6 is concerned that the inmate may have been ex- 7 posed to HIV/AIDS. 8 (C) An inmate’s request for an HIV test 9 shall not be considered an indication that the 10 inmate has put him/herself at risk of infection 11 and/or committed a violation of prison rules. 12 (5) HIV TESTING OF PREGNANT WOMAN.— 13 (A) Health care personnel shall provide 14 routine HIV testing to all inmates who become 15 pregnant. 16 (B) All HIV tests under this paragraph 17 shall comply with the opt-out provision. 18 (6) COMPREHENSIVE TREATMENT.— 19 (A) Health care personnel shall provide all 20 inmates who test positive for HIV— 21 (i) timely, comprehensive medical 22 treatment; 23 (ii) confidential counseling on man- 24 aging their medical condition and pre- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00661 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 662 •HR 5942 IH venting its transmission to other persons; 1 and 2 (iii) voluntary partner notification 3 services. 4 (B) Health care provided under this para- 5 graph shall be consistent with current Depart- 6 ment of Health and Human Services guidelines 7 and standard medical practice. Health care per- 8 sonnel shall discuss treatment options, the im- 9 portance of adherence to antiretroviral therapy, 10 and the side effects of medications with inmates 11 receiving treatment. 12 (C) Health care personnel and pharmacy 13 personnel shall ensure that the facility for- 14 mulary contains all Food and Drug Administra- 15 tion-approved medications necessary to provide 16 comprehensive treatment for inmates living with 17 HIV/AIDS, and that the facility maintains ade- 18 quate supplies of such medications to meet in- 19 mates’ medical needs. Health care personnel 20 and pharmacy personnel shall also develop and 21 implement automatic renewal systems for these 22 medications to prevent interruptions in care. 23 (D) Correctional staff, health care per- 24 sonnel, and pharmacy personnel shall develop 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00662 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 663 •HR 5942 IH and implement distribution procedures to en- 1 sure timely and confidential access to medica- 2 tions. 3 (7) PROTECTION OF CONFIDENTIALITY.— 4 (A) Health care personnel shall develop 5 and implement procedures to ensure the con- 6 fidentiality of inmate tests, diagnoses, and 7 treatment. Health care personnel and correc- 8 tional staff shall receive regular training on the 9 implementation of these procedures. Penalties 10 for violations of inmate confidentiality by health 11 care personnel or correctional staff shall be 12 specified and strictly enforced. 13 (B) HIV testing, counseling, and treat- 14 ment shall be provided in a confidential setting 15 where other routine health services are provided 16 and in a manner that allows the inmate to re- 17 quest and obtain these services as routine med- 18 ical services. 19 (8) TESTING, COUNSELING, AND REFERRAL 20 PRIOR TO REENTRY.— 21 (A) Health care personnel shall provide 22 routine HIV testing to all inmates no more 23 than 3 months prior to their release and re- 24 entry into the community. Inmates who are al- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00663 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 664 •HR 5942 IH ready known to be infected need not be tested 1 again. This requirement may be waived if an in- 2 mate’s release occurs without sufficient notice 3 to the Bureau to allow health care personnel to 4 perform a routine HIV test and notify the in- 5 mate of the results. 6 (B) All HIV tests under this paragraph 7 shall comply with the opt-out provision. 8 (C) To all inmates who test positive for 9 HIV and all inmates who already are known to 10 have HIV/AIDS, health care personnel shall 11 provide— 12 (i) confidential prerelease counseling 13 on managing their medical condition in the 14 community, accessing appropriate treat- 15 ment and services in the community, and 16 preventing the transmission of their condi- 17 tion to family members and other persons 18 in the community; 19 (ii) referrals to appropriate health 20 care providers and social service agencies 21 in the community that meet the inmate’s 22 individual needs, including voluntary part- 23 ner notification services and prevention 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00664 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 665 •HR 5942 IH counseling services for people living with 1 HIV/AIDS; and 2 (iii) a 30-day supply of any medically 3 necessary medications the inmate is cur- 4 rently receiving. 5 (9) OPT-OUT PROVISION.—Inmates shall have 6 the right to refuse routine HIV testing. Inmates 7 shall be informed both orally and in writing of this 8 right. Oral and written disclosure of this right may 9 be included with other general health information 10 and counseling provided to inmates by health care 11 personnel. If an inmate refuses a routine test for 12 HIV, health care personnel shall make a note of the 13 inmate’s refusal in the inmate’s confidential medical 14 records. However, the inmate’s refusal shall not be 15 considered a violation of prison rules or result in dis- 16 ciplinary action. Any reference in this section to the 17 ‘‘opt-out provision’’ shall be deemed a reference to 18 the requirement of this paragraph. 19 (10) EXCLUSION OF TESTS PERFORMED UNDER 20 SECTION 4014(b) FROM THE DEFINITION OF ROU- 21 TINE HIV TESTING.—HIV testing of an inmate 22 under section 4014(b) of title 18, United States 23 Code, is not routine HIV testing for the purposes of 24 the opt-out provision. Health care personnel shall 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00665 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 666 •HR 5942 IH document the reason for testing under section 1 4014(b) of title 18, United States Code, in the in- 2 mate’s confidential medical records. 3 (11) TIMELY NOTIFICATION OF TEST RE- 4 SULTS.—Health care personnel shall provide timely 5 notification to inmates of the results of HIV tests. 6 (g) CHANGES IN EXISTING LAW.— 7 (1) SCREENING IN GENERAL.—Section 4014(a) 8 of title 18, United States Code, is amended— 9 (A) by striking ‘‘for a period of 6 months 10 or more’’; 11 (B) by striking ‘‘, as appropriate,’’; and 12 (C) by striking ‘‘if such individual is deter- 13 mined to be at risk for infection with such virus 14 in accordance with the guidelines issued by the 15 Bureau of Prisons relating to infectious disease 16 management’’ and inserting ‘‘unless the indi- 17 vidual declines. The Attorney General shall also 18 cause such individual to be so tested before re- 19 lease unless the individual declines.’’. 20 (2) INADMISSIBILITY OF HIV TEST RESULTS IN 21 CIVIL AND CRIMINAL PROCEEDINGS.—Section 22 4014(d) of title 18, United States Code, is amended 23 by inserting ‘‘or under the Stop AIDS in Prison 24 Act’’ after ‘‘under this section’’. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00666 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 667 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00667 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 668 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00668 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 669 •HR 5942 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. 759. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00669 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 670 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00670 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 671 •HR 5942 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. 760. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00671 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 672 •HR 5942 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) HIV/AIDS.—The term ‘HIV/AIDS’ has 8 the meaning given to such term in section 2689. 9 ‘‘(2) NATIONAL HIV/AIDS STRATEGY.—The 10 term ‘National HIV/AIDS Strategy’ means the Na- 11 tional HIV/AIDS Strategy for the United States 12 issued by the President in July 2010 and includes 13 any subsequent revisions to such Strategy.’’. 14 SEC. 761. REPORT ON THE IMPLEMENTATION OF GOAL 4 15 (IMPROVED COORDINATION) OF THE NA- 16 TIONAL HIV/AIDS STRATEGY. 17 (a) REPORT REQUIRED.—The President, in consulta- 18 tion with the heads of all relevant Federal departments 19 and agencies including the Department of Education, the 20 Department of Health and Human Services, the Depart- 21 ment of Housing and Urban Development, the Depart- 22 ment of Justice, the Department of Labor, the Depart- 23 ment of Veteran Affairs, and the Social Security Adminis- 24 tration, shall transmit to the Congress and make publicly 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00672 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 673 •HR 5942 IH available a report on the status of implementation of Goal 1 4 of the National HIV/AIDS Strategy. 2 (b) CONTENTS.—The report required by subsection 3 (a) shall include a description, an analysis, and an evalua- 4 tion of— 5 (1) the extent to which the National HIV/AIDS 6 Strategy has improved coordination of efforts, en- 7 hanced capacity, and strengthened infrastructure in 8 order to maximize the effective delivery of HIV/ 9 AIDS prevention, care, and treatment services at the 10 community level, including coordination— 11 (A) within and among Federal agencies 12 and departments; 13 (B) between the Federal Government and 14 State and local governments and health depart- 15 ments; 16 (C) between the Federal Government and 17 nonprofit foundations and civil society organiza- 18 tions, including community- and faith-based or- 19 ganizations focused on addressing the issue of 20 HIV/AIDS; and 21 (D) between the Federal Government and 22 private businesses; and 23 (2) efforts by the Federal Government to edu- 24 cate, involve, and establish and strengthen partner- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00673 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 674 •HR 5942 IH ships with civil society organizations, including 1 community- and faith-based organizations, in order 2 to implement the National HIV/AIDS Strategy and 3 achieve its goals. 4 (c) DEFINITION.—In this section, the term ‘‘National 5 HIV/AIDS Strategy’’ means the National HIV/AIDS 6 Strategy for the United States issued by the President in 7 July 2010, the revision to such Strategy issued in July 8 2015, and any subsequent revisions to such Strategy. 9 Subtitle F—Diabetes 10 SEC. 771. RESEARCH, TREATMENT, AND EDUCATION. 11 Subpart 3 of part C of title IV of the Public Health 12 Service Act (42 U.S.C. 285c et seq.) is amended by adding 13 at the end the following new section: 14 ‘‘SEC. 434B. DIABETES IN MINORITY POPULATIONS. 15 ‘‘(a) IN GENERAL.—The Director of NIH shall ex- 16 pand, intensify, and support ongoing research and other 17 activities with respect to prediabetes and diabetes, particu- 18 larly type 2, in minority populations. 19 ‘‘(b) RESEARCH.— 20 ‘‘(1) DESCRIPTION.—Research under subsection 21 (a) shall include investigation into— 22 ‘‘(A) the causes of diabetes, including so- 23 cioeconomic, geographic, clinical, environmental, 24 genetic, and other factors that may contribute 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00674 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 675 •HR 5942 IH to increased rates of diabetes in minority popu- 1 lations; and 2 ‘‘(B) the causes of increased incidence of 3 diabetes complications in minority populations, 4 and possible interventions to decrease such inci- 5 dence. 6 ‘‘(2) INCLUSION OF MINORITY PARTICIPANTS.— 7 In conducting and supporting research described in 8 subsection (a), the Director of NIH shall seek to in- 9 clude minority participants as study subjects in clin- 10 ical trials. 11 ‘‘(c) REPORT; COMPREHENSIVE PLAN.— 12 ‘‘(1) IN GENERAL.—The Diabetes Mellitus 13 Interagency Coordinating Committee shall— 14 ‘‘(A) prepare and submit to the Congress, 15 not later than 6 months after the date of enact- 16 ment of this section, a report on Federal re- 17 search and public health activities with respect 18 to prediabetes and diabetes in minority popu- 19 lations; and 20 ‘‘(B) develop and submit to the Congress, 21 not later than 1 year after the date of enact- 22 ment of this section, an effective and com- 23 prehensive Federal plan (including all appro- 24 priate Federal health programs) to address 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00675 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 676 •HR 5942 IH prediabetes and diabetes in minority popu- 1 lations. 2 ‘‘(2) CONTENTS.—The report under paragraph 3 (1)(A) shall at minimum address each of the fol- 4 lowing: 5 ‘‘(A) Research on diabetes and prediabetes 6 in minority populations, including such research 7 on— 8 ‘‘(i) genetic, behavioral, and environ- 9 mental factors; and 10 ‘‘(ii) prevention and complications 11 among individuals within these populations 12 who have already developed diabetes. 13 ‘‘(B) Surveillance and data collection on 14 diabetes and prediabetes in minority popu- 15 lations, including with respect to— 16 ‘‘(i) efforts to better determine the 17 prevalence of diabetes among Asian-Amer- 18 ican and Pacific Islander subgroups; and 19 ‘‘(ii) efforts to coordinate data collec- 20 tion on the American Indian population. 21 ‘‘(C) Community-based interventions to ad- 22 dress diabetes and prediabetes targeting minor- 23 ity populations, including— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00676 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 677 •HR 5942 IH ‘‘(i) the evidence base for such inter- 1 ventions; 2 ‘‘(ii) the cultural appropriateness of 3 such interventions; and 4 ‘‘(iii) efforts to educate the public on 5 the causes and consequences of diabetes. 6 ‘‘(D) Education and training programs for 7 health professionals (including community 8 health workers) on the prevention and manage- 9 ment of diabetes and its related complications 10 that is supported by the Health Resources and 11 Services Administration, including such pro- 12 grams supported by— 13 ‘‘(i) the National Health Service 14 Corps; or 15 ‘‘(ii) the community health centers 16 program under section 330. 17 ‘‘(d) EDUCATION.—The Director of NIH shall— 18 ‘‘(1) through the National Institute on Minority 19 Health and Health Disparities and the National Di- 20 abetes Education Program— 21 ‘‘(A) make grants to programs funded 22 under section 464z–4 (relating to centers of ex- 23 cellence) for the purpose of establishing a men- 24 toring program for health care professionals to 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00677 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 678 •HR 5942 IH be more involved in weight counseling, obesity 1 research, and nutrition; and 2 ‘‘(B) provide for the participation of mi- 3 nority health professionals in diabetes-focused 4 research programs; and 5 ‘‘(2) make grants for programs to establish a 6 pipeline from high school to professional school that 7 will increase minority representation in diabetes-fo- 8 cused health fields by expanding Minority Access to 9 Research Careers (MARC) program internships and 10 mentoring opportunities for recruitment. 11 ‘‘(e) DEFINITIONS.—For purposes of this section: 12 ‘‘(1) DIABETES MELLITUS INTERAGENCY CO- 13 ORDINATING COMMITTEE.—The ‘Diabetes Mellitus 14 Interagency Coordinating Committee’ means the Di- 15 abetes Mellitus Interagency Coordinating Committee 16 established under section 429. 17 ‘‘(2) MINORITY POPULATION.—The term ‘mi- 18 nority population’ means a racial and ethnic minor- 19 ity group, as defined in section 1707.’’. 20 SEC. 772. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 21 Part B of title III of the Public Health Service Act 22 (42 U.S.C. 243 et seq.) is amended by inserting after sec- 23 tion 317X of such Act, as added, the following section: 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00678 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 679 •HR 5942 IH ‘‘SEC. 317Y. DIABETES IN MINORITY POPULATIONS. 1 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 2 ‘‘(1) IN GENERAL.—The Secretary, acting 3 through the Director of the Centers for Disease 4 Control and Prevention, shall conduct and support 5 research and public health activities with respect to 6 diabetes in minority populations. 7 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 8 paragraph (1) regarding diabetes in minority popu- 9 lations shall include the following: 10 ‘‘(A) Further enhancing the National 11 Health and Nutrition Examination Survey by 12 oversampling Asian American, Native Hawai- 13 ian, and Pacific Islanders in appropriate geo- 14 graphic areas to better determine the preva- 15 lence of diabetes in such populations as well as 16 to improve the data collection of diabetes pene- 17 tration disaggregated into major ethnic groups 18 within such populations. The Secretary shall en- 19 sure that any such oversampling does not re- 20 duce the oversampling of other minority popu- 21 lations including African-American and Latino 22 populations. 23 ‘‘(B) Through the Division of Diabetes 24 Translation— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00679 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 680 •HR 5942 IH ‘‘(i) providing for prevention research 1 to better understand how to influence 2 health care systems changes to improve 3 quality of care being delivered to such pop- 4 ulations; 5 ‘‘(ii) carrying out model demonstra- 6 tion projects to design, implement, and 7 evaluate effective diabetes prevention and 8 control interventions for minority popu- 9 lations, including culturally appropriate 10 community-based interventions; 11 ‘‘(iii) developing and implementing a 12 strategic plan to reduce diabetes in minor- 13 ity populations through applied research to 14 reduce disparities and culturally and lin- 15 guistically appropriate community-based 16 interventions; 17 ‘‘(iv) supporting, through the national 18 diabetes prevention program under section 19 399V–3, diabetes prevention program sites 20 in underserved regions highly impacted by 21 diabetes; and 22 ‘‘(v) implementing, through the na- 23 tional diabetes prevention program under 24 section 399V–3, a demonstration program 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00680 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 681 •HR 5942 IH developing new metrics measuring health 1 outcomes related to diabetes that can be 2 stratified by specific minority populations. 3 ‘‘(b) EDUCATION.—The Secretary, acting through 4 the Director of the Centers for Disease Control and Pre- 5 vention, shall direct the Division of Diabetes Translation 6 to conduct and support both programs to educate the pub- 7 lic on diabetes in minority populations and programs to 8 educate minority populations about the causes and effects 9 of diabetes. 10 ‘‘(c) DIABETES; HEALTH PROMOTION, PREVENTION 11 ACTIVITIES, AND ACCESS.—The Secretary, acting through 12 the Director of the Centers for Disease Control and Pre- 13 vention and the National Diabetes Education Program, 14 shall conduct and support programs to educate specific 15 minority populations through culturally appropriate and 16 linguistically appropriate information campaigns about 17 prevention of, and managing, diabetes. 18 ‘‘(d) DEFINITION.—For purposes of this section, the 19 term ‘minority population’ means a racial and ethnic mi- 20 nority group, as defined in section 1707.’’. 21 SEC. 773. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 22 Part P of title III of the Public Health Service Act 23 (42 U.S.C. 280g et seq.), as amended, is further amended 24 by adding at the end the following new section: 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00681 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 682 •HR 5942 IH ‘‘SEC. 399V–9. 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) to 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, the Centers for Ex- 21 cellence, and the Minority Faculty Fellowship Pro- 22 gram to partner with the Office of Minority Health 23 under section 1707 and the National Institutes of 24 Health to strengthen programs for career opportuni- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00682 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 683 •HR 5942 IH ties focused on diabetes treatment and care within 1 underserved 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–10. RESEARCH, EDUCATION, AND OTHER ACTIVI- 16 TIES REGARDING DIABETES IN AMERICAN IN- 17 DIAN POPULATIONS. 18 ‘‘In addition to activities under sections 399V–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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00683 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 684 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00684 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 685 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00685 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 686 •HR 5942 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) a description of how the Federal Gov- 21 ernment may better coordinate and improve its 22 response to asthma including identifying any 23 barriers that may exist; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00686 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 687 •HR 5942 IH (B) a description of how the Federal Gov- 1 ernment 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00687 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 688 •HR 5942 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 this 4 section, the National Asthma Education and Prevention 5 Program shall evaluate the analyses and recommendations 6 under such report and determine whether a new report 7 to the Congress is necessary, and make appropriate rec- 8 ommendations 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00688 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 689 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00689 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 690 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00690 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 691 •HR 5942 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 2019 through 2023 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00691 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 692 •HR 5942 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 2019 through 2023. 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00692 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 693 •HR 5942 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 in 11 America, claiming over 134,000 lives in 2010. 12 (6) Since 2000, deaths for women with COPD 13 have exceeded 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00693 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 694 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00694 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 695 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00695 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 696 •HR 5942 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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00696 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 697 •HR 5942 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 2019 through 2023. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00697 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 698 •HR 5942 IH Subtitle H—Tuberculosis 1 SEC. 781. ELIMINATION OF ALL FORMS OF TUBERCULOSIS. 2 (a) SHORT TITLE.—This subtitle be cited as the 3 ‘‘End Tuberculosis Act’’. 4 (b) FINDINGS.—The Congress makes the following 5 findings: 6 (1) In the United States, 9,272 people were di- 7 agnosed with tuberculosis (referred to in this section 8 as ‘‘TB’’) in 2016. 9 (2) Disparities in TB exist and significantly im- 10 pact minority communities in the United States. The 11 Centers for Disease Control and Prevention (re- 12 ferred to in this section as ‘‘CDC’’) finds that 87 13 percent of people diagnosed with TB in 2016 self- 14 identified as racial and ethnic minorities. 15 (3) African Americans comprised 21 percent of 16 people diagnosed with TB during 2016. The popu- 17 lation-adjusted rate of TB among African Americans 18 is 1.7 times higher than the national total, and 8.2 19 times higher than among Whites. 20 (4) Asian Americans, Native Hawaiians, and 21 other Pacific Islanders comprised 35 percent of peo- 22 ple diagnosed with TB during 2016. The population- 23 adjusted rate of TB among Asian Americans is 6.2 24 times higher than the national total, and 30 times 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00698 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 699 •HR 5942 IH higher than among Whites. The population-adjusted 1 rate of TB among Native Hawaiians and other Pa- 2 cific Islanders is 4.8 times higher than the national 3 total, and 23.2 times higher than among Whites. 4 (5) Hispanics and Latinos comprised 28 per- 5 cent of people diagnosed with TB during 2016. The 6 population-adjusted rate of TB among Hispanics 7 and Latinos is 1.6 times higher than the national 8 total, and 7.5 times higher than among Whites. 9 (6) TB is both preventable and curable, but the 10 current rate of decline of TB in the United States 11 remains too slow to achieve TB elimination in this 12 century. 13 (7) TB is transmitted through the air when a 14 person who has TB disease in their lungs coughs or 15 sneezes. People who are in close proximity to the 16 person with TB can breathe in the TB bacteria, and 17 the bacteria will initially settle in their lungs. With- 18 out proper and timely diagnosis and access to treat- 19 ment, the TB bacteria may grow and spread to 20 other parts of their body. 21 (8) As many as 13,000,000 people in the 22 United States may have Latent TB Infection (re- 23 ferred to in this section as ‘‘LTBI’’). People with 24 LTBI have TB bacteria in their bodies, but their 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00699 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 700 •HR 5942 IH immune system is containing the bacteria, and they 1 are not sick, nor do they have any current risk of 2 spreading TB to others. LTBI can activate into in- 3 fectious, life-threatening TB if not treated. Modeling 4 has shown that eliminating TB is not possible with- 5 out addressing LTBI. 6 (9) Comorbidities associated with TB include 7 cancer, diabetes mellitus, and HIV. People with 8 these medical conditions and compromised immune 9 systems are more likely to develop active TB disease 10 and to have worse outcomes from TB. 11 (10) Forms of active TB that do not show drug 12 resistance are classified as Drug-susceptible TB (re- 13 ferred to in this section as ‘‘DS–TB’’). Drug-resist- 14 ant TB (referred to in this section as ‘‘DR–TB’’) is 15 a rising threat to the public health of the United 16 States. DR–TB that exhibits resistance to two or 17 more first-line drugs is referred to as multi-drug re- 18 sistant TB (referred to in this section as ‘‘MDR– 19 TB’’). MDR–TB that also is resistant to at least 20 one injectable second-line medication and at least 21 one fluoroquinolone is classified as extensively drug- 22 resistant TB (referred to in this section as ‘‘XDR– 23 TB’’). 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00700 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 701 •HR 5942 IH (11) Approximately 78 people in the United 1 States were diagnosed with MDR–TB in 2016. One 2 person was diagnosed with XDR–TB in the same 3 year. 4 (12) In the United States, direct treatment 5 costs average $17,000 to treat a patient with DS– 6 TB, $150,000 to treat a patient with MDR–TB, and 7 $482,000 to treat a patient with XDR–TB. When 8 factoring in productivity losses during treatment, 9 DS–TB averages $46,000, MDR–TB averages 10 $294,000 and XDR–TB averages $694,000. Treat- 11 ment is often difficult, with daily complex multi-pill 12 regimens and injections, with side-effects ranging 13 from hearing and vision loss to mental health issues. 14 (13) Recognizing the public health, economic 15 and societal costs to the threat of MDR–TB, the 16 National Action Plan to Combat MDR–TB (NAP) 17 was developed by the White House to provide the 18 United States with a comprehensive three-pronged 19 strategy to address MDR–TB by strengthening do- 20 mestic capacity to combat MDR–TB; improve inter- 21 national capacity and cooperation to combat MDR– 22 TB; accelerate basic and applied research and devel- 23 opment for new therapies, diagnostics and preven- 24 tion strategies to combat MDR–TB. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00701 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 702 •HR 5942 IH (14) Additional Federal support is necessary to 1 expand TB control efforts in case finding and treat- 2 ment to address LTBI in a national prevention ini- 3 tiative. Key policy and research breakthroughs in- 4 crease the success of a TB prevention initiative: the 5 U.S. Preventative Services Task Force recommenda- 6 tion’s ‘‘B’’ rating, screening for LTBI among high- 7 risk adults as a covered service increases the likeli- 8 hood that impacted racial and ethnic minority 9 groups can get tested for TB; a new, shorter course 10 treatment regimen (3HP) reduces the length of 11 treatment for LTBI from every day for 6 to 9 12 months to one dose per week for 12 weeks, increas- 13 ing likelihood of treatment completion; and the use 14 of blood-based diagnostic tests, Interferon-gamma 15 release assays or IGRAs, increases ability to detect 16 LTBI among patients in affected communities. 17 SEC. 782. ADDITIONAL FUNDING FOR STATES IN COM- 18 BATING AND ELIMINATING TUBERCULOSIS. 19 Section 317E(f) of the Public Health Act (42 U.S.C. 20 247b6(f)) is amended by adding at the end the following: 21 ‘‘(3) ADDITIONAL FUNDING FOR STATES IN 22 COMBATING AND ELIMINATING TUBERCULOSIS.—In 23 addition to amounts otherwise authorized to be ap- 24 propriated to carry out this section, there are au- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00702 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 703 •HR 5942 IH thorized to be appropriated such sums as may be 1 necessary to carry out sections 247–b(1)(2)(3) for 2 each of fiscal years 2019 through 2021.’’. 3 SEC. 783. STRENGTHENING CLINICAL RESEARCH FUNDING 4 FOR TUBERCULOSIS. 5 (a) IN GENERAL.—The Secretary of Health and 6 Human Services shall expand and intensify support for 7 current and prospective research activities of the National 8 Institutes of Health, the Biomedical Advanced Research 9 and Development Authority, and the Centers for Disease 10 Control and Prevention Division of Tuberculosis Elimi- 11 nation to develop new therapeutics, diagnostics, vaccines, 12 and other prevention modalities in addressing all forms 13 of tuberculosis (in this section referred to as ‘‘TB’’). 14 (b) INCLUDED RESEARCH ACTIVITIES.—Research 15 activities under subsection (a) shall include— 16 (1) research to develop novel, safe drugs and 17 drug regimens for the treatment of TB, including in 18 adolescent and pediatric populations and in pregnant 19 and lactating women; 20 (2) research to develop rapid diagnostic tests 21 for all forms of TB, including diagnostics that can 22 be used for pediatric populations and people living 23 with HIV, diagnostics that can detect extra pul- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00703 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 704 •HR 5942 IH monary TB and drug resistance, and diagnostics 1 that can be used at the point of care; 2 (3) research to advance basic knowledge of the 3 pathogenesis of TB and its major comorbidities, in- 4 cluding HIV and diabetes mellitus; 5 (4) research to improve knowledge and under- 6 standings of the role of latency in TB and the fac- 7 tors that increase the risk of latent TB infection 8 progressing to active, symptomatic TB disease; 9 (5) awarding grants and contracts to specifi- 10 cally develop new and needed vaccines to address 11 TB; 12 (6) awarding grants and contracts to support 13 the training and development of clinical researchers 14 whose research improves the landscape of tools to 15 combat TB; and 16 (7) awarding grants and contracts to support 17 capacity-building and develop clinical trial site infra- 18 structure in the United States and in TB endemic 19 countries to support the aforementioned research ac- 20 tivities. 21 Subtitle I—Osteoarthritis and 22 Musculoskeletal Diseases 23 SEC. 785. FINDINGS. 24 The Congress finds as follows: 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00704 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 705 •HR 5942 IH (1) Eighty percent of African-American women 1 and nearly 74 percent of Hispanic men are either 2 overweight or obese, speeding the onset and progres- 3 sion of arthritis. 4 (2) Arthritis affects 46 million Americans, and 5 that number will rise to 67 million by the year 2030. 6 (3) Twenty-seven million Americans suffer from 7 osteoarthritis, the most common form of arthritis, 8 making it the leading cause of disability in the 9 United States. Osteoarthritis is sometimes referred 10 to as degenerative joint disease. 11 (4) Obesity accelerates the onset of arthritis: 70 12 percent of obese adults with mild osteoarthritis of 13 the knee at age 60 will develop advanced end-stage 14 disease by age 80. In contrast, just 43 percent of 15 nonobese adults will have end-stage disease over the 16 same time period. 17 (5) Arthritis affects one in five Americans, and 18 is the single greatest cause of chronic pain and dis- 19 ability in the United States. 20 (6) Women, African Americans, and Hispanics 21 have more severe arthritis and functional limitations. 22 These same individuals are more likely to be obese, 23 diabetic, and have higher incidence of heart dis- 24 ease—medical conditions that can be improved with 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00705 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 706 •HR 5942 IH physical activity. Instead of moving; however, these 1 groups have an inactivity rate of 40 to 50 percent, 2 which continues to increase. 3 (7) Arthritis costs $128 billion a year, including 4 $81 billion in direct costs (medical) and $47 billion 5 in indirect costs (lost earnings). Each year, $309 bil- 6 lion in direct and indirect costs is lost due to dis- 7 parities in osteoarthritis and musculoskeletal dis- 8 eases. 9 (8) Obesity and other chronic health conditions 10 exacerbate the debilitating impact of arthritis, lead- 11 ing to inactivity, loss of independence, and a per- 12 petual cycle of comorbid chronic conditions. 13 (9) Sixty-one percent of arthritis sufferers are 14 women, and women represent 64 percent of an esti- 15 mated 43 million annual visits to physicians’ offices 16 and outpatient clinics where arthritis was the pri- 17 mary diagnosis. Women also represented 60 percent 18 of approximately 1 million hospitalizations that oc- 19 curred in 2003 for which arthritis was the primary 20 diagnosis. 21 (10) Women ages 65 and older have up to 21⁄2 22 times more disabilities than men of the same age. 23 Higher rates of obesity and arthritis among this 24 group explained up to 48 percent of the gender gap 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00706 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 707 •HR 5942 IH in disability, above all other common chronic health 1 conditions. 2 (11) The primary indication for total knee 3 arthroplasty (TKA), also known as knee replace- 4 ment, is relief of significant, disabling pain caused 5 by severe arthritis. 6 (12) Knee replacement is surgery for people 7 with severe knee damage. Knee replacement can re- 8 lieve pain and allow you to be more active. When 9 you have a total knee replacement, the surgeon re- 10 moves damaged cartilage and bone from the surface 11 of your knee joint and replaces them with a man- 12 made surface of metal and plastic. In a partial knee 13 replacement, the surgeon only replaces one part of 14 your knee joint. 15 (13) Total hip replacement, also called total hip 16 arthroplasty (THA), is used if your hip pain inter- 17 feres with daily activities and more conservative 18 treatments have not helped. Arthritis damage is the 19 most common reason to need hip replacement. 20 (14) The odds of a family practice physician 21 recommending TKA to a male patient with moderate 22 arthritis are twice that of a female patient, while the 23 odds of an orthopaedic surgeon recommending TKA 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00707 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 708 •HR 5942 IH to a male patient with moderate arthritis are 22 1 times that of a female patient. 2 (15) African Americans with doctor-diagnosed 3 arthritis have a higher prevalence of severe pain at- 4 tributable to arthritis, compared with Whites (34.0 5 percent versus 22.6 percent). African Americans, 6 compared to Whites, report a higher proportion of 7 work limitations (39.5 percent versus 28.0 percent) 8 and a higher prevalence of arthritis-attributable 9 work limitation (6.6 percent versus 4.6 percent). 10 (16) Hispanics are 50 percent more likely than 11 non-Hispanic Whites to report needing assistance 12 with at least one instrumental activity of daily living 13 and to have difficulty walking. 14 (17) African Americans and Hispanics were 1.3 15 times more likely to have activity limitation, 1.6 16 times more likely to have work limitations, and 1.9 17 times more likely to have severe joint pain than 18 Whites. 19 (18) In 2003, the Institute of Medicine reported 20 that the rates of TKA and THA among African- 21 American and Hispanic patients are significantly 22 lower than for Whites—even for those with equitable 23 health care coverage such as through Medicare or 24 the Department of Veterans Affairs. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00708 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 709 •HR 5942 IH (19) According to the Centers for Disease Con- 1 trol and Prevention, in 2000, African-American 2 Medicare enrollees were 37 percent less likely than 3 White Medicare enrollees to undergo total knee re- 4 placements. In 2006, the disparity increased to 39 5 percent. 6 (20) Even after adjusting for insurance and 7 health access, Hispanics and African Americans are 8 almost 50 percent less likely to undergo total knee 9 replacement than Whites. 10 SEC. 786. OSTEOARTHRITIS AND OTHER MUSCULO- 11 SKELETAL HEALTH-RELATED ACTIVITIES OF 12 THE CENTERS FOR DISEASE CONTROL AND 13 PREVENTION. 14 (a) EDUCATION AND AWARENESS ACTIVITIES.—The 15 Secretary of Health and Human Services, acting through 16 the Director of the Centers for Disease Control and Pre- 17 vention, shall direct the National Center for Chronic Dis- 18 ease Prevention and Health Promotion to conduct and ex- 19 pand the Health Community Program and Arthritis Pro- 20 gram to educate the public on— 21 (1) the causes of, preventive health actions for, 22 and effects of arthritis and other musculoskeletal 23 conditions in minority patient populations; and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00709 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 710 •HR 5942 IH (2) the effects of such conditions on other 1 comorbidities including obesity, hypertension, and 2 cardiovascular disease. 3 (b) PROGRAMS ON ARTHRITIS AND MUSCULO- 4 SKELETAL CONDITIONS.—Education and awareness pro- 5 grams of the Centers for Disease Control and Prevention 6 on arthritis and other musculoskeletal conditions in minor- 7 ity communities shall— 8 (1) be culturally and linguistically appropriate 9 to minority patients, targeting musculoskeletal 10 health promotion and prevention programs of each 11 major ethnic group, including— 12 (A) Native Americans and Alaska Natives; 13 (B) Asian Americans; 14 (C) African Americans/Blacks; 15 (D) Hispanic/Latino Americans; and 16 (E) Native Hawaiians and Pacific Island- 17 ers; and 18 (2) include public awareness campaigns directed 19 toward these patient populations that emphasize the 20 importance of musculoskeletal health, physical activ- 21 ity, diet and healthy lifestyle, and weight reduction 22 for overweight and obese patients. 23 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 24 out this section, there are authorized to be appropriated 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00710 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 711 •HR 5942 IH such sums as are necessary for fiscal year 2019 and each 1 subsequent fiscal year. 2 SEC. 787. GRANTS FOR COMPREHENSIVE OSTEOARTHRITIS 3 AND MUSCULOSKELETAL DISEASE HEALTH 4 EDUCATION WITHIN HEALTH PROFESSIONS 5 SCHOOLS. 6 (a) PROGRAM AUTHORIZED.—The Secretary of 7 Health and Human Services (in this section referred to 8 as the ‘‘Secretary’’), in coordination with the Secretary of 9 Education, shall award grants, on a competitive basis, to 10 academic health science centers, health professions 11 schools, and other institutions of higher education to en- 12 able such institutions to provide people with comprehen- 13 sive education on arthritis and musculoskeletal health, 14 particularly— 15 (1) obesity-related musculoskeletal diseases; 16 (2) arthritis and osteoarthritis; 17 (3) arthritis and musculoskeletal health dispari- 18 ties; and 19 (4) the relationship between arthritis and mus- 20 culoskeletal diseases and metabolic activity, psycho- 21 logical health, and comorbidities such as diabetes, 22 cardiovascular disease, and hypertension. 23 (b) DURATION.—Grants awarded under this section 24 shall be for a period of 5 years. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00711 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 712 •HR 5942 IH (c) APPLICATIONS.—An academic health science cen- 1 ter, health professions school, or other institution of high- 2 er education seeking a grant under this section shall sub- 3 mit an application to the Secretary at such time, in such 4 manner, and containing such information as the Secretary 5 may require. 6 (d) PRIORITY.—In awarding grants under this sec- 7 tion, the Secretary shall give priority to an institution of 8 higher education that— 9 (1) has an enrollment of needy students, as de- 10 fined in section 318(b) of the Higher Education Act 11 of 1965 (20 U.S.C. 1059e(b)); 12 (2) is a Hispanic-serving institution, as defined 13 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 14 (3) is a Tribal College or University, as defined 15 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 16 (4) is an Alaska Native-serving institution, as 17 defined in section 317(b) of such Act (20 U.S.C. 18 1059d(b)); 19 (5) is a Native Hawaiian-serving institution, as 20 defined in section 317(b) of such Act (20 U.S.C. 21 1059d(b)); 22 (6) is a Predominately Black Institution, as de- 23 fined in section 318(b) of such Act (20 U.S.C. 24 1059e(b)); 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00712 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 713 •HR 5942 IH (7) is a Native American-serving, non-Tribal in- 1 stitution, as defined in section 319(b) of such Act 2 (20 U.S.C. 1059f(b)); 3 (8) is an Asian-American and Native American 4 Pacific Islander-serving institution, as defined in 5 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 6 (9) is a minority institution, as defined in sec- 7 tion 365 of such Act (20 U.S.C. 1067k), with an en- 8 rollment of needy students, as defined in section 312 9 of such Act (20 U.S.C. 1058). 10 (e) USES OF FUNDS.—An institution of higher edu- 11 cation receiving a grant under this section may use grant 12 funds to integrate issues relating to comprehensive arthri- 13 tis and musculoskeletal health into the academic or sup- 14 port sectors of the institution in order to reach a large 15 number of students, by carrying out 1 or more of the fol- 16 lowing activities: 17 (1) Developing educational content for issues 18 relating to comprehensive arthritis and musculo- 19 skeletal health education that will be incorporated 20 into first-year orientation or core courses. 21 (2) Creating innovative technology-based ap- 22 proaches to deliver arthritis and musculoskeletal 23 health education to students, faculty, and staff. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00713 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 714 •HR 5942 IH (3) Developing and employing peer-outreach 1 and education programs to generate discussion, edu- 2 cate, and raise awareness among students about 3 issues relating to arthritis and musculoskeletal 4 health disorders, and their relationship to diabetes, 5 hypertension, cardiovascular disease, psychological 6 health, and other comorbid conditions. 7 (f) REPORT TO CONGRESS.— 8 (1) IN GENERAL.—Not later than 1 year after 9 the date of the enactment of this Act, and annually 10 thereafter for a period of 5 years, the Secretary shall 11 prepare and submit to the appropriate committees of 12 Congress a report on the activities to provide health 13 professions students with comprehensive arthritis 14 and musculoskeletal health education funded under 15 this section. 16 (2) REPORT ELEMENTS.—The report described 17 in paragraph (1) shall include information about— 18 (A) the number of entities that are receiv- 19 ing grant funds; 20 (B) the specific activities supported by 21 grant funds; 22 (C) the number of students served by 23 grant programs; and 24 (D) the status of program evaluations. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00714 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 715 •HR 5942 IH Subtitle J—Sleep and Circadian 1 Rhythm Disorders 2 SEC. 791. SHORT TITLE; FINDINGS. 3 (a) SHORT TITLE.—This subtitle may be cited as the 4 ‘‘Sleep and Circadian Rhythm Disorders Health Dispari- 5 ties Act’’. 6 (b) FINDINGS.—The Congress finds the following: 7 (1) Decrements in sleep health such as sleep 8 apnea, insufficient sleep time, and insomnia, affect 9 50–70 million United States adults. Twelve to eight- 10 een million United States adults have sleep apnea, a 11 chronic disorder characterized by one or more 12 pauses in breathing which can last from a few sec- 13 onds to minutes. They may occur 30 times or more 14 an hour, disrupting sleep and resulting in excessive 15 daytime sleepiness and loss in productivity. 16 (2) Seventy percent of high school students are 17 not getting enough sleep on school nights, while 33 18 percent of Americans get fewer than 7 hours of sleep 19 per night, and roughly 6,000 fatal motor vehicle 20 crashes are caused by drowsy drivers. 21 (3) Insufficient sleep and insomnia are more 22 prevalent in women. Women who are pregnant and 23 have sleep apnea are at an increased risk of cardio- 24 vascular complications during pregnancy. The im- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00715 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 716 •HR 5942 IH pact of disparities in sleep health is associated with 1 a growing number of health problems, including the 2 following: 3 (A) Hypertension. 4 (B) Cancer. 5 (C) Stroke. 6 (D) Cardiac arrhythmia. 7 (E) Chronic heart failure and heart dis- 8 ease. 9 (F) Diabetes. 10 (G) Cognitive functioning and behavior. 11 (H) Depression and bipolar disorder. 12 (I) Substance abuse. 13 (4) A ‘‘sleep disparity’’ exists in that poor sleep 14 quality is strongly associated with poverty and race. 15 Factors such as employment, education, and health 16 status, amongst others, significantly mediated this 17 effect only in poor subjects, suggesting a differential 18 vulnerability to these factors in poor relative to 19 nonpoor individuals in the context of sleep quality. 20 (5) African Americans sleep worse than Cauca- 21 sian Americans. African Americans take longer to 22 fall asleep, report poorer sleep quality, have more 23 light and less deep sleep, and nap more often and 24 longer. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00716 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 717 •HR 5942 IH (6) African Americans and individuals in lower 1 socioeconomic status groups may be at an increased 2 risk for sleep disturbances and associated health 3 consequences. 4 (7) Among young African Americans, the likeli- 5 hood of having sleep disordered breathing and exhib- 6 iting risk factors for poor sleep is twice that in 7 young Caucasians. Frequent snoring is more com- 8 mon among African American and Hispanic women 9 and Hispanic men compared to non-Hispanic Cauca- 10 sians, independent of other factors including obesity. 11 (8) African Americans with sleep-disordered 12 breathing develop symptoms at a younger age than 13 Caucasians but appear less likely to be diagnosed 14 and treated in a timely manner. This delay may at 15 least in part be due to reduced access to care. 16 (9) Sleep loss contributes to increased risk for 17 chronic conditions such as obesity, diabetes, and hy- 18 pertension, all of which have increased prevalence in 19 underserved, underrepresented minorities. Racial 20 and ethnic disparities related to obesity may also 21 contribute to disparities in health outcomes related 22 to sleep-disordered breathing. 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00717 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 718 •HR 5942 IH (10) Non-Caucasian adults report an insomnia 1 rate of 12.9 percent compared to only 6.6 percent 2 for Caucasians. 3 (11) African-American women have a higher in- 4 cidence of insomnia than African-American men, 5 perhaps related in part to higher risk for chronic 6 persisting symptoms. 7 SEC. 792. SLEEP AND CIRCADIAN RHYTHM DISORDERS RE- 8 SEARCH ACTIVITIES OF THE NATIONAL IN- 9 STITUTES OF HEALTH. 10 (a) IN GENERAL.—The Director of the National In- 11 stitutes of Health, acting through the Director of the Na- 12 tional Heart, Lung, and Blood Institute, shall— 13 (1) continue to expand research activities ad- 14 dressing sleep health disparities; and 15 (2) continue implementation of the ‘‘NIH Sleep 16 Disorders Research Plan’’ across all institutes and 17 centers of the National Institutes of Health to im- 18 prove treatment and prevention of sleep health dis- 19 parities. 20 (b) REQUIRED RESEARCH ACTIVITIES.—In con- 21 ducting or supporting research relating to sleep and circa- 22 dian rhythm, the Director of the National Heart, Lung, 23 and Blood Institute shall— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00718 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 719 •HR 5942 IH (1) advance epidemiology and clinical research 1 to achieve a more complete understanding of dispari- 2 ties in domains of sleep health and across population 3 subgroups for which cardiovascular and metabolic 4 health disparities exist, including— 5 (A) prevalence and severity of sleep apnea; 6 (B) habitual sleep duration; 7 (C) sleep timing and regularity; and 8 (D) insomnia; 9 (2) develop study designs and analytical ap- 10 proaches to explain and predict multilevel and life- 11 course determinants of sleep health and to elucidate 12 the sleep-related causes of cardiovascular and meta- 13 bolic health disparities across the age spectrum, in- 14 cluding such determinants and causes that are— 15 (A) environmental; 16 (B) biological or genetic; 17 (C) psychosocial; 18 (D) societal; 19 (E) political; or 20 (F) economic; 21 (3) determine the contribution of sleep impair- 22 ments such as sleep apnea, insufficient sleep dura- 23 tion, irregular sleep schedules, and insomnia to un- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00719 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 720 •HR 5942 IH explained disparities in cardiovascular and metabolic 1 risk and disease outcomes; 2 (4) develop study designs, data sampling and 3 collection tools, and analytical approaches to opti- 4 mize understanding of mediating and moderating 5 factors, and feedback mechanisms coupling sleep to 6 cardiovascular and metabolic health disparities; 7 (5) advance research to understand cultural 8 and linguistic barriers (on the person, provider, or 9 system level) to access to care, medical diagnosis, 10 and treatment of sleep disorders in diverse popu- 11 lation groups; 12 (6) develop and test multilevel interventions (in- 13 cluding sleep health education in diverse commu- 14 nities) to reduce disparities in sleep health that will 15 impact ability to improve disparities in cardio- 16 vascular and metabolic risk or disease; 17 (7) create opportunities to integrate sleep and 18 health disparity science by strategically utilizing re- 19 sources (existing or anticipated cohorts), exchanging 20 scientific data and ideas (cross-over into scientific 21 meetings), and develop multidisciplinary investi- 22 gator-initiated grant applications; and 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00720 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 721 •HR 5942 IH (8) enhance the diversity and foster career de- 1 velopment of young investigators involved in sleep 2 and health disparities science. 3 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 4 out this section, there are authorized to be appropriated 5 such sums as may be necessary for fiscal year 2019 and 6 each subsequent fiscal year. 7 SEC. 793. SLEEP AND CIRCADIAN RHYTHM HEALTH DIS- 8 PARITIES-RELATED ACTIVITIES OF THE CEN- 9 TERS FOR DISEASE CONTROL AND PREVEN- 10 TION. 11 (a) IN GENERAL.—The Director of the Centers for 12 Disease Control and Prevention shall conduct, support, 13 and expand public health strategies and prevention, diag- 14 nosis, surveillance, and public and professional awareness 15 activities regarding sleep and circadian rhythm disorders. 16 (b) FINDINGS.—The Congress finds as follows: 17 (1) Sleep disorders and sleep deficiency unre- 18 lated to a primary sleep disorder are underdiagnosed 19 and are increasingly detrimental to health status. 20 (2) The consequences to society include addi- 21 tional diseases, motor vehicle accidents, decreased 22 longevity, elevated direct medical costs, and indirect 23 costs related to work absenteeism and property dam- 24 age. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00721 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 722 •HR 5942 IH (c) REQUIRED SURVEILLANCE AND EDUCATION 1 AWARENESS ACTIVITIES.—In conducting or supporting 2 research relating to sleep and circadian rhythm disorders 3 surveillance and education awareness activities, the Direc- 4 tor of the Centers for Disease Control and Prevention 5 shall— 6 (1) ensure that such activities are culturally 7 and linguistically appropriate to minority patients, 8 targeting sleep and circadian rhythm health pro- 9 motion and prevention programs of each major eth- 10 nic group, including— 11 (A) Native Americans and Alaska Natives; 12 (B) Asian Americans; 13 (C) African Americans/Blacks; 14 (D) Hispanic/Latino-Americans; and 15 (E) Native Hawaiians and Pacific Island- 16 ers; 17 (2) collect and compile national and State sur- 18 veillance data on sleep disorders health disparities; 19 (3) continue to develop and implement new 20 sleep questions in public health surveillance systems 21 to increase public awareness of sleep health and 22 sleep disorders and their impact on health; 23 (4) publish monthly reports highlighting geo- 24 graphic, racial, and ethnic disparities in sleep health, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00722 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 723 •HR 5942 IH as well as relationships between insufficient sleep 1 and chronic disease, health risk behaviors, and other 2 outcomes as determined necessary by the Director; 3 and 4 (5) include public awareness campaigns that in- 5 form patient populations from major ethnic groups 6 about the prevalence of sleep and circadian rhythm 7 disorders and emphasize the importance of sleep 8 health. 9 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 10 out this section, there are authorized to be appropriated 11 such sums as may be necessary for fiscal year 2019 and 12 each subsequent fiscal year. 13 SEC. 794. GRANTS FOR COMPREHENSIVE SLEEP AND CIR- 14 CADIAN HEALTH EDUCATION WITHIN 15 HEALTH PROFESSIONS SCHOOLS. 16 (a) PROGRAM AUTHORIZED.—The Secretary of 17 Health and Human Services (in this section referred to 18 as the ‘‘Secretary’’), in coordination with the Secretary of 19 Education, shall award grants, on a competitive basis, to 20 academic health science centers, health professions 21 schools, and other institutions of higher education to en- 22 able such institutions to provide people with comprehen- 23 sive education on sleep and circadian health, particu- 24 larly— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00723 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 724 •HR 5942 IH (1) poor sleep health; 1 (2) sleep disorders; 2 (3) sleep health disparities; and 3 (4) the relationship between sleep and circadian 4 health on metabolic activity, neurological activity, 5 comorbidities, and other diseases. 6 (b) DURATION.—Grants awarded under this section 7 shall be for a period of 5 years. 8 (c) APPLICATIONS.—Any academic health science 9 center, health professions school, or other institutions of 10 higher education seeking a grant under this section shall 11 submit an application to the Secretary at such time, in 12 such manner, and containing such information as the Sec- 13 retary may require. 14 (d) PRIORITY.—In awarding grants under this sec- 15 tion, the Secretary shall give priority to an institution 16 that— 17 (1) has an enrollment of needy students, as de- 18 fined in section 318(b) of the Higher Education Act 19 of 1965 (20 U.S.C. 1059e(b)); 20 (2) is a Hispanic-serving institution, as defined 21 in section 502(a) of such Act (20 U.S.C. 1101a(a)); 22 (3) is a Tribal College or University, as defined 23 in section 316(b) of such Act (20 U.S.C. 1059c(b)); 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00724 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 725 •HR 5942 IH (4) is an Alaska Native-serving institution, as 1 defined in section 317(b) of such Act (20 U.S.C. 2 1059d(b)); 3 (5) is a Native Hawaiian-serving institution, as 4 defined in section 317(b) of such Act (20 U.S.C. 5 1059d(b)); 6 (6) is a Predominately Black Institution, as de- 7 fined in section 318(b) of such Act (20 U.S.C. 8 1059e(b)); 9 (7) is a Native American-serving, nontribal in- 10 stitution, as defined in section 319(b) of such Act 11 (20 U.S.C. 1059f(b)); 12 (8) is an Asian-American and Native American 13 Pacific Islander-serving institution, as defined in 14 section 320(b) of such Act (20 U.S.C. 1059g(b)); or 15 (9) is a minority institution, as defined in sec- 16 tion 365 of such Act (20 U.S.C. 1067k), with an en- 17 rollment of needy students, as defined in section 312 18 of such Act (20 U.S.C. 1058). 19 (e) USES OF FUNDS.—An institution of higher edu- 20 cation receiving a grant under this section may use grant 21 funds to integrate issues relating to comprehensive sleep 22 and circadian health into the academic or support sectors 23 of the institution in order to reach a large number of stu- 24 dents, by carrying out 1 or more of the following activities: 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00725 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 726 •HR 5942 IH (1) Developing educational content for issues 1 relating to comprehensive sleep and circadian health 2 education that will be incorporated into first-year 3 orientation or core courses. 4 (2) Creating innovative technology-based ap- 5 proaches to deliver sleep health education to stu- 6 dents, faculty, and staff. 7 (3) Developing and employing peer-outreach 8 and education programs to generate discussion, edu- 9 cate, and raise awareness among students about 10 issues relating to poor quality sleep, sleep and circa- 11 dian disorders, and the role sleep health plays in 12 other diseases and comorbidities. 13 (f) REPORT TO CONGRESS.— 14 (1) IN GENERAL.—Not later than 1 year after 15 the date of the enactment of this Act, and annually 16 thereafter for a period of 5 years, the Secretary shall 17 prepare and submit to the appropriate committees of 18 Congress a report on the activities to provide health 19 professions students with comprehensive sleep and 20 circadian health education funded under this section. 21 (2) REPORT ELEMENTS.—The report described 22 in paragraph (1) shall include information about— 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00726 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 727 •HR 5942 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 AND 10 RACIAL/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 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00727 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 728 •HR 5942 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 Subtitle K—Sickle Cell Disease Re- 8 search, Surveillance, Preven- 9 tion, and Treatment 10 SEC. 796. SHORT TITLE. 11 This subtitle may be cited as the ‘‘Sickle Cell Disease 12 Research, Surveillance, Prevention, and Treatment Act of 13 2018’’. 14 SEC. 796A. SICKLE CELL DISEASE RESEARCH. 15 Part P of title III of the Public Health Service Act 16 (42 U.S.C. 280g et seq.), as amended, is further amended 17 by adding at the end the following: 18 ‘‘SEC. 399V–11. NATIONAL SICKLE CELL DISEASE RE- 19 SEARCH, SURVEILLANCE, PREVENTION, AND 20 TREATMENT PROGRAM. 21 ‘‘(a) RESEARCH.—The Secretary may conduct or 22 support research to expand the understanding of the cause 23 of, and to find a cure for, sickle cell disease.’’. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00728 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 729 •HR 5942 IH SEC. 796B. SICKLE CELL DISEASE SURVEILLANCE. 1 Section 399V–11 of the Public Health Service Act, 2 as added by section 796A, is amended by adding at the 3 end the following: 4 ‘‘(b) SURVEILLANCE.— 5 ‘‘(1) GRANTS.—The Secretary may, for each 6 fiscal year for which appropriations are available to 7 carry out this subsection, make grants— 8 ‘‘(A) to conduct surveillance and maintain 9 data on the prevalence and distribution of sickle 10 cell disease and its associated health outcomes, 11 complications, and treatments; 12 ‘‘(B) to conduct public health initiatives 13 with respect to sickle cell disease, including— 14 ‘‘(i) increasing efforts to improve ac- 15 cess to, and receipt of, high-quality sickle 16 cell disease-related health care, including 17 the use of treatments approved under sec- 18 tion 505 of the Federal Food, Drug, and 19 Cosmetic Act or licensed under section 351 20 of this Act; 21 ‘‘(ii) working with partners to improve 22 health outcomes of people with sickle cell 23 disease over their lifespan by promoting 24 guidelines for sickle cell disease screening, 25 prevention, and treatment, including man- 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00729 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 730 •HR 5942 IH agement of sickle cell disease complica- 1 tions; 2 ‘‘(iii) providing support to community- 3 based organizations and State and local 4 health departments in conducting sickle 5 cell disease education and training activi- 6 ties for patients, communities, and health 7 care providers; and 8 ‘‘(iv) supporting and training State 9 health departments and regional labora- 10 tories in comprehensive testing to identify 11 specific forms of sickle cell disease in peo- 12 ple of all ages; and 13 ‘‘(C) to identify and evaluate promising 14 strategies for prevention and treatment of sickle 15 cell disease complications, including through— 16 ‘‘(i) improving estimates of the na- 17 tional incidence and prevalence of sickle 18 cell disease, including estimates about the 19 specific types of sickle cell disease; 20 ‘‘(ii) identifying health disparities re- 21 lated to sickle cell disease; 22 ‘‘(iii) assessing the utilization of 23 therapies and strategies to prevent com- 24 plications related to sickle cell disease; and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00730 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 731 •HR 5942 IH ‘‘(iv) evaluating the impact of genetic, 1 environmental, behavioral, and other risk 2 factors that may affect sickle cell disease 3 health outcomes. 4 ‘‘(2) POPULATION INCLUDED.—The Secretary 5 shall, to the extent practicable, award grants under 6 this subsection to States, academic institutions, or 7 nonprofit organizations across the United States so 8 as to include data on the majority of the United 9 States population with sickle cell disease. 10 ‘‘(3) APPLICATION.—To seek a grant under this 11 subsection, a State, academic institution, or non- 12 profit organization shall submit an application to the 13 Secretary at such time, in such manner, and con- 14 taining such information as the Secretary may re- 15 quire. 16 ‘‘(4) DEFINITIONS.—In this subsection: 17 ‘‘(A) SECRETARY.—The term ‘Secretary’ 18 means the Secretary of Health and Human 19 Services, acting through the Director of the Na- 20 tional Center on Birth Defects and Develop- 21 mental Disabilities. 22 ‘‘(B) STATE.—The term ‘State’ includes 23 the 50 States, the District of Columbia, the 24 Commonwealth of Puerto Rico, the United 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00731 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 732 •HR 5942 IH States Virgin Islands, the Commonwealth of the 1 Northern Mariana Islands, American Samoa, 2 Guam, the Federated States of Micronesia, the 3 Republic of the Marshall Islands, and the Re- 4 public of Palau.’’. 5 SEC. 796C. SICKLE CELL DISEASE PREVENTION AND 6 TREATMENT. 7 (a) REAUTHORIZATION.—Section 712(c) of the 8 American Jobs Creation Act of 2004 (Public Law 108– 9 357; 42 U.S.C. 300b–1 note) is amended— 10 (1) by striking ‘‘Sickle Cell Disease’’ each place 11 it appears and inserting ‘‘sickle cell disease’’; 12 (2) in paragraph (1)(A), by striking ‘‘grants to 13 up to 40 eligible entities for each fiscal year in which 14 the program is conducted under this section for the 15 purpose of developing and establishing systemic 16 mechanisms to improve the prevention and treat- 17 ment of Sickle Cell Disease’’ and inserting ‘‘grants 18 to up to 25 eligible entities for each fiscal year in 19 which the program is conducted under this section 20 for the purpose of developing and establishing sys- 21 temic mechanisms to improve the prevention and 22 treatment of sickle cell disease in populations with 23 a high density of sickle cell disease patients’’; 24 (3) in paragraph (1)(B)— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00732 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 733 •HR 5942 IH (A) by striking clause (ii) (relating to pri- 1 ority); and 2 (B) by striking ‘‘GRANT AWARD REQUIRE- 3 MENTS’’ and all that follows through ‘‘the ad- 4 ministrator shall’’ and inserting ‘‘GEOGRAPHIC 5 DIVERSITY.—The Administrator shall’’; 6 (4) in paragraph (2), by adding the following 7 new subparagraph at the end: 8 ‘‘(E) To expand, coordinate, and imple- 9 ment transition services for adolescents with 10 sickle cell disease making the transition to adult 11 health care.’’; and 12 (5) in paragraph (6), by striking ‘‘$10,000,000 13 for each of fiscal years 2005 through 2009’’ and in- 14 serting ‘‘$4,455,000 for each of fiscal years 2019 15 through 2023’’. 16 (b) TECHNICAL CHANGES.—Subsection (c) of section 17 712 of the American Jobs Creation Act of 2004 (Public 18 Law 108–357; 42 U.S.C. 300b–1 note), as amended by 19 subsection (a), is— 20 (1) transferred to the Public Health Service Act 21 (42 U.S.C. 201 et seq.); and 22 (2) inserted at the end of section 399V–11 of 23 such Act, as added and amended by sections 796A 24 and 796B. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00733 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 734 •HR 5942 IH SEC. 796D. COLLABORATION WITH COMMUNITY-BASED EN- 1 TITIES. 2 Section 399V–11 of the Public Health Service Act, 3 as amended by section 796C, is further amended by add- 4 ing at the end the following: 5 ‘‘(d) COLLABORATION WITH COMMUNITY-BASED EN- 6 TITIES.—To be eligible to receive a grant or other assist- 7 ance under subsection (b) or (c), an entity must have in 8 effect a collaborative agreement with a community-based 9 organization with 5 or more years of experience in pro- 10 viding services to sickle cell disease patients.’’. 11 TITLE VIII—HEALTH 12 INFORMATION TECHNOLOGY 13 SEC. 800. DEFINITIONS. 14 In this title: 15 (1) CERTIFIED ELECTRONIC HEALTH RECORD 16 TECHNOLOGY.—The term ‘‘Certified Electronic 17 Health Record Technology’’ has the meaning given 18 to that term in section 3000 of the Public Health 19 Service Act (42 U.S.C. 300jj). 20 (2) EHR.—The term ‘‘EHR’’ means an elec- 21 tronic health record. 22 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00734 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 735 •HR 5942 IH Subtitle A—Reducing Health 1 Disparities Through Health IT 2 SEC. 801. HRSA ASSISTANCE TO HEALTH CENTERS FOR 3 PROMOTION OF HEALTH IT. 4 The Secretary of Health and Human Services, acting 5 through the Administrator of the Health Resources and 6 Services Administration, shall expand and intensify the 7 programs and activities of the Administration (directly or 8 through grants or contracts) to provide technical assist- 9 ance and resources to health centers (as defined in section 10 330(a) of the Public Health Service Act (42 U.S.C. 11 254b(a)) to adopt and meaningfully use Certified Elec- 12 tronic Health Record Technology for the management of 13 chronic diseases and health conditions and reduction of 14 health disparities. 15 SEC. 802. ASSESSMENT OF IMPACT OF HEALTH IT ON RA- 16 CIAL AND ETHNIC MINORITY COMMUNITIES; 17 OUTREACH AND ADOPTION OF HEALTH IT IN 18 SUCH COMMUNITIES. 19 (a) NATIONAL COORDINATOR FOR HEALTH INFOR- 20 MATION TECHNOLOGY.— 21 (1) IN GENERAL.—The National Coordinator 22 for Health Information Technology shall conduct an 23 evaluation of the level of use and accessibility of 24 electronic health records in racial and ethnic minor- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00735 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 736 •HR 5942 IH ity communities focusing on whether patients in 1 those communities have providers with electronic 2 health records, stratified by providers participating 3 in Medicare and Medicaid programs, and whether 4 such providers have received EHR incentive pay- 5 ments under the HITECH Act, and by providers 6 participating in the Merit-Based Incentive Payment 7 System (MIPS) under the Quality Payment Pro- 8 gram (QPP) established by the Medicare Access and 9 CHIP Reauthorization Act of 2015 (MACRA). 10 (2) CONTENT.—In conducting the evaluation 11 under paragraph (1), the National Coordinator shall 12 publish the results of a study regarding the 100,000 13 providers recruited by the Regional Extension Cen- 14 ter established under section 3012 of the Public 15 Health Service Act (42 U.S.C. 300jj–32), including 16 the race and ethnicity of such providers and the pop- 17 ulations served by such providers, with the popu- 18 lations stratified by providers participating in Medi- 19 care and Medicaid programs, and whether such pro- 20 viders have received EHR incentive payments under 21 the HITECH Act, and by providers participating in 22 the MIPS. 23 (b) NATIONAL CENTER FOR HEALTH STATISTICS.— 24 As soon as practicable after the date of enactment of this 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00736 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 737 •HR 5942 IH Act, the Director of the National Center for Health Statis- 1 tics shall provide to Congress a more detailed analysis of 2 the data presented in NCHS Data Brief No. 236, Adop- 3 tion of Certified Electronic Health Record Systems and 4 Electronic Information Sharing in Physician Offices: 5 United States, 2013 and 2014 the Data Brief 79. 6 (c) CENTERS FOR MEDICARE & MEDICAID SERV- 7 ICES.— 8 (1) IN GENERAL.—As part of the process of 9 collecting information, with respect to a provider, at 10 registration and attestation for purposes of the 11 Medicare and Medicaid Electronic Health Records 12 Incentive Programs and MIPS, the Secretary of 13 Health and Human Services shall collect the race 14 and ethnicity of such provider. 15 (2) MEDICARE AND MEDICAID ELECTRONIC 16 HEALTH RECORDS INCENTIVE PROGRAMS DE- 17 FINED.—For purposes of paragraph (1), the term 18 ‘‘Medicare and Medicaid Electronic Health Records 19 Incentive Programs’’ means the incentive programs 20 under section 1814(l)(3), subsections (a)(7) and (o) 21 of section 1848, subsections (l) and (m) of section 22 1853, subsections (b)(3)(B)(ix)(I) and (n) of section 23 1886, and subsections (a)(3)(F) and (t) of section 24 1903 of the Social Security Act (42 U.S.C. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00737 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 738 •HR 5942 IH 1395f(l)(3), 1395w–4, 1395w–23, 1395ww, and 1 1396b). 2 (d) NATIONAL COORDINATOR’S ASSESSMENT OF IM- 3 PACT OF HIT.—Section 3001(c)(6)(C) of the Public 4 Health Service Act (42 U.S.C. 300jj–11(c)(6)(C)) is 5 amended— 6 (1) in the heading by inserting ‘‘, RACIAL AND 7 ETHNIC MINORITY COMMUNITIES,’’ after ‘‘HEALTH 8 DISPARITIES’’; 9 (2) by inserting ‘‘, in communities with a high 10 proportion of individuals from racial and ethnic mi- 11 nority groups (as defined in section 1707(g)), in- 12 cluding people with disabilities in these groups,’’ 13 after ‘‘communities with health disparities’’; and 14 (3) by adding at the end the following new sen- 15 tence: ‘‘In any publication under the previous sen- 16 tence, the National Coordinator shall include best 17 practices for encouraging partnerships between the 18 Federal Government, States, and private entities to 19 expand outreach for and the adoption of certified 20 EHR technology in communities with a high propor- 21 tion of individuals from racial and ethnic minority 22 groups (as so defined), while also maintaining the 23 accessibility requirements of section 508 of the Re- 24 habilitation Act to encourage patient involvement in 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00738 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 739 •HR 5942 IH patient health care. The National Coordinator 1 shall— 2 ‘‘(i) not later than 6 months after the 3 submission to the Congress of the report 4 required by section 822 of the Health Eq- 5 uity and Accountability Act of 2018, estab- 6 lish criteria for evaluating the impact of 7 health information technology on commu- 8 nities with a high proportion of individuals 9 from racial and ethnic minority groups (as 10 so defined) taking into account the find- 11 ings in such report; and 12 ‘‘(ii) not later than 12 months after 13 the submission to the Congress of such re- 14 ports, conduct and publish the results of 15 an evaluation of such impact.’’. 16 Subtitle B—Modifications To 17 Achieve Parity in Existing Pro- 18 grams 19 SEC. 811. EXTENDING FUNDING TO STRENGTHEN THE 20 HEALTH IT INFRASTRUCTURE IN RACIAL 21 AND ETHNIC MINORITY COMMUNITIES. 22 Section 3011 of the Public Health Service Act (42 23 U.S.C. 300jj–31) is amended— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00739 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 740 •HR 5942 IH (1) in subsection (a), by adding at the end the 1 following new paragraph: 2 ‘‘(8) Activities described in the previous para- 3 graphs of this subsection with respect to commu- 4 nities with a high proportion of individuals from ra- 5 cial and ethnic minority groups (as defined in sec- 6 tion 1707(g)).’’; and 7 (2) by adding at the end the following new sub- 8 section: 9 ‘‘(e) ANNUAL REPORT ON EXPENDITURES.—The 10 National Coordinator shall report annually to the Con- 11 gress on activities and expenditures under this section.’’. 12 SEC. 812. EXTENDING COMPETITIVE GRANTS FOR THE DE- 13 VELOPMENT OF LOAN PROGRAMS TO FACILI- 14 TATE ADOPTION OF CERTIFIED ELECTRONIC 15 HEALTH RECORD TECHNOLOGY BY PRO- 16 VIDERS SERVING RACIAL AND ETHNIC MI- 17 NORITY GROUPS. 18 Section 3014(e) of the Public Health Service Act (42 19 U.S.C. 300jj–34(e)) is amended— 20 (1) in paragraph (3), by striking at the end 21 ‘‘or’’; 22 (2) in paragraph (4), by striking the period at 23 the end and inserting ‘‘; or’’; and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00740 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 741 •HR 5942 IH (3) by adding at the end the following new 1 paragraph: 2 ‘‘(5) carry out any of the activities described in 3 a previous paragraph of this subsection with respect 4 to communities with a high proportion of individuals 5 from racial and ethnic minority groups (as defined 6 in section 1707(g)).’’. 7 SEC. 813. AUTHORIZATION OF APPROPRIATIONS. 8 Section 3018 of the Public Health Service Act (42 9 U.S.C. 300jj–38) is amended by striking ‘‘fiscal years 10 2009 through 2013’’ and inserting ‘‘fiscal years 2019 11 through 2024’’. 12 Subtitle C—Additional Research 13 and Studies 14 SEC. 821. DATA COLLECTION AND ASSESSMENTS CON- 15 DUCTED IN COORDINATION WITH MINORITY- 16 SERVING INSTITUTIONS. 17 Section 3001(c)(6) of the Public Health Service Act 18 (42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 19 end the following new subparagraph: 20 ‘‘(F) DATA COLLECTION AND ASSESS- 21 MENTS CONDUCTED IN COORDINATION WITH 22 MINORITY-SERVING INSTITUTIONS.— 23 ‘‘(i) IN GENERAL.—In carrying out 24 subparagraph (C) with respect to commu- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00741 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 742 •HR 5942 IH nities with a high proportion of individuals 1 from racial and ethnic minority groups (as 2 defined in section 1707(g)), the National 3 Coordinator shall, to the greatest extent 4 possible, coordinate with an entity de- 5 scribed in clause (ii). 6 ‘‘(ii) MINORITY-SERVING INSTITU- 7 TIONS.—For purposes of clause (i), an en- 8 tity described in this clause is a historically 9 Black college or university, a Hispanic- 10 serving institution, a Tribal college or uni- 11 versity, or an Asian-American-, Native 12 American-, Pacific Islander-serving institu- 13 tion with an accredited public health, 14 health policy, or health services research 15 program.’’. 16 SEC. 822. STUDY OF HEALTH INFORMATION TECHNOLOGY 17 IN MEDICALLY UNDERSERVED COMMU- 18 NITIES. 19 (a) IN GENERAL.—Not later than 24 months after 20 the date of enactment of this Act, the Secretary of Health 21 and Human Services shall— 22 (1) enter into an agreement with the National 23 Academies of Sciences, Engineering, and Medicine to 24 conduct a study on the development, implementa- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00742 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 743 •HR 5942 IH tion, and effectiveness of health information tech- 1 nology within medically underserved areas (as de- 2 scribed in subsection (c)); and 3 (2) submit a report to Congress describing the 4 results of such study, including any recommenda- 5 tions for legislative or administrative action. 6 (b) STUDY.—The study described in subsection 7 (a)(1) shall— 8 (1) identify barriers to successful implementa- 9 tion of health information technology in medically 10 underserved areas; 11 (2) examine the impact of health information 12 technology on providing quality care and reducing 13 the cost of care to individuals in such areas, includ- 14 ing the impact of such technology on improved 15 health outcomes for individuals, including which 16 technology worked for which population and how it 17 improved health outcomes for that population; 18 (3) examine the impact of health information 19 technology on improving health care-related deci- 20 sions by both patients and providers in such areas; 21 (4) identify specific best practices for using 22 health information technology to foster the con- 23 sistent provision of physical accessibility and reason- 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00743 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 744 •HR 5942 IH able policy accommodations in health care to individ- 1 uals with disabilities in such areas; 2 (5) assess the feasibility and costs associated 3 with the use of health information technology in 4 such areas; 5 (6) evaluate whether the adoption and use of 6 qualified electronic health records (as described in 7 section 3000(13) of the Public Health Service Act 8 (42 U.S.C. 300jj(13)) is effective in reducing health 9 disparities, including analysis of clinical quality 10 measures reported by Medicare and Medicaid pro- 11 viders pursuant to programs to encourage the adop- 12 tion and use of Certified Electronic Health Record 13 Technology; 14 (7) identify providers in medically underserved 15 areas that are not electing to adopt and use elec- 16 tronic health records and determine what barriers 17 are preventing those providers from adopting and 18 using such records; and 19 (8) examine urban and rural community health 20 systems and determine the impact that health infor- 21 mation technology may have on the capacity of pri- 22 mary health providers in those systems. 23 (c) MEDICALLY UNDERSERVED AREA.—The term 24 ‘‘medically underserved area’’ means— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00744 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 745 •HR 5942 IH (1) a population that has been designated as a 1 medically underserved population under section 2 330(b)(3) of the Public Health Service Act (42 3 U.S.C. 254b(b)(3)); 4 (2) an area that has been designated as a 5 health professional shortage area under section 332 6 of the Public Health Service Act (42 U.S.C. 254e); 7 (3) an area or population that has been des- 8 ignated as a medically underserved community under 9 section 799B(6) of the Public Health Service Act 10 (42 U.S.C. 295p(6)); or 11 (4) an area or population that— 12 (A) is not described in paragraphs (1) 13 through (3) of this subsection; 14 (B) experiences significant barriers to ac- 15 cessing quality health services; and 16 (C) has a high prevalence of diseases or 17 conditions described in title VII of this Act, 18 with such diseases or conditions having a dis- 19 proportionate impact on racial and ethnic mi- 20 nority groups (as defined in section 1707(g) of 21 the Public Health Service Act (42 U.S.C. 22 300u–6(g))) or a subgroup of people with dis- 23 abilities who have specific functional impair- 24 ments. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00745 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 746 •HR 5942 IH Subtitle D—Closing Gaps in 1 Funding To Adopt Certified EHRs 2 SEC. 831. EXTENDING MEDICAID EHR INCENTIVE PAY- 3 MENTS TO REHABILITATION FACILITIES, 4 LONG-TERM CARE FACILITIES, AND HOME 5 HEALTH AGENCIES. 6 Section 1903(t)(2)(B) of the Social Security Act (42 7 U.S.C. 1396b(t)(2)(B)) is amended— 8 (1) in clause (i), by striking ‘‘, or’’ and insert- 9 ing a semicolon; 10 (2) in clause (ii), by striking the period at the 11 end and inserting a semicolon; and 12 (3) by inserting after clause (ii) the following 13 new clauses: 14 ‘‘(iii) a rehabilitation facility (as defined in sec- 15 tion 1886(j)(1)) that furnishes acute or subacute re- 16 habilitation services; 17 ‘‘(iv) a long-term care hospital (as defined in 18 section 1886(d)(1)(B)(iv)(I)); or 19 ‘‘(v) a home health agency (as defined in sec- 20 tion 1861(o)).’’. 21 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00746 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 747 •HR 5942 IH SEC. 832. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 1 FOR MEDICAID ELECTRONIC HEALTH 2 RECORD INCENTIVE PAYMENTS. 3 (a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 4 Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 5 amended to read as follows: 6 ‘‘(v) physician assistant.’’. 7 (b) EFFECTIVE DATE.—The amendment made by 8 subsection (a) shall apply with respect to amounts ex- 9 pended under section 1903(a)(3)(F) of the Social Security 10 Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be- 11 ginning on or after the date of the enactment of this Act. 12 TITLE IX—ACCOUNTABILITY 13 AND EVALUATION 14 SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL 15 ASSISTED HEALTH CARE SERVICES AND RE- 16 SEARCH PROGRAMS ON THE BASIS OF SEX, 17 RACE, COLOR, NATIONAL ORIGIN, MARITAL 18 STATUS, FAMILIAL STATUS, SEXUAL ORI- 19 ENTATION, GENDER IDENTITY, OR DIS- 20 ABILITY STATUS. 21 (a) IN GENERAL.—No person in the United States 22 shall, on the basis of sex, race, color, national origin, mar- 23 ital status, familial status, sexual orientation, gender iden- 24 tity, or disability status, be excluded from participation 25 in, be denied the benefits of, or be subjected to discrimina- 26 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00747 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 748 •HR 5942 IH tion under any health program or activity, including any 1 health research program or activity, receiving Federal fi- 2 nancial assistance. 3 (b) DEFINITION.—In this section, the term ‘‘familial 4 status’’ means, with respect to one or more individuals— 5 (1) being domiciled with any individual related 6 by blood or affinity whose close association with the 7 individual is the equivalent of a family relationship; 8 (2) being in the process of securing legal cus- 9 tody of any individual; or 10 (3) being pregnant. 11 SEC. 902. TREATMENT OF MEDICARE PAYMENTS UNDER 12 TITLE VI OF THE CIVIL RIGHTS ACT OF 1964. 13 A payment to a provider of services, physician, or 14 other supplier under part B, C, or D of title XVIII of 15 the Social Security Act shall be deemed a grant, and not 16 a contract of insurance or guaranty, for the purposes of 17 title VI of the Civil Rights Act of 1964. 18 SEC. 903. ACCOUNTABILITY AND TRANSPARENCY WITHIN 19 THE DEPARTMENT OF HEALTH AND HUMAN 20 SERVICES. 21 Title XXXIV of the Public Health Service Act, as 22 amended by titles I, II, and III of this Act, is further 23 amended by inserting after subtitle B the following: 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00748 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 749 •HR 5942 IH ‘‘Subtitle C—Strengthening 1 Accountability 2 ‘‘SEC. 3441. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 3 ‘‘(a) IN GENERAL.—The Secretary shall establish 4 within the Office for Civil Rights an Office of Health Dis- 5 parities, which shall be headed by a director to be ap- 6 pointed by the Secretary. 7 ‘‘(b) PURPOSE.—The Office of Health Disparities 8 shall ensure that the health programs, activities, and oper- 9 ations of health entities which receive Federal financial as- 10 sistance are in compliance with title VI of the Civil Rights 11 Act, which prohibits discrimination on the basis of race, 12 color, or national origin. The activities of the Office shall 13 include the following: 14 ‘‘(1) The development and implementation of 15 an action plan to address racial and ethnic health 16 care disparities, which shall address concerns relat- 17 ing to the Office for Civil Rights as released by the 18 United States Commission on Civil Rights in the re- 19 port entitled ‘Health Care Challenge: Acknowledging 20 Disparity, Confronting Discrimination, and Ensur- 21 ing Equity’ (September 1999) in conjunction with 22 the reports by the Institute of Medicine entitled ‘Un- 23 equal Treatment: Confronting Racial and Ethnic 24 Disparities in Health Care’, ‘Crossing the Quality 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00749 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 750 •HR 5942 IH Chasm: A New Health System for the 21st Cen- 1 tury’, ‘In the Nation’s Compelling Interest: Ensur- 2 ing Diversity in the Health Care Workforce’, ‘The 3 National Partnership for Action to End Health Dis- 4 parities’, and ‘The Health of Lesbian, Gay, Bisexual, 5 and Transgender People’, and other related reports 6 by the Institute of Medicine. This plan shall be pub- 7 licly disclosed for review and comment and the final 8 plan shall address any comments or concerns that 9 are received by the Office. 10 ‘‘(2) Investigative and enforcement actions 11 against intentional discrimination and policies and 12 practices that have a disparate impact on minorities. 13 ‘‘(3) The review of racial, ethnic, gender iden- 14 tity, sexual orientation, sex, disability status, socio- 15 economic status, and primary language health data 16 collected by Federal health agencies to assess health 17 care disparities related to intentional discrimination 18 and policies and practices that have a disparate im- 19 pact on minorities. 20 ‘‘(4) Outreach and education activities relating 21 to compliance with title VI of the Civil Rights Act. 22 ‘‘(5) The provision of technical assistance for 23 health entities to facilitate compliance with title VI 24 of the Civil Rights Act. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00750 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 751 •HR 5942 IH ‘‘(6) Coordination and oversight of activities of 1 the civil rights compliance offices established under 2 section 3442. 3 ‘‘(7) Ensuring— 4 ‘‘(A) at a minimum, compliance with the 5 1997 Office of Management and Budget Stand- 6 ards for Maintaining, Collecting, and Pre- 7 senting Federal Data on Race and Ethnicity; 8 and 9 ‘‘(B) consideration of available data and 10 language standards such as— 11 ‘‘(i) the standards for collecting and 12 reporting data under section 3101; and 13 ‘‘(ii) the National Standards on Cul- 14 turally and Linguistically Appropriate 15 Services of the Office of Minority Health 16 within the Department of Health and 17 Human Services. 18 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en- 19 sure the effectiveness of the Office of Health Disparities 20 by ensuring that the Office is provided with— 21 ‘‘(1) adequate funding to enable the Office to 22 carry out its duties under this section; and 23 ‘‘(2) staff with expertise in— 24 ‘‘(A) epidemiology; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00751 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 752 •HR 5942 IH ‘‘(B) statistics; 1 ‘‘(C) health quality assurance; 2 ‘‘(D) minority health and health dispari- 3 ties; 4 ‘‘(E) cultural and linguistic competency; 5 ‘‘(F) civil rights; and 6 ‘‘(G) social, behavioral, and economic de- 7 terminants of health. 8 ‘‘(d) REPORT.—Not later than December 31, 2019, 9 and annually thereafter, the Secretary, in collaboration 10 with the Director of the Office for Civil Rights and the 11 Deputy Assistant Secretary for Minority Health, shall 12 submit a report to the Committee on Health, Education, 13 Labor, and Pensions of the Senate and the Committee on 14 Energy and Commerce of the House of Representatives 15 that includes— 16 ‘‘(1) the number of cases filed, broken down by 17 category; 18 ‘‘(2) the number of cases investigated and 19 closed by the office; 20 ‘‘(3) the outcomes of cases investigated; 21 ‘‘(4) the staffing levels of the office including 22 staff credentials; 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00752 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 753 •HR 5942 IH ‘‘(5) the number of other lingering and emerg- 1 ing cases in which civil rights inequities can be dem- 2 onstrated; and 3 ‘‘(6) the number of cases remaining open and 4 an explanation for their open status. 5 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 6 are authorized to be appropriated to carry out this section 7 such sums as may be necessary for each of fiscal years 8 2019 through 2024. 9 ‘‘SEC. 3442. ESTABLISHMENT OF HEALTH PROGRAM OF- 10 FICES FOR CIVIL RIGHTS WITHIN FEDERAL 11 HEALTH AND HUMAN SERVICES AGENCIES. 12 ‘‘(a) IN GENERAL.—The Secretary shall establish 13 civil rights compliance offices in each agency within the 14 Department of Health and Human Services that admin- 15 isters health programs. 16 ‘‘(b) PURPOSE OF OFFICES.—Each office established 17 under subsection (a) shall ensure that recipients of Fed- 18 eral financial assistance under Federal health programs 19 administer their programs, services, and activities in a 20 manner that— 21 ‘‘(1) does not discriminate, either intentionally 22 or in effect, on the basis of race, national origin, lan- 23 guage, ethnicity, sex, age, disability, sexual orienta- 24 tion, and gender identity; and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00753 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 754 •HR 5942 IH ‘‘(2) promotes the reduction and elimination of 1 disparities in health and health care based on race, 2 national origin, language, ethnicity, sex, age, dis- 3 ability, sexual orientation, and gender identity. 4 ‘‘(c) POWERS AND DUTIES.—The offices established 5 in subsection (a) shall have the following powers and du- 6 ties: 7 ‘‘(1) The establishment of compliance and pro- 8 gram participation standards for recipients of Fed- 9 eral financial assistance under each program admin- 10 istered by an agency within the Department of 11 Health and Human Services including the establish- 12 ment of disparity reduction standards to encompass 13 disparities in health and health care related to race, 14 national origin, language, ethnicity, sex, age, dis- 15 ability, sexual orientation, and gender identity. 16 ‘‘(2) The development and implementation of 17 program-specific guidelines that interpret and apply 18 Department of Health and Human Services guid- 19 ance under title VI of the Civil Rights Act of 1964 20 and section 1557 of the Patient Protection and Af- 21 fordable Care Act to each Federal health program 22 administered by the agency. 23 ‘‘(3) The development of a disparity-reduction 24 impact analysis methodology that shall be applied to 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00754 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 755 •HR 5942 IH every rule issued by the agency and published as 1 part of the formal rulemaking process under sections 2 555, 556, and 557 of title 5, United States Code. 3 ‘‘(4) Oversight of data collection, analysis, and 4 publication requirements for all recipients of Federal 5 financial assistance under each Federal health pro- 6 gram administered by the agency; compliance with, 7 at a minimum, the 1997 Office of Management and 8 Budget Standards for Maintaining, Collecting, and 9 Presenting Federal Data on Race and Ethnicity; and 10 consideration of available data and language stand- 11 ards such as— 12 ‘‘(A) the standards for collecting and re- 13 porting data under section 3101; and 14 ‘‘(B) the National Standards on Culturally 15 and Linguistically Appropriate Services of the 16 Office of Minority Health within the Depart- 17 ment of Health and Human Services. 18 ‘‘(5) The conduct of publicly available studies 19 regarding discrimination within Federal health pro- 20 grams administered by the agency as well as dis- 21 parity reduction initiatives by recipients of Federal 22 financial assistance under Federal health programs. 23 ‘‘(6) Annual reports to the Committee on 24 Health, Education, Labor, and Pensions and the 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00755 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 756 •HR 5942 IH Committee on Finance of the Senate and the Com- 1 mittee on Energy and Commerce and the Committee 2 on Ways and Means of the House of Representatives 3 on the progress in reducing disparities in health and 4 health care through the Federal programs adminis- 5 tered by the agency. 6 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS 7 IN THE DEPARTMENT OF JUSTICE.— 8 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN 9 SERVICES.—The Office for Civil Rights in the De- 10 partment of Health and Human Services shall pro- 11 vide standard-setting and compliance review inves- 12 tigation support services to the Civil Rights Compli- 13 ance Office for each agency. 14 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 15 for Civil Rights in the Department of Justice shall 16 continue to maintain the power to institute formal 17 proceedings when an agency Office for Civil Rights 18 determines that a recipient of Federal financial as- 19 sistance is not in compliance with the disparity re- 20 duction standards of the agency. 21 ‘‘(e) DEFINITION.—In this section, the term ‘Federal 22 health programs’ mean programs— 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00756 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 757 •HR 5942 IH ‘‘(1) under the Social Security Act (42 U.S.C. 1 301 et seq.) that pay for health care and services; 2 and 3 ‘‘(2) under this Act that provide Federal finan- 4 cial assistance for health care, biomedical research, 5 health services research, and programs designed to 6 improve the public’s health, including health service 7 programs.’’. 8 SEC. 904. UNITED STATES COMMISSION ON CIVIL RIGHTS. 9 (a) COORDINATION WITHIN DEPARTMENT OF JUS- 10 TICE OF ACTIVITIES REGARDING HEALTH DISPARI- 11 TIES.—Section 3(a) of the Civil Rights Commission Act 12 of 1983 (42 U.S.C. 1975a(a)) is amended— 13 (1) in paragraph (1), by striking ‘‘and’’ at the 14 end; 15 (2) in paragraph (2), by striking the period at 16 the end and inserting ‘‘; and’’; and 17 (3) by adding at the end the following: 18 ‘‘(3) shall, with respect to activities carried out 19 in health care and correctional facilities toward the 20 goal of eliminating health disparities between the 21 general population and members of racial or ethnic 22 minority groups, coordinate such activities of— 23 ‘‘(A) the Office for Civil Rights within the 24 Department of Justice; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00757 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 758 •HR 5942 IH ‘‘(B) the Office of Justice Programs within 1 the Department of Justice; 2 ‘‘(C) the Office for Civil Rights within the 3 Department of Health and Human Services; 4 and 5 ‘‘(D) the Office of Minority Health within 6 the Department of Health and Human Services 7 (headed by the Deputy Assistant Secretary for 8 Minority Health).’’. 9 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 10 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 11 1975c) is amended by striking the first sentence and in- 12 serting the following: ‘‘For the purpose of carrying out 13 this Act, there are authorized to be appropriated 14 $30,000,000 for fiscal year 2019, and such sums as may 15 be necessary for each of the fiscal years 2020 through 16 2024.’’. 17 SEC. 905. SENSE OF CONGRESS CONCERNING FULL FUND- 18 ING OF ACTIVITIES TO ELIMINATE RACIAL 19 AND ETHNIC HEALTH DISPARITIES. 20 (a) FINDINGS.—Congress makes the following find- 21 ings: 22 (1) The health status of the American populace 23 is declining and the United States currently ranks 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00758 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 759 •HR 5942 IH below most industrialized nations in health status 1 measured by longevity, sickness, and mortality. 2 (2) Racial and ethnic minority populations tend 3 have the poorest health status and face substantial 4 cultural, social, and economic barriers to obtaining 5 quality health care. 6 (3) Lesbian, gay, bisexual, transgender, queer, 7 and questioning (LGBTQ) populations experience 8 significant personal and structural barriers to ob- 9 taining high-quality health care. 10 (4) Efforts to improve minority health have 11 been limited by inadequate resources (funding, staff- 12 ing, and stewardship) and lack of accountability. 13 (b) SENSE OF CONGRESS.—It is the sense of Con- 14 gress that— 15 (1) health disparities negatively impact out- 16 comes for health and human security of the Nation; 17 (2) reducing racial, ethnic, sexual, and gender 18 disparities in prevention and treatment are unique 19 civil and human rights challenges and as such Fed- 20 eral agencies and health care entities and systems 21 receiving Federal funds must be accountable for 22 their role in causing disparities and inequity; 23 (3) funding should be doubled by fiscal year 24 2020 for the National Institute for Minority Health 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00759 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 760 •HR 5942 IH Disparities, the Office of Civil Rights in the Depart- 1 ment of Health and Human Services, the National 2 Institute of Nursing Research, and the Office of Mi- 3 nority Health; 4 (4) adequate funding by fiscal year 2020, and 5 subsequent funding increases, should be provided for 6 health and human service professions training pro- 7 grams, the Racial and Ethnic Approaches to Com- 8 munity Health (REACH) Initiative at the Centers 9 for Disease Control and Prevention, the Minority 10 HIV/AIDS Initiative, and the Excellence Centers to 11 Eliminate Ethnic/Racial Disparities (EXCEED) 12 Program at the Agency for Healthcare Research and 13 Quality; 14 (5) funding should be fully restored to the Ra- 15 cial and Ethnic Approaches to Community Health 16 (REACH) Initiative at the Centers for Disease Con- 17 trol and Prevention, which has been a successful 18 program at the community health level, and efforts 19 should continue to place a strong emphasis on build- 20 ing community capacity to secure financial resources 21 and technical assistance to eliminate health dispari- 22 ties; 23 (6) adequate funding for fiscal year 2020 and 24 increased funding for future years should be pro- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00760 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 761 •HR 5942 IH vided for the REACH Initiative’s United States Risk 1 Factor Survey to ensure adequate data collection to 2 track health disparities, and there should be appro- 3 priate avenues provided to disseminate findings to 4 the general public; 5 (7) current and newly created health disparity 6 elimination incentives, programs, agencies, and de- 7 partments under this Act (and the amendments 8 made by this Act) should receive adequate staffing 9 and funding by fiscal year 2020; and 10 (8) stewardship and accountability should be 11 provided to the Congress and the President for 12 measurable and sustainable progress toward health 13 disparity elimination. 14 SEC. 906. GAO AND NIH REPORTS. 15 (a) GAO REPORT ON NIH GRANT RACIAL AND ETH- 16 NIC DIVERSITY.— 17 (1) IN GENERAL.—The Comptroller General of 18 the United States shall conduct a study on the racial 19 and ethnic diversity among the following groups: 20 (A) All applicants for grants, contracts, 21 and cooperative agreements awarded by the Na- 22 tional Institutes of Health during the period be- 23 ginning on January 1, 2006, and ending De- 24 cember 31, 2017. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00761 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 762 •HR 5942 IH (B) All recipients of such grants, con- 1 tracts, and cooperative agreements. 2 (C) All members of the peer review panels 3 of such applicants and recipients, respectively. 4 (2) REPORT.—Not later than six months after 5 the date of the enactment of this Act, the Comp- 6 troller General shall complete the study under para- 7 graph (1) and submit to Congress a report con- 8 taining the results of such study. 9 (b) NIH REPORT ON CERTAIN AUTHORITY OF NA- 10 TIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH 11 DISPARITIES.—Not later than six months after the date 12 of the enactment of this Act, and biennially thereafter, the 13 Director of the National Institutes of Health, in collabora- 14 tion with the Director of the National Institute on Minor- 15 ity Health and Health Disparities, shall submit to Con- 16 gress a report that details and evaluates— 17 (1) the steps taken during the applicable report 18 period by the Director of the National Institutes of 19 Health to enforce the expanded planning, coordina- 20 tion, review, and evaluation authority provided the 21 National Institute on Minority Health and Health 22 Disparities under section 464z–3(h) of the Public 23 Health Service Act (42 U.S.C. 285(h)), as added by 24 section 10334(c) of the Patient Protection and Af- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00762 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 763 •HR 5942 IH fordable Care Act, over all minority health and 1 health disparity research that is conducted or sup- 2 ported by the Institutes and Centers at the National 3 Institutes of Health; and 4 (2) the outcomes of such steps. 5 (c) GAO REPORT RELATED TO RECIPIENTS OF 6 PPACA FUNDING.—Not later than one year after the 7 date of the enactment of this Act and biennially thereafter 8 until 2022, the Comptroller General of the United States 9 shall submit to Congress a report that identifies— 10 (1) the racial and ethnic diversity of commu- 11 nity-based organizations that applied for Federal en- 12 rollment funding provided pursuant to the provisions 13 of (and amendments made by) the Patient Protec- 14 tion and Affordable Care Act; 15 (2) the percentage of such organizations that 16 were awarded such funding; and 17 (3) the impact of such community-based organi- 18 zations’ enrollment efforts on the insurance status of 19 their communities. 20 (d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL 21 INSTITUTE ON MINORITY HEALTH AND HEALTH DIS- 22 PARITIES.—The Director of the National Institute on Mi- 23 nority Health and Health Disparities shall prepare an an- 24 nual report on the activities carried out or to be carried 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00763 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 764 •HR 5942 IH out by the Institute, and shall submit each such report 1 to the Committee on Health, Education, Labor, and Pen- 2 sions of the Senate, the Committee on Energy and Com- 3 merce of the House of Representatives, the Secretary of 4 Health and Human Services, and the Director of the Na- 5 tional Institutes of Health. With respect to the fiscal year 6 involved, the report shall— 7 (1) describe and evaluate the progress made in 8 health disparities research conducted or supported 9 by institutes and centers of the National Institutes 10 of Health; 11 (2) summarize and analyze expenditures made 12 for activities with respect to health disparities re- 13 search conducted or supported by the National Insti- 14 tutes of Health; 15 (3) include a separate statement applying the 16 requirements of paragraphs (1) and (2) specifically 17 to minority health disparities research; and 18 (4) contain such recommendations as the Direc- 19 tor of the Institute considers appropriate. 20 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00764 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 765 •HR 5942 IH TITLE X—ADDRESSING SOCIAL 1 DETERMINANTS AND IM- 2 PROVING ENVIRONMENTAL 3 JUSTICE 4 Subtitle A—In General 5 SEC. 1001. DEFINITIONS. 6 (a) DETERMINANTS OF HEALTH.—The term ‘‘deter- 7 minants of health’’— 8 (1) refers to the range of personal, social, eco- 9 nomic, and environmental factors that influence 10 health status; and 11 (2) includes social determinants of health 12 (which are sometimes referred to as ‘‘social and eco- 13 nomic determinants of health’’ or ‘‘socioeconomic de- 14 terminants of health’’), environmental determinants 15 of health, and personal determinants of health. 16 (b) ENVIRONMENTAL DETERMINANTS OF 17 HEALTH.—The term ‘‘environmental determinants of 18 health’’ refers to the broad physical, psychological, social, 19 and aesthetic environment. 20 (c) PERSONAL DETERMINANTS OF HEALTH.—The 21 term ‘‘personal determinants of health’’ refers to an indi- 22 vidual’s behavior, biology, and genetics. 23 (d) SOCIAL DETERMINANTS OF HEALTH.—The term 24 ‘‘social determinants of health’’ refers to a subset of deter- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00765 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 766 •HR 5942 IH minants of the health of individuals and environments 1 (such as communities, neighborhoods, and societies) that 2 describe people’s social identity, describe the social and 3 economic resources to which people have access, and de- 4 scribe the conditions in which people work, live, and play. 5 SEC. 1002. FINDINGS. 6 The Congress finds as follows: 7 (1) There are more opportunities to improve 8 health for everyone when we understand that health 9 starts, first, not in a medical setting, but in our 10 families, in our schools and workplaces, in our 11 neighborhoods, and in the air we breathe and water 12 we drink. 13 (2) The social determinants of health are the 14 largest predictors of health outcomes. 15 (3) Healthy People 2020 identifies health and 16 health care quality as a function of not only access 17 to health care, but also the social determinants of 18 health, categorized into the following: neighborhoods 19 and the built environment; social and community 20 context; education; and economic stability. The fol- 21 lowing examples illustrate the nexus between the un- 22 equal distribution of the social determinants of 23 health and health disparities: 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00766 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 767 •HR 5942 IH (A) The built environment influences resi- 1 dents’ level of physical activity. Neighborhoods 2 with high levels of poverty are significantly less 3 likely to have places where children can be 4 physically active, such as parks, green spaces, 5 and bike paths and lanes. Neighborhoods and 6 communities can provide opportunities for phys- 7 ical activity and support active lifestyles 8 through accessible and safe parks and open 9 spaces and through land use policy, zoning, and 10 healthy community design. 11 (B) Emotional and physical health and 12 well-being are directly impacted by perceived 13 levels of safety, such as unlit streets at night. 14 Community members have expressed that safety 15 is not only a barrier to accessing programs and 16 services that increase quality of life but they 17 are also not able to access physical activity in 18 their community through the built environment. 19 (C) In many workplace environments, toxic 20 chemicals have lasting detrimental effects on 21 employees’ health. The hazardous compounds 22 found in most nail salon products affect the 23 respiratory system, reproductive system, and 24 central nervous system, and also cause kidney 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00767 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 768 •HR 5942 IH and liver damage. Recognizing the importance 1 of addressing occupational hazards as a matter 2 of public health, especially for Asian-American 3 women who constitute 40 percent of nail salon 4 technicians—with Vietnamese-American women 5 accounting for 37 percent of this—the White 6 House Initiative on Asian American Pacific Is- 7 landers has created an interagency working 8 group to coordinate efforts by the Environ- 9 mental Protection Agency, Occupational and 10 Safety Health Administration, Food and Drug 11 Administration, and other Federal agencies to 12 create programming, draft regulations, and con- 13 duct more outreach on educating workers on 14 health and safety issues. 15 (D) Historical and institutional discrimina- 16 tion against certain racial groups in the United 17 States has shaped the way in which social and 18 economic resources and exposure to health pro- 19 moting environments are distributed. Income, 20 education, occupation, neighborhood conditions, 21 schools, workplaces, the use of and health and 22 social services, and experiences with the crimi- 23 nal justice system are all highly patterned by 24 race, with racial minorities (compared to 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00768 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 769 •HR 5942 IH Whites) experiencing more that is health harm- 1 ing. Finding ways to uncouple the link between 2 race and access to resources and healthy envi- 3 ronments is a principal means of reducing 4 health disparities. Additionally, the anticipation 5 of racism itself causes higher psychological and 6 cardiovascular stress levels that are linked to 7 poor health outcomes. Remedying discrimina- 8 tory practices at the individual and systemic 9 levels will likely reduce health disparities caused 10 by this unequal distribution of stress. 11 (E) Poor health among Native Americans 12 has largely been driven by post-colonial oppres- 13 sion and historical trauma. The expropriation of 14 native lands and territories to the American 15 state had severe consequences on Native Amer- 16 ican health. This resulted in the deprivation of 17 traditional food sources—and nutrients—for 18 Native Americans and also the destruction of 19 traditional economies and community organiza- 20 tion. Today, Native Americans have twice the 21 rate of diabetes than non-Hispanic Whites. Rec- 22 ognition of the origins of the diabetes as having 23 a social and community context, rather than 24 just individual responsibility and genetic pre- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00769 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 770 •HR 5942 IH disposition, will shape better policy to provide 1 food security. 2 (F) In the context of prisons, overcrowding 3 has led to the deterioration of the physical and 4 mental health of individuals after they leave 5 prison. In particular, the mass incarceration of 6 African-American males as a result of unequal 7 contact with and treatment in the criminal jus- 8 tice system has contributed to an overburdening 9 of certain infectious diseases within the African- 10 American community. As a social institution, 11 incarceration amplifies existing adverse health 12 conditions by concentrating diseases and harm 13 health behaviors such as tobacco use, drug use, 14 and violence. 15 (G) Educational attainment is the strong- 16 est predictor of adult mortality. It is a basic 17 component of socioeconomic status by shaping 18 earning potential to access resources that pro- 19 mote health. People with more education are 20 less likely to report that they are in poor health, 21 and are also less likely to have diabetes and 22 other chronic diseases. 23 (H) Similarly, reading ability is a strong 24 predictor of adult health status and is often 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00770 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 771 •HR 5942 IH correlated with other child health issues, such 1 as developmental problems, vision and hearing 2 impairments, and frequent school absence due 3 to illness. 4 (I) Individuals with lower levels of edu- 5 cational attainment are much more likely to re- 6 port to be current smokers. In 2015, smoking 7 prevalence was 34.1 percent among adults with 8 a GED diploma, 24.2 percent with less than a 9 high school diploma, and 19.8 percent with a 10 high school diploma, while dropping signifi- 11 cantly to 7.4 percent among adults with an un- 12 dergraduate college degree and 3.6 percent with 13 a postgraduate college degree. 14 (J) Social class differences account for a 15 large part of health disparities. For example, 16 children living in poverty experience poorer 17 housing conditions, increased exposure to in- 18 door allergens and toxins (such as pesticides, 19 lead, mercury, radon, air pollution, and carcino- 20 gens), and more psychological stress. These ex- 21 periences culminate in worse adult health as 22 compared with children with higher socio- 23 economic status. Specifically, children living in 24 socioeconomic neighborhoods have higher rates 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00771 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 772 •HR 5942 IH of asthma due to higher rates of psychological 1 stress resulting from higher rates of violence. 2 (K) Lesbian, gay, bisexual, transgender, 3 queer, questioning, questioning and intersex 4 (LGBTQIA) individuals face health disparities 5 linked to societal stigma, discrimination, and 6 denial of their civil and human rights. Discrimi- 7 nation against LGBTQIA individuals has been 8 associated with high rates of psychiatric dis- 9 orders, substance abuse, and suicide. Experi- 10 ences of violence and victimization are frequent 11 for LGBTQIA individuals, and have long-last- 12 ing effects on the individual and the commu- 13 nity. Personal, family, and social acceptance of 14 sexual orientation and gender identity affects 15 the mental health and personal safety of 16 LGBTQIA individuals. 17 (L) Individuals in older and cheaper hous- 18 ing are at higher risks to be exposed to lead, 19 particularly in housing built prior to 1960. The 20 threat of lead poisoning disproportionally af- 21 fects vulnerable populations, with children living 22 in poverty (5.6 percent) and Black children 23 (5.6) experiencing the highest rates. According 24 to the Department of Housing and Urban De- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00772 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 773 •HR 5942 IH velopment, about 3.6 million homes nationwide 1 that house young children have lead hazards 2 such as peeling paint, contaminated dust, or 3 toxic soil. The combined cost of medical treat- 4 ment and special education for lead poisoned 5 children averages about $5,600 per child per 6 year, and lead poisoning costs the United 7 States an estimated $50 billion annually. 8 (4) Laws and regulations that improve opportu- 9 nities to live in safe neighborhoods, with more social 10 cohesion, attain higher education, sustain stable em- 11 ployment, and bridge class differences help foster 12 the health and safety of individuals. 13 (5) The global public health community has 14 reached consensus through the Rio Political Declara- 15 tion of Social Determinants of Health that 16 ‘‘[c]ollaboration in coordinated and intersectoral pol- 17 icy actions has proven to be effective. Health in All 18 Policies, together with intersectoral cooperation and 19 action, is one promising approach to enhance ac- 20 countability in other sectors of health, as well as the 21 promotion of health equity and more inclusive and 22 productive societies.’’. 23 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00773 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 774 •HR 5942 IH SEC. 1003. HEALTH IMPACT ASSESSMENTS. 1 (a) FINDINGS.—Congress makes the following find- 2 ings: 3 (1) Health Impact Assessment is a tool to help 4 planners, health officials, decisionmakers, and the 5 public make more informed decisions about the po- 6 tential health effects of proposed plans, policies, pro- 7 grams, and projects in order to maximize health 8 benefits and minimize harms. 9 (2) Health Impact Assessments can be done at 10 a fraction of the cost and time typically required for 11 other planning and permitting reviews. 12 (3) Health Impact Assessments can build com- 13 munity support and reduce opposition to a project or 14 policy, thereby facilitating economic growth by aid- 15 ing the development of consensus regarding new de- 16 velopment proposals. 17 (4) Health Impact Assessments facilitate col- 18 laboration across sectors. 19 (b) PURPOSES.—It is the purpose of this section to— 20 (1) provide more information about the poten- 21 tial human health effects of policy decisions and the 22 distribution of those effects; 23 (2) improve how health is considered in plan- 24 ning and decisionmaking processes; and 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00774 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 775 •HR 5942 IH (3) build stronger, healthier communities 1 through the use of Health Impact Assessment. 2 (c) HEALTH IMPACT ASSESSMENTS.—Part P of title 3 III of the Public Health Service Act (42 U.S.C. 280g et 4 seq.), as amended, is further amended by adding at the 5 end the following: 6 ‘‘SEC. 399V–12. HEALTH IMPACT ASSESSMENTS. 7 ‘‘(a) DEFINITIONS.—In this section and section 8 399V–13: 9 ‘‘(1) ADMINISTRATOR.—The term ‘Adminis- 10 trator’ means the Administrator of the Environ- 11 mental Protection Agency. 12 ‘‘(2) BUILT ENVIRONMENT.—The term ‘built 13 environment’ means the components of the environ- 14 ment, and the location of these components in a geo- 15 graphically defined space, that are created or modi- 16 fied by individuals to form the physical and social 17 characteristics of a community or enhance quality of 18 human life, including— 19 ‘‘(A) homes, schools, and places of work 20 and worship; 21 ‘‘(B) parks, recreation areas, and green- 22 ways; 23 ‘‘(C) transportation systems; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00775 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 776 •HR 5942 IH ‘‘(D) business, industry, and agriculture; 1 and 2 ‘‘(E) land-use plans, projects, and policies 3 that impact the physical or social characteris- 4 tics of a community, including access to services 5 and amenities. 6 ‘‘(3) DIRECTOR.—The term ‘Director’ means 7 the Director of the Centers for Disease Control and 8 Prevention. 9 ‘‘(4) ELIGIBLE ENTITY.—The term ‘eligible en- 10 tity’ means a unit of State or Tribal government the 11 jurisdiction of which includes individuals or popu- 12 lations the health of which are, or will be, affected 13 by an activity or a proposed activity. 14 ‘‘(5) ELIGIBLE INSTITUTION.—The term ‘eligi- 15 ble institution’ means a public agency or private 16 nonprofit institution that submits to the Secretary, 17 in consultation with the Administrator, an applica- 18 tion for a grant authorized under such section at 19 such time, in such manner, and containing such 20 agreements, assurances, and information as the Sec- 21 retary and Administrator may require. 22 ‘‘(6) HEALTH IMPACT ASSESSMENT.—The term 23 ‘Health Impact Assessment’ means a systematic 24 process that uses an array of data sources and ana- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00776 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 777 •HR 5942 IH lytic methods and considers input from stakeholders 1 to determine the potential effects of a proposed pol- 2 icy, plan, program, or project on the health of a pop- 3 ulation and the distribution of those effects within 4 the population. Such term includes identifying and 5 recommending appropriate actions on monitoring 6 and maximizing potential benefits and minimizing 7 the potential harms. 8 ‘‘(7) HEALTH DISPARITIES.—The term ‘health 9 disparities’ are a particular type of health dif- 10 ferences that are closely linked with social, economic, 11 and/or environmental disadvantage. Health dispari- 12 ties adversely affect groups of people who have sys- 13 tematically experienced greater obstacles to health 14 based on their racial or ethnic group; religion; socio- 15 economic status; gender; age; mental health; cog- 16 nitive, sensory, or physical disability; sexual orienta- 17 tion or gender identity; geographic location; or other 18 characteristics historically linked to discrimination 19 or exclusion. 20 ‘‘(8) PROPOSED ACTIVITY.—The term ‘proposed 21 activity’ means a proposed policy, program, plan, or 22 project currently under consideration by a local, 23 State, Tribal, or Federal agency or government. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00777 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 778 •HR 5942 IH ‘‘(b) ESTABLISHMENT.—The Secretary, acting 1 through the Director and in collaboration with the Admin- 2 istrator, shall carry out the following: 3 ‘‘(1) Establish a program at the National Cen- 4 ter for Environmental Health at the Centers for Dis- 5 ease Control and Prevention focused on advancing 6 the field of Health Impact Assessment. In devel- 7 oping and implementing the program, the Director 8 of the National Center for Environmental Health 9 shall consult with the Director of the National Cen- 10 ter for Chronic Disease Prevention and Health Pro- 11 motion as well as relevant offices within the Depart- 12 ment of Housing and Urban Development, the De- 13 partment of Transportation, and the Department of 14 Agriculture. The program shall include— 15 ‘‘(A) collecting and disseminating best 16 practices; 17 ‘‘(B) administering capacity building 18 grants to States to support grantees in initi- 19 ating Health Impact Assessments, in accord- 20 ance with subsection (d); 21 ‘‘(C) providing technical assistance; 22 ‘‘(D) developing training tools and pro- 23 viding training on conducting Health Impact 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00778 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 779 •HR 5942 IH Assessment and the implementation of built en- 1 vironment and health indicators; 2 ‘‘(E) making information available, as ap- 3 propriate, regarding the existence of other com- 4 munity healthy living tools, checklists, and indi- 5 ces that help connect public health to other sec- 6 tors, and tools to help examine the effect of the 7 indoor built environment and building codes on 8 population health; 9 ‘‘(F) conducting research and evaluations 10 of Health Impact Assessments; and 11 ‘‘(G) awarding competitive extramural re- 12 search grants. 13 ‘‘(2) In accordance with subsection (c), develop 14 guidance and guidelines to conduct Health Impact 15 Assessments. 16 ‘‘(3) In accordance with subsection (d), estab- 17 lish a grant program to allow States to fund eligible 18 entities to conduct Health Impact Assessments. 19 ‘‘(c) GUIDANCE.—The Director, in consultation with 20 the Director of the National Center for Environmental 21 Health and, the Director of the National Center for 22 Chronic Disease Prevention and Health Promotion, and 23 relevant offices within the Department of Housing and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00779 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 780 •HR 5942 IH Urban Development, the Department of Transportation, 1 and the Department of Agriculture, shall— 2 ‘‘(1) develop guidance for conducting Health 3 Impact Assessment, including— 4 ‘‘(A) background on national and inter- 5 national efforts to bridge urban planning and 6 public health institutions and disciplines, in- 7 cluding a review of Health Impact Assessment 8 best practices internationally; 9 ‘‘(B) evidence-based direct and indirect 10 pathways that link land-use planning, transpor- 11 tation, and housing policy and objectives to 12 human health outcomes; 13 ‘‘(C) data resources and quantitative and 14 qualitative forecasting methods to evaluate both 15 the status of health determinants and health ef- 16 fects, including identification of existing pro- 17 grams that can disseminate these resources; 18 ‘‘(D) best practices for inclusive public in- 19 volvement in conducting Health Impact Assess- 20 ments; and 21 ‘‘(E) technical assistance for other agen- 22 cies seeking to develop their own guidelines and 23 procedures for Health Impact Assessment; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00780 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 781 •HR 5942 IH ‘‘(2) in developing the guidance, consider avail- 1 able international Health Impact Assessment guid- 2 ance, North American Health Impact Assessment 3 Practice Standards, and recommendations from the 4 National Academy of Science; and 5 ‘‘(3) not later than 1 year after the date of en- 6 actment of this section, publish the guidance. 7 ‘‘(d) GRANT PROGRAM.—The Secretary, acting 8 through the Director and in collaboration with the Admin- 9 istrator, shall establish a program under which the Sec- 10 retary shall award grants to States to fund eligible entities 11 for capacity building or to prepare Health Impact Assess- 12 ments, and shall ensure that States receiving a grant 13 under this subsection further support training and tech- 14 nical assistance for grantees under the program by fund- 15 ing and overseeing appropriate local, State, Tribal, Fed- 16 eral, university, or nonprofit Health Impact Assessment 17 experts to provide technical assistance. Such assessments 18 shall— 19 ‘‘(1) ensure that appropriate health factors are 20 taken into consideration as early as practicable dur- 21 ing the planning, review, or decisionmaking proc- 22 esses; 23 ‘‘(2) assess the effect on the health of individ- 24 uals and populations of proposed policies, projects, 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00781 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 782 •HR 5942 IH or plans that result in modifications to the built en- 1 vironment; and 2 ‘‘(3) assess the distribution of health effects 3 across various factors, such as race, income, eth- 4 nicity, age, disability status, gender, and geography. 5 ‘‘(e) APPLICATIONS.— 6 ‘‘(1) IN GENERAL.—To be eligible to receive a 7 grant under this section, an eligible entity shall sub- 8 mit to the Secretary an application in accordance 9 with this subsection, at such time, in such manner, 10 and containing such additional information as the 11 Secretary may require. 12 ‘‘(2) INCLUSION.—An application under this 13 subsection shall include a list of proposed activities 14 that require or would benefit from conducting a 15 Health Impact Assessment within six months of 16 awarding funds. The list should be accompanied by 17 supporting documentation, including letters of sup- 18 port, from potential conductors of Health Impact 19 Assessments for the listed proposed activities. Each 20 application should also include an assessment by the 21 eligible entity of the health of the population of its 22 jurisdiction and describe potential adverse or positive 23 effects on health that the proposed activities may 24 create. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00782 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 783 •HR 5942 IH ‘‘(3) PREFERENCE.—Preference in awarding 1 funds under this section may be given to eligible en- 2 tities that demonstrate the potential to significantly 3 improve population health or lower health care costs 4 as a result of potential Health Impact Assessment 5 work. 6 ‘‘(f) USE OF FUNDS.— 7 ‘‘(1) IN GENERAL.—An eligible entity shall use 8 amounts provided under a grant under this section 9 to conduct Health Impact Assessment capacity 10 building or to conduct or fund subgrantees to con- 11 duct a Health Impact Assessment for a proposed ac- 12 tivity in accordance with this subsection. 13 ‘‘(2) PURPOSES.—The purposes of a Health 14 Impact Assessment under this subsection are— 15 ‘‘(A) to facilitate the involvement of Tribal, 16 State, and local public health officials in com- 17 munity planning, transportation, housing, and 18 land use decisions and other decisions affecting 19 the built environment to identify any potential 20 health concern or health benefit relating to an 21 activity or proposed activity; 22 ‘‘(B) to provide for an investigation of any 23 health-related issue of concern raised in a plan- 24 ning process, an environmental impact assess- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00783 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 784 •HR 5942 IH ment process, or policy appraisal relating to a 1 proposed activity; 2 ‘‘(C) to describe and compare alternatives 3 (including no-action alternatives) to a proposed 4 activity to provide clarification with respect to 5 the potential health outcomes associated with 6 the proposed activity and, where appropriate, to 7 the related benefit-cost or cost-effectiveness of 8 the proposed activity and alternatives; 9 ‘‘(D) to contribute, when applicable, to the 10 findings of a planning process, policy appraisal, 11 or an environmental impact statement with re- 12 spect to the terms and conditions of imple- 13 menting a proposed activity or related mitiga- 14 tion recommendations, as necessary; 15 ‘‘(E) to ensure that the disproportionate 16 distribution of negative impacts among vulner- 17 able populations is minimized as much as pos- 18 sible; 19 ‘‘(F) to engage affected community mem- 20 bers and ensure adequate opportunity for public 21 comment on all stages of the Health Impact As- 22 sessment; 23 ‘‘(G) where appropriate, to consult with 24 local and county health departments and appro- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00784 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 785 •HR 5942 IH priate organizations, including planning, trans- 1 portation, and housing organizations and pro- 2 viding them with information and tools regard- 3 ing how to conduct and integrate Health Im- 4 pact Assessment into their work; and 5 ‘‘(H) to inspect homes, water systems, and 6 other elements that pose risks to lead exposure, 7 with an emphasis on areas that pose a higher 8 risk to children. 9 ‘‘(3) ELIGIBLE ACTIVITIES.— 10 ‘‘(A) IN GENERAL.—Eligible entities fund- 11 ed under this subsection shall conduct an eval- 12 uation of any proposed activity to determine 13 whether it will have a significant adverse or 14 positive effect on the health of the affected pop- 15 ulation in the jurisdiction of the eligible entity, 16 based on the criteria described in subparagraph 17 (B). 18 ‘‘(B) CRITERIA.—The criteria described in 19 this subparagraph include, as applicable to the 20 proposed activity, the following: 21 ‘‘(i) Any substantial adverse effect or 22 significant health benefit on health out- 23 comes or factors known to influence health, 24 including the following: 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00785 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 786 •HR 5942 IH ‘‘(I) Physical activity. 1 ‘‘(II) Injury. 2 ‘‘(III) Mental health. 3 ‘‘(IV) Accessibility to health-pro- 4 moting goods and services. 5 ‘‘(V) Respiratory health. 6 ‘‘(VI) Chronic disease. 7 ‘‘(VII) Nutrition. 8 ‘‘(VIII) Land use changes that 9 promote local, sustainable food 10 sources. 11 ‘‘(IX) Infectious disease. 12 ‘‘(X) Health disparities. 13 ‘‘(XI) Existing air quality, 14 ground or surface water quality or 15 quantity, or noise levels. 16 ‘‘(XII) Lead exposure. 17 ‘‘(ii) Other factors that may be con- 18 sidered, including— 19 ‘‘(I) the potential for a proposed 20 activity to result in systems failure 21 that leads to a public health emer- 22 gency; 23 ‘‘(II) the probability that the pro- 24 posed activity will result in a signifi- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00786 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 787 •HR 5942 IH cant increase in tourism, economic de- 1 velopment, or employment in the ju- 2 risdiction of the eligible entity; 3 ‘‘(III) any other significant po- 4 tential hazard or enhancement to 5 human health, as determined by the 6 eligible entity; or 7 ‘‘(IV) whether the evaluation of a 8 proposed activity would duplicate an- 9 other analysis or study being under- 10 taken in conjunction with the pro- 11 posed activity. 12 ‘‘(C) FACTORS FOR CONSIDERATION.—In 13 evaluating a proposed activity under subpara- 14 graph (A), an eligible entity may take into con- 15 sideration any reasonable, direct, indirect, or 16 cumulative effect that can be clearly related to 17 potential health effects and that is related to 18 the proposed activity, including the effect of 19 any action that is— 20 ‘‘(i) included in the long-range plan 21 relating to the proposed activity; 22 ‘‘(ii) likely to be carried out in coordi- 23 nation with the proposed activity; 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00787 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 788 •HR 5942 IH ‘‘(iii) dependent on the occurrence of 1 the proposed activity; or 2 ‘‘(iv) likely to have a disproportionate 3 impact on high-risk or vulnerable popu- 4 lations. 5 ‘‘(4) REQUIREMENTS.—A Health Impact As- 6 sessment prepared with funds awarded under this 7 subsection shall incorporate the following, after con- 8 ducting the screening phase (identifying projects or 9 policies for which a Health Impact Assessment 10 would be valuable and feasible) through the applica- 11 tion process: 12 ‘‘(A) SCOPING.—Identifying which health 13 effects to consider and the research methods to 14 be utilized. 15 ‘‘(B) ASSESSING RISKS AND BENEFITS.— 16 Assessing the baseline health status and factors 17 known to influence the health status in the af- 18 fected community, which may include aggre- 19 gating and synthesizing existing health assess- 20 ment evidence and data from the community. 21 ‘‘(C) DEVELOPING RECOMMENDATIONS.— 22 Suggesting changes to proposals to promote 23 positive or mitigate adverse health effects. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00788 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 789 •HR 5942 IH ‘‘(D) REPORTING.—Synthesizing the as- 1 sessment and recommendations and commu- 2 nicating the results to decisionmakers. 3 ‘‘(E) MONITORING AND EVALUATING.— 4 Tracking the decision and implementation effect 5 on health determinants and health status. 6 ‘‘(5) PLAN.—An eligible entity that is awarded 7 a grant under this section shall develop and imple- 8 ment a plan, to be approved by the Director, for 9 meaningful and inclusive stakeholder involvement in 10 all phases of the Health Impact Assessment. Stake- 11 holders may include community-based organizations, 12 youth-serving organizations, planners, public health 13 experts, State and local public health departments 14 and officials, health care experts or officials, housing 15 experts or officials, and transportation experts or of- 16 ficials. 17 ‘‘(6) SUBMISSION OF FINDINGS.—An eligible 18 entity that is awarded a grant under this section 19 shall submit the findings of any funded Health Im- 20 pact Assessment activities to the Secretary and 21 make these findings publicly available. 22 ‘‘(7) ASSESSMENT OF IMPACTS.—An eligible en- 23 tity that is awarded a grant under this section shall 24 ensure the assessment of the distribution of health 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00789 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 790 •HR 5942 IH impacts (related to the proposed activity) across 1 race, ethnicity, income, age, gender, disability status, 2 and geography. 3 ‘‘(8) CONDUCT OF ASSESSMENT.—To the great- 4 est extent feasible, a Health Impact Assessment 5 shall be conducted under this section in a manner 6 that respects the needs and timing of the decision- 7 making process it evaluates. 8 ‘‘(9) METHODOLOGY.—In preparing a Health 9 Impact Assessment under this subsection, an eligible 10 entity or partner shall follow the guidance published 11 under subsection (c). 12 ‘‘(g) HEALTH IMPACT ASSESSMENT DATABASE.— 13 The Secretary, acting through the Director and in collabo- 14 ration with the Administrator, shall establish, maintain, 15 and make publicly available a Health Impact Assessment 16 database, including— 17 ‘‘(1) a catalog of Health Impact Assessments 18 received under this section; 19 ‘‘(2) an inventory of tools used by eligible enti- 20 ties to conduct Health Impact Assessments; and 21 ‘‘(3) guidance for eligible entities with respect 22 to the selection of appropriate tools described in 23 paragraph (2). 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00790 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 791 •HR 5942 IH ‘‘(h) EVALUATION OF GRANTEE ACTIVITIES.—The 1 Secretary shall award competitive grants to Prevention 2 Research Centers, or nonprofit organizations or academic 3 institutions with expertise in Health Impact Assessments 4 to— 5 ‘‘(1) assist grantees with the provision of train- 6 ing and technical assistance in the conducting of 7 Health Impact Assessments; 8 ‘‘(2) evaluate the activities carried out with 9 grants under subsection (d); and 10 ‘‘(3) assist the Secretary in disseminating evi- 11 dence, best practices, and lessons learned from 12 grantees. 13 ‘‘(i) REPORT TO CONGRESS.—Not later than 1 year 14 after the date of enactment of this section, the Secretary 15 shall submit to Congress a report concerning the evalua- 16 tion of the programs under this section, including rec- 17 ommendations as to how lessons learned from such pro- 18 grams can be incorporated into future guidance docu- 19 ments developed and provided by the Secretary and other 20 Federal agencies, as appropriate. 21 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 22 are authorized to be appropriated to carry out this section 23 such sums as may be necessary. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00791 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 792 •HR 5942 IH ‘‘SEC. 399V–13. IMPLEMENTATION OF RESEARCH FINDINGS 1 TO IMPROVE HEALTH OUTCOMES THROUGH 2 THE BUILT ENVIRONMENT. 3 ‘‘(a) RESEARCH GRANT PROGRAM.— 4 ‘‘(1) GRANTS.—The Secretary, in collaboration 5 with the Administrator, shall award grants to eligi- 6 ble institutions to implement evidence-based pro- 7 gramming to improve the built environment and sub- 8 sequently human health. Factors that influence 9 health that may be considered include— 10 ‘‘(A) levels of physical activity; 11 ‘‘(B) consumption of nutritional foods; 12 ‘‘(C) rates of crime; 13 ‘‘(D) air, water, and soil quality; 14 ‘‘(E) risk or rate of injury; 15 ‘‘(F) accessibility to health-promoting 16 goods and services; 17 ‘‘(G) chronic disease rates; 18 ‘‘(H) community design; 19 ‘‘(I) housing; and 20 ‘‘(J) other indicators as determined appro- 21 priate by the Secretary. 22 ‘‘(2) RESEARCH.—The Secretary, in consulta- 23 tion with the Administrator, shall support research 24 under this section that— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00792 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 793 •HR 5942 IH ‘‘(A) uses evidence-based research to im- 1 prove the built environment and human health; 2 ‘‘(B) examines— 3 ‘‘(i) the scope and intensity of the im- 4 pact that the built environment (including 5 the various characteristics of the built en- 6 vironment) has on the human health; or 7 ‘‘(ii) the distribution of such impacts 8 by— 9 ‘‘(I) location; and 10 ‘‘(II) population subgroup; 11 ‘‘(C) is used to develop— 12 ‘‘(i) measures and indicators to ad- 13 dress health impacts and the connection of 14 health to the built environment; 15 ‘‘(ii) efforts to link the measures to 16 transportation, land use, and health data- 17 bases; and 18 ‘‘(iii) efforts to enhance the collection 19 of built environment surveillance data; 20 ‘‘(D) distinguishes carefully between per- 21 sonal attitudes and choices and external influ- 22 ences on behavior to determine how much the 23 association between the built environment and 24 the health of residents, versus the lifestyle pref- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00793 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 794 •HR 5942 IH erences of the people that choose to live in the 1 neighborhood, reflects the physical characteris- 2 tics of the neighborhood; and 3 ‘‘(E)(i) identifies or develops effective 4 intervention strategies focusing on enhance- 5 ments to the built environment that promote in- 6 creased use physical activity, access to nutri- 7 tious foods, or other health-promoting activities 8 by residents; and 9 ‘‘(ii) in developing the intervention strate- 10 gies under clause (i), ensures that the interven- 11 tion strategies will reach out to high-risk or vul- 12 nerable populations, including low-income urban 13 and rural communities and aging populations, 14 in addition to the general population. 15 ‘‘(3) SURVEYS.—The Secretary may use funds 16 appropriated under this section to support the ex- 17 pansion of national surveys and data tracking sys- 18 tems to provide more detailed information about the 19 connection between the built environment and 20 health. 21 ‘‘(4) PRIORITY.—In providing assistance under 22 the grant program under this section, the Secretary 23 and the Administrator shall give priority to pro- 24 gramming that incorporates— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00794 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 795 •HR 5942 IH ‘‘(A) interdisciplinary approaches; or 1 ‘‘(B) the expertise of the public health, 2 physical activity, urban planning, land use, and 3 transportation research communities in the 4 United States and abroad. 5 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 6 are authorized to be appropriated such sums as may be 7 necessary to carry out this section. Not to exceed 20 per- 8 cent of amounts appropriated for each fiscal year under 9 this subsection may be used for the research component 10 of the program under this section.’’. 11 SEC. 1004. IMPLEMENTATION OF RECOMMENDATIONS BY 12 ENVIRONMENTAL PROTECTION AGENCY. 13 (a) INSPECTOR GENERAL RECOMMENDATIONS.—The 14 Administrator of the Environmental Protection Agency 15 shall, as promptly as practicable, carry out each of the 16 following recommendations of the Inspector General of the 17 Agency as set forth in Report No. 2006–P–00034 entitled 18 ‘‘EPA needs to conduct environmental justice reviews of 19 its programs, policies and activities’’: 20 (1) The recommendation that the Agency’s pro- 21 gram and regional offices identify which programs, 22 policies, and activities need environmental justice re- 23 views and require these offices to establish a plan to 24 complete the necessary reviews. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00795 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 796 •HR 5942 IH (2) The recommendation that the Administrator 1 of the Agency ensure that these reviews determine 2 whether the programs, policies, and activities may 3 have a disproportionately high and adverse health or 4 environmental impact on minority and low-income 5 populations. 6 (3) The recommendation that each program 7 and regional office develop specific environmental 8 justice review guidance for conducting environmental 9 justice reviews. 10 (4) The recommendation that the Administrator 11 designate a responsible office to compile results of 12 environmental justice reviews and recommend appro- 13 priate actions. 14 (b) GAO RECOMMENDATIONS.—In developing rules 15 under laws administered by the Environmental Protection 16 Agency, the Administrator of the Agency shall, as prompt- 17 ly as practicable, carry out each of the following rec- 18 ommendations of the Comptroller General of the United 19 States as set forth in GAO Report numbered GAO–05– 20 289 entitled ‘‘EPA Should Devote More Attention to En- 21 vironmental Justice when Developing Clean Air Rules’’: 22 (1) The recommendation that the Administrator 23 ensure that workgroups involved in developing a rule 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00796 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 797 •HR 5942 IH devote attention to environmental justice while draft- 1 ing and finalizing the rule. 2 (2) The recommendation that the Administrator 3 enhance the ability of such workgroups to identify 4 potential environmental justice issues through such 5 steps as providing workgroup members with guid- 6 ance and training to help them identify potential en- 7 vironmental justice problems and involving environ- 8 mental justice coordinators in the workgroups when 9 appropriate. 10 (3) The recommendation that the Administrator 11 improve assessments of potential environmental jus- 12 tice impacts in economic reviews by identifying the 13 data and developing the modeling techniques needed 14 to assess such impacts. 15 (4) The recommendation that the Administrator 16 direct appropriate Agency officers and employees to 17 respond fully when feasible to public comments on 18 environmental justice, including improving the Agen- 19 cy’s explanation of the basis for its conclusions, to- 20 gether with supporting data. 21 (c) 2004 INSPECTOR GENERAL REPORT.—The Ad- 22 ministrator of the Environmental Protection Agency shall, 23 as promptly as practicable, carry out each of the following 24 recommendations of the Inspector General of the Agency 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00797 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 798 •HR 5942 IH as set forth in the report entitled ‘‘EPA Needs to Consist- 1 ently Implement the Intent of the Executive Order on En- 2 vironmental Justice’’ (Report No. 2004–P–00007): 3 (1) The recommendation that the Agency clear- 4 ly define the mission of the Office of Environmental 5 Justice (OEJ) and provide Agency staff with an un- 6 derstanding of the roles and responsibilities of the 7 Office. 8 (2) The recommendation that the Agency estab- 9 lish (through issuing guidance or a policy statement 10 from the Administrator) specific timeframes for the 11 development of definitions, goals, and measurements 12 regarding environmental justice and provide the re- 13 gions and program offices a standard and consistent 14 definition for a minority and low-income community, 15 with instructions on how the Agency will implement 16 and put into operation environmental justice in the 17 Agency’s daily activities. 18 (3) The recommendation that the Agency en- 19 sure the comprehensive training program currently 20 under development includes standard and consistent 21 definitions of the key environmental justice concepts 22 (such as ‘‘low-income’’, ‘‘minority’’, and ‘‘dispropor- 23 tionately impacted’’) and instructions for implemen- 24 tation of those concepts. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00798 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 799 •HR 5942 IH The Administrator shall submit an initial report to Con- 1 gress within 6 months after the enactment of this Act re- 2 garding the Administrator’s strategy for implementing the 3 recommendations referred to in paragraphs (1), (2), and 4 (3). Thereafter, the Administrator shall provide semi- 5 annual reports to Congress regarding the Administrator’s 6 progress in implementing such recommendations and 7 modifying the Administrator’s emergency management 8 procedures to incorporate environmental justice in the 9 Agency’s Incident Command Structure (in accordance 10 with the December 18, 2006, letter from the Deputy Ad- 11 ministrator to the Acting Inspector General of the Agen- 12 cy). 13 (d) FEDERAL ACTION PLAN FOR SAVING LIVES, 14 PROTECTING PEOPLE AND THEIR FAMILIES FROM 15 RADON.— 16 (1) IN GENERAL.—Because radon is a naturally 17 occurring radioactive gas that is recognized as the 18 leading cause of lung cancer among nonsmokers and 19 is a particular environmental threat for low-income 20 and minority individuals because of the lack of infor- 21 mation about radon levels in their own homes, the 22 Administrator of the Environmental Protection 23 Agency shall within 6 months after the date of the 24 enactment of this Act, implement the action plan en- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00799 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 800 •HR 5942 IH titled ‘‘Protecting People and Families from Radon: 1 A Federal Action Plan for Saving Lives’’ (June 20, 2 2011), working with the Secretary of Health and 3 Human Services acting through the Director of the 4 Centers for Disease Control and Prevention, and 5 with the other Federal agencies mentioned in and as 6 set forth in the action plan. 7 (2) SPECIFIC STEPS.—In carrying out para- 8 graph (1), the Administrator shall take steps to 9 achieve each of the following: 10 (A) The recommendation that the 11 workgroup comprised of the Federal agencies 12 participating in the development of the action 13 plan referred to in paragraph (1) implement 14 specific steps within the current authority and 15 activities of each Federal agency to reduce ex- 16 posure to radon. 17 (B) The recommendation that such 18 workgroup meet on the 1-year anniversary of 19 the plan to assess and recognize achievements 20 of the plan. 21 (3) REPORT.—The Administrator shall report 22 to the Congress on the 1-year assessment of the 23 plan’s implementation, including the challenges re- 24 maining and the progress in reducing radon expo- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00800 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 801 •HR 5942 IH sure particularly to low-income and minority fami- 1 lies. 2 (e) FEDERAL ACTION PLAN FOR PREVENTING 3 CHILDHOOD LEAD POISONING.— 4 (1) FINDINGS.—The Congress finds the fol- 5 lowing: 6 (A) The effects of lead poisoning are irre- 7 versible and cost the United States millions an- 8 nually in medical and education costs. 9 (B) The cognitive effects suffered by lead 10 exposed children result in a lifetime of health 11 and behavioral problems, which makes preven- 12 tion efforts more critical. 13 (C) The risk is especially high for vulner- 14 able minority populations who are more likely 15 to live in older homes, where lead-based paint 16 is more likely to be present. 17 (2) ACTION PLAN.—The Administrator of the 18 Environmental Protection Agency shall, not later 19 than 6 months after the date of the enactment of 20 this Act, develop an action plan, working with the 21 Secretary of Health and Human Services acting 22 through the Director of the Centers for Disease 23 Control and Prevention, and other Federal agencies 24 as necessary. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00801 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 802 •HR 5942 IH (3) SPECIFIC STEPS.—In carrying out para- 1 graph (2), the Administrator of the Environmental 2 Protection Agency shall take steps to achieve each of 3 the following: 4 (A) The establishment of a working group, 5 comprised of representatives of the Federal 6 agencies participating in the development of the 7 action plan referred to in paragraph (2), to 8 make recommendations for implementation of 9 specific steps within the existing authority and 10 activities of each Federal agency to reduce ex- 11 posure to lead. 12 (B) The development by Federal agencies 13 of materials on the hazards of lead-based paint 14 aimed at educating tenants and landlords, and 15 how to both recognize potential causes for expo- 16 sure and how to remediate them. 17 SEC. 1005. GRANT PROGRAM TO CONDUCT ENVIRON- 18 MENTAL HEALTH IMPROVEMENT ACTIVITIES 19 AND TO IMPROVE SOCIAL DETERMINANTS OF 20 HEALTH. 21 (a) DEFINITIONS.—In this section: 22 (1) DIRECTOR.—The term ‘‘Director’’ means 23 the Director of the Centers for Disease Control and 24 Prevention, acting in collaboration with the Adminis- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00802 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 803 •HR 5942 IH trator of the Environmental Protection Agency and 1 the Director of the National Institute of Environ- 2 mental Health Sciences. 3 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti- 4 ty’’ means a State or local community that— 5 (A) bears a disproportionate burden of ex- 6 posure to environmental health hazards; 7 (B) bears a disproportionate burden of ex- 8 posure to unhealthy living conditions, low 9 standard housing conditions, low socioeconomic 10 status, poor nutrition, less opportunity for edu- 11 cational attainment, disproportionate unemploy- 12 ment rates, or lower literacy levels; 13 (C) has established a coalition— 14 (i) with not less than 1 community- 15 based organization or demonstration pro- 16 gram; and 17 (ii) with not less than 1— 18 (I) public health entity; 19 (II) health care provider organi- 20 zation; 21 (III) academic institution, includ- 22 ing any minority-serving institution 23 (including a Hispanic-serving institu- 24 tion, a historically Black college or 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00803 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 804 •HR 5942 IH university, and a Tribal college or uni- 1 versity); 2 (IV) child-serving institution; or 3 (V) landlord or housing provider 4 working on lead remediation; 5 (D) ensures planned activities and funding 6 streams are coordinated to improve community 7 health; and 8 (E) submits an application in accordance 9 with subsection (c). 10 (b) ESTABLISHMENT.—The Director shall establish a 11 grant program under which eligible entities shall receive 12 grants to conduct environmental health improvement ac- 13 tivities and to improve social determinants of health. 14 (c) APPLICATION.—To receive a grant under this sec- 15 tion, an eligible entity shall submit an application to the 16 Director at such time, in such manner, and accompanied 17 by such information as the Director may require. 18 (d) COOPERATIVE AGREEMENTS.—An eligible entity 19 may use a grant under this section— 20 (1) to promote environmental health; 21 (2) to address environmental health disparities 22 among all populations, including children; and 23 (3) to address racial and ethnic disparities in 24 social determinants of health. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00804 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 805 •HR 5942 IH (e) AMOUNT OF COOPERATIVE AGREEMENT.— 1 (1) IN GENERAL.—The Director shall award 2 grants to eligible entities at the 3 different funding 3 levels described in this subsection. 4 (2) LEVEL 1 COOPERATIVE AGREEMENTS.— 5 (A) IN GENERAL.—An eligible entity 6 awarded a grant under this paragraph shall use 7 the funds to identify environmental health prob- 8 lems and solutions by— 9 (i) establishing a planning and 10 prioritizing council in accordance with sub- 11 paragraph (B); and 12 (ii) conducting an environmental 13 health assessment in accordance with sub- 14 paragraph (C). 15 (B) PLANNING AND PRIORITIZING COUN- 16 CIL.— 17 (i) IN GENERAL.—A prioritizing and 18 planning council established under sub- 19 paragraph (A)(i) (referred to in this para- 20 graph as a ‘‘PPC’’) shall assist the envi- 21 ronmental health assessment process and 22 environmental health promotion activities 23 of the eligible entity. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00805 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 806 •HR 5942 IH (ii) MEMBERSHIP.—Membership of a 1 PPC shall consist of representatives from 2 various organizations within public health, 3 planning, development, and environmental 4 services and shall include stakeholders 5 from vulnerable groups such as children, 6 the elderly, disabled, and minority ethnic 7 groups that are often not actively involved 8 in democratic or decisionmaking processes. 9 (iii) DUTIES.—A PPC shall— 10 (I) identify key stakeholders and 11 engage and coordinate potential part- 12 ners in the planning process; 13 (II) establish a formal advisory 14 group to plan for the establishment of 15 services; 16 (III) conduct an in-depth review 17 of the nature and extent of the need 18 for an environmental health assess- 19 ment, including a local epidemiological 20 profile, an evaluation of the service 21 provider capacity of the community, 22 and a profile of any target popu- 23 lations; and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00806 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 807 •HR 5942 IH (IV) define the components of 1 care and form essential programmatic 2 linkages with related providers in the 3 community. 4 (C) ENVIRONMENTAL HEALTH ASSESS- 5 MENT.— 6 (i) IN GENERAL.—A PPC shall carry 7 out an environmental health assessment to 8 identify environmental health concerns. 9 (ii) ASSESSMENT PROCESS.—The 10 PPC shall— 11 (I) define the goals of the assess- 12 ment; 13 (II) generate the environmental 14 health issue list; 15 (III) analyze issues with a sys- 16 tems framework; 17 (IV) develop appropriate commu- 18 nity environmental health indicators; 19 (V) rank the environmental 20 health issues; 21 (VI) set priorities for action; 22 (VII) develop an action plan; 23 (VIII) implement the plan; and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00807 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 808 •HR 5942 IH (IX) evaluate progress and plan- 1 ning for the future. 2 (D) EVALUATION.—Each eligible entity 3 that receives a grant under this paragraph shall 4 evaluate, report, and disseminate program find- 5 ings and outcomes. 6 (E) TECHNICAL ASSISTANCE.—The Direc- 7 tor may provide such technical and other non- 8 financial assistance to eligible entities as the 9 Director determines to be necessary. 10 (3) LEVEL 2 COOPERATIVE AGREEMENTS.— 11 (A) ELIGIBILITY.— 12 (i) IN GENERAL.—The Director shall 13 award grants under this paragraph to eli- 14 gible entities that have already— 15 (I) established broad-based col- 16 laborative partnerships; and 17 (II) completed environmental as- 18 sessments. 19 (ii) NO LEVEL 1 REQUIREMENT.—To 20 be eligible to receive a grant under this 21 paragraph, an eligible entity is not re- 22 quired to have successfully completed a 23 Level 1 Cooperative Agreement (as de- 24 scribed in paragraph (2)). 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00808 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 809 •HR 5942 IH (B) USE OF GRANT FUNDS.—An eligible 1 entity awarded a grant under this paragraph 2 shall use the funds to further activities to carry 3 out environmental health improvement activi- 4 ties, including— 5 (i) addressing community environ- 6 mental health priorities in accordance with 7 paragraph (2)(C)(ii), including— 8 (I) geography; 9 (II) the built environment; 10 (III) air quality; 11 (IV) water quality; 12 (V) land use; 13 (VI) solid waste; 14 (VII) housing; 15 (VIII) crime; 16 (IX) socioeconomic status; 17 (X) ethnicity, social construct 18 and language preference; 19 (XI) educational attainment; 20 (XII) employment; 21 (XIII) food safety; 22 (XIV) nutrition; 23 (XV) health care services; and 24 (XVI) injuries; 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00809 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 810 •HR 5942 IH (ii) building partnerships between 1 planning, public health, and other sectors, 2 including child-serving institutions, to ad- 3 dress how the built environment impacts 4 food availability and access and physical 5 activity to promote healthy behaviors and 6 lifestyles and reduce overweight and obe- 7 sity, musculoskeletal diseases, respiratory 8 conditions, dental, oral and mental health 9 conditions, poverty, and related co- 10 morbidities; 11 (iii) establishing programs to ad- 12 dress— 13 (I) how environmental and social 14 conditions of work and living choices 15 influence physical activity and dietary 16 intake; or 17 (II) how those conditions influ- 18 ence the concerns and needs of people 19 who have impaired mobility and use 20 assistance devices, including wheel- 21 chairs, lower limb prostheses, and hip, 22 knee, and other joint replacements; 23 and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00810 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 811 •HR 5942 IH (iv) convening intervention and dem- 1 onstration programs that examine the role 2 of the social environment in connection 3 with the physical and chemical environ- 4 ment in— 5 (I) determining access to nutri- 6 tional food; 7 (II) improving physical activity to 8 reduce overweight, obesity, and co- 9 morbidities and increase quality of 10 life; and 11 (III) location and access to med- 12 ical facilities. 13 (4) LEVEL 3 COOPERATIVE AGREEMENTS.— 14 (A) IN GENERAL.—An eligible entity 15 awarded a grant under this paragraph shall use 16 the funds to identify and address racial and 17 ethnic disparities in social determinants of 18 health by creating demonstration programs that 19 assess the feasibility of establishing a federally 20 funded comprehensive program and describe 21 key outcomes that address racial and ethnic dis- 22 parities in social determinants of health. 23 (B) PROGRAM DESIGN.— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00811 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 812 •HR 5942 IH (i) EVALUATION.—No later than 1 1 year after enactment of this Act, the Di- 2 rector shall evaluate the best practices of 3 existing programs from the private, public, 4 community based, and academically sup- 5 ported initiatives focused on reducing dis- 6 parities in the social determinants of 7 health for racial and ethnic populations. 8 (ii) DEMONSTRATION PROJECTS.— 9 Not later than two years after the date of 10 enactment of this Act, the Director shall 11 implement at least ten demonstration 12 projects including at least one project for 13 each major racial and ethnic minority 14 group, each of which is unique to the cul- 15 tural and linguistic needs of each of the 16 following groups: 17 (I) Native Americans and Alaska 18 Natives. 19 (II) Asian Americans. 20 (III) African Americans/Blacks. 21 (IV) Hispanic/Latino-Americans. 22 (V) Native Hawaiians and Pacific 23 Islanders. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00812 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 813 •HR 5942 IH (iii) REPORT TO CONGRESS.—No later 1 than 2 years after the implementation of 2 the initial demonstration projects, the Di- 3 rector shall submit to Congress a report 4 which includes— 5 (I) a description of each dem- 6 onstration project and design; 7 (II) an evaluation of the cost-ef- 8 fectiveness of each project’s preven- 9 tion and treatment efforts; 10 (III) an evaluation of the cultural 11 and linguistic appropriateness of each 12 project by racial and ethnic group; 13 and 14 (IV) an evaluation of the bene- 15 ficiary’s health status improvement 16 under the demonstration project. 17 (iv) ANY OTHER INFORMATION 18 DEEMED APPROPRIATE BY THE DIREC- 19 TOR.—The Director shall require any other 20 information deemed appropriate to be 21 shared by or developed by eligible entities 22 awarded a grant under this paragraph, in- 23 cluding the following: 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00813 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 814 •HR 5942 IH (I) Developing models and evalu- 1 ating methods that improve the cul- 2 tural and linguistically appropriate 3 services provided through the Centers 4 for Disease Control and Prevention to 5 target individuals impacted by health 6 disparities based on their race, eth- 7 nicity, and gender. 8 (II) Promoting the collaboration 9 between primary and specialty care 10 health care providers and patients, to 11 ensure patients impacted by health 12 disparities based on race, ethnicity, 13 and gender are receiving comprehen- 14 sive and organized treatment and 15 care. 16 (III) Educating health care pro- 17 fessionals on the causes and effects of 18 disparities in the social determinants 19 of health as it relates to minority and 20 racial and ethnic communities and the 21 need for culturally and linguistically 22 appropriate care in the prevention and 23 treatment of high-impact diseases. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00814 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 815 •HR 5942 IH (IV) Encouraging collaboration 1 among community and patient-based 2 organizations which work to address 3 disparities in the social determinants 4 of health as it relates to high-impact 5 diseases in minority and racial and 6 ethnic populations. 7 (f) AUTHORIZATION OF APPROPRIATIONS.—There 8 are authorized to be appropriated to carry out this sec- 9 tion— 10 (1) $25,000,000 for fiscal year 2019; and 11 (2) such sums as may be necessary for fiscal 12 years 2020 through 2022. 13 SEC. 1006. ADDITIONAL RESEARCH ON THE RELATIONSHIP 14 BETWEEN THE BUILT ENVIRONMENT AND 15 THE HEALTH OF COMMUNITY RESIDENTS. 16 (a) DEFINITION OF ELIGIBLE INSTITUTION.—In this 17 section, the term ‘‘eligible institution’’ means a public or 18 private nonprofit institution that submits to the Secretary 19 of Health and Human Services (in this section referred 20 to as the ‘‘Secretary’’) and the Administrator of the Envi- 21 ronmental Protection Agency (in this section referred to 22 as the ‘‘Administrator’’) an application for a grant under 23 the grant program authorized under subsection (b)(2) at 24 such time, in such manner, and containing such agree- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00815 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 816 •HR 5942 IH ments, assurances, and information as the Secretary and 1 Administrator may require. 2 (b) RESEARCH GRANT PROGRAM.— 3 (1) DEFINITION OF HEALTH.—In this section, 4 the term ‘‘health’’ includes— 5 (A) levels of physical activity; 6 (B) degree of mobility due to factors such 7 as musculoskeletal diseases, arthritis, and obe- 8 sity; 9 (C) consumption of nutritional foods; 10 (D) rates of crime; 11 (E) air, water, and soil quality; 12 (F) risk of injury; 13 (G) accessibility to health care services; 14 (H) levels of educational attainment; and 15 (I) other indicators as determined appro- 16 priate by the Secretary. 17 (2) GRANTS.—The Secretary, in collaboration 18 with the Administrator, shall provide grants to eligi- 19 ble institutions to conduct and coordinate research 20 on the built environment and its influence on indi- 21 vidual and population-based health. 22 (3) RESEARCH.—The Secretary shall support 23 research that— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00816 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 817 •HR 5942 IH (A) investigates and defines the causal 1 links between all aspects of the built environ- 2 ment and the health of residents; 3 (B) examines— 4 (i) the extent of the impact of the 5 built environment (including the various 6 characteristics of the built environment) on 7 the health of residents; 8 (ii) the variance in the health of resi- 9 dents by— 10 (I) location (such as inner cities, 11 inner suburbs, and outer suburbs); 12 and 13 (II) population subgroup (includ- 14 ing children, the elderly, the disadvan- 15 taged); or 16 (iii) the importance of the built envi- 17 ronment to the total health of residents, 18 which is the primary variable of interest 19 from a public health perspective; 20 (C) is used to develop— 21 (i) measures to address health and the 22 connection of health to the built environ- 23 ment; and 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00817 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 818 •HR 5942 IH (ii) efforts to link the measures to 1 travel and health databases; 2 (D) distinguishes carefully between per- 3 sonal attitudes and choices and external influ- 4 ences on observed behavior to determine how 5 much an observed association between the built 6 environment and the health of residents, versus 7 the lifestyle preferences of the people that 8 choose to live in the neighborhood, reflects the 9 physical characteristics of the neighborhood; 10 and 11 (E)(i) identifies or develops effective inter- 12 vention strategies to promote better health 13 among residents with a focus on behavioral 14 interventions and enhancements of the built en- 15 vironment that promote increased use by resi- 16 dents; and 17 (ii) in developing the intervention strate- 18 gies under clause (i), ensures that the interven- 19 tion strategies will reach out to high-risk popu- 20 lations, including racial and ethnic minorities, 21 low-income urban and rural communities, and 22 children. 23 (4) PRIORITY.—In providing assistance under 24 the grant program authorized under paragraph (2), 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00818 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 819 •HR 5942 IH the Secretary and the Administrator shall give pri- 1 ority to research that incorporates— 2 (A) minority-serving institutions as grant- 3 ees; 4 (B) interdisciplinary approaches; or 5 (C) the expertise of the public health, 6 physical activity, nutrition and health care (in- 7 cluding child health), urban planning, and 8 transportation research communities in the 9 United States and abroad. 10 SEC. 1007. ENVIRONMENT AND PUBLIC HEALTH RESTORA- 11 TION. 12 (a) FINDINGS.— 13 (1) GENERAL FINDINGS.—The Congress finds 14 as follows: 15 (A) As human beings, we share our envi- 16 ronment with a wide variety of habitats and 17 ecosystems that nurture and sustain a diversity 18 of species. 19 (B) The abundance of natural resources in 20 our environment forms the basis for our econ- 21 omy and has greatly contributed to human de- 22 velopment throughout history. 23 (C) The accelerated pace of human devel- 24 opment over the last several hundred years has 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00819 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 820 •HR 5942 IH significantly impacted our natural environment 1 and its resources, the health and diversity of 2 plant and animal wildlife, the availability of 3 critical habitats, the quality of our air and our 4 water, and our global climate. 5 (D) The intervention of the Federal Gov- 6 ernment is necessary to minimize and mitigate 7 human impact on the environment for the ben- 8 efit of public health, to maintain air quality and 9 water quality, to sustain the diversity of plants 10 and animals, to combat global climate change, 11 and to protect the environment. 12 (E) Laws and regulations in the United 13 States have been created and promulgated to 14 minimize and mitigate human impact on the en- 15 vironment for the benefit of public health, to 16 maintain air quality and water quality, to sus- 17 tain wildlife, and to protect the environment. 18 (F) Such laws include the Antiquities Act 19 of 1906 (16 U.S.C. 431 et seq.) initiated by 20 President Theodore Roosevelt to create the na- 21 tional park system, the National Environmental 22 Policy Act of 1969 (42 U.S.C. 4321 et seq.), 23 the Clean Air Act (42 U.S.C. 7401 et seq.), the 24 Federal Water Pollution Control Act (33 U.S.C. 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00820 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 821 •HR 5942 IH 1251 et seq.), the Comprehensive Environ- 1 mental Response, Compensation, and Liability 2 Act of 1980 (42 U.S.C. 9601 et seq.), the En- 3 dangered Species Act of 1973 (Public Law 93– 4 205), and the National Forest Management Act 5 of 1976 (Public Law 94–588). 6 (G) Attempts to repeal or weaken key envi- 7 ronmental safeguards pose dangers to the pub- 8 lic health, air quality, water quality, wildlife, 9 and the environment. 10 (2) FINDINGS ON CHANGES AND PROPOSED 11 CHANGES IN LAW.—The Congress finds that, since 12 2001, the following changes and proposed changes 13 to existing law or regulations have negatively im- 14 pacted or will negatively impact the environment and 15 public health: 16 (A) CLEAN WATER.— 17 (i) On May 9, 2002, the Environ- 18 mental Protection Agency (EPA) and the 19 Army Corps of Engineers put forth a final 20 rule that reconciled regulations imple- 21 menting section 404 of the Federal Water 22 Pollution Control Act by redefining the 23 term ‘‘fill material’’ and amending the def- 24 inition of the term ‘‘discharge of fill mate- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00821 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 822 •HR 5942 IH rial’’, reversing a 25-year-old regulation. 1 The new rule fails to restrict the dumping 2 of hardrock mining waste, construction de- 3 bris, and other industrial wastes into riv- 4 ers, streams, lakes, and wetlands. The rule 5 further allows destructive mountaintop re- 6 moval coal mining companies to dump 7 waste into streams and lakes, polluting the 8 surrounding natural habitat and poisoning 9 plants and animals that depend on those 10 water sources. 11 (ii) On February 12, 2003, the Envi- 12 ronmental Protection Agency published the 13 rule ‘‘National Pollutant Discharge Elimi- 14 nation System Permit Regulation and Ef- 15 fluent Limitation Guidelines and Stand- 16 ards for Concentrated Animal Feeding Op- 17 erations’’, new livestock waste regulations 18 that aimed to control factory farm pollu- 19 tion but which would severely undermine 20 existing protections under the Federal 21 Water Pollution Control Act. This regula- 22 tion allows large-scale animal factories to 23 foul the Nation’s waters with animal 24 waste, allows livestock owners to draft 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00822 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 823 •HR 5942 IH their own pollution-management plans and 1 avoid ground water monitoring, legalizes 2 the discharge of contaminated runoff water 3 rich in nitrogen, phosphorus, bacteria, and 4 metals, and ensures that large factory 5 farms are not held liable for the environ- 6 mental damage they cause. In a 2005 Fed- 7 eral court decision (‘‘Waterkeeper Alliance, 8 et al. v. Environmental Protection Agen- 9 cy’’, 399 F.3d 486 (2nd Cir. 2005)), major 10 parts of the rule were upheld, others va- 11 cated, and still others remanded back to 12 the EPA. On November 20, 2008, the En- 13 vironmental Protection Agency published a 14 revised final rule which undermines envi- 15 ronmental protection provisions by remov- 16 ing mandatory permitting requirements 17 and allowing large animal farms to self- 18 certify the absence of pollutant discharge 19 activity. 20 (iii) On March 19, 2003, the Environ- 21 mental Protection Agency published a new 22 rule regarding the Total Maximum Daily 23 Load program of the Federal Water Pollu- 24 tion Control Act that regulates the max- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00823 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 824 •HR 5942 IH imum amount of a particular pollutant 1 that can be present in a body of water and 2 still meet water quality standards. The new 3 rule withdrew the existing regulation put 4 forth on July 13, 2000, and halted mo- 5 mentum in cleaning up polluted waterways 6 throughout the Nation. By abandoning the 7 existing rule, the Environmental Protection 8 Agency is undermining the effectiveness of 9 cleanup plans and is allowing States to 10 avoid cleaning polluted waters entirely by 11 dropping them from their cleanup lists. 12 Waterways play a crucial role in the lives 13 of the people of the United States and are 14 critical to the livelihood of fish and wildlife. 15 The result of dropping the July 2000 rule 16 is that the restoration of polluted rivers, 17 shorelines, and lakes will be delayed, harm- 18 ing more fish and wildlife and worsening 19 the quality of drinking water. 20 (iv) On December 2, 2008, the Envi- 21 ronmental Protection Agency and the 22 Army Corps of Engineers jointly issued a 23 guidance document in the form of a legal 24 memorandum, titled ‘‘Clean Water Act Ju- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00824 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 825 •HR 5942 IH risdiction Following the U.S. Supreme 1 Court’s Decision in Rapanos v. United 2 States & Carabell v. United States’’. This 3 new guidance dictates enforcement actions 4 under the Federal Water Pollution Control 5 Act and calls for a complicated ‘‘case-by- 6 case’’ analysis to determine jurisdiction for 7 waterways that do not flow all year. Such 8 actions endanger small streams and wet- 9 lands that serve as important habitats for 10 aquatic life, which play a fundamental role 11 in safeguarding sources of clean drinking 12 water and mitigate the risks and effects of 13 floods and droughts. Further, the defini- 14 tion provided therein for ‘‘waters of the 15 United States’’ is applicable to the Federal 16 Water Pollution Control Act as a whole, 17 potentially affecting programs that control 18 industrial pollution and sewage levels, pre- 19 vent oil spills, and set water quality stand- 20 ards for all waters in the United States 21 protected under the Federal Water Pollu- 22 tion Control Act. 23 (B) FORESTS AND LAND MANAGEMENT.— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00825 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 826 •HR 5942 IH (i) On December 3, 2003, the Presi- 1 dent signed into law the Healthy Forests 2 Restoration Act of 2003 (Public Law 108– 3 148; 16 U.S.C. 6501 et seq.). Although the 4 law attempts to reduce the risk of cata- 5 strophic forest fires, it provides a boon to 6 timber companies by accelerating the ag- 7 gressive thinning of backcountry forests 8 that are far from at-risk communities. The 9 law allows for increased logging of large, 10 fire-resistant trees that are not in close 11 proximity of homes and communities; it 12 undermines critical protections for endan- 13 gered species by exempting Federal land 14 management agencies from consulting with 15 the United States Fish and Wildlife Serv- 16 ice before approving any action that could 17 harm endangered plants or wildlife; and it 18 limits public participation by reducing the 19 number of environmental project reviews. 20 (ii) On April 21, 2008, the Depart- 21 ment of Agriculture issued a Final Plan- 22 ning Rule and Record of Decision for Na- 23 tional Forest System Land Management 24 Planning. Similar to rules enacted by the 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00826 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 827 •HR 5942 IH Administration on January 5, 2005, later 1 remanded back to the agency in Federal 2 district court for violating the National 3 Environmental Policy Act of 1969, the En- 4 dangered Species Act of 1973, and the Ad- 5 ministrative Procedure Act (‘‘Citizens for 6 Better Forestry v. United States Depart- 7 ment of Agriculture’’, 481 F. Supp. 2d 8 1059 (N.D. Cal. 2007)), this revised rule 9 eliminates strict forest planning standards 10 established in 1982, and opens millions of 11 acres of public lands to damaging and 12 invasive logging, mining, and drilling oper- 13 ations. These regulations would reverse 14 more than 20 years of protection for wild- 15 life and national forests by removing the 16 overall goal of ensuring ecological sustain- 17 ability in managing the national forest sys- 18 tem, weakening the National Forest Man- 19 agement Act of 1976, and effectively end- 20 ing the review of forest management plans 21 under the National Environmental Policy 22 Act of 1969. 23 (iii) On September 20, 2006, the Dis- 24 trict Court for the Northern District of 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00827 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 828 •HR 5942 IH California vacated the Protection of Inven- 1 toried Roadless Areas rule, enacted on May 2 13, 2005, which gave State Governors 18 3 months to petition the Federal Government 4 to either restore the previous rule for their 5 States, or submit a new management and 6 development plan for national forest areas 7 inventoried under the rule. Despite the 8 enjoinment of the Administration’s 2005 9 rule, and the subsequent restoration of the 10 original Roadless Area Conservation Rule, 11 the United States Forest Service has con- 12 tinued to allow States to petition for a spe- 13 cial rule under the authority of the Admin- 14 istrative Procedure Act, publishing a final 15 special rule for Idaho on October 16, 2008. 16 As a result, 58.5 million acres of wild na- 17 tional forests are still vulnerable to log- 18 ging, road building, and other develop- 19 ments that may fragment natural habitats 20 and negatively impact fish and wildlife. 21 (iv) On November 17, 2008, the De- 22 partment of the Interior’s Bureau of Land 23 Management (BLM) signed the Record of 24 Decision (ROD) amending 12 resource 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00828 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 829 •HR 5942 IH management plans in Colorado, Utah, and 1 Wyoming, opening 2,000,000 acres of pub- 2 lic lands to commercial tar sands and oil 3 shale exploration and development. On No- 4 vember 18, 2008, the BLM published a 5 final rule for Oil Shale Management set- 6 ting the policies and procedures for a com- 7 mercial leasing program for the manage- 8 ment of federally owned oil shale in those 9 three States. Previously barred by a con- 10 gressional moratorium on the commercial 11 leasing regulations for oil shale until Sep- 12 tember 30, 2008, the development of oil 13 shale on public lands poses a serious threat 14 to land conservation, endangered and 15 threatened species, and critical habitat. 16 Domestic shale oil production allowed by 17 these regulations is highly water and en- 18 ergy intensive, the impacts of which will in- 19 tensify existing water scarcity in the arid 20 Western Region and potentially degrade 21 air and water quality for surrounding pop- 22 ulations. 23 (C) SCIENTIFIC REVIEW.—On December 24 16, 2008, the United States Fish and Wildlife 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00829 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 830 •HR 5942 IH Service of the Department of the Interior and 1 the National Oceanic and Atmospheric Admin- 2 istration of the Department of Commerce joint- 3 ly issued a new rule amending regulations gov- 4 erning interagency cooperation under section 7 5 of the Endangered Species Act of 1973 (ESA). 6 This rule undermines the intention of the ESA 7 to protect species and the ecosystems upon 8 which they depend by allowing Federal agencies 9 to carry out, permit, or fund an action without 10 proper environmental review and expert third- 11 party consultation from Federal wildlife ex- 12 perts. Under this new rule, Federal agencies 13 can unilaterally circumvent the formal review 14 process, eliminating longstanding and scientif- 15 ically grounded safeguards that serve to protect 16 the biodiversity of our Nation’s ecosystems and 17 avert harm to thousands of endangered and 18 threatened species. 19 (b) STATEMENT OF POLICY.—It is the policy of the 20 United States Government to work in conjunction with 21 States, territories, Tribal governments, international orga- 22 nizations, and foreign governments in order to act as a 23 steward of the environment for the benefit of public 24 health, to maintain air quality and water quality, to sus- 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00830 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 831 •HR 5942 IH tain the diversity of plant and animal species, to combat 1 global climate change, and to protect the environment for 2 future generations to enjoy. 3 (c) STUDY AND REPORT ON PUBLIC HEALTH OR EN- 4 VIRONMENTAL IMPACT OF REVISED RULES, REGULA- 5 TIONS, LAWS, OR PROPOSED LAWS.— 6 (1) STUDY.—Not later than 30 days after the 7 date of enactment of this Act, the President shall 8 enter into an arrangement under which the National 9 Academy of Sciences will conduct a study to deter- 10 mine the impact on public health, air quality, water 11 quality, wildlife, and the environment of the fol- 12 lowing regulations, laws, and proposed laws: 13 (A) CLEAN WATER.— 14 (i) Final revisions to the Federal 15 Water Pollution Control Act regulatory 16 definitions of ‘‘fill material’’ and ‘‘dis- 17 charge of fill material’’, finalized and pub- 18 lished in the Federal Register on May 9, 19 2002 (67 Fed. Reg. 31129), amending 20 part 232 of title 40, Code of Federal Regu- 21 lations. 22 (ii) Revised National Pollutant Dis- 23 charge Elimination System Permit Regula- 24 tion and Effluent Limitation Guidelines 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00831 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 832 •HR 5942 IH and Standards for Concentrated Animal 1 Feeding Operations in response to the 2 ‘‘Waterkeeper Alliance, et al. v. Environ- 3 mental Protection Agency’’ decision, final- 4 ized and published in the Federal Register 5 on November 20, 2008 (73 Fed. Reg. 6 225), amending parts 9, 122, and 412 of 7 title 40, Code of Federal Regulations. 8 (iii) A March 19, 2003, rule published 9 in the Federal Register (68 Fed. Reg. 10 13608) withdrawing a July 13, 2000, rule 11 revising the Total Maximum Daily Load 12 program of the Federal Water Pollution 13 Control Act (65 Fed. Reg. 43586), amend- 14 ing parts 9, 122, 123, 124, and 130 of 15 title 40, Code of Federal Regulations. 16 (iv) Official Guidance Document, 17 ‘‘Clean Water Act Jurisdiction Following 18 the United States Supreme Court’s Deci- 19 sion in Rapanos v. United States & 20 Carabell v. United States’’, issued on De- 21 cember 2, 2008, relating to jurisdiction 22 under section 404 of the Federal Water 23 Pollution Control Act. 24 (B) FORESTS AND LAND MANAGEMENT.— 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00832 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 833 •HR 5942 IH (i) Healthy Forests Restoration Act of 1 2003, signed into law on December 3, 2 2003 (Public Law 108–148; 16 U.S.C. 3 6501 et seq.). 4 (ii) National Forest System Land 5 Management Planning Rule, finalized and 6 published in the Federal Register on April 7 21, 2008 (73 Fed. Reg. 21468), replacing 8 the 2005 final rule (70 Fed. Reg. 1022, 9 Jan. 5, 2005), as amended March 3, 2006 10 (71 Fed. Reg. 10837), and the 2000 final 11 rule adopted on November 9, 2000 (65 12 Fed. Reg. 67514), as amended on Sep- 13 tember 29, 2004 (69 Fed. Reg. 58055), 14 amending title 36, Code of Federal Regula- 15 tions, part 219. 16 (iii) The application of the Adminis- 17 trative Procedure Act (5 U.S.C. 551 to 18 559, 701 to 706, et seq.), such that States 19 may petition for a special rule for the 20 roadless areas in all or part of said State. 21 (iv) Record of Decision, ‘‘Oil Shale 22 and Tar Sands Resources Resource Man- 23 agement Plan Amendments’’, issued on 24 November 17, 2008, along with the Final 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00833 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 834 •HR 5942 IH Rule, Oil Shale Management-General, pub- 1 lished in the Federal Register on Novem- 2 ber 18, 2008 (73 Fed. Reg. 223), amend- 3 ing title 43, Code of Federal Regulations, 4 parts 3900, 3910, 3920, and 3930. 5 (C) SCIENTIFIC REVIEW.—Final Rule, 6 Interagency Cooperation Under the Endangered 7 Species Act, published in the Federal Register 8 on December 16, 2008, amending title 50, Code 9 of Federal Regulations, part 402. 10 (2) METHOD.—In conducting the study under 11 paragraph (1), the National Academy of Sciences 12 may utilize and compare existing scientific studies 13 regarding the regulations, laws, and proposed laws 14 listed in paragraph (1). 15 (3) REPORT.—Under the arrangement entered 16 into under paragraph (1), not later than 270 days 17 after the date on which such arrangement is entered 18 into, the National Academy of Sciences shall make 19 publicly available and shall submit to the Congress 20 and to the head of each department and agency of 21 the Federal Government that issued, implements, or 22 would implement a regulation, law, or proposed law 23 listed in paragraph (1), a report containing— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00834 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 835 •HR 5942 IH (A) a description of the impact of all such 1 regulations, laws, and proposed laws on public 2 health, air quality, water quality, wildlife, and 3 the environment, compared to the impact of 4 preexisting regulations, or laws in effect, includ- 5 ing— 6 (i) any negative impacts to air quality 7 or water quality; 8 (ii) any negative impacts to wildlife; 9 (iii) any delays in hazardous waste 10 cleanup that are projected to be hazardous 11 to public health; and 12 (iv) any other negative impact on pub- 13 lic health or the environment; and 14 (B) any recommendations that the Na- 15 tional Academy of Sciences considers appro- 16 priate to maintain, restore, or improve in whole 17 or in part protections for public health, air 18 quality, water quality, wildlife, and the environ- 19 ment for each of the regulations, laws, and pro- 20 posed laws listed in paragraph (1), which may 21 include recommendations for the adoption of 22 any regulation or law in place or proposed prior 23 to January 1, 2001. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00835 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 836 •HR 5942 IH (d) DEPARTMENT AND AGENCY REVISION OF EXIST- 1 ING RULES, REGULATIONS, OR LAWS.—Not later than 2 180 days after the date on which the report is submitted 3 pursuant to subsection (c)(3), the head of each depart- 4 ment and agency that has issued or implemented a regula- 5 tion or law listed in subsection (c)(1) shall submit to the 6 Congress a plan describing the steps such department or 7 such agency will take, or has taken, to restore or improve 8 protections for public health and the environment in whole 9 or in part that were in existence prior to the issuance of 10 such regulation or law. 11 SEC. 1008. GAO REPORT ON HEALTH EFFECTS OF DEEP- 12 WATER HORIZON OIL RIG EXPLOSION IN THE 13 GULF COAST. 14 (a) STUDY.—The Comptroller General of the United 15 States shall conduct a study on the type and scope of 16 health care services administered through the Department 17 of Health and Human Services addressing the provision 18 of health care to racial and ethnic minorities, including 19 residents, cleanup workers, and volunteers, affected by the 20 explosion of the mobile offshore drilling unit Deepwater 21 Horizon that occurred on April 20, 2010. 22 (b) SPECIFIC COMPONENTS; REPORTING.—In car- 23 rying out subsection (a), the Comptroller General shall— 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00836 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 837 •HR 5942 IH (1) assess the type, size, and scope of programs 1 administered by the Department of Health and 2 Human Services that focus on provision of health 3 care to communities in the Gulf Coast; 4 (2) identify the merits and disadvantages asso- 5 ciated with each the programs; 6 (3) perform an analysis of the costs and bene- 7 fits of the programs; 8 (4) determine whether there is any duplication 9 of programs; and 10 (5) not later than 180 days after the date of 11 the enactment of this Act, submit to Congress a re- 12 port containing— 13 (A) the findings of the study conducted 14 under this section; and 15 (B) recommendations for improving access 16 to health care for racial and ethnic minorities. 17 Subtitle B—Gun Violence 18 SEC. 1011. FINDINGS. 19 Congress finds as follows: 20 (1) On average, 86 Americans are killed by 21 guns each day. 22 (2) An estimated 15,549 people were killed by 23 guns in 2017, not including suicides. 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00837 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 838 •HR 5942 IH (3) Gun violence disproportionately affects com- 1 munities of color, especially African Americans (who 2 comprise around 14 percent of the United States 3 population but account for more than half the coun- 4 try’s gun homicide victims). 5 (4) On average, there is more than one mass 6 shooting each day in the United States. 7 SEC. 1012. REAFFIRMING RESEARCH AUTHORITY OF THE 8 CENTERS FOR DISEASE CONTROL AND PRE- 9 VENTION. 10 (a) IN GENERAL.—Section 391 of the Public Health 11 Service Act (42 U.S.C. 280b) is amended— 12 (1) in subsection (a)(1), by striking ‘‘research 13 relating to the causes, mechanisms, prevention, diag- 14 nosis, treatment of injuries, and rehabilitation from 15 injuries;’’ and inserting ‘‘research, including data 16 collection, relating to— 17 ‘‘(A) the causes, mechanisms, prevention, 18 diagnosis, and treatment of injuries, including 19 with respect to gun violence; and 20 ‘‘(B) rehabilitation from such injuries;’’; 21 and 22 (2) by adding at the end the following new sub- 23 section: 24 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00838 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 839 •HR 5942 IH ‘‘(c) NO ADVOCACY OR PROMOTION OF GUN CON- 1 TROL.—Nothing in this section shall be construed to— 2 ‘‘(1) authorize the Secretary to give assistance, 3 make grants, or enter into cooperative agreements or 4 contracts for the purpose of advocating or promoting 5 gun control; or 6 ‘‘(2) permit a recipient of any assistance, grant, 7 cooperative agreement, or contract under this section 8 to use such assistance, grant, agreement, or contract 9 for the purpose of advocating or promoting gun con- 10 trol.’’. 11 SEC. 1013. NATIONAL VIOLENT DEATH REPORTING SYSTEM. 12 The Secretary of Health and Human Services, acting 13 through the Director of the Centers for Disease Control 14 and Prevention, shall improve, particularly through the in- 15 clusion of additional States, the National Violent Death 16 Reporting System, as authorized by title III of the Public 17 Health Service Act (42 U.S.C. 241 et seq.). Participation 18 in the system by the States shall be voluntary. 19 SEC. 1014. REPORT ON EFFECTS OF GUN VIOLENCE ON 20 PUBLIC HEALTH. 21 Not later than one year after the date of the enact- 22 ment of this Act, and annually thereafter, the Surgeon 23 General of the Public Health Service shall submit to Con- 24 gress a report on the effects on public health, including 25 VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00839 Fmt 6652 Sfmt 6201 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS 840 •HR 5942 IH mental health, of gun violence in the United States during 1 the preceding year, and the status of actions taken to ad- 2 dress such effects. 3 SEC. 1015. REPORT ON EFFECTS OF GUN VIOLENCE ON 4 MENTAL HEALTH IN MINORITY COMMU- 5 NITIES. 6 Not later than one year after the date of the enact- 7 ment of this Act, the Deputy Assistant Secretary for Mi- 8 nority Health in the Office of the Secretary of Health and 9 Human Services shall submit to the Congress a report on 10 the effects of gun violence on public health, including men- 11 tal health, in minority communities in the United States, 12 and the status of actions taken to address such effects. 13 Æ VerDate Sep 11 2014 20:12 Jun 26, 2018 Jkt 079200 PO 00000 Frm 00840 Fmt 6652 Sfmt 6301 E:\BILLS\H5942.IH H5942 pbinns on DSK79D2C42PROD with BILLS